A 34-year-old skateboarder has a partial-thickness abrasion on the lateral thigh. On day 5, small pink islands of new epithelium appear scattered across the center of the wound, well away from the wound edges. These islands arise MOST likely from which source?

Keratinocytes from hair follicles and sweat ducts

Fibroblasts differentiating within the reticular dermis

Melanocytes migrating upward from the stratum basale

Langerhans cells proliferating in the stratum spinosum

A 58-year-old woman treated for breast cancer with axillary node dissection has firm swelling of the right hand and forearm. On examination, the clinician cannot pinch and lift a fold of skin at the base of the second finger. What does this finding MOST likely indicate?

Positive Stemmer sign indicating lymphedema

Deep vein thrombosis of the upper extremity

Lipedema involving both upper extremities

Pitting edema from right-sided heart failure

A patient on negative pressure wound therapy at -125 mmHg in intermittent mode has severe pain each time the pressure cycles back on. The seal is intact, and the wound shows no signs of infection. What is the MOST appropriate adjustment?

Switch to continuous mode and lower the pressure to about -80 mmHg

Turn the unit off for several hours after each painful pressure cycle

Lengthen the off phase of the intermittent cycle

Raise pressure to -150 mmHg to stabilize the foam

A 57-year-old man with long-standing diabetic neuropathy has had a warm, swollen, red midfoot for 2 weeks. He has no fever, and the affected foot is 3°C warmer than the other foot. Which additional examination finding MOST strongly favors active Charcot neuroarthropathy over cellulitis?

Intact skin with no ulcer or other portal of entry

Loss of protective sensation on monofilament testing

Bounding dorsalis pedis and posterior tibial pulses

Little pain despite marked swelling and warmth

A 68-year-old man with a Braden score of 19 on admission undergoes a 6-hour spinal fusion and returns to the unit sedated and on bed rest. When should his pressure injury risk be reassessed?

Now, because his condition has changed

At the next scheduled weekly reassessment

At discharge from the acute care unit

Only if new skin redness is found

A dehisced ankle wound has a narrow tunnel and a segment of exposed Achilles tendon. Negative pressure wound therapy is ordered. Which wound filler is MOST appropriate in contact with the tendon and tunnel?

Denser white polyvinyl alcohol foam

Hydrocolloid paste under black foam

Dry gauze packed tightly into the tunnel

Black polyurethane foam packed firmly

Finding Result Erythema beyond wound edge 1.2 cm Tissue involved Skin and subcutaneous tissue Temperature / heart rate 37.1°C / 80 per min WBC 8,200/mm³ Probe-to-bone test Negative ABI 1.02 A 63-year-old man with diabetes has a plantar forefoot ulcer with purulent drainage. Findings are shown above. He has taken no antibiotics in the past year, has no history of MRSA, and lives in a temperate climate. Which antibiotic approach is MOST appropriate?

Oral agent for gram-positive cocci for 1 to 2 weeks

Oral agent covering Pseudomonas for 1 to 2 weeks

IV broad-spectrum agent with anaerobes for 2 weeks

Oral agent for gram-positive cocci for 6 weeks

CWS Certified Wound Specialist Exam

Free CWS Certified Wound Specialist Practice Questions

10 sample questions for the CWS Certified Wound Specialist 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 Healing Environment, Assessment and Diagnosis, Patient Management, Etiological Considerations, Professional Issues.

Question 1 · Wound Healing Environment
A 34-year-old skateboarder has a partial-thickness abrasion on the lateral thigh. On day 5, small pink islands of new epithelium appear scattered across the center of the wound, well away from the wound edges. These islands arise MOST likely from which source?
- A.Fibroblasts differentiating within the reticular dermis
- B.Keratinocytes from hair follicles and sweat ducts
- C.Melanocytes migrating upward from the stratum basale
- D.Langerhans cells proliferating in the stratum spinosum
Show answer and explanation
Answer: B. Keratinocytes from hair follicles and sweat ducts
Partial-thickness wounds retain dermal adnexal structures, and the epithelial lining of hair follicles and sweat ducts supplies keratinocytes that resurface the wound from the center as well as the edges. Fibroblasts build dermal matrix but do not form epidermis, and melanocytes and Langerhans cells are not sources of new keratinocytes.
Question 2 · Assessment and Diagnosis
A 58-year-old woman treated for breast cancer with axillary node dissection has firm swelling of the right hand and forearm. On examination, the clinician cannot pinch and lift a fold of skin at the base of the second finger. What does this finding MOST likely indicate?
- A.Deep vein thrombosis of the upper extremity
- B.Lipedema involving both upper extremities
- C.Pitting edema from right-sided heart failure
- D.Positive Stemmer sign indicating lymphedema
Show answer and explanation
Answer: D. Positive Stemmer sign indicating lymphedema
Inability to pinch a skin fold at the base of the second toe or finger is a positive Stemmer sign, a specific clinical finding of lymphedema caused by fibrosis and thickening of the skin. Lipedema characteristically spares the hands and feet, so the Stemmer sign is negative. Cardiac edema is bilateral and pitting, and DVT presents with acute rather than fibrotic swelling.
Question 3 · Assessment and Diagnosis
Braden subscale Score
Sensory perception 3
Moisture 2
Activity 2
Mobility 2
Nutrition 2
Friction and shear 1
A 79-year-old woman is admitted after a hip fracture repair. Her Braden subscale scores are listed below. What is her total score and risk category?
- A.13; moderate risk
- B.14; moderate risk
- C.12; high risk
- D.12; moderate risk
Show answer and explanation
Answer: C. 12; high risk
The total is 3 + 2 + 2 + 2 + 2 + 1 = 12. Braden totals of 10–12 indicate high risk, 13–14 moderate risk, 15–18 mild risk, and 9 or below very high risk. Treating 12 as moderate risk underestimates her need for prevention.
Question 4 · Patient Management
A patient on negative pressure wound therapy at -125 mmHg in intermittent mode has severe pain each time the pressure cycles back on. The seal is intact, and the wound shows no signs of infection. What is the MOST appropriate adjustment?
- A.Switch to continuous mode and lower the pressure to about -80 mmHg
- B.Turn the unit off for several hours after each painful pressure cycle
- C.Lengthen the off phase of the intermittent cycle
- D.Raise pressure to -150 mmHg to stabilize the foam
Show answer and explanation
Answer: A. Switch to continuous mode and lower the pressure to about -80 mmHg
Pain on the repeated re-application of suction in intermittent mode is a common reason to switch to continuous therapy, and lowering the pressure further improves comfort. Higher pressure increases pain. Leaving the unit off for more than about 2 hours turns the foam into a closed, undrained dressing that requires removal. A longer off phase keeps the painful cycling.
Question 5 · Etiological Considerations
A 57-year-old woman with diabetes has a plantar forefoot ulcer with purulent drainage and erythema extending 3 cm from the wound edge. The infection involves skin and subcutaneous tissue only. Her temperature is 37.4°C, heart rate 84/min, respiratory rate 16/min, and WBC 9,800/mm³. The probe-to-bone test is negative. How is this infection classified under the IWGDF/IDSA system?
- A.Uninfected (IWGDF grade 1)
- B.Severe (IWGDF grade 4)
- C.Moderate (IWGDF grade 3)
- D.Mild (IWGDF grade 2)
Show answer and explanation
Answer: C. Moderate (IWGDF grade 3)
Local infection with erythema extending more than 2 cm from the wound margin, or involving structures deeper than skin and subcutaneous tissue, without systemic inflammