NCWO Skin and Wound Healing 2 — Questions and Answers
Question 1: Moisture-associated skin damage (MASD) can be caused by all of the following EXCEPT:
- Wound exudate
- Perspiration and sweat
- Feces and urine
- Mechanical friction from turning (Correct answer)
Correct answer: Mechanical friction from turning
MASD is caused by prolonged skin exposure to moisture sources such as urine, feces, wound exudate, or perspiration; friction causes mechanical skin injury, not MASD.
Question 2: The skin pH of a healthy adult is approximately:
- 7.0–7.4 (neutral to slightly alkaline)
- 4.5–5.5 (mildly acidic) (Correct answer)
- 6.0–6.5 (near neutral)
- 3.0–4.0 (strongly acidic)
Correct answer: 4.5–5.5 (mildly acidic)
Healthy skin has a mildly acidic surface pH of approximately 4.5–5.5, which inhibits pathogen colonization and supports the skin's resident microbiome.
Question 3: Skin tears are classified by the Payne-Martin or ISTAP classification based on:
- Depth of tissue involvement from epidermis to bone
- Presence or absence of a skin flap and its viability (Correct answer)
- Location on the body and patient age
- Bacterial colonization of the wound bed
Correct answer: Presence or absence of a skin flap and its viability
The ISTAP classification categorizes skin tears based on whether a skin flap is present, whether it can cover the wound base, and whether it is viable, guiding treatment approach.
Question 4: In a patient with suspected skin cancer on the lower extremity presenting as a non-healing wound, the WOC nurse should:
- Initiate aggressive sharp debridement immediately
- Refer for biopsy and dermatology or oncology evaluation (Correct answer)
- Apply zinc oxide barrier cream and reassess in 30 days
- Increase the frequency of standard wound dressings only
Correct answer: Refer for biopsy and dermatology or oncology evaluation
Any chronic non-healing wound that fails to respond to standard treatment must be referred for tissue biopsy to rule out malignancy, including squamous cell carcinoma (Marjolin's ulcer).
Question 5: Which vitamin is essential for collagen cross-linking and deficiency of which directly impairs wound healing?
- Vitamin A
- Vitamin B12
- Vitamin C (Correct answer)
- Vitamin D
Correct answer: Vitamin C
Vitamin C is a required cofactor for prolyl and lysyl hydroxylase enzymes that cross-link collagen fibers; deficiency causes impaired collagen synthesis and poor wound healing (scurvy).
Question 6: The role of zinc in wound healing is to:
- Provide direct energy substrate for fibroblast proliferation
- Support collagen synthesis, immune function, and epithelialization (Correct answer)
- Act as a primary antimicrobial against gram-negative bacteria
- Replace protein loss through wound exudate directly
Correct answer: Support collagen synthesis, immune function, and epithelialization
Zinc is a cofactor for DNA polymerase and numerous enzymes involved in collagen synthesis, immune cell function, and epithelial cell proliferation, making it essential for wound repair.
NCWO Skin and Wound Healing 2
Moisture-associated skin damage (MASD) can be caused by all of the following EXCEPT: