Wound Healing and Dressing Techniques, Exams of Nursing

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Wound Care Certified Test Exam And Answers. fibroblast - \The cell responsible for building new granulation tissue keratinocytes - \Cells involved in epithelialization macrophages and polymorphonuclear neutrophils - \Cells which can kill bacteria lightly fill the wound base with gauze to prevent premature epithelialization - \To assist with managing a wound that is hypogranular: high levels of MMPs and low levels of TIMPs - \Chronic wounds contain insufficient collagen tensile strength - \Surgical wound dehiscence is most often due to: secondary wound closure - \A severely contaminated wound should be allowed to close by: Integrins - \cell surface receptors that allow cells to reversibly bind to the extracellular matrix to achieve cell migration 80% - \The maximum strength that a scar tissue can attain after the occurrence of remodeling is: six months to two years. - \The maturation and remodeling phase of wound healing typically lasts for: fibroblasts - \Cells that can be found in the dermis are: epidermis - \The stratum corneum can be found in the: epidermis, dermis, and subcutaneous tissue - \A full-thickness wound involves the following tissue layers: partial-thickness - \A stage 2 pressure injury can also be described as a ________ lesion. False - \A callus is caused by a build-up of cells within the stratum basale. histamine - \Mast cells produce the following substance: Nonviable joint capsule - \When examining a patient's wound, you notice gray-black, dry, leathery-appearing, irregular fibrous tissue. What do you suspect this structure is? Muscle - \When examining a patient's wound, you notice regularly arranged red tissue. What do you suspect this structure is? adipose tissue and fascia - \The subcutaneous tissue consists of: faster - \Partial-thickness wounds heal ___ than full-thickness wounds warm - \Wounds should heal faster if both the patient and the patient's wound are kept ___. faster - \Surgical wounds heal ___ than traumatic wounds True - \Change in wound surface area can be used to predict wound healing. slowly - \Covering a wound with a dressing facilitates wound healing because a dry wound progresses through the phases of inflammation more ___ than a moist wound. barriers - \Serial debridement facilitates wound healing by removing ___ to healing False - \Wound debridement is vital to wound healing and should be completed despite a patient's pain complaint. granulation - \Wet-to-dry dressings impair wound healing by traumatizing healthy ___ tissue \Wound dressings that are gels, pads, particles, pastes, powders, sheets or solutions derived from bovine, equine, porcine or avian sources. Some interact with wound exudate to form a gel. Indicated for partial- and full-thickness pressure ulcers, venous ulcers, donor sites, surgical wounds, vascular ulcers, diabetic ulcers, second-degree burns, abrasions and traumatic wounds Composites - \Dressings that combine physically distinct components into a single product to provide multiple functions such as a bacterial barrier, absorption and adhesion. Usually, they are composed of multiple layers and incorporate a semi- or non-adherent pad that covers the wound. May also include an adhesive border of non-woven fabric tape or transparent film. Contact Layers - \Dressings that are thin, non-adherent sheets placed on an open wound bed to protect tissue from direct contact with other agents or dressings applied to the wound. They conform to the shape of the wound and are porous to allow exudate to pass through for absorption by an overlying, secondary dressing. Indicated for partial- and full-thickness wounds, infected wounds, donor sites and split-thickness skin grafts Foam Dressings - \Dressings that are sheets and other shapes of foamed polymer solutions (most commonly polyurethane) with small, open cells capable of holding fluids. They may be impregnated or layered in combination with other materials. Indicated for partial- and full-thickness wounds. Some dressings are indicated for pressure injury prevention when used as part of a broader pressure injury prevention protocol. Gauzes & Non-Wovens - \dry woven or non-woven sponges and wraps with varying degrees of absorbency, based on design. Fabric composition may include cotton, polyester or rayon. Available sterile or non-sterile in bulk and with or without an adhesive border. They are used for cleansing, packing and covering a variety of wounds. Medical Grade Honey - \useful for acute and chronic wounds. The dressings help to prepare the wound bed and promote an optimal healing environment. Multiple mechanisms of action include reducing edema, lowering wound pH and debriding slough and eschar. Multiple versions of the dressing are available to handle differing levels of exudates. Indicated for partial- and full-thickness wounds including pressure ulcers, leg ulcers (arterial, venous