Maximize Examination Preparation With Self Assessment Exam

All of us have grown up hearing the words, “Practice makes perfect”! There is much wisdom in this old adage. It certainly applies to psychomotor skills such as learning how to give an injection or discerning the difference between heart and lung sounds. It also takes practice to apply classroom learning and critical thinking in the direct care of patients. WOCNCB certified nurses are professionals who have demonstrated that they can indeed provide high-quality care by utilizing a specialized set of psychomotor skills and knowledge in the care of patients with wounds, ostomies, incontinence, and foot and nail conditions. This same principle applies when preparing to take the certification exam. Very few people can simply walk into a testing site cold and successfully take the exam. To be successful, most people need to prepare in some way. Preparation for certification by taking a practice certification exam can be very beneficial. Many CWOCN candidates are “rusty” when it comes to test taking skills and need to practice both the psychomotor component, taking a computerized exam, and the cognitive component that requires critically thinking through a question. The WOCNCB offers the opportunity to take a practice test, the Self Assessment Examination (SAE), on our Web site, www.WOCNCB.org. The Web-based exam gives you instantaneous scoring and results, along with feedback on your answers. Each specialty SAE (wounds, ostomy, continence, or foot care) includes 40 questions that are representative of the questions on the certification exam. Once purchased, you will have 90 days to access that SAE and return to the SAE to review the information as a means of study, as long as you do not submit it for scoring. Immediately after you select “Score,” the exam will close out, and you will receive your score with feedback detailing your areas of strength and need. With this information you will be able to go directly to the examination content outline found in the Examination Handbook and focus your study on those areas of need. Practice may not make “perfect” but it is a time-honored strategy to maximize your success as you prepare for certification. The following continence questions are representative of questions found on the WOCNCB continence exam. The questions are of 3 types: recall, application, and analysis. The answers, reference citations, and content outline identifiers follow the questions. Visit WOCNCB in New Orleans Attending the WOCN's 43rd Annual Conference? Visit our booth! Online PGP demos Questions answered Win a certification fee! WOCNCB & Social Media Follow WOCNCB on Facebook, YouTube, Twitter, and LinkedIn. Online PGP for WOC Recertification As of 1-1-11, only online Professional Growth Portfolio (PGP) submissions are accepted for recertification in wound, ostomy or continence. Take a test cruise at www.wocncb.org/pgp. CASTLE now WOCNCB Exam Provider As of October 1, 2010, a new provider began administering certification exams. The new exam manager, Castle Worldwide, Inc, stands ready to assist you with an online application and registration system. CASTLE provides over 450 exam sites in the United States and Canada and over 200 additional international sites. More information is available at www.WOCNCB.org. Become a Certified Foot Care Nurse® The WOCNCB offers foot care certification to RNs. No bachelor's degree is required. Learn more at www.wocncb.org/WhyCFCN. Not Recertifying Due to Economic Issues? The WOCNCB created a Benevolence Fund in 2007 to cover exam fees in times like these. Don't let your certification lapse. Contact [email protected]. All inquiries are treated with the utmost confidentiality. Contact the WOCNCB 1-888-496–2622 [email protected] What urinary incontinence containment product is best indicated for a 57-year-old man who is experiencing small amounts of urinary leakage with strenuous exercise and coughing after having a robotic prostatectomy? Disposable brief External catheter Intermittent catheterization Penile pouch A 68-year-old woman with a history of a recent sling procedure complains of urinary frequency and loss of urine when she lifts heavy objects or with exercise. She changes her incontinence containment pad 4 to 5 times a day and 2 times at night. Which diagnostic test would best assist in planning treatment for her incontinence? Uroflow Postvoid residual by ultrasound EMG studies Urodynamic study Which of the following intermittent catheterization schedules is the most appropriate for a patient with multiple sclerosis requiring intermittent catheterization? Catheterize: 2 times a day and whenever leakage is experienced. every 8 hours and when needed for feelings of fullness or leakage. based upon frequency of previous voiding patterns. based upon tracked intake and bladder volumes. When teaching a female patient pelvic muscle exercises for urge incontinence, what