WOCN WOUND EXAM PRACTICE PAPER 2026
COMPLETE SOLUTIONS
◉ Why does hyperglycemia affect wound healing? Answer: Impairs
leukocyte function and negatively impacts collagen syntehesis,
development of tensile strength, epithelial resurfacing
◉ What BG parameters should be maintained for wound healing?
Answer: 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? Answer: 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? Answer:
compromise collagen synthesis/crosslinking
◉ What amino acids are essential for collagen synthesis?
,What is the effect of stress on these amino acids? Answer: Glutamine
and l-arginine
Not adequately produced during times of physiologic stress
◉ What weight trend suggests nutritional deficiency? Answer:
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? Answer: <3.5
g/dl
◉ What serum transferrin level indicates malnutrition? Answer:
<100mg/dl
◉ What serum prealbumin level indicates malnutrition? Answer:
<19.5
◉ What total lymphocyte count level indicates malnutrition?
Answer: <1500
◉ What are s/s of nutritional deficits? Answer: 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? Answer: 30-35 cal/kg body
weight
◉ What is the suggested protein intake? Answer: 1.25-1.5 g/kg body
weight
◉ What is the suggested fluid intake? Answer: 30ml per kg (unless
fluid restriction indicated)
◉ How do you assess perfusion/oxygenation? Answer: 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? Answer:
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? Answer: renal
failure, liver failure, multisystem trauma, smoking, advanced age
◉ What are the layers of the skin Answer: Epidermis
, Basement Membrane Zone
Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
◉ What are the layers of the epidermis? Answer: 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? Answer: Dermal-
epidermal junction
◉ What are the components of the dermis? Answer: 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? Answer: Epidermis
and parts of the dermis
COMPLETE SOLUTIONS
◉ Why does hyperglycemia affect wound healing? Answer: Impairs
leukocyte function and negatively impacts collagen syntehesis,
development of tensile strength, epithelial resurfacing
◉ What BG parameters should be maintained for wound healing?
Answer: 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? Answer: 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? Answer:
compromise collagen synthesis/crosslinking
◉ What amino acids are essential for collagen synthesis?
,What is the effect of stress on these amino acids? Answer: Glutamine
and l-arginine
Not adequately produced during times of physiologic stress
◉ What weight trend suggests nutritional deficiency? Answer:
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? Answer: <3.5
g/dl
◉ What serum transferrin level indicates malnutrition? Answer:
<100mg/dl
◉ What serum prealbumin level indicates malnutrition? Answer:
<19.5
◉ What total lymphocyte count level indicates malnutrition?
Answer: <1500
◉ What are s/s of nutritional deficits? Answer: 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? Answer: 30-35 cal/kg body
weight
◉ What is the suggested protein intake? Answer: 1.25-1.5 g/kg body
weight
◉ What is the suggested fluid intake? Answer: 30ml per kg (unless
fluid restriction indicated)
◉ How do you assess perfusion/oxygenation? Answer: 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? Answer:
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? Answer: renal
failure, liver failure, multisystem trauma, smoking, advanced age
◉ What are the layers of the skin Answer: Epidermis
, Basement Membrane Zone
Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
◉ What are the layers of the epidermis? Answer: 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? Answer: Dermal-
epidermal junction
◉ What are the components of the dermis? Answer: 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? Answer: Epidermis
and parts of the dermis
