Wound, Ostomy and Continence Nurses Society (WOCN) Practice Exam

What is a feature of spontaneously irreversible lymphedema?

1. Pitting edema that resolves with elevation

2. Non-pitting, rough texture with positive stemmer sign

3. Swelling that improves with fluid intake

4. Temporary swelling in response to injury

The correct answer is: Non-pitting, rough texture with positive stemmer sign

Spontaneously irreversible lymphedema is characterized by specific features that highlight the underlying pathophysiology of the condition. One prominent feature is non-pitting edema, which indicates that the swelling does not leave an indentation when pressure is applied. This occurs because the fluid accumulation in lymphedema is often due to the protein-rich lymph fluid that builds up, leading to a firm texture in the affected area. Additionally, the presence of a positive Stemmer sign – which is the inability to pinch and lift the skin on the dorsum of the second toe or finger – suggests significant lymphatic impairment. This sign specifically indicates advanced lymphedema, where the skin becomes thickened and fibrotic due to chronic fluid buildup and changes in the extracellular matrix. These characteristics make option B the correct choice for identifying a feature of spontaneously irreversible lymphedema. Other choices do not accurately represent the characteristics of this condition. For example, pitting edema that resolves with elevation is more typical of conditions like venous insufficiency. Options involving improvement with fluid intake or temporary swelling are not consistent with the chronic nature of spontaneously irreversible lymphedema, where the swelling is sustained and does not fluctuate significantly based on these factors