and diabetic ulcers), burns, donor sites and surgical wounds. Hydrocolloids - \wafers, powders or pastes composed of gelatin, pectin or carboxymethylcellulose. Absorption capability depends on thickness and composition. Wafers are self-adhering and available with or without an adhesive border and in a wide variety of shapes and sizes. Useful on areas that require contouring, such as heels and sacral ulcers. Powders and pastes require a secondary dressing. Indicated for partial- and full- thickness wounds with or without necrotic tissue. Hydrogels: Amorphous - \formulations of water, polymers and other ingredients with no shape, designed to donate moisture to a dry wound and to maintain a moist healing environment. The high moisture content serves to rehydrate wound tissue. Indicated for partial- and full- thickness wounds, wounds with necrosis, minor burns and radiation tissue damage. Hydrogels: Impregnated - \gauzes and non-woven sponges, ropes and strips saturated with an amorphous hydrogel. The high moisture content serves to rehydrate wound tissue. Indicated for partial- and full-thickness wounds, wounds with necrosis and deep wounds with tunneling or sinus tracts. Hydrogels: Sheets - \three-dimensional networks of cross-linked hydrophilic polymers that are insoluble in water and interact with aqueous solutions by swelling. They are highly conformable and permeable and can absorb varying amounts of drainage, depending on their composition. Indicated for partial- and full-thickness wounds, wounds with necrosis, minor burns and radiation tissue damage. Impregnated Dressings - \gauzes and non-woven sponges, ropes and strips saturated with a solution, an emulsion, oil or some other agent or compound. Agents most commonly used include saline, oil, zinc salts, petrolatum, xeroform and scarlet red. Silicone Gel Sheets - \soft wound covers composed of cross-linked polymers reinforced with or bonded to mesh or fabric. Indicated to prevent or improve the appearance of old and new hypertrophic and keloid scars. Hypertrophic scars occur from poorly designed surgical wound closure, too much tension applied to a surgical wound closure, a wound infection or partial- and full-thickness burns. Keloid scars result from an inherited metabolic alteration in collagen. Transparent Films - \polymer membranes of varying thickness coated on one side with an adhesive. They are impermeable to liquid, water and bacteria but permeable to moisture vapor and atmospheric gases. Transparency allows visualization of the wound. Indicated for partial-thickness wounds with little or no exudate, wounds with necrosis and as both a primary or secondary dressing. Also used to cover IV sites, donor sites, lacerations, abrasions and second-degree burns. Wound Fillers - \beads, creams, foams, gels, ointments, pads, pastes, pillows, powders, strands or other formulations that are non-adherent. They may include a time-released antimicrobial. Fillers function to maintain a moist environment and manage exudate. Indicated for partial- and full- thickness wounds, infected wounds, draining wounds and deep wounds that require packing. 312 - \Order the following dressings from least absorptive to most absorptive 1. semipermeable foam 2. alginate 3. Semipermeable film occlusive - \An ___ dressing is impermeable to water, vapor, and bacteria. lower - \Moisture-retentive dressings are associated with a ___ rate of infection than gauze dressings water, bacteria - \Hydrocolloid dressings are impermeable to ___ and ___ protect - \Skin sealants ___ the periwound from maceration and adhesives pressurized - \Wound irrigation can be delivered with ___ saline canisters limb - \Whirlpools increase ___ volume granulation - \Pulsed lavage with suction promotes ___ tissue formation cell, collagen - \Electrical stimulation is believed to increase ___ proliferation and ___ synthesis scar - \Ultrasound may be used during the maturation and remodeling phase of wound healing in order to increase ___ mobility transcutaneous oxygen - \Systemic, or chamber, hyperbaric oxygen therapy should be chosen based on the results of a ___ ___ test. 75-200, 80-125 - \parameters for electrical stimulation as an adjunct to wound healing: Intensity of __-__ Volts, frequency of __-__ Hz. venous HTN - \Venous insufficiency ulcers are ultimately caused by Irregular, glossy, mild to moderate - \Shape, wound bed, pain characteristics of venous ulcer dermatitis - \Patients with chronic venous insufficiency often have inflammation of the skin associated with itching and redness also known as True - \It is common for patients with chronic venous insufficiency to have allergic reactions or sensitization. Semipermeable foam - \Given the following dressing choices, which would be the most appropriate for a typical patient with a venous insufficiency ulcer? acute infection - \contraindication to the use of compression therapy for patients with venous insufficiency? walk regularly - \When using compression therapy for venous insufficiency ulcer management, the patient should be instructed to: Shear, impaired mobility, and excessive moisture - \risk factors for pressure injuries stage II - \A pressure injury that presents as a shallow crater or blister should be described as a ________ pressure injury. partial thickness - \A stage 3 pressure injury would be classified as impaired integumentary integrity associated with __-__ skin involvement ischium, posterior heel, lateral malleolus - \Pressure injuries are most commonly seen in these locations osteomyelitis - \When assessing your patient's sacral pressure injury, you are able to probe to bone but cannot visualize the bone. This patient is at risk for ___. hydrocolloid - \Your patient presents with a stage 3 pressure injury over his right greater trochanter without evidence of infection. Which of the following dressings would be most appropriate? odor control - \Charcoal-containing wound dressings may be beneficial for patients with pressure injuries because charcoal dressings can assist in ___ reactive - \support surfaces should be used for patients who can attain a variety of positions without bearing weight on an existing pressure injury. Sharp - \Which of the following methods of debridement would be most appropriate for your patient with a full-thickness eschar-covered pressure injury with signs of infection? Stage III/IV - \Undermining and tunneling may be found in these types of pressure injuries: 2 - \Type ___ diabetes is the most common form of diabetes in the United States. amputation - \About half of patients with a diabetic foot ulcer who have an ___ will eventually have a contralateral amputation. Native Americans - \Hispanic/Latino Americans and ___ ___ are more likely to develop diabetes than non- Hispanic Whites. Callus rim, foot deformities, minimal - \typical characteristics of a neuropathic ulceration? edges, appearance of foot, drainage Autonomic neuropathy - \Your patient with diabetes presents with dry, cracked skin. What is the most likely cause of this? Charcot - \Your patient with diabetes presents with a rocker-bottom foot. This is most likely due to fractures and/or dislocations causing a ___ deformity. increase - \A localized ___ in plantar foot skin temperature is a hallmark of future ulceration or a current deep space infection. Wagner Grade I and II - \Total contact casts are appropriate for the following neuropathic ulcers: radiological testing for OM - \Patients with neuropathic ulcerations that contain exposed bone would most benefit from: Insoles - \High plantar foot pressures increase the risk of neuropathic ulceration. Plantar foot pressures can be reduced by providing full contact ___ Blood flow - \Autonomic neuropathy increases ___ ___ to the bones of the foot in patients with diabetes predisposes them to fracture due to osteopenia Contact time - \The severity of a thermal burn is dependent upon: low voltage current - \Most electrical burns are the result of: outpatient - \Provided the patient has adequate pain control, in what setting are patients with minor burns generally treated? cellular, perfusion - \The zone of stasis is an area of burned tissue with ___ injury and compromised ___. pressure ulcers, contractures, infection - \Patients with burn wound injuries are at risk for: infection - \The prophylactic use of topical antimicrobials on burn wounds is encouraged because this patient population is at a high risk for ___. Silicone gel sheeting - \What dressings can be used to help reduce or prevent scarring of healed, intact, burned skin False - \Debridement of burn wounds takes priority over intravenous fluid administration. cosmesis - \A key benefit of a full-thickness skin graft is improved fistula - \A sinus tract that connects two epithelial surfaces is called: \Most early melanomas are ___ Basal cell carcinoma - \Which form of skin cancer presents primarily on the face, head, and neck? malignant melanoma (MM) - \Most serious form of skin cancer; often characterized by black or dark brown patches on the skin that may appear uneven in texture, jagged, or raised. squamous cell carcinoma (SCC) - \skin cancer that begins in the epidermis but may grow into deeper tissue; does not generally metastasize to other areas of the body Kaposi's sarcoma - \Which type of lesion appears red, pink, or tan in color and becomes purple-brown with a green hemosiderin halo over time? reaction to silver sulfadiazine - \A patient is being treated in an outpatient wound center for an infected plantar diabetic foot ulcer. Treatment includes debridement as needed, silver sulfadiazine, dry dressings, and off-loading with a post-op shoe. On the second day of treatment, the patient reports a rash and severe pruritus around the wound and along the dorsum of the foot. The most likely cause of the patient's symptoms is: Whirlpool - \Which of the following interventions for cellulitis is generally discouraged, as