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CWOCN practice questions

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Question 1Wound Care

A pressure injury over the sacrum has a shallow, moist, pink-red wound bed. Subcutaneous fat, slough, and eschar are not visible. How should this injury be staged?

  1. Stage 1
  2. Stage 3
  3. Unstageable
  4. Stage 2 Correct answer.

Explanation

Stage 2 pressure injuries involve partial-thickness loss of skin with exposed dermis; the wound bed is viable, pink or red, and moist, and adipose tissue is not visible. They may also appear as an intact or ruptured serum-filled blister.

Question 2Wound Care

An adult client scores 14 on the Braden Scale. How should this score be interpreted?

  1. Moderate risk Correct answer.
  2. No risk
  3. Mild risk
  4. Very high risk

Explanation

Braden totals range from 6 to 23, and lower scores indicate higher risk. A total of 13 to 14 falls in the moderate-risk band, which generally calls for a repositioning schedule and a support-surface plan.

Question 3Wound Care

Which dressing forms a gel as it absorbs exudate and provides a moist environment beneath an occlusive adhesive?

  1. Woven gauze
  2. Calcium alginate rope
  3. Hydrocolloid wafer Correct answer.
  4. Transparent film

Explanation

Hydrocolloids are occlusive adhesive wafers that absorb small-to-moderate exudate and form a gel over the wound bed, maintaining a moist environment. Transparent films are nonabsorptive, alginates need heavy exudate and a secondary dressing, and gauze does not maintain occlusion.

Question 4Wound Care

For which wound is an alginate dressing most appropriate?

  1. A dry wound with adherent eschar
  2. A wound with minimal serous drainage
  3. A heavily exudating cavity wound Correct answer.
  4. An intact surgical incision

Explanation

Alginates are highly absorbent seaweed-derived fibers that need wound fluid to gel, so they suit moderately to heavily draining cavity or partial-thickness wounds. In a dry wound they can dehydrate the bed and adhere painfully at removal.

Question 5Wound Care

Granulation tissue formation, angiogenesis, and collagen deposition are hallmarks of which phase of healing?

  1. Hemostasis
  2. Proliferative Correct answer.
  3. Maturation
  4. Inflammatory

Explanation

During the proliferative phase, fibroblasts deposit collagen, new capillaries form, and the wound fills with granulation tissue. Hemostasis and inflammation precede this phase, and maturation follows it.

Question 6Wound Care

A shallow, irregular ulcer above the medial malleolus is surrounded by edema, hemosiderin staining, and lipodermatosclerosis. Which cause is most likely?

  1. Venous insufficiency Correct answer.
  2. Arterial insufficiency
  3. Pressure injury
  4. Neuropathic disease

Explanation

Venous leg ulcers occur in the gaiter area, especially near the medial malleolus, with edema, hemosiderin deposition, and lipodermatosclerosis from chronic venous hypertension. Arterial ulcers are typically deeper, punched out, and more painful.

Question 7Wound Care

Which nutrient is most important as a building block for collagen synthesis during wound repair?

  1. Protein Correct answer.
  2. Calcium
  3. Vitamin K
  4. Iron

Explanation

Protein supplies the amino acids required for collagen synthesis and cell proliferation, and requirements rise substantially in clients with healing wounds. Vitamin C is a necessary cofactor, but protein provides the structural substrate.

Question 8Wound Care

Which solution is the standard for cleansing most chronic wounds?

  1. 0.25% acetic acid
  2. 3% hydrogen peroxide
  3. 0.9% sodium chloride Correct answer.
  4. 10% povidone-iodine

Explanation

Normal saline is isotonic, noncytotoxic, and mechanically removes debris without injuring new tissue. Routine use of antiseptics such as hydrogen peroxide, povidone-iodine, and acetic acid can be cytotoxic to healing cells.

Question 9Wound Care

Which assessment finding identifies a deep tissue pressure injury?

