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WCC App. Prep course TEST 1

front 1

A diabetic foot ulcer that has penetrated through the subcutaneous tissue to involve tendon/ligament/joint capsule w/out abscess or Ostemyelitis (osteoM) is classified as which Wagner grade?

Grade 4

Grade 5

Grade 3

Grade 2

back 1

Grade 2

According to the widely used Wagner classification system, diabetic foot ulcers are graded from 0 to 5 based on the depth of tissue involvement & the presence of infection, osteomyelitis, or gangrene. Grade 2 ulcers penetrate the subcutaneous tissue & may expose bone, tendon, ligament, or joint capsule w/out abscess formation or osteoM

front 2

Which of the following is not a sign of zinc deficiency?

Slow wound healing

Spoon-shaped nails

Loss of taste

Thin, sparse hair

back 2

Spoon-shaped nails

Concave, spoon-shaped nails indicate insufficient iron level in the body. The other symptoms-thin, sparse hair; loss of taste; and slow wound healing- are associated with zinc deficiency.

front 3

Thin, sparse hair; loss of taste; and slow wound healing- are associated with____ deficiency.

back 3

zinc

front 4

What legal documentation is essential to palliative wound care, particularly regarding patient preferences?

Treatment plan

Power of Attorney

Living Will

Consent form

back 4

Living will

A living will is legally recognized document that outlines a patient's preferences for medical treatment, including palliative care. It explicitly states which interventions the patient does or does not want, providing clear guidance to healthcare providers. This document is particularly valuable in palliative wound care, as it ensures the treatment plan aligns w/the patient's wishes & respects their autonomy.

front 5

What legal documentation designate someone to make healthcare decisions on behalf of the the patient if they become unable to do so themselves. It's a back up measure to the living will, the living will takes precedence for medical treatment.

back 5

Power of attorney

front 6

What legal documentation gives permission for specific treatment or procedures. They are crucial for informed consent but lack the comprehensive scope of a living will, which details preferences across various medical situations, including palliative care, thus offering broader legal guidance.

back 6

Consent forms

front 7

Empiric treatment of severe diabetic foot infection involves which of the following antibiotics?

Ampicillin/sulbactam

Cephalexin

Vancomycin

Amoxicillin/clavulanate

back 7

Ampicillin/sulbactam

front 8

For severely infected ____ ___ ___, initiate antibiotic therapy intravenously, then switch to oral administration once the patient improves.

back 8

diabetic foot wound

front 9

What are the recommended empiric treatment options for DFU.

back 9

Ampicillin/sulbactam 2.1 g IV every 6hrs plus ciprofloxacin 750mg PO BID (twice daily)

front 10

This empiric treatment option is for what type of wound?

Ampicillin/sulbactam 2.1 g IV every 6hrs plus ciprofloxacin 750mg PO BID (twice daily)

back 10

DFU that is severly infected

front 11

Cephalexin & amoxicillin/clavulanate (Augmentin) are indicated for ___ ___ __ __ (oral therapy for the entire course).

back 11

mild to moderate infections

front 12

What antibiotic is reserved for life threatening infections and requires prolonged IV Therapy?

back 12

Vancomycin

front 13

Which of the following study designs is considered the gold standard of research?

Case series or case reports

Cohort studies

Case-control studies

Randomized controlled trials

back 13

Randomized controlled trials

RCTs are considered the gold standard of research: participants are randomly allocated to either a treatment (intervention) group or a control group (receiving placebo or standard treatment)

front 14

Meta-analysis & randomized controlled trials (RCTs) are ranked as the__ __ ___ because their designs minimize the biases and systematic errors.

back 14

highest levels of evidence

front 15

What type of approach is where neither participants nor researches know assignment-further reduces bias & threats to validity, including the placebo effect

back 15

Double-blind approach

front 16

A nurse is changing a dressing on a patient and notes red drainage both on the old dressing, and oozing from the wound bed. What type of exudate is this?

back 16

Sanguinous

Sanguinous exudate is thin, watery, and bloody (red) in appearance. Its presence indicates new blood vessel growth or disruption of existing vessels, and it is normal during the proliferative phase of wound healing. Propliferative Phase- the third stage of wound healing, generally lasting from day 4 to day 21 post-injury.

front 17

What stage of wound healing is the 3rd stage and generally lasts 4 to 21 days, where new blood vessel growth, or disruptions of existing vessels takes place.

back 17

Propliferative Phase

front 18

____ exudate is thin, clear, to straw-colored, and also normal during the Proliferative phase (3rd phase).

back 18

Serous

front 19

______ exudate is thin, watery, and pink to light pink; it is normal during the inflammatory and proliferative phases.

back 19

Serosanguineous exudate

Common in the Inflammatory (1st / critical stage), and the Proliferative phase (3rd phase).

front 20

______ is the critical first phase in the wound healing process. Beginning immediately upon injury, it aims to stop bleeding and clean the wound bed of bacteria and debris. last 2-6 days.

back 20

Inflammatory phase

front 21

How long does the first / critical phase, the inflammatory phase last?

back 21

Beginning immediately upon injury, it aims to stop bleeding and clean the wound bed of bacteria and debris. Typically lasts for the first 2 to 6 days and is characterized by swelling, redness, pain, and heat

front 22

_____ ______ is medical treatment started based on clinical experience and an "educated guess" before a definitive diagnosis or test result is confirmed.

back 22

Empiric treatment (or empiric therapy)

front 23

Empiric treatment (or empiric therapy)

back 23

A treatment that is initiated based off of an educated guess, or clinical experience?

front 24

A patient has a surgical wound resulting from a skin tissue biopsy. Which surgical wound classification does this wound receive?