best explains why the exercises work? Detrusor contractions are inhibited. The internal sphincter is strengthened. Pelvic muscle relaxation is improved. The resting tone of the levator ani muscle is improved. A dually incontinent, elderly nursing home resident with severe dementia passes hard dry stools 2 or fewer times a week. Which of the following interventions is most appropriate as initial treatment? Start a bowel-training program Sensory motor reeducation via biofeedback Increase fiber in the diet Daily stimulant laxatives Question 1: The correct answer to this application-level question is option d. When recommending a containment product, it is important to select a product that matches the volume of urine leakage as well as to provide protection that is discreet and allows for independent toileting. The penile pouch drip-collector is designed for small-volume leakage such as what our patient here is experiencing. A disposable brief is designed for moderate to severe leakage as well as for the containment of fecal incontinence. External or condom-type catheters are also indicated for moderate or severe incontinence and would prohibit self-toileting. Intermittent catheterization is not indicated for this type of incontinence. Reference Newman DK, Wein AJ. Managing and Treating Urinary Incontinence. 2nd ed. Baltimore, MD: Health Professions Press; 2009:373–425. Content Outline Location: III-B-5-b Question 2: The correct answer to this analysis-level question is option d. A urodynamic study would give valuable information toward diagnosis of this complex symptom profile. Urodynamic evaluation would determine if the patient had hypersensitivity when filling, adequate sensory and motor function, or leakage due to detrusor overactivity vs that due to inadequate sphincter function. A postvoid residual would only evaluate an ability to adequately empty the bladder. EMG evaluates s the function of the pelvic floor muscles. Reference Krissovich M. Pathology and management of the overactive bladder. In: Dougherty D, ed. Urinary and Fecal Incontinence Current Management Concepts. 3rd ed. St Louis, MO: Mosby; 2006:132–133. Content Outline Location: III-A-7-c Question 3: The answer to the application-level question is option d. The frequency of intermittent catheterization in a patient with urinary retention is based upon the need to prevent bladder over distention. A general rule to follow is not to allow catheterized volumes to exceed 400 to 500 mL. The patient with multiple sclerosis may not have adequate bladder sensation or be able to fully empty the bladder. Being as the disease can be progressive, basing a catheterization schedule upon previous voiding patterns is not appropriate. Reference Moore K. Pathology and management of acute and chronic urinary retention. In: Dougherty D, ed. Urinary and Fecal Incontinence Current Management Concepts. 3rd ed. St Louis, MO: Mosby; 2006:237–238. Newman DK, Wein AJ. Managing and Treating Urinary Incontinence. 2nd ed. Baltimore, MD: Health Professions Press; 2009:454–455. Content Outline Location: B-4-h Question 4: The answer to this knowledge-level question is option A. The role of the pelvic muscle exercises in the treatment of overactive bladder and urgency incontinence is to improve reflex tone of the pelvic floor muscles, which is one of the normal physiologic mechanisms to suppress bladder contractility during filling. The internal urethral sphincter is primarily constructed of smooth muscle and thus outside voluntary control. Pelvic muscle relaxation is an important part of pelvic muscle exercises but does not play a role in inhibition of detrusor contractions. Overall tone of the levator ani muscle is critical in maintaining urethral resistance during episodes of increased abdominal pressure thus excellent treatment for stress UI. Reference Krissovich M. Pathology and management of the overactive bladder. In: Dougherty D, ed. Urinary and Fecal Incontinence Current Management Concepts. 3rd ed. St Louis, MO: Mosby; 2006:146. Newman DK, Wein AJ. Managing and Treating Urinary Incontinence. 2nd ed. Baltimore, MD: Health Professions Press; 2009:266–272. Content Outline Location: III-B-4-a Question 5: The answer to this application-level question is option c. First-line treatment for constipation is to create soft, bulky stools by adding fiber in the diet. A bowel-training program and sensory motor reeducation via biofeedback would not be indicated in a patient with severe dementia. Daily stimulant laxatives are reserved for constipation that is unresponsive to fiber and osmotic laxatives and are thus not initial treatment options. Reference Bliss DZ, Doughty DB, Heitkemper MM. Pathology and management of bowel dysfunction. In: Dougherty D, ed. Urinary and Fecal Incontinence Current Management Concepts. 3rd ed. St Louis, MO: Mosby; 2006:442–444. Content Outline Location: III-C-3-a

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