Certified Wound and Ostomy Care Nurse (CWOCN) Exam Review
The Certified Wound and Ostomy Care Nurse certification indicates specialization in the area of managing and treating patients with an ostomy and the management and prevention of wounds. This specialization focuses on those patients with chronic disease processes that may require an ostomy along with the prevention of potential wound complications.
In order to be eligible to take the Certified Wound and Ostomy Care Nurse exam, the applicant must be a licensed Registered Nurse who has a Baccalaureate Degree. Initially, the RN must obtain Wound, Ostomy, Continence Nursing Certification Board (WOCNCB) certification. At least 1,500 hours of employment engaged in caring for patients with at least one ostomy and/or wounds must have been completed within the past 5 years, with 375 of those hours obtained during the past year. In addition, at least 50 continuing education hours in ostomy and wound care should be completed in the past 5 years.
The Certified Wound and Ostomy Care Nurse exam is offered quarterly at various testing centers across the United States. The fee to take the exam is $300 with discounts applied if more than one WOCNCB certification exam is taken at a time.
The exam questions focus on testing the RN's knowledge of care of the patient with at least one ostomy and treatment and/or prevention of skin wounds that may be associated with an ostomy. These can address the physiological processes involved with an ostomy, along with the psychosocial and behavioral needs of the patient. The exam also contains questions pertaining to the specific pathophysiologic processes involved with wound formation and repair, along with specific treatment modalities used to treat wounds. A portion of the exam also tests the RN's knowledge on the specific devices used with an ostomy.
Certification as a Certified Wound and Ostomy Care Nurse is valid for 5 years. At that time, the RN can retake the exam to recertify, or requirements for the Professional Growth Program are met to qualify for recertification. This program utilizes a mixture of direct patient care and continuing education activities to meet specific requirements necessary to maintain certification.
Certified Wound and Ostomy Care Nurse (CWOCN) Practice Questions
1. A 57-year-old male is diagnosed with stage III cancer of the bladder with invasion of the muscle tissue. Which primary treatment is MOST common?
- Partial or segmental cystectomy
- Interstitial radiation only
- Radical cystectomy with urinary diversion and chemotherapy
- Chemotherapy only
2. Which of the following stomal complications indicates a need for surgical intervention?
- Slight bleeding when changing stomal appliance
- Slow oozing at one area of the mucocutaneous juncture
- Slow bleeding at mucocutaneous juncture and caput medusa
- Frank bleeding from the mucocutaneous juncture
3. Which of the following occurs during phase I (filling/storing) of the urination process?
- Spinal nerves contract the detrusor muscles
- Spinal nerves relax internal sphincter muscles
- Neurotransmitters signal the detrusor muscles to relax
- External sphincter muscles relax
4. Peristomal abscess is most commonly associated with:
- Crohn's disease
- Systemic bacterial infection
- Paralytic ileus
- Ulcerative colitis
5. With nocturnal enuresis, which medication can be taken at bedtime by a female patient to reduce urinary production?
Certified Wound and Ostomy Care Nurse (CWOCN) Answer Key
1. Answer: C
The most standard treatment for cancer that has invaded the muscle is radical cystectomy with urinary diversion. Chemotherapy may be done prior to or after surgery to improve survival rates, because recurrence rates are about 50%. In males, the bladder, prostate, seminal vesicles, and perivesical tissues are removed; in females, the bladder, uterus, ovaries, fallopian tubes, urethra, and anterior vaginal wall are removed. Urinary diversions may include an ileal conduit or an internal pouch, such as the Indiana pouch or neobladder (formed from part of the intestine).
2. Answer: D
Frank bleeding from the mucocutaneous juncture may indicate bleeding from a mesenteric artery, requiring surgery to open the incision and ligate the artery. A slight bleeding when changing of stomal appliance relates to mechanical trauma to the mucosa and is normal, unless it continues. Slow oozing usually stops, but may require cauterization. Oozing of blood may be caused by antiplatelet drugs, such as salicylates. Slow bleeding along with caput medusa (distention of veins about the umbilicus) is a complication related to portal hypertension.
3. Answer: C
Phase I: Filling/storing is triggered by emptying the bladder. Neurotransmitters in the brain signal the detrusor muscle to relax and the bladder to expand, drawing urine from the kidney and ureters. When the bladder reaches capacity (8 to 16 ounces), nerves send a signal back to the brain. Voluntarily tightening the external sphincter muscles retains the urine. Phase II: Emptying occurs when the nervous system signals the voiding reflex, and spinal nerves contract the detrusor muscle and relax internal sphincter muscles, allowing urine to flow to the urethra. Relaxing external sphincter muscles allows urination.
4. Answer: A
Peristomal abscess is common with active Crohn's disease distal to the stoma. Crohn's disease is a form of inflammatory bowel disease in which ulcerations occur in the small and sometimes in the large intestines. Peristomal abscess is characterized by open (from fistulae) and closed lesions that are painful, swollen, and erythematous. Peristomal abscess may also occur after stomal revision, because of contamination from skin bacteria. Colostomy irrigation may result in perforation that causes abscess formation. A peristomal abscess rarely heals spontaneously but requires surgical incision and drainage.
5. Answer: C
Desmopressin at bedtime reduces urinary production for 5 to 6 hours. Antidepressants, such as Imipramine, relax the bladder and tighten the urethral sphincter, and anticholinergics (such as oxybutynin) reduce instability of the detrusor muscle. Tamsulosin (Flomax®) may reduce nocturnal enuresis in males with benign prostatic hypertrophy. Other treatments for nocturnal enuresis include behavior modifications such as bladder training, scheduled urination, fluid restriction, and dietary modifications. Conditioning therapy with enuresis alarms may be helpful, especially for primary nocturnal enuresis.
Last Updated: 12/14/2017