WCC wound care practice test: 30 questions

A patient who had gastric bypass surgery 2 years ago has a slowly healing surgical wound despite adequate calorie intake. Which re-evaluation is MOST important?

1. Repeat a 3-day calorie count

   Repeating a 3-day calorie count measures intake again, and intake is already adequate; after bypass the problem is absorption, not eating.
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2. Test for nutrient deficiencies

   Gastric bypass limits absorption, so protein, iron, vitamin B12, zinc and other deficiencies can stall healing even when calories are adequate; testing for these nutrient deficiencies, then replacing them with dietitian help, targets the likely cause.
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3. Recalculate the body mass index

   Recalculating the body mass index describes body size, and a normal or high BMI can hide protein and micronutrient deficiencies.
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4. Track body weight each week

   Tracking body weight each week shows trends in mass but cannot reveal missing iron, zinc or vitamin B12.
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Select an answer to record it. The card then marks the key and opens the reasoning under every choice.

A DFU has adequate perfusion and a treatable cause, but after full discussion the patient declines any offloading because of his job. How is this wound best classified for goal-setting?

1. Nonhealable wound

   A nonhealable wound lacks the biology to heal, such as uncorrectable ischemia; this foot has adequate perfusion and a treatable cause.
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2. Maintenance wound

   A maintenance wound could heal but is not expected to because of patient or system factors, here his refusal of offloading, so goals shift to preventing deterioration while the discussion continues.
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3. Healable wound

   A healable wound assumes the cause will be corrected, and without offloading the pressure on this ulcer is not removed.
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4. Palliative wound

   Palliative wound care aims at comfort in people with a life-limiting illness, which is not this patient's situation.
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A patient with a diabetic foot ulcer has had rising blood glucose for 4 days despite taking insulin as prescribed. The ulcer looks unchanged and there is no periwound erythema. What should the clinician do?

1. Adjust the insulin dose only

   Adjusting the insulin dose alone treats the number but ignores the likely driver in a patient with an open foot ulcer.
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2. Continue current care

   Continuing current care assumes no infection, but absent redness does not rule it out in a diabetic foot.
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3. Order a serum albumin level

   Albumin reflects inflammation and fluid status more than nutrition, and it does not explain a sudden rise in glucose.
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4. Look for an occult infection

   In diabetes, rising glucose with no other cause can be the first sign of a foot infection, because neuropathy and poor perfusion blunt redness and pain; the foot is examined closely, including probing the ulcer.
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A patient with a stalled leg ulcer has missed several visits, and at re-evaluation he admits to drinking heavily most days. What is the MOST appropriate response?

1. Wait until he raises the topic again

   Waiting for him to bring it up again wastes the opening he has just given.
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2. Leave it out of the care plan

   Alcohol use impairs healing and adherence, so leaving it out of the plan ignores a likely reason the ulcer has stalled.
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3. Discharge him from the clinic

   Discharge removes care without dealing with the reason he has been missing visits.
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4. Offer a brief intervention and referral

   Heavy drinking affects nutrition, immunity and attendance, so a nonjudgmental brief intervention with feedback, advice and an offer of referral addresses a real barrier to healing.
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A deep partial-thickness burn is re-evaluated on day 5. Areas that were moist, pink and painful are now white, dry and leathery, and they do not sense a pinprick. This change is most consistent with:

1. Normal re-epithelialization

   New epithelium looks pink and moist and is sensitive to touch, the opposite of white, dry, numb tissue.
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2. Maceration from the dressing

   Maceration from a too-moist dressing leaves skin white but soft, wrinkled and wet, not dry and leathery, and sensation is kept.
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3. A healing superficial partial-thickness burn

   A superficial partial-thickness burn is moist, pink and painful; loss of sensation means the injury has become deeper, not shallower.
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4. Conversion to a full-thickness injury

   Deep partial-thickness burns can deepen over the first days; white, dry, leathery, insensate areas are the picture of full-thickness injury, which usually needs surgical review.
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At a follow-up visit, a patient with diabetic neuropathy has a red, hot, swollen midfoot with intact skin. The foot is 3 °C warmer than the other foot, and there is no fever or open wound. What should be suspected?

1. Charcot arthropathy

   A red, hot, swollen neuropathic foot with intact skin and a temperature difference of more than 2 °C is active Charcot neuroarthropathy until proven otherwise.
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2. Midfoot cellulitis

   Cellulitis usually needs a break in the skin and often brings fever; this skin is intact and the patient is afebrile.
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3. Acute gout attack

   Gout typically flares in one joint, most often the big toe, with severe pain; a diffusely hot midfoot in a neuropathic patient fits Charcot better.
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4. Deep vein thrombosis

   Deep vein thrombosis swells the calf and leg rather than producing a hot, red midfoot with a sharp temperature gradient.
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During re-evaluation, when should exudate amount and wound odor each be assessed?

1. Both after the wound has been cleansed

   Cleansing removes the drainage, so exudate judged after the wound has been cleansed is underestimated.
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2. Exudate after cleansing; odor on the removed dressing

   Judging exudate after cleansing and odor on the removed dressing reverses both timings, underestimating drainage and overcalling odor.
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3. Exudate on the removed dressing; odor after cleansing

   Exudate amount is judged on the removed dressing before cleansing washes the evidence away, and odor after cleansing, since old dressings and liquefied tissue smell even without infection.
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4. Both on the removed dressing, before cleansing

   Odor on a used dressing often comes from the product and old drainage, so judging both before cleansing overstates odor.
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A hospital changes its Braden 'at-risk' trigger from a score of 16 or less to 18 or less. What effect should the wound team expect?

1. Fewer patients missed, but more false alarms

   Raising the cutoff to 18 flags more patients, so fewer people who go on to develop injuries are missed (higher sensitivity) at the cost of prevention for some who would have stayed intact.
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2. Fewer patients flagged, and each flag more accurate

   A higher cutoff flags more patients, not fewer; fewer and more specific flags come from lowering it.
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3. More patients missed, but fewer false alarms

   More misses with fewer false alarms is what lowering the cutoff does, the opposite change.
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4. No change in who gets flagged

   The items stay the same, but the cutoff decides who is called at risk, so moving it from 16 to 18 changes the flagged group.
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A patient on an alternating-pressure mattress for a healing pressure injury reports that the constant inflating and deflating makes him nauseated and keeps him awake. Which change is most appropriate?

1. Return to standard foam

   Returning to standard foam does not redistribute pressure well enough for a patient with a pressure injury.
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2. Try another redistributing surface

   A different surface that meets the same pressure-redistribution needs, such as low-air-loss or reactive air, protects the wound while respecting his intolerance of the motion.
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3. Turn the mattress off at night

   Switched off, an alternating surface becomes a poor static mattress for the hours he spends lying still.
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4. Continue; he will get used to it

   Telling him to continue and get used to it dismisses real intolerance, nausea and lost sleep, and invites him to refuse the surface altogether.
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A venous ulcer has healed slowly despite good compression. The patient's ankle is stiff from an old fracture and he walks with a flat-footed shuffle. Which referral best addresses this barrier?

1. Vascular surgery for bypass

   Bypass treats arterial disease; nothing in this history suggests poor arterial flow, and it would not free a stiff ankle.
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2. Physical therapy evaluation

   The calf muscle pump depends on ankle motion, so physical therapy for range of motion and gait targets the reason compression alone has not been enough.
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3. Dietitian for protein supplements

   A dietitian for protein supplements answers a nutrition deficit, but this history points to a mechanical barrier instead.
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4. Dermatology for a skin biopsy

   A biopsy is for atypical ulcers; here a clear mechanical cause explains the slow progress.
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A patient with a painful pressure injury becomes very anxious during dressing changes, even though analgesia is given beforehand. Which added strategy is most appropriate?

1. Let the patient call time-outs

   Giving the patient control, such as an agreed signal to pause, lowers anxiety and perceived pain during the procedure.
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2. Hold the patient's hands still

   Restraining the hands adds fear and loss of control, which heightens pain.
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3. Avoid explaining the steps

   Withholding information adds uncertainty; explaining each step beforehand is what reduces anxiety.
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4. Change the dressing twice as often

   More frequent changes add painful, anxiety-provoking events with no benefit to the wound.
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A toe ulcer with dry eschar was kept dry with povidone-iodine painting until the patient had successful revascularization. The foot is now warm with a strong pulse. How should local wound care change?

