WCC wound care certification: entry routes and renewal

A resident with a healing heel pressure injury has a Braden score of 18. Three days later the resident develops pneumonia, becomes confused and stops eating. When should the Braden Scale be repeated?

1. Now, since the condition changed

   Braden risk is re-scored whenever the condition changes: new confusion, infection and poor intake shift the mobility, sensory, moisture and nutrition subscores right away, so the old 18 no longer describes this resident.
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2. At the next quarterly review

   The next quarterly review is the routine for a stable resident, not a reason to wait through an acute illness that has just changed several risk factors.
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3. Once the pneumonia has resolved

   Waiting until the pneumonia has resolved skips the period of highest risk, when the score is most likely to fall and prevention most needs to step up.
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4. If a new pressure injury appears

   Re-scoring after a new pressure injury appears turns a prediction tool into a damage report; the Braden Scale is meant to flag rising risk before skin breaks down.
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Select an answer to record it. The card then marks the key and opens the reasoning under every choice.

A patient with a venous leg ulcer and an ABI of 1.0 removes full multilayer compression within hours because of pain. Which plan change is most appropriate?

1. Replace compression with a diuretic

   Venous edema comes from venous hypertension, not fluid overload, so a diuretic does little for it and leaves the ulcer without its core treatment.
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2. Reduce compression, then step it up

   Reducing compression to a level that stays on, with analgesia, treats the venous disease better than a full-strength system removed within hours; the level is stepped up as edema and pain settle.
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3. Stop compression; rely on elevation

   Elevation reduces swelling only while the legs are up, and stopping compression removes the treatment that actually heals a venous ulcer.
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4. Keep full compression; pain will pass

   A full-strength system the patient keeps taking off delivers no compression at all, and unexplained pain under a bandage needs assessment, not dismissal.
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Which re-evaluation finding best shows that the compression itself is working for a patient with a venous leg ulcer?

1. The wound bed has more slough

   More slough is a step backward in the wound bed and says nothing about control of venous hypertension.
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2. The patient reports less itching

   Less itching is welcome but subjective and has many causes, so it cannot show that the compression itself is working.
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3. The ankle measures 3 cm smaller

   Compression works by lowering venous pressure and edema, so an ankle that measures smaller is direct, objective evidence that the bandage is doing its job.
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4. The patient's ABI rose to 1.1

   The ABI reflects arterial inflow, which compression does not improve; a change in it is no measure of venous edema control.
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Several sacral deep tissue pressure injuries are found 2 to 3 days after long cardiac surgeries. Which process change best addresses this pattern?

1. Change the unit's turning schedule from every 2 hours to hourly

   Turning more often on the unit cannot undo pressure already applied during hours on the table; the pattern points to the operating room, not the ward.
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2. Stage these injuries as Stage 1 until the skin opens

   A deep tissue pressure injury is its own category of purple or maroon intact skin; calling it Stage 1 understates the damage and misdirects care.
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3. Record the injuries as present on admission to the unit

   Labeling a hospital-acquired injury as present on admission hides it in the data and blocks the improvement work this pattern calls for.
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4. Add OR positioning time and skin status to the post-op handoff

   Deep tissue injury from the operating table typically appears 48 to 72 hours later, so passing on case length, positioning and skin findings lets the receiving unit target early checks and prevention.
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