WOCN Wound Exam
CWCN Certification Exam 2026 –
WOCNCB Latest Verified over 400
Questions & Answers (Complete
Practice Test)
Goals of wound assessment 1. Determine etiologic factors
2. Assess systemic factors/comorbidities
3. Assess wound to determine phase of healing
4. Determine goals of topical therapy
Why does hyperglycemia affect wound healing? Impairs leukocyte function and negatively impacts collagen syntehesis,
development of tensile strength, epithelial resurfacing
What BG parameters should be maintained for wound BG <180 for leukocyte function; <140 for healing
healing? A1C <7 for most, <8 if hx of severe hypoglycemia, advanced comorbidities, limited
life expectancy
Why is nutrition relevant to wound healing? Muscle or SubQ wasting increases risk of pressure/shear damage
malnourished pt unable to synthesize and cross-link collagen normally
protein deficiency increases risk of infection
What effect do low zinc levels have on wound healing? compromise collagen synthesis/crosslinking
What amino acids are essential for collagen synthesis? Glutamine and l-arginine
What is the effect of stress on these amino acids? Not adequately produced during times of physiologic stress
What weight trend suggests nutritional deficiency? Unplanned weight loss =>2.5% of usual weight in 30 days or =>10% within 180 days
BMI <18.5
What serum albumin level indicates malnutrition? <3.5 g/dl
What serum transferrin level indicates malnutrition? <100mg/dl
What serum prealbumin level indicates malnutrition? <19.5
,What total lymphocyte count level indicates malnutrition? <1500
,What are s/s of nutritional deficits? skin rashes, cracks in mucous membranes, edema, muscle and subQ tissue
wasting, nonhealing wounds, dry/pluckable hair, dry flaky itchy skin
What is the suggested caloric intake? 30-35 cal/kg body weight
What is the suggested protein intake? 1.25-1.5 g/kg body weight
What is the suggested fluid intake? 30ml per kg (unless fluid restriction indicated)
How do you assess perfusion/oxygenation? capillary refill, pulses, presence/absence of edema, TcpO2 levels (at least 40),
color of wound bed (bright pink/red), ABI for lower extremity ulcers, systolic
bp/episodes of hypotension, vasopressor administration
How do you assess for immunosuppression? Comorbidities/therapies such as HIV, steroid tehrapy in doses >30mg/day for >30
days, and/or chemo resulting in neutropenia; high dose NSAIDs
What comorbidities compromise wound healing? renal failure, liver failure, multisystem trauma, smoking, advanced age
What are the layers of the skin Epidermis
Basement Membrane Zone
Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
What are the layers of the epidermis? Stratum corneum - keratinocytes filled with keratin
Stratum lucidum - only in palms/soles, thick areas
Stratum granulosum - odland bodies secrete ceramides, lipophilic
Stratum spinosum - desmosomes (cell to cell junctions)
Stratum germinativum - dermal-epidermal junction
What is the Basement Membrane Zone? Dermal-epidermal junction
What are the components of the dermis? Papillary dermis: papillae interlock with rete ridges, capillary loops, sensitive to
point pressure
Reticular dermis: mostly type 1 collagen, vasculars, and lymphatics
What structures of the skin can regenerate? Epidermis and parts of the dermis
What structures of the skin heal by scar formation? Epidermal appendages, Subcutaneous tissue/fascia/muscle
How is newborn skin different? No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? Very thin, increased fluid loss, functional stratum corneum at 30-32 weeks
What problems may arise with infant skin? increased permeability, increased MARSI risk, extravasation, diaper dermatitis
How do you mitigate MARSI risk in infants/elderly? avoid tape or use hydrocolloid base or silicone adhesive, no alcohol removers
only mineral oil, petroleum, silicone (preferred), and citrus)
, How do you mitigate extravasation in an infant? Hyaluronidase
OR
phentolamine if vasoconstrictor
How do you mitigate diaper dermatitis? Higher pH
Use petroleum base for mild erythema and zinc oxide for denuded skin
sever denudation - carboxymethylcellulose/petrolatum/zinc oxide (Ilex)
What bathing considerations must you take for premature <30 weeks bathe with water only for 2 weeks
infants?
What are common issues with older skin? Thinner, collagen shrinks and causes wrinkles
Rete ridges and dermal papillae flatten - increased risk for tears/stripping
Reduced sebaceous and sweat glands - dry skin
Erratic/decreased melanin production
Decreased sensation - increased trauma risk
Loss of SubQ tissue - increased shear and decreased insulation
Increased malignant lesions - refer to derm
Reduced blood flow, increased epidermal turnover - slow healing
Increased senescense
Maybe increased inflammatory mediators, decreased inhibitors
Increased capillary fragility (bruises)
What strategies keep skin healthy? pH balanced cleaners - no alkaline soaps
Superfatted nonalkaline soaps for dry skin
CHG reduces pathogens and sepsis
Individualize bathing schedule
Apply lubricants, oils, creams to clean slightly damp skin
What types of products are emollients? mineral oil, petrolatum, lanolin, ceramides
What do emollients do? penetrates stratum corneum to increase lipid component and soften
Layer on skin retards water loss to rehydrate
What is dimethicone? Moisture barrier that retards water loss
What products are humectants? glycerin, urea, propylene glycol, lachydrin, alpha hydroxy acids
What do humectants do? Water attractants - increase strateum corneum water content
Who are humectants for? Only for xerosis - not for macerated and sometimes not for fragile skin
Which tissue layer is most susceptible to ischemic Muscle/fascia layer
damage?