1. Apply compression to prevent edema

   Compression is not part of arterial wound care after revascularization and does nothing to clear the eschar.
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2. Debride it and keep the bed moist

   Dry eschar on an ischemic toe is kept dry only while perfusion is too poor to heal; once flow is restored, it is safe to debride it and keep the bed moist.
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3. Keep painting the eschar to keep it dry

   Keeping the eschar dry made sense while the toe could not heal; with a strong pulse it now delays healing.
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4. Let the eschar separate on its own

   Waiting for the eschar to lift leaves a necrotic cap on a wound that can now heal and wastes the restored blood flow.
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A patient with a venous ulcer in four-layer compression now has new shortness of breath, crackles in both lungs and rapid weight gain from worsening heart failure. What should the clinician do?

1. Hold compression and notify the provider

   Compression pushes fluid from the legs into the central circulation, so it is held and the provider notified in decompensated heart failure until the patient is stabilized.
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2. Switch to a short-stretch bandage

   A short-stretch bandage still compresses and still moves fluid toward the heart.
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3. Keep compression; elevate the legs

   Keeping compression on with the legs elevated adds to the fluid returning to an overloaded heart.
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4. Add an extra layer to control edema

   Another layer means more compression and more central fluid shift, the opposite of what this patient needs.
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At re-evaluation, clear fluid is weeping from intact skin on a very swollen lower leg, soaking the patient's socks. What is the most appropriate plan?

1. Leave the leg open to air to dry

   Leaving weeping skin uncovered soaks clothing and bedding, macerates the skin and raises infection risk.
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2. Use compression and absorbent pads

   This is lymphorrhea, lymph leaking through the skin of a swollen leg; compression reduces the swelling that drives it, absorbent pads protect the skin, and lymphedema referral follows.
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3. Apply a transparent film

   A transparent film traps the fluid against the skin and will not stay on a weeping surface.
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4. Restrict all oral fluid intake

   Lymph leakage is not caused by drinking too much, and fluid restriction does not reduce lymphedema.
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A patient with a venous ulcer cannot wear bandages or stockings because of severe hand arthritis and a leg deformity, and he is mostly immobile. Which option can provide compression therapy?

1. Intermittent pneumatic compression

   Intermittent pneumatic compression delivers pressure through a sleeve and pump, and it works without the calf muscle action this immobile patient lacks.
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2. An Unna boot changed every week

   An Unna boot is a bandage, which this patient cannot wear, and its rigid support works mainly when the calf contracts during walking.
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3. Leg elevation alone, mainly at night

   Elevation reduces swelling only while the legs are up and gives far less edema control than compression.
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4. Compression stockings put on by family

   The leg deformity, not only his hands, rules out compression stockings, so having family put them on does not solve the problem.
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A resident with a stalled pressure injury coughs during meals, pockets food in her cheeks and takes an hour to finish half a tray. Which referral best addresses the barrier to intake?

1. Gastroenterology for a colonoscopy

   A colonoscopy examines the lower bowel and does nothing for a problem that starts in the mouth and throat.
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2. Dermatology for the wound

   The wound is stalled because of poor intake, and a skin specialist does not address the feeding barrier.
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3. Speech-language swallow evaluation

   Coughing during meals, pocketing food and very slow eating point to dysphagia; a speech-language pathologist assesses the swallow and sets safe textures so intake can rise.
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4. Occupational therapy for adaptive utensils

   Adaptive utensils address grip and self-feeding, but coughing and pocketing point to the swallow itself.
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A patient has worn 30–40 mmHg compression for a healed venous ulcer for 2 years. The ABI was 1.0 at the start, and he now has new calf pain on walking. What should be done?

1. Stop compression for good

   Stopping compression for good, without testing, abandons the treatment that keeps his venous ulcer healed.
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2. Continue compression; the old ABI is still valid

   An ABI from 2 years ago does not reflect his perfusion now that he has symptoms of claudication.
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3. Increase compression to 40–50 mmHg

   Increasing compression on a limb that could now be ischemic risks pressure damage; the ABI comes first.
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4. Repeat the ABI before continuing compression

   New calf pain on walking suggests arterial disease that may have developed since the first ABI, so perfusion is rechecked before compression continues.
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A venous ulcer with signs of local infection has been treated with a silver dressing and compression for 2 weeks. The signs of infection have not improved. What is the most appropriate next step?