Class II

Class III

Class I

Class IV

back 24

Class I

A surgical wound from skin tissue biopsy is considered a Class 1 (clean) wound. The biopsy specimen is obtained from clean tissue using a scapel or punch bipsy, and the bleeding is controlled. There is no traumatic injury or inflammation during the procedure, and steril technique is maintained throughout.

front 25

A 69 year old male patient w/diabetes present w/foot ulcer. He reports a mild allergy to latex and is concerned about the cost of treament. Which dressing is most appropriate?

Latex gauze dressing

Latex-containing hydrocolloid dressing

Alginate dressing

Silicone foam dressing

back 25

Silicone foam dressing

Silicone foam dressing is the most appropriate choice for this patient. It is latex-free, avoiding any risk of allergic reaction-and offers effective exudate management and wound protection at a reasonable cost.

front 26

RE: A male pt. worried about cost w/DFU and latex allergy. Which dressing option describles the below dressing type. Read thoroughly!

___ __ are excellent for high exudate wounds such a DFUs, they can be more expensive and do not address the patient's latex allergy.

back 26

Alginate dressing

front 27

What is the standard treatment for chronic venous insufficiency?

Pharmacologic management

Exercise

Compression therapy

Weight control & dietary modifications

back 27

Compression Therapy

Compression therapy is the standard treatment for chronic venous insufficiency. Because venous insufficiency is associated w/increased hydrostatic pressure in the leg veins, compression therapy reduces that pressure & aids venous return.

front 28

____ ___ in leg veins is the physical force exerted by the weight of the blood column against the vein walls, heavily influenced by gravity.

back 28

Hydrostatic pressure

front 29

A patient has been prescribed silver sulfadiazine cream for a burn wound. Pt. education regarding this topical agent should include which of the following?

Do not use it for longer than 2 weeks

This medication penetrates burn eschar well, making it useful when an infections is suspected or vascular supply is limited

This medication is safe for use during pregnancy

There may be some pain associated w/the application of this cream

back 29

Do not use it for longer than 2 weeks

front 30

___ _____ is a topical antibiotic effective against both grampositive and gram-negative organisms, as well as some fungi. It is the indicated for second-and thrid degree burns.

back 30

Silver Sulfadiazine

front 31

Key teaching points for ____ _____

- Limit use to no more than 2 weeks

- Do not use in pregnant women, neonates, or pts w/sulfonamid allergy

- Application is usually comfortable & soothing; pain is NOT typically associated w/its use.

back 31

Silver sulfadiazine

front 32

___ ___ not silver sulfadiazine- penetrates eschar more effectively and is preferred when infection is suspected or vascular supply is minimal.

back 32

Mafenide acetate

front 33

Which classification of pressure ulcer is characterized by wound presenting w/non-blanchable erythema of intact skin?

Suspected deep tissue injury (sDTI)

Unstageable

Stage I

Stage II

back 33

Stage I

Stage I pressure ulcers present as intact skin w/non-blanchable erythema localized over a bony prominence.

front 34

What stage ulcer presents with intact skin, and with non blanchable erythema localized over a bony prominence?

back 34

Stage I

front 35

A suspected ___ ___ __ looks like an area of intact or non-intact skin with localized purple or maroon discoloration, or a blood-filled blister. The affected area often feels different from the surrounding skin—it can be painful, firm, mushy, boggy, warmer, or cooler to the touch.

back 35

deep tissue injury (sDTI)

front 36

Which of the following conditions is not an acute complication of major burns?

Pneumonia

Wound infection

Acute renal failure (ARF)

Cellulitis

back 36

Acute renal failure (ARF)

front 37

Can you guess the top 5 without looking?

The top acute complications of major burns include:

back 37

Pneumonia

Wound infection

Cellulitis

Respiratory failure

Urinary tract infection

front 38

Which of the following statements about herpes simple virus (HSV) is false?

