A shallow leg wound has stalled for 3 weeks. The base is pink and moist, but the edges are rolled, thickened, and smooth. Which intervention should the WOC nurse recommend?

Cauterize the rolled edges with silver nitrate, then reassess the cause

Add a silver dressing for 2 weeks to treat bioburden at the wound edges

Switch to a hydrogel sheet to add moisture to the wound edges and base

Apply a hydrocolloid to promote autolytic debridement of the rolled edges

A 34-year-old man with Crohn's disease and an end ileostomy reports severe pain around his stoma. The WOC nurse finds two shallow ulcers next to the stoma with ragged, undermined edges and a dark purple border; he says they began as small pustules and grew quickly. Which condition is MOST likely?

Peristomal pyoderma gangrenosum

Irritant contact dermatitis from leakage

Mucocutaneous separation at the stoma junction

Peristomal candidiasis with satellite lesions

A man with a urostomy is flying overseas for 2 weeks. Which travel instruction is MOST appropriate?

Pack supplies in the carry-on bag, including precut barriers and extra pouches

Bring uncut barriers and scissors in the carry-on so each can be fitted on site

Pack all ostomy supplies in checked luggage so security does not inspect them

Bring exactly 14 days of supplies so that his luggage stays as light as possible

A nursing home resident with moderate dementia can say whether she needs to use the toilet when asked and walks with standby assistance. She is incontinent several times a day. Which toileting program is MOST appropriate?

Prompted voiding: check, ask about the need to void, assist, and give praise

Pelvic floor muscle training with biofeedback three times a week

Clean intermittent catheterization every 6 hours to keep her dry

Bladder training with intervals lengthened by about 30 minutes each week

A WOC nurse evaluates a 66-year-old woman with diabetes and end-stage renal disease who has a heel ulcer. Her ankle-brachial index is 1.45, so toe pressures are obtained. Site Systolic pressure (mmHg) Right brachial 156 Left brachial 160 Right great toe 48 Based on the data, which interpretation is correct?

TBI 0.30; significant arterial disease is present despite the elevated ABI

TBI 0.31; mild arterial disease is present, so full compression is safe

TBI 0.30; the result is invalid because toe vessels are also noncompressible

TBI 0.30; perfusion is normal, which agrees with the ABI of 1.45

A WOC nurse is considering a bioengineered skin substitute for a stalled diabetic foot ulcer. Which condition must be met before it is applied?

The wound bed is clean, vascularized, and free of infection

The wound has failed only 1 week of standard care

The wound is actively infected and needs a biologic barrier

The wound bed is covered with a thin layer of dry eschar

Three weeks after an end colostomy, a 50-year-old teacher says she will not return to work or go out because she is sure everyone will notice her pouch. Which action should the WOC nurse take FIRST?

Explore her specific worries and how the stoma affects her life

Tell her firmly that no one will be able to see the pouch under clothes

Check her pouch seal by having her bend and twist in the clinic room

Give her a list of stores that sell ostomy-friendly clothing and wraps

A 48-year-old woman who had an abdominoperineal resection and pelvic radiation for rectal cancer reports pain with intercourse and vaginal dryness since treatment. Which action is MOST appropriate?

Refer her to a gynecology or sexual health specialist and discuss lubricants

Tell her that pain with intercourse is permanent after APR and best accepted

Tell her the pain comes from the pouch and suggest switching to a closed mini pouch

Recommend colostomy irrigation before intimacy to prevent the painful episodes

A 73-year-old woman has fecal incontinence with loose Bristol type 6 stools two to three times a day. Infection and impaction have been ruled out. Which recommendation is MOST appropriate as an initial approach?

Soluble fiber such as psyllium, with loperamide if stools stay loose

A daily tap water enema to clear the rectum before leaving the house

A stimulant laxative at bedtime to empty the colon fully before morning

An osmotic agent such as lactulose to regulate the stool pattern

CWOCN Exam

Free CWOCN Practice Questions

10 sample questions for the CWOCN Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Wound Assessment: History, Risk Factors and Etiology, Wound Care Planning, Education and Referral, Wound Treatment: Bed Preparation, Debridement, Dressings and Advanced Therapies, Ostomy Care Planning, Education and Referral, Skin Health, Prevention and Wound Interventions.

