The questions on the certification examination for Wound, Ostomy and Continence Nursing come from the content outline found in the WOC Examination Handbook. The handbook is available for viewing on the Wound, Ostomy, Continence Nursing Certification Board Web site at http://www.wocncb.org. On the ostomy portion of the outline, topic B is general principles of management and patient teaching. Next to this heading is the number (23), which means that there are 23 questions on the examination about management of an ostomy and patient teaching. There will be recall, application, and analysis-level questions. Below are examples of the types of questions that could be included in this portion of the examination.

Recall-Level Question

1. For a patient who has had an abdominoperineal resection, you would teach about the care of a

A. permanent ileostomy.

B. temporary ileostomy.

C. permanent colostomy.

D. temporary colostomy.

Application-Level Question

2. In site marking a patient for an ostomy prior to surgery, it is most important to consider

A. the style of clothing he or she wears.

B. the abdominal contours.

C. his or her ability to learn to care for the ostomy.

D. where the patient would like to have the stoma.

Analysis-Level Question

3. A patient with an ileostomy has a denuded area of skin below the stoma. The patient reports recent frequent leakage from the pouching system usually from the bottom edge of the wafer and describes this area as raw and painful. The most likely etiology of this skin breakdown is

A. suture granulomas.

B. allergic dermatitis.

C. peristomal candidiasis.

D. irritant dermatitis.

Answers

1. (C) An abdominoperineal resection involves the removal of the rectum, anus, and sphincter mechanism with formation of a permanent end colostomy. A permanent ileostomy (A) is unnecessary as the remainder of the colon above the rectum is intact allowing for the formation of a sigmoid colostomy. A temporary ileostomy (B) or temporary colostomy (D) would not usually be done as closure of the ostomy is not possible when the anus and sphincter have been removed.

Reference

Vasilevsky C, Gordon P. Gastrointestinal cancers: surgical management. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions: Management Principles. St Louis, MO: Mosby; 2004:127.

2. (B) The abdominal contours are most important because if a stoma is placed in a crease or fold, or in area that is not easy for a person to visualize, it may be difficult to obtain an adequate seal for the pouching system. This will certainly have a negative effect on the person's quality of life for as long as he or she has a stoma. The style of clothing worn (A) and the patient's preference (D) may be a consideration in site marking if there are several choices, but these factors would not be the most important in selecting a site. The patient's ability to learn to care for the ostomy (C) would be a consideration in selecting a pouching system or teaching methods but would not influence stoma site marking.

Reference

Carmel J, Goldberg M. Preoperative and postoperative management. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions: Management Principles. St Louis, MO: Mosby; 2004:219-221.

3. (D) Irritant dermatitis is caused by skin contact with an irritant such as the fecal effluent. Since there is a recent history of leakage from the area where the skin is raw, this is the most likely cause. Suture granulomas (A) occur at the mucocutaneous junction and present as raised red bumps. Allergic dermatitis (B) presents as small vesicles and will usually involve the entire area covered by the skin barrier in the pouching system. Peristomal candidiasis (C) presents as a cluster of pustules with satellite lesions, which often cause pruritus.

Reference

Colwell J. Stomal and peristomal complications. In: Colwell J, Goldberg M, Carmel J, eds. Fecal and Urinary Diversions: Management Principles. St Louis, MO: Mosby; 2004:315-321.

Resources for Preparing for the WOC Certification Exam

Self Assessment Exam

* The Self-Assessment Exam (SAE) is a computer-based test available from the testing company that produces our exam. You can find this by going to Web site http://www.goamp.org and clicking on "e-store." Then select "Health Care" and then "Wound, Ostomy, Continence Nurses." For $90, you may purchase all 3 exams or for $30, you can purchase the exams individually. The SAE has 40 questions in each specialty and you may grade it as you take the test. References and the rationale for the answers are provided. The test is available for 90 days after purchase, and when you exit from the exam for the final time, you will be provided with a score report.

* The WOCN Society has CD-ROMs of the certification review course offered each year at their national conference. These may be purchased online at http://www.prolibraries.com/wocns/.

* The WOC Nursing Education Program at Emory University has a certification review manual for sale for $65.00. The order form is available online at http://www.surgery.emory.edu/wocnec/order.form.pdf. You may also obtain this order form by calling 404-778-3159 or by faxing your request to 404-778-4778.

* The Wound Care Education Program at the Medical College of South Carolina has a Wound Care Study Guide that may be purchased for $125.00 by contacting Carol Whelan at 843-792-265 or toll free at 866-637-6835.