1. Switch to a hydrocolloid dressing

   An occlusive hydrocolloid is a poor choice for a wound with active infection.
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2. Stop antimicrobials and wait

   Stopping antimicrobials and waiting lets an unresolved infection progress.
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3. Obtain a tissue culture and reassess

   A topical antimicrobial is reviewed at about 2 weeks; when infection signs persist, a tissue culture and a review of debridement, perfusion and possible systemic treatment come next.
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4. Continue the silver dressing for 4 more weeks

   Persisting with an agent that has failed for 2 weeks only delays effective treatment.
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Despite dietitian input and oral supplements for 2 weeks, a resident with a Stage 4 pressure injury still eats less than half of her needs. Healing and full treatment are her stated goals. What should the team discuss next?

1. High-dose vitamin C and zinc

   High-dose vitamin C and zinc benefit healing only when a deficiency exists, and they do not supply the missing protein and energy.
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2. Waiting another month to see

   Another month at less than half her needs deepens the protein-energy deficit that is stalling healing.
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3. Stopping all oral supplements

   Stopping supplements cuts her intake further when it is already too low.
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4. Starting enteral tube feeding

   When oral intake with supplements still falls short and the resident's goals support full treatment, enteral tube feeding is the next option to discuss with her.
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At follow-up, a patient with a venous ulcer admits to reusing the same foam dressing for a week because the prescribed dressings are not covered by the insurance plan and are too expensive. What is the best response?

1. Involve case management and find affordable options

   Cost is the barrier, so case management or social work helps find an equally suitable dressing the plan covers, with change frequency set by the exudate.
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2. Document nonadherence and continue the same order

   Recording nonadherence without solving the cost problem guarantees that it continues.
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3. Explain that reuse is fine if the foam looks clean

   A used foam holds exudate and bacteria even when it looks clean, risking infection and maceration.
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4. Keep the order but reduce changes to once weekly

   Wear time is set by the exudate, not by the budget; a week without assessing drainage risks maceration.
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A patient with a painful venous leg ulcer is starting multilayer compression and worries that it will make the pain worse. What usually happens to venous ulcer pain with well-applied compression?

1. It stays the same until the ulcer closes

   Compression reduces the edema behind much of the pain, so pain does not stay the same until the ulcer closes; relief usually comes well before healing.
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2. It usually worsens for the first weeks

   Pain that worsens under compression signals a problem, such as a poorly applied bandage, rather than an expected first phase.
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3. It eases as the leg swelling goes down

   Venous ulcer pain comes largely from edema and venous hypertension, so it typically eases within days to weeks as the leg swelling goes down, with analgesia at first if needed.
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4. It eases mainly when the leg hangs down

   Letting the leg hang down raises venous pressure, so venous pain eases with compression and elevation, not when the leg is dependent.
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A wound team has produced a patient video on putting on compression stockings. Before releasing it, what is the BEST way to evaluate it?

1. Count how many patients viewed it in the first month

   View counts measure reach after release, not whether anyone learned to put on a stocking.
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2. Check that the narration uses correct medical terminology

   Technical terms work against plain language and health literacy, so checking for them is the wrong goal.
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3. Have target patients view it, then demonstrate the skill

   Teaching media succeed only if the intended audience can use them, so a pilot with representative patients and a return demonstration tests real learning of a hands-on skill.
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4. Have the wound team review it for clinical accuracy only

   Expert review confirms accuracy but not that patients understand the video and can follow it.
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Which way of sharing pressure injury data is most likely to improve prevention on the units?

1. Quarterly unit rates emailed to the nurse managers

   Data that stop in the managers' inboxes, four times a year, rarely reach the bedside where prevention happens.
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2. Names of the nurses involved posted with each new injury

   Posting nurses' names is punitive, discourages reporting and ignores the system causes of most injuries.
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3. Monthly unit-level results shared with front-line staff

   Frequent, unit-specific results given to the staff who deliver care let them see the effect of their own practice and act on it.
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4. An annual facility-wide rate reported to the board

   One facility-wide figure a year, reported to the board, is too late and too general for any unit to act on.
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Heel-offloading compliance was 95% during a week of announced bedside audits, but heel injuries did not fall. Which factor most likely inflated the audit result?

1. Heel injuries take months to respond to change

   A slow response would explain flat injury rates, not a compliance figure that was too high.
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2. Staff behaved differently while being observed

   Known observation changes behavior (the Hawthorne effect), so announced audits capture best-behavior practice; unannounced checks at varied times give a truer figure.
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3. The audit tool measured the wrong heel device

   Nothing suggests the tool counted the wrong device; it measured what it was meant to, under unusual conditions.
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4. Compliance data should come from incident reports

   Incident reports record events after harm, not everyday compliance, so they cannot replace observation.
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At an NPWT dressing change, the nurse removes two pieces of foam, but the previous note documents that three pieces were placed in the wound. What should the nurse do?

