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

What prevents a fistula from closing effectively?

1. High volume output

2. Short fistula tract

3. Low nutrient intake

4. Stable bowel wall

The correct answer is: High volume output

A high volume output from a fistula can prevent effective closure for several reasons. When a fistula has a high volume output, it typically indicates significant fluid loss, which can lead to dehydration and an imbalance of electrolytes in the body. The continuous flow of secretions can also interfere with the wound healing process, as it creates a moist environment that can hinder the development of healthy granulation tissue necessary for closure. Additionally, high output may lead to skin irritation and breakdown, making the surrounding area difficult to manage and complicating efforts to promote healing. The body's resources become directed towards maintaining fluid balance and replacing lost nutrients rather than focusing on repairing the fistula. Therefore, managing output is critical in promoting the chances of a successful closure. In contrast, a short fistula tract may actually facilitate closure as the distance between the inner and outer openings is small, making it easier for tissues to heal together. Low nutrient intake can impact overall health and healing but does not directly prevent closure as effectively as high output does. A stable bowel wall, while indicating a healthy surrounding structure, does not actively contribute to closure if high output continues.