Wound Care Certification (WCC) Exam — Questions and Answers

Question 1: A patient develops a new pressure injury despite being on a pressure-redistribution mattress. What is the FIRST action the wound care nurse should take?

Notify the physician for antibiotic orders
Reassess the patient's risk factors and current prevention protocol (Correct answer)
Upgrade to the next level of support surface immediately
Document the wound and continue the current plan

Correct answer: Reassess the patient's risk factors and current prevention protocol

Reassessing the patient's risk factors and current prevention protocol identifies gaps and guides revision of the care plan.

Question 2: Which compression system is considered the gold standard for venous leg ulcer treatment?

Short-stretch bandage applied alone
Four-layer compression bandage system (Charing Cross regimen) (Correct answer)
Class I elastic stockings providing 15–20 mmHg
Intermittent pneumatic compression device only

Correct answer: Four-layer compression bandage system (Charing Cross regimen)

The four-layer compression bandage system delivers sustained 40 mmHg compression at the ankle and has the strongest evidence base for venous leg ulcer healing.

Question 3: Which product offers the best and longest skin protection against incontinence?

Moisturizers
Lotions
Moisture Barriers (Correct answer)
Powders

Correct answer: Moisture Barriers

Moisture barriers, typically in cream or paste form, create a protective layer on the skin that repels urine and feces, preventing direct contact with irritants. This physical barrier is crucial for shielding the skin from breakdown and irritation caused by prolonged exposure to moisture and enzymes in incontinent individuals. Unlike lotions or moisturizers, their primary function is to provide long-lasting protection against external moisture and irritants.

Question 4: Which characteristic of a pressure injury MOST strongly supports classifying it as 'unstageable' rather than Stage 3 or 4?

Wound base is obscured by slough or eschar preventing depth assessment (Correct answer)
Presence of serosanguineous exudate
Surrounding skin shows periwound erythema
The wound has a tunneling tract extending 2 cm

Correct answer: Wound base is obscured by slough or eschar preventing depth assessment

Unstageable pressure injuries cannot be staged because slough or eschar covers the wound base, preventing accurate depth assessment.

Question 5: A patient with peripheral arterial disease (ABI 0.45) has a suspected pressure injury on the lateral ankle. What assessment finding would MOST influence the wound care approach?

Wound size greater than 4 cm²
Patient BMI below 20 kg/m²
Presence of moderate yellow slough in the wound bed
Severely compromised arterial blood flow limiting healing capacity (Correct answer)

Correct answer: Severely compromised arterial blood flow limiting healing capacity

An ABI of 0.45 indicates severe arterial insufficiency, which critically limits tissue perfusion and requires vascular evaluation before standard wound care.

Question 6: Which laboratory value is considered the most reliable indicator of nutritional status relevant to wound healing?

Total lymphocyte count
C-reactive protein
Prealbumin (transthyretin) (Correct answer)
Albumin

Correct answer: Prealbumin (transthyretin)

Prealbumin has a short half-life (~2–3 days) making it a more sensitive marker of acute nutritional changes than albumin (half-life ~20 days).

Question 7: A clinician is assessing a pressure injury on a patient's sacrum. The wound bed is completely obscured by a thick, leathery, black eschar. What is the correct stage for this pressure injury according to the NPIAP guidelines?

Deep Tissue Injury
Stage 3
Stage 4
Unstageable (Correct answer)

Correct answer: Unstageable

The correct stage is Unstageable. When the base of a full-thickness wound is covered by slough or eschar to the extent that the true depth cannot be determined, it is classified as Unstageable. Once the slough or eschar is removed, the wound will be revealed as either a Stage 3 or Stage 4 pressure injury.

Question 8: Negative pressure wound therapy (NPWT) promotes wound healing primarily by:

Promoting eschar formation over the wound bed
Maintaining an alkaline wound pH
Delivering antibiotics directly to wound tissue
Applying continuous or intermittent sub-atmospheric pressure to remove exudate and stimulate granulation (Correct answer)

Correct answer: Applying continuous or intermittent sub-atmospheric pressure to remove exudate and stimulate granulation

NPWT (vacuum-assisted closure) applies sub-atmospheric pressure to remove excess fluid, decrease edema, and stimulate perfusion and granulation tissue formation.

Question 9: Which growth factor plays the PRIMARY role in stimulating fibroblast proliferation and collagen synthesis during wound healing?

Platelet-derived growth factor (PDGF)
Vascular endothelial growth factor (VEGF)
Epidermal growth factor (EGF)
Transforming growth factor-beta (TGF-β) (Correct answer)

Correct answer: Transforming growth factor-beta (TGF-β)

TGF-β is the primary cytokine responsible for fibroblast proliferation, collagen deposition, and scar tissue formation in the proliferative phase.

Question 10: The ____ is not one of the three layers of skin.

dermis
subcutaneous
subdermis (Correct answer)
epidermis

Correct answer: subdermis

The skin is composed of three primary layers: the epidermis (the outermost protective layer), the dermis (the middle layer containing connective tissue, hair follicles, and sweat glands), and the hypodermis (the innermost layer, also known as subcutaneous tissue, composed of fat and connective tissue). 'Subdermis' is not a recognized anatomical layer of the skin.

Question 11: A patient with a venous leg ulcer should be treated with compression therapy delivering how many mmHg at the ankle?

30–40 mmHg (Correct answer)
40–50 mmHg
20–30 mmHg
10–20 mmHg

Correct answer: 30–40 mmHg

Therapeutic compression for venous leg ulcers requires 30–40 mmHg at the ankle level.

Question 12: Which of the following descriptions best characterizes a healthy, well-prepared granulating wound bed ready for epithelialization?

Dark red, dry, and extremely painful to touch.
Bright, beefy red with a moist, granular or 'cobblestone' texture. (Correct answer)
Dusky or gray with a smooth, shiny surface.
Pale pink with high-volume, thin, serous drainage.

Correct answer: Bright, beefy red with a moist, granular or 'cobblestone' texture.

Healthy granulation tissue is characterized by its bright, beefy red appearance, which indicates good vascularity. It should have a moist, granular, or 'cobblestone' texture, representing the budding of new capillaries and connective tissue. This forms the necessary foundation for epithelial cells to migrate and close the wound.

Question 13: According to NPUAP guidelines, a suspected Deep Tissue Pressure Injury (DTPI) most commonly presents as:

Partial-thickness skin loss with a pink or red wound bed
Intact or non-intact skin with persistent non-blanchable deep red, maroon, or purple discoloration (Correct answer)
Open wound with visible red granulation tissue
Stage 1 erythema that blanches with pressure

Correct answer: Intact or non-intact skin with persistent non-blanchable deep red, maroon, or purple discoloration

DTPI presents as intact or non-intact skin with persistent non-blanchable deep red, maroon, or purple discoloration caused by pressure damage to underlying soft tissue.

Question 14: What nutrient repairs the body from damage, produces new tissue, and supports many critical body functions?

fat
protein (Correct answer)
carbohydrate
sugar

Correct answer: protein

Protein is a macronutrient vital for numerous bodily functions, including repairing damaged tissues, producing new cells, and supporting the immune system. It is particularly crucial for wound healing, as it provides the building blocks necessary for collagen synthesis and tissue regeneration.

Question 15: Periwound maceration is MOST likely caused by which of the following?

Use of a hydrogel on a dry wound
Insufficient dressing change frequency
Inadequate moisture balance with excessive exudate pooling on intact skin (Correct answer)
Application of zinc oxide barrier cream

Correct answer: Inadequate moisture balance with excessive exudate pooling on intact skin

Maceration occurs when excess wound exudate pools on intact periwound skin, breaking down skin integrity.

Question 16: Charcot neuroarthropathy (Charcot foot) is best characterized as:

A fungal osteomyelitis of the tarsal bones requiring antifungal treatment
A progressive destructive arthropathy causing bone and joint deformity in neuropathic patients (Correct answer)
A venous ulcer complication unique to patients with diabetes mellitus
A pressure-induced heel injury in bedridden diabetic patients

Correct answer: A progressive destructive arthropathy causing bone and joint deformity in neuropathic patients

Charcot neuroarthropathy is a progressive, destructive condition in which undetected repetitive trauma leads to bone fractures, joint dislocation, and deformity creating high plantar pressure points prone to ulceration.

Question 17: The most important rule to follow when deciding when to change a pressure ulcer's dressing is _____.

keep the ulcer tissue dry and the surrounding intact skin moist
keep the ulcer tissue and surrounding intact skin dry
keep the ulcer tissue and surrounding intact skin moist
keep the ulcer tissue moist and the surrounding intact skin dry (Correct answer)

Correct answer: keep the ulcer tissue moist and the surrounding intact skin dry

The most important rule for pressure ulcer dressing changes is to maintain a moist environment for the ulcer tissue while keeping the surrounding intact skin dry. A moist wound bed promotes faster healing by facilitating cell migration and enzyme activity, while dry surrounding skin prevents maceration and further skin breakdown.

Question 18: A patient with a chronic venous ulcer has been on long-term, high-dose corticosteroid therapy for an autoimmune condition. Which phase of wound healing is MOST significantly impaired by this medication?

Inflammatory phase (Correct answer)
Maturational phase
Proliferative phase
Hemostasis

Correct answer: Inflammatory phase

Corticosteroids are potent anti-inflammatory agents that suppress the initial inflammatory response crucial for healing. They inhibit the migration and function of key immune cells like neutrophils and macrophages, which are essential for clearing debris and signaling the start of the repair process.

Question 19: The word "slough" is used to describe a wound and means:

softening and irritation caused by akin contact with liquid
bright pink or red granular new tissue formed from capillary beds
a soft viscous yellow layer of necrotic tissue that covers and adheres to the wound (Correct answer)
formation of healed tissue from epidermal cells over granulation

Correct answer: a soft viscous yellow layer of necrotic tissue that covers and adheres to the wound

The term 'slough' in wound care describes a soft, viscous, yellow or tan layer of necrotic tissue that covers and adheres to the wound bed. It consists of dead cells, fibrin, and exudate. Slough must be removed, often through debridement, for the wound to progress to healing.

Question 20: Which bacteria is MOST commonly isolated from infected diabetic foot ulcers in patients with no prior antibiotic exposure?

Staphylococcus aureus (Correct answer)
Pseudomonas aeruginosa
Methicillin-resistant Staphylococcus aureus (MRSA)
Bacteroides fragilis

Correct answer: Staphylococcus aureus

Staphylococcus aureus is the most frequent causative organism in previously unexposed diabetic foot infections, though MRSA is common in healthcare-associated infections.

Question 21: A patient with end-stage renal disease on dialysis develops extremely painful, stellate-shaped necrotic lesions on the thighs and abdomen. Skin biopsy reveals calcium deposits in small vessel walls. Which condition is most likely?

Livedoid vasculopathy
Calciphylaxis (Correct answer)
Martorell ulcer
Pyoderma gangrenosum

Correct answer: Calciphylaxis

Calciphylaxis is characterized by vascular calcification and occlusion causing painful necrotic skin lesions, most commonly in patients with renal failure.

Question 22: A patient's sacral wound is documented as having 'epibole.' What does this finding indicate and how does it affect healing?

Rolled or thickened wound edges that prevent epithelial migration and impair healing (Correct answer)
Granulation tissue overgrowth above the wound surface level
New epithelial tissue migrating across the wound bed, indicating healing is progressing normally
Presence of biofilm on the wound surface requiring antimicrobial dressings

Correct answer: Rolled or thickened wound edges that prevent epithelial migration and impair healing

Epibole refers to rolled, closed wound edges that prevent epithelial cells from migrating across the wound base, stalling healing.

Question 23: A wound care specialist selects larval (maggot) debridement therapy for a patient. What is a CONTRAINDICATION to this therapy?

Wounds communicating with body cavities or organs (Correct answer)
Chronic venous ulcer with slough
Diabetic foot ulcer with necrotic tissue
Pressure injury with fibrinous slough

Correct answer: Wounds communicating with body cavities or organs

Larval debridement is contraindicated in wounds with fistulae or communication with body cavities due to risk of larvae migration.

Question 24: A wound is documented as having 'induration' in the periwound area. What does this finding indicate?

Maceration from excessive wound moisture
Tissue hardness suggesting deep tissue involvement or infection (Correct answer)
Normal healing response with new collagen
Superficial skin dryness requiring moisturizer

Correct answer: Tissue hardness suggesting deep tissue involvement or infection

Induration (abnormal firmness or hardness) in periwound tissue suggests inflammation, infection, or deep tissue involvement beyond the visible wound.

Question 25: Which factor is NOT considered a significant risk factor for lower extremity amputation in patients with diabetes?

Peripheral neuropathy with loss of protective sensation
History of a prior healed diabetic foot ulcer
Peripheral arterial disease with reduced perfusion
Hemoglobin A1c of 5.8% (Correct answer)

Correct answer: Hemoglobin A1c of 5.8%

An HbA1c of 5.8% is near-normal glycemic control (below the 6.5% diagnostic threshold for diabetes), whereas neuropathy, PAD, and prior ulcer history are well-established risk factors for amputation.

Question 26: A nurse is completing a Braden Scale assessment. The patient can perceive pressure-related discomfort throughout the body but is confined to bed. What Braden subscale scores would reflect this scenario?

Sensory Perception = 2, Activity = 2
Sensory Perception = 1, Activity = 4
Sensory Perception = 4, Activity = 2 (Correct answer)
Sensory Perception = 4, Activity = 4

Correct answer: Sensory Perception = 4, Activity = 2

A Sensory Perception score of 4 (no impairment) and Activity score of 2 (chairfast/bedrest) reflect intact sensation with restricted physical activity.

Question 27: When it comes to bandages and binders, a straight binder is utilized for ______.

Wrist, fingers, and trunk
Head, fingers, and stump of an amputated limb
Chest and abdomen (Correct answer)
Joints, such as the knee, elbow, ankle, and wrist

Correct answer: Chest and abdomen

A straight binder is a rectangular piece of fabric designed to provide support and compression to large, flat areas of the body. Its shape and size make it particularly suitable for wrapping around the chest or abdomen. It is commonly used to support surgical incisions, provide compression for rib fractures, or manage abdominal distention.

Question 28: A patient with a diabetic neuropathic ulcer has 'callus' surrounding the wound. What is the most appropriate initial intervention?

Debride the callus to allow proper wound assessment and offloading (Correct answer)
Prescribe antifungal cream to the callus margins
Apply a thick occlusive dressing over the callus
Initiate systemic antibiotics immediately

Correct answer: Debride the callus to allow proper wound assessment and offloading

Callus removal (debridement) is essential in diabetic neuropathic ulcers because callus increases plantar pressure and obscures wound depth; debridement improves healing outcomes.

Question 29: When repositioning a patient to prevent pressure injuries on the sacrum, what is the recommended side-lying position?

The prone position.
A 30-degree lateral inclined position. (Correct answer)
A high-Fowler's position.
A 90-degree lateral position.

Correct answer: A 30-degree lateral inclined position.

The 30-degree lateral inclined position is recommended to relieve pressure from the sacrum and coccyx without placing the full weight on the trochanter, which can happen in a 90-degree position. This position effectively offloads common pressure points.

Question 30: Which effect of uncontrolled diabetes MOST directly reduces the tensile strength of a healing wound?

Diabetes increases sebaceous gland secretion, blocking collagen deposition
Elevated insulin resistance activates keratinocyte apoptosis
Hyperglycemia glycates collagen, impairing its structural integrity (Correct answer)
High glucose causes cellular dehydration, thinning wound edges

Correct answer: Hyperglycemia glycates collagen, impairing its structural integrity

Non-enzymatic glycation of collagen molecules in hyperglycemia cross-links them abnormally, reducing their mechanical strength and wound tensile integrity.

Question 31: A morbidly obese patient undergoes bariatric surgery and develops a post-operative wound dehiscence. Beyond poor vascularity, which additional obesity-related factor contributes most to dehiscence?

Excess adipose hormones (adipokines) activate collagenase at wound margins
Hyperlipidemia coats suture material, preventing tissue adhesion
Increased mechanical tension on the wound due to abdominal fat mass (Correct answer)
Elevated leptin levels suppress macrophage recruitment

Correct answer: Increased mechanical tension on the wound due to abdominal fat mass

The mechanical tension exerted by a large abdominal pannus places constant stress on incision lines, overwhelming even adequate collagen formation and causing dehiscence.

Question 32: Most likely to require specialized surgical intervention are lacerations involving:

Large forehead flap
Fingertip/nailbed with suspected phalangeal fracture
The vermilion border
Medial portion of eyelid margin (Correct answer)

Correct answer: Medial portion of eyelid margin

Lacerations involving the medial portion of the eyelid margin are highly complex due to the presence of the delicate lacrimal drainage system (tear ducts). Damage to these structures can lead to chronic tearing (epiphora) and infection if not meticulously repaired. Such repairs often require specialized ophthalmic surgical techniques to ensure proper alignment and function of the tear ducts, making it a critical area for specialized intervention.

Question 33: Which laboratory finding is most consistently associated with calciphylaxis?

Elevated D-dimer
Low serum albumin
Elevated ESR
Elevated calcium-phosphate product (>55 mg²/dL²) (Correct answer)

Correct answer: Elevated calcium-phosphate product (>55 mg²/dL²)

An elevated calcium-phosphate product above 55 mg²/dL² promotes precipitation of calcium salts in vessel walls, a hallmark of calciphylaxis.

Question 34: When measuring a wound, what is the correct anatomical orientation for wound length?

Head to toe (superior to inferior) (Correct answer)
Diagonal from corner to corner
Side to side (medial to lateral)
Widest dimension regardless of direction

Correct answer: Head to toe (superior to inferior)

Wound length is measured head to toe (superior to inferior) using the clock face analogy with 12 o'clock toward the head.

Question 35: A wound exhibiting signs of biofilm (recalcitrant to treatment, surface glycocalyx) would BEST benefit from which combination approach?

Mechanical debridement + topical antimicrobial dressing (Correct answer)
Transparent film dressing to maintain occlusion
Hydrogel only to rehydrate the biofilm
Dry dressing + oral antibiotics alone

Correct answer: Mechanical debridement + topical antimicrobial dressing

Biofilm management requires physical disruption through debridement combined with an antimicrobial dressing to reduce recolonization.

Question 36: Which wound characteristic best differentiates a diabetic neuropathic ulcer from an arterial ulcer?

Severe pain that worsens with limb elevation
Pale wound bed with minimal exudate and necrotic base
Associated with absent pedal pulses and dependent rubor
Located on the plantar surface at bony pressure points with surrounding callus (Correct answer)

Correct answer: Located on the plantar surface at bony pressure points with surrounding callus

Neuropathic diabetic ulcers characteristically occur on plantar pressure points and are surrounded by callus from undetected repetitive trauma due to loss of protective sensation.

Question 37: Which CEAP classification class describes a patient with active venous ulceration?

C6 (Correct answer)
C5
C3
C4b

Correct answer: C6

CEAP class C6 designates active venous ulcer, while C5 indicates a healed venous ulcer.

Question 38: Which factor is MOST important to assess when determining if a wound is healing appropriately over time?

Serial wound measurements showing reduction in size (Correct answer)
Wound odor at each visit
Type of dressing applied at previous visit
Patient pain level during dressing changes

Correct answer: Serial wound measurements showing reduction in size

Serial measurements documenting reduction in wound dimensions over time are the most objective indicator of wound healing progress.

Question 39: Obesity impairs wound healing through which DIRECT mechanism?

