Certified Wound Care Nurse Exam (CWCN) Practice Test

Prepare with confidence using our comprehensive Certified Wound Care Nurse (CWCN) Practice Test designed for nurses preparing for the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) examination. This updated question bank includes challenging, board-style multiple-choice questions with detailed answer explanations that closely reflect the knowledge and clinical reasoning required on the actual exam.

Whether you are preparing for your first attempt or retaking the certification exam, this CWCN study guide helps strengthen your understanding of wound assessment, treatment interventions, pressure injury prevention, vascular ulcers, diabetic foot ulcers, wound healing physiology, advanced therapies, patient education, and interdisciplinary care. Every question is written to reinforce concepts tested on the real exam and improve your confidence before test day.

What Is the CWCN Exam?

The Certified Wound Care Nurse (CWCN®) credential is awarded by the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB®). It validates advanced knowledge and clinical competence in wound assessment, treatment planning, pressure injury management, vascular ulcers, diabetic foot care, prevention strategies, and patient education.

The examination evaluates a nurse’s ability to apply evidence-based wound care principles, identify wound etiology, develop appropriate interventions, and collaborate with interdisciplinary teams to optimize patient outcomes.

Earning the CWCN credential demonstrates expertise in:

• Acute and chronic wound management
• Pressure injury prevention and staging
• Diabetic foot ulcer care
• Venous and arterial ulcers
• Wound healing physiology
• Advanced wound therapies
• Infection control and biofilm management
• Patient education and discharge planning
• Interdisciplinary wound care coordination

What’s Included in This CWCN Practice Exam?

This premium question bank contains:

✔ 700 high-quality board-style multiple-choice questions

✔ Detailed answer explanations for every question

✔ Scenario-based clinical application questions

✔ Advanced-level questions similar to the real exam

✔ Coverage of all CWCN examination domains

✔ Wound assessment and differential diagnosis questions

✔ Pressure injury staging and prevention questions

✔ Diabetic foot ulcer and offloading questions

✔ Venous, arterial, neuropathic, and atypical wound questions

✔ Hyperbaric oxygen therapy and NPWT questions

✔ Biofilm, infection, and osteomyelitis questions

✔ Vascular assessment and ABI interpretation questions

✔ Patient teaching and interdisciplinary care questions

✔ Updated content based on current wound care standards and practice guidelines

CWCN Exam Test Domains

The CWCN certification exam focuses on five major areas:

Assessment

Perform comprehensive patient and wound assessments, identify risk factors, recognize wound etiologies, evaluate vascular status, and interpret diagnostic findings.

Intervention

Select evidence-based interventions, debridement techniques, offloading strategies, support surfaces, compression therapy, and prevention methods.

Treatment

Manage acute and chronic wounds using appropriate dressings, advanced wound therapies, infection control, moisture balance, and wound bed preparation principles.

Care Planning

Develop individualized plans of care, establish measurable goals, monitor healing progress, and prevent recurrence.

Education and Referral

Educate patients and caregivers, coordinate interdisciplinary care, and determine appropriate specialty referrals.

Complete Topics Covered

Unlike generic practice tests, this CWCN questions bank covers the most important concepts tested on the certification exam.

Wound Assessment

• Wound measurements
• Tissue types
• Undermining and tunneling
• Exudate assessment
• Periwound skin evaluation
• Differential diagnosis
• Pain assessment
• Wound documentation

Pressure Injuries

• NPIAP staging
• Deep tissue pressure injuries
• Unstageable wounds
• Medical device-related pressure injuries
• Risk factors
• Pressure redistribution
• Support surfaces
• Repositioning schedules
• Moisture management

Wound Healing Physiology

• Hemostasis phase
• Inflammatory phase
• Proliferative phase
• Remodeling phase
• Growth factors
• Angiogenesis
• Fibroblasts and collagen
• Matrix metalloproteinases (MMPs)
• Keratinocyte migration

Vascular Assessment

• Peripheral arterial disease
• Venous insufficiency
• ABI interpretation
• Toe-brachial index
• Transcutaneous oxygen measurements
• Critical limb ischemia
• Doppler studies
• Signs of ischemia

Diabetic Foot Ulcers

• Neuropathy assessment
• Monofilament testing
• Charcot neuroarthropathy
• Offloading principles
• Total contact casting
• Foot deformities
• Therapeutic footwear
• Recurrence prevention

Venous Ulcers

• Venous hypertension
• Compression therapy
• Lipodermatosclerosis
• Hemosiderin staining
• Atrophie blanche
• Edema management

Arterial Ulcers

• Ischemic wounds
• Rest pain
• Revascularization
• ABI contraindications
• Dry gangrene
• Stable heel eschar

Infection and Biofilms

• Local infection
• Cellulitis
• Osteomyelitis
• Probe-to-bone test
• MRI findings
• Wound cultures
• Biofilm management
• Critical colonization
• Pseudomonas infections
• MRSA

Debridement

• Sharp debridement
• Autolytic debridement
• Enzymatic debridement
• Mechanical debridement
• Biological debridement
• Contraindications

Advanced Wound Therapies

• Negative pressure wound therapy (NPWT)
• Hyperbaric oxygen therapy (HBOT)
• Growth factors
• Tissue substitutes
• Advanced dressings
• Antimicrobial dressings

Dressing Selection

• Hydrocolloids
• Hydrogels
• Calcium alginates
• Foams
• Transparent films
• Silver dressings
• Moist wound healing

Atypical Wounds

• Pyoderma gangrenosum
• Vasculitic ulcers
• Calciphylaxis
• Cholesterol embolization syndrome
• Necrobiosis lipoidica
• Autoimmune disorders

Nutrition and Healing

• Protein requirements
• Albumin and prealbumin
• Zinc deficiency
• Vitamin C deficiency
• Iron deficiency
• Malnutrition

Patient Education and Prevention

• Foot care
• Compression therapy adherence
• Smoking cessation
• Exercise recommendations
• Skin care
• Recurrence prevention

Why This CWCN Questions Bank Works

Many study guides only test memorization. The actual CWCN exam evaluates clinical judgment and application.

This question bank was created to help you:

• Understand why answers are correct
• Recognize high-risk clinical situations
• Apply wound care principles in real scenarios
• Strengthen critical thinking skills
• Master difficult concepts frequently missed on exams
• Build confidence before test day

Detailed explanations reinforce important concepts rather than simply providing an answer key.

CWCN Exam Eligibility

Candidates must meet the eligibility requirements established by the WOCNCB®. Requirements generally include:

• Active RN license
• Completion of approved wound care education
• Clinical practice requirements or accredited WOC nursing education

Always review the current requirements directly from the certification board because eligibility standards may change.

Retaking the CWCN Exam

If you do not pass the examination, you may apply to retake it according to current WOCNCB policies. Many successful CWCN nurses pass on a subsequent attempt after identifying weak areas and using targeted practice questions.

Focus on:

• Understanding wound etiology
• Pressure injury staging
• Vascular assessment
• Diabetic foot ulcers
• Compression therapy
• Advanced wound therapies
• Infection management
• Patient education and prevention

Consistent practice with board-style questions significantly improves retention and confidence.

Study Tips to Pass the CWCN Exam

1. Learn Wound Etiology First

Understanding why wounds develop is more important than memorizing dressing names.

Know the differences between:

• Arterial ulcers
• Venous ulcers
• Neuropathic ulcers
• Pressure injuries
• Atypical wounds

2. Master Pressure Injury Staging

Know:

• Stage 1–4 injuries
• Deep tissue pressure injury
• Unstageable pressure injury
• Medical device-related pressure injuries

3. Understand Vascular Assessment

Be comfortable with:

• ABI interpretation
• Toe pressures
• Critical limb ischemia
• Signs of arterial disease
• Compression contraindications

4. Focus on Diabetic Foot Ulcers

Review:

• Neuropathy
• Monofilament testing
• Charcot foot
• Offloading
• Total contact casting
• Footwear modifications

5. Memorize the TIME Framework

Understand:

• Tissue management
• Infection and inflammation control
• Moisture balance
• Edge advancement

6. Study Advanced Therapies

Know indications and contraindications for:

• NPWT
• Hyperbaric oxygen therapy
• Debridement techniques
• Antimicrobial dressings

7. Practice Questions Every Day

The best way to prepare is through repetition and application.

