J Wound Ostomy Continence Nurs. 2013;40(5):533-535. Published by Lippincott Williams & Wilkins
GETTING READY FOR CERTIFICATION
Overcoming WOCNCB Test Anxiety Carolyn A. Sorensen
Kay Durkop-Scott
■ Introduction Test anxiety is defined as perceived arousal, reported worry, self-denigrating thoughts, tension, and reports of somatic symptoms in examinations or similar evaluative situations.1 It is common and can develop for a number of reasons. Test anxiety may be a reminder of previous negative experiences, lack of confidence, fear of failure, or anxiety over employment linked to successful certification. Factors likely to aggravate test anxiety include poor study habits, inadequate preparation, and feeling overwhelmed by the amount of information that must be mastered. Although some degree of apprehension is helpful when preparing for a certification examination, excessive anxiety can prompt negative thoughts and frustration. These distressing emotions may result in “going blank” when trying to recall important information, misreading questions, or changing correct answers to incorrect. Physical reactions related to test anxiety gone awry include heart palpitations, nausea, and sweaty palms. With some simple strategies, high levels of anxiety can be controlled, resulting in improved test performance. The Knowledge Base, Anxiety control, Test–Taking Skills2 framework was developed to assist new nursing graduates to pass the NCLEX exam. This same skill set can be useful in assisting the WOC nurse in preparing for the WOCNCB Certification Exams. Knowledge is enhanced by developing a study plan based on your assessment of your own personal strengths and weaknesses. We recommend beginning the least familiar components of the examination. For instance, if you work in a wound care clinic and also see ostomy patients, your strongest skill set is most likely those that have pouching difficulties. So, begin your ostomy review with those types of ostomies that are unfamiliar to you, such as continent or pediatric diversions. We also recommend using a standardized practice examination to determine areas of need. The WOCNCB’s Self-Assessment Exam (SAE) is available on the WOCNCB Web site (http://www.wocncb.org/about/). It provides multiple-choice questions that reflect the content areas, level of difficulty, and format of the actual examination. Practice examinations are accessible through any computer with Internet access. The SAE is constructed to give the test-taker feedback on all answer options and thus is
Lea R. Crestodina
an invaluable tool in developing a study plan on the basis of identified problem areas. Multiple strategies can be used to control anxiety. Selfawareness can be pivotal in managing test anxiety. Maintaining a positive attitude and avoiding negative thoughts about your performance are powerful tools to overcome testing anxiety. We have observed that getting a good night’s sleep and eating a healthy diet contribute to a feeling of well-being that reduces the negative effects of text anxiety. Familiarity with types of questions used on the certification examination helps the tester feel more confident. Here is where the SAE is particularly helpful. It identifies the type of question and offers insights on correct and incorrect options. Three types of questions are used on the WOCNCB certification exams: recall, application, and analysis. Refer to Amy Schaffner’s 2009 Certification Feature column (volume 36, issue 3, pages 327-329) for a more detailed explanation of these question types.
■ References 1. Damer D, Melendres L. “Tackling test anxiety”: a group for college students. J Spec Group Work. 2011;36(3):163-177. 2. McDowell B. KATTS: a framework for maximizing NCLEX-RN performance. J Nurs Educ. 2008;47(4):183-185.
Question 1: A 70-year-old patient with a new ileostomy due to a ruptured diverticula returns from physical therapy complaining of lethargy, muscle cramps, and abdominal cramping. Past medical history includes type 2 diabetes mellitus, hypertension, and hypothyroidism. The WOC nurse understands that it is important to teach the patient to: a. b. c. d.
Take blood pressure medication as prescribed Increase fluid intake to 10 to 12 8-ounce glasses per day Eat foods that are high in potassium Check blood glucose before and after physical therapy
Carolyn A. Sorensen, MSN, RN, CRRN, CWOCN. Kay Durkop-Scott, BSN, RN, CWOCN. Lea R. Crestodina, MSN, ARNP, CWOCN, CDE. Correspondence: Anniekay Erby, WOCNCB Office, 555 E. Wells St, Ste 1100, Milwaukee, WI 53202 ([email protected]). DOI: 10.1097/WON.0b013e3182a4655f
Copyright © 2013 by the Wound, Ostomy and Continence Nurses Society™
J WOCN
■ September/October 2013 533
Copyright © 2013 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
WON200508.indd 533
8/28/13 11:12 AM
534
J WOCN
Sorensen et al
Answer: B. Lethargy, muscle cramps, abdominal cramping, increased thirst, decreased urine output, and dry mouth are all common symptoms of dehydration. A person with an ileostomy is at risk for dehydration because of the loss of the colon’s absorptive function. Exercise can compound this risk so it is imperative that the patient is taught to recognize the symptoms of dehydration, and how to prevent dehydration with an adequate fluid intake of 10 to 12 eight-ounce glasses of liquid per day. This question tests an understanding of potential complications with an ileostomy and applied education for prevention of those complications.
■ Distractors A. Symptoms of hypotension include lethargy, weakness, fatigue, and dizziness, but there is nothing to suggest that this patient has either under- or overmedicated with his antihypertensives. Similarity to the symptoms of dehydration can be confusing, but there is no indication in this scenario that the patient is overmedicated with antihypertensives. C. Eating high-potassium foods may be important if the patient is not taking a potassium-sparing diuretic, but this is not noted in the question. D. Symptoms of hypoglycemia include shakiness, diaphoresis, lethargy, irritability, restlessness, and possibly disorientation. Although similar to the symptoms described here, there is no abdominal pain or muscle cramping associated with hypoglycemia. Content Outline Number: 020405; Question Type: Analysis
■ September/October 2013
discomfort in the lower abdomen, bloating, and constipation with this condition.
■ Distractors A. Ulcerative colitis is characterized by edematous, granular, and erythematous smooth bowel mucosa with pinpoint ulcerations. B. When diverticula become inflamed and/or infected, diverticulitis is suspected. The most common symptom of diverticulitis is severe abdominal pain that comes on suddenly. The intensity of the pain can fluctuate. A person may experience cramping, nausea, vomiting, fever, chills, or a change in bowel habits. C. Crohn’s disease is characterized by focal, discontinuous, irregular-shaped ulcerations predisposing to strictures and fistulas. Content Outline Number: 020100; Question Type: Recall
■ References 1.
2.
Colwell JC, Goldberg MT, Carmel JE. Fecal and Urinary Diversions: Management Principles. Chicago, IL: Mosby; 2004: 66-67, 137-139. National Digestive Diseases Information Clearinghouse. Diverticulosis and diverticulitis [electronic version]. National Digestive Diseases Information Clearinghouse (Publication No. 08-1163). http://digestive.niddk.nih.gov/ddiseases/pubs/ diverticulosis/index.aps. Published 2008. Accessed April 2013.
■ References
Question 3: A patient with bladder cancer has a radical cystectomy with construction of an orthotopic neobladder. Incontinence can be a problem postoperatively, so the WOC nurse teaches the patient that the one of the best ways to prevent this is by:
1. Colwell JC, Goldberg MT, Carmel JE. Fecal and Urinary Diversions: Management Principles. Chicago, IL: Mosby; 2004:234. 2. Goldberg M, Aukett LK, Carmel J, et al. Management of the Patient With a Fecal Ostomy: Best Practice Guideline for Clinicians. Mount Laurel, NJ: Wound Ostomy and Continence Nurses Society; 2010:13-14.
