As discussed in a prior blog, reflecting on why you want to become certified and knowing how to begin the process are some important initial steps when considering certification. Understanding certification, knowing how it relates to or potentially changes your current position and employer recognition are some important initial considerations as well. Certification is a mark of professionalism and a designation as an expert in your field of practice. After deciding on a certifying body that aligns with your goals and values, and those of your employer, the next step is to prepare for the exam.

Certification Exam Preparation Tips

Exam preparation is a process... it takes time, patience and can be costly. Remember to factor in the cost of exam prep materials along with the test taking fee when determining a budget. It is also beneficial to look at the cost and requirements for recertification. Be sure to determine which study materials you will use, and to set a budget, before deciding on an exam. Additionally, you should map out a timeline from start to finish.

The amount of detail can vary from significant events (registration, preparation and test date), to specific dates and times set aside for studying, as well as exam content to be focused on during those specific dates and times. Do what works for you based on your learning style and lifestyle! Also, be sure to review the exam content outline, usually available on the certifying body's website. This will help to determine which areas you should focus on and to understand the test breakdown.

An important take away point for any exam prep is to leave yourself enough time. Feeling rushed will not lend to exam success and the added stress will distract your focus from the exam questions. As we've all heard, getting a good night's rest, eating a good breakfast and going into the exam prepared are all important points for success. For wound care certification specifically, it is important to understand the basics along with the details. The skin is our largest organ, which also means there is a large amount of information and content areas that will be present on an exam. Some things to keep in mind with testing are to focus on the buzz words in the question, break down the question content, remember facts, safety first and try to recall the focus area for the question. Mark those answers you're unsure of and go back to check... however, be careful with changing answers or spending too much time on one question. You're the expert, you know this, and you're prepared! With the hopes to ease some test anxiety, let's try some sample questions... focusing on correct answers along with rationales (why the others are not correct).

Certification Sample Questions and Rationales

Question 1: A 78-year-old male patient with a diagnosis of dementia and functional incontinence presents with an open, shallow, circular wound over the coccyx. There is no surrounding skin damage or erythema. The wound measures 1.6cm x 1.7cm x 0.1cm and has a pink, shiny base. There is a small amount of serous drainage and no signs or symptoms of infection. The patient reports weakness and spending more time in bed. What are the wound etiology and initial treatment plan? A. Stage 1 pressure injury; offload pressure from the area, apply a clear film dressing daily. B. Moisture associated skin damage (MASD); apply barrier cream BID. C. Stage 2 pressure injury; apply a foam dressing biweekly, offload pressure, and implement a toileting schedule with nursing to reduce incontinence episodes. D. Pilonidal cyst; consult General Surgery.

Answer: C. Stage 2 pressure injury; apply a foam dressing, offload pressure, and implement a toileting schedule with nursing to reduce incontinence episodes.

Rationale: Because the wound is directly over the coccyx, circular and partial-thickness, it would be classified as a stage 2 pressure injury. A stage 1 pressure injury manifests as closed, reddened skin that is non-blanchable. Although the patient is incontinent, MASD is usually over a larger area, may be open or closed skin, and can be regularly or irregularly distributed. MASD is sometimes painful and can certainly lead to pressure. A pilonidal cyst is a chronic or recurrent wound that usually manifests at the upper gluteal cleft. It can become infected or inflamed, and usually requires surgical excision of the sinus. Pilonidal cysts typically manifest as a sinus tract that is chronic. It is important also to differentiate pilonidal cyst, hidradenitis suppurativa, anal fistulas and pressure injuries when determining a diagnosis or wound etiology and treatment plan. Also, remember to always identify wound etiology first, then develop a treatment plan, because the etiology of the wound usually guides your treatment.

Resources:

National Pressure Ulcer Advisory Panel (NPUAP). npuap.org. Accessed on May 17, 2019. Stechmiller JK, Cowan L, Oomens CWJ. Bottom-Up (Pressure Shear) Injuries. In: Doughty DB, McNichol LL, eds. WOCN Society Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016: 313-321.

Take away points or hints with this question:

• Know your pressure injury definitions from the National Pressure Ulcer Advisory Panel (NPUAP)
• Determine etiology first and then treatment second
• Remember to treat the actual cause of the wound along with a topical treatment plan
• Focus on key words (open, shallow wound) – this is partial-thickness, making the wound a stage 2

Question 2:

The ____________is the layer of skin found between the stratum corneum and the stratum granulosum. It consists of translucent cells present only on the palms of the hands and the soles of the feet. A. Stratum lucidum B. Stratum corneum C. Stratum basale D. Dermis

Answer:

A. The stratum lucidum

Rationale:

The stratum lucidum is not present on thinner skin and other body regions but is present on the palms of the hands and the soles of the feet. It is found between the stratum corneum and the stratum granulosum. The stratum corneum is the outermost layer of the epidermis; it is thickest on the soles of the feet and palms of the hands but present on other regions of the body. The stratum basale is the deepest layer of the epidermis and is characterized by proliferating keratinocytes. In addition, the dermis is the layer of the skin that is below the epidermis, and is the major anatomic component of the skin; the epidermis and the dermis do connect.

Resources:

Mufti A, Ayello E., Sibbald RG. Anatomy and Physiology of the Skin. In: Doughty DB, McNichol LL, eds. WOCN Society Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016: 4-5.

Take away points or hints with this question:

• Read closely – one of the answers may be eliminated early on because it wouldn't make sense to be listed in the question and again as an answer (stratum corneum)
• This questions focuses on memorization. Although it is important to understand concepts, some of these concepts need to be committed to memory to understand the cellular level and components of the skin as our largest organ.

Best of luck to you as you consider or actively prepare for wound care certification! Keep an eye out for future blogs on ostomy and continence certification preparation as well!

Suggested Reading:

Mufti A, Ayello E., & Sibbald RG. Anatomy and Physiology of the Skin. In: Doughty DB & McNichol LL, eds. WOCN Society Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016: 4-5. National Pressure Ulcer Advisory Panel (NPUAP). Retrieved from: npuap.org on 05/17/2019.

Stechmiller JK, Cowan L, & Oomens CWJ. Bottom-Up (Pressure Shear) Injuries. In: Doughty DB & McNichol LL, eds. WOCN Society Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016: 313-321.

About the Author

Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.