Wound Care Certification Exam Wound Care Certification Systemic Factors Affecting Healing 4 — Questions and Answers
Question 1: A patient with venous insufficiency has a wound that is not healing despite local wound care. The underlying systemic mechanism causing delayed healing is BEST described as:
- Arterial hypoperfusion causing tissue ischemia and necrosis
- Chronic venous hypertension leading to fibrin cuff formation and tissue hypoxia (Correct answer)
- Lymphatic obstruction causing immune cell accumulation
- Venous thrombosis blocking growth factor delivery to wound
Correct answer: Chronic venous hypertension leading to fibrin cuff formation and tissue hypoxia
Elevated venous pressure causes pericapillary fibrin cuff deposition, which acts as a diffusion barrier reducing oxygen and nutrient delivery to wound tissue.
Question 2: Radiation therapy to a wound area impairs healing primarily because it:
- Activates MMPs that degrade the extracellular matrix excessively
- Causes obliterative endarteritis, reducing microvascular blood supply (Correct answer)
- Directly denatures fibronectin, preventing cell adhesion
- Elevates TGF-β to levels that trigger excessive inflammation
Correct answer: Causes obliterative endarteritis, reducing microvascular blood supply
Radiation damages endothelial cells and causes progressive obliterative endarteritis (fibrosis of small vessels), permanently impairing tissue perfusion.
Question 3: Which vitamin plays a key role in keratinocyte differentiation and epithelialization, and its deficiency is associated with delayed wound healing?
- Vitamin K
- Vitamin D
- Vitamin A (Correct answer)
- Vitamin E
Correct answer: Vitamin A
Vitamin A promotes keratinocyte proliferation and differentiation, as well as collagen synthesis; deficiency impairs epithelialization and inflammatory phase initiation.
Question 4: A patient with sickle cell disease has a chronic leg ulcer. The primary mechanism contributing to impaired healing in this condition is:
- Elevated hemoglobin causes hyperviscosity, blocking capillary flow
- Sickling of red cells causes vaso-occlusion, leading to tissue ischemia (Correct answer)
- Sickle cell anemia reduces platelet count below hemostatic levels
- Abnormal hemoglobin releases excess iron that damages fibroblasts
Correct answer: Sickling of red cells causes vaso-occlusion, leading to tissue ischemia
Sickled erythrocytes occlude microvessels, creating repeated ischemia-reperfusion injury and chronic tissue hypoxia that prevent wound healing.
Question 5: NSAIDs (non-steroidal anti-inflammatory drugs) taken chronically can impair early wound healing because they:
- Directly inhibit fibroblast DNA replication
- Block prostaglandin synthesis, impairing platelet aggregation and early inflammation (Correct answer)
- Cause systemic vitamin C depletion over time
- Reduce hepatic albumin synthesis by inhibiting COX enzymes in hepatocytes
Correct answer: Block prostaglandin synthesis, impairing platelet aggregation and early inflammation
NSAIDs inhibit COX enzymes, reducing prostaglandins needed for platelet aggregation and triggering the inflammatory cascade essential to early wound healing.
Question 6: Zinc deficiency specifically impairs wound healing by affecting which process?
- Oxygen transport to wound tissue
- Collagen cross-linking and DNA polymerase activity needed for cell division (Correct answer)
- Platelet activation at injury sites
- Lymphocyte-mediated immune surveillance
Correct answer: Collagen cross-linking and DNA polymerase activity needed for cell division
Zinc is a cofactor for DNA polymerase and collagen-stabilizing enzymes; deficiency impairs cell proliferation and collagen synthesis during wound repair.
Question 7: A morbidly obese patient undergoes bariatric surgery and develops a post-operative wound dehiscence. Beyond poor vascularity, which additional obesity-related factor contributes most to dehiscence?
- Excess adipose hormones (adipokines) activate collagenase at wound margins
- Increased mechanical tension on the wound due to abdominal fat mass (Correct answer)
- Hyperlipidemia coats suture material, preventing tissue adhesion
- Elevated leptin levels suppress macrophage recruitment
Correct answer: Increased mechanical tension on the wound due to abdominal fat mass
The mechanical tension exerted by a large abdominal pannus places constant stress on incision lines, overwhelming even adequate collagen formation and causing dehiscence.
Wound Care Certification Exam Wound Care Certification Systemic Factors Affecting Healing 4
A patient with venous insufficiency has a wound that is not healing despite local wound care.
The underlying systemic mechanism causing delayed healing is BEST described as: