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Other Wounds

Schaffner, Amy

Journal of Wound, Ostomy and Continence Nursing: November-December 2009 - Volume 36 - Issue 6 - p 671–673
doi: 10.1097/WON.0b013e3181bd86fb
GETTING READY FOR CERTIFICATION
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Amy Schaffner, ARNP, CNS, CWOCN, Board Liaison, WOCNCB Examination Committee, Spokane WA and Family Home Care and Hospice, Liberty Lake, Washington.

Corresponding author: Amy Schaffer, ARNP, CNS, CWOCN, WOCNCB Examination Committee, Spokane WA and Family Home Care and Hospice, Liberty Lake, WA 99224 (farbenblinde@hotmail.com).

If you have been following this feature “Getting Ready for Certification” over the past year, you now have an understanding of the types of questions to expect (recall, application, or analysis) and how to break them down for a successful exam. This experience adds up to decreased test anxiety—something we can all benefit from. The Wound, Ostomy, Continence Nursing Certification Board (WOCNCB) offers even more exam help.

At the WOCN Society 2009 annual conference, Donna Thompson, MSN, CRNP, FNP-BC, CCCN, gave a presentation “To Test or Not to Test: That Is the Question: How to Prepare for the WOCNCB Certification Exams.” This helpful PowerPoint presentation is available on the WOCNCB Web site. Just go to the WOCNCB home page at www. wocncb.org and enter Test-taking into the Search box.

One of the specific strategies Ms Thomson drives home is to use the Content Outline to study. This is why we include the Content Outline location with the answer to each question in this feature. The Content Outline is found in the WOCNCBCandidate Handbook. You can download the handbook for free from the WOCNCB Web site. Just type Content Outline in the Search box.

In this article, we turn our attention to wound care and look at what is discussed in the content outline as “Other Wounds” (Content Outline location 1E). Of the 80 questions asked on the wound care exam, 8 will come from this section. Questions may be categorized as recall, application, or analysis. Here are some practice examples.

1. When cleansing an infected wound, which cleansing solution would be most appropriate to select?

a. Normal saline

b. Povidone-iodine (Betadine)

c. Commercial topical antiseptic

d. Dakin's solution

1. This is a recall question—a question that tests the recognition or recall of specific information. Wounds do not heal unless the infection is treated. However, the use of an antimicrobial or bactericidal cleansing agent is generally discouraged due to nonselective cytotoxicity. The current recommendation is to use tap water or normal saline to cleanse the wound and decrease bacterial load. Even if you might use Betadine, commercial antiseptics, or Dakin's solution in your practice, research continues to support the use of water or normal saline to reduce surface contaminant and metabolic by-products, rather than cure the infection, as the preferred cleansing agent. Note the question has a clue in the stem, “most appropriate.” Let this clue help guide you in answer selection. Be sure to answer what the question is asking!

Answer: a

Content Outline Location: 1E2e

Reference

Stotts N. Wound infections: diagnosis and management. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:170.

2. Which topical treatment would be effective for odor control in a fungating wound?

a. Metronidazole gel (MetroGel)

b. Silver sulfadiazine (Silvadene)

c. Mupirocin 2% cream

d. Cadexomer Iodine

2. In this analysis question, you must be familiar with the treatment of fungating wounds. You must also be aware of the mechanism of action of several different antimicrobial/antibiotic choices. Metronidazole gel or cream is effective in fungating wounds due to gram-negative activity.

Answer: a

Content Outline Location: 1E1d

Reference

Goldberg M, McGinn-Byer M. Oncology-related skin damage. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:479.

3. A home care patient undergoing radiation therapy of the head and neck is experiencing weepy desquamation. The patient shows the WOC nurse a cream that a friend recommended for him that he bought at the local drug store. The WOC nurse is not familiar with all the ingredients. The best advice to offer this patient is

a. tell the patient to call a pharmacist for an explanation of the ingredients.

b. tell the patient if it worked for the friend, go ahead and use it.

c. tell the patient not to use the cream.

d. tell the patient to take the cream to the next radiation therapy appointment and ask the radiologist.

3. This answer is an application question that involves basic knowledge of topical treatment of radiation injury/burns. Since many creams can interfere with radiation therapy, the patient should always consult with the physician prior to using any nonprescribed topical therapy.

Answer: d

Content Outline Location 1E2c

Reference

Goldberg M, McGinn-Byer M. Oncology-related skin damage. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:483–484.

4. A patient with a lower extremity wound diagnosed as vasculitis comes into the clinic. Local treatment of this wound includes

a. debridement and hyperbaric oxygen treatments.

b. debridement and protection from trauma.

c. antibiotics and compression dressings.

d. antibiotics and offloading.

