Wound Care Certification Exam Wound Care Certification Systemic Factors Affecting Healing 3 — Questions and Answers
Question 1: A patient receiving chemotherapy develops a wound that fails to progress through the proliferative phase. Chemotherapy most likely impairs healing by:
- Increasing platelet-derived growth factor (PDGF) to toxic levels
- Suppressing rapidly dividing cells including fibroblasts and keratinocytes (Correct answer)
- Causing direct collagenase release from tumor cells
- Elevating serum calcium, which inhibits angiogenesis
Correct answer: Suppressing rapidly dividing cells including fibroblasts and keratinocytes
Chemotherapy targets rapidly dividing cells; fibroblasts and keratinocytes essential for wound repair are collateral casualties of cytotoxic therapy.
Question 2: Which hematologic condition most directly impairs the inflammatory phase of wound healing by reducing the supply of growth factors released during clot formation?
- Polycythemia vera
- Thrombocytopenia (Correct answer)
- Leukocytosis
- Hypercoagulable state
Correct answer: Thrombocytopenia
Platelets degranulate at injury sites releasing PDGF, TGF-β, and EGF; thrombocytopenia reduces this critical growth factor reservoir.
Question 3: A wound care nurse notes that a patient with rheumatoid arthritis on methotrexate has impaired wound healing. Methotrexate contributes primarily by:
- Blocking TNF-α receptors on fibroblasts
- Inhibiting folate metabolism required for DNA synthesis and cell proliferation (Correct answer)
- Directly lysing collagen type I fibers
- Stimulating excess MMP-9 activity
Correct answer: Inhibiting folate metabolism required for DNA synthesis and cell proliferation
Methotrexate is a folate antagonist; by blocking dihydrofolate reductase it impairs DNA synthesis, reducing fibroblast and keratinocyte proliferation.
Question 4: In a patient with liver cirrhosis, which specific mechanism most impairs wound healing?
- Portal hypertension increases wound exudate volume
- Impaired hepatic synthesis of clotting factors and albumin reduces healing capacity (Correct answer)
- Elevated ammonia directly inactivates matrix metalloproteinases
- Jaundice causes bilirubin to inhibit keratinocyte migration
Correct answer: Impaired hepatic synthesis of clotting factors and albumin reduces healing capacity
The liver synthesizes clotting factors for hemostasis and albumin for protein stores; cirrhosis impairs both, undermining the inflammatory and proliferative phases.
Question 5: Which effect of uncontrolled diabetes MOST directly reduces the tensile strength of a healing wound?
- Hyperglycemia glycates collagen, impairing its structural integrity (Correct answer)
- High glucose causes cellular dehydration, thinning wound edges
- Diabetes increases sebaceous gland secretion, blocking collagen deposition
- Elevated insulin resistance activates keratinocyte apoptosis
Correct answer: Hyperglycemia glycates collagen, impairing its structural integrity
Non-enzymatic glycation of collagen molecules in hyperglycemia cross-links them abnormally, reducing their mechanical strength and wound tensile integrity.
Question 6: An elderly patient's wound heals significantly slower than a younger adult with the same injury. Which age-related change is the PRIMARY contributor?
- Increased skin sebum production traps bacteria at wound edges
- Decreased macrophage function and reduced growth factor production slow repair (Correct answer)
- Aging causes excess scar tissue formation, blocking epithelialization
- Elevated estrogen in elderly patients inhibits collagen synthesis
Correct answer: Decreased macrophage function and reduced growth factor production slow repair
Aging reduces macrophage efficiency and diminishes growth factor secretion, prolonging the inflammatory phase and delaying transition to proliferation.
Question 7: Which nutritional marker best reflects a patient's IMMEDIATE (within 48–72 hours) response to nutritional intervention in wound care?
- Serum albumin
- Transferrin
- Prealbumin (transthyretin) (Correct answer)
- Total lymphocyte count
Correct answer: Prealbumin (transthyretin)
Prealbumin's 2–3 day half-life makes it the most responsive lab marker for monitoring acute changes in nutritional status after intervention.
Wound Care Certification Exam Wound Care Certification Systemic Factors Affecting Healing 3
A patient receiving chemotherapy develops a wound that fails to progress through the proliferative phase.
Chemotherapy most likely impairs healing by: