A patient complains of unrelenting, burning pain 4 hours after the application of a chemical debriding agent. The nurse should understand that wound pain may:

Which of the following is an appropriate intervention for stage I pressure ulcers?

How often should a transparent film dressing covering a dermal ulcer be changed?

Which of the following factors is NOT likely to contribute to developing a postoperative complication of wound dehiscence?

Question 5 & 6: Apligraf® and Dermagraft® are biological advanced therapies that are similar in that they both contain a specific cell type and were previously called skin substitutes.

Pick the cell type found in both devices (Apligraf® and Dermagraft®):

What is the current terminology used to classify both devices (Apligraf® and Dermagraft®):

The rationale for using hyperbaric oxygen in treating patients with a diagnosis of gas gangrene include all of the following EXCEPT:

Question 8 & 9: A 70-year-old woman with a recent left hip fracture has been admitted to the hospital for operative intervention. During her postoperative recovery serial skin assessments identify that she has developed a Stage II pressure ulcer.

Which of the following best describes her ulcer?

Based on the clinical scenario which is the most likely anatomical location of the pressure injury?

Radiation has a variety of destructive effects on tissue which can negatively impact wound healing. Which of the following is NOT considered a potential compromising side effect of therapeutic radiation therapy?

Questions 11, 12 & 13. In mid-August a patient with paraplegia returns to the wound care clinic. She has developed a pressure ulcer over the ischial tuberosity. This is the second ulcer that has developed in this exact location within the past year. The patient is actively employed as a safety officer in steel factory which she complains is very warm during the summer. She reports a 15 pound weight loss (current weight 185 pounds) over the past 3 months, but states she “has been trying to lose some weight”.

Which of the following is the most likely explanation for the recurrence of the ulcer?

Which intervention is absolutely mandatory as part of her care plan?

Which best describes her current nutritional status?

A 45 year old paraplegic presents with a stage IV pressure ulceration. Exposed bone and necrotic muscle is noted. She has a low grade fever but no evidence of cellulitis. Appropriate initial management includes all of the following EXCEPT:

Which of the following has the most beneficial effect on the healing of venous leg ulcers?

Regarding personal protective equipment and Infection Control Standards, which of the following statements is INCORRECT?

A TCPO2 and a CPP (capillary perfusion pressure) of 50mm Hg are considered:

Which of the following statements is MOST accurate related to collagen synthesis and tissue oxygen tension?

Questions 19 & 20. A patient is being evaluated for a possible pressure ulcer. The patient is febrile and unresponsive but moans when the area is palpated. The skin examination finds a blister filled with viscous yellow fluid.

Using the NPUAP staging system, this is best classified as:

Which of the following is BEST initial therapy?

Use of four layer compression therapy to treat a venous ulcer is CONTRAINDICATED in a patient with:

The key layers of the skin from the external surface to the deeper layers are most accurately listed by which of the following?

Which of the following statements about wound care is TRUE?

Which of the following statements accurately characterizes colonization of a wound?

Wet to dry, hydrotherapy, irrigation and pulsatile lavage are forms of what type of debridement?

Hyperbaric oxygen is effective in wound-healing enhancement due to which of the following physiologic mechanisms?

What process best represents the cellular activity in the early or initial phase of wound healing?

A person with arterial lower extremity ulcers will commonly have a history of which of the following?

Question 29 &30: A patient presents with progressive destruction of the bones and joints in the foot, which over time results in the collapse of the arch and a rocker bottom appearance to the foot.

Which of the following BEST describes this condition?

Which intervention should be considered early in this patient’s management?

Which of the following is a component of the Braden Scale?

A patient with a pressure ulcer of the right lateral malleolus is seen in the wound clinic. Examination during prior visits showed wound erythema, undermining of wound edges, and exudate. Findings at the time of the current visit show that the wound is contracting with healthy granulation tissue, reduced undermining and neodermis at the margins. Which of the following stages of wound healing BEST describes the wound today?

The presence of replicating microorganisms adherent to the wound in the absence of injury to the host is referred to as:

A female patient with metastatic breast cancer is admitted with a fungating mass that measures 12cm x 10cm in the left breast. To assist with palliative care and pain management, the nurse should recommend applying:

Leukocytes plays a key role during which of the following phases of wound healing?

Question 36 and 37: A patient with a long history of severe Rheumatoid Arthritis controlled only by methylprednisolone and methotrexate presents to the wound clinic for evaluation of a recent traumatic wound.

She should be advised that she is at risk for compromised would healing due to:

Reasonable initial wound care treatment plan should include:

All of the following are appropriate indications for performing transcutaneous oxygen evaluation on a hyperbaric patient EXCEPT:

Which one of the following Braden Scale total scores should trigger implementation of a pressure ulcer prevention protocol?

According to CMS policy, all of the following criteria must be met prior to the initiation of HBOT in the management of the diabetic foot ulcer EXCEPT

To assess for sensory neuropathy, the wound nurse should:

Which component of the blood significantly contributes and actively participates in hemostasis by helping to seal injured blood vessels?

The most common predisposing risk factor leading to the development of a diabetic foot ulceration is:

Which of the following wound and dressing combinations BEST illustrates an appropriate indication and utilization of autolytic debridement?

Which of the followed defines a RLE ABI (right lower extremity ankle brachial index):

A patient with diabetic neuropathy has an ulcer on the plantar surface of the foot. The patient has regularly returned to the clinic for wound care and blood glucose monitoring. After 15 weeks, the wound is healed. Which of the following should the nurse include in the teaching plan?

Which of the following characterize the molecular environment of the chronic wound?

Which of the following is the most important assessment parameter in a patient with a lower extremity ischemic ulcer?

Initiation of a clinical strategy to optimize which of the following factors is considered the primary therapy for healing a patient with venous insufficiency ulceration?

Which of the following is NOT typically considered a factor which leads to wound chronicity?

The bluish-gray color of skin associated with the lack of oxygen is called:

When conducting a preliminary assessment of a patient's nutritional status, which of the following indicates probable need for nutritional support?

Which of the following therapies when utilized as a single modality intervention is generally associated with the fastest healing times and greatest percentage of healed diabetic foot ulcers in a 12 week time period?

A 62 year-old patient with acute myelocytic leukemia is undergoing chemotherapy. During the skin assessment, the right heel is covered with dry eschar. Which of the following is the most appropriate intervention?

In addition to topical wound care, which of the following is MOST important in treating nonhealing arterial ulcers?

What type of lymphedema arises from congenital defects in the lymph system?

All of the following are accurate pairings of causes and classification of types of lymphedema EXCEPT:

Which physical properties of short stretch bandages allow them to be effective in reducing edema in a patient with a diagnosis of chronic venous insufficiency?

Cellular senescence is best defined by which of the following:

The treatment of a patient with a nonhealing wound includes a global perspective and management of the patient’s chronic underlying conditions and disease states. This is facilitated by classification of the wound based on:

The Braden Scale is used to stratify patients at risk for Pressure Ulcers. Several parameters are graded during this assessment including sensory perception, activity, and mobility. Which is the correct number and description of the other factors evaluated?

Diabetic Foot Ulcers are also more commonly called:

Wound infection is directly related to which of the following?

A detailed history is performed during the initial consult and evaluation of a patient presenting with lower extremity swelling and a superficial lateral ulcer. The initial working diagnosis is venous insufficiency. It is likely that the patient will provide pertinent positives during the review of systems. Which one of the following is not likely to be reported a prior condition and risk factor?

Cellular and Tissue Based products (CTPs) are claimed to enhance wound healing via several mechanisms. Which of the following is the primary mechanism of action?

Which of the following conditions is associated with high mortality rates and is characterized by progressive cutaneous necrosis occurring more commonly in patience with end state renal disease on dialysis?

Which of the following tissues is considered not to contribute to the composition of lean body mass?

Which of the following is NOT suggested as a benefit of sharp debridement in the management of a wound care patient?

Which of the following BEST defines primary role of the macrophage and phase of wound healing where it has significant activity?

Palliative wound care for patients with end of life conditions focuses on all of the following EXCEPT:

Which of the following statements about standards of care, practice, guidelines, policies, and procedures is FALSE?

Given the understanding of the physiology related to the development of deep tissue injury (DTI) and the definition of DTI published by the NPUAP, a deep blue-purplish bruise looking area over the sacrum on an immobile patient that was not observed on the admission skin assessment but appears 24 hours later would be:

A patient returns to the wound care clinic with a change in the subjective and objective findings related to their wound. The patient is started on antibiotics based on concern for a local wound infection. Which of the following listed findings will most likely be noted?

Which of the following correctly describes the Levine Technique for wound culturing?

Which one of the following practices is not appropriate as policy for a skin tear prevention program?

Removable cast walkers may offer advantages over the total contact cast for all of the following reasons EXCEPT?

Which of the following is the most common initiating factor resulting in the formation of a venous ulcer?

What type of debridement is achieved by the utilization of semi-occlusive or occlusive dressings to contain wound fluid?

Which of the following distinguishes a wound colonized with bacteria from one that is infected?

Which of the following statements is MOST accurate concerning basal cell carcinoma?

Inaccurate ankle brachial pressure index may be associated with all of the following conditions EXCEPT:

Chronic arterial occlusion may result in the development of ischemic lower extremity ulcers. All of the following clinical features are commonly associated with these ulcers EXCEPT:

Which of the following bandages provides nonelastic (support) compression therapy?

The silver cation, Ag+, is a very potent antimicrobial agent because it can do all of the following, EXCEPT:

A patient presents with a 4 month history of an enterocutaneous fistula which drains 700- 1000cc’s daily depending on oral intake. The skin around the fistula has broken down and is painful. Appropriate management strategies include ALL of the following EXCEPT:

As a diagnosis of exclusion, chronic wounds of a factitial etiology are typically:

Which of the following describes the erroneous practice of changing the wound stage in order to reflect the changing depth noted as the wound heals?

An elderly, bed ridden patient is evaluated for a dry, gangrenous, non-infected calcaneal ulcer. The most appropriate initial primary dressing is:

The use of crutches as an effective off-loading therapy for foot ulcerations is limited and often not implemented due to all of the following reasons EXCEPT?

The role of fibroblasts in wound healing include all of the following EXCEPT:

Which of the following represents the strongest level of evidence in support of a given treatment strategy or therapeutic device?

In a diabetic patient who presents with a non-healing foot ulcer due to compromising factors including protein energy malnutrition (recent unintended weight loss of 5-10%) the best way to manage the nutritional status is by:

The first immune cells to arrive at a wounded site are:

A 84 year-old patient with dementia presents with a foul smelling ulceration in the sacral region. During the prior three weeks the nursing home staff has been treating the wound application of a hydrocolloid changed every 3 days. The ulcer is now covered with a soft and boggy black eschar and is draining a malodorous yellow-brown fluid. Which of the following would be the BEST approach for general management?

There are several indications for tissue biopsy to evaluate a wound for an atypical etiology, which of the following is NOT an appropriate indication for wound biopsy?

CSWS PHOTO EXAMINATION Please use the provided photos to answer the remaining questions

(Photo 1 – Refer to this Photo to answer the question)While working in the Wound Care Center you see this placard on the outside of an examination room. The patient has been placed in the room by one of your staff members and the door is closed. What should you do next?

(Photo 2 – Refer to Photo 2 to answer this Question)The patient you are caring for is being debrided by the physician. For the purposes of documentation and billing, what is the MOST appropriate description of the procedure being performed?

(Photo 2 – Refer to Photo 2 to answer this Question)Based on the appearance of this patient’s wound select the BEST description of the etiology and MOST likely primary factor that is compromising healing:

(Photo 2 – Refer to Photo 2 to answer this Question)Debridement of this wound was limited due to pain, thus nonviable tissue remains. All of the following management strategies would be acceptable for this patient upon discharge from this visit EXCEPT:

(Refer to Photos 3, 4, 5, 6, 7, 8 to answer this question)Please select the photo that is the BEST example of a Venous Insufficiency Ulcer.

(Refer to Photos 3, 4, 5, 6, 7, 8 to answer this question)Please select the photo that is the BEST example of a Pressure Ulcer.

(Refer to Photos 3, 4, 5, 6, 7, 8 to answer this question)Please select the photo that is the BEST example of a Diabetic Ulcer.

(Refer to Photos 3, 4, 5, 6, 7, 8 to answer this question)Please select the photo that is the BEST example of an Arterial Ulcer.

(Refer to Photo 3 to answer this Question)Which of the following describes the BEST approach to the management of this patient?

(Photo 7 – Refer to Photo 7 to answer this Question) Which of the following describes the BEST initial approach to the management of this patient?

(Photo 3, 4, 6, 7 – Refer to Photos 3, 4, 6, 7 to answer this Question) The utilization of Intermittent Pneumatic Compression would be MOST appropriate for this patient:

(Refer to Photos 3, 4, 5, 6, 7, 8 to answer this question)Please select the photo that is the BEST example of a patient that would have offloading as a primary treatment incorporated into their care plan?

( Refer to Photos 3, 4, 5, 6, 7, 8 to answer this question)Please select the photo that is the BEST example of a patient that would have pressure redistribution as a primary treatment incorporated into their care plan?

(Refer to Photos 9, 10, 11, 12 to answer this question)You are the supervising a new technician who has just completed her Transcutaneous Oxygen Training. Which of the following photos show good technique and placement of the electrodes?

(Refer to Photos 9, 10, 11, 12 to answer this question)Transcutaneous Oximetry Testing can be affected by several variables. Which of the following combinations of clinical scenarios BEST illustrates a clinical variable that might cause inaccurate TCOM measurement?

(Refer to Photos 13, 14, 15, 16 to answer this question)The wound care order reads “Apply Foam Dressing to Wound Base”. You are asked to apply the dressing. Please indicate which one of the above categories of dressings should you use?

(Refer to Photos 13, 14, 15, 16 to answer this question)The wound care order reads “Apply Hydrocolloid Dressing to Wound Base”. You are asked to apply the dressing. Please indicate which one of the above categories of dressings should you use?

