Taking a test can be a stressful event; it provokes a spectrum of emotions, from excitement to anxiety, and preparation is key! Developing a study plan and organizing reference materials are important strategies that contribute to success on your Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) certification examination. Study plans may include organizing a study schedule, self-testing of material, and preparing study help such as flashcards.
The WOCNCB offers resources and tools to assist candidates for certification when preparing for testing (http://www.wocncb.org/become-certified/test-preparation/hints.php). This resource provides useful information on how to prepare for the examination and how to review each question based on its parts: stem, correct response, and distracters. Practice in test taking is another strategy to help prepare for the WOCNCB certification examination. Practice questions are regularly published in the Journal's Certification department, and archived questions are available at the Journal's Web page (http://journals.lww.com/jwocnonline/pages/default.aspx). In addition to these resources, the WOCNCB has a self-assessment examination, which can be purchased (see our Web site). I also recommend testing your knowledge by writing your own questions or using flash cards to test your understanding of key terminology and concepts.
The most important component of preparation is knowing what to study. When preparing for the WOCNCB Foot Care Exam, the study can be focused by using the exam content outline (http://www.wocncb.org/pdf/FootExamOutlinemb.pdf). This outline breaks down examination content into subject areas and provides the number of questions that will test content in that area. Having the content laid out in this fashion helps guide you through material in a logical and thorough manner.
Here is an example of how to use the content outline when preparing for WOCNCB Foot Care certification. Knowledge of foot assessment is a key element in the content outline. In order to develop a plan of care, it is imperative to correlate those assessments into an overall picture of what is happening with the patient. For example, the certified foot care nurse (CFCN) should understand that an Ankle Brachial Index (ABI) (section 1-B-1 of the content outline) of 0.5 indicates challenges for healing and a need for a referral to a vascular surgeon.1 The application of that knowledge means that a question might ask about compression therapy and ABI. The CFCN should know that a patient with an ABI of 0.5 would not have a compression dressing to the lower extremity (section 2-A-5 of the content outline) as part of the plan of care because it is a major contraindication for low extremity compression therapy.2 The certification exam might ask a question about patient education related to dry skin. The content outline (section 3-A-1-c) lists that knowledge about skin changes in aging is important. A question may relate to patient education and the knowledge of the CFCN that the increased dry skin on the foot is considered an age-related change while changes in pigmentation are related to a circulation deficit.3
The CFCN is able to implement interventions that can improve both the quality of life for patients and the quality of care provided by health care institutions. If you are interested in becoming a CFCN and would like to learn more about the foot care certification, please look at the certification information provided by the WOCNCB at http://www.wocncb.org.
1. Doughty D. Arterial ulcers. In: Bryant R, Nix D eds. Acute and Chronic Wounds: Current Management Concepts. 4th ed. St Louis, MO: Mosby; 2012:185.
2. Carmel J. Venous ulcers. In: Bryant R, Nix D eds. Acute and Chronic Wounds: Current Management Concepts. 4th ed. St Louis, MO: Mosby; 2012:205.
3. Howes-Trammel S, Bryant RA, Nix DP. Foot and nail care. In: Bryant R, Nix D eds. Acute and Chronic Wounds: Current Management Concepts. 4th ed. St Louis, MO: Mosby; 2012:249.
The following questions are representative of the types of questions included on the WOCNCB Foot Care Examination.
- A 25-year-old woman with poorly controlled insulin-dependent diabetes mellitus reports a new complaint of frequent “pins and needles” in the plantar surfaces of both her feet. No open areas are noted with assessment. What is the most appropriate initial intervention?
- Evaluate the patient's footwear
- Perform Semmes-Weinstein monofilament test
- Doppler examination of the pedal pulses
- Transcutaneous oximetry on the large toes
- An ABI of 1.2 in a nondiabetic elderly female patient indicates
- normal perfusion
- mild claudication
- severe claudication
- significant ischemia
- A 35-year-old male patient complains of feeling “constantly itchy” on the sole of his right foot. On assessment, dry patches with scaling are noted on the plantar aspect. What would be the most appropriate intervention for this patient?
- Salicylic acid to the affected area
- Reduce scales with a file
- Topical antifungal twice daily
- Systemic corticosteroids
Answers and Rationale
Question 1 Answer: B
“Pins and needles” is a common complaint stated by patients who are experiencing neuropathic pain, and other complaints would be “burning, tingling, shooting.” Neuropathy has been associated with poor glycemic control and of the complications that affect the lower extremities in diabetic patients, and it is the most frequently diagnosed. The Semmes-Weinstein monofilament test is a screening tool that is noninvasive and quick and is a reliable indicator of the presence of neuropathy. The other interventions are appropriate for evaluation of a diabetic foot, but the patient's complaints are indicative of neuropathy requiring a screening assessment of sensation. This question tests an understanding of content in the foot assessment portion of the exam outline.
Content outline: Foot 1-B-9
Cognitive Level: Analysis
Driver VR, LeBretton JM, Landowski MA, Madsen JL. Neuropathic wounds: the diabetic wound. In: Bryant R, Nix D eds. Acute and Chronic Wounds: Current Management Concepts. 4th ed. St Louis, MO: Mosby; 2012:226–233.
Question 2 Answer: A
The ABI is a simple test that can be performed at the bedside and can provide an indication of the presence of peripheral arterial disease. Understanding the results of the ABI can help guide the appropriate dressing choice for the patient. In the case of this patient, the value was 1.2, which is considered a normal result, while ABIs of 0.90 or less are indicative of peripheral arterial disease. Diabetic patients may have false high pressures in the ankle due to calcifications in the vessels, so an ABI is a less-accurate screening tool for the diabetic population. Assessment of perfusion of the foot is a key content area on the foot care exam outline.
Content outline: Foot 1-B-11
Cognitive Level: Recall
Jarvis C. Peripheral vascular system and lymphatic system. In: Physical Examination and Health Assessment. 6th ed. St Louis, MO: Elsevier Saunders; 2012:516.
Question 3 Answer: C
The patient complaint of pruritus coupled with the assessment findings of scaling, dry patches are consistent with tinea pedis (planter) that has also been described as peeling, hyperkeratotic, and cracking; common locations are the sole, heel, and side of the foot. The treatment for this fungal deficit is topical antifungal twice daily for a minimum of 1 week, and urea cream may be used for the itching and scaling. Removal of scales would not resolve the underlying infection and systemic corticosteroids are the treatment for tinea pedis (vesiculobullous). This question is an example of nursing interventions that guide treatment for the patient.
Content outline: Foot 2-A-8-d
Cognitive Level: Application