Wound Care Certification Dressings and Topical Agents Questions and Answers — Questions and Answers
Question 1: A patient has a moderately draining venous leg ulcer with 50% granulation tissue and 50% yellow slough. The periwound skin is intact but requires protection from moisture. Which dressing is MOST appropriate for this wound?
- Transparent film
- Hydrogel sheet
- Calcium alginate
- Foam dressing (Correct answer)
Correct answer: Foam dressing
Foam dressings are designed to absorb moderate to heavy exudate while providing a moist wound environment and thermal insulation. They are an excellent choice for this wound type as they manage drainage effectively, protecting the periwound skin from maceration. Transparent films are non-absorbent, hydrogels donate moisture, and alginates are typically for heavy exudate.
Question 2: A clinician is selecting an enzymatic debriding agent for a wound with adherent necrotic tissue. Which of the following is the primary mechanism of action for collagenase Santyl?
- It uses the body's own enzymes and moisture to break down necrotic tissue.
- It selectively digests denatured collagen that anchors non-viable tissue to the wound bed. (Correct answer)
- It kills bacteria through the release of silver ions, which then allows for natural debridement.
- It physically pulls away devitalized tissue when the dressing is removed.
Correct answer: It selectively digests denatured collagen that anchors non-viable tissue to the wound bed.
Collagenase is an exogenous enzyme that selectively targets and digests the denatured collagen filaments that anchor necrotic tissue to the wound bed. This facilitates debridement without harming viable granulation tissue. Using the body's own enzymes is autolytic debridement, killing bacteria describes an antimicrobial, and physically pulling away tissue describes mechanical debridement.
Question 3: Which of the following dressing categories is known for its ability to donate moisture to a dry wound bed, promoting autolytic debridement?
- Calcium alginates
- Hydrocolloids
- Amorphous hydrogels (Correct answer)
- Foam dressings
Correct answer: Amorphous hydrogels
Amorphous hydrogels are water- or glycerin-based products with a high moisture content (often over 90% water). They are specifically designed to donate moisture to dry or desiccated wound beds, which softens slough and eschar and facilitates autolytic debridement. Alginates and foams are absorptive, and hydrocolloids manage minimal to moderate exudate.
Question 4: A home health nurse is caring for a patient with a deep, tunneling wound on the thigh with copious, purulent drainage and a suspected anaerobic infection. Which dressing would be contraindicated for this wound?
- Silver-impregnated alginate rope
- Hydrocolloid sheet (Correct answer)
- Gauze packing strip
- Foam dressing
Correct answer: Hydrocolloid sheet
Hydrocolloid dressings are occlusive, meaning they do not allow air or moisture to pass through. Using an occlusive dressing over an infected wound, especially a deep wound with suspected anaerobic infection, can trap bacteria and exudate, creating an environment that worsens the infection and can lead to abscess formation. Therefore, they are contraindicated in clinically infected wounds.
Question 5: When selecting a topical antimicrobial agent, a clinician considers the potential for cytotoxicity. Which of the following agents has historically been associated with causing damage to healthy fibroblasts and keratinocytes, potentially impairing wound healing?
- Medical-grade honey
- Povidone-iodine (Correct answer)
- Polyhexamethylene biguanide (PHMB)
- Cadexomer iodine
Correct answer: Povidone-iodine
While it is a broad-spectrum antiseptic, traditional povidone-iodine has been shown in multiple studies to be cytotoxic to essential wound healing cells like fibroblasts and keratinocytes. This potential to harm healthy tissue is why its routine use in open wounds is often limited in favor of less cytotoxic alternatives.
Question 6: A patient has a Stage 3 pressure injury on the sacrum with moderate serosanguinous drainage. The surrounding skin is erythematous and beginning to show signs of maceration. Which topical agent is most appropriate for application to the *periwound* skin?
- Amorphous hydrogel
- Collagenase ointment
- A silver-impregnated cream
- A zinc oxide-based moisture barrier (Correct answer)
Correct answer: A zinc oxide-based moisture barrier
The primary goal for the periwound skin in this scenario is to protect it from moisture-associated skin damage (MASD) or maceration caused by wound exudate. A zinc oxide-based moisture barrier cream or ointment creates a protective film on the skin, repelling moisture and preventing further breakdown. Hydrogel would add moisture, collagenase is a debrider for the wound bed, and an antimicrobial is not indicated for non-infected periwound skin.
Wound Care Certification Dressings and Topical Agents Questions and Answers
A patient has a moderately draining venous leg ulcer with 50% granulation tissue and 50% yellow slough.
The periwound skin is intact but requires protection from moisture.
Which dressing is MOST appropriate for this wound?