Obesity elevates platelet count, causing excessive clot formation
High BMI triggers autoimmune destruction of fibroblasts
Adipose tissue is poorly vascularized, reducing oxygen tension at wound edges (Correct answer)
Increased serum lipids coat collagen fibers, preventing cross-linking

Correct answer: Adipose tissue is poorly vascularized, reducing oxygen tension at wound edges

Adipose tissue has relatively poor blood supply, resulting in lower oxygen tension in subcutaneous layers and impairing the oxygen-dependent steps of wound healing.

Question 40: A 35-year-old woman walks into the emergency room with only her left hand. She says that she cut herself when she tried to cut a bagel. She has a small, 2-cm cut on the left side of her thenar eminence. There aren't any deeper structures involved. How should the wound be cleaned?

Punch holes in a normal saline bag or bottle and irrigate the wound.
Soak her hand in normal saline for 30 minutes.
Use a high-pressure syringe and irrigate with water. (Correct answer)
Wound cleaning is unnecessary because wound was sustained from a clean knife.

Correct answer: Use a high-pressure syringe and irrigate with water.

High-pressure irrigation is the most effective method for cleaning wounds, as it mechanically removes debris, bacteria, and contaminants, thereby reducing the risk of infection. Using a high-pressure syringe (e.g., a 35-mL syringe with a 19-gauge angiocatheter) with clean water or saline provides the necessary force to adequately cleanse the wound. Soaking or low-pressure irrigation is less effective at dislodging foreign material and bacteria.

Question 41: A patient has a wound with a PUSH score of 12. What does a higher PUSH score indicate?

Greater wound severity or poorer healing (Correct answer)
Better wound healing progress
Absence of infection
A fully granulated wound bed

Correct answer: Greater wound severity or poorer healing

The Pressure Ulcer Scale for Healing (PUSH) tool uses a higher score to indicate a more severe wound; as healing progresses, the score should decrease toward zero.

Question 42: Which term describes new pink/purple tissue growing across a wound surface from the edges toward the center?

Fibrinolysis
Epithelialization (Correct answer)
Contraction
Granulation

Correct answer: Epithelialization

Epithelialization is the migration of epithelial cells across the wound surface to restore the skin barrier.

Question 43: What is the PRIMARY purpose of wound debridement?

Increase wound pain sensation
Remove necrotic tissue and reduce bacterial load to promote healing (Correct answer)
Create a dry wound environment
Prevent bleeding

Correct answer: Remove necrotic tissue and reduce bacterial load to promote healing

Debridement removes necrotic tissue, slough, and bacterial burden that impede wound healing and prevent granulation tissue formation.

Question 44: A pressure ulcer that shows up as a deep crater, with or without damage to the surrounding tissue, is called a ____.

stage IV
stage III (Correct answer)
stage II
stage I

Correct answer: stage III

A Stage III pressure ulcer is characterized by full-thickness skin loss, where subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed. This stage often presents as a deep crater, indicating significant tissue damage extending into the subcutaneous layer.

Question 45: What is round, fluid-filled, and bigger than 1 cm?

II
Tertiary
Vesicle
Bulla (Correct answer)

Correct answer: Bulla

A bulla is defined as a fluid-filled blister or lesion that is greater than 1 centimeter in diameter. It is essentially a larger version of a vesicle, which is also fluid-filled but typically measures less than 1 cm. Therefore, for a round, fluid-filled lesion larger than 1 cm, 'bulla' is the correct medical term.

Question 46: When assessing a dark-skinned patient for early pressure injury signs, which assessment technique is MOST reliable since erythema may not be visible?

Checking oxygen saturation over the bony prominence with a pulse oximeter
Comparing skin color only under fluorescent lighting
Relying solely on Braden Scale scores to determine risk
Assessing for skin temperature changes, firmness, bogginess, and patient-reported pain or discomfort (Correct answer)

Correct answer: Assessing for skin temperature changes, firmness, bogginess, and patient-reported pain or discomfort

In dark-skinned patients, palpating for temperature changes, firmness or bogginess, and asking about localized pain are the most reliable early detection methods.

Question 47: A 28-year-old man comes to the emergency department with a wound on his lower left leg. He says he hurt his left calf while pulling branches out of a flooded creek in his back yard. He says that the wound was made while his legs were in the water. When the puncture wound is looked at, it is 1 cm in diameter, several centimeters deep, and has redness around it. After cleaning the wound with water, you find a splinter in the wound. How should management proceed?

Radiograph to map the exact location of the foreign body.
Dress the wound with a sterile bandage and treat with a fluoroquinolone.
Close the wound with 4-0 nylon.
Remove the splinter. (Correct answer)

Correct answer: Remove the splinter.

The immediate priority for a visible foreign body in a wound, especially one causing redness and inflammation, is its removal. Leaving the splinter in place would act as a persistent source of irritation, inflammation, and a nidus for infection, significantly impeding wound healing. Once removed, the wound can be thoroughly cleaned and managed appropriately.

Question 48: Which fistula treatment strategy is likely to be the most effective in preventing wound contamination from drainage for a significant open abdominal lesion that has a fistula on the posterior aspect?

Troughing
Bridging (Correct answer)
Simple pouching
Saddle bagging

Correct answer: Bridging

For a fistula located on the posterior aspect of a significant open abdominal wound, 'bridging' is the most effective strategy to prevent wound contamination. This technique involves creating a pathway or 'bridge' over the wound to direct the fistula drainage away from the open wound bed, often into a collection system. Bridging protects the healing wound from corrosive effluent and infection, which is crucial for promoting wound healing and preventing complications.

Question 49: A patient has a pressure injury with a wound that cannot be staged because the base is obscured by slough. This is classified as:

Unstageable pressure injury (Correct answer)
Stage 3
Stage 4
Deep tissue pressure injury

Correct answer: Unstageable pressure injury

When slough or eschar obscures the wound base, the depth — and therefore the stage — cannot be determined, making it unstageable.

Question 50: Which topical agent is MOST appropriate to apply to hypergranulation tissue to reduce it and allow re-epithelialization?

Hydrogel
Zinc oxide paste
Silver nitrate or foam dressing with compression (Correct answer)
Collagenase ointment

Correct answer: Silver nitrate or foam dressing with compression

Silver nitrate sticks chemically cauterize hypergranulation tissue, and compressive foam dressings reduce it mechanically to allow epithelial migration.

Question 51: What does a positive probe-to-bone test indicate in a diabetic foot wound assessment?

High likelihood of osteomyelitis (Correct answer)
Presence of biofilm in the wound
Neuropathy affecting wound healing
Wound depth extends to subcutaneous tissue

Correct answer: High likelihood of osteomyelitis

A positive probe-to-bone test (sterile probe contacts bone) has high specificity for osteomyelitis in diabetic foot wounds.

Question 52: A wound clinician measures a wound as 3 cm × 2 cm at the first visit and 2.5 cm × 1.8 cm at week 2. What percentage of wound area reduction occurred?

Approximately 25% reduction (Correct answer)
Approximately 5% reduction
Approximately 40% reduction
Approximately 15% reduction

Correct answer: Approximately 25% reduction

Initial area = 6 cm²; week 2 area = 4.5 cm²; reduction = 1.5/6 = 25% — a clinically significant improvement.

Question 53: A patient with a Stage 3 pressure injury has a BMI of 16.2 and serum albumin of 2.1 g/dL. Which nutritional intervention is MOST appropriate to support wound healing?

Provide 1.25–1.5 g/kg/day protein with caloric supplementation (Correct answer)
Restrict protein to 0.8 g/kg/day to prevent renal strain
Supplement with vitamin C only and recheck albumin in 4 weeks
Initiate parenteral nutrition immediately regardless of GI function

Correct answer: Provide 1.25–1.5 g/kg/day protein with caloric supplementation

Malnourished patients with pressure injuries require 1.25–1.5 g/kg/day protein and adequate calories to support tissue repair.

Question 54: Which dressing should be AVOIDED on a dry, necrotic eschar when autolytic debridement is the goal?

Hydrogel sheet
Dry gauze (Correct answer)
Hydrocolloid
Transparent film

Correct answer: Dry gauze

Dry gauze desiccates tissue and impedes autolytic debridement, making it counterproductive for softening dry eschar.

Question 55: Hydrosurgery debridement (e.g., VERSAJET) works by:

Ultrasonic cavitation of bacteria
Enzymatic breakdown of necrotic tissue
Electrical stimulation to liquefy eschar
High-pressure water jet that simultaneously cuts and evacuates tissue (Correct answer)

Correct answer: High-pressure water jet that simultaneously cuts and evacuates tissue

Hydrosurgery devices use a high-velocity saline jet that cuts and simultaneously evacuates devitalized tissue with precision.

Question 56: Hyperbaric oxygen therapy (HBOT) is most indicated for which wound condition?

Stage II pressure injury
Wagner Grade 3–4 diabetic foot ulcer (Correct answer)
Venous leg ulcer with adequate compression
Surgical incision with delayed closure

Correct answer: Wagner Grade 3–4 diabetic foot ulcer

HBOT is evidence-based and indicated for Wagner Grade 3–4 diabetic foot ulcers with inadequate perfusion.

Question 57: A wound clinician observes satellite lesions (small wounds) surrounding a primary wound. This finding most likely indicates:

Spreading infection or cutaneous involvement beyond primary wound (Correct answer)
Wound dehiscence from suture failure
Adequate moisture balance in the wound environment
Normal wound edge migration during epithelialization

Correct answer: Spreading infection or cutaneous involvement beyond primary wound

Satellite lesions surrounding a primary wound suggest spreading infection, autoimmune conditions, or malignancy requiring further investigation.