Aim to:

• Complete 50–100 questions daily
• Review explanations carefully
• Track weak topics
• Simulate timed practice exams
• Focus on clinical reasoning instead of memorization

Prepare for the CWCN Exam with Confidence

Passing the Certified Wound Care Nurse (CWCN®) certification exam requires more than memorizing facts. Success comes from understanding wound healing principles, recognizing wound etiologies, applying evidence-based interventions, and developing sound clinical judgment.

Our CWCN Practice Test Questions and Answers provide realistic exam preparation with comprehensive explanations and challenging board-style questions designed to help you strengthen your knowledge, improve critical thinking skills, and walk into exam day with confidence.

CWCN Sample Questions and Answers

Question 1. A patient with venous insufficiency has a shallow ulcer above the medial malleolus with moderate drainage and surrounding hemosiderin staining. Which intervention is most appropriate?

A. Offloading with a total contact cast
B. Compression therapy after arterial assessment
C. Daily dry gauze dressings only
D. Hyperbaric oxygen therapy immediately

✅ Correct Answer: B. Compression therapy after arterial assessment

Explanation: Venous leg ulcers account for most lower extremity ulcers and typically appear around the medial malleolus. Compression therapy is the cornerstone of treatment because it improves venous return and reduces edema. Before applying compression, arterial circulation must be assessed using the ankle-brachial index (ABI) to avoid ischemic complications. Total contact casting is indicated for diabetic plantar ulcers, while dry gauze dressings alone do not address venous hypertension. Hyperbaric oxygen therapy is reserved for selected refractory wounds. Effective management includes edema control, moisture balance, exercise, leg elevation, and addressing underlying venous disease to promote healing and prevent recurrence.

Question 2. Which wound healing phase is characterized by fibroblast activity and collagen synthesis?

A. Hemostasis
B. Inflammatory phase
C. Proliferative phase
D. Maturation phase

✅ Correct Answer: C. Proliferative phase

Explanation: The proliferative phase begins several days after injury and is characterized by granulation tissue formation, angiogenesis, fibroblast proliferation, epithelialization, and collagen deposition. Fibroblasts produce collagen and extracellular matrix components necessary for wound strength and closure. Hemostasis occurs immediately after injury and focuses on clot formation. The inflammatory phase involves neutrophils and macrophages removing debris and bacteria. Remodeling or maturation occurs later and may continue for months as collagen fibers reorganize and tensile strength increases. Understanding these phases helps wound care nurses recognize whether healing is progressing normally or has become stalled due to infection, ischemia, or other systemic factors.

Question 3. A diabetic patient with a plantar neuropathic ulcer would benefit most from:

A. Compression stockings
B. Hydrotherapy twice daily
C. Total contact casting
D. Leg elevation

✅ Correct Answer: C. Total contact casting

Explanation: Total contact casting is considered the gold standard for offloading diabetic plantar ulcers. Neuropathy causes loss of protective sensation, allowing repetitive pressure and shear to impede healing. A total contact cast redistributes pressure over the entire foot and lower leg while limiting activity that contributes to tissue breakdown. Compression stockings are primarily used for venous disease. Leg elevation helps venous edema but does not adequately offload plantar pressure. Hydrotherapy has limited use and may macerate tissue. Successful management of diabetic foot ulcers also requires blood glucose control, infection prevention, vascular assessment, and patient education to reduce recurrence and amputation risk.

Question 4. Which finding is most suggestive of arterial insufficiency?

