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Wound: Lower Extremity Ulcers

Schaffner, Amy

Journal of Wound, Ostomy and Continence Nursing: September-October 2009 - Volume 36 - Issue 5 - p 550–552
doi: 10.1097/WON.0b013e3181b40abd
GETTING READY FOR CERTIFICATION
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Amy Schaffner, ARNP, CNS, CWOCN, Board Liaison, WOCNCB Examination Committee, Spokane, Washington and Wound, Ostomy and Continence Nurse Specialist, Family Home Care, Liberty Lake, Washington.

Corresponding author: Amy Schaffner, ARNP, CNS, CWOCN, (farbenblinde@hotmail.com).

While attending the annual WOCN Society Conference in St Louis, I met many nurses who were getting ready for their certification examinations. The best recommendation I could offer them was to study the Detailed Content Examination Outline. Every question on the certification examinations for wound, ostomy, and continence nursing comes from the content outline found in the Wound, Ostomy and Continence Nursing Certification Board's (WOCNCB's) Candidate Handbook. You can download the most current handbook for free from the WOCNCB Web site www.wocncb.org.

In this article, we will discuss lower extremity ulcers. If you look at the section on wound care in the examination content outline, you will see the number 80, which means there will be 80 questions about wound care in the examination. Next, look at subsection D in the content outline; this section covers lower extremity ulcers. Next to this heading is the number 20, which means there will be 20 questions in the examination from this section. Of those 20 questions, expect all levels of test questions including recall-, application-, and analysis-level questions. Listed below are 7 questions covering ulcers in the lower extremity. The content outline for these questions is included in the general principles of management in the wound care content outline.

1. Which anatomical structure is most important to assess in the patient with lower extremity arterial disease?

a. Knee.

b. Ankle.

c. Toe.

d. Calf.

1. (C) One may use the logic of physiology to answer the question if the item is not memorized. As the toe is the most distal part of the leg, it is logical that it would be the anatomical structure first affected by arterial disease.

Content Outline Location: 1D1a

Reference

Doughty DB, Holbrook R. Lower-extremity ulcers of vascular etiology. In: Bryant RA, Nix D, eds. Acute and Chronic Wounds: Current Management Concepts. 3rd ed. Philadelphia, PA: Mosby; 2007:261, 272.

2. The WOC nurse consults with a patient in the ICU. The patient is comatose and intubated and has bilateral heel ulcers and 100% thick black leathery eschar. The periwound has mild erythema and is nonboggy. What is the most important treatment to recommend to the nurses?

a. Paint with povidone/iodine (Betadine) daily.

b. Silver sulfadiazine (Silvadene) and gauze.

c. Chemical debrider and gauze.

d. Float heels off bed with pillow.

2. (d) This analysis question asks you to prioritize interventions. Although painting the heels with povidone/iodine (Betadine) would be the correct “dressing,” offloading the pressure is the priority intervention with pressure ulcers. Always remember: Treat pressure ulcers by offloading the pressure! Softening the wounds with silver sulfadiazine (Silvadine) or a chemical debrider could potentially open the wounds. This could potentially lead to sepsis or a nonhealing wound.

Content Outline Location: 1C2d

Reference

Pieper B. Mechanical forces: pressure, shear, and friction. In: Bryant RA, Nix D, eds. Acute and Chronic Wounds: Current Management Concepts. 3rd ed. Philadelphia, PA: Mosby; 2007:228.

3. The WOC nurse visits a patient with venous stasis disease. In teaching regarding long-term management, it is important to emphasize what information?

a. Elevation and compression of the lower extremities.

b. Elevation and nail care of the lower extremities.

c. Compression of the lower extremities and high fluid intake.

d. Compression of the lower extremities and high protein intake.

3. (a) In this application question, the test taker is asked to identify the hallmarks of treatment for the patient with lower extremity venous stasis disease: elevation and compression.

Content Outline Location: 1D2b

Reference

Doughty DB, Holbrook R. Lower-extremity ulcers of vascular etiology. In: Bryant RA, Nix D, eds. Acute and Chronic Wounds: Current Management Concepts. 3rd ed. Philadelphia, PA: Mosby; 2007:284.

