Wound Care Certification Exam Wound Care Certification Systemic Factors Affecting Healing 5 — Questions and Answers
Question 1: Which hemoglobin A1c (HbA1c) level is generally considered the threshold above which wound healing is significantly compromised in diabetic patients?
- Above 6.5%
- Above 7.0%
- Above 8.0% (Correct answer)
- Above 9.0%
Correct answer: Above 8.0%
HbA1c above 8% is associated with significantly impaired leukocyte function, angiogenesis, and collagen synthesis, substantially increasing wound healing risk.
Question 2: A patient on dialysis for end-stage renal disease has a non-healing wound. Beyond uremic toxins, which electrolyte imbalance common in ESRD further impairs wound healing?
- Hyponatremia reducing cellular osmotic pressure
- Hyperphosphatemia causing vascular calcification and reduced tissue perfusion (Correct answer)
- Hyperkalemia directly inhibiting collagen synthesis
- Hypocalcemia blocking platelet activation
Correct answer: Hyperphosphatemia causing vascular calcification and reduced tissue perfusion
Hyperphosphatemia in ESRD promotes vascular calcification, narrowing vessel lumens and further reducing perfusion to wound tissue.
Question 3: Which immune condition is associated with neutrophil dysfunction that results in recurrent wound infections and impaired healing despite a normal white blood cell count?
- HIV/AIDS with CD4 count below 200
- Poorly controlled type 2 diabetes mellitus (Correct answer)
- Chronic lymphocytic leukemia
- Systemic lupus erythematosus
Correct answer: Poorly controlled type 2 diabetes mellitus
Hyperglycemia in type 2 diabetes impairs neutrophil chemotaxis, phagocytosis, and oxidative burst, compromising innate immunity despite normal neutrophil numbers.
Question 4: A patient with protein-calorie malnutrition has a Stage 3 pressure injury. What is the MINIMUM daily protein intake generally recommended to support wound healing in malnourished patients?
- 0.6–0.8 g/kg/day
- 1.0–1.2 g/kg/day
- 1.25–1.5 g/kg/day (Correct answer)
- 2.0–2.5 g/kg/day
Correct answer: 1.25–1.5 g/kg/day
Current guidelines recommend 1.25–1.5 g/kg/day of protein for patients with pressure injuries to support collagen synthesis and immune function.
Question 5: Which mechanism explains how smoking impairs wound healing at the microvascular level?
- Nicotine raises blood pH, denaturing collagen enzymes
- Carbon monoxide binds hemoglobin, reducing oxygen delivery; nicotine causes vasoconstriction (Correct answer)
- Tar particles physically block capillary lumen flow
- Cigarette chemicals elevate serum fibrinogen to wound-toxic levels
Correct answer: Carbon monoxide binds hemoglobin, reducing oxygen delivery; nicotine causes vasoconstriction
Carbon monoxide from smoking reduces hemoglobin oxygen-carrying capacity while nicotine-induced vasoconstriction compounds tissue hypoxia at wound sites.
Question 6: Depression and chronic psychological stress impair wound healing primarily through which neuroendocrine pathway?
- Increased serotonin causes vasoconstriction at wound margins
- Elevated cortisol from HPA axis activation suppresses immune function and collagen synthesis (Correct answer)
- Dopamine deficiency reduces pain signaling that triggers wound care behavior
- Chronic stress depletes acetylcholine needed for local wound vasodilation
Correct answer: Elevated cortisol from HPA axis activation suppresses immune function and collagen synthesis
Chronic stress activates the HPA axis, elevating cortisol, which suppresses the immune response and downregulates collagen production needed for tissue repair.
Question 7: A wound care specialist identifies lymphedema as a contributing factor in a patient's non-healing lower extremity wound. Lymphedema impairs healing primarily because:
- Lymphatic fluid has a high pH that inactivates wound healing enzymes
- Protein-rich edema fluid creates a hypoxic environment and serves as a bacterial culture medium (Correct answer)
- Lymphatic obstruction prevents platelet delivery to the wound site
- Excess lymph fluid dilutes growth factors below therapeutic concentrations
Correct answer: Protein-rich edema fluid creates a hypoxic environment and serves as a bacterial culture medium
Lymphedema causes protein-rich fluid accumulation that increases tissue oxygen diffusion distance, impairs immune cell trafficking, and supports bacterial growth.
Wound Care Certification Exam Wound Care Certification Systemic Factors Affecting Healing 5
Which hemoglobin A1c (HbA1c) level is generally considered the threshold above which wound healing is significantly compromised in diabetic patients?