Question 1 · Wound Assessment: History, Risk Factors and Etiology
A WOC nurse obtains Doppler pressures on a 74-year-old man with a nonhealing ulcer on the right lateral malleolus.
Site Systolic pressure (mmHg)
Right brachial 142
Left brachial 148
Right dorsalis pedis 96
Right posterior tibial 104
Based on the data, what is the right ankle-brachial index (ABI) and its interpretation?
- A.0.70, consistent with moderate arterial disease
- B.0.68, consistent with moderate arterial disease
- C.0.65, consistent with moderate arterial disease
- D.0.73, consistent with mild arterial disease
Show answer and explanation
Answer: A. 0.70, consistent with moderate arterial disease
The ABI divides the higher ankle pressure on that leg (104) by the higher of the two brachial pressures (148): 104 / 148 = 0.70, which falls in the moderate range of 0.41 to 0.70. Using only the right brachial gives 104 / 142 = 0.73, and using the lower dorsalis pedis pressure gives 96 / 148 = 0.65 or 96 / 142 = 0.68; each error misstates the index.
Question 2 · Wound Treatment: Bed Preparation, Debridement, Dressings and Advanced Therapies
A shallow leg wound has stalled for 3 weeks. The base is pink and moist, but the edges are rolled, thickened, and smooth. Which intervention should the WOC nurse recommend?
- A.Add a silver dressing for 2 weeks to treat bioburden at the wound edges
- B.Switch to a hydrogel sheet to add moisture to the wound edges and base
- C.Apply a hydrocolloid to promote autolytic debridement of the rolled edges
- D.Cauterize the rolled edges with silver nitrate, then reassess the cause
Show answer and explanation
Answer: D. Cauterize the rolled edges with silver nitrate, then reassess the cause
Rolled edges (epibole) prevent epithelial cells from migrating; chemical cauterization with silver nitrate per protocol reopens the edges, and the cause, such as excess dryness or bioburden, must then be addressed. Adding moisture to an already moist base, autolysis and silver do not remove the rolled edge itself.
Question 3 · Ostomy Care Planning, Education and Referral
A 34-year-old man with Crohn's disease and an end ileostomy reports severe pain around his stoma. The WOC nurse finds two shallow ulcers next to the stoma with ragged, undermined edges and a dark purple border; he says they began as small pustules and grew quickly. Which condition is MOST likely?
- A.Peristomal pyoderma gangrenosum
- B.Irritant contact dermatitis from leakage
- C.Mucocutaneous separation at the stoma junction
- D.Peristomal candidiasis with satellite lesions
Show answer and explanation
Answer: A. Peristomal pyoderma gangrenosum
Rapidly enlarging, very painful ulcers that start as pustules and have undermined, violaceous edges in a patient with inflammatory bowel disease are typical of pyoderma gangrenosum, which needs referral and no sharp debridement. Irritant dermatitis is a shallow erosion where effluent touches the skin, candidiasis is a papular rash with satellite lesions, and mucocutaneous separation is a split at the stoma-skin junction, not separate ulcers.
Question 4 · Ostomy Care Planning, Education and Referral
A man with a urostomy is flying overseas for 2 weeks. Which travel instruction is MOST appropriate?
- A.Bring uncut barriers and scissors in the carry-on so each can be fitted on site
- B.Pack all ostomy supplies in checked luggage so security does not inspect them
- C.Pack supplies in the carry-on bag, including precut barriers and extra pouches
- D.Bring exactly 14 days of supplies so that his luggage stays as light as possible
Show answer and explanation
Answer: C. Pack supplies in the carry-on bag, including precut barriers and extra pouches
Supplies belong in the carry-on, because checked bags can be lost or delayed, with extra supplies for delays and barriers precut at home to avoid needing scissors. Checked luggage risks losing everything, an exact count leaves no margin for leaks or heat-shortened wear time, and scissors may be confiscated at security.
Question 5 · Skin Health, Prevention and Wound Interventions
A nursing home resident with moderate dementia can say whether she needs to use the toilet when asked and walks with standby assistance. She is incontinent several times a day. Which toileting program is MOST appropriate?
- A.Pelvic floor muscle training with biofeedback three times a week
- B.Clean intermittent catheterization every 6 hours to keep her dry
- C.Bladder training with intervals lengthened by about 30 minutes each week
- D.Prompted voiding: check, ask about the need to void, assist, and give praise
Show answer and explanation
Answer: D. Prompted voiding: check, ask about the need to void, assist, and give praise
Prompted voiding suits cognitively impaired people who can recognize and respond to a prompt: staff check regularly, ask, assist with toileting and give positive feedback. Bladder training and PFMT require memory and motivation she lacks, and catheterization is not indicated for functional incontinence without retention.
Question 6 · Wound Assessment: History, Risk Factors and Etiology
A WOC nurse evaluates a 66-year-old woman with diabetes and end-stage renal disease who has a heel ulcer. Her ankle-brachial index is 1.45, so toe pressures are obtained.
