The WOCNCB is acutely aware of the increased demands on our certified nurses in all practice settings and the need for wound care specialists at all levels of nursing education, licensure, and scope of practice. This need is best illustrated when considering the aging US population and the need to promote additional bedside collaborative team support for the WOCNCB certified nurse. To help meet the increased demands for certified wound treatment nurses, the WOCNCB has created a psychometrically sound and legally defensible certification examination for those completing the WOCN-sponsored Wound Treatment Associate (WTA) program. The WTA-C exam validates basic wound care knowledge and principles underlying the clinical skills needed to support safe, quality, patient/family-centered care. The certification is voluntary and confirms that the nonbaccalaureate-prepared nurse under the guidance of a CWOCN or CWOCN-AP, has adequate knowledge to implement effective wound treatments and pressure ulcer prevention strategies. Development of the WTA-C represents a critical stage in the evolution of nursing-based wound care delivery. The valuable addition of this WTA-C role continues the tradition of improving outcomes at the bedside, the community, and with whom all WOCNCB certified nurses touch, one patient at a time. This article provides examples of the types of WOCNCB certification questions content outline of each nursing scope of practice for additional information (http://www.wocncb.org).
1. Corbett LQ. Wound Care Nursing: Professional Issues and Opportunities. Adv Wound Care 2012;1(5):189-193.
2. Wound Treatment Associate Task Force. Position Statement about the Role and Scope of Practice for Wound Care Providers. J Wound Ostomy Continence Nurs. 2012;39(2 Supp;):S2-S4.
WTA-C Question: Pyoderma Gangrenosum
1. Which of the following is an expected finding in a pyoderma gangrenosum (PG) wound?
A. Foul odor
B. Exquisitely painful
C. Periwound denudation
D. Ashen periwound
Content Outline: Domain I; Task 2; Skill: D 010204
Cognitive Level: Recall
Correct Answer: B
A hallmark finding in PG is intensely painful lesions. The question points the test taker to identify expected findings. Periwound denudation, malodor, and ashen periwound are not expected findings. Periwound color is most typically a deep red-purplish hue.
1. Pieper B. Atypical lower extremity wounds. In: Doughty DB, McNichol LL, eds. Wound Management Core Curriculum. Philadelphia, PA: Wolters Kluwer; 2015:519-521.
CWOCN Question: Pyoderma Gangrenosum
1. A treatment plan for pyoderma gangrenosum (PG) lesions should include which of the following?
A. Serial debridement
B. Oral corticosteroids
C. Negative pressure wound therapy (NPWT) dressing
D. Whirlpool therapy
Content Outline: Domain I; Task 2; Classification: 010200
Cognitive Level: Application
Correct Answer: B
Systemic corticosteroids are considered standard of care in the treatment of PG in addition to cyclosporine and topical steroids, when appropriate. Minor trauma usually precipitates an exacerbation and is a common, notable characteristic of PG. Serial debridement often leads to enlargement of the wound with further extension of the disease. Local treatment must also focus on minimizing wound trauma during dressing changes. Whirlpool and NPWT are not the current standard of care for PG.
1. Pieper B. Atypical lower extremity wounds. In: Doughty DB, McNichol LL, eds. Wound Management Core Curriculum. Philadelphia, PA: Wolters Kluwer; 2015:519-521.
CWOCN-AP Question: Pyoderma Gangrenosum
1. A new patient presents with a rapidly enlarging, painful, violaceous leg ulceration caused by a minor scrape. Comorbid conditions include ulcerative colitis, rheumatoid arthritis, and chronic obstructive pulmonary disease. Initial systemic treatment will start with a systemic glucocorticoid; if no improvement is noted after a few days, which treatment should the APRN consider next?
A. Intravenous levofloxacin
B. Hyperbaric oxygen
C. Cyclosporine
D. Hyoscyamine
Content Outline: 020208, 040305
Cognitive Level: Application
Correct Answer: C
Pyoderma gangrenosum is an inflammatory, necrotizing ulcerative skin disorder often associated with autoimmune diseases such as inflammatory bowel disease (30%) and rheumatoid arthritis. The ulceration can deteriorate rapidly with concurrent lesion expansion over a few days. Oral systemic steroids are the initial treatment option to reverse the neutrophilic dermatoses. Cyclosporine is an effective nonsteroidal immunosuppressant that can be used concomitantly with the systemic steroid. PG is not associated with an infectious process; there is no evidence that the use of hyperbaric oxygen has any effect on PG. While hyoscyamine is used for managing bowel spasticity in those with irritable bowel syndrome, the anticholinergic action has no efficacy in treating PG. Topical therapies include moist wound healing.
1. Pieper B. Atypical lower extremity wounds. In: Doughty DB, McNichol LL, eds. Wound Management Core Curriculum. Philadelphia, PA: Wolters Kluwer; 2015:519-521.
2. Habif TP, Campbell JL, Chapman MS, Dinulos JGH, Zug KA. Skin Disease: Diagnosis and Treatment. 3rd ed. New York, NY: Elsevier Saunders; 2011:634-627.
WTA-C Question: Necrotizing Fasciitis
2. When changing a necrotizing fasciitis wound dressing in the postoperative phase, what finding should be reported immediately to the supervising clinician?
A. Increased granulation tissue
B. Discomfort with dressing removal
C. Moderate to large amount of drainage
D. Presence of new necrotic tissue
Content Outline: 010403
Cognitive Level: Application
Correct Answer: D
Postsurgical examination of a debrided necrotizing fasciitis wound includes identifying new necrotic tissue because further surgical intervention may be required. The other options are normal assessment findings in a postsurgical necrotizing fasciitis wound.
1. Pieper B. Atypical lower extremity wounds. In: Doughty DB, McNichol LL, eds. Wound Management Core Curriculum. Philadelphia, PA: Wolters Kluwer; 2015:519-521.
CWOCN Question: Necrotizing Fasciitis
2. Which of the following is a key adjunct treatment following surgical debridement of necrotizing fasciitis?
A. Daily whirlpool
B. Silver nitrate
C. Hyperbaric oxygen
D. Pulsatile lavage
Content Outline: 010200
Cognitive Level: Application
Correct Answer: C
Hyperbaric oxygen is indicated for increased tissue perfusion and accelerated tissue growth through optimized oxygenation. Silver nitrate may be used if hypergranulation tissue or epibole are present. Pulsatile lavage and whirlpool are not current standards of care for necrotizing fasciitis.
1. Pieper B. Atypical lower extremity wounds. In: Doughty DB, McNichol LL, eds. Wound Management Core Curriculum. Philadelphia, PA: Wolters Kluwer; 2015:519-521.
CWOCN-AP Question: Necrotizing Fasciitis
2. An APRN has been consulted to manage cellulitis and rash in a febrile patient with diabetes mellitus (DM) and a body mass index of 55. The patient complains of intense pain and redness to the perineal area. Visual examination of the posterior perineal area reveals significant induration, multiple vesicles on a purplish base, with an erythematous margin rapidly migrating. A significant concern for necrotizing fasciitis exists. The surgeon has been notified; labs and a swab culture have been obtained. The patient is stable, and pain is adequately managed. Which of the following treatment options is most appropriate?
A. Gram-positive antibiotics
B. Dextrose 5% in normal saline at 100 mL/h
C. Dopamine infusion at renal dosing
D. Broad-spectrum antibiotics
Content Outline: 010201, 040301
Cognitive Level: Application
Correct Answer: D
Necrotizing fasciitis is a rapidly progressive infectious process often along the fascial plane. This scenario is an example of Fournier's gangrene, which occurs in the perineal, perianal, or genital areas. The polymicrobial infection is often due to group A [beta]-hemolytic Streptococcus, Staphylococcus, other gram-positive and gram-negative bacteria, anaerobes, and fungi. The synergy between the bacteria increases the virulence and devastates the soft tissue, especially in a host with compromised immunity (DM and morbid obesity). Broad-spectrum empiric coverage will be initiated until the return of tissue culture and sensitivity results. While intravenous fluid is a reasonable option, the solution would not be high in dextrose, given the DM diagnosis. The patient is currently stable, so dopamine to maintain adequate systolic pressures is not needed.
1. Van Driessche F. Wounds caused by infectious processes. In: Doughty DB, McNichol LL, eds. Wound Management Core Curriculum. Philadelphia, PA: Wolters Kluwer; 2015:565-566.
WTA-C Question: NPWT
3. A treatment plan for reducing pain when removing a negative pressure wound therapy (NPWT) dressing includes which of the following?
A. Reduce dressing change frequency
B. Use black foam in the wound base
C. Medicate before the dressing change
D. Use intermittent pressure settings
Content Outline: 020606, 020607
Cognitive Level: Application
Correct Answer: C
Common measures to decrease pain with NPWT dressing removal include saturation of the dressing with normal saline or sterile water, use of a nonadherent contact layer or utilization of a dressing that prevents tissue ingrowth (white foam), and medicating for pain prior to the dressing change. Reducing the dressing change frequency would result in increased pain secondary to the ingrowth of new tissue into the foam. Intermittent pressure settings are not clinically indicated for reduction of pain with dressing changes.
1. Pieper B. Atypical lower extremity wounds. In: Doughty DB, McNichol LL, eds. Wound Management Core Curriculum. Philadelphia, PA: Wolters Kluwer; 2015:519-521.
CWOCN Question: NPWT
3. Which of the following assessment findings would be a contraindication for use of negative pressure wound therapy (NPWT)?
A. Malignancy in the wound
B. Presence of hardware
C. Pending skin graft
D. Dehisced surgical wound
Content Outline: 010200
Cognitive Level: Application
Correct Answer: A
Malignancy in the wound bed is a contraindication for use of NPWT, as this can accelerate tumor growth. NPWT in the presence of orthopedic hardware is supported by the current clinical guidelines. NPWT is used to optimize blood flow and promote granulation tissue in preparation for pending skin grafts and flaps. NPWT aids in the management of moisture while promoting blood flow and tissue growth.
1. Pieper B. Atypical lower extremity wounds. In: Doughty DB, McNichol LL, eds. Wound Management Core Curriculum. Philadelphia, PA: Wolters Kluwer; 2015:519-521.
CWOCN-AP Question: NPWT
3. As an APRN, you are considering placement of negative pressure wound therapy (NPWT) on a patient with diabetes mellitus who has a neuropathic foot ulcer on the plantar surface with dimensions of 4 x 5 x 0.3 cm. The wound bed consists of 70% slough and 30% viable tissue without evidence of infection. What is the most important step in deciding whether to use NPWT?
A. Obtain consent and perform sharp excisional wound debridement
B. Ensure the patient can return to future clinic visits
C. Refer the patient to a dietician for glycemic management
D. Refer the patient to an orthotist to obtain adequate off-loading footwear
Content Outline: 040303
Cognitive Level: Application
Correct Answer: A
Wound bed preparation prior to the placement of NPWT includes debridement of avascular tissue. Sharp excisional debridement is the best available response to creating a clean wound bed. Ensuring regular clinic visits, promoting adequate glycemic management through diet choices, and preventing repetitive plantar pressure through a proper footwear should be included in any neuropathic foot care plan.
1. Netsch D. Negative pressure wound therapy. In: Bryant R, Nix D, eds. Acute and Chronic Wounds: Current Management Concepts. 4th ed. St Louis, MO: Mosby; 2012:337-344.
2. Wound, Ostomy and Continence Nurses Society. Guideline for Management of Wounds in Patients With Lower-Extremity Neuropathic Disease (3 WOCN Clinical Practice Guidelines Series). Mount Laurel, NJ: Wound, Ostomy and Continence Nurses Society; 2012:24-42.