A. Edema and hemosiderin staining
B. Warm extremity with palpable pulses
C. Pain relieved by leg elevation
D. Pale foot with diminished pulses and cool skin

✅ Correct Answer: D. Pale foot with diminished pulses and cool skin

Explanation: Arterial insufficiency results from impaired blood flow and is characterized by cool extremities, diminished pulses, pallor, delayed capillary refill, dependent rubor, and pain that worsens with elevation. Ulcers are commonly found on toes or pressure areas and have minimal drainage. Venous disease, in contrast, causes edema, hyperpigmentation, and pain relieved by elevation. Recognizing signs of ischemia is essential because aggressive compression or debridement without adequate circulation may worsen tissue damage. Vascular assessment, ABI measurement, and referral for revascularization when appropriate are critical components of arterial wound management and limb preservation.

Question 5. Which pressure injury stage involves full-thickness skin loss with visible adipose tissue?

A. Stage 1
B. Stage 2
C. Stage 3
D. Deep tissue pressure injury

✅ Correct Answer: C. Stage 3

Explanation: Stage 3 pressure injuries involve full-thickness skin loss with exposed adipose tissue. Slough may be present, but bone, tendon, or muscle are not visible. Stage 1 presents as nonblanchable erythema with intact skin. Stage 2 includes partial-thickness skin loss or a serum-filled blister. Deep tissue pressure injuries involve persistent deep red, maroon, or purple discoloration without visible depth. Accurate staging guides treatment plans and documentation. Pressure redistribution, nutritional support, moisture management, and infection prevention are essential in all stages to promote healing and prevent progression.

Question 6. Which dressing is most appropriate for a wound with heavy exudate?

A. Transparent film
B. Hydrocolloid
C. Alginate dressing
D. Dry gauze only

✅ Correct Answer: C. Alginate dressing

Explanation: Alginate dressings are highly absorbent and are derived from seaweed. They interact with wound fluid to form a gel that maintains a moist environment while managing moderate to heavy drainage. Transparent films are suitable for minimally draining wounds. Hydrocolloids work best with light to moderate exudate. Dry gauze often adheres to tissue and can damage healthy granulation during removal. Excessive moisture contributes to maceration and delayed healing, making appropriate exudate management a key component of wound care. Dressing selection should always consider wound depth, drainage amount, and surrounding skin condition.

Question 7. A patient with an ankle-brachial index (ABI) of 0.45 most likely has:

A. Normal arterial perfusion
B. Mild venous disease
C. Significant arterial disease
D. Normal circulation suitable for high compression

✅ Correct Answer: C. Significant arterial disease

Explanation: An ABI below 0.5 indicates severe arterial insufficiency. Compression therapy should generally be avoided until vascular status is further evaluated. Normal ABI ranges from 0.9 to 1.3. Severe arterial disease significantly increases the risk of tissue ischemia and poor wound healing. Patients may require vascular consultation and possible revascularization procedures. CWCN nurses must recognize ABI values and understand their implications because inappropriate compression in severe peripheral arterial disease can result in worsening ischemia and tissue loss. Accurate assessment is fundamental before initiating treatment.

Question 8. Which nutrient is essential for collagen synthesis and wound healing?

A. Vitamin C
B. Vitamin K
C. Sodium
D. Magnesium

✅ Correct Answer: A. Vitamin C

Explanation: Vitamin C plays an essential role in collagen formation, immune function, and tissue repair. Deficiency can lead to delayed wound healing and impaired collagen cross-linking. Adequate protein intake is also crucial because amino acids are necessary for tissue regeneration. Vitamin K primarily supports blood clotting, while sodium and magnesium have other physiologic functions but are not specifically responsible for collagen production. Nutritional assessment is an important component of wound management, especially in older adults and chronically ill patients. Malnutrition can significantly delay healing and increase susceptibility to infection.

Question 9. The acronym TIME in wound bed preparation includes:

A. Tissue, Infection, Moisture, Edge
B. Temperature, Integrity, Moisture, Edema
C. Tissue, Ischemia, Maceration, Exudate
D. Treatment, Infection, Moisture, Evaluation

✅ Correct Answer: A. Tissue, Infection, Moisture, Edge

Explanation: The TIME framework guides wound bed preparation. Tissue management addresses necrotic material requiring debridement. Infection or inflammation control minimizes bacterial burden. Moisture balance maintains an optimal environment for healing without causing maceration. Edge advancement focuses on promoting epithelial migration and addressing stalled wound margins. This structured approach helps clinicians systematically evaluate wounds and optimize conditions for healing. It is widely used in wound care practice and is emphasized in CWCN examination content. Proper application of the TIME principles improves healing outcomes and supports evidence-based care.

Question 10. Which microorganism is commonly associated with green drainage and a sweet odor?

A. Streptococcus pyogenes
B. Pseudomonas aeruginosa
C. Staphylococcus epidermidis
D. Enterococcus faecalis

✅ Correct Answer: B. Pseudomonas aeruginosa

Explanation: Pseudomonas aeruginosa commonly produces green or blue-green drainage and a characteristic fruity or sweet odor. It thrives in moist environments and can delay wound healing through biofilm formation and persistent infection. Identifying clinical signs of infection allows prompt intervention and appropriate culture collection when indicated. Management may include topical antimicrobials, systemic antibiotics, and debridement. CWCN nurses must recognize common pathogens and understand their implications because chronic wounds often harbor polymicrobial populations. Clinical assessment should guide treatment rather than relying solely on culture results.

Question 11. Negative pressure wound therapy primarily promotes healing by:

A. Drying the wound bed
B. Increasing pressure on tissue
C. Removing exudate and promoting granulation
D. Destroying bacteria through heat

✅ Correct Answer: C. Removing exudate and promoting granulation

Explanation: Negative pressure wound therapy removes excess exudate, reduces edema, improves perfusion, and stimulates granulation tissue formation through mechanical deformation. It is commonly used for surgical wounds, traumatic injuries, and chronic wounds with moderate drainage. The therapy does not sterilize wounds or rely on heat. Proper patient selection and monitoring are important because exposed vessels, untreated osteomyelitis, and necrotic tissue are contraindications. Understanding the indications and mechanisms of NPWT is important for CWCN nurses because it is frequently used in advanced wound management settings.

Question 12. Which factor most delays wound healing in diabetic patients?

A. Hyperglycemia
B. Mild anemia
C. Low potassium levels
D. Hypertension alone

✅ Correct Answer: A. Hyperglycemia

Explanation: Persistent hyperglycemia impairs leukocyte function, reduces collagen synthesis, damages blood vessels, and contributes to neuropathy and infection risk. These effects collectively delay wound healing and increase the risk of complications. Glycemic control is one of the most important interventions for diabetic wound management. Although anemia and electrolyte disturbances can affect healing, uncontrolled blood glucose has the greatest impact. Multidisciplinary care involving endocrinology, podiatry, nutrition, and wound specialists improves outcomes and reduces the risk of lower-extremity amputation.

Question 13. Autolytic debridement is best achieved using:

A. Wet-to-dry dressings
B. Hydrocolloid dressings
C. Surgical scalpels
D. Pulsed lavage

✅ Correct Answer: B. Hydrocolloid dressings

Explanation: Autolytic debridement uses the body’s natural enzymes and moisture to soften and liquefy devitalized tissue. Hydrocolloid dressings maintain a moist environment that facilitates this process. It is selective and relatively painless but may be slower than surgical methods. Wet-to-dry dressings are nonselective and can damage healthy tissue. Surgical debridement is indicated when rapid removal of necrotic tissue is necessary. CWCN nurses should understand all debridement methods and select the most appropriate approach based on wound characteristics, patient condition, and treatment goals.

Question 14. Which support surface is recommended for patients at high risk for pressure injuries?

A. Standard mattress
B. Alternating pressure mattress
C. Wooden board
D. Foam donut cushion

✅ Correct Answer: B. Alternating pressure mattress

Explanation: Alternating pressure mattresses redistribute pressure and periodically change contact points to reduce tissue ischemia. They are recommended for patients with limited mobility and those at high risk for pressure injury development. Donut cushions are discouraged because they concentrate pressure and impair circulation. Support surfaces should complement repositioning schedules and skin assessments rather than replace them. Effective prevention strategies also include moisture management, nutrition optimization, and minimizing friction and shear forces. Pressure injury prevention remains a major responsibility of wound care nurses.

Question 15. Which wound characteristic suggests biofilm formation?

A. Rapid healing progression
B. Healthy epithelialization
C. Recurrent inflammation and delayed healing
D. Complete wound closure

✅ Correct Answer: C. Recurrent inflammation and delayed healing

Explanation: Biofilms consist of communities of microorganisms embedded in a protective matrix that resists antibiotics and immune responses. Wounds with biofilms often exhibit persistent inflammation, delayed healing, and recurrent infection despite appropriate treatment. Management usually requires regular debridement and antimicrobial strategies. Biofilm recognition has become increasingly important in modern wound care because it contributes significantly to chronic wound pathology. Addressing biofilms improves wound healing and reduces bacterial burden. CWCN candidates should understand their role in chronic wound management.

Question 16. Which pressure injury stage exposes muscle, tendon, or bone?

A. Stage 2
B. Stage 3
C. Stage 4
D. Unstageable

✅ Correct Answer: C. Stage 4

Explanation: Stage 4 pressure injuries involve full-thickness tissue loss with exposed or palpable fascia, muscle, tendon, ligament, cartilage, or bone. These injuries carry a high risk of osteomyelitis and require comprehensive management. Stage 3 injuries expose adipose tissue only. Unstageable injuries are obscured by slough or eschar. Accurate staging ensures proper treatment, documentation, and reimbursement. Prevention remains the most effective strategy because advanced pressure injuries are associated with prolonged hospitalization and increased morbidity.

Question 17. Which finding is most consistent with venous ulcer pain?

A. Pain relieved by dangling the leg
B. Severe nighttime ischemic pain
C. Pain improved by elevation
D. Complete absence of discomfort

✅ Correct Answer: C. Pain improved by elevation

Explanation: Venous ulcers often produce aching or heaviness that improves with leg elevation because venous return is enhanced and edema decreases. In arterial disease, pain typically worsens with elevation and improves when the legs are dependent. Understanding pain patterns helps differentiate ulcer etiologies and guide treatment decisions. Compression therapy, exercise, and edema control are central components of venous ulcer management. Correct identification of wound etiology is essential because therapies effective for one type of ulcer may be harmful in another.

Question 18. Which Braden Scale category evaluates friction and shear?

A. Sensory perception
B. Activity
C. Nutrition
D. Friction and shear

✅ Correct Answer: D. Friction and shear

Explanation: The Braden Scale assesses pressure injury risk through six categories: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Friction and shear contribute to tissue deformation and vascular compromise, increasing pressure injury risk. Identifying patients with low scores enables early implementation of preventive measures. The Braden Scale is widely used across healthcare settings and remains an important tool for CWCN nurses. Risk assessment should be combined with clinical judgment and individualized prevention strategies.

Question 19. Which type of debridement is considered selective and uses the body’s own enzymes?

A. Surgical debridement
B. Mechanical debridement
C. Autolytic debridement
D. Sharp debridement

✅ Correct Answer: C. Autolytic debridement

Explanation: Autolytic debridement is selective because it preserves healthy tissue while allowing endogenous enzymes to digest necrotic material. Moisture-retentive dressings facilitate this process. Mechanical and surgical methods may remove viable tissue and are less selective. Autolytic techniques are useful for patients who cannot tolerate aggressive procedures and for wounds with small amounts of necrosis. However, they are slower and inappropriate in the presence of advancing infection. CWCN nurses should understand the advantages and limitations of each debridement method to support individualized care plans.

Question 20. The strongest indicator that a wound is progressing toward healing is:

A. Increased necrotic tissue
B. Development of black eschar
C. Formation of healthy red granulation tissue
D. Foul odor and purulent drainage

✅ Correct Answer: C. Formation of healthy red granulation tissue

Explanation: Granulation tissue is a hallmark of the proliferative phase and indicates active healing. Healthy granulation appears moist, red, and well vascularized. Increasing necrosis, eschar formation, foul odor, and purulent drainage suggest deterioration or infection. Wound assessment should focus on tissue quality, drainage characteristics, wound size, and surrounding skin. Recognizing signs of healing allows clinicians to continue effective therapies, while identifying delayed healing prompts reassessment of factors such as perfusion, infection, nutrition, and pressure redistribution. Comprehensive evaluation and evidence-based interventions are essential components of successful wound management and are heavily emphasized on the CWCN examination.

