EXAM (ELABORATIONS) 2026 CERTIFIED WOUND CARE NURSE (CWCN
CERTIFICATION EXAM) BY WOCNCB NEW LATEST VERSION WITH ALL 120
QUESTIONS, CORRECT ANSWERS AND RATI
1. What are 6 risk factor components of Braden Scale for pressure ulcer? sensory
perception, moisture, mobility, activity, nutrition, and shear/friction
2. What is the name of the organization that developed the pressure ulcer
staging? NPUAP (national pressure ulcer advisory panel)
3. pathological effect of excessive pressure on soft tissue can be attributed by 3
factors? what are they? tissue tolerance, duration of pressure, and intensity of
pressure
4. what are the extrinsic factors that impact pressure ulcers? increase in moisture,
friction and shearing
5. how does friction play a role in shearing which eventually leads to pressure
ulcer? friction alone causes only superfical abrasion, but with gravity it plays a
synergistic effect leading to shearing. When gravity pushes down on the body
and resistance (friction) between the patient and surface is exerted, shearing
occurs. because skin does not freely move, primary effect of shearing occurs at
the deeper fascial level.
6. what are the intrisinc factors of pressur ulcers? nutritional debilitation,
advanced age, low BP, stress, smoking, elevated body temperature
7. Aging skin undergoes what elements affecting risk for pressure ulcer?
dermoepidermal junction flattens, less nutrient exchange occurs, less resistance
to shearing, changes in sensory perception, loss of dermal thickness, increased
vascular fragility; ability of soft tisuse to distribute mechanical load w/out
comprosing blood flow is impaired
8. What does nonblanching erythema indicate in the skin r/t PU? when pressure
is applied to the erythematic area skin becomes white (blanched), but once
relieved, erythema returns -indicating blood flow; however in nonblanching
,erythema, skin does not blanche-indicating impaired blood flow-suggesting
tissue destructon
9. why does sitting in a chair pose more of a risk in skin break down than lying?
deep tissue injury or PU is likely to occur sooner sitting down because tissue
offloading over boney prominences is higher
10. Describe what you will see in deep tissue injury? purple or maroon localized
area of discolored intact skin skinor blood filled blister; may be preceded by
painful, firm, mushy, or boggy; skin may be warmer to cooler in adjacent tissue.
In dark skin, thin blister or eschar over a dark wound bed may bee seen
11. Describe stage I pressure ulcer? Intact skin with nonblanchable redness of
localized area. Will not see blanching in dark skin, but changes in skin tissue
consistency (firm vs boggy when palpated), sensation (pain), and warmer or
cooler temperature may differ from surrounding area
12. Describe stage II pressure ulcer? partial-thickness wound where epidermis
and tip of dermis is lost with red-pink wound bed w/out slough. may also
present as intact or open/ruptured serum -filled blister
13. Describe stage III pressure ulcer? full-thickness wound where both epidermis
and dermis is lost and subcutaneous tissue may be visible, but deeper structures
such as muscle, bone, and tendon are not exposed; slough my be present but it
doesn't obscure depth and tunneling and undermining may be present
14. Describe stage IV pressure ulcer? full-thickness wound with exposed
bone,tendon, and muscle; slough or eschar may be seen in some parts of the
wound bed. you will often see tunneling and undermining. Osteomyelitis may
be dxed at this stage, since bone is palpable
15. Describe unstageble ulcers? full-thickness wound where base of the ulcer is
covered by slough and/or eschar, obscuring depth
16. When should eschars not be removed? when it's stable with dry, adherent,
and intact w/out erythema on the heel; this serves as the body's natural cover
and should not be removed.
, 17. Therapeutic function of pressure distribution is accomplised by what 2
factors? immersion and envelopement
18. Define immersion? depth of penetration or skining into surgace allowing
pressure to be spread out over surrounding area rather than directly over boney
prominence
19. Define envelopement? is the ability of support surface to conform to
irregularities without causing substantial increase in pressure
20. what is bottoming out? this occurs when depth of penetration or sinking is
excessive, allowing increased pressure to concentrate over boney prominences
21. what factors contribute to bottoming out? weight, disproportion of weight
and size such as amputation, tendency to keep HOB >30 degrees, inappropriate
support surface settings
22. When should you consider reactive support surface with features and
components such as low air loss, alternating pressure, viscous or air fluids? for
patients who cannot effectively position off their wound, have PUs in multiple
turning surfaces, or have PUs that fail to improve despite optimal
comprehensive management
23. When should active support surface be considered? when effective
positioning is determined by an MD to be medically contraindicated
24. What is the difference between an active and reactive support surfaces/ active
support surface is a powered mattress or overlay that changes it's load-
distribution with or without applied load; pressure is redistributed across the
body by inflating and deflating the cells of alternating zones. conversely a
reactive support surface moves or changes load-distribution properties only in
response to applied load, such as the patient's body.
25. When are active support surfaces appropriate? when manual frequent
repositioning is not possible
26. when are reactive support surfaces appropriate? for pressure ulcer
prevention
CERTIFICATION EXAM) BY WOCNCB NEW LATEST VERSION WITH ALL 120
QUESTIONS, CORRECT ANSWERS AND RATI
1. What are 6 risk factor components of Braden Scale for pressure ulcer? sensory
perception, moisture, mobility, activity, nutrition, and shear/friction
2. What is the name of the organization that developed the pressure ulcer
staging? NPUAP (national pressure ulcer advisory panel)
3. pathological effect of excessive pressure on soft tissue can be attributed by 3
factors? what are they? tissue tolerance, duration of pressure, and intensity of
pressure
4. what are the extrinsic factors that impact pressure ulcers? increase in moisture,
friction and shearing
5. how does friction play a role in shearing which eventually leads to pressure
ulcer? friction alone causes only superfical abrasion, but with gravity it plays a
synergistic effect leading to shearing. When gravity pushes down on the body
and resistance (friction) between the patient and surface is exerted, shearing
occurs. because skin does not freely move, primary effect of shearing occurs at
the deeper fascial level.
6. what are the intrisinc factors of pressur ulcers? nutritional debilitation,
advanced age, low BP, stress, smoking, elevated body temperature
7. Aging skin undergoes what elements affecting risk for pressure ulcer?
dermoepidermal junction flattens, less nutrient exchange occurs, less resistance
to shearing, changes in sensory perception, loss of dermal thickness, increased
vascular fragility; ability of soft tisuse to distribute mechanical load w/out
comprosing blood flow is impaired
8. What does nonblanching erythema indicate in the skin r/t PU? when pressure
is applied to the erythematic area skin becomes white (blanched), but once
relieved, erythema returns -indicating blood flow; however in nonblanching
,erythema, skin does not blanche-indicating impaired blood flow-suggesting
tissue destructon
9. why does sitting in a chair pose more of a risk in skin break down than lying?
deep tissue injury or PU is likely to occur sooner sitting down because tissue
offloading over boney prominences is higher
10. Describe what you will see in deep tissue injury? purple or maroon localized
area of discolored intact skin skinor blood filled blister; may be preceded by
painful, firm, mushy, or boggy; skin may be warmer to cooler in adjacent tissue.
In dark skin, thin blister or eschar over a dark wound bed may bee seen
11. Describe stage I pressure ulcer? Intact skin with nonblanchable redness of
localized area. Will not see blanching in dark skin, but changes in skin tissue
consistency (firm vs boggy when palpated), sensation (pain), and warmer or
cooler temperature may differ from surrounding area
12. Describe stage II pressure ulcer? partial-thickness wound where epidermis
and tip of dermis is lost with red-pink wound bed w/out slough. may also
present as intact or open/ruptured serum -filled blister
13. Describe stage III pressure ulcer? full-thickness wound where both epidermis
and dermis is lost and subcutaneous tissue may be visible, but deeper structures
such as muscle, bone, and tendon are not exposed; slough my be present but it
doesn't obscure depth and tunneling and undermining may be present
14. Describe stage IV pressure ulcer? full-thickness wound with exposed
bone,tendon, and muscle; slough or eschar may be seen in some parts of the
wound bed. you will often see tunneling and undermining. Osteomyelitis may
be dxed at this stage, since bone is palpable
15. Describe unstageble ulcers? full-thickness wound where base of the ulcer is
covered by slough and/or eschar, obscuring depth
16. When should eschars not be removed? when it's stable with dry, adherent,
and intact w/out erythema on the heel; this serves as the body's natural cover
and should not be removed.
, 17. Therapeutic function of pressure distribution is accomplised by what 2
factors? immersion and envelopement
18. Define immersion? depth of penetration or skining into surgace allowing
pressure to be spread out over surrounding area rather than directly over boney
prominence
19. Define envelopement? is the ability of support surface to conform to
irregularities without causing substantial increase in pressure
20. what is bottoming out? this occurs when depth of penetration or sinking is
excessive, allowing increased pressure to concentrate over boney prominences
21. what factors contribute to bottoming out? weight, disproportion of weight
and size such as amputation, tendency to keep HOB >30 degrees, inappropriate
support surface settings
22. When should you consider reactive support surface with features and
components such as low air loss, alternating pressure, viscous or air fluids? for
patients who cannot effectively position off their wound, have PUs in multiple
turning surfaces, or have PUs that fail to improve despite optimal
comprehensive management
23. When should active support surface be considered? when effective
positioning is determined by an MD to be medically contraindicated
24. What is the difference between an active and reactive support surfaces/ active
support surface is a powered mattress or overlay that changes it's load-
distribution with or without applied load; pressure is redistributed across the
body by inflating and deflating the cells of alternating zones. conversely a
reactive support surface moves or changes load-distribution properties only in
response to applied load, such as the patient's body.
25. When are active support surfaces appropriate? when manual frequent
repositioning is not possible
26. when are reactive support surfaces appropriate? for pressure ulcer
prevention