1. Apply the new dressing and note the discrepancy

   Noting the mismatch while sealing a new dressing over it leaves a possible foreign body in the wound.
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2. Increase the pressure to draw out any remnants

   Suction will not pull out foam that granulation has grown into, and higher pressure can injure the bed.
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3. Search for the retained foam before reapplying

   A missing piece of foam left in the wound causes infection and stalled healing, so the wound is inspected and the piece found, with the provider if needed, before a new dressing goes on.
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4. Assume the note is wrong and use two new pieces

   Assuming a charting error without looking risks leaving a foreign body behind.
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An NPWT unit malfunction leads to a serious injury in a hospital patient. Under the Safe Medical Devices Act, what must the hospital do?

1. Report it to the manufacturer within 10 workdays

   Under the Safe Medical Devices Act, a user facility reports a device-related serious injury to the manufacturer within 10 work days, or to the FDA if the manufacturer is unknown; deaths go to both.
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2. Handle it only through internal incident reporting

   An internal incident report is filed as well, but it does not replace the external report the law requires.
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3. Report it only if the patient or family files a complaint

   The duty to report is triggered by the injury itself, not by whether anyone complains.
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4. Report it to the state board of nursing within 24 hours

   A board of nursing regulates nursing licenses, not medical devices, and does not receive device reports.
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A wheelchair user with paraplegia has an ischial Stage 3 pressure injury that has not improved in 3 weeks. The patient sits for 10 hours a day on a standard foam cushion and does not do pressure relief. Which plan change best addresses the barrier?

1. Add a silver dressing

   A silver dressing does not take pressure off the ischium, and nothing here suggests infection.
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2. Keep the plan but turn the patient at night

   The damage comes from daytime sitting, so night turning leaves the main cause untouched.
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3. Switch to a ring cushion

   Ring cushions concentrate pressure around the hole and reduce blood flow to the tissue in the middle.
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4. Limit sitting time and teach weight shifts

   Ten hours a day of unrelieved sitting is the barrier, so sitting time is limited while the wound heals, the cushion is reviewed and regular weight shifts are taught.
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A patient on NPWT for a heel wound has new non-blanchable redness on the lateral foot where the tubing lies under the leg. What is the most appropriate change?

1. Pad the redness and continue as is

   Padding the redness while the tubing still lies under the leg keeps the device pressure in place.
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2. Stop NPWT until the redness fades

   Stopping therapy is unnecessary; moving the tubing removes the cause while treatment continues.
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3. Lower the NPWT pressure setting

   The suction setting does not change how hard the tube presses on the skin from outside.
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4. Reroute the tubing off bony areas

   Tubing trapped between the leg and the bed acts as a device pressing on the skin, so it is routed or bridged away from bony prominences and out from under the limb.
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A hospital protocol for prophylactic silicone foam dressings on the sacrum should apply them to which patients?

1. High-risk patients in ICU or after long surgery

   Guidelines support prophylactic silicone foam on the sacrum for high-risk patients, such as those in intensive care or after long surgery, added to repositioning and lifted daily to inspect the skin.
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2. Patients whose repositioning can then be reduced to every 4 hours

   A prophylactic dressing adds protection but never replaces repositioning or allows it less often.
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3. Every patient on admission, regardless of risk level

   Universal use adds cost without shown benefit for low-risk patients.
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4. Only patients who already have a Stage 1 sacral injury

   Prophylactic foam is meant to prevent injury in at-risk skin; waiting for a Stage 1 injury means prevention has already failed, and that injury needs offloading and treatment.
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A resident is repositioned every 2 hours on a new support surface. At each turn, the nurse finds non-blanchable redness over the trochanter that persists 30 minutes after pressure is relieved. What is the most appropriate change?

1. Position the resident on that side

   Positioning the resident on that side loads the injured trochanter, tissue that is already damaged.
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2. Shorten the repositioning interval

   Redness that does not blanch 30 minutes after relief is a Stage 1 injury, showing that 2 hours is too long for this resident on this surface; the repositioning interval is shortened and the surface reviewed.
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3. Massage the reddened area at each turn

   Massage over reddened bony areas damages fragile tissue further and is not recommended.
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4. Keep the 2-hour schedule unchanged

   Persistent redness is evidence that the current schedule is not protecting this resident.
   Check