  1. Full-thickness loss with visible fascia
  2. A shallow ulcer with a pink, moist bed
  3. Intact skin with deep maroon discoloration Correct answer.
  4. Blanchable erythema clearing within one hour

Explanation

A deep tissue pressure injury presents as intact or nonintact skin with a persistent deep purple or maroon area, reflecting damage to underlying tissue from pressure and shear. It may evolve and reveal the true depth of injury.

Question 10Wound Care

In a client with a venous leg ulcer, at which ankle-brachial pressure index should compression therapy be withheld?

  1. 0.9
  2. 1.0
  3. 1.2
  4. 0.4 Correct answer.

Explanation

An ABPI below 0.5 signals severe arterial insufficiency, and compression could cause ischemic injury, so it is withheld pending vascular evaluation. Values above roughly 0.8 generally permit compression.

Question 11Wound Care

A silver dressing is started on a wound with signs of critical colonization. What is the appropriate follow-up plan?

  1. Continue indefinitely to prevent reinfection
  2. Switch to a higher-strength silver weekly
  3. Combine routinely with systemic antibiotics
  4. Reassess in 2 weeks and stop if resolved Correct answer.

Explanation

Antimicrobial dressings are intended for time-limited use, so the wound should be reassessed within about 2 weeks and the silver stopped once signs of infection or critical colonization resolve. Prolonged use adds cost and cytotoxicity risk without added benefit.

Question 12Wound Care

Which method provides the most reliable culture from a chronic wound?

  1. Tissue biopsy from the cleansed wound base Correct answer.
  2. Swab of the wound edge before cleansing
  3. Swab of pooled exudate on the wound surface
  4. Aspiration of drainage from the dressing

Explanation

Quantitative tissue biopsy from the cleansed wound base is the reference standard because it samples tissue rather than surface contaminants. The Levine swab technique is an acceptable alternative when biopsy is not feasible.

Question 13Wound Care

Which approach most effectively manages biofilm in a chronic wound?

  1. Weekly transparent film dressing changes
  2. Saline irrigation at each dressing change
  3. Debridement plus topical antimicrobial Correct answer.
  4. Systemic antibiotics alone for several weeks

Explanation

Biofilm resists topical agents and host defenses, so mechanical disruption by debridement must be paired with an antimicrobial agent to slow reformation. Systemic antibiotics alone penetrate biofilm poorly.

Question 14Wound Care

Which structure is a contraindication to direct application of negative pressure wound therapy?

  1. Healthy granulation tissue
  2. Subcutaneous adipose tissue
  3. An exposed blood vessel Correct answer.
  4. Intact muscle fascia

Explanation

Exposed vessels, organs, anastomoses, and untreated osteomyelitis are contraindications because of the risk of erosion, bleeding, or seeding infection. Granulation tissue and intact fascia are acceptable wound surfaces when the dressing is correctly placed.

Question 15Wound Care

A skin tear has a viable flap that is still attached. What is the best initial management?

  1. Apply a hydrocolloid and change it every 24 hours
  2. Approximate the flap under a nonadherent dressing Correct answer.
  3. Secure the flap in place with adhesive tape strips
  4. Excise the flap to reduce the risk of infection

Explanation

A viable flap should be gently approximated to preserve perfusion and serve as a biological cover, then protected with a nonadherent dressing and left undisturbed for several days. Adhesive tapes and frequent dressing changes can avulse the flap.

Question 16Wound Care

How does moisture-associated skin damage differ from a pressure injury?

  1. It results from moisture and friction, not pressure Correct answer.
  2. It occurs only over the bony prominences of the pelvis
  3. It is staged using the NPIAP pressure system
  4. It always involves full-thickness tissue loss

Explanation

Moisture-associated skin damage results from prolonged moisture exposure with friction, typically in skin folds or under incontinence products, and is not caused by pressure. Pressure injuries occur at pressure points over bone and are staged.

Question 17Wound Care

For surveillance purposes, a surgical site infection related to an implanted device is counted if it appears within how long after surgery?

  1. 180 days
  2. 7 days
  3. 1 year
  4. 90 days Correct answer.

Explanation

Standard surveillance counts superficial incisional infections within 30 days of surgery, extending deep incisional and organ/space infections to 90 days when an implant is placed. Longer windows fall outside the standard definition.

Question 18Wound Care

A scar that grows beyond the original wound margins and does not regress over time is called:

  1. A normally maturing scar
  2. A contracture
  3. A keloid Correct answer.
  4. A hypertrophic scar

Explanation

Keloids extend beyond the borders of the original injury and rarely regress, whereas hypertrophic scars remain within the wound margins and improve over months. Both involve excess collagen, but only keloids invade adjacent tissue.

Question 19Wound Care

To reduce pain during a planned sharp debridement, when should analgesia be given?

  1. Immediately after the procedure
  2. The night before the procedure
  3. At the start of the procedure
  4. 30 to 60 minutes before the procedure Correct answer.

Explanation

The analgesic must reach peak effect during the procedure, so it is typically given 30 to 60 minutes beforehand. Nonpharmacologic measures and gentle technique further reduce distress.

Question 20Wound Care

Autolytic debridement works by:

  1. Maintaining moisture so endogenous enzymes work Correct answer.
  2. Applying medical-grade larvae to the wound bed
  3. Applying exogenous proteolytic enzyme ointment
  4. Using forceps and scissors at the bedside

Explanation

Autolytic debridement uses moisture-retentive dressings to keep the bed moist so the body's own enzymes and macrophages break down necrotic tissue. It is selective and painless but slower than sharp methods.

Question 21Wound Care

A rapidly enlarging, intensely painful ulcer has a violaceous, undermined border and worsened sharply after a minor debridement. Which action is most appropriate?

  1. Perform wide surgical debridement of the ulcer
  2. Apply multilayer compression bandages
  3. Give immunosuppressants and avoid debridement Correct answer.
  4. Start antibiotics and continue sharp debridement

Explanation

These findings suggest pyoderma gangrenosum, a neutrophilic dermatosis in which trauma, including debridement, provokes pathergy and enlarges the lesion. Treatment is immunosuppression with gentle, non-traumatic wound care.

Question 22Wound Care

Which finding most suggests necrotizing fasciitis rather than uncomplicated cellulitis?

  1. Pain out of proportion with rapid progression Correct answer.
  2. Warm, erythematous skin with mild tenderness
  3. Slowly enlarging induration over several weeks
  4. Leukocytosis with a low-grade fever

Explanation

Necrotizing fasciitis produces severe pain out of proportion to skin findings, rapid progression, systemic toxicity, and sometimes crepitus or skin anesthesia. Cellulitis is usually less painful relative to appearance and progresses more slowly.

Question 23Wound Care

A long-standing burn scar develops a raised, nonhealing lesion with an everted margin many years later. Which cause should be suspected?

  1. Venous ulceration
  2. Keloid formation
  3. Marjolin ulcer Correct answer.
  4. Pressure injury

Explanation

Marjolin ulcer is a squamous cell carcinoma arising in chronic scars, ulcers, or sinus tracts, often years after a burn. Any chronic wound that changes appearance or fails to heal should be biopsied.

Question 24Wound Care

A client with a venous leg ulcer has an ankle-brachial pressure index of 0.7. Which plan is most appropriate?

  1. Apply full multilayer high compression as usual
  2. Use reduced compression with close monitoring Correct answer.
  3. Use compression only if the ulcer becomes infected
  4. Withhold all compression from now on

Explanation

An ABPI of 0.6 to 0.8 indicates some arterial impairment, so modified reduced compression may be used with close monitoring and vascular follow-up. Full high compression is reserved for ABPI above roughly 0.8, and compression is withheld below 0.5.

Question 25Wound Care

A wound stalls for several weeks and then shows friable red granulation, increased exudate, and localized pain, with no erythema beyond the wound edge. Which category best fits this presentation?

  1. Spreading infection
  2. Contamination
  3. Critical colonization Correct answer.
  4. Normal healing

Explanation

Critical colonization is rising bioburden that delays healing and produces subtle local signs such as friable granulation, increased drainage, and new pain, without cellulitis beyond the wound. True infection adds erythema, warmth, and possibly systemic signs.

Question 26Wound Care

Which finding is characteristic of a stage 1 pressure injury?

  1. Blanchable erythema that fades with pressure relief
  2. Superficial abrasion caused by tape removal
  3. Nonblanchable erythema of intact skin Correct answer.
  4. Intact skin with maceration from urine

Explanation

A stage 1 pressure injury is intact skin with nonblanchable erythema at a site of pressure or shear. Blanchable redness, moisture damage, and tape injury do not meet that definition.

Question 27Wound Care

A bed-bound client at risk for pressure injury has no existing skin breakdown and tolerates movement. What is the most appropriate preventive repositioning plan?

  1. Only when the client reports discomfort
  2. Every 2 hours, adjusted to tissue tolerance Correct answer.
  3. Every 8 hours to protect sleep
  4. Continuous 45-degree head-of-bed elevation

Explanation

Repositioning is individualized but commonly performed at least every 2 hours for at-risk bed-bound clients. A 45-degree head elevation increases shear and should be minimized when possible.

Question 28Wound Care

Which factor is one of the six Braden Scale subscales?

  1. Probe-to-bone
  2. Tissue type
  3. Wound exudate
  4. Friction and shear Correct answer.

Explanation

The Braden Scale scores sensory perception, moisture, activity, mobility, nutrition, and friction/shear. It estimates pressure injury risk rather than measuring wound characteristics.

Question 29Wound Care

Which assessment best fits an arterial leg ulcer?

  1. Painless ulcer at the medial malleolus with hemosiderin staining
  2. Irregular ulcer with copious drainage and surrounding edema
  3. Deep ulcer over the sacrum after prolonged bed rest
  4. Punched-out ulcer with pale base and cool, hairless foot Correct answer.

Explanation

Arterial ulcers result from inadequate perfusion, so they are often distal, punched out, pale, and painful, with cool skin and reduced hair growth. Venous and pressure ulcers have different typical locations and surrounding skin changes.

Question 30Wound Care

Where do most neuropathic diabetic foot ulcers develop?

  1. Sacrum in a chair-bound client
  2. Plantar metatarsal heads or heel Correct answer.
  3. Dorsal forearm after intravenous therapy
  4. Lateral malleolus with varicose veins

Explanation

Neuropathic diabetic ulcers usually occur at high plantar pressure sites, especially the metatarsal heads and heel. Repetitive pressure over insensate skin is the key mechanism.

Question 31Wound Care

Which event occurs first in the normal wound healing cascade?

  1. Collagen remodels and scar matures
  2. Epithelial cells migrate across the wound
  3. Fibroblasts deposit collagen
  4. Platelets aggregate and form a clot Correct answer.

Explanation

Hemostasis is the first phase; platelets aggregate and a fibrin clot forms. Inflammation, proliferation, and remodeling follow.

Question 32Wound Care

Which wound is healing by primary intention?

  1. An infected wound left open to drain
  2. A pressure injury packed with gauze and left open
  3. A sutured surgical incision Correct answer.
  4. A burn allowed to form granulation tissue

Explanation

Primary intention occurs when a clean wound has approximated edges, such as a sutured surgical incision. Secondary intention heals by granulation from the base.

Question 33Wound Care

Which dressing is most appropriate for a clean, dry wound bed with scant exudate?

  1. Highly absorbent alginate
  2. Dry gauze changed twice daily
  3. Foam dressing for heavy drainage
  4. Hydrogel that donates moisture Correct answer.

Explanation

A dry wound bed needs moisture donation, and amorphous hydrogel provides that without adding absorbency. Dry gauze can adhere and traumatize a clean wound.

Question 34Wound Care

A client has a neuropathic plantar diabetic foot ulcer with good perfusion and no infection. Which offloading method is preferred?

  1. Bed rest with a pillow under the calf
  2. Loose cotton socks and daily ambulation
  3. Total contact cast Correct answer.
  4. Surgical shoes worn only outdoors

Explanation

An irremovable total contact cast is preferred for neuropathic plantar ulcers when perfusion is adequate and infection is controlled because it reliably redistributes pressure. Removable devices depend on adherence.

Question 35Wound Care

Which bedside finding most raises suspicion for osteomyelitis in a diabetic foot ulcer?

  1. Granulation tissue covering the wound base
  2. Positive bacterial culture from a swab
  3. Serous drainage from the wound edges
  4. Bone palpable when the wound is probed Correct answer.

Explanation

A positive probe-to-bone test in a diabetic foot ulcer substantially raises the likelihood of underlying osteomyelitis. It should prompt imaging and specialist evaluation.

Question 36Wound Care

Which finding most suggests a wound is infected rather than simply colonized?

  1. A stable wound size over one week
  2. Clear serous exudate
  3. Pink granulation tissue
  4. Spreading erythema, warmth, and pain Correct answer.

Explanation

Infection is suggested by spreading erythema, warmth, pain, purulent drainage, or systemic signs. Colonization may have organisms without these host responses.

Question 37Wound Care

A surgical wound opens and bowel is visible. What is the priority action?

  1. Push the bowel back and apply a tight binder
  2. Irrigate the wound with hydrogen peroxide
  3. Saline-moistened sterile cover; notify surgeon Correct answer.
  4. Apply a dry gauze and schedule a clinic visit

Explanation

Evisceration is a surgical emergency; do not reinsert organs. Cover the wound with sterile saline-moistened gauze and notify the surgeon immediately.

Question 38Wound Care

A colon resection is performed with controlled entry into the bowel and no unusual spillage. How is the wound classified?

  1. Clean wound with no entry into a hollow viscus
  2. Contaminated wound with gross spillage
  3. Dirty wound with old devitalized tissue
  4. Clean-contaminated wound Correct answer.

Explanation

A clean-contaminated wound involves controlled entry into a hollow viscus without unusual spillage. Clean wounds do not enter the respiratory, GI, or GU tract.

Question 39Wound Care

What is the recommended principle for managing a split-thickness skin graft donor site?

  1. Apply povidone-iodine-soaked gauze daily
  2. Maintain a moist, protected environment Correct answer.
  3. Keep it dry and uncovered to form a scab
  4. Debride the site daily until epithelialization

Explanation

Donor sites re-epithelialize best in a moist, protected environment that limits trauma and infection. They are painful and should not be left to dry and scab.

Question 40Wound Care

Which finding defines a stage 3 pressure injury?

  1. Intact skin with nonblanchable erythema
  2. Partial-thickness loss with a shallow open ulcer
  3. Full-thickness loss with visible subcutaneous fat Correct answer.
  4. Full-thickness loss exposing muscle or bone

Explanation

Stage 3 pressure injuries are full-thickness with visible subcutaneous fat but no exposed muscle, tendon, or bone. Stage 4 exposes deeper structures.

Question 41Wound Care

Which three parameters are scored in the PUSH tool?

  1. Perfusion, infection, and sensation
  2. Area, exudate, and tissue type Correct answer.
  3. Pain, odor, and periwound color
  4. Depth, tunneling, and undermining

Explanation

The PUSH tool scores surface area, exudate amount, and tissue type to track pressure injury healing. It does not include pain, odor, or tunneling.

Question 42Wound Care

Which wound is best suited for a hydrocolloid dressing?

