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WOUND CERTIFICATION EXAM QUESTIONS
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WOUND CERTIFICATION EXAM QUESTIONS
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WOUND CERTIFICATION EXAM QUESTIONSWhat are 6 risk factor components of Braden Scale for pressure ulcer? - Answers-
sensory perception, moisture, mobility, activity, nutrition, and shear/friction
What is the name of the organization that developed the pressure ulcer staging? -
Answers- NPUAP (national pressure ulcer advisory panel)
Pathological effect of excessive pressure on soft tissue can be attributed by 3 factors?
What are they? - Answers- tissue tolerance, duration of pressure, and intensity of
pressure
What are the extrinsic factors that impact pressure ulcers? - Answers- increase in
moisture, friction and shearing
How does friction play a role in shearing which eventually leads to pressure ulcer? -
Answers- friction alone causes only superfical abrasion, but with gravity it plays a
synergistic effect leading to shearing. When gravity pushes down on the body and
resistance (friction) between the patient and surface is exerted, shearing occurs.
Because skin does not freely move, primary effect of shearing occurs at the deeper
fascial level.
What are the intrisinc factors of pressur ulcers? - Answers- nutritional debilitation,
advanced age, low BP, stress, smoking, elevated body temperature
Aging skin undergoes what elements affecting risk for pressure ulcer? - Answers-
dermoepidermal junction flattens, less nutrient exchange occurs, less resistance to
shearing, changes in sensory perception, loss of dermal thickness, increased vascular
fragility; ability of soft tisuse to distribute mechanical load w/out comprosing blood flow
is impaired
What does nonblanching erythema indicate in the skin r/t PU? - Answers- when
pressure is applied to the erythematic area skin becomes white (blanched), but once
relieved, erythema returns -indicating blood flow; however in nonblanching erythema,
skin does not blanche-indicating impaired blood flow-suggesting tissue destructon
Why does sitting in a chair pose more of a risk in skin break down than lying? -
Answers- deep tissue injury or PU is likely to occur sooner sitting down because tissue
offloading over boney prominences is higher
Describe what you will see in deep tissue injury? - Answers- purple or maroon localized
area of discolored intact skin skinor blood filled blister; may be preceded by painful, firm,
mushy, or boggy; skin may be warmer to cooler in adjacent tissue. In dark skin, thin
blister or eschar over a dark wound bed may bee seen
,Describe stage I pressure ulcer? - Answers- Intact skin with nonblanchable redness of
localized area. Will not see blanching in dark skin, but changes in skin tissue
consistency (firm vs boggy when palpated), sensation (pain), and warmer or cooler
temperature may differ from surrounding area
Describe stage II pressure ulcer? - Answers- partial-thickness wound where epidermis
and tip of dermis is lost with red-pink wound bed w/out slough. May also present as
intact or open/ruptured serum -filled blister
Describe stage III pressure ulcer? - Answers- full-thickness wound where both
epidermis and dermis is lost and subcutaneous tissue may be visible, but deeper
structures such as muscle, bone, and tendon are not exposed; slough my be present
but it doesn't obscure depth and tunneling and undermining may be present
Describe stage IV pressure ulcer? - Answers- full-thickness wound with exposed
bone,tendon, and muscle; slough or eschar may be seen in some parts of the wound
bed. You will often see tunneling and undermining. Osteomyelitis may be dxed at this
stage, since bone is palpable
Describe unstageble ulcers? - Answers- full-thickness wound where base of the ulcer is
covered by slough and/or eschar, obscuring depth
When should eschars not be removed? - Answers- when it's stable with dry, adherent,
and intact w/out erythema on the heel; this serves as the body's natural cover and
should not be removed.
Therapeutic function of pressure distribution is accomplised by what 2 factors? -
Answers- immersion and envelopement
Define immersion? - Answers- depth of penetration or skining into surgace allowing
pressure to be spread out over surrounding area rather than directly over boney
prominence
Define envelopement? - Answers- is the ability of support surface to conform to
irregularities without causing substantial increase in pressure
What is bottoming out? - Answers- this occurs when depth of penetration or sinking is
excessive, allowing increased pressure to concentrate over boney prominences
What factors contribute to bottoming out? - Answers- weight, disproportion of weight
and size such as amputation, tendency to keep HOB >30 degrees, inappropriate
support surface settings
When should you consider reactive support surface with features and components such
as low air loss, alternating pressure, viscous or air fluids? - Answers- for patients who
, cannot effectively position off their wound, have pus in multiple turning surfaces, or have
pus that fail to improve despite optimal comprehensive management
When should active support surface be considered? - Answers- when effective
positioning is determined by an MD to be medically contraindicated
What is the difference between an active and reactive support surfaces/ - Answers-
active support surface is a powered mattress or overlay that changes it's load-
distribution with or without applied load; pressure is redistributed across the body by
inflating and deflating the cells of alternating zones. Conversely a reactive support
surface moves or changes load-distribution properties only in response to applied load,
such as the patient's body.
When are active support surfaces appropriate? - Answers- when manual frequent
repositioning is not possible
When are reactive support surfaces appropriate? - Answers- for pressure ulcer
prevention
What is a benefit in low air loss feature and when is it contraindicated? - Answers- low
air loss assists in managing mositure. It is contraindicated in patients with unstable
spine and it puts patients at risk for entrapment
When is an air fluidized feature integrated in bed systems appropriate? - Answers- for
patients with multiple stage III or Iv pressure ulcers, burns, myocutaneous skin flap
For what kind of patients are traditional air-fluidized bed not recommended? - Answers-
pulmonary diseases or unstable spine patients
What are some general guidelines for caring for patients on a support surface? -
Answers- support surfaces alone doe snot prevent or heal pus, fuctions best with
minimal linens and pads under patients, must be able to assume variety of positions to
prevent bottoming out, patients should be turned regardless of support surfaces,
patients who sit with a risk for PU should have a sitting plan- duration, position, and
posture
What type of patient is a lateral rotation feature in a supportive surface beneficial? -
Answers- for patients with acute respiratory conditions- requiring pulmonary hygience
What are the 3 essential physical properties for normal venous function? - Answers-
competent valves, venous wall, and calf muscle pump
What are the classical characteristic traits seen in venous ulcers? - Answers- shallow,
irregular wound eges, with moderate to heavy exudate, dark red or "ruddy" wound base
or thin layer of yellow slough, macerated periwound, crusting, scaling and /or
hemosiderin staining
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