WOCN WOUND EXAM QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
Goals of wound assessment - ANSWER 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? - 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
What structures of the skin heal by scar formation? - ANSWER Epidermal appendages, Subcutaneous
tissue/fascia/muscle
How is newborn skin different? - ANSWER No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? - ANSWER Very thin, increased fluid loss, functional stratum
corneum at 30-32 weeks
What problems may arise with infant skin? - ANSWER increased permeability, increased MARSI risk,
extravasation, diaper dermatitis
, How do you mitigate MARSI risk in infants/elderly? - ANSWER 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? - ANSWER Hyaluronidase
OR
phentolamine if vasoconstrictor
How do you mitigate diaper dermatitis? - ANSWER 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? - ANSWER <30 weeks bathe with
water only for 2 weeks
What are common issues with older skin? - ANSWER 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? - ANSWER pH balanced cleaners - no alkaline soaps
Superfatted nonalkaline soaps for dry skin
CHG reduces pathogens and sepsis
ANSWERS WITH SOLUTIONS 2024
Goals of wound assessment - ANSWER 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? - 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
What structures of the skin heal by scar formation? - ANSWER Epidermal appendages, Subcutaneous
tissue/fascia/muscle
How is newborn skin different? - ANSWER No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? - ANSWER Very thin, increased fluid loss, functional stratum
corneum at 30-32 weeks
What problems may arise with infant skin? - ANSWER increased permeability, increased MARSI risk,
extravasation, diaper dermatitis
, How do you mitigate MARSI risk in infants/elderly? - ANSWER 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? - ANSWER Hyaluronidase
OR
phentolamine if vasoconstrictor
How do you mitigate diaper dermatitis? - ANSWER 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? - ANSWER <30 weeks bathe with
water only for 2 weeks
What are common issues with older skin? - ANSWER 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? - ANSWER pH balanced cleaners - no alkaline soaps
Superfatted nonalkaline soaps for dry skin
CHG reduces pathogens and sepsis
