Preparation for test taking begins with a comprehensive and organized study plan. For the certification exams offered by the WOCNCB, the study plan can be best organized by using the examination content outline as a guideline. The test taker can use the outline to make sure that each element addressed on the outline is reviewed and core concepts are understood. Exam content outlines are located within the WOCNCB Examination Handbook and are available for download from the WOCNCB Web site: http://www.wocncb.org. Some suggestions on how to use the exam content outline to study include writing your own questions for each area of content, creating flash cards enabling a review relevant vocabulary in each area, listing elements of nursing assessment and management, searching the Journal of Wound, Ostomy and Continence Nursing for case studies or multiple case series that integrate care of patients related to a specific problem, and writing your own case study that integrates elements of care.
Content outlines are based on role delineation surveys distributed to practicing WOC nurses every 5 years. This survey looks at common components of the role of the WOC nurse in order to define basic-level practice. Certification examinations contain 80 questions. The Wound Examination includes the following content areas: (1) general principles of assessment, (2) general principles of management, (3) pressure ulcers, (4) lower extremity ulcers, and (5) other types of wounds. The examination questions included here not only provide a rationale for the correct and incorrect answers but also identify where on the test outline this question applies. Obtaining a correct answer confirms area of strength and wrong answers aid preparation by identifying areas that require further review prior to taking the certification examination.
A patient with chronic nonhealing arterial ulcers continues to smoke cigarettes. Which by-product of smoking causes vasoconstriction and promotes platelet aggregation and clot formation?
- Carbon monoxide
- Hydrogen cyanide
The Content Outline location for this question is: D. Lower Extremity Ulcers; Arterial insufficiency; B. Recommend: 1. Lifestyle changes to maximize perfusion (WOCNCB Examination Handbook, p 18).
This recall question assesses the test taker's knowledge base for the profession that not only includes terminology and facts but also demonstrates an understanding of important principles in giving competent safe care and patient education. The correct answer is C, nicotine. Nicotine, carbon monoxide, hydrogen cyanide, and carcinogens are all by-products of smoking tobacco. The most significant of these by-products to peripheral vascular disease and the healing of arterial ulcers is nicotine. Nicotine is a potent vasoconstrictor that promotes platelet aggregation and the formation of clots. Carbon monoxide reduces the oxygen-carrying capacity of the red blood cells. Hydrogen cyanide is inhaled with the cigarette smoke but is also present in second-hand smoke.
Doughty D. Arterial ulcers. In: Bryant R, Nix D, eds. Acute and Chronic Wounds, Current Management Concepts. 4th ed. St Louis, MO: Elsevier Mosby; 2012:.
Wound, Ostomy and Continence Nurses Society. Guideline for Management of Wounds in Patients With Lower-Extremity Arterial Disease. Mount Laurel, NJ: Wound, Ostomy and Continence Nurses Society; 2008. WOCN Clinical Practice Guideline No. 1:4.
A patient with chronic venous insufficiency and ulcers on the lower leg has been coming to the wound clinic for 2 months for treatment. One of the ulcers has several areas of hypergranulation tissue. What is the most appropriate treatment at this time to manage this hypergranulation tissue?
- Apply a hydrogel dressing every other day.
- Apply an enzymatic debriding ointment daily.
- Perform conservative sharp debridement.
- Cauterize affected areas with silver nitrate.
The Content Outline location for this question is: B. General Principles of Management; 5. Identify the need for: f. chemical cauterization (WOCNCB Examination Handbook, p 17).
This application question poses a circumstance or problem the test taker might experience in performing his or her job. The test taker must then choose the correct answer for a method or procedure based on fact or principle. The correct answer is D. Cauterize affected areas with silver nitrate. Hypergranulation (or hyperplasia) is the excessive growth of wound tissue above the level of the skin. Typical venous stasis ulcers can have moderate to heavy exudate and if the dressing regimen does not manage exudate, then hypergranulation can occur impeding lateral migration of epithelial cells. Use of silver nitrate is the best choice in this question. (An alternative to silver nitrate, not listed as a choice but could be used to eliminate discomfort caused by silver nitrate, is a steroid preparation such as triamcinolone cream 0.1% or 0.5% applied 2-3 times daily.) Applying a hydrogel will only add moisture to the already-moist wound environment, and the use of an enzymatic debriding agent and conservative sharp debridement would be indicated only for necrotic tissue in the wound bed.
Coha T. Skin care needs of the pediatric and neonatal patient part I: The pediatric patient. In: Bryant R, Nix D, eds. Acute and Chronic Wounds, Current Management Concepts. 4th ed. St Louis, MO: Elsevier Mosby; 2012:494.
Doughty D, Sparks-DeFriese B. Wound-healing physiology. In: Bryant R, Nix D, eds. Acute and Chronic Wound, Current Management Concepts. 4th ed. St Louis, MO: Elsevier Mosby; 2012:65.
Ramundo J. Wound debridement. In: Bryant R, Nix D, eds. Acute and Chronic Wounds, Current Management Concepts. 4th ed. St Louis, MO: Elsevier Mosby; 2012:281.
Wound, Ostomy and Continence Nurses Society. Guideline for Management of Wounds in Patients With Lower-Extremity Venous Disease. Mount Laurel, NJ: Wound, Ostomy and Continence Nurses Society; June 1, 2011. WOCN Clinical Practice Guideline No. 4:6–8.
Which patient has the highest potential for heel pressure ulcer formation?
- Bedbound adult with a feeding tube
- An elderly patient hospitalized for hip fracture repair
- Trauma patient on backboard
- Paraplegic wheelchair bound patient
The Content Outline location for this question is: C. Pressure ulcers; 1. Assessment; a. conduct and interpret risk assessment (WOCNCB Examination Handbook, p 18).
This analysis question asks the test taker to distinguish and evaluate the facts and inferences relevant in each answer choice to reach a correct conclusion. The correct answer is B, the elderly patient hospitalized for hip fracture repair. The elderly hip fracture patient is immobile, may experience pain with movement and repositioning, and usually cannot tolerate elevation of the head of bed. In addition to these factors, an elderly patient may have decreased circulation and impaired sensation to the affected limb due to multiple comorbidities. Heel pressure ulcer formation has the highest potential in this population unless preventive offloading occurs. With choice A, the head of the bed must be elevated at least 30° for a patient with a feeding tube to limit risk of aspiration. Elevating the head of the bed places this patient at risk for increased pressure, shear, and friction to the sacrum. In choice C, the most common sites for discomfort and pressure ulcer formation for a trauma patient on a backboard is the occiput, scapula, and sacrum. And choice D, the ischium is the most common pressure ulcer location for a paraplegic sitting in a wheelchair for long periods of time.
Edlich RF, Mason SS, Vissers RJ, et al. Revolutionary advances in enhancing patient comfort on patients transported on a backboard. Am J Emerg Med. 2011;29:181–186.
Fowler E, Scott-Williams S, McGuire JB. Practice recommendations for preventing heel pressure ulcers. Ostomy Wound Manage. 2008;54:42–48, 50-52, 54-57.
Giuglea C, Marinescu S, Glorescu IP, Crenguta J. Pressure sores—a constant problem for plegic patients and a permanent challenge for plastic surgery. J Med Life. 2010;3(2):149–153.
Jenkins ML, O'Neal E. Pressure ulcer prevalence and incidence in acute care. Adv Skin Wound Care. 2010;23(12):556–559.
Pieper B. Pressure ulcers: impact, etiology, and classification. In: Bryant R, Nix D, eds. Acute and Chronic Wounds, Current Management Concepts. 4th ed. St Louis, MO: Elsevier Mosby; 2012:125–127.