Free CWCA Practice Test
1. On the Braden scale for predicting risk of developing pressure scores, a patient scores 2 (1 to 4 or 1 to 3 scale) on each of 6 parameters (total score 12). What is the patient's risk of developing a pressure sore?
a. Very minimal risk
b. Breakpoint for risk
c. High risk
d. Extremely high risk (worst score)
2. Which of the following off-loading measures is usually the MOST effective for treatment of neuropathic ulcers?
a. Total contact cast
b. Removable cast walkers
3. A patient with venous insufficiency requires compression therapy and has Unna's boot applied but must be on bed rest for four weeks. Which action is correct?
a. Continue Unna's boot therapy during bed rest, but change 2 times weekly
b. Continue Unna's boot therapy, but keep leg elevated
c. Discontinue Unna's boot therapy during the bed rest period
d. Continue Unna's boot therapy, but change only every 2 weeks
4. A patient with pemphigus vulgaris has generalized lesions with ulcerations and crusting, causing the patient's skin to adhere to the bed sheets. How can the patient manage this?
a. Apply talcum powder liberally to the sheets
b. Set an alarm to turn frequently during the night
c. Place a piece of soft plastic over the sheets
d. Use an alternating pressure mattress
5. One of the primary treatments for contact dermatitis with an itching, blistering rash is
a. Nonadherent dressings
b. Topical corticosteroid
d. Cleansing with povidone-iodine
Answers & Explanations
1. C: A Braden score of 12 indicates high risk. The Braden scale rates 5 areas (sensory perception, moisture, activity, mobility, and usual nutrition pattern) with a 1 to 4 scale and one area (friction and shear) with a 1 to 3 scale. Lower scores correlate with increased risk. The scores for all six items are totaled, and a risk is assigned according to the number.
- 23 (best score): excellent prognosis with very minimal risk
- ≤16: breakpoint for risk of pressure ulcer (will vary somewhat for different populations)
- 12 to 14: high risk
- 6 (worst score): prognosis is very poor with strong likelihood of developing pressure ulcer
2. A: Total contact casts (TCC) encase the lower extremity in a walking cast that equalizes pressure of the plantar surface. The casts may have windows over pressure ulcers to allow observation and treatment. TCC is more successful than other off-loading measures, possibly because people restrict activity more. Removable cast walkers allow patients to remove the casts, but studies show that people only use them 28% of the time, decreasing effectiveness. Wheelchairs allow dependency of using a limb but prevent pressure. Half shoes may have a high walking heel with the front of the foot elevated off of the ground.
3. C: Unna's boot (ViscoPaste®) is a gauze wrap impregnated with zinc oxide, glycerin, or gelatin to provide a supporting compression "boot" to support the calf muscle pump during ambulation, so it is not suitable for nonambulatory patients and should be discontinued during the bed rest period. The bandage must be applied carefully, without tension. It may either be left open to dry or covered with an elastic or self-adherent wrap. The dressings are changed according to individual needs, determined by a decrease in edema, the amount of exudate, and hygiene, with dressing changes ranging from twice weekly to once every other week.
4. A: Applying talcum powder liberally to the sheets may help keep the patient's skin from sticking to them. Pemphigus vulgaris (PV), an autoimmune disorder causing blistering of both the skin and the mucus membranes (presenting symptom in 50 to 70% of patients), creates burn-like wounds, which may heal slowly or not at all, often starting in the mouth and genital areas. Untreated, the disorder can lead to death. Blisters on skin rupture, causing ulcerations, and those in folds may develop hypergranulation and crusting. Treatment includes corticosteroids, immunosuppressive drugs, and plasmapheresis to remove antibodies.
5. B: With contact dermatitis, topical corticosteroid is used to control inflammation and itching. Skin should be gently cleansed with water or oatmeal bath and left open without dressings. Antibiotics are needed only if a secondary infection occurs. Caladryl® lotion may relieve itching, and antihistamines may reduce allergic response. Contact dermatitis is a localized response to contact with an allergen, resulting in a rash that may blister and itch. Common allergens include poison oak, poison ivy, latex, benzocaine, nickel, and preservatives, but people may react to a wide range of items, preparations, and products.
Last Updated: 03/01/2017