WOCNCB CFCN Foot Care - Final Test Review (Qns & Ans) - 2025, Exams of Nursing

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CFCN

Final Test Review

(Questions & Solutions)

1. Case: A 65-year-old man with type 2 diabetes presents with a 1.5 cm plantar ulcer beneath the first metatarsal head. He has a 5-second positive 10 g monofilament test and a 3 mm callus rim. What is your next priority? A. Prescribe topical antibiotic B. Debride hyperkeratosis and offload pressure C. Order MRI for osteomyelitis D. Initiate systemic antifungal therapy ANS : B Rationale: Callus debridement and offloading redistribute plantar pressure, a prerequisite for ulcer healing.
2. Case: A 70-year-old woman with nonhealing toe ulcer has an ABI of 0.68. Transcutaneous O₂ tension (TCOM) at the forefoot is 18 mmHg. What do these findings suggest? A. Adequate perfusion for healing B. Critical ischemia; refer for revascularization C. False-high ABI from calcification D. Vasospasm; start calcium channel blocker ANS : B Rationale: ABI <0.7 and TCOM <20 mmHg indicate insufficient perfusion; revascularization is indicated.
3. Case: A 58-year-old patient with chronic venous insufficiency has foot edema, hemosiderin staining, and superficial excoriations. Which intervention best addresses skin integrity? A. Ionic silver dressing B. Graduated compression stocking (30–40 mmHg) C. Topical corticosteroid ointment D. Daily talcum powder application ANS : B Rationale: Medical-grade compression reduces edema, improves venous return, and prevents dermatitis.

and scaling. KOH prep is positive. Next best step: A. Oral terbinafine B. Daily foot soaks in Epsom salts C. Topical tolnaftate 2 weeks D. Empiric topical steroid ANS : C Rationale: Topical tolnaftate is first-line for tinea pedis; systemic therapy reserved for refractory or extensive disease.

8. Case: A 68-year-old with claudication walks 100 m before calf pain. Doppler signals are monophasic in dorsalis pedis. Which foot-care advice is most appropriate? A. Encourage daily uphill walking B. Advise wide, cushioned shoes with rocker sole C. Teach daily foot inspection and cotton socks D. Start pneumatic compression boots ANS : C Rationale: In PAD, protect feet by inspecting daily, wearing moisture- wicking socks and well-fitting shoes.
9. A patient with a diabetic forefoot ulcer is nonadherent to removable off-loading. Which device yields the highest healing rates? A. Prefabricated rocker-bottom shoe B. Total contact cast C. Felted foam dressing D. Standard post-op shoe ANS : B Rationale: Total contact casting ensures consistent off-loading and yields superior healing outcomes.
10. Case: A post-amputation patient cannot use a total contact cast. Which off-loading alternative is best? A. Forefoot relief insole B. Charcot restraint orthotic walker C. Removable walking boot with crutches

D. Standard sneaker with padding ANS : C Rationale: A removable boot plus crutches provides effective pressure relief when casting is contraindicated.

11. Case: An elderly patient has longitudinal nail dystrophy, onychomycosis, and subungual hyperkeratosis. The most appropriate foot-care intervention is: A. Systemic fluconazole B. Careful nail debridement and topical ciclopirox C. Daily foot baths in vinegar D. Surgical nail removal ANS : B Rationale: Mechanical debridement plus topical antifungal is standard; systemic therapy if severe or multi-digit.
12. A 62-year-old has a 0.7 cm plantar ulcer classified as Wagner Grade II. What defines this grade? A. Superficial ulcer, no subcutaneous tissue involvement B. Ulcer penetrating to tendon or capsule C. Deep ulcer with abscess formation D. Gangrene of digit(s) ANS : B Rationale: Wagner II denotes penetration to deeper structures (tendon, joint capsule) without abscess. — FIB (n=8) —
13. The standard instrument for testing protective foot sensation is the 10-gram monofilament. Rationale: The 10 g Semmes–Weinstein monofilament assesses loss of protective sensation.
14. An ankle-brachial index (ABI) is calculated by dividing the higher ankle systolic pressure by the higher brachial systolic pressure. Rationale: ABI = ankle / brachial systolic pressures for PAD screening.

22. An ABI >1.30 indicates noncompressible arteries often due to medial arterial calcification. ANS : True Rationale: ABI >1.30 suggests vessel rigidity; TBI or TCOM is preferred.
23. A TCOM measurement below 30 mmHg predicts poor wound healing potential. ANS : True Rationale: TCOM <30 mmHg correlates with impaired angiogenesis and delayed healing.
24. In diabetic neuropathy, small-fiber testing with 128 Hz tuning fork is more sensitive than monofilament. ANS : False Rationale: Monofilament (large-fiber) detects protective loss; tuning fork tests vibration large-fiber function.
25. An elevated plantar temperature difference (>2 °C compared to contralateral foot) may indicate acute Charcot arthropathy. ANS : True Rationale: Local hyperemia and inflammation raise skin temperature in Charcot.
26. Peripheral arterial disease (PAD) with ABI <0.5 contraindicates sharp debridement of foot ulcers. ANS : True Rationale: Severe ischemia (ABI <0.5) risks tissue loss; revascularize before debridement.
27. Bioengineered skin substitutes are first-line for uncomplicated diabetic foot ulcers. ANS : False Rationale: Standard care (off-loading, debridement, moisture balance) precedes advanced modalities.

28. Regular use of pumice stones to remove plantar callus is recommended for diabetic patients with neuropathy. ANS : False Rationale: Self-use risks skin breaks; callus removal should be by trained clinician. — MR (n=12) —
29. Select all elements of a comprehensive diabetic foot examination: A. Inspection of skin color and lesions B. 10 g monofilament testing C. Ankle-brachial index measurement D. Quantitative sweat test E. Vibration perception threshold ANS : A, B, C, E Rationale: Skin inspection, sensation testing, ABI, and vibration threshold are routine; sweat test is research-based.
30. Effective off-loading strategies include (select all): A. Total contact cast B. Removable cast walker with adherence monitoring C. Custom molded infrared boot D. Forefoot off-loading shoe E. Extra-depth diabetic sneakers ANS : A, B, D, E Rationale: All provide pressure relief; custom infrared boot is not a standard device.
31. Critical factors to optimize foot ulcer healing (select all): A. Glycemic control B. Pressure redistribution C. Infection control D. Topical steroid use E. Adequate perfusion ANS : A, B, C, E

A. Culture and sensitivity B. Sharp debridement of necrotic tissue C. Empiric broad-spectrum antibiotics for 2 years D. Off-loading the infected area E. MRI to evaluate for osteomyelitis if bone involvement suspected ANS : A, B, D, E Rationale: Culture directs therapy; debridement and off-loading aid resolution; prolonged empiric antibiotics without culture is inappropriate.

36. Common foot dermatologic conditions in older adults include (select all): A. Tinea pedis B. Plantar callus C. Onychogryphosis D. Erythema nodosum E. Dyshidrotic eczema ANS : A, B, C, E Rationale: Fungal skin infection, callus, thickened nails, and eczema are prevalent; erythema nodosum is systemic.
37. Vascular assessment modalities for foot perfusion include (select all): A. ABI B. Toe brachial index (TBI) C. TCOM D. Laser-Doppler flowmetry E. Venous plethysmography ANS : A, B, C, D Rationale: ABI, TBI, TCOM, and laser-Doppler assess arterial; venous plethysmography measures venous function.
38. Management strategies for acute Charcot arthropathy include (select all): A. Total contact casting B. Custom Charcot restraint orthotic walker (CROW)

C. Early weight-bearing to promote bone remodeling D. Bisphosphonate therapy adjunct E. Frequent temperature monitoring ANS : A, B, D, E Rationale: Off-loading, protective devices, pharmacotherapy, and temperature checks are standard; early weight-bearing worsens collapse.