Question 58: The BEST evidence-based repositioning schedule to prevent hospital-acquired pressure injuries in a high-risk patient is:

Every 1 hour when using a pressure-redistribution mattress
Repositioning only when patient requests it
Every 4 hours on a standard mattress
Every 2 hours with documented position changes (Correct answer)

Correct answer: Every 2 hours with documented position changes

Every-2-hour repositioning with documentation is the standard of care supported by NPUAP/EPUAP guidelines for high-risk patients.

Question 59: Which assessment technique is used to detect undermining in a wound?

Using a sterile cotton-tipped applicator to probe beneath wound edges (Correct answer)
Applying wound photography for documentation
Measuring wound width at its widest visible point
Pressing firmly on periwound skin to check for blanching

Correct answer: Using a sterile cotton-tipped applicator to probe beneath wound edges

A sterile cotton-tipped applicator is gently inserted under wound edges to detect and measure undermining depth and direction.

Question 60: A clinician is preparing a chronic wound for a skin graft. The wound bed has pale, friable granulation tissue that bleeds easily, and the epithelial edges are stalled and not advancing. These signs are most indicative of which underlying problem?

Excessive moisture in the wound bed
Inadequate protein intake
Over-use of enzymatic debriding agents
High bacterial bioburden or critical colonization (Correct answer)

Correct answer: High bacterial bioburden or critical colonization

Pale, friable granulation tissue and stalled epithelial edges are classic signs of critical colonization or a high bacterial bioburden (biofilm). These microorganisms disrupt the healing process, leading to unhealthy tissue formation and preventing wound closure. Addressing the bioburden is a critical step before a skin graft can be successful.

Question 61: Which bacteria is most commonly associated with a wound that has a characteristic 'fruity' or 'grape-like' odor?

Pseudomonas aeruginosa (Correct answer)
Escherichia coli
Staphylococcus aureus
Bacteroides fragilis

Correct answer: Pseudomonas aeruginosa

Pseudomonas aeruginosa produces a distinctive sweet, grape-like or fruity odor and often causes blue-green discoloration of wound exudate.

Question 62: In wound care documentation, MASD stands for:

Medical Adhesive Skin Dermatitis
Minimal Absorbency Standard Dressing
Macerated And Slough Deterioration
Moisture-Associated Skin Damage (Correct answer)

Correct answer: Moisture-Associated Skin Damage

Moisture-Associated Skin Damage (MASD) is a category of skin damage caused by prolonged exposure to urine, feces, wound exudate, perspiration, or other moisture sources.

Question 63: A nurse is completing a risk assessment for pressure injury using the Braden Scale on a new resident in a long-term care facility. The resident scores a 16. What is the appropriate interpretation of this score?

The resident has no risk.
The resident is at mild risk. (Correct answer)
The resident is at moderate risk.
The resident is at high risk.

Correct answer: The resident is at mild risk.

According to the Braden Scale for Predicting Pressure Sore Risk, a total score of 15-18 is categorized as mild risk. A score of 13-14 is moderate risk, 10-12 is high risk, and 9 or less is severe risk.

Question 64: In a patient with liver cirrhosis, which specific mechanism most impairs wound healing?

Elevated ammonia directly inactivates matrix metalloproteinases
Jaundice causes bilirubin to inhibit keratinocyte migration
Impaired hepatic synthesis of clotting factors and albumin reduces healing capacity (Correct answer)
Portal hypertension increases wound exudate volume

Correct answer: Impaired hepatic synthesis of clotting factors and albumin reduces healing capacity

The liver synthesizes clotting factors for hemostasis and albumin for protein stores; cirrhosis impairs both, undermining the inflammatory and proliferative phases.

Question 65: Buruli ulcer caused by Mycobacterium ulcerans is best characterized by which clinical feature?

Painful, rapidly spreading cellulitis
Painless, undermined necrotic ulcer with extensive subcutaneous tissue destruction (Correct answer)
Superficial erosion limited to the epidermis
Multiple satellite pustules around a central nodule

Correct answer: Painless, undermined necrotic ulcer with extensive subcutaneous tissue destruction

M. ulcerans secretes mycolactone toxin that causes painless, extensive subcutaneous necrosis with characteristic undermined wound edges.

Question 66: A wound with 100% black eschar on the heel of an immobile patient should initially be treated by:

Applying moisture to soften and remove the eschar
Immediate sharp debridement at bedside
Applying an enzymatic debrider immediately
Leaving it intact and monitoring for signs of infection (Correct answer)

Correct answer: Leaving it intact and monitoring for signs of infection

Stable, dry, non-infected heel eschar should be left intact per NPUAP/EPUAP guidelines, as it serves as the body's natural cover over an ischemic area.

Question 67: A patient presents with multiple, small, deep, "punched-out" ulcers on the lower legs, which are surrounded by palpable purpura. This presentation is a hallmark clinical sign of which atypical wound etiology?

Calciphylaxis
Sickle cell ulcer
Lymphedema-associated ulceration
Vasculitis (Correct answer)

Correct answer: Vasculitis

Cutaneous small-vessel vasculitis is an inflammation of the small blood vessels in the skin. A classic manifestation is palpable purpura (raised, non-blanching purple spots), which can break down and lead to the formation of painful, deep, "punched-out" ulcers.

Question 68: Which assessment finding best differentiates an arterial ulcer from a venous ulcer?

Pale wound bed with minimal drainage and painful (Correct answer)
Presence of wound exudate
Location on the lower extremity
Irregular wound edges with hyperpigmentation

Correct answer: Pale wound bed with minimal drainage and painful

Arterial ulcers typically have a pale, necrotic wound bed with minimal exudate and are painful due to ischemia, contrasting with venous ulcers.

Question 69: Which intervention is MOST appropriate to prevent a new pressure injury in a patient who developed a Stage 2 sacral pressure injury during a previous hospitalization?

Apply prophylactic wound dressings only after a pressure injury is confirmed
Implement a comprehensive prevention bundle including risk assessment, skin inspection, pressure redistribution, and repositioning from admission (Correct answer)
Maintain the patient in the same position that was most comfortable during the prior stay
Wait until signs of early skin breakdown appear before initiating preventive measures

Correct answer: Implement a comprehensive prevention bundle including risk assessment, skin inspection, pressure redistribution, and repositioning from admission

A history of pressure injury is a major risk factor; a full prevention bundle implemented from admission is the most appropriate proactive approach.

Question 70: Do pressure ulcers typically develop over bony prominences and are caused by persistent pressure that damages the underlying tissue?

FALSE
TRUE (Correct answer)

Correct answer: TRUE

Pressure ulcers, also known as bedsores or decubitus ulcers, are typically caused by prolonged pressure on the skin and underlying tissue. This pressure usually occurs over bony prominences, restricting blood flow and leading to tissue damage and breakdown. Therefore, the statement accurately describes the common development and cause of pressure ulcers.

Question 71: A comprehensive wound assessment should include multiple components to guide the plan of care. Which of the following is the MOST complete list of essential assessment components?

Presence of odor and the patient's nutritional status.
Wound size and color only.
Location, size, drainage amount, and pain level.
Anatomical location, dimensions (length, width, depth), wound bed tissue types, drainage characteristics, and condition of the periwound skin. (Correct answer)

Correct answer: Anatomical location, dimensions (length, width, depth), wound bed tissue types, drainage characteristics, and condition of the periwound skin.

A thorough wound assessment must be comprehensive to be effective. This includes precise anatomical location, measurements (length, width, depth, and any undermining or tunneling), assessment of the tissue types in the wound bed (e.g., granulation, slough, eschar), characteristics of any exudate (amount, color, consistency), and the condition of the skin surrounding the wound (periwound).

Question 72: Total contact casting (TCC) is considered the gold standard offloading device for plantar diabetic neuropathic ulcers because it:

Redistributes plantar pressure over the entire foot and lower leg surface (Correct answer)
Prevents infection by creating a completely sealed wound environment
Eliminates the need for surgical debridement of the ulcer
Allows daily wound inspection and easy dressing changes

Correct answer: Redistributes plantar pressure over the entire foot and lower leg surface

TCC redistributes plantar pressure over the entire plantar foot and lower leg, dramatically reducing focal pressure at the ulcer site and achieving the highest documented healing rates.

Question 73: A transparent film dressing is MOST appropriate for which wound type?

Cavity wound requiring packing
Infected surgical wound
Stage 3 pressure injury with heavy exudate
Superficial abrasion with minimal exudate (Correct answer)

Correct answer: Superficial abrasion with minimal exudate

Transparent film dressings are semi-permeable and best suited for superficial wounds with little to no exudate.

Question 74: A 19-year-old girl comes to the ED with a cut on her lip. He got the cut when he got into an argument. On close inspection, he has a 2-cm horizontal cut in the middle of his lower right lip. The lower lip has gotten a lot bigger. The attending asks you, the intern, to do a mental block for anesthesia. Which of the following is a true statement about mental blocks?

A mental block is not appropriate in this patient because it will lead to worsened swelling of the lower lip swelling.
The patient requires a right-sided mental block.
A mental block is performed by injecting lidocaine into the mental nerve foramen.
A mental block anesthetizes the mental nerve, which innervates the lower lip. (Correct answer)

Correct answer: A mental block anesthetizes the mental nerve, which innervates the lower lip.

A mental block specifically targets the mental nerve, which is a branch of the inferior alveolar nerve. This nerve provides sensory innervation to the skin of the chin and the lower lip. Therefore, a mental block effectively anesthetizes the lower lip, making it an appropriate choice for repairing a laceration in that area.

Question 75: Which nutritional marker is MOST sensitive for identifying malnutrition that may impair wound healing?

Serum prealbumin (transthyretin) (Correct answer)
Total lymphocyte count
Serum transferrin
Serum albumin

Correct answer: Serum prealbumin (transthyretin)

Prealbumin has a short half-life of 2–3 days, making it a more sensitive and responsive marker of recent nutritional status compared to albumin.

Question 76: A patient requires wound bed preparation before split-thickness skin grafting. Which wound bed characteristic is MOST predictive of graft success?