4. What advice would be helpful for the diabetic patient with a past history of ulcerations on the feet?

a. Soak nightly in magnesium sulfate (Epsom salts).

b. Inspect feet daily.

c. Wear shoes with a tight toe box.

d. Wear shoes with a gel insole.

4. (b) This simple application question assures the test taker understands that daily foot inspection is an important component of diabetic foot care.

Content Outline Location: 1D4a

Reference

Driver VR, Landowski MA, Madsen JL. Neuropathic wounds: the diabetic wound. In: Bryant RA, Nix D, eds. Acute and Chronic Wounds: Current Management Concepts. 3rd ed. Philadelphia, PA: Mosby; 2007:326.

5. An arterial ulcer of the lower extremity can best be described as:

a. Painful lesion with well-defined edges, pale wound bed, and slough.

b. Irregular edges with thick creamy slough.

c. Painful lesion with dry edges and large amount of serous exudate.

d. Nonpainful lesion with eschar.

5. (a) This application question asks the examination candidate to distinguish between different types of lower extremity wounds.

Content Outline Location: 1D1a

Reference

Doughty DB, Holbrook R. Lower-extremity ulcers of vascular etiology. In: Bryant RA, Nix D, eds. Acute and Chronic Wounds: Current Management Concepts. 3rd ed. Philadelphia, PA: Mosby; 2007:272.

6. A patient comes to the wound clinic with brown skin discoloration on both lower extremities. What is the likely cause?

a. Breakdown of hemoglobin in the tissues.

b. Contact dermatitis due to lotion.

c. Build up necrotic tissue.

d. Chronic erythema with edema.

6. (a) This application question asks about the physical assessment of a patient with venous stasis disease. In particular, it asks about the cause of hemosiderin staining.

Content Outline Location: 1D2a

Reference

Doughty DB, Holbrook R. Lower-extremity ulcers of vascular etiology. In: Bryant RA, Nix D, eds. Acute and Chronic Wounds: Current Management Concepts. 3rd ed. Philadelphia, PA: Mosby; 2007:284.

7. A home health patient with a large chronic venous stasis ulcer complains that the wound is draining more heavily and seems larger. Upon assessment, the WOC nurse notes that the ulcer is 100% slough with bright red erythema and a foul odor. What intervention would be appropriate?

a. Use an absorptive foam dressing.

b. Apply an antimicrobial dressing.

c. Cleanse the wound with an antiseptic.

d. Call the MD for an antibiotic order.

7. (d) This analysis question asks the WOC nurse to identify classic signs and symptoms of an infected wound and select the right course of action.

Content Outline Location: 1B18

Reference

Stotts NA. Wound infection: diagnosis and management. In: Bryant RA, Nix D, eds. Acute and Chronic Wounds: Current Management Concepts. 3rd ed. Philadelphia, PA: Mosby; 2007:167.

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Resources for Preparing for the WOC Certification Exam

Whether you are taking the examination for the first time or recertifying by taking the examination again, it is important to prepare to successfully pass the examination. Here are a few resources to help you study:

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Free Sample Test

Try a user-friendly online test at http://www.lxr.com/webtest/login.aspx.

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Self-Assessment Exam

Order a computer-based test from the testing company that produces our exam. Go to www.goamp.com and click first on “E-Store” and then on “Web Tests.” Then select “Health Care” and then “Wound, Ostomy, Continence Nursing.” Each individual practice exam costs $30, which gives you 90-day access.

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WOCN Society Review Courses

Each year, the WOCN Society offers CD-ROMs of the certification review course presented at its national conference. You can buy these online at www.prolibraries.com/wocns/.

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New 2009 Certification Review Manual

The WOC Nursing Education Program at Emory University has a new certification review manual for sale for $65. Go to http://www.surgery.emory.edu/wocnec/order.form.pdf or contact Brenda Michael at brmicha@emory.edu.

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Wound Care Study Guide

The Wound Care Education Program at the Medical College of South Carolina offers a guide for $125. Contact Carol Whelan at 843-792-265 or toll free at 866-637-6835.

Copyright © 2009 by the Wound, Ostomy and Continence Nurses Society