Question 21. A patient with diabetes has a plantar ulcer beneath the first metatarsal head. Monofilament testing reveals loss of protective sensation, and pedal pulses are palpable. Which factor is the primary cause of this ulcer?

A. Venous hypertension
B. Repetitive pressure with sensory neuropathy
C. Arterial insufficiency
D. Vasculitis

✅ Correct Answer: B. Repetitive pressure with sensory neuropathy

Explanation: Loss of protective sensation from peripheral neuropathy is the major cause of diabetic plantar ulcers. Because the patient cannot perceive pain or pressure, repetitive trauma continues unnoticed. Motor neuropathy and foot deformities further increase pressure points. Palpable pulses suggest that ischemia is not the primary cause. Effective management requires pressure redistribution, offloading devices, glycemic control, and patient education. Wound care nurses should recognize neuropathic ulcers early because recurrence rates are high and untreated ulcers increase the risk of infection and amputation. Proper assessment of sensation is essential to identify patients at risk.

Question 22.  A stage 4 pressure injury contains 70% adherent slough and tunneling. Which intervention should be prioritized first?

A. Growth factor therapy
B. Tissue debridement and wound bed preparation
C. Hyperbaric oxygen therapy
D. Skin grafting

✅ Correct Answer: B. Tissue debridement and wound bed preparation

Explanation: Necrotic tissue impairs wound healing and harbors bacteria. According to the TIME principle, tissue management is the first priority. Removing slough and preparing the wound bed allow granulation tissue formation and make advanced therapies more effective. Wound care nurses should select the appropriate debridement method based on vascular status, infection, and patient tolerance. Attempting advanced therapies before wound bed preparation often results in poor outcomes. Proper tissue management is foundational to chronic wound treatment.

Question 23: Which dressing is most appropriate for a heavily draining wound with moderate depth and no necrosis?

A. Hydrogel sheet
B. Transparent film
C. Calcium alginate dressing
D. Hydrocolloid dressing

✅ Correct Answer: C. Calcium alginate dressing

Explanation: Calcium alginates are highly absorbent dressings derived from seaweed and are ideal for moderate to heavily exudative wounds. They maintain moisture balance and conform to cavity wounds. Hydrogels are more appropriate for dry wounds, whereas transparent films are suitable for minimally draining wounds. Wound care nurses should base dressing selection on exudate volume, tissue type, and wound depth. Maintaining moisture balance is essential for optimal healing.

Question 24: A patient with a venous leg ulcer healed successfully after 12 weeks of compression therapy. What should be included in the long-term care plan?

A. Discontinue compression therapy permanently
B. Lifelong compression stockings and exercise program
C. Weekly prophylactic antibiotics
D. Bed rest for six months

✅ Correct Answer: B. Lifelong compression stockings and exercise program

Explanation: Venous insufficiency is a chronic disease. Although ulcers may heal, venous hypertension persists. Lifelong compression therapy, calf muscle exercises, weight control, and skin care are essential to prevent recurrence. Recurrence rates are extremely high when compression is discontinued. Wound care nurses play a key role in patient education and long-term prevention strategies. Maintaining venous return reduces edema and improves quality of life.

Question 25. A patient with an ABI of 0.40 has a painful toe ulcer and absent pedal pulses. Which referral is most urgent?

A. Dermatology consultation
B. Nutrition services
C. Vascular surgery referral
D. Occupational therapy

✅ Correct Answer: C. Vascular surgery referral

Explanation: An ABI of 0.40 indicates severe arterial disease and critical limb ischemia. Pain, absent pulses, and distal ulceration further support compromised perfusion. Healing cannot occur without adequate blood flow. Wound care nurses should recognize vascular emergencies and expedite referral for revascularization assessment. Delayed intervention increases the risk of gangrene and amputation. Timely referral is essential for limb preservation.