The Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) recently celebrated the 10th anniversary of Advanced Practice (AP) certification in wound, ostomy, and continence (WOC) nursing. As healthcare increases in complexity, consumer confidence and comfort in their provider's ability to meet their unique and specialized needs continue to grow. The WOC APRN's competency is validated with the AP exam certification. The examination incorporates the analytical, critical thinking and practice skills as defined in the LACE APRN practice model.1 The candidate for WOC-AP certification must possess entry-level knowledge of relevant disease processes, clinical presentations, diagnostics with interpretations, and pharmacology in wound, ostomy, and/or continence specialty nursing as well as a working understanding of the APRN professional practice role. The WOCNCB wants every nurse pursuing WOC-AP certification to be comfortable with the material and has provided a wide set of AP exam preparatory resources available on the Web site www.wocncb.org.
Success on WOCNCB-AP examinations is maximized when the Detailed Content Outline (DCO) is carefully reviewed and is used to identify didactic strengths and weaknesses. The DCO can be used as a self-assessment road map to determine knowledge deficits; it is the starting point for developing a study plan identifying areas where you are least comfortable. The Web site also lists APRN study references for each specialty to provide additional material for review. The experienced certified WOC nurses who have advanced their career as an APRN may want to assess their core clinical knowledge and how their professional practice role has changed. The experienced APRNs who are new to WOC specialty practice may also want to assess their clinical understanding of each specialty. The newly developed self-assessment examinations provide a means to accomplish this and are now available online. The practice questions with their accompanying detailed rationale can help pinpoint areas of additional study when preparing to complete an AP-WOC examination.
As the role and growth of our subspecialty nursing in various practice settings are expanding, including at the APRN level, we at the WOCNCB, strive for successful partnership and recognition of all our certified nurses. When you have passed your WOC-AP exams, we will gladly welcome you to participant in one of our APRN committees; the networking and sharing of practice pearls are truly priceless!
1. Stanley JM, Werner KE, Apple K. Positioning advanced practice registered nurses for health care reform: consensus on APRN regulation. J Prof Nurs. 2009;25(6):340–348.
PRACTICE QUESTION FOR WOC-AP TEST: WOUND CARE
1. A 78-year-old woman with a sepsis diagnosis has just been transferred to the intensive care unit with a deteriorating sacral wound. What are the BEST initial laboratory studies for this patient?
- complete blood cell (CBC) count
- albumin and C-reactive protein
- hemoglobin A1c (HbA1c)
- prealbumin and C-reactive protein
Cognitive type: Application
Content outline: 1A, E, 2A
ANSWER D: Rationale: The critical issue in this question is what diagnostic test best evaluates the patient's inflammatory and nutritional status. When interpreting the results of the prealbumin and C-reactive protein (CRP), the APRN must understand their inverse relationship: as the CRP decreases, the prealbumin will increase. Prealbumin alone is a poor indicator of the nutritional level during sepsis. As the patient recovers with a concomitant decrease in inflammation, the reciprocal improvement in the prealbumin level does not reflect improved nutritional intake. Albumin would not be a good choice because the half-life is longer, making it ineffective for short-term measurement. The stem establishes the diagnosis of sepsis, and a repeat CBC count is unwarranted. HbA1c would provide a historical evaluation of glucose values and does not provide additional data for immediate interventions.
1. Davis CJ, Sowa D, Keim KS, Kinnare K, Peterson S. The use of pre-albumin and C-reactive protein for monitoring nutrition support in adult patients receiving enteral nutrition in an urban medical center. J Parenter Enteral Nutr. 2012;36(2):197–204.
Stotts NA. Nutritional assessment and support. In: Bryant RA, Nix DP, eds. Acute & Chronic Wounds: Current Management Concepts. 5th ed. St Louis, MO: Elsevier Mosby; 2016:412.
PRACTICE QUESTION FOR WOC-AP TEST: OSTOMY CARE
1. A patient with an ostomy presents with a new-onset, painful violaceous shallow ulcers to the peristomal skin. You anticipate the family history to reveal:
- Kaposi sarcoma.
- rheumatoid arthritis.
- squamous cell carcinoma.
Cognitive type: Application
Content outline: O1A, O1B, O2A, O2B
ANSWER C: Rationale: The patient presents with a differential diagnosis of pyoderma, an autoimmune disorder. A pertinent positive family history of rheumatoid arthritis, also within the spectrum of autoimmune disease, supports the possible likelihood of a pyoderma diagnosis. Osteoarthritis is a degenerative joint disease. Kaposi sarcoma and squamous cell carcinoma can clinically present as a skin injury/lesion; however, the etiology is different.
Bryant RA. Uncommon wounds and manifestations of intrinsic disease. In: Bryant RA, Nix DP, eds. Acute & Chronic Wounds: Current Management Concepts. 5th ed. St Louis, MO: Elsevier Mosby; 2016:441–461.
2. Wu X, Shen B. Diagnosis and management of parastomal pyoderma gangrenosum. Gastroenterol Rep. 2013;1(1):1–8.
PRACTICE QUESTION FOR WOC-AP TEST: CONTINENCE CARE
1. A 42-year-old woman is bothered by urine leakage with exercise. The physical examination reveals urethral hypermobility, and urine leakage is visualized with Valsalva's maneuver. What is the best initial plan of care for this patient?
- Refer for urodynamic evaluation.
- Prescribe a β3-adrenergic agonist.
- Refer for a midurethral sling.
- Pelvic floor muscle training (PFMT).
Cognitive type: Application
Content outline: C1C, C2A, C2B, C2C, C2E, C3A-C
ANSWER D: Rationale: The information in the question stem clearly identifies that this patient has stress urinary incontinence (SUI). Strong evidence supports PFMT as a first-line treatment for motivated women with SUI. With a strong pelvic floor muscle contraction, the levator ani muscle lifts forward and upward, a motion that increases compression on the urethra. A 2014 Cochran review of current research supported PFMT as the effective treatment of SUI. Urodynamic evaluation of this patient would be indicated if there was an unclear symptom profile making a diagnosis difficult. Urodynamic testing might be considered if the patient was being considered for surgery because findings from testing have been shown to influence the type of surgery (transobturator vs midurethral sling) or sling tension. A β3-adrenergic agonist is not a treatment option for SUI and is primarily used for the treatment of overactive bladder characterized by urgency, usually accompanied by frequent urination and sometimes accompanied by urgency incontinence. Stress incontinence surgery would be a good choice after a patient had attempted lifestyle modifications and PFMT.
1. Collins CW, Winters C. AUA/SUFU adult urodynamics guideline: a clinical review. Urol Clin N Am. 2014;41:353–362.
2. Doumoulin D, Hay-Smith EJC, Mac Habee-Seguin G. Pelvic floor muscle training versus no treatment, or inactive control treatment, for urinary incontinence in women. Cochrane Database Syst Rev. 2014;5:CD00564. doi:10.1002/14651858.CD005654.pub3.
3. Engberg S. Urinary incontinence/voiding dysfunction in the female. In: Doughty DB, Moore KN, eds. Wound, Ostomy and Continence Nurses Society Core Curriculum Continence Management. Philadelphia, PA: Wolters Kluwer; 2016:155–163.