What is a macule Flat spot of color change less than 0.5cm in diameter
What is a papule Flat spot of color change greater than 0.5cm in diameter
What is a patch? Raised spot of color change less than 0.5cm in diameter
CWCN Certification Exam 2026 –
WOCNCB Latest Verified over 400
Questions & Answers (Complete
Practice Test)
Goals of wound assessment 1. Determine etiologic factors
2. Assess systemic factors/comorbidities
3. Assess wound to determine phase of healing
4. Determine goals of topical therapy
Why does hyperglycemia affect wound healing? Impairs leukocyte function and negatively impacts collagen syntehesis,
development of tensile strength, epithelial resurfacing
What BG parameters should be maintained for wound BG <180 for leukocyte function; <140 for healing
healing? A1C <7 for most, <8 if hx of severe hypoglycemia, advanced comorbidities, limited
life expectancy
Why is nutrition relevant to wound healing? Muscle or SubQ wasting increases risk of pressure/shear damage
malnourished pt unable to synthesize and cross-link collagen normally
protein deficiency increases risk of infection
What effect do low zinc levels have on wound healing? compromise collagen synthesis/crosslinking
What amino acids are essential for collagen synthesis? Glutamine and l-arginine
What is the effect of stress on these amino acids? Not adequately produced during times of physiologic stress
What weight trend suggests nutritional deficiency? Unplanned weight loss =>2.5% of usual weight in 30 days or =>10% within 180 days
BMI <18.5
What serum albumin level indicates malnutrition? <3.5 g/dl
What serum transferrin level indicates malnutrition? <100mg/dl
What serum prealbumin level indicates malnutrition? <19.5
,What total lymphocyte count level indicates malnutrition? <1500
,What are s/s of nutritional deficits? skin rashes, cracks in mucous membranes, edema, muscle and subQ tissue
wasting, nonhealing wounds, dry/pluckable hair, dry flaky itchy skin
What is the suggested caloric intake? 30-35 cal/kg body weight
What is the suggested protein intake? 1.25-1.5 g/kg body weight
What is the suggested fluid intake? 30ml per kg (unless fluid restriction indicated)
How do you assess perfusion/oxygenation? capillary refill, pulses, presence/absence of edema, TcpO2 levels (at least 40),
color of wound bed (bright pink/red), ABI for lower extremity ulcers, systolic
bp/episodes of hypotension, vasopressor administration
How do you assess for immunosuppression? Comorbidities/therapies such as HIV, steroid tehrapy in doses >30mg/day for >30
days, and/or chemo resulting in neutropenia; high dose NSAIDs
What comorbidities compromise wound healing? renal failure, liver failure, multisystem trauma, smoking, advanced age
What are the layers of the skin Epidermis
Basement Membrane Zone
Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
What are the layers of the epidermis? Stratum corneum - keratinocytes filled with keratin
Stratum lucidum - only in palms/soles, thick areas
Stratum granulosum - odland bodies secrete ceramides, lipophilic
Stratum spinosum - desmosomes (cell to cell junctions)
Stratum germinativum - dermal-epidermal junction
What is the Basement Membrane Zone? Dermal-epidermal junction
What are the components of the dermis? Papillary dermis: papillae interlock with rete ridges, capillary loops, sensitive to
point pressure
Reticular dermis: mostly type 1 collagen, vasculars, and lymphatics
What structures of the skin can regenerate? Epidermis and parts of the dermis
What structures of the skin heal by scar formation? Epidermal appendages, Subcutaneous tissue/fascia/muscle
How is newborn skin different? No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? Very thin, increased fluid loss, functional stratum corneum at 30-32 weeks
What problems may arise with infant skin? increased permeability, increased MARSI risk, extravasation, diaper dermatitis
How do you mitigate MARSI risk in infants/elderly? avoid tape or use hydrocolloid base or silicone adhesive, no alcohol removers
only mineral oil, petroleum, silicone (preferred), and citrus)
, How do you mitigate extravasation in an infant? Hyaluronidase
OR
phentolamine if vasoconstrictor
How do you mitigate diaper dermatitis? Higher pH
Use petroleum base for mild erythema and zinc oxide for denuded skin
sever denudation - carboxymethylcellulose/petrolatum/zinc oxide (Ilex)
What bathing considerations must you take for premature <30 weeks bathe with water only for 2 weeks
infants?
What are common issues with older skin? Thinner, collagen shrinks and causes wrinkles
Rete ridges and dermal papillae flatten - increased risk for tears/stripping
Reduced sebaceous and sweat glands - dry skin
Erratic/decreased melanin production
Decreased sensation - increased trauma risk
Loss of SubQ tissue - increased shear and decreased insulation
Increased malignant lesions - refer to derm
Reduced blood flow, increased epidermal turnover - slow healing
Increased senescense
Maybe increased inflammatory mediators, decreased inhibitors
Increased capillary fragility (bruises)
What strategies keep skin healthy? pH balanced cleaners - no alkaline soaps
Superfatted nonalkaline soaps for dry skin
CHG reduces pathogens and sepsis
Individualize bathing schedule
Apply lubricants, oils, creams to clean slightly damp skin
What types of products are emollients? mineral oil, petrolatum, lanolin, ceramides
What do emollients do? penetrates stratum corneum to increase lipid component and soften
Layer on skin retards water loss to rehydrate
What is dimethicone? Moisture barrier that retards water loss
What products are humectants? glycerin, urea, propylene glycol, lachydrin, alpha hydroxy acids
What do humectants do? Water attractants - increase strateum corneum water content
Who are humectants for? Only for xerosis - not for macerated and sometimes not for fragile skin
Which tissue layer is most susceptible to ischemic Muscle/fascia layer
damage?
What is a macule Flat spot of color change less than 0.5cm in diameter
What is a papule Flat spot of color change greater than 0.5cm in diameter
What is a patch? Raised spot of color change less than 0.5cm in diameter
