FREE Wound Care Certification Trivia Question and Answer

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The skin layer that lies between the stratum corneum and the stratum granulosum is known as the _________ . It is made up of translucent cells that are exclusively found on the soles of the feet and the palms of the hands.

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The stratum lucidum is found on the palms of the hands and the soles of the feet but not on thinner skin or other parts of the body. Between the stratum corneum and the stratum granulosum, it can be found. The stratum corneum, the epidermis' outermost layer, is thickest on the palms of the hands and the soles of the feet but is also found in other parts of the body. The stratum basale, the deepest layer of the epidermis, is distinguished by keratinocytes that are actively proliferating. Additionally, the dermis, which is the skin layer beneath the epidermis and is a fundamental anatomical component of the skin, does connect to the epidermis.

A 28-year-old man comes to the emergency department with a wound on his lower left leg. He says he hurt his left calf while pulling branches out of a flooded creek in his back yard. He says that the wound was made while his legs were in the water. When the puncture wound is looked at, it is 1 cm in diameter, several centimeters deep, and has redness around it. After cleaning the wound with water, you find a splinter in the wound. How should management proceed?

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Foreign bodies that could cause infection or inflammation must be removed right away (examples include thorns, splinters, spines, teeth, soil-covered objects). These materials may cause inflammation that is strong and too much. If the doctor in the ED can't get the foreign object out, the right specialist should be called. (b) Since organic materials don't show up on x-rays, they can't be used to find organic foreign bodies. To find and get rid of all organic foreign bodies, a thorough direct visual inspection is needed. (d) Antibiotics are important, but getting rid of the foreign body is more important. After the splinter is taken out, an outpatient fluoroquinolone should be given to the patient. Wounds that have been in stagnant freshwater are likely to get infected by gram-positive, Pseudomonas, and Aeromonas species and should be treated with antibiotics just in case. (a) Closing a puncture wound, especially if it has a foreign object stuck in it, will cause inflammation and probably an infection. It would not be the right thing to do to close this patient's wound.

A 25-year-old woman comes to the ED with a small, 2-cm cut in the middle of her forehead. You clean the wound and put a bandage on it. The patient wants to be an actress and is worried about how her looks will change over time. She wants detailed instructions on how to care for a wound. Which of the following is a good way to tell someone how to care for a wound?

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If you go out in the sun while you're healing, you could get permanent hyperpigmentation. So, staying out of the sun and using sunblock for up to a year can improve the way you look. a ) The patient should be told to wash the wound with water and mild soap as soon as 8 hours after the sutures are put in. Even though the wound should be kept dry, telling the person not to wash is not the right thing to do. Wet wounds that are healing should be patted dry instead of wiped with force.  (c) How the scar looks at first does not show how it will look in the long run. (d) Sutures on the face should be taken out in 3 to 5 days. If you leave your stitches in for 7 to 10 days, the outcome will be worse.

A 35-year-old man walks into the emergency room with a hole in his left foot where he stepped on a rusty nail. His last tetanus shot was when he was a child, which caused a severe allergic reaction and a long stay in the hospital. Which of these statements is true about this patient's tetanus immunization?

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Tetanus toxoid shouldn't be given to people who have had a severe allergic reaction, like trouble breathing or a heart attack. In these people, tetanus immunoglobulin can be used. It is not a contraindication if the injection site becomes red, painful, and swollen as a result of the response.

After an accident, a 29-year-old man comes to the ED with the cut shown below. There are no broken teeth, and he has tetanus. After an accident, a 27-year-old man comes to the ED with the cut shown below. There are no broken teeth, and he is up to date on his tetanus shot. What are the best steps for management to take next?

(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency Medicine. New York, NY: McGraw-Hill, 2002: 162.)

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This is a cut on the face that goes past the vermilion line (demarcation of the lip mucosa and facial skin). In this case, the goal of the repair is to get as close as possible to the vermilion border with less than 2 mm of displacement. This is because a lot of displacement looks bad. A nerve block is needed because local anesthesia would change the anatomy of the tissue, making it hard to get an accurate estimate. Before closing the other parts of the wound, the first stitch should focus on getting close to the edge. (a, c) Local anesthesia infiltration will change the anatomy of the tissue and may make it hard to get the right alignment. It shouldn't be used unless the nerve block fails. Initial alignment of the dermis or mucosa (c and d) of the laceration may make it hard to get close to the vermilion border.

Which of the following therapies is recommended as a first line of treatment for weepy, red, itchy atopic dermatitis?

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Weepy lesions linked to atopic dermatitis are treated with wet aluminum acetate compresses. Eczema is a persistent, inflammatory condition of the superficial skin. It is associated with xerosis, which is dry skin with a compromised barrier function, and allergies. It is related to cold, dry weather, central heating (which dries the air), and skin irritants like soap. Vesicles may form, leak, and crust while the skin is frequently red and irritated. The skin could be flaky, scaly, and rough. The skin may get thicker and darker with time, and lichenification (marking caused by repeated scratching) may appear.

A woman who is 20 years old comes to the emergency room with a cut on her lower lip. The patient says she fell forward when her heel got stuck in a storm drain. She also has some small cuts on her face and a 3 cm-deep cut on the inside of her lower lip. You plan to close the cut to stop the bleeding and keep food from getting stuck. Which of the following materials for a suture would be best for this patient?

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The choice of suture material depends on the type of tissue, the tension of the tissue, and whether or not the sutures will need to be taken out. Oral mucosa is healing quickly and is under a moderate amount of stress. Also, because the inner mucosa of the lip doesn't need to look good, absorbable sutures should be used. So, absorbable chromic gut is the best choice for a suture. The tensile strength of a 5-0 chromic gut will be equal to that of the oral mucosa. D A chromic gut of 1-0 is much bigger than it needs to be. Oral mucosa doesn't need the tensile strength that a 1-0 suture gives, and it would leave a knot that is too big to be comfortable. B and C are not the best choice for oral cavity repairs because the patient would have to come back to have them taken out.

What is the shortest amount of time that an EMLA cream (Eutectic Mixture of Local Anesthetics) should be applied before initiating a dressing change in order to relieve pain?

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Good pain management is offered by a eutectic mixture of local anesthetic (EMLA Cream). After cleaning the incision, thick (1/4 inch) layers of cream are applied, going about 1/2 inch beyond the wound to the surrounding tissue. The plastic wrap is then secured and left on the wound for at least 60 minutes in order to have the greatest impact. After the plastic wrap is taken off, the tissue should continue to be numb for roughly an hour, giving the wound time to be cleaned, debrided, and/or redressed.

An illustration of a wound that most likely may see secondary healing is

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The process of secondary healing involves leaving the wound open so that it can heal through granulation and epithelialization. Used to stop abscess formation and enable drainage in "dirty" or infected wounds.
> Primary healing: This process involves medically covering a wound entirely with split or full-thickness grafts, flaps, or sutures. When a wound is virtually "clean," it is used for surgeries or the repair of lacerations or wounds.
> Tertiary healing entails debriding the wound, letting it start healing while still open, and finally closing it. used for infected wounds or wounds from combined trauma, such as severe animal attacks.

Which of the following complications could arise if a patient is positioned prone with their head tilted laterally to ease strain on their hips and spine?

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Decreases in blood pressure, preload, and cardiac output may occur as a result of blood pooling in the extremities and pressure on the belly. Lung compliance declines and respiratory effort rises. The head may be maintained in a neutral position or turned laterally if it is not safe to do so due to arthritis or cerebrovascular illness. Circulation in the brain may be hampered by a head that is tilted sharply to one side or the other. The dependent eye must be closely scrutinized for external compression that could result in ocular injury if the head is rotated laterally.