Wound culture negative for all organisms
Wound depth less than 2 cm
Clean, well-vascularized granulation tissue covering >95% of the wound bed (Correct answer)
Presence of at least 30% granulation tissue

Correct answer: Clean, well-vascularized granulation tissue covering >95% of the wound bed

Successful graft take requires a well-vascularized, clean granulation tissue bed covering nearly the entire wound surface.

Question 77: During a skin assessment, a nurse notes an area on the patient's heel that is intact, with a localized area of persistent, non-blanchable deep red discoloration. The patient reports pain in the area, which feels boggy upon palpation compared to the surrounding tissue. Which of the following is the most likely classification for this finding?

Deep Tissue Pressure Injury (Correct answer)
Stage 2 Pressure Injury
Venous Stasis Ulcer
Stage 1 Pressure Injury

Correct answer: Deep Tissue Pressure Injury

This presentation is characteristic of a Deep Tissue Pressure Injury (DTPI). A DTPI involves a localized area of persistent non-blanchable deep red, maroon, or purple discoloration of intact or non-intact skin. Pain and temperature changes often precede the skin color changes, and the tissue may feel boggy or firm.

Question 78: Lois Griffin has red blood coming out of a wound. What's this exudate?

Sanguineous drainage (Correct answer)
Purulent drainage
Serosanguineous drainage
Serous drainage

Correct answer: Sanguineous drainage

Sanguineous drainage is characterized by its bright red appearance, indicating the presence of fresh blood. This type of exudate is often seen immediately after an injury or during the initial stages of wound healing. It can also signify active bleeding within the wound.

Question 79: Which debridement method is most appropriate for a patient with a large necrotic wound requiring rapid tissue removal?

Wet-to-dry gauze
Autolytic debridement
Enzymatic debridement
Surgical/sharp debridement (Correct answer)

Correct answer: Surgical/sharp debridement

Surgical or sharp debridement is the fastest method and is appropriate when rapid removal of large amounts of necrotic tissue is required.

Question 80: What is the primary purpose of performing periwound skin assessment during wound evaluation?

To calculate total wound surface area
To identify signs of wound edge complications and skin breakdown (Correct answer)
To select appropriate wound dressing
To determine wound staging

Correct answer: To identify signs of wound edge complications and skin breakdown

Periwound assessment identifies complications such as maceration, induration, erythema, or satellite lesions that affect treatment planning.

Question 81: A 35-year-old chef comes to the emergency room with a whole fingertip. She says that her knife fell while she was cutting up vegetables. She brought the pulp that had been cut off in a plastic bag. On examination, the patient's distal volar tip of the second finger has a clean, 5-mm-wide slice of skin. There is a lot of bleeding that doesn't pulsate. There is no damage to the distal interphalangeal joint (DIP), the proximal interphalangeal joint (PIP), or the nail. Her last tetanus shot was about a year ago. Which is the best next step in management?

Consult hand surgery for replantation of the pulp in the operating room.
Irrigate the hand and replant distal tip in the ED as soon as possible.
Immediately place the amputated tip on ice to prevent cell death.
Discharge the patient with a pressure dressing and splint after the wound is irrigated and the bleeding is controlled. (Correct answer)

Correct answer: Discharge the patient with a pressure dressing and splint after the wound is irrigated and the bleeding is controlled.

For small fingertip amputations, especially those involving only the pulp without bone exposure or significant joint involvement, conservative management is often preferred. The fingertip has excellent regenerative capacity, and healing by secondary intention with a pressure dressing and splint can lead to good functional and cosmetic outcomes. Replantation is typically reserved for larger, more complex amputations.

Question 82: In wound bed preparation, biofilm management is critical. Which intervention is MOST effective at disrupting mature wound biofilm?

Occlusive dressings
Mechanical debridement combined with antimicrobial dressings (Correct answer)
Systemic antibiotics alone
Topical antiseptics alone

Correct answer: Mechanical debridement combined with antimicrobial dressings

Mature biofilm requires physical disruption through mechanical debridement followed by antimicrobial therapy to prevent rapid reformation.

Question 83: A wound care nurse notes that a patient with rheumatoid arthritis on methotrexate has impaired wound healing. Methotrexate contributes primarily by:

Directly lysing collagen type I fibers
Inhibiting folate metabolism required for DNA synthesis and cell proliferation (Correct answer)
Stimulating excess MMP-9 activity
Blocking TNF-α receptors on fibroblasts

Correct answer: Inhibiting folate metabolism required for DNA synthesis and cell proliferation

Methotrexate is a folate antagonist; by blocking dihydrofolate reductase it impairs DNA synthesis, reducing fibroblast and keratinocyte proliferation.

Question 84: Maggot debridement therapy (MDT) is contraindicated in wounds that:

Have heavy exudate
Communicate with body cavities or have exposed vessels (Correct answer)
Contain slough only
Are located on the lower extremity

Correct answer: Communicate with body cavities or have exposed vessels

MDT is contraindicated when the wound communicates with a body cavity or has exposed vessels due to risk of migration and hemorrhage.

Question 85: What is the recommended technique for measuring the depth of a wound tunnel or sinus tract?

Ultrasound imaging only
Insertion of a sterile cotton-tipped applicator or probe until resistance is felt (Correct answer)
Wound culture swab inserted to maximum depth
Visual inspection with a penlight

Correct answer: Insertion of a sterile cotton-tipped applicator or probe until resistance is felt

A sterile cotton-tipped applicator or wound probe is gently inserted into the tunnel until resistance is felt, then measured against a ruler to determine depth in centimeters.

Question 86: A patient with chronic hepatitis C presents with palpable purpura, arthralgias, and lower extremity ulcers. Serum immunofixation shows a type II cryoglobulin. The underlying wound etiology is:

Diabetic microangiopathy
Cryoglobulinemic vasculitis (Correct answer)
Venous insufficiency
Pyoderma gangrenosum

Correct answer: Cryoglobulinemic vasculitis

Hepatitis C-associated cryoglobulinemia causes immune complex deposition in vessel walls, triggering small vessel vasculitis that produces purpura and ulceration.

Question 87: Which clinical sign best differentiates wound infection from critical colonization?

Presence of systemic fever and erythema extending beyond the wound margin (Correct answer)
Wound odor
Change in exudate color
Increased exudate volume alone

Correct answer: Presence of systemic fever and erythema extending beyond the wound margin

Systemic signs (fever, spreading cellulitis) distinguish wound infection from colonization, which lacks host inflammatory response.

Question 88: What is the clinical significance of wound 'tunneling' (also called sinus tract)?

It represents a channel extending from the wound into surrounding tissue, increasing infection risk (Correct answer)
It indicates superficial epidermal breakdown
It is a normal variant during the remodeling phase
It shows healthy tissue regeneration under the wound surface

Correct answer: It represents a channel extending from the wound into surrounding tissue, increasing infection risk

Tunneling creates a channel from the wound into adjacent tissue, harboring bacteria and preventing complete wound closure.

Question 89: Collagen and elastin are the proteins that compose the dermis. Both of these proteins are in charge of:

Decompenstaed CHF, Peripheral arterial disease, ABI </ = 0.5
bacteria
Giving skin tensile strength and providing the skin with elastic recoll (Correct answer)
Secondary

Correct answer: Giving skin tensile strength and providing the skin with elastic recoll

Collagen and elastin are crucial proteins found in the dermis layer of the skin. Collagen provides the skin with its tensile strength and structural integrity, preventing tearing. Elastin, on the other hand, gives the skin its elasticity, allowing it to stretch and recoil back to its original shape. Together, these proteins ensure the skin's durability and flexibility.

Question 90: Which characteristic distinguishes a Stage 3 pressure injury from a Stage 4 pressure injury?

Presence of slough in the wound bed
Presence of tunneling
Depth extending through dermis
Exposure of bone, tendon, or muscle (Correct answer)

Correct answer: Exposure of bone, tendon, or muscle

Stage 4 pressure injuries involve full-thickness tissue loss with exposed bone, tendon, or muscle, distinguishing them from Stage 3.

Question 91: A patient presents with a pressure injury over the coccyx. The assessment reveals full-thickness skin and tissue loss, with directly palpable fascia and muscle in the wound bed. Slough is present in 25% of the wound base, and undermining is noted from the 2 o'clock to 5 o'clock position. This wound would be classified as:

Stage 2
Stage 3
Stage 4 (Correct answer)
Unstageable

Correct answer: Stage 4

This wound is a Stage 4 pressure injury. The defining characteristic is full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone. While slough is present, it does not obscure the entire wound bed, allowing for determination of the wound's depth and the visualization of underlying structures, making it stageable.

Question 92: When assessing wound depth using a cotton-tipped applicator, the clinician identifies that the probe contacts bone. This finding most likely indicates:

Unstageable pressure injury
Stage 3 pressure injury
Suspected osteomyelitis requiring further evaluation (Correct answer)
Deep tissue pressure injury

Correct answer: Suspected osteomyelitis requiring further evaluation

A positive probe-to-bone test is highly predictive of osteomyelitis and should prompt further workup including imaging and possible bone biopsy.

Question 93: A wound care specialist selects a silver-containing dressing for a wound. What is the primary purpose of silver in wound dressings?

To reduce pain at the wound site
To provide antimicrobial activity against a broad spectrum of organisms (Correct answer)
To stimulate granulation tissue formation
To autolytically debride necrotic tissue

Correct answer: To provide antimicrobial activity against a broad spectrum of organisms

Silver ions released by these dressings exert broad-spectrum antimicrobial effects by disrupting bacterial cell membranes and interfering with metabolic enzymes.

Question 94: A clinician is assessing a wound for the presence of biofilm. Which clinical finding is MOST suggestive of biofilm presence?