Site Systolic pressure (mmHg)
Right brachial 156
Left brachial 160
Right great toe 48
Based on the data, which interpretation is correct?
- A.TBI 0.31; mild arterial disease is present, so full compression is safe
- B.TBI 0.30; the result is invalid because toe vessels are also noncompressible
- C.TBI 0.30; perfusion is normal, which agrees with the ABI of 1.45
- D.TBI 0.30; significant arterial disease is present despite the elevated ABI
Show answer and explanation
Answer: D. TBI 0.30; significant arterial disease is present despite the elevated ABI
The toe-brachial index uses the higher brachial pressure: 48 / 160 = 0.30, well below the abnormal threshold of about 0.7, so arterial disease is present even though the ABI of 1.45 is falsely elevated by calcified, noncompressible ankle vessels. Using 156 gives 0.31, which is an arithmetic error, and toe vessels are usually spared from calcification, which is why the TBI is valid.
Question 7 · Wound Treatment: Bed Preparation, Debridement, Dressings and Advanced Therapies
A WOC nurse is considering a bioengineered skin substitute for a stalled diabetic foot ulcer. Which condition must be met before it is applied?
- A.The wound has failed only 1 week of standard care
- B.The wound bed is clean, vascularized, and free of infection
- C.The wound is actively infected and needs a biologic barrier
- D.The wound bed is covered with a thin layer of dry eschar
Show answer and explanation
Answer: B. The wound bed is clean, vascularized, and free of infection
Skin substitutes need a clean, well-vascularized, infection-free bed to take. Eschar and infection prevent adherence and incorporation, and these products are reserved for wounds that fail several weeks (typically about 4) of good standard care.
Question 8 · Ostomy Care Planning, Education and Referral
Three weeks after an end colostomy, a 50-year-old teacher says she will not return to work or go out because she is sure everyone will notice her pouch. Which action should the WOC nurse take FIRST?
- A.Tell her firmly that no one will be able to see the pouch under clothes
- B.Check her pouch seal by having her bend and twist in the clinic room
- C.Give her a list of stores that sell ostomy-friendly clothing and wraps
- D.Explore her specific worries and how the stoma affects her life
Show answer and explanation
Answer: D. Explore her specific worries and how the stoma affects her life
Body image concerns are assessed before intervening: exploring what she fears (odor, noise, visibility, leaks) and how her roles have changed lets the nurse target teaching, practical solutions and referral. Checking the seal, giving clothing resources or offering reassurance may help later but do not first identify her actual concerns, and dismissive reassurance can close the discussion.
Question 9 · Ostomy Care Planning, Education and Referral
A 48-year-old woman who had an abdominoperineal resection and pelvic radiation for rectal cancer reports pain with intercourse and vaginal dryness since treatment. Which action is MOST appropriate?
- A.Tell her that pain with intercourse is permanent after APR and best accepted
- B.Refer her to a gynecology or sexual health specialist and discuss lubricants
- C.Tell her the pain comes from the pouch and suggest switching to a closed mini pouch
- D.Recommend colostomy irrigation before intimacy to prevent the painful episodes
Show answer and explanation
Answer: B. Refer her to a gynecology or sexual health specialist and discuss lubricants
Dyspareunia after APR and pelvic radiation stems from pelvic nerve injury, scarring and vaginal changes, so the WOC nurse offers limited information such as lubricants and positioning and refers to gynecology or a sexual health specialist for evaluation and treatment. The pouch does not cause pelvic pain, labeling it permanent is inaccurate and discouraging, and irrigation does not address the cause.
Question 10 · Skin Health, Prevention and Wound Interventions
A 73-year-old woman has fecal incontinence with loose Bristol type 6 stools two to three times a day. Infection and impaction have been ruled out. Which recommendation is MOST appropriate as an initial approach?
- A.Soluble fiber such as psyllium, with loperamide if stools stay loose
- B.A daily tap water enema to clear the rectum before leaving the house
- C.A stimulant laxative at bedtime to empty the colon fully before morning
- D.An osmotic agent such as lactulose to regulate the stool pattern
Show answer and explanation
Answer: A. Soluble fiber such as psyllium, with loperamide if stools stay loose
Firming loose stool is the first step in managing fecal incontinence: soluble fiber absorbs water and adds bulk, and loperamide slows transit and increases internal sphincter tone. Stimulant and osmotic laxatives loosen stool further, and routine enemas are not a first-line approach for loose stools.

Site	Systolic pressure (mmHg)
Right brachial	142
Left brachial	148
Right dorsalis pedis	96
Right posterior tibial	104

Site	Systolic pressure (mmHg)
Right brachial	156
Left brachial	160
Right great toe	48

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