The Wound, Ostomy, Continence Certification Board (WOCNCB) is an accredited organization that provides nurses with the opportunity for certification in wound, ostomy, continence, and foot care nursing. There are currently 3028 nurses certified in continence care by the WOCNCB. Nurses certified by the WOCNCB either have completed a formal Wound Ostomy Continence Nursing Education Program or are qualified to take the examination through an experiential pathway.

The following reflects the type of questions on the examination.

1. An ambulatory patient in a long-term care facility has functional incontinence with mild to moderate dementia but is cooperative with caregivers. The best way to manage the incontinence would be

A. diapers with use of appropriate skin protection products.

B. a bedside commode.

C. a scheduled toileting program.

D. a raised toilet seat with hand rails on either side.

2. A person with reflex incontinence has been doing clean intermittent catheterization (CIC) at home, but an acute respiratory infection has necessitated admission to hospital. Labored breathing and high fevers have made it impossible for the patient to perform self-catheterization. What would be the most appropriate intervention during the hospitalization?

A. Have a family member do the catheterizations every 4 hours.

B. Use an indwelling catheter until the patient can resume CIC.

C. Use absorbent products and skin-protective ointments.

D. Have the patient use a bedpan and check for residual urine every 12 hours.

3. Initial management of a person with chronic constipation includes

A. adequate fluid and fiber in the diet.

B. a bowel diary.

C. motility studies.

D. enemas followed by laxatives.

Answers

1. (C) A scheduled toileting program. Functional incontinence in this person is likely due to dementia. Since the person is cooperative with caregivers, it is likely that routine toileting will decrease or eliminate incontinent episodes and increase dignity and comfort. Diapers with skin protection (A) would not help the person maintain normal urinary function and increase the risk of impaired skin integrity. A bedside commode (B) or a raised toilet seat with hand rails on either side (D) is an appropriate intervention for persons with impaired mobility but does not address the problem that the person with cognitive impairment is unable to respond appropriately to the urge to void.

Reference

Thompson D. Pathology and management of functional factors contributing to incontinence. In: Doughty D, ed. Urinary & Fecal Incontinence: Current Management Concepts. St Louis, MO: Mosby; 2006:178.

2. (B) Use of an indwelling catheter until the patient can resume CIC. The short-term use of a catheter will protect the upper urinary tract from chronic retention and reflux of urine and allow for accurate monitoring of urine output. Having a family member do the catheterizations every 4 hours (A) is unrealistic in the hospital setting and places an unfair burden on the family member. Use of absorbent products and skin-protective ointments (C) is not an appropriate alternate management, as the patient is unable to void adequately due to the neurogenic bladder. Having the patient use a bedpan and checking for residual urine every shift (D) allows for emptying of the bladder only every 12 hours since the patient will not be able to void adequately in a bedpan between catheterizations.

Reference

Gray M. Pathology and management of reflex urinary incontinence/neurogenic bladder. In: Doughty D, ed. Urinary & Fecal Incontinence: Current Management Concepts. St Louis, MO: Mosby; 2006:212.

3. (A) Adequate fluid and fiber intake in the diet. This will help normalize stool consistency and relieve constipation if there are no abnormalities of the intestinal tract or pelvic floor present. A bowel diary (B) is an effective assessment tool but is not a management strategy. Motility studies (C) are indicated for assessment of transit time through the colon. Enemas and laxatives (D) may be a necessary part of the treatment if a fecal impaction is present but would not be the initial approach to treating constipation.

Reference

Doughty D, Jensen L. Assessment and management of the patient with fecal incontinence and related bowel dysfunction. In: Doughty D, ed. Urinary & Fecal Incontinence: Current Management Concepts. St Louis, MO: Mosby; 2006:474.

Resources for Preparing for the WOC Certification Exam

Self Assessment Exam

* The Self-Assessment Exam (SAE) is a computer-based test available from the testing company that produces our exam. You can find this by going to Web site http://www.goamp.org and clicking on "e-store." Then select "Health Care" and then "Wound, Ostomy, Continence Nurses." For $90, you may purchase all 3 exams or for $30, you can purchase the exams individually. The SAE has 40 questions in each specialty and you may grade it as you take the test. References and the rationale for the answers are provided. The test is available for 90 days after purchase, and when you exit from the exam for the final time, you will be provided with a score report.

* The WOCN Society has CD-ROMs of the certification review course offered each year at their national conference. These may be purchased online at http://www.prolibraries.com/wocns/.

* The WOC Nursing Education Program at Emory University has a certification review manual for sale for $65.00. The order form is available online at http://www.surgery.emory.edu/wocnec/order.form.pdf. You may also obtain this order form by calling 404-778-3159 or by faxing your request to 404-778-4778.

* The Wound Care Education Program at the Medical College of South Carolina has a Wound Care Study Guide that may be purchased for $125.00 by contacting Carol Whelan at 843-792-265 or toll free at 866-637-6835.