FREE Wound Care Certification MCQ Question and Answer

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A 35-year-old chef comes to the emergency room with a whole fingertip. She says that her knife fell while she was cutting up vegetables. She brought the pulp that had been cut off in a plastic bag. On examination, the patient's distal volar tip of the second finger has a clean, 5-mm-wide slice of skin. There is a lot of bleeding that doesn't pulsate. There is no damage to the distal interphalangeal joint (DIP), the proximal interphalangeal joint (PIP), or the nail. Her last tetanus shot was about a year ago. Which is the best next step in management?

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Bleeding management, a nonadherent bandage, and a finger splint are often used to manage this patient's less than 10-mm dermal slice in order to prevent reinjury and lessen discomfort. Every 24 to 48 hours, you have to change your clothes. If the fingertip is cut off more than 10 mm, the bone is exposed, or the nail is involved, you may need to see a hand surgeon. But this patient's dermal slice is only 5 mm and does not involve the phalanx or nail, so it can be treated with less invasive measures. Most of the time, pressure dressing is enough to stop bleeding from dermal tip amputations. If direct pressure does not stop the bleeding, commercial hemostatic agents can be used. It's not clear how fingertip amputations should be treated. There are different ways to fix amputations of a lot of the distal digit, such as partial-thickness skin grafts and full-thickness skin grafts. Most of these are done by a hand surgeon in the operating room. (a, b, d) But replanting a dermal tip that is less than 10 mm is not a good idea. Even if the cut end is replanted, it is most likely to die and fall off. Given how small the wound is, there is no need to use the piece that was cut off as a natural dressing.

When taking steps to avoid friction that could lead to a pressure ulcer, which of the following should be avoided?

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Only dermal and epidermal injuries, such as "sheet burns" or abrasions, are caused by friction on their own. However, friction and pressure can combine to cause ulcers, therefore prevention is essential. Although cornstarch can be applied to the skin or bed linens, talcum powder should be avoided since it may cause skin abrasion. Skin lubricants, alcohol- or non-alcohol-based skin sealants, and alcohol- or non-alcohol-based skin barriers may help reduce friction.

How would a wound that initially healed as expected but then showed signs of plateauing and stayed unaltered for the second and third weeks be classified?

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> Stunned wound: A wound that initially seems to be healing nicely but suddenly stops progressing after reaching the point of healing.
> Acute wound: results from surgery or trauma and often heals without complications within the anticipated time frame.
> Chronic wound: One that lasts more than 30 days without healing. Some might never recover.
> Recalcitrant wound: A wound that resists healing normally and is challenging to manage because it resists healing despite numerous treatments.

What is the separation of one or more layers of a wound caused by too much pressure on a wound that hasn't healed? Muscles are usually intact in this state.

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Dehiscence, which results from improper wound healing, is the partial or complete separation of previously approached wound margins. Typically, this scenario takes place 5 to 8 days after surgery, when healing is still in the beginning phases.

A 30-year-old man comes to the emergency room (ED) with a cut on his right forearm. It was caused by a piece of glass during a fight in a bar. He says the cut hurts, but he denies feeling like something is in there. At first look, the cut is small and only 4 cm long. The patient has normal strength and feeling in the extremities. Which of the following claims about imaging this patient is true?

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Between 80% and 90% of foreign bodies can be seen on plain films. Plain film can show glass that is bigger than 2 mm. (b) The sensitivity of a foreign body feeling is 43%, and the specificity is 83%. So, the fact that you don't feel a foreign body doesn't mean there isn't one. a b) Foreign bodies that get stuck in the body can cause a local inflammatory response called granulomatous granuloma or a local and systemic infection. (c) CT can find more types of foreign bodies than plain film, but it is not often used because it takes a long time and costs a lot of money.

If a lesion has been in the inflammatory phase of healing for 10 days without progressing and the surrounding skin has remained erythematous and edematous, which of the following should the healthcare provider initially suspect?

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The most frequent cause of a wound staying in the inflammatory phase of healing rather than moving on to the proliferation phase is an infection of the tissue. If there is necrotic tissue present, the inflammation may also last longer. To establish what interventions might be required, the wound should be assessed with regard to culture and sensitivity. IV, oral, or topical antibiotics may be used to treat an infected wound, depending on its size and the level of infection.

A 19-year-old girl comes to the ED with a cut on her lip. He got the cut when he got into an argument. On close inspection, he has a 2-cm horizontal cut in the middle of his lower right lip. The lower lip has gotten a lot bigger. The attending asks you, the intern, to do a mental block for anesthesia. Which of the following is a true statement about mental blocks?

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The mental nerve is an extension of the inferior alveolar nerve. It comes out of the mental foramen below the second premolar and gives feeling to the skin and mucosa of the lower lip. Given that this patient's lip is swelling, the best way to put him to sleep is with a mental nerve block. (d) Injecting lidocaine locally will cause more swelling and change the shape of the body even more. A mental block will numb the lips without changing their shape.  b) You shouldn't inject directly into the foramen because it can cause damage to the nerves and blood vessels. a) This patient will need two mental blocks because his cut goes through the middle of his body.

The kind of wound most likely to contract at the slowest rate is

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When a ring of myofibroblast forms beneath the skin during phase III of healing, and proliferation, the tissue contracts and the wound closes. In general, circular wounds take longer to close than linear wounds (like a surgical cut), while square and rectangular wounds close more quickly. Contraction should be monitored and regulated, especially in places like the face to prevent deformity and the hands to prevent loss of mobility because if it happens quickly, it can lead to severe scarring.

The word "slough" is used to describe a wound and means:

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> Granulation: Bright pink or red granular-appearing new tissue generated from capillary beds.
> Slough: Soft viscous yellow covering of necrotic tissue that covers and adheres to the incision.
> Eschar: Leathery, oxidized tissue that is dark brown or black.
> Epithelization: the process by which epidermal cells form healed tissue over granulation.
> Maceration: the softening and irritation brought on by contact with fluids.
> Necrosis: is the term used to describe dead tissue.
> Cellulitis: Tissue inflammation that frequently includes edema and obvious erythema.

During what part of the healing process does the body's general response show up most?

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Inflammation is the first step of the generalized body response, and it starts soon after an injury and continues for a few days. During this stage, the body sends different cells and molecules to the wound site to fight infection, clean up debris, and get ready for tissue repair. Some common symptoms, like redness, swelling, heat, and pain, are also caused by this stage.

A 12-years girl with a forehead injury is brought to the emergency room by her parents. The patient hit her head on a doorknob, according to her dad. During the exam, the patient is cooperative, but he or she is nervous about getting the anesthetic shot. She has a 0.5-cm cut in the middle of her forehead. The edges are clean. Her parents ask about "skin glue," which they saw on TV and heard about. Which of the following is true about tissue adhesives made from cyanoacrylate?

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Tissue adhesives seal laceration edges with an adhesive layer. You can't use them on mucous membranes or places with a lot of hair. For best results, it should be spread in three to four layers on a dry, bloodless field. {a) When used correctly, the risk of infection and wound opening is the same with tissue adhesives as with sutures. (d) They work best on small (less than 5 cm), clean, straight wounds in places with low tension. (c) It is spread as a layer over the healthy epithelium while the edges of the wound are held close together. It can't be put inside the wound because it causes a strong reaction of inflammation.

Which diagnostic test is best recommended for a patient who follows a strict vegan diet and doesn't eat any foods containing gluten or legumes?

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The patient is at risk for zinc deficiency and should have their zinc levels checked because they avoid foods that contain animal protein, gluten, and legumes. Supplements should typically be given (usually 110-220 mg zinc gluconate or zinc sulfate TID). Vitamin A and D supplements may also be thought about since zinc deficiency frequently occurs in conjunction with these deficiencies. Due to the patient's restrictive diet, it is important to check for anorexia, which might be a sign of a zinc shortage.

How should the syringe be positioned when performing a wound irrigation?

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Holding the syringe 1 inch (2 cm) above the wound, gradually flush the fluid back into the needle until it is clear. If at all possible, the wound should face the collection basin vertically to allow the solution to drain off.

What is osteomyelitis?

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A bone infection called osteomyelitis is brought on by bacteria or fungus. The soft tissue inside your bones, the bone marrow, becomes painfully swollen as a result. Without treatment, the swelling brought on by this bone infection may stop the blood flow to your bone, which could result in bone death.

A 35-year-old woman walks into the emergency room with only her left hand. She says that she cut herself when she tried to cut a bagel. She has a small, 2-cm cut on the left side of her thenar eminence. There aren't any deeper structures involved. How should the wound be cleaned?

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To get low bacterial counts through irrigation, a pressure of 5 to 8 psi is recommended. You can create this pressure with an irrigation syringe or a 35-mL syringe and a 19-gauge needle. Normal sterile saline is as effective as sterile tap water. Most doctors recommend using 60 to 100 cc of irrigant per 1 cm of wound length. Using regular saline bottles or bags with holes (b) may not create enough pressure. (c)  Soaking doesn't help clean wounds.  Last, irrigation is needed (d) no matter how the injury happened.

On wounds, silver nitrate chemical cauterization is used to

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Hyper granulation is occasionally treated with chemical cauterization with silver nitrate. Cauterization is the process of destroying aberrant cells by burning or searing them with heat. Water is used to activate silver nitrate sticks before they are gently rubbed over the tissue to be treated for a brief period of time. Chemical cauterization is most frequently used to manage the hypergranulation tissue that develops in wounds, particularly stomas. The tissue in hypergranulation is frequently friable and readily bleeds. Up to four days of treatment, twice daily repetitions are possible till the extra tissue sheds.

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