(Refer to Photos 13, 14, 15, 16 to answer this question)The wound care order reads “Apply Alginate Dressing to Wound Base”. You are asked to apply the dressing. Please indicate which one of the above categories of dressings should you use?

(Refer to Photos 13, 14, 15, 16 to answer this question)The wound care order reads “Apply Hydrogel to Wound Base”. You are asked to apply the dressing. Please indicate which one of the above categories of dressings should you use?

(Refer to Photos 13, 14, 15, 16 to answer this question)Which of the above categories of dressings can be utilized for autolytic debridement?

(Refer to Photo 17 to answer this question)You are assisting in the evaluation and documentation of wound assessment of this patient. What finding is being illustrated?

(Refer to Photo 17 to answer this question)You are assisting in the evaluation and documentation of wound assessment of this patient. What is the BEST description of this wound?

(Refer to Photo 18 to answer this question)A patient presents to the Wound Care Clinic for initial consultation. The above wound has been present for 4 years, but recently has significantly increased in size. This wound would BEST be classified into what group of wound etiologies?

(Refer to Photo 18 to answer this question)You are motivated by efficiency and want to “have everything ready for the doctor”. Based on your evaluation and assessment of this patient, what would you anticipate will be needed in the room by the physician after she has evaluated the patient?

(Refer to Photos 19, 20, 21, 22 to answer this question)After evaluating the patient illustrated in Photo 17, the physician determines that wound debridement is appropriate. Which of the illustrated instruments is NOT typically used for debridement of necrotic soft tissues?

(Refer to Photo 17 to answer this question)Examination of the wound following debridement of the patient illustrated in Photo 17, the physician states that the sacral bone is now palpable. The MOST appropriate diagnosis of this wound would be?

(Refer to Photo 23 to answer this question)A patient presents to the Wound Care Clinic for a follow up evaluation. After removing the dressing and cleansing the wound, you are asked to describe the appearance of the wound. How would this wound be BEST described

(Refer to Photo 23 to answer this question)Close inspection of the margins of this wound reveals a thin border of tissue which is pale white semi-translucent but well adherent to the wound. Which of the following terms BEST describes this tissue?

(Refer to Photo 24 to answer this question)A patient presents to the Wound Care Clinic for a follow up evaluation. He is being treated with the product illustrated above. Which of the following BEST describes the classification of the wound and the type product being used?

(Refer to Photo 24 to answer this question)Associated with the procedure illustrated which treatment plan is associated with the best clinical outcomes?

(Refer to Photos 25, 26, 27, 28 to answer this question)A patient presents to the wound care clinic for initial consultation after being seen in the Emergency Department last night for increasing wound pain and low grade fever. You evaluate the wound and notice erythema and odor. To prepare the room for the physician, you anticipate needing which of the above items?

(Refer to Photo 29 to answer this question)You are evaluating the patient’s wound illustrated above. The BEST terminology to describe the appearance of this wound would be:

(Refer to Photo 29 to answer this question)This patient is being considered for application of a Cellular and Tissue Based Product (CTP). The following are all important considerations associated with this procedure EXCEPT?

(Refer to Photo 30 to answer this question)You are evaluating the patient’s wound illustrated above. The patient states that she had a cast applied to her lower extremity following surgical intervention on her Hallux several days ago. The cast was removed by the surgeon earlier today after she went in complaining of increasing pain over the past 24-48 hours. Subsequently she was referred to the Wound Care Clinic for evaluation. The patient states the pain is now slightly improved after removal of the cast. She is afebrile, but states that she had chills and sweats last night. Examination of the wound reveals mild tenderness with palpation, surrounding erythema and evidence of underlying fluctuance. The BEST terminology to describe the appearance of this wound would be:

(Refer to Photo 30 to answer this question)Her surgeon should be called and provided with recommendations for a Plan of Care. Which of the following is the BEST immediate advice?

The therapy that would most likely be used in the management of a surgical wound is shown in which photo?

(Refer to Photos 31, 32, 33, 34 to answer this question)The therapy that would most likely be used in the management of a necrotic wound in a patient that is not a candidate for surgical intervention is shown in which photo?

(Refer to Photos 31, 32, 33, 34 to answer this question)Based on the therapy illustrated in the above photos, which patient is MOST likely to have a positive past medical history for Deep Venous Thrombosis?

(Refer to Photos 31, 32, 33, 34 to answer this question)The therapy that would MOST likely be used in the management of a superficial diabetic foot ulcer is shown in which photo?

(Refer to Photos 31, 32, 33, 34 to answer this question)Each of the above advanced therapy demonstrated in Photos 31, 32, 33, 34 is associated with a patient that is a classic example of a wound type. Which of these illustrated conditions is associated with a diagnosis that may be an appropriate indication for adjunctive hyperbaric oxygen therapy?