Wound Care Certification Exam Wound Care Certification Systemic Factors Affecting Healing 2 — Questions and Answers
Question 1: Which mechanism explains why patients with chronic kidney disease (CKD) experience impaired wound healing?
- Elevated erythropoietin levels stimulate excess collagen
- Uremic toxins inhibit fibroblast proliferation and collagen synthesis (Correct answer)
- Hyperkalemia directly damages keratinocytes
- Decreased renin production reduces tissue perfusion
Correct answer: Uremic toxins inhibit fibroblast proliferation and collagen synthesis
Uremic toxins that accumulate in CKD inhibit fibroblast function and impair collagen synthesis, delaying wound repair.
Question 2: A patient on long-term systemic corticosteroids presents with a non-healing surgical wound. Which cellular process is most directly impaired by corticosteroids?
- Platelet aggregation at the wound site
- Neutrophil and macrophage inflammatory response (Correct answer)
- Endothelial cell apoptosis
- Erythrocyte oxygen transport
Correct answer: Neutrophil and macrophage inflammatory response
Corticosteroids suppress the inflammatory phase by inhibiting neutrophil and macrophage activity, which are essential for wound debridement and growth factor release.
Question 3: Which nutritional deficiency most directly impairs hydroxylation of proline and lysine, weakening collagen cross-linking?
- Vitamin A deficiency
- Vitamin C deficiency (Correct answer)
- Zinc deficiency
- Iron deficiency
Correct answer: Vitamin C deficiency
Vitamin C (ascorbic acid) is a required cofactor for prolyl and lysyl hydroxylase enzymes that stabilize collagen's triple helix structure.
Question 4: A patient with poorly controlled hypothyroidism has a wound that is healing slowly. What is the primary reason thyroid hormone deficiency impairs healing?
- Hypothyroidism raises cortisol, suppressing inflammation
- Reduced basal metabolic rate decreases cellular energy for repair (Correct answer)
- Thyroid hormone directly cleaves fibrin clots
- Low T3 causes hyperglycemia, damaging capillaries
Correct answer: Reduced basal metabolic rate decreases cellular energy for repair
Thyroid hormones regulate basal metabolic rate; deficiency reduces the energy available for cell proliferation, protein synthesis, and tissue remodeling.
Question 5: Peripheral arterial disease (PAD) impairs wound healing primarily by:
- Increasing venous hypertension and edema at the wound site
- Reducing oxygen and nutrient delivery due to arterial insufficiency (Correct answer)
- Causing lymphatic obstruction and protein accumulation
- Elevating inflammatory cytokines that degrade collagen
Correct answer: Reducing oxygen and nutrient delivery due to arterial insufficiency
PAD reduces arterial blood flow, limiting the oxygen and nutrients required for cellular proliferation and collagen synthesis.
Question 6: Which laboratory value is the BEST indicator of a patient's long-term nutritional status and protein availability for wound healing?
- Serum albumin
- Prealbumin (transthyretin) (Correct answer)
- C-reactive protein
- Hemoglobin A1c
Correct answer: Prealbumin (transthyretin)
Prealbumin has a half-life of 2–3 days, making it the most sensitive short-to-medium-term marker of current protein status and nutritional change.
Question 7: Obesity impairs wound healing through which DIRECT mechanism?
- Increased serum lipids coat collagen fibers, preventing cross-linking
- Adipose tissue is poorly vascularized, reducing oxygen tension at wound edges (Correct answer)
- Obesity elevates platelet count, causing excessive clot formation
- High BMI triggers autoimmune destruction of fibroblasts
Correct answer: Adipose tissue is poorly vascularized, reducing oxygen tension at wound edges
Adipose tissue has relatively poor blood supply, resulting in lower oxygen tension in subcutaneous layers and impairing the oxygen-dependent steps of wound healing.
Wound Care Certification Exam Wound Care Certification Systemic Factors Affecting Healing 2
Which mechanism explains why patients with chronic kidney disease (CKD) experience impaired wound healing?