Wound that stalls despite optimal standard of care (Correct answer)
Wound with serosanguineous drainage
Wound with acute erythema and purulent exudate
Wound with excessive granulation tissue

Correct answer: Wound that stalls despite optimal standard of care

A wound that fails to progress despite appropriate treatment is a hallmark sign of biofilm, which resists standard care.

Question 95: A diabetic foot ulcer has a yellow fibrinous slough covering 80% of the wound bed. Which debridement method is SAFEST in a patient with peripheral arterial disease (ABI 0.5)?

Pulsed lavage
Sharp debridement at bedside
Autolytic debridement with hydrogel (Correct answer)
Surgical debridement in the OR

Correct answer: Autolytic debridement with hydrogel

In patients with severe PAD, autolytic debridement is the safest as it is non-traumatic and does not risk further ischemic tissue damage.

Question 96: When assessing a venous leg ulcer, which finding is most characteristic and expected?

Pale wound bed with minimal exudate
Irregular wound margins with moderate to heavy exudate (Correct answer)
Punched-out appearance with regular borders
Deep wound with exposed tendon

Correct answer: Irregular wound margins with moderate to heavy exudate

Venous ulcers characteristically present with irregular margins, heavy fibrinous exudate, and often ruddy granulation tissue.

Question 97: The most effective and least harmful way to lower the risk of wound infection is:

Cephalexin 50-75 mg/kg/d
Povidone-iodine scrub
Hydrogen peroxide skin preparation
Normal saline irrigation 50-100 ml/cm of wound (Correct answer)

Correct answer: Normal saline irrigation 50-100 ml/cm of wound

Thorough irrigation with normal saline is the most effective and least harmful method to reduce bacterial load and remove foreign debris from a wound. This mechanical cleansing action physically flushes out contaminants without damaging healthy tissue, unlike antiseptic solutions like povidone-iodine or hydrogen peroxide, which can be cytotoxic. A high volume of irrigation (50-100 ml/cm) ensures adequate cleansing to significantly lower the risk of infection.

Question 98: Which classification system is most widely used to grade diabetic foot ulcers in clinical practice?

Push Tool wound scoring system
Bates-Jensen Wound Assessment Tool (BWAT)
Wagner Ulcer Classification System (grades 0–5) (Correct answer)
National Pressure Injury Advisory Panel (NPIAP) staging system

Correct answer: Wagner Ulcer Classification System (grades 0–5)

The Wagner system grades diabetic foot ulcers 0–5 based on depth and presence of infection or gangrene, and remains the most widely used diabetic foot ulcer classification tool.

Question 99: Periwound erythema, warmth, induration, and pain extending more than 2 cm from the wound edge BEST describe:

Wound critical colonization
Normal inflammatory phase
Cellulitis requiring systemic antibiotics (Correct answer)
Wound colonization

Correct answer: Cellulitis requiring systemic antibiotics

These classic signs of spreading infection beyond the wound edge define cellulitis, which requires systemic antibiotic treatment.

Question 100: A wound care nurse is assessing a shallow, open ulcer on a patient's ischium. The wound bed is pink and moist, with partial-thickness loss of the dermis. There is no slough, eschar, or granulation tissue visible. Adipose tissue is not exposed. How should this pressure injury be staged?

Stage 1
Unstageable
Stage 2 (Correct answer)
Stage 3

Correct answer: Stage 2

This wound should be staged as a Stage 2 pressure injury. A Stage 2 injury is defined as partial-thickness skin loss with an exposed dermis. The wound bed is viable, pink or red, moist, and may also present as a serum-filled blister. The absence of slough, eschar, granulation tissue, and exposed adipose tissue are key characteristics of a Stage 2 injury.

Question 101: Which physical finding is most consistent with chronic venous insufficiency of the lower extremity?

Lipodermatosclerosis and hemosiderin staining (Correct answer)
Dry, shiny, hairless skin with nail changes
Pallor on elevation and rubor on dependency
Absent pedal pulses and dependent rubor

Correct answer: Lipodermatosclerosis and hemosiderin staining

Lipodermatosclerosis (subcutaneous fibrosis) and hemosiderin staining (brown discoloration) are hallmarks of chronic venous insufficiency from red blood cell extravasation.

Question 102: When repositioning a patient to prevent pressure injury, which technique BEST reduces shear forces?

Elevating the head of bed to 90 degrees before turning
Asking the patient to push with their heels during repositioning
Using a draw sheet or friction-reducing slide sheet to move the patient (Correct answer)
Rolling the patient directly across the mattress surface

Correct answer: Using a draw sheet or friction-reducing slide sheet to move the patient

Friction-reducing slide sheets minimize the shear and friction forces applied to skin during repositioning.

Question 103: Which transcutaneous oxygen pressure (TcPO2) value best indicates adequate tissue perfusion for lower extremity wound healing?

TcPO2 of 10 mmHg
TcPO2 of 20 mmHg
TcPO2 of 30 mmHg
TcPO2 of 40 mmHg or greater (Correct answer)

Correct answer: TcPO2 of 40 mmHg or greater

A TcPO2 ≥40 mmHg indicates sufficient tissue oxygenation for wound healing; values <20 mmHg predict healing failure and may indicate the need for revascularization.

Question 104: Collagen production, intracellular cement substance maintenance, and iron absorption are all helped by this vitamin.

Thiamine
Vitamin C (Correct answer)
Vitamin A
Zinc

Correct answer: Vitamin C

Vitamin C, also known as ascorbic acid, is essential for several critical bodily functions, including the synthesis of collagen, a vital protein for skin, blood vessels, and connective tissues. It also plays a role in maintaining intracellular cement substances and significantly enhances the absorption of non-heme iron, making it crucial for wound healing and overall health.

Question 105: Which professional scope of practice typically permits conservative sharp debridement in the US?

Only podiatrists
Wound care certified nurses (CWCN) in many states (Correct answer)
Only surgeons
Only medical doctors

Correct answer: Wound care certified nurses (CWCN) in many states

Wound care certified nurses (CWCN) in many US states are within scope to perform conservative sharp debridement, though regulations vary by state.

Question 106: Which vitamin plays a key role in keratinocyte differentiation and epithelialization, and its deficiency is associated with delayed wound healing?

Vitamin A (Correct answer)
Vitamin K
Vitamin E
Vitamin D

Correct answer: Vitamin A

Vitamin A promotes keratinocyte proliferation and differentiation, as well as collagen synthesis; deficiency impairs epithelialization and inflammatory phase initiation.

Question 107: During a dressing, forgetting to count the packing pieces raises the chance of _______.

Pain
A piece of material being left behind (Correct answer)
Bleeding
Legislative action

Correct answer: A piece of material being left behind

Forgetting to count packing pieces during a dressing change significantly increases the risk of leaving material behind in the wound. Retained foreign bodies can lead to serious complications such as infection, abscess formation, delayed healing, and even necessitate further surgical intervention. Therefore, meticulous counting is a critical safety measure.

Question 108: After a primary assessment has shown that a wound doesn't threaten life or limb, the first step in treating a wound that needs sutures is:

Local anesthesia (Correct answer)
Irrigation
Exploration
Radiographic evaluation

Correct answer: Local anesthesia

After ensuring a wound is not life or limb-threatening, the immediate priority for a wound requiring sutures is to manage pain and allow for thorough assessment and treatment. Administering local anesthesia first ensures patient comfort, facilitates a more complete exploration, irrigation, and debridement of the wound, and allows for precise suturing without causing further distress. Without adequate anesthesia, these crucial steps would be difficult or impossible to perform effectively.

Question 109: When a Stage 2 pressure injury heals, how should it be restaged?

Documented as 'healed Stage 2' — pressure injuries are never restaged downward (Correct answer)
Restaged downward to Stage 1 as it improves
Reclassified as a skin tear once epithelialized
Upgraded to Stage 3 if slough appeared during healing

Correct answer: Documented as 'healed Stage 2' — pressure injuries are never restaged downward

Pressure injuries are never restaged downward because the body does not regenerate the same tissue layers that were lost; a healed wound is documented as 'healed Stage 2.'

Question 110: What is the primary goal of negative pressure wound therapy (NPWT)?

Eliminate biofilm
Deliver antibiotics locally
Promote angiogenesis and reduce edema (Correct answer)
Maintain moist wound environment

Correct answer: Promote angiogenesis and reduce edema

NPWT applies subatmospheric pressure to promote granulation tissue formation, angiogenesis, and reduction of wound edema.

Question 111: A key component of wound bed preparation is the TIME framework. What does the 'M' in this acronym represent?

Moisture imbalance (Correct answer)
Mechanical debridement
Medication application
Measurement of wound dimensions

Correct answer: Moisture imbalance

The 'M' in the TIME framework stands for Moisture imbalance. The framework guides clinicians to assess and manage four key areas to promote healing: Tissue (non-viable or deficient), Infection/Inflammation, Moisture imbalance, and Edge of wound (non-advancing).

Question 112: A patient has a pressure injury where the wound bed is not visible due to slough covering the entire base. How should this wound be staged?

Stage 4
Deep Tissue Pressure Injury
Stage 3
Unstageable (Correct answer)

Correct answer: Unstageable

When slough or eschar obscures the wound bed, the wound is classified as Unstageable because depth cannot be determined.

Question 113: A wound care specialist documents 'epithelialization at 30% of wound surface.' This finding indicates the wound is in which phase of healing?

Inflammatory phase
Remodeling phase
Hemostasis phase
Proliferative phase (Correct answer)

Correct answer: Proliferative phase

Epithelialization occurs during the proliferative phase, alongside granulation tissue formation, as keratinocytes migrate across the wound surface.

Question 114: A patient has a wound with 25% black eschar, 50% yellow slough, and 25% red granulation. How would the wound bed be documented using the RYB (Red-Yellow-Black) system?

Yellow wound — treat with autolytic debridement only
Mixed wound: 25% black, 50% yellow, 25% red — treat as black wound priority (Correct answer)
Primarily healing wound with minor slough
Red wound requiring moisture retention

Correct answer: Mixed wound: 25% black, 50% yellow, 25% red — treat as black wound priority

In the RYB system, when multiple tissue types are present, treatment prioritizes the most problematic color (black > yellow > red).

Question 115: A wound with hyperkeratotic edges fails to advance despite good wound bed preparation. What is the MOST appropriate next intervention?

Increase frequency of dressing changes
Apply a hydrocolloid dressing
Debride the wound edges mechanically or chemically (Correct answer)
Start systemic antibiotics

Correct answer: Debride the wound edges mechanically or chemically

Hyperkeratotic or rolled wound edges must be debrided to stimulate edge epithelial cell migration and wound closure.

Question 116: Which finding on wound assessment indicates the wound is in the proliferative phase of healing?

Bright red granulation tissue filling the wound bed (Correct answer)
Eschar covering the wound base
Wound edges rolled under (epibole)
Presence of fibrin slough covering 50% of the wound bed

Correct answer: Bright red granulation tissue filling the wound bed

Bright red granulation tissue indicates active angiogenesis and collagen synthesis, hallmarks of the proliferative healing phase.

Question 117: A 12-years girl with a forehead injury is brought to the emergency room by her parents. The patient hit her head on a doorknob, according to her dad. During the exam, the patient is cooperative, but he or she is nervous about getting the anesthetic shot. She has a 0.5-cm cut in the middle of her forehead. The edges are clean. Her parents ask about "skin glue," which they saw on TV and heard about. Which of the following is true about tissue adhesives made from cyanoacrylate?

Tissue adhesives have a higher rate of infection and tissue dehiscence than sutures.
Tissue adhesives are applied inside the wound to pull skin edges together.
It cannot be applied to mucous membranes and areas with thick hair. (Correct answer)
Tissue adhesives are best suited for forehead lacerations between 5 and 10 cm in length.

Correct answer: It cannot be applied to mucous membranes and areas with thick hair.

Cyanoacrylate tissue adhesives are not suitable for use on mucous membranes, such as the inside of the mouth or lips, because moisture can cause premature polymerization and irritation. Additionally, they are less effective in areas with thick hair, as the hair can interfere with proper adhesion and wound edge approximation, compromising the seal.

Question 118: Which diagnostic test is best recommended for a patient who follows a strict vegan diet and doesn't eat any foods containing gluten or legumes?

Zinc level (Correct answer)
BUN
Vitamin D level
Prealbumin

Correct answer: Zinc level

Zinc is an essential trace element vital for numerous physiological processes, including wound healing, immune function, and protein synthesis. A strict vegan diet that also excludes gluten and legumes (common dietary sources of zinc) significantly increases the risk of zinc deficiency. Therefore, a zinc level test is the most appropriate diagnostic to assess nutritional status related to wound healing in this patient.

Question 119: What is the primary mechanism of action for autolytic debridement?

The physical removal of dead tissue using irrigation or scrubbing.
The use of the body's own enzymes and phagocytic cells to liquefy non-viable tissue. (Correct answer)
The surgical excision of devitalized tissue with a scalpel.
The application of topical chemical enzymes to dissolve necrotic tissue.

Correct answer: The use of the body's own enzymes and phagocytic cells to liquefy non-viable tissue.

Autolytic debridement harnesses the body's endogenous enzymes and phagocytic cells (like macrophages) to break down and digest necrotic tissue. This process is facilitated by creating a moist wound environment with moisture-retentive dressings, which allows these natural processes to occur effectively.

Question 120: When a patient has steri-strips, what is the best way to clean their bodies?

Instruct patient just to wash face for a while
Instruct patient to soak in bath tub
Instruct a patient to take a shower (Correct answer)
Instruct patient not to take a bath

Correct answer: Instruct a patient to take a shower

When a patient has steri-strips, taking a shower is generally the best way to clean their body. A shower allows for gentle cleansing without prolonged soaking, which could loosen the adhesive and cause the strips to detach prematurely. Soaking in a bathtub should be avoided to preserve the integrity of the steri-strips.

Question 121: Epibole (rolled wound edges) indicates which healing problem?

Excessive granulation tissue overgrowth
Deep tissue destruction progressing outward
Epithelial cells rolling inward preventing resurfacing (Correct answer)
Wound infection preventing closure

Correct answer: Epithelial cells rolling inward preventing resurfacing

Epibole occurs when epithelial cells roll under the wound edge rather than migrating across the wound bed, halting resurfacing.

Question 122: Pyoderma gangrenosum is most commonly associated with which underlying systemic condition?

Type 1 diabetes mellitus
Chronic kidney disease
Systemic lupus erythematosus
Inflammatory bowel disease (Crohn's disease or ulcerative colitis) (Correct answer)

Correct answer: Inflammatory bowel disease (Crohn's disease or ulcerative colitis)

Approximately 50% of pyoderma gangrenosum cases are associated with systemic diseases, with inflammatory bowel disease being the most common association.

Question 123: A clinician documents wound undermining at '9 to 12 o'clock, extends 2 cm.' Using the clock face method, where is this undermining located?

On the patient's right lateral to superior border (Correct answer)
On the patient's inferior to left lateral border
On the patient's left lateral to superior border
On the patient's right medial to inferior border

Correct answer: On the patient's right lateral to superior border

With 12 o'clock toward the head, 9 o'clock is the patient's right side and 12 o'clock is superior, so undermining spans right lateral to superior.

Question 124: In the Bates-Jensen Wound Assessment Tool (BWAT), a lower total score indicates:

Better wound status with healing progress (Correct answer)
Greater wound depth and undermining
More necrotic tissue present in the wound
Worse wound status requiring intensive intervention

Correct answer: Better wound status with healing progress

In the BWAT, items are scored 1-5 where lower scores indicate healthier wound characteristics, so a lower total score means better wound status.

Question 125: A 15-year-old girl comes to the emergency room with a cut on her left index finger. She hurt herself when her friend closed the car door on her by accident. She has a half-circle cut on the back of her left second finger, just past the distal interphalangeal (DIP) joint. Sensation is still there after the cut. The DIP joint can still move as it should. The patient wants to be a hand model in the future, so he or she is very worried about how the surgery will look. Which of the following would be the best way to put this patient to sleep?

Local infiltration through the wound margins with 3 cc of lidocaine
Local infiltration through the wound margins with 3 cc of lidocaine with epinephrine
Application of a tourniquet to control bleeding and irrigation of the wound with 3 cc of lidocaine
A digital block at the base of the proximal phalanx with 3 cc of lidocaine (Correct answer)

Correct answer: A digital block at the base of the proximal phalanx with 3 cc of lidocaine

A digital block at the base of the proximal phalanx provides effective and complete anesthesia to the entire finger distal to the injection site. This method is superior to local infiltration directly into the wound margins, as it avoids distorting the delicate tissue of the finger, which is crucial for precise wound repair and achieving an optimal cosmetic outcome, especially for a patient concerned about future appearance.

Question 126: A fungating malignant wound is best described as:

A wound infected with fungal organisms
A wound in a patient who uses antifungal medications
A deep tissue pressure injury with fungal superinfection
A wound arising from tumor infiltration through the skin causing ulceration, exudate, and malodor (Correct answer)

Correct answer: A wound arising from tumor infiltration through the skin causing ulceration, exudate, and malodor

Fungating wounds occur when malignant cells infiltrate and proliferate through the skin, causing ulceration, heavy exudate, friable tissue, and malodor.

Question 127: Which of the following findings would correctly identify a pressure injury as Stage 3?

Full-thickness skin loss with visible adipose (fat) tissue and granulation tissue. (Correct answer)
Partial-thickness skin loss with exposed dermis.
Intact skin with non-blanchable erythema.
Full-thickness skin and tissue loss with exposed muscle and bone.

Correct answer: Full-thickness skin loss with visible adipose (fat) tissue and granulation tissue.

A Stage 3 pressure injury is characterized by full-thickness loss of skin, where adipose (fat) is visible in the ulcer. Granulation tissue and epibole (rolled wound edges) are often present. Muscle, tendon, or bone are not exposed in a Stage 3 injury.

Question 128: Antimicrobial dressings containing polyhexamethylene biguanide (PHMB) are BEST described as:

A growth factor that stimulates re-epithelialization
An enzyme that selectively digests biofilm matrix
A type of antibiotic that induces bacterial resistance rapidly
A broad-spectrum antiseptic that disrupts bacterial cell membranes (Correct answer)

Correct answer: A broad-spectrum antiseptic that disrupts bacterial cell membranes

PHMB is a broad-spectrum antiseptic that disrupts bacterial cell membranes and is associated with a low risk of resistance development.

Question 129: What does the term 'biofilm' mean in the context of wound assessment, and why is it clinically significant?

A structured community of bacteria embedded in a protective matrix that resists antibiotics (Correct answer)
A transparent protective film applied to cover wounds
The fibrin layer that forms naturally during wound healing
A type of wound dressing that promotes moisture balance

Correct answer: A structured community of bacteria embedded in a protective matrix that resists antibiotics

Biofilm is a bacterial community encased in a self-produced matrix that dramatically increases antibiotic resistance and perpetuates wound chronicity.

Question 130: What is used to make the skin tacky and secure a steri-strip?

Cold cream
Vaseline
Iodine
Tincture of benzoin (Correct answer)

Correct answer: Tincture of benzoin

Tincture of benzoin is a topical adhesive used to prepare the skin for better adherence of dressings like steri-strips. It creates a tacky, protective layer on the skin, which helps the adhesive strips stick more securely and for a longer duration, especially in areas prone to moisture or movement.

Question 131: When documenting wound measurements, the MOST clinically consistent method for measuring wound length and width is:

Longest axis by shortest axis perpendicular to it
Measuring at the widest visible point in any direction
Head-to-toe axis by side-to-side axis regardless of wound shape (Correct answer)
Area calculated by tracing on acetate

Correct answer: Head-to-toe axis by side-to-side axis regardless of wound shape

Using a consistent head-to-toe by side-to-side orientation eliminates clinician variability and allows accurate serial comparisons over time.