Vesicles are uniformly shaped and grouped

HSV-1 is associated w/cold sores, while HSV-2 causes genital and perianal herpes

Erythema indicates a secondary infection

HSV infections occur in two phases; primary & secondary

back 38

Erythema indicates a secondary infection

front 39

HSV 1

back 39

Oral herpes

front 40

HSV has two phases: Primary infection & a secondary phase

During the primary infection-

back 40

Your body’s very first encounter with the virus (HSV-1 or HSV-2)

Significant inflammatory response extends from the base of the lesions into the dermis, resulting in the classic presentation of uniform, grouped vesicles on an erythematous base. Can also cause fatigue, flu-like symptoms, swollen lymphnodes that can last up to 3 weeks.

front 41

HSV can be confirmed with a ___ ___.

back 41

Tzanck smear

front 42

HSV I Secondary phase :

back 42

Refers to latency, the dormant period that follows the initial outbreak. During this phase, the virus retreats into the nerve cells near the spine (the trigeminal ganglion for oral herpes) where it remains inactive, causing no symptoms but staying in the body permanently

front 43

HSV secondary phase:

back 43

the blistering stage of a standard outbreak (the second localized stage after initial tingling), or a recurrent outbreak (subsequent outbreaks after the initial primary infection)

front 44

What should be emphasized as the primary goal when educating a new physician about wound care?

back 44

Applying evidence-based practices.

This is the primary goal when educating a new physician about wound care. Without evidence, clinical practice rapidly becomes outdated. Evidence based wound care ensures that treatment decisions are informed by the latest & most effective research.

front 45

Evidence based practice integrates:

back 45

Individual clinical experience, the best available evidence, and patient preferences to guide decision-making.

front 46

In management of the second-degree burn (superficial dermal injury), which of the following interventions is not appropriate?

Cleanse & debride broken blisters

Perform early surgical grafting

Apply nonadherent dressings or CTPs

Leave intact blisters alone unless they interfere w/movement

back 46

Perform early surgical grafting

Surgical grafting is reserved for deep dermal second-degree injuries & third-degree burns; it is not indicated for superficial dermal (superficial second-degree) burns.

front 47

Surgical grafting is for deep dermal second degree injuries & third degree burns

True or false

back 47

True

front 48

In management of a second-degree burn (superficial dermal injury), are the following interventions appropriate?

Cleanse & debride broken blisters

Apply nonadherent dressings or CTPs

Leave intact blisters alone unless they interfere w/movement

back 48

Yes

front 49

Which of the following is not a sign of zinc deficiency?

Loss of taste

Slow wound healing

Thin, sparse hair

Spoon-shaped nails

back 49

Spoon-shaped nails

This indicates insufficient iron levels

front 50

What is the primary function of fibroblasts?

To participate in the biosynthesis of collagen to form the extracellular matrix (ECM)

To promote cell migration, proliferation, and angiogenesis

To facilitate the reepithelialization & formation of granulation tissue

To control infection as long as the wound remains open

back 50

To participate in the biosynthesis of collagen to form the extracellular matrix (ECM)

Fibroblasts migrate to the wound area along fibrin strands of the wound clot & synthesize ground substance and collagen to form the ECM.

front 51

____ are involved in the cell adhesion & signaling during wound healing, play a critical role in reepithelialization & granulation tissue formation.

back 51

Intergrins

front 52

___ ___ promote cell migration, proliferation, and angiogenesis

back 52

Growth factors

Growth factors are: naturally occurring proteins that act as chemical messengers in the body

front 53

Which of the following indicators would most effectively help a wound care nurse evaluate a patient's adherence to a wound dressing regimen?

Improvement in healing rate & wound appearance

Patient's verbal confirmation of adherence

Prescription refill frequency

Number of missed appointments.

back 53

Improvement in healing rate & wound appearance

This is the most objective / direct objective evidence that the treatment plan is both followed and effective.

front 54

How soon after a patient is diagnosed w/malnutrition should they receive a malnutrition care plan?

Immediately

Within 24hrs

Within 48hrs

Within 12hrs

back 54

Immediately

Why delay?

front 55

What primarily occurs during the first phase of wound healing?

Granulation

Angiogensis

Inflammation

Clotting

back 55

Clotting

front 56

During the __ __ __ ____ hemostasis-platelets adhere to the injured vessel wall, forming a platelet plug & generating thrombin to initiate the coagulation cascade. * This clot formation stops bleeding & creates a provisional ECM that supports subsequent inflammatory & repairative processes.

back 56

first phase of wound healing

front 57

What do the phases below represent?

1. Hemostatis (clotting)

2. Inflammation (erythema, edema, and neutrophil-mediated debris removal)

3. Proliferation/granulation (fibroblast-driven collagen synthesis & new tissue formation.

4. Maturation/remodeling (collagen reorganiztion and scar contaction)

back 57

The four primary phases of wound healing

front 58

Which intervention is most appropriate for a patient w/a high risk of skin breakdown due to incontinence?

Application of an antimicrobial ointment

Frequent repositioning

Increased use of absorbent pads

Application of moisture barrier

back 58

Application of moisture barrier

Protect against irritants such as urine, feces, and sweat. Moisture barriers are creams, ointments, or films that create a protective layer over the skin, preventing moisture-induced irritation & breakdown.

front 59

What is the recommended daily allowance (RDA) of protein for a healthy person?

0.5 g/kg/day

2.2 g/kg/day

0.8 g/kg/day

1.2 g/kg/day

back 59

0.8 g/kg/day

This is the RDA for protein per kilogram of body weight per day. After injury or during periods of catabolic stress, protein needs may increase to approx. 1.5 g/kg/day.

front 60

True / False

Older adults often require LESS protein than younger individuals.

back 60

False

* they often require more.