INTRODUCTION
Foot care nursing, like all specialty areas, has unique terminology. Some terms referring to the toenails can appear deceivingly simple. Developing mastery of nail-specific terminology is a key to understanding and correctly answering certification examination questions. When preparing for the WOCNCB foot care certification examination, knowledge and mastery of foot care terminology and nail care are a first step and are listed as a critical area on the WOCNCB foot care examination content outline under Domain 1, Task 2 (http://www.wocncb.org).
Breaking down terms into their components is a practical way to mastering terminology that may be helpful for examination preparation. Understanding the base components of a term can help determine meaning and aid in choosing the correct answer option. Look at the prefix, the root, and the suffix of a word. Prefixes and suffixes commonly encountered in nail care include "onych" and "onycho," which simply mean pertaining to the nail.1 Another commonly used root word is "ungula." An example commonly encountered is the descriptor subungual, which means under the nail. The presence of these prefixes or suffixes should alert the test taker that the question refers to the nails. Nail pathology, which is part of the WOCNCB foot care certification examination, is often defined using these same prefixes/suffixes. Consider 3 common nail abnormalities, onychocryptosis, paronychia, and onychomycosis. Onchocyrptosis refers to an ingrown nail.2 The prefix "oncho" means nail, "crypto" means hidden or behind, and the final suffix "sis" simply means a condition. Combining the etymologic components of this term informs the test taker that the nail has grown under surrounding nail tissue and is hidden. A question that asks about paronychia is asking about an infection of soft tissue surrounding the nail. The prefix "par" refers to beyond, the root "onych" indicates a nail, with "ia" on the end of the word meaning condition. If the word onychomycosis appears in a question-answer option, the symptoms listed in the stem should be consistent with a fungal infection of the nail. The root of the word is "onycho," referring to the nail and suffix "mycosis" means disease by a fungus.
Each of the sample questions in this Getting Ready for Certification employs language specific to toenails. The rationales of each question will explain how to improve your test-taking skills by breaking apart the terminology used in order to choose the correct answer.
1. Howes-Trammel S, Bryant RA. Foot and nail care. In: Bryant RA, Rolstad BS, eds. Acute and Chronic Wounds: Current Management Concepts. 5th ed. Kindle Location; 2016:15263. [Context Link]
2. Driver VR, LeBretton JM, Allen L, Park NJ. Neuropathic wounds: the diabetic wound. In: Bryant RA, Rolstad BS, eds. Acute and Chronic Wounds: Current Management Concepts. 5th ed. Kindle Location; 2016:13649. [Context Link]
PRACTICE QUESTIONS
1. The foot care nurse should describe the distal margin of superficial skin extending over the base of the toenail as:
a. subungual
b. periungual
c. perionychium
d. eponychium
Content Outline: Domain 1, Task 2, 010204
Cognitive Level: Knowledge
Answer D:
Rationale: The correct answer is eponychium. The question stem asks about tissue surrounding the nail that extends over the base of the nail. All of the answer options have a word root that refers to the nail, "onychium" and "ungual." To best answer the question, the prefix of each term needs to be identified and defined. The prefix "sub" refers to under the nail and the prefix "peri" refers to around the nail. The options that use these prefixes are thus not correct. Only the correct answer option, eponychium, with its prefix "ep" meaning over, refers to the skin covering the root of the nail. Cuticle is another name for the eponychium.
1. Howes-Trammel S, Bryant RA. Foot and nail care. In: Bryant RA, Rolstad BS, eds. Acute and Chronic Wounds: Current Management Concepts. 5th ed. Kindle; 2016:14644.
2. Burdette-Taylor M, Fong L. Foot and nail care. In: Doughty DB, McNichol LL, eds. Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016:530-557.
2. A certified foot care nurse is caring for a patient with onychocryptosis. Where on the toes should the nurse expect to see a deviation from normal?
a. Subungual area
b. Periungual area
c. Perionychium
d. Eponychium
Content Outline: Domain 1, Task 2, 010204
Cognitive Level: Application
Answer B:
Rationale: To answer this question, the test taker should first define the term "onychocryptosis." The prefix of the term tells the test taker that this is nail pathology and the root "crypto" meaning hidden or buried. Onychocryptosis is a nail deformity where the lateral nail curves inward into adjacent tissue, causing pain, inflammation, and (in some cases) infection. It is commonly referred to as an ingrown toenail. All of the answer options refer to different parts of the nail and the toe that would be part of the foot care nurse's assessment. Subungual assessment would look at what is underneath the nail plate, and periungual is assessment of tissue around the nail. Assessment of the perionychium required inspection of the skin that overlays the nail plate on the sides. Assessment of the eponychium requires inspection of the base of the nail, also known as the cuticle. The correct answer reflects the pathology consistent with onychocryptosis, periungual inflammation, or inflammation around the nail.
1. Howes-Trammel S, Bryant RA. Foot and nail care. In: Bryant RA, Rolstad BS, eds. Acute and Chronic Wounds: Current Management Concepts. 5th ed. Kindle; 2016:14644.
2. Burdette-Taylor M, Fong L. Foot and nail care. In: Doughty DB, McNichol LL, eds. Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016:530-557.
3. A homeless person presents at the foot screening clinic and reports being unable to keep the nails trimmed. Assessment reveals thickened yellow toenail that has curved lateral, causing irritation on the adjacent toe. What nail condition is most likely?
a. Pes planus
b. Onychogryphosis
c. Hallux valgus
d. Onycholysis
Content Outline: Domain 2, Task 4, 020402
Cognitive Level: Analysis
Answer B:
Rationale: The question stem asks about a nail condition. A review of the answer options shows that only 2 options relate to toenails. Hallux valgus is a common condition of the toes but not the nails. It is an outgrowth of the first metatarsophalangeal joint (big toe and the foot) most commonly called a bunion. Pes planus, frequently referred to as flat foot, is characterized by foot pain on the back of the heel or bottom of the foot. There are 2 options that refer to toenails identified by use of the prefix "onycho." Onychogryphosis is characterized by thickened, curved nails that appear claw-like or like a curved ram's horn. The root of the word "grypho" refers to curving. A major risk factor to onychogryphosis is inadequate nail care. Onycholysis describes a nail that has lifted from its bed and has an irregular border between the pink portion of the nail and the white outside edge of the nail. A greater portion of the nail is opaque, either whitened or discolored to yellow or green. The nail is usually smooth. Onycholysis has many possible causes that range from systemic diseases, dermatologic conditions, mechanical trauma, and drug-associated nail changes. A careful reading of the question stem reveals that the patient is homeless and unable to adequately trim the toenails. Based upon the information available in the answer stem, onychogryphosis is the most accurate answer.
1. Howes-Trammel S, Bryant RA. Foot and nail care. In: Bryant RA, Rolstad BS, eds. Acute and Chronic Wounds: Current Management Concepts. 5th ed. Kindle; 2016:15289.
2. Burdette-Taylor M, Fong L. Foot and nail care. In: Doughty DB, McNichol LL, eds. Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016:530-557.
4. Assessment of the foot of a 52-year-old woman with diabetes mellitus reveals a thickened, brittle, discolored nail on the second toe. After trimming the nails, the foot care nurse reviews the assessment with the health care provider and microscopic evaluation of nail scrapings is ordered to confirm the diagnosis of:
a. hyperkeratosis
b. onychopathy
c. onychomycosis
d. onychocryptosis
Content Outline: Domain 2, Task 4, 020402
Cognitive Level: Application
Answer C:
Rationale: All answer options refer to toenail conditions. Three of the 4 answer options include the prefix "onycho" that clearly identifies these answer options as pertaining to the nail. "Hyperkeratosis" is a general term that describes the process behind thickened nails. "Onychopathy" is another general term that refers to any nail condition. When answering certification examination questions, it is best to look for the answer option that is the most specific to the details given in the question stem. The question stem describes a thickened, brittle, and discolored nail. Onychocryptosis is commonly known as an ingrown toenail and does not match the description given in the stem and since it is not an infectious condition, it does not require scrapings to best define treatment. The only nail condition listed that is consistent with the description in the question stem and would require microscopic evaluation of nail scrapings prior to systemic treatment would be onychomycosis. Onychomycosis is a nail fungal disease caused by dermatophytic fungi, nondermotophyic fungi, or yeast. The treating clinician may be considering both topical and systemic treatments to best penetrate the hyperkeratotic layers of the affected nail.
REFERENCE