it may exacerbate the condition? fungal infections - \When examining a patient's foot, you should assess the interdigital spaces for signs of tinea pedis and educate the patient regarding appropriate foot care to care for the following: intertriginous dermatitis - \A patient has skin damage from perspiration and friction under his abdominal pannus and the culture comes back as Candida. The best way to classify this skin damage is as: Psoriasis - \Which disease is characterized by round, circumscribed, erythematous, dry, scaling plaques of various sizes that are covered by silvery, white scales? first-degree burns - \Which types of dressings are not covered under the Medicare/Medicaid surgical dressings benefits? randomized controlled clinical trial - \A study in which the participants are assigned by chance to separate groups that compare different treatments is called a Cohort studies - \take a group of people who have a specific condition or receive a particular treatment over time and compare them with another group that has not been affected by the condition or treatment being studied Quantitative research - \Research based on something that can be accurately and precisely measured. Meta-analysis - \thoroughly examine a number of valid studies on a topic and combine the results using accepted statistical methodology as if they were from one large study ischemic ulcer - \develops within hours of events such as hemorrhage, multisystem trauma, severe burns, heart failure, or sepsis zinc - \In wound healing zinc is needed for stratum basale - \deepest layer of epidermis Stratum lucidum - \a layer of the epidermis found only in the thick skin of the fingers, palms, and soles Stratum germinativum - \also known as the basal cell layer, the deepest live layer of the epidermis that produces new epidermal skin cells and is responsible for growth stratum spinosum - \a layer of the epidermis that provides strength and flexibility to the skin Basement membrane zone - \The epidermis is anchored to the dermis by the Elastin - \responsible for skin recoil Thermoregulation`` - \Which function of the skin involves sweating, vasoconstriction, and vasodilation? Protection - \Which function of the skin is involved in preventing excessive fluid loss Platelets - \Which cells play a major role in hemostasis? Inflammatory - \In which phase of wound healing do the macrophages destroy bacteria and cleanse the wound site of cellular debris? Proliferative - \In which phase of wound healing are buds of granulation tissue generated? maturation - \the third phase of wound healing, in which scar tissue forms remodeling phase - \Also known as the Maturation Phase Can last up to 1 year post injury Strengthening of scar tissue occurs during this phase collagen - \Where tissue gets its tensile strength and structure from delayed primary intention - \surgical closure after irrigation or drainage secondary intention - \Wound healing where edges can't be easily approximated and wound fills with granulation tertiary intention - \The wound is purposely left open due to heavy infection or contamination initially cleaned, debrided and observed primary intention - \wounds that heal under conditions of minimal tissue loss necrosis, maceration, and infection - \Local factors that impede wound healing include systemic infection, chronic disease, and immunosuppression - \Systemic factors that impede wound healing include: critical colonization - \The theoretical turning point when the bacterial load in the wound reaches a level in which it interferes with healing is called: 3 - \In the Meggit-Wagner classification system, which grade would be used for a diabetic foot ulcer with osteomyelitis? Low - \___ frequency debrides over time. matrix metalloproteinases (MMPs) - \A family of zinc-containing enzymes that act in the extracellular space to digest various extracellular proteins and proteoglycans Vitamin C - \The most important vitamin required for adequate collagen synthesis during tissue repair is: exceeds - \Lymphedema can occur when the volume of lymph ___ the transport capacity Painful - \Partial-thickness burns are usually ___ foam dressing - \A patient presents with a chronic erythematous traumatic wound on the anterior lower leg. Current care includes use of mupirocin (Bactroban) cream and a four-layer compression wrap. Hypergranulation tissue is present in the wound bed. Which of the following modifications should be made to the treatment program? amorphous hydrogel - \-best for: dry wounds, arterial wounds; will add moisture to wound Silver nitrate - \Treats hyper granulation of wound edges ABI (Ankle-brachial index) - \MOST significant assessment parameter in a patient with a lower extremity ischemic ulcer? Surgically - \Eschar is found in full-thickness thermal injuries and must be removed ___ Perfusion - \MOST significant factor in healing an ischemic ulcer? Hydrocolloid - \The MOST appropriate dressing for a shallow