WOCN Wound Exam with elaborated
questions answers 2025\2026
Goals of wound assessment - correct answers-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? - correct answers-Impairs leukocyte function and
negatively impacts collagen syntehesis, development of tensile strength, epithelial resurfacing
What BG parameters should be maintained for wound healing? - correct answers-BG <180 for leukocyte
function; <140 for healing
A1C <7 for most, <8 if hx of severe hypoglycemia, advanced comorbidities, limited life expectancy
Why is nutrition relevant to wound healing? - correct answers-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? - correct answers-compromise collagen
synthesis/crosslinking
What amino acids are essential for collagen synthesis?
What is the effect of stress on these amino acids? - correct answers-Glutamine and l-arginine
Not adequately produced during times of physiologic stress
What weight trend suggests nutritional deficiency? - correct answers-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? - correct answers-<3.5 g/dl
What serum transferrin level indicates malnutrition? - correct answers-<100mg/dl
What serum prealbumin level indicates malnutrition? - correct answers-<19.5
What total lymphocyte count level indicates malnutrition? - correct answers-<1500
What are s/s of nutritional deficits? - correct answers-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? - correct answers-30-35 cal/kg body weight
What is the suggested protein intake? - correct answers-1.25-1.5 g/kg body weight
What is the suggested fluid intake? - correct answers-30ml per kg (unless fluid restriction indicated)
How do you assess perfusion/oxygenation? - correct answers-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? - correct answers-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? - correct answers-renal failure, liver failure,
multisystem trauma, smoking, advanced age
What are the layers of the skin - correct answers-Epidermis
Basement Membrane Zone
,Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
What are the layers of the epidermis? - correct answers-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? - correct answers-Dermal-epidermal junction
What are the components of the dermis? - correct answers-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? - correct answers-Epidermis and parts of the dermis
What structures of the skin heal by scar formation? - correct answers-Epidermal appendages,
Subcutaneous tissue/fascia/muscle
How is newborn skin different? - correct answers-No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? - correct answers-Very thin, increased fluid loss, functional
stratum corneum at 30-32 weeks
, What problems may arise with infant skin? - correct answers-increased permeability, increased MARSI
risk, extravasation, diaper dermatitis
How do you mitigate MARSI risk in infants/elderly? - correct answers-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? - correct answers-Hyaluronidase
OR
phentolamine if vasoconstrictor
How do you mitigate diaper dermatitis? - correct answers-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 infants? - correct answers-<30 weeks bathe
with water only for 2 weeks
What are common issues with older skin? - correct answers-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)
questions answers 2025\2026
Goals of wound assessment - correct answers-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? - correct answers-Impairs leukocyte function and
negatively impacts collagen syntehesis, development of tensile strength, epithelial resurfacing
What BG parameters should be maintained for wound healing? - correct answers-BG <180 for leukocyte
function; <140 for healing
A1C <7 for most, <8 if hx of severe hypoglycemia, advanced comorbidities, limited life expectancy
Why is nutrition relevant to wound healing? - correct answers-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? - correct answers-compromise collagen
synthesis/crosslinking
What amino acids are essential for collagen synthesis?
What is the effect of stress on these amino acids? - correct answers-Glutamine and l-arginine
Not adequately produced during times of physiologic stress
What weight trend suggests nutritional deficiency? - correct answers-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? - correct answers-<3.5 g/dl
What serum transferrin level indicates malnutrition? - correct answers-<100mg/dl
What serum prealbumin level indicates malnutrition? - correct answers-<19.5
What total lymphocyte count level indicates malnutrition? - correct answers-<1500
What are s/s of nutritional deficits? - correct answers-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? - correct answers-30-35 cal/kg body weight
What is the suggested protein intake? - correct answers-1.25-1.5 g/kg body weight
What is the suggested fluid intake? - correct answers-30ml per kg (unless fluid restriction indicated)
How do you assess perfusion/oxygenation? - correct answers-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? - correct answers-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? - correct answers-renal failure, liver failure,
multisystem trauma, smoking, advanced age
What are the layers of the skin - correct answers-Epidermis
Basement Membrane Zone
,Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
What are the layers of the epidermis? - correct answers-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? - correct answers-Dermal-epidermal junction
What are the components of the dermis? - correct answers-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? - correct answers-Epidermis and parts of the dermis
What structures of the skin heal by scar formation? - correct answers-Epidermal appendages,
Subcutaneous tissue/fascia/muscle
How is newborn skin different? - correct answers-No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? - correct answers-Very thin, increased fluid loss, functional
stratum corneum at 30-32 weeks
, What problems may arise with infant skin? - correct answers-increased permeability, increased MARSI
risk, extravasation, diaper dermatitis
How do you mitigate MARSI risk in infants/elderly? - correct answers-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? - correct answers-Hyaluronidase
OR
phentolamine if vasoconstrictor
How do you mitigate diaper dermatitis? - correct answers-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 infants? - correct answers-<30 weeks bathe
with water only for 2 weeks
What are common issues with older skin? - correct answers-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)