Question 132: Which wound bed tissue type has the poorest prognosis for healing and requires the most aggressive intervention?

Red granulation tissue (100% of wound bed)
Pink epithelial tissue at wound edges
Black eschar (100% of wound bed) (Correct answer)
Yellow fibrin slough (50% of wound bed)

Correct answer: Black eschar (100% of wound bed)

Black eschar (necrotic tissue) blocks healing, harbors bacteria, and must be debrided before healing can progress.

Question 133: A patient in palliative care suddenly got a dark, pear-shaped ulcer on the sacrum. It had uneven edges and grew quickly. This means that the pt:

FALSE
A Kennedy Terminal Ulcer (Correct answer)
Primary, secondary, tertiary
Predicting pressure ulcer development and determining risk level

Correct answer: A Kennedy Terminal Ulcer

A Kennedy Terminal Ulcer (KTU) is a specific type of pressure injury that often appears suddenly in individuals who are terminally ill. It is characterized by its rapid onset, dark discoloration (often purple, black, or red), pear or butterfly shape, and irregular borders, typically found on the sacrum. This ulcer is considered a sign of the body's systemic decline rather than solely localized pressure.

Question 134: From day 3 or 4 to day 21, when the injury happens, this phase of healing gets longer. The area has more collagen. Capillaries run across the wound.

None of these
Maturation phase
Inflammatory phase
Proliferative phase (Correct answer)

Correct answer: Proliferative phase

The proliferative phase of wound healing typically occurs from day 3-4 to day 21 post-injury. During this phase, fibroblasts produce collagen, and new capillaries form (angiogenesis), leading to the development of granulation tissue that fills the wound bed. This stage is crucial for rebuilding tissue and closing the wound.

Question 135: Which support surface feature is MOST important for a patient with a pressure injury on the sacrum who is fully dependent for repositioning?

Low air-loss capability to manage moisture
Lateral rotation to prevent pulmonary complications
Alternating pressure to cyclically relieve pressure (Correct answer)
High-density foam for cost-effective immobility support

Correct answer: Alternating pressure to cyclically relieve pressure

Alternating pressure surfaces cyclically relieve pressure and are recommended for high-risk patients who cannot reposition themselves.

Question 136: Which wound exudate characteristic is most concerning and warrants immediate clinical evaluation?

Purulent exudate with foul odor (Correct answer)
Serosanguineous drainage after debridement
Increased drainage after compression therapy
Serous exudate in a healing wound

Correct answer: Purulent exudate with foul odor

Purulent exudate with foul odor indicates infection and requires immediate evaluation and intervention.

Question 137: When a wound is first starting to heal, the first white blood cells to come are the ones whose job it is to ingest the bacteria and cell debris that have accumulated there.

Fibroblasts
Leukocytes (Correct answer)
A and B
Macrophages

Correct answer: Leukocytes

Leukocytes, specifically neutrophils, are the first white blood cells to arrive at a wound site during the inflammatory phase of healing. Their primary function is to phagocytose (ingest) bacteria, foreign debris, and dead cells. This crucial action cleans the wound bed, preparing it for subsequent stages of tissue repair and regeneration.

Question 138: What is the primary reason moisture-associated skin damage (MASD) must be distinguished from pressure injuries during wound assessment?

MASD only occurs in the sacral region unlike pressure injuries
MASD is always more painful than pressure injuries
Pressure injuries always have full-thickness tissue loss
Treatment strategies differ significantly between the two conditions (Correct answer)

Correct answer: Treatment strategies differ significantly between the two conditions

MASD and pressure injuries require different treatments; misclassification leads to ineffective care and potential harm.

Question 139: Which dressing strategy is most appropriate for a venous leg ulcer with moderate exudate?

Absorbent foam dressing under compression bandaging (Correct answer)
Calcium alginate dressing applied without compression
Dry gauze dressing changed daily with compression over it
Hydrocolloid dressing applied without compression

Correct answer: Absorbent foam dressing under compression bandaging

Foam dressings effectively manage moderate exudate, are compatible with compression bandaging, and together the combination addresses both wound moisture balance and venous hypertension.

Question 140: A diabetic patient presents with a wound on the plantar surface of the foot over the first metatarsal head. What wound classification system is most appropriate?

NPUAP pressure injury staging
Bates-Jensen Wound Assessment Tool
Wagner Ulcer Classification (Correct answer)
CEAP classification

Correct answer: Wagner Ulcer Classification

The Wagner Ulcer Classification System is specifically designed for diabetic foot ulcers and grades severity from 0 to 5.

Question 141: Regular callus debridement around a diabetic neuropathic ulcer is performed primarily to:

Reduce infection risk by eliminating bacterial reservoirs
Redistribute pressure, stimulate wound edge healing, and remove healing barriers (Correct answer)
Remove all periwound tissue for better wound visualization
Eliminate the patient's need for offloading footwear

Correct answer: Redistribute pressure, stimulate wound edge healing, and remove healing barriers

Callus debridement redistributes concentrated plantar pressure, converts the chronic wound edge to an acute state to enable epithelial migration, and removes physical barriers to healing.

Question 142: Which factor is part of the Braden Scale used to predict pressure injury risk?

Wound pH
Hemoglobin A1c level
Ankle-brachial index
Sensory perception (Correct answer)

Correct answer: Sensory perception

The Braden Scale assesses pressure injury risk using six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.

Question 143: What happens (mostly) in the first phase of wound healing?

Angiogenesis
Granulation tissue formation
Hemostasis (Correct answer)
Inflammation

Correct answer: Hemostasis

The first phase of wound healing, occurring immediately after injury, is hemostasis. This rapid process involves vasoconstriction to reduce blood flow, platelet aggregation to form a plug, and the activation of the coagulation cascade to form a stable fibrin clot. The primary goal is to stop bleeding and create a temporary seal.

Question 144: Which hematologic condition most directly impairs the inflammatory phase of wound healing by reducing the supply of growth factors released during clot formation?

Thrombocytopenia (Correct answer)
Polycythemia vera
Leukocytosis
Hypercoagulable state

Correct answer: Thrombocytopenia

Platelets degranulate at injury sites releasing PDGF, TGF-β, and EGF; thrombocytopenia reduces this critical growth factor reservoir.

Question 145: If you've lost ___ of your weight in the last three months, that means your nutrition has gone down a lot.

patient abandonment
Medical Battery
Calciphylaxis
10% (Correct answer)

Correct answer: 10%

Unintentional weight loss of 10% or more over a three-month period is a significant indicator of nutritional decline and is often used as a criterion for malnutrition risk. This level of weight loss suggests a severe catabolic state or inadequate caloric and nutrient intake, which can severely impair wound healing and overall health.

Question 146: A patient develops hypergranulation (proud flesh) in a chronic wound. The most appropriate initial intervention is:

Switch to a hydrogel dressing
Apply silver nitrate or foam dressing with compression (Correct answer)
Begin systemic steroids
Increase NPWT pressure

Correct answer: Apply silver nitrate or foam dressing with compression

Hypergranulation is managed by chemical cauterization with silver nitrate sticks or foam dressings that apply light compression to reduce overgrowth.

Question 147: Autolytic debridement is CONTRAINDICATED in which situation?

Partial thickness wound with slough
Clinically infected wound requiring rapid debridement (Correct answer)
Chronic wound with fibrinous debris
Dry eschar on a venous ulcer

Correct answer: Clinically infected wound requiring rapid debridement

Autolytic debridement is too slow for clinically infected wounds, where rapid debridement and infection control are necessary.

Question 148: What is the best dressing to use when a deep ulcerated area has a lot of exudate and the drainage is caused by tumor necrosis?

Alginate (Correct answer)
Charcoal dressing
Foam
Gauze

Correct answer: Alginate

Alginate dressings are highly absorbent, making them the best choice for deep, highly exudative wounds, especially those with significant drainage from tumor necrosis. Made from seaweed, alginates form a gel upon contact with wound exudate, which helps to manage moisture, promote autolytic debridement, and conform to the wound bed, creating an optimal healing environment.

Question 149: Which laboratory value is the BEST indicator of a patient's long-term nutritional status and protein availability for wound healing?

Serum albumin
Prealbumin (transthyretin) (Correct answer)
C-reactive protein
Hemoglobin A1c

Correct answer: Prealbumin (transthyretin)

Prealbumin has a half-life of 2–3 days, making it the most sensitive short-to-medium-term marker of current protein status and nutritional change.

Question 150: A patient presents with a painless ulcer on the perimalleolar area with a 'wet wood' odor and extensive undermining. They recently returned from West Africa. The most appropriate initial diagnostic step is:

Venous duplex scan
Wound surface swab for MRSA
ANCA panel and ANA titer
PCR testing of wound tissue for Mycobacterium ulcerans (Correct answer)

Correct answer: PCR testing of wound tissue for Mycobacterium ulcerans

The clinical presentation of painless, undermined ulceration with extensive subcutaneous destruction in a traveler from West Africa is classic for Buruli ulcer; PCR for M. ulcerans confirms the diagnosis.

Question 151: Creating new blood vessels is formally called:

Coagulation
Biogenesis
Angina
Angiogenesis (Correct answer)

Correct answer: Angiogenesis

Angiogenesis is the physiological process of forming new blood vessels from pre-existing ones. In the context of wound healing, angiogenesis is a critical component of the proliferative phase, ensuring that the newly forming granulation tissue receives an adequate blood supply for oxygen, nutrients, and waste removal, which are essential for tissue repair.

Wound Care Certification (WCC) Exam

The WCC exam certifies healthcare professionals in the specialized knowledge and skills required for effective wound management and patient care.

150

Questions

180 min

Time Limit

70%

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