a. Performing pelvic floor muscle (PFM) exercises up to 2 to 3 times daily b. Clean intermittent catheterization c. Irrigating the neobladder to reduce mucous d. Drinking enough fluids (2-3 L) to dilute the urine
Question 2: A patient is admitted to the hospital with abdominal pain, cramps, and bloating. The WOC nurse is consulted to mark the patient for an ileostomy in the right lower quadrant. The colonoscopy reveals small lesions of mucosa and submucosa that balloon out through the muscularis layer of the intestinal wall. The WOC nurse knows that this finding is consistent with:
Answer: A. The postoperative patient with an orthotopic neobladder must first learn to recognize the sensation of bladder filling. This may be difficult, especially at night, so incontinence, especially at night, is common. Patients then must learn how to regain control over urination. Because the orthotopic neobladder lacks the contractility of a normal bladder, patients are taught to relax and bear down. Correctly identifying and relaxing the PFMs will facilitate emptying. Conversely, learning to strengthen and squeeze the PFMs can prevent accidental leakage.
a. Ulcerative colitis b. Diverticulitis c. Crohn’s disease d. Diverticulosis Answer: D. Diverticulosis is a condition in which pouches of intestinal lining balloon out through weakened areas of the intestinal wall. The pouches are called diverticula. Some people may experience crampy pain or
■ Distractors B. Clean intermittent catheterization may be performed postoperatively and sometimes long term to facilitate emptying and help evacuate mucous.
Copyright © 2013 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
WON200508.indd 534
8/28/13 11:12 AM
J WOCN
■ Volume 40/Number 5
C. Irrigation may be done to prevent blockage from mucous, always short term and sometimes long term, but is not the primary method of preventing incontinence. D. Adequate fluid intake is important to reduce the risk of urinary tract infection and constipation postoperatively, but this is also not the best answer related to incontinence. Content Outline Number: 020704; Question Type: Application
Sorensen et al
535
■ References 1. Colwell JC, Goldberg MT, Carmel JE. Fecal and Urinary Diversions: Management Principles. Chicago, IL: Mosby; 2004: 201-202. 2. Herdiman O, Ong K, Johnson L, Lawrentschuk N. Orthotopic bladder substitution (neobladder) part II: postoperative complications, management, and long-term follow-up. J Wound Ostomy Continence Nurs. 2013;40(2):175-177.
Copyright © 2013 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
WON200508.indd 535
8/28/13 11:12 AM
GETTING READY FOR CERTIFICATION
Overcoming WOCNCB Test Anxiety Carolyn A. Sorensen
Kay Durkop-Scott
■ Introduction Test anxiety is defined as perceived arousal, reported worry, self-denigrating thoughts, tension, and reports of somatic symptoms in examinations or similar evaluative situations.1 It is common and can develop for a number of reasons. Test anxiety may be a reminder of previous negative experiences, lack of confidence, fear of failure, or anxiety over employment linked to successful certification. Factors likely to aggravate test anxiety include poor study habits, inadequate preparation, and feeling overwhelmed by the amount of information that must be mastered. Although some degree of apprehension is helpful when preparing for a certification examination, excessive anxiety can prompt negative thoughts and frustration. These distressing emotions may result in “going blank” when trying to recall important information, misreading questions, or changing correct answers to incorrect. Physical reactions related to test anxiety gone awry include heart palpitations, nausea, and sweaty palms. With some simple strategies, high levels of anxiety can be controlled, resulting in improved test performance. The Knowledge Base, Anxiety control, Test–Taking Skills2 framework was developed to assist new nursing graduates to pass the NCLEX exam. This same skill set can be useful in assisting the WOC nurse in preparing for the WOCNCB Certification Exams. Knowledge is enhanced by developing a study plan based on your assessment of your own personal strengths and weaknesses. We recommend beginning the least familiar components of the examination. For instance, if you work in a wound care clinic and also see ostomy patients, your strongest skill set is most likely those that have pouching difficulties. So, begin your ostomy review with those types of ostomies that are unfamiliar to you, such as continent or pediatric diversions. We also recommend using a standardized practice examination to determine areas of need. The WOCNCB’s Self-Assessment Exam (SAE) is available on the WOCNCB Web site (http://www.wocncb.org/about/). It provides multiple-choice questions that reflect the content areas, level of difficulty, and format of the actual examination. Practice examinations are accessible through any computer with Internet access. The SAE is constructed to give the test-taker feedback on all answer options and thus is
Lea R. Crestodina
an invaluable tool in developing a study plan on the basis of identified problem areas. Multiple strategies can be used to control anxiety. Selfawareness can be pivotal in managing test anxiety. Maintaining a positive attitude and avoiding negative thoughts about your performance are powerful tools to overcome testing anxiety. We have observed that getting a good night’s sleep and eating a healthy diet contribute to a feeling of well-being that reduces the negative effects of text anxiety. Familiarity with types of questions used on the certification examination helps the tester feel more confident. Here is where the SAE is particularly helpful. It identifies the type of question and offers insights on correct and incorrect options. Three types of questions are used on the WOCNCB certification exams: recall, application, and analysis. Refer to Amy Schaffner’s 2009 Certification Feature column (volume 36, issue 3, pages 327-329) for a more detailed explanation of these question types.
■ References 1. Damer D, Melendres L. “Tackling test anxiety”: a group for college students. J Spec Group Work. 2011;36(3):163-177. 2. McDowell B. KATTS: a framework for maximizing NCLEX-RN performance. J Nurs Educ. 2008;47(4):183-185.
Question 1: A 70-year-old patient with a new ileostomy due to a ruptured diverticula returns from physical therapy complaining of lethargy, muscle cramps, and abdominal cramping. Past medical history includes type 2 diabetes mellitus, hypertension, and hypothyroidism. The WOC nurse understands that it is important to teach the patient to: a. b. c. d.
Take blood pressure medication as prescribed Increase fluid intake to 10 to 12 8-ounce glasses per day Eat foods that are high in potassium Check blood glucose before and after physical therapy
Carolyn A. Sorensen, MSN, RN, CRRN, CWOCN. Kay Durkop-Scott, BSN, RN, CWOCN. Lea R. Crestodina, MSN, ARNP, CWOCN, CDE. Correspondence: Anniekay Erby, WOCNCB Office, 555 E. Wells St, Ste 1100, Milwaukee, WI 53202 ([email protected]). DOI: 10.1097/WON.0b013e3182a4655f
Copyright © 2013 by the Wound, Ostomy and Continence Nurses Society™
J WOCN
■ September/October 2013 533
Copyright © 2013 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
WON200508.indd 533
8/28/13 11:12 AM
534
J WOCN
Sorensen et al
Answer: B. Lethargy, muscle cramps, abdominal cramping, increased thirst, decreased urine output, and dry mouth are all common symptoms of dehydration. A person with an ileostomy is at risk for dehydration because of the loss of the colon’s absorptive function. Exercise can compound this risk so it is imperative that the patient is taught to recognize the symptoms of dehydration, and how to prevent dehydration with an adequate fluid intake of 10 to 12 eight-ounce glasses of liquid per day. This question tests an understanding of potential complications with an ileostomy and applied education for prevention of those complications.
■ Distractors A. Symptoms of hypotension include lethargy, weakness, fatigue, and dizziness, but there is nothing to suggest that this patient has either under- or overmedicated with his antihypertensives. Similarity to the symptoms of dehydration can be confusing, but there is no indication in this scenario that the patient is overmedicated with antihypertensives. C. Eating high-potassium foods may be important if the patient is not taking a potassium-sparing diuretic, but this is not noted in the question. D. Symptoms of hypoglycemia include shakiness, diaphoresis, lethargy, irritability, restlessness, and possibly disorientation. Although similar to the symptoms described here, there is no abdominal pain or muscle cramping associated with hypoglycemia. Content Outline Number: 020405; Question Type: Analysis
■ September/October 2013
discomfort in the lower abdomen, bloating, and constipation with this condition.