A 55-year-old man comes to the emergency room for stitches. A piece of glass cut his right calf when he was on vacation in Jamaica two days ago. The cut was 4 cm long. At that time, the cut was cleaned, an x-ray was taken to check for a foreign object, and it was fixed. At the moment, the edges of the wound are healing well and there is no redness or drainage from the wound. What is the best management step to take next?

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Suture removal is a balance between how the wound looks and how well it heals. Increasing the time it takes to sew up a wound makes it stronger, but it makes the wound look worse. Most stitches can be taken out 7 days after they are put in. If you have stitches on your face, they should be taken out in 3 to 5 days to avoid unsightly marks called hatch marks. Sutures in places with a lot of tension, like the arms, legs, hands, and feet, take about 10 days. Since this patient's cut is big and in a high-stress area, the sutures should be taken out 10 days after they were put in. If this patient came back in 3 days (b) that would be too soon, and if they came back in 14 days (a) that would be too late. (d) Even though it has been 2 days since the sutures were put in, there is no need to take them out because there are no signs of infection. Only if there were signs of an infection would it be the right thing to do to take out the stitches.

A 15-year-old girl comes to the emergency room with a cut on her left index finger. She hurt herself when her friend closed the car door on her by accident. She has a half-circle cut on the back of her left second finger, just past the distal interphalangeal (DIP) joint. Sensation is still there after the cut. The DIP joint can still move as it should. The patient wants to be a hand model in the future, so he or she is very worried about how the surgery will look. Which of the following would be the best way to put this patient to sleep?

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The digital nerves can be blocked by putting a lidocaine digital block at the base of the finger. This lets the anesthesia work properly. The needle is put into the space between the webs on both sides, and anesthesia is put in both the front and back of the foot. This is done again on the affected digit's other side.

A 45-year-old woman comes to the emergency room with a deep dog bite on her left forearm. The dog is well-vaccinated. Which of the following is true about how to treat wounds from animal bites?

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Puncture wounds can't be cleaned well because they are so deep. When these wounds aren't closed right away, the risk of abscesses and wound infections goes down. b)  About 5% of dog bites and 40% of cat bites turn into infections. To keep a wound from getting infected, you must wash it a lot. Most bite wounds can be fixed by closing them up on their own. a ) Puncture wounds, small cuts, and wounds on the hands and feet are more likely to get infected and should be treated with delayed primary closure. Putting deep sutures in this patient's puncture wound would make it more likely that the wound would get infected. c) The most common organism in cat bites is Pasteurella. Most dog bites contain both microorganisms that live in the air and those that don't. Antibiotics should be considered for all people with a high chance of getting an infection (i.e., elderly, diabetics, immunocompromised patients, puncture wounds, and wounds of the hands and feet). 

Which of the following is the appropriate intervention when a wound has a damaged matrix and cell debris that prevents healing?

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Debridement, which may be done episodically or continuously depending on the state of the wound, is the correct intervention when a wound has a damaged matrix and cell debris that prevents healing. Debridement techniques include autolytic, biological, sharp, mechanical, and surgical ones. The objective is to repair the wound's foundation so that there is still healthy tissue there to start the healing process.

What should be considered when assessing a patient's nutritional status is the typical daily caloric requirement for effective wound healing?

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Depending on the patient's age, size, and overall health, an intake of 1500 to 3500 calories per day is typically necessary for adequate wound healing. A lower calorie intake could limit the protein required to encourage collagen formation and wound healing. Protein may be used as an energy source by the body if carbohydrate consumption is too low. Fats are essential for the creation of the cell membrane, and a lack of them hinders recovery. Patients require a vitamin and mineral-rich, well-balanced diet. Iron, copper, vitamin A, vitamin C, and vitamin A are all crucial for the growth of collagen.

A 5-year-old boy's mother takes him to the emergency room for a forehead injury. On the icy sidewalk, he slid and banged his head, she said. No unconsciousness. The child is aware and active. He has a 3-cm hairline-crossing forehead laceration. What is the best way to close the wound on this patient?

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Face cuts should be stitched back together with an interrupted 6-0 nylon suture.

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