4. This question requires the WOC nurse to embrace the general principles of local treatment of a vasculitis wound. Wound pathology is inflammation of the blood vessels, endothelial swelling, and necrosis, and a systemic disorder is often suspected. Therefore, the most important interventions would include debridement and injury prevention. Hyperbaric oxygen treatments are not routinely performed on these patients. Compression is not indicated. Antibiotics are not indicated unless there is an infection.

Answer: b

Content Outline Location 1E1e

Reference

Bryant R, Clark R. Skin pathology and types of damage. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:119–120.

5. The most important intervention when treating a skin allergy is

a. hydrocortisone cream 0.05%.

b. avoid contact with allergen.

c. wash skin with soap and water.

d. prevention of secondary infection.

5. This is a straightforward question with a clue in the stem! The clue is MOST. Again, be sure to answer what the question is asking. This is a basic rule of thumb in test taking! Although all the answers may be appropriate interventions for a skin allergy, avoidance of the allergen is obviously the most important.

Answer: b

Content Outline Location 1E2a

Reference

Bryant R, Clark R. Skin pathology and types of damage. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:117–118.

6. After a traumatic injury, what is the maximum time a wound can be left open prior to closure?

a. 2–4 hours

b. 6–8 hours

c. 12–24 hours

d. 24–48 hours

6. This recall question asks important information regarding safe management of traumatic wounds. Traumatic wounds should be closed within 12 to 24 hours. After this amount of time, traumatic wounds are considered contaminated and should be allowed to close via secondary intention.

Answer: c

Content Outline Location 1E1b

Reference

Black J, Black S, Bryant R, Clark R. The role of surgery in wound healing. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:465–466.

Studying the Content Outline is an important aspect of WOCNCB test preparation. If the topic is mentioned on the outline, there will be a question about it. Remember to study the Content Outline and you would not miss any important areas! Bear in mind that careful preparation and targeted study are key concepts in your success on the WOC certification exams.

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Not Recertifying Due to Economic Issues?

The WOCNCB created a Benevolence Fund in 2007 for times like this. Do not let your certification lapse. Contact info@wocncb.org. All inquiries are treated with the utmost confidentiality.

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Resources for Preparing for the WOC Certification Exam

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.org and click “e-store,” select “Health Care,” and then “Wound, Ostomy, Continence Nurses.” 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 their 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.

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Update

Board Certification for AP Wound, Ostomy, and Continence Nurses

Leanne Richbourg

A year ago, the National Council of State Boards of Nursing APRN Advisory Committee and the APRN Consensus Work Group proposed a new model for APRN regulation that addressed the need for consensus in licensure, accreditation, certification, and education (LACE) of advanced practice nurses across the country. The model proposed that APRN practice be defined by 4 roles, certified registered nurse anesthetist, certified nurse midwife, clinical nurse specialist, and certified nurse practitioner, all to be designated by the title “advanced practice registered nurse” (APRN). APRNs will then be educated and licensed in 1 of the 4 roles and in a population focus such as family, adult/gerontology, women's health, neonatal, pediatrics, and psychiatric/mental health. The LACE model designates that the APRN must successfully pass a national certification examination that measures competencies of role and population foci. The model has been endorsed by numerous nursing organizations, including the WOCN Society and WOCNCB. The targeted timeline for full implementation of the model is 2015.

The LACE model recognizes specialty advanced practice nursing (APN) practice as more focused in education and practice. Specialty APN education and practice build upon the APRN role and population foci and will not be regulated by state boards of nursing. Rather, specialty APN practice will be recognized and monitored by the profession, in our case, the Wound Ostomy and Continence Nurses Society (WOCN Society).

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How WOCNCB Supports Specialty APN Practice

As many of you may know, the WOCN Society is already pursuing recognition of wound, ostomy, and continence nursing as a specialty under the ANA Criteria for Recognition as a Nursing Specialty. The WOCNCB has been keeping a very close eye on the developments in this area to best serve our advanced practice certificants.

The WOCNCB first awarded APN certification in wounds, ostomies, and/or continence via portfolio in 2005. Recently, the WOCNCB established an Advanced Practice Committee of 6 advanced practice nurses who are involved in ongoing evaluation of the process and specifications for the recertification by the advanced practice portfolio. Through diligence of the committee, an updated and revised Advanced Practice Portfolio Handbook is now available for free download at http://www.wocncb.org/pdf/ap_certification2009.pdf. The revised portfolio incorporates a more flexible approach when validating the APN participation in or application of research. In addition, in order to serve our busy advanced practice nurses who find the portfolio process burdensome, the WOCNCB has approved the development of an advanced practice examination.

The WOCNCB will continue to monitor the development of a national model for APRN licensing and will also continue to support the board certification process for advanced practice wound, ostomy, and continence nurses.

▪ Leanne Richbourg, MSN, APRN-BC, CWON-AP, Chair, Advanced Practice Committee, WOCNCB.

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