Have you experienced test anxiety? If so this section is for you. It is also designed for anyone with a general interest in the wound, ostomy, and continence exams or for those who simply enjoy the challenge of sample test questions!
Over the past year, this column has been discussing how to carefully analyze all 3 types of exam questions (recall, application, or analysis) and select the correct answer. The series of articles has repeatedly emphasized the value of the Content Outline because every exam question comes directly from the Content Outline. For example, in the continence test you will encounter a question on the Q-Tip test. If you had not scrutinized the Content Outline, you might not have specifically studied for the Q-Tip test! You can easily download the exam handbook for free from the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) Web site. Just go to www.wocncb.org and type Content Outline in the Search box. You can also find even more exam help on the site.
In this issue, the focus is on Continence Care, or Section 3 of the Content Outline. Of the eighty (80) questions asked on the Continence Care exam, 38 questions concern general principles of Continence Care. Additionally, 34 questions challenge the candidate regarding differentiation and management of types of urinary incontinence. Finally, 8 questions ask about bowel incontinence.
Here are some examples for you to practice.
1. Which of these diagnostic tests is most useful in assessing urinary incontinence in an elderly home care patient?
a. Folstein Mini-Mental Status Exam
b. Complete blood count
c. Gait evaluation
d. Bladder diary
2. An adult diapered patient with urinary incontinence develops a severe rash over the inguinal folds. The skin is painful and weepy with a bright red macular papular rash. Which intervention is most appropriate?
b. Miconazole nitrate 2%
c. Hydrocolloid dressing
d. Stomahesive powder
3. A home health WOC nurse evaluates a patient with recent-onset urinary incontinence characterized by large-volume urine loss 2 to 3 times per day without nocturia. The patient recently fractured the right foot and is now using a walker. What type of urinary incontinence should the nurse suspect?
4. What signs and symptoms would best indicate that a patient with an indwelling urinary catheter has a urinary tract infection (UTI)?
a. Occluded catheter and bacturia
b. Confusion and elevated blood urea nitrogen
c. Fever and foul-smelling urine
d. Cloudy urine and diarrhea
5 A female patient with small volume urine leakage when coughing and sneezing asks the wound, ostomy, and continence nurse for advice. Which of the following is the best recommendation?
a. Increase fluids intake
b. Wear an incontinence containment pad
c. Practice Kegel exercises
d. Void on a schedule
6 The WOC nurse visits a home care patient with dual incontinence. The patient is in bed pooled with foul-smelling watery diarrhea. Patient reports feeling miserable and very weak after several episodes of diarrhea this morning. The best intervention is:
a. Call the primary care provider to obtain a urinalysis.
b. Administer ordered prn diphenoxylate hydrochloride (Lomotil).
c. Recommend the BRAT diete (bananas, rice, a pplesauce, and toast).
d. Call primary care provider to obtain a stool culture for Clostridium difficile.
- 1. D. While all these diagnostics might help assess urinary incontinence, a bladder diary is the best tool, particularly in the home care environment. A bladder diary quantifies multiple variables, including time and amount of urine loss/fluid intake. An order for a complete blood cell count might be obtained if you suspect dehydration, while gait evaluation and Folstein Mini-Mental Status Exam might be more helpful in evaluating functional incontinence.
Krissovich M. Pathology and management of the overactive bladder. In: Doughty D, ed. Urinary and Fecal Incontinence: Current Management Concepts. St Louis, MO: Mosby; 2006:128.
- 2. B. In this analysis question, the exam candidate must identify a Candida infection and select the correct treatment. Please note the phrase most appropriate in the questions' stem. Hydrocolloid dressings are not indicated for treating Candida infection, so this choice may be quickly eliminated. While petrolatum or stomahesive powder may be used in some cases, miconazole nitrate 2% is specifically indicated for treatment of Candida infections. Therefore it is the most appropriate intervention.
Lekan-Rutledge D. Management of urinary incontinence skin care, containment devices, catheters, absorptive products. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:316.
- 3. A. With careful analysis, this application question may be dissected and answered confidently! Remember, all information given in the stem is directly related to the correct answer. Do not make the mistake of “reading into” clinical scenarios and imagining information that is not part of the stem or even relevant to the question. The clues in this stem are recent onset, large volume, and use of a walker. Patients with functional incontinence have a barrier that delays toileting. In this case, use of a walker is related to incontinence.
Thompson D. Pathology and management of functional factors contributing to incontinence. In: Doughty D, ed. Urinary and Fecal Incontinence: Current Management Concepts. St Louis, MO: Mosby; 2006:167–185.
