CE Quiz for 7.0 Contact Hours [Evidence-based Medicine Ostomy Wound Manage 2007;53(10)]

1. Which of the following has NOT been identified as a barrier to the implementation of clinical practice guidelines for wound care:
A. Lack of leadership support from the facility
B. The limited availability of computer equipment
C. The widespread use of a standardized tool for the nursing assessment of pressure ulcer risk
D. The lack of time for nurses to acquire computer skills 2. Which of the following is/are good resource(s) for clinical practice guidelines for wound care:
A. The Agency for Health Care Policy and Research (AHCPR), Treat of Pressure Ulcers: Clinical Practice Guideline, No. 15
B. The Consortium for Spinal Cord Medicine. Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for health-care professionals
C. European Pressure Ulcer Advisory Panel. Guidelines on treatment of pressure ulcers
D. All of the above

3. Which of the following wound condition(s) has/have been recommended to be appropriate for the use of negative pressure wound therapy on chronic, difficult-to-heal wounds?
A. A wound that has been debrided and is free of active infections
B. A wound that has not been debrided and is free of active infections
C. A wound that has been debrided and has signs of active infections
D. All of the above

4. Which of the following statements is false?
A. Evidence-based education programs for the prevention of pressure ulcers are effective in increasing the awareness and knowledge base of nurses in pressure ulcer practice standards
B. Evidence-based practice for wound care is prevalent in all facilities
C. Adherence to pressure ulcer prevention guidelines has been reported to be low in nursing homes
D. The implementation of a guideline-based pressure ulcer prevention program may decrease short-term incidence of pressure ulcers

5. What team approaches should be employed to ensure quality wound care?
A. Clinical teams of nurses and physicians are most appropriate
B. Teams are not necessary. One clinician can cover everything
C. Integrated multidisciplinary teams are the best way to approach the multifactorial problem of wound care
D. It is best to have different people see a patient each time they come to the hospital

6. What role can telehealth play in wound care?
A. None. Patients prefer to travel to see their physician in person
B. The technology is not yet available to be able to tell
C. It is useful only for clinicians to videoconference
D. Real-time videoconferencing can be used to assess patients’ wounds while they are at the satellite clinic or digital images can be stored and forwarded to the central team personnel for videoconference review by both teams after the assessment

7. How can digital photography currently be employed in the evaluation of wounds?
A. Digital photography is easy to use with no training
B. Digital photography should currently be employed only under controlled conditions and with rigorous evaluator training. Further study is needed to determine the impact on clinical care
C. Digital photography should just be used for measuring wound size
D. Wounds evaluated by digital photography can fully replace in-person evaluation because there are no differences between any wound measures

8. How may gluteal electrical stimulation prevent pressure ulcers?
A. Electrical stimulation can both improve regional tissue health and provide a means for weight-shifting in individuals with reduced mobility
B. Using gluteal electrical stimulation means the patient is thinking more about regular weight-shifting
C. Gluteal electrical stimulation can make any wheelchair cushion more effective
D. Gluteal electrical stimulation replaces the need for regular skin inspections

9. How can multidisciplinary teams play a role in wound care research?
A. All the clinical problems have been solved so there is no need for wound care research
B. Wound care is simple and straightforward; only clinicians should be concerned with it
C. Multidisciplinary research teams are key to optimizing the translation from research to clinical practice
D. Multidisciplinary teams are to be discouraged; the NIH Roadmap encourages researchers to specialize and not work with people outside their area of expertise 

10. What are commonly hypothesized pathophysiological explanations for pressure ulcer development?
A. Ischemia caused by capillary occlusion
B. Reperfusion injury
C. Accumulation of metabolic wastes from lymphatic occlusion
D. All of the above

11. In which tissue does externally applied pressure typically result in the highest stress?
A. In the epidermis
B. At the dermal-epidermal boundary
C. In the subcutaneous fat
D. In the deep muscles

12. Deep tissue injury may initially appear as which of the following?
A. Blanchable erythema
B. A superficial ulcer
C. A purple or maroon localized area of discolored intact skin
D. An ulcer extending down to bone

13. What should a superficial ulceration over the sacrum caused by sliding a patient in bed be called?
A. Friction-induced erosion
B. Stage I pressure ulcer
C. Stage II pressure ulcer
D. Stage III pressure ulcer

14. Which best characterizes a Stage I ulcer?
A. It is always superficial
B. It usually progresses to a Stage III or Stage IV ulcer
C. May evidence dermal capillary and venule engorgement and necrosis in subcutaneous fat on biopsy
D. May include extensive disruption of the epidermis

15. Which mechanical factors contribute to the formation of pressure ulcers:
A. Pressure 
B. Shear
C. Tissue rigidity
D. All of the above 

16. Which environmental factors contribute to the formation of pressure ulcers?
A. Temperature
B. Moisture
C. Duration of applied load
D. All of the above

17. The average charge in the year 2003 for treating pressure ulcers per person was:
A $7,000
B. $17,000
C. $27,000
D. $37,800

18. The most frequent location of pressure ulcer on the human body is the:
A. Occiput 
B. Sacrum
C. Knee
D. Heel 

19. The correlation between interface pressure and pressure ulcer occurrence on the human body is:
A. Very positive
B. Positive
C. Zero
D. Slightly negative

20. Which of the following is NOT an element of good wound care?
A. Effective antimicrobial treatment of invasive bacterial infection
B. Consistent offloading of pressure
C. Dressings that promote a moist wound healing environment
D. Routine application of platelet-derived growth factors

21. Which two aspects of the Chronic Care Model lead to productive patient and provider encounters?
A. The community resources and the healthcare organization 
B. The self-management support and the clinical information system
C. The informed activated patient and the prepared, proactive team 
D. The delivery system design and decision support

22. A computerized foot ulcer care template offers the following advantages over routine medical records:
A. Provides uniform data collection
B. Standardizes ordering of laboratory and imaging studies
C. Improves coding and billing processes
D. All of the above

23. In the Reiber study, which of the following was NOT a function of all team members?
A. Medical photography
B. Dressing removal and application
C. Debridement of ulcers
D. Callus and nail care

24. Which of the following would NOT be considered a diabetic foot ulcer?
A. Pressure ulcers
B. Puncture injuries
C. Vasculitis
D. All of the above 

25. Tissue samples from Stage I pressure ulcers indicate:
A. Changes in the dermis of the tissue
B. Changes in the epidermis of the tissue
C. Changes in the dermis and epidermis of the tissue
D. No tissue change at all

26. In healthy tissue, dermal papillae: 
A. Are regularly spaced and similarly sized
B. Are absent
C. Stain deep red
D. Appear to be missing their tops 

27. As compared to normal tissue, Stage IV pressure ulcer tissue does not exhibit:
A. The presence of fat and collagen
B. Thicker fiber bundles
C. More straight and wavy fibers
D. Increased vascularity

28. The Kosiak and Husain studies are important because:
A. They show modest pressure may cause great changes in tissue
B. Time is the most important factor related to pressure effects
C. The effects of pressure are irreversible
D. None of the above

29. The concept of “adaptive remodeling” addresses
A. The effects of fur and loose skin in certain animals
B. The elasticity of skin
C. Evolutionary changes in response to factors such as load
D. Reengineering care protocols

30. The purpose of exploring the issues addressed in this exercise is to:
A. Elucidate the importance of a sound evidence base
B. Encourage acquisition of a sound knowledge of the relevant literature
C. Encourage research
D. All of the above