Certified Wound Care Nurse (CWCN) Practice Exam

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What is a key indicator of primary lymphedema during a clinical examination?

  1. Positive Stemmer's sign

  2. Negative Stemmer's sign

  3. High limb temperature

  4. Skin discoloration

The correct answer is: Negative Stemmer's sign

The negative Stemmer's sign is a key indicator of primary lymphedema during a clinical examination. This sign is tested by attempting to pinch the skin at the base of the second toe or finger. In individuals with lymphedema, this skin fold cannot be lifted, leading to a positive Stemmer's sign. A negative Stemmer's sign suggests that the skin can be pinched and lifted easily, indicating that significant lymphedema is not present at that time. This is particularly relevant for distinguishing primary lymphedema, which typically presents with different characteristics compared to secondary lymphedema. In the context of other indicators, high limb temperature might suggest inflammation or an acute infection rather than lymphedema, while skin discoloration can be attributed to various conditions, including venous stasis and not exclusively to lymphedema. A positive Stemmer's sign indicates the presence of significant fluid accumulation in the tissue, implying a more severe form of lymphedema than what is identified by a negative sign, reinforcing the importance of the negative Stemmer's sign in identifying a lack of lymphedema.