■ Distractors A. Ulcerative colitis is characterized by edematous, granular, and erythematous smooth bowel mucosa with pinpoint ulcerations. B. When diverticula become inflamed and/or infected, diverticulitis is suspected. The most common symptom of diverticulitis is severe abdominal pain that comes on suddenly. The intensity of the pain can fluctuate. A person may experience cramping, nausea, vomiting, fever, chills, or a change in bowel habits. C. Crohn’s disease is characterized by focal, discontinuous, irregular-shaped ulcerations predisposing to strictures and fistulas. Content Outline Number: 020100; Question Type: Recall
■ References 1.
2.
Colwell JC, Goldberg MT, Carmel JE. Fecal and Urinary Diversions: Management Principles. Chicago, IL: Mosby; 2004: 66-67, 137-139. National Digestive Diseases Information Clearinghouse. Diverticulosis and diverticulitis [electronic version]. National Digestive Diseases Information Clearinghouse (Publication No. 08-1163). http://digestive.niddk.nih.gov/ddiseases/pubs/ diverticulosis/index.aps. Published 2008. Accessed April 2013.
■ References
Question 3: A patient with bladder cancer has a radical cystectomy with construction of an orthotopic neobladder. Incontinence can be a problem postoperatively, so the WOC nurse teaches the patient that the one of the best ways to prevent this is by:
1. Colwell JC, Goldberg MT, Carmel JE. Fecal and Urinary Diversions: Management Principles. Chicago, IL: Mosby; 2004:234. 2. Goldberg M, Aukett LK, Carmel J, et al. Management of the Patient With a Fecal Ostomy: Best Practice Guideline for Clinicians. Mount Laurel, NJ: Wound Ostomy and Continence Nurses Society; 2010:13-14.
a. Performing pelvic floor muscle (PFM) exercises up to 2 to 3 times daily b. Clean intermittent catheterization c. Irrigating the neobladder to reduce mucous d. Drinking enough fluids (2-3 L) to dilute the urine
Question 2: A patient is admitted to the hospital with abdominal pain, cramps, and bloating. The WOC nurse is consulted to mark the patient for an ileostomy in the right lower quadrant. The colonoscopy reveals small lesions of mucosa and submucosa that balloon out through the muscularis layer of the intestinal wall. The WOC nurse knows that this finding is consistent with:
Answer: A. The postoperative patient with an orthotopic neobladder must first learn to recognize the sensation of bladder filling. This may be difficult, especially at night, so incontinence, especially at night, is common. Patients then must learn how to regain control over urination. Because the orthotopic neobladder lacks the contractility of a normal bladder, patients are taught to relax and bear down. Correctly identifying and relaxing the PFMs will facilitate emptying. Conversely, learning to strengthen and squeeze the PFMs can prevent accidental leakage.
a. Ulcerative colitis b. Diverticulitis c. Crohn’s disease d. Diverticulosis Answer: D. Diverticulosis is a condition in which pouches of intestinal lining balloon out through weakened areas of the intestinal wall. The pouches are called diverticula. Some people may experience crampy pain or
■ Distractors B. Clean intermittent catheterization may be performed postoperatively and sometimes long term to facilitate emptying and help evacuate mucous.
Copyright © 2013 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
WON200508.indd 534
8/28/13 11:12 AM
J WOCN
■ Volume 40/Number 5
C. Irrigation may be done to prevent blockage from mucous, always short term and sometimes long term, but is not the primary method of preventing incontinence. D. Adequate fluid intake is important to reduce the risk of urinary tract infection and constipation postoperatively, but this is also not the best answer related to incontinence. Content Outline Number: 020704; Question Type: Application
Sorensen et al
535
■ References 1. Colwell JC, Goldberg MT, Carmel JE. Fecal and Urinary Diversions: Management Principles. Chicago, IL: Mosby; 2004: 201-202. 2. Herdiman O, Ong K, Johnson L, Lawrentschuk N. Orthotopic bladder substitution (neobladder) part II: postoperative complications, management, and long-term follow-up. J Wound Ostomy Continence Nurs. 2013;40(2):175-177.
Copyright © 2013 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
WON200508.indd 535
8/28/13 11:12 AM