- 4. C. This recall question requires the exam candidate to correctly identify the signs and symptoms that best indicate a UTI in a patient with a urinary catheter. In order to identify the correct answer, the exam candidate needs to recognize that both bacturia and cloudy urine may by present in absence of a UTI. Confusion may be a symptom of UTI (especially in the elderly); however, an elevated blood urea nitrogen level is a nonspecific sign. The best indicators of a UTI are fever and foul-smelling urine.
Smith J. Current concepts in catheter management. In: Doughty D, ed. Urinary and Fecal Incontinence: Current Management Concepts. St Louis, MO: Mosby; 2006:286.
- 5. This is an application question to test the candidate's ability to identify that Kegel exercises are typically recommended for stress incontinence.
Doughty D, Burns P. Pathology and management of stress incontinence. In Doughty D, ed. Urinary and Fecal Incontinence: Current Management Concepts. St Louis, MO: Mosby; 2006:89–104.
- 6. B. Here, the candidate must analyze a brief clinical situation and select the most appropriate intervention. As previously mentioned, all pertinent information needed to select the correct answer is contained in the stem. Refrain from adding anything based on your professional experience. Read the patient scenario questions very carefully and work only with the information provided.
In this case, the nurse finds a patient so weak that he is unable to clean himself up. A urinalysis is not indicated, even though the patient has dual incontinence. Although the patient has a preexisting prescription for diphenoxylate hydrochloride (), it is not necessarily appropriate for this type of diarrhea. A BRAT diet recommendation would be helpful; however, the best intervention is to culture the stool for Clostridium difficile.
Zimmaro Bliss D, Doughty D, Heitkemer M. Pathology and management of bowel dysfunction. In: Doughty D, ed. Urinary and Fecal Incontinence: Current Management Concepts. St Louis, MO: Mosby; 2006:432–433.
The WOCNCB is committed to offering practice questions in each issue of the Journal of Wound, Ostomy and Continence Nursing. Watch for the next issue, in which this column will focus on questions germane to those interested in obtaining the WOCNCB's Certified Foot Care Nurse (CFCN) credential.
Not Recertifying Due to Economic Issues?
The WOCNCB created a Benevolence Fund in 2007 to cover exam fees in times like this. Don't let your certification lapse. Contact email@example.com. All inquiries are treated with the utmost confidentiality.
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.
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.
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/.
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 firstname.lastname@example.org.
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.
Marketing Yourself and the WOCNCB Credentials
Bill P. Brandon Jr, BSN, RN, CWOCN
As I write this article, the debate on healthcare and how to best proceed continues in Congress. While I do not have the solution, I have an opinion (imagine that a nurse with an opinion). Unfortunately—or fortunately—most of us will not have the opportunity to impact healthcare on such a scale. There is one opinion that I believe you, as nurses, will find value in Marketing Yourself!
As a WOCNCB-certified wound, ostomy, and continence or foot care nurse, you have a lot to be proud of. You have the ability to impact the lives of every person you come in contact with. For example:
- Your patients can achieve a quality of life they would not have without your help
- Your peers can benefit from you sharing in-depth knowledge that leads to a higher level of care and better outcomes
- Your physician partners rely on your expertise to manage patients with complications
- Your family and others have a resource to turn to for the best care possible with the fastest and least painful recovery
There are challenges facing the wound, ostomy and continence nursing population today. Some of these relate to changes in the certification arena where new credentials have diluted the impact of the WOCNCB's certifications by significantly shortening curricula or requiring no didactic coursework at all. This challenge, for me, was demonstrated dramatically. Last year I had the opportunity to hear a well-known wound care physician speak about several organizations that offer certifications in wound care. He spoke with admiration when discussing the CWOCN certification from the WOCNCB. However, there was another certificate that did not fare as well. As the physician pointed out, that certificate did not adequately prepare healthcare practitioners to care for many of the challenging wounds patients present.
As a credentialing body of healthcare providers, the WOCNCB does not want any confusion regarding our credentials and qualifications. Ultimately, the competition could impact your job security and the confidence of your customers across the continuum of care. The answer rests in the ability of each of us to market ourselves and our credential as The Gold Standard for Certificationsm.
Another challenge is our aging population, within both our certificant population and the general population. Approximately 45% of the current CWOCN certificants are over the age of 50 and there is a significant onslaught of baby boomers (456 grow a year older every hour of every day). This challenge impacts us all and we must each begin to train our replacements, share the pride, and transfer the knowledge that sets us apart.
Every WOCNCB-certified nurse plays a vital role in the healthcare community and performs a job like none other in the community. Each of us needs to spread the word about the skills we utilize every day and the quality of certification by the WOCNCB. We all reap the benefits in personal satisfaction, recognition, and opportunities for career advancement.
Bill P. Brandon Jr, BSN, RN, CWOCN
WOCNCB Marketing Committee Chairman.