  1. Infected wound with copious purulent drainage
  2. Shallow wound with light exudate Correct answer.
  3. Heavily draining wound with macerated edges
  4. Deep cavity wound requiring packing

Explanation

Hydrocolloids suit shallow wounds with light exudate and intact periwound skin because they maintain moisture and provide a protective barrier. They are not used in heavily draining or infected wounds.

Question 43Wound Care

A wound has a 3-cm tunnel. What is the best packing approach?

  1. Loosely fill the tunnel and measure its depth Correct answer.
  2. Insert one continuous gauze strip until resistance
  3. Leave the tunnel open and unpadded
  4. Pack tightly to prevent dead space

Explanation

Tunnels should be loosely filled so drainage can be absorbed without creating pressure or closing the opening. The depth and direction should be measured and documented.

Question 44Wound Care

Which agent provides enzymatic debridement of necrotic tissue?

  1. Collagenase ointment Correct answer.
  2. Medical-grade honey
  3. Hypertonic saline gauze
  4. Cadexomer iodine

Explanation

Collagenase is an enzymatic debrider that digests collagen in necrotic tissue. It requires adequate moisture and should not be used with heavy metal antiseptics.

Question 45Wound Care

Which description fits a superficial partial-thickness burn?

  1. Dry, white, firm skin with little pain
  2. Moist, blistered, painful skin that blanches Correct answer.
  3. Involves muscle and bone with charring
  4. Leathery, insensate skin with thrombosed vessels

Explanation

Superficial partial-thickness burns involve the epidermis and upper dermis, so they are moist, blistered, and painful and usually blanch. Deep burns are drier and less sensate.

Question 46Wound Care

A diabetic client has a hot, swollen, red foot without a break in the skin. Which condition should be suspected?

  1. Superficial partial-thickness burn
  2. Venous insufficiency ulcer
  3. Acute Charcot neuroarthropathy Correct answer.
  4. Cellulitis from a minor scrape

Explanation

Acute Charcot neuroarthropathy presents with a warm, swollen, red foot in a neuropathic diabetic client, often without skin break. It can mimic cellulitis and requires offloading and imaging.

Question 47Wound Care

A dialysis client develops painful purpuric plaques that ulcerate on the thighs. Which diagnosis is most likely?

  1. Neuropathic diabetic ulcer
  2. Calciphylaxis Correct answer.
  3. Stasis dermatitis
  4. Contact dermatitis

Explanation

Calciphylaxis causes painful purpuric plaques and necrosis in end-stage kidney disease due to medial calcification of small vessels. It is not simply stasis or dermatitis.

Question 48Wound Care

An older client has dry, black eschar on the heel with no drainage, redness, or pain. What is the appropriate management?

  1. Start systemic antibiotics immediately
  2. Apply a wet-to-dry dressing and change daily
  3. Sharp debridement down to bleeding tissue
  4. Protect the area and monitor for infection Correct answer.

Explanation

Stable dry gangrene without infection or drainage is usually kept dry and protected because debridement can convert it to a wet, infected wound. Urgent intervention is needed if infection develops.

Question 49Wound Care

A client on long-term corticosteroids has a clean wound that fails to progress. Which effect best explains this?

  1. Rapid epithelial migration across the wound
  2. Excess collagen cross-linking and scar stiffness
  3. Suppressed inflammation and collagen repair Correct answer.
  4. Increased platelet aggregation and clot formation

Explanation

Long-term corticosteroids suppress the inflammatory phase and reduce fibroblast proliferation and collagen synthesis, delaying repair. The wound may look clean but stall.

Question 50Wound Care

How does negative pressure wound therapy promote wound healing?

  1. It sterilizes the wound surface and prevents all infection
  2. It replaces the need for sharp debridement
  3. It increases wound surface area to aid drainage
  4. It removes exudate and promotes contraction Correct answer.

Explanation

Negative pressure wound therapy applies subatmospheric pressure to remove exudate, reduce edema, and promote granulation and wound contraction. It does not sterilize the wound or replace debridement.