wound that is clean and granulating with minimal exudate is: partial thickness, min to mod exudate - \Wound indications for hydrocolloids Mod to heavy exudate - \Drainage for Alginate Dressings Partial-thickness skin loss - \A 70-year-old woman with a recent left hip fracture has developed a stage II pressure ulcer on her right heel. What BEST describes her ulcer? inflammatory - \Leukocytosis plays a key role during which of the following phases of wound healing? (3-7 days) Neutrophils - \Primary cells responsible for cleansing the wound of microorganisms Hemostasis - \One sequence of events occurring during the inflammatory phase. Clotting factors are released when injury occurs, results of platelet aggregation and vasocontriction proliferative - \Granulation occurs in this phase as a result of fibroblasts stimulating the ongoing production of collagen and granulation tissues (4-24 days) remodeling - \Phase aka maturation that lasts up to 1+ years. Collagen fibers organize and reorganize, increasing tensile strength. Fibroblasts are the key cells organizing this process neuropathy - \Over-the-counter orthotics have the potential to cause pressure and ulcerations in a patient with ___ Elevate - \Non pharm intervention for venous insufficiency arterial - \Prior to application of a compression wrap, ___ disease needs to be ruled out. venous HTN - \Dependent edema is a predisposing factor in ___ ___, which may lead to chronic venous insufficiency and ulceration. Distal paresthesia - \___ ___ is a characteristic of sensory neuropathy and is a predisposing factor in the development of neuropathic ulcers. venous - \Leg pain that is relieved by elevation is more consistent with a ___ etiology. Intermittent claudication - \Pain occurring with moderate to heavy activity and relieved by rest is a common finding in patients with arterial disease. infected - \A hydrocolloid dressing is contraindicated for ___ wounds. autolytic - \Hydrocolloid dressing will facilitate ___ debridement and absorb minimal exudate. Moist saline gauze - \dressings is MOST appropriate for a patient with a full-thickness pressure ulcer with undermining? dead space - \Moist saline gauze maintains a moist wound environment and fills ___ ___. circulation - \Limb elevation further impairs arterial ___ and causes pain. ischemia - \Arterial ulcers occur as a result of severe tissue ___. Therefore, tissue perfusion must be improved to promote healing. venous stasis - \Moisturizing the skin will decrease the pruritis often found in patients with chronic ___ ___ Lanolin - \Lanolin is a sensitizer in many patients and could increase dermatitis that is present. Dehiscence - \The absence of the healing ridge in a surgical incision between five and nine days post- operative is a sign of potential: overgrowth - \Hyperplasia is an ___ of granulation tissue. \___ ulcers are more commonly found on the foot with well-defined borders and a faint halo of erythema. Venous - \___ ulcers present with irregular borders and maceration, crusting, and scaling of surrounding skin. Calciphylaxis - \These lesions may have some of the same characteristics as pyoderma gangrenosum, but is associated with end-stage renal disease. hypoxia - \A patient complains of unrelenting burning pain four hours after the application of a chemical debriding agent. The pain may lead wound to ___, impairing healing and increasing rate of infection Prealbumin - \levels are often the most current indicator of nutritional status. The normal value is 15- 25 mg/dL. 300 - \Transferring normal value ___ mg/dL 2,000 - \TLC normal value ___ cells per mm3 gel fusion - \A neonate has developed a non-erythemic eschar on the occiput. Which should be the INITIAL intervention? intact peripheral pulses - \Which of the following assessment parameters is critical in distinguishing calciphylaxis from other forms of peripheral vascular disease ischemia - \Non palpable pulses is critical indicator for limb ___. Also including ABI >0.4 and rest pain damage to cellular components - \An adult received irradiation therapy to the sacral area eight years ago and has now developed a sacral pressure ulcer. The factor that MOST LIKELYputs this patient at risk is: 8 - \Irradiation-induced ulcers appear approximately ___ years after therapy. arterial insufficiency - \Use of compression therapy to treat a venous ulcer is CONTRAINDICATED in a patient with: reduces - \Compression therapy decreases edema and ___ exudate fibrinolytic - \Compression therapy increases fibrinolytic activity. When fluid collects over the lesion - \How often should a transparent film dressing covering a dermal ulcer be changed? Hypertonic saline gauze - \MOST appropriate dressing for a deep, heavily exudating, stage-III trochanteric pressure plaques, papules, and pustules - \Fungal infections are typically characterized by: Vitamin A - \The effects of corticosteroids on wound healing can be partially counteracted by the administration of: