CERTIFIED WOUND CARE NURSE
(CWCN) PRACTICE EXAM 2026/2027
1. Which of the following cellular components is primarily responsible for the degradation of
the extracellular matrix (ECM) in a chronic wound stalled in the inflammatory phase?
A. Matrix Metalloproteinases (MMPs)
B. Platelet-derived growth factors (PDGF)
C. Tissue Inhibitors of Metalloproteinases (TIMPs)
D. Keratinocytes
Answer: A
Conceptual Explanation: MMPs are enzymes that break down the ECM. In chronic
wounds, an imbalance where MMPs outweigh their inhibitors (TIMPs) leads to excessive
tissue degradation and stalls healing.
2. A patient presents with a full-thickness pressure injury where the base is completely
covered by yellow slough and tan eschar. How should this injury be staged?
A. Unstageable Pressure Injury
B. Stage 4 Pressure Injury
,C. Stage 3 Pressure Injury
D. Deep Tissue Pressure Injury (DTPI)
Answer: A
Conceptual Explanation: If slough or eschar obscures the extent of tissue loss, the injury
is classified as Unstageable until enough devitalized tissue is removed to visualize the
wound bed.
3. An Ankle-Brachial Index (ABI) result of 1.45 in a patient with a history of long-standing
diabetes likely indicates which of the following?
A. Normal arterial flow
B. Non-compressible calcified vessels
C. Mild peripheral artery disease
D. Severe arterial occlusion
Answer: B
Conceptual Explanation: An ABI > 1.3 usually indicates calcification of the tunica media
(Mönckeberg’s sclerosis), which is common in diabetic patients and makes the vessels non-
compressible.
4. During the proliferative phase of wound healing, which process involves the formation of
new blood vessels from pre-existing ones?
A. Hemostasis
, B. Epibole
C. Angiogenesis
D. Apoptosis
Answer: C
Conceptual Explanation: Angiogenesis is the physiological process through which new
blood vessels form from pre-existing vessels, essential for supplying nutrients to the
granulation tissue.
5. Which of the following is considered the ‘Gold Standard’ for the diagnosis of osteomyelitis
in a deep diabetic foot ulcer?
A. Bone biopsy and culture
B. Plain Film Radiograph (X-ray)
C. Magnetic Resonance Imaging (MRI)
D. Probing to bone (PTB) test
Answer: A
Conceptual Explanation: While MRI is the gold standard for imaging, a bone biopsy with
histological and microbiological analysis remains the definitive diagnostic gold standard
for osteomyelitis.
(CWCN) PRACTICE EXAM 2026/2027
1. Which of the following cellular components is primarily responsible for the degradation of
the extracellular matrix (ECM) in a chronic wound stalled in the inflammatory phase?
A. Matrix Metalloproteinases (MMPs)
B. Platelet-derived growth factors (PDGF)
C. Tissue Inhibitors of Metalloproteinases (TIMPs)
D. Keratinocytes
Answer: A
Conceptual Explanation: MMPs are enzymes that break down the ECM. In chronic
wounds, an imbalance where MMPs outweigh their inhibitors (TIMPs) leads to excessive
tissue degradation and stalls healing.
2. A patient presents with a full-thickness pressure injury where the base is completely
covered by yellow slough and tan eschar. How should this injury be staged?
A. Unstageable Pressure Injury
B. Stage 4 Pressure Injury
,C. Stage 3 Pressure Injury
D. Deep Tissue Pressure Injury (DTPI)
Answer: A
Conceptual Explanation: If slough or eschar obscures the extent of tissue loss, the injury
is classified as Unstageable until enough devitalized tissue is removed to visualize the
wound bed.
3. An Ankle-Brachial Index (ABI) result of 1.45 in a patient with a history of long-standing
diabetes likely indicates which of the following?
A. Normal arterial flow
B. Non-compressible calcified vessels
C. Mild peripheral artery disease
D. Severe arterial occlusion
Answer: B
Conceptual Explanation: An ABI > 1.3 usually indicates calcification of the tunica media
(Mönckeberg’s sclerosis), which is common in diabetic patients and makes the vessels non-
compressible.
4. During the proliferative phase of wound healing, which process involves the formation of
new blood vessels from pre-existing ones?
A. Hemostasis
, B. Epibole
C. Angiogenesis
D. Apoptosis
Answer: C
Conceptual Explanation: Angiogenesis is the physiological process through which new
blood vessels form from pre-existing vessels, essential for supplying nutrients to the
granulation tissue.
5. Which of the following is considered the ‘Gold Standard’ for the diagnosis of osteomyelitis
in a deep diabetic foot ulcer?
A. Bone biopsy and culture
B. Plain Film Radiograph (X-ray)
C. Magnetic Resonance Imaging (MRI)
D. Probing to bone (PTB) test
Answer: A
Conceptual Explanation: While MRI is the gold standard for imaging, a bone biopsy with
histological and microbiological analysis remains the definitive diagnostic gold standard
for osteomyelitis.