39. Key principles of clinical nail care in diabetic foot include (select all): A. Trim nails straight across B. Debride ingrown nails carefully C. Irrigate under nail plate before trimming D. Use corn pads for paronychia E. Maintain clean, dry interdigital spaces ANS : A, B, C, E Rationale: Proper trimming, debridement, cleaning prevent trauma and infection; corn pads risk pressure injury.
40. Indications for compression therapy in foot and ankle care include (select all): A. Chronic venous stasis dermatitis B. Lymphedema management C. Arterial insufficiency (ABI < 0.5) D. Post-traumatic edema E. Mixed etiology with adequate arterial flow ANS : A, B, D, E Rationale: Compression treats venous and lymphatic edema and post- traumatic swelling; contraindicated in severe arterial disease (ABI < 0.5). Multiple Choice Which of the following conditions is most commonly associated with diabetic foot ulcers? A) Peripheral vascular disease B) Osteoarthritis C) Gout D) Plantar fasciitis

D) Hyperbaric oxygen therapy Correct ANS : C Rationale: Debridement and proper wound care are essential for healing superficial diabetic foot ulcers. Fill-in-the-Blank Charcot foot is a condition characterized by __ of the foot bones, often seen in patients with neuropathy. Correct ANS : fracture and deformity Rationale: Charcot foot leads to fractures and deformities due to loss of sensation and unrecognized trauma. True/False True or False: Moisture control is not important in preventing foot ulcers. Correct ANS : False Rationale: Moisture control is crucial in preventing skin breakdown and subsequent foot ulcers. Multiple Response Which of the following are common signs of a foot infection? (Select all that apply) A) Redness B) Swelling C) Odor D) Cold temperature Correct ANS s: A, B, C Rationale: Redness, swelling, and odor are classic signs of infection, while cold temperature may indicate poor blood flow. Multiple Choice What is the most significant risk factor for developing a diabetic foot ulcer? A) Age B) Duration of diabetes

C) Body mass index D) Gender Correct ANS : B Rationale: The duration of diabetes is a critical risk factor as it correlates with the development of complications like foot ulcers. Fill-in-the-Blank The protective sensation of the feet is primarily assessed using a __ test. Correct ANS : monofilament Rationale: The monofilament test is a standard method to assess protective sensation in diabetic patients. True/False True or False: All forms of footwear are appropriate for patients with foot deformities. Correct ANS : False Rationale: Patients with foot deformities require specially designed footwear to prevent pressure sores and ulcers. Multiple Response Which of the following interventions are recommended for patients with peripheral neuropathy? (Select all that apply) A) Regular foot examinations B) Avoiding foot baths C) Wearing appropriate footwear D) Daily foot inspections Correct ANS s: A, C, D Rationale: Regular examinations, appropriate footwear, and daily inspections are essential to prevent complications. Multiple Choice Which type of dressing is most appropriate for a heavily exudating diabetic foot ulcer? A) Hydrocolloid dressing

A) To improve circulation B) To reduce pressure on the ulcer C) To enhance sensation D) To promote mobility Correct ANS : B Rationale: Offloading is specifically aimed at reducing pressure on the ulcer to facilitate healing. Fill-in-the-Blank The use of __ in the treatment of diabetic foot ulcers has been shown to enhance healing by providing a moist environment. Correct ANS : biological dressings Rationale: Biological dressings promote healing by maintaining moisture and protecting the ulcer. True/False True or False: The presence of calluses is beneficial for diabetic foot health. Correct ANS : False Rationale: Calluses can increase pressure and risk for ulceration in diabetic patients. Multiple Response Which of the following are recommended practices for patients post- foot ulcer healing? (Select all that apply) A) Regular follow-up appointments B) Self-monitoring of foot condition C) Discontinuation of diabetes medications D) Continued education on foot care Correct ANS s: A, B, D Rationale: Regular follow-ups, self-monitoring, and continuous education are critical for preventing recurrence.