CMSRN Wound & Ostomy Care Practice Questions

Question 1

An obese patient with a tracheostomy develops a pressure injury under the tube flange. Which prevention strategy is essential?

• A) A) Applying antibiotic ointment around the stoma twice daily
• B) B) Using foam padding to suspend the flange above the skin✓
• C) C) Rotating the tracheostomy tube 90 degrees every 4 hours
• D) D) Cleansing the site with hydrogen peroxide once per shift

Question 2

For a patient with darkly pigmented skin and a history of malnutrition, which technique best detects stage 1 pressure injury?

• A) A) Palpating for temperature changes over bony prominences✓
• B) B) Using a halogen light to inspect for subtle color shifts
• C) C) Assessing capillary refill time on the sacral area
• D) D) Comparing skin integrity to unaffected contralateral sites

Question 3

An agitated dementia patient with stage 3 pressure injuries repeatedly attempts to climb over bed rails in a dimly lit isolation room. Which environmental intervention balances safety and autonomy?

• A) A) Applying soft limb restraints and increasing sedation frequency
• B) B) Installing pressure-relieving mattress and using bed exit alarms
• C) C) Lowering the bed to floor level and adding motion-sensor lighting✓
• D) D) Implementing scheduled repositioning and raising all side rails

Question 4

A 72-year-old patient with type 2 diabetes and heart failure is admitted for pneumonia. The nurse observes a shallow open ulcer with pink wound bed and no slough on the sacrum, with partial-thickness skin loss. Which pressure injury stage does this presentation indicate?

• A) A) Stage 1: Non-blanchable erythema of intact skin
• B) B) Stage 2: Partial-thickness skin loss with exposed dermis✓
• C) C) Stage 3: Full-thickness skin loss with visible adipose tissue
• D) D) Unstageable: Full-thickness skin loss obscured by slough/eschar

Question 5

A patient with a sacral wound vac has "LOW PRESSURE" and "LEAK" alarms activated during ambulation. The dressing edges are intact, but tubing is disconnected from the canister port. How should the nurse respond?

• A) A) Reconnect tubing to the canister and restart suction after resealing the dressing✓
• B) B) Replace the entire dressing and tubing set using sterile technique
• C) C) Silence alarms temporarily and assess for fluid accumulation under the dressing
• D) D) Clamp tubing near the dressing, replace the canister, and restart suction

Question 6

An obese patient (BMI 42) with heart failure develops redness on their sacrum 48 hours post-admission. Skin is intact but warmer than surrounding tissue, with non-blanchable erythema. Which assessment is essential?

• A) A) Measure bilateral calf circumference
• B) B) Assess nutritional albumin/prealbumin levels
• C) C) Perform a 4-hourly Braden Scale reassessment✓
• D) D) Check for fecal incontinence episodes

Question 7

During a callback for a diabetic patient discharged after foot ulcer debridement, the patient reports new erythema extending 2cm around the wound and localized warmth. The patient's temperature is 37.8°C (100°F) orally. Which instruction is most appropriate?

• A) A) Apply ice to the area and monitor for temperature changes
• B) B) Increase insulin dosage by 20% for presumed hyperglycemia
• C) C) Elevate the foot and return to clinic at next scheduled visit
• D) D) Arrive at wound care clinic within 4 hours for assessment✓

Question 8

A diabetic patient with a stage III pressure injury expresses cultural reluctance toward protein-rich wound diets. The unit’s evidence-based guideline recommends high-protein nutrition, but the nurse notes limited research in culturally diverse populations. What is the optimal EBP approach?

• A) A) Strictly follow the guideline to ensure consistency with current best evidence
• B) B) Eliminate protein targets entirely to respect the patient’s cultural preferences
• C) C) Collaborate with the dietitian to modify protein sources aligning with cultural preferences✓
• D) D) Delay nutritional interventions until more inclusive research is available

Question 9

During a pressure injury CQI project, a nurse suggests involving physical therapists in skin assessments. The team has only included wound care nurses thus far. Which CQI tenet supports this suggestion?

• A) A) Leveraging interprofessional expertise for comprehensive solutions✓
• B) B) Restricting changes to directly involved disciplines
• C) C) Prioritizing speed by minimizing team size
• D) D) Using existing workflows to limit disruption

Question 10

A case manager coordinates care for a Spanish-speaking patient with low health literacy recovering from abdominal surgery. The patient expresses confusion about ostomy care despite interpreter use. Which strategy best addresses health equity?

• A) A) Providing printed educational materials in Spanish before discharge
• B) B) Requesting extended home health visits for hands-on teaching
• C) C) Arranging teach-back sessions using visual aids and simplified language✓
• D) D) Scheduling a family meeting with the wound care nurse present

Question 11

A nurse notes frequent supply shortages of wound vac equipment, causing delayed dressing changes. The materials management department reports budget constraints, and the nurse manager suggests "making do." Which approach follows organizational escalation protocols?

• A) A) Mobilizing nursing staff to share equipment across units informally
• B) B) Submitting a non-formulary supply request through clinical leadership✓
• C) C) Contacting the vendor directly for emergency donations
• D) D) Alerting hospital administration via anonymous safety hotline

Question 12

A postoperative patient on warfarin for atrial fibrillation develops a warm, erythematous incision with white exudate. International Normalized Ratio (INR) is 3.8. Which collaborative action is essential?

• A) A) Hold warfarin and initiate therapeutic enoxaparin
• B) B) Obtain wound culture before antibiotic administration✓
• C) C) Consult physical therapy for early mobility promotion
• D) D) Apply warm compresses four times daily to incision

Question 13

A construction worker with a new colostomy grimaces during wound care teaching, muttering, "Just give me the instructions." The nurse notes he learns best hands-on. Which action aligns with adult learning principles?

• A) A) Simplify verbal explanations using construction analogies for each step
• B) B) Have him perform pouch changes with guided practice immediately✓
• C) C) Show an instructional video followed by written quizzes
• D) D) Reassure him that skills improve with time and provide diagrams

Question 14

A patient with a new ileostomy and depression refuses to empty the pouch, stating, "It's disgusting." Which approach supports self-management?

• A) A) Arrange home health visits for ostomy care indefinitely
• B) B) Explore odor-control products during desensitization practice✓
• C) C) Schedule a peer visit from an ostomy support group member
• D) D) Prescribe antidepressant medication before resuming teaching

Question 15

A stroke patient with left hemiparesis and unilateral neglect resists repositioning. Which approach reduces agitation while preventing pressure injuries?

• A) A) Scheduled 2-hour turns toward the unaffected side
• B) B) Hourly shifts to the affected side with mirrors✓
• C) C) Continuous lateral rotation therapy
• D) D) Supine with frequent shoulder adjustments