WOCN CERTIFICATION BUNDLED EXAM
SCRIPT 2026 QUESTIONS WITH VERIFIED
SOLUTIONS
◉ 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
SCRIPT 2026 QUESTIONS WITH VERIFIED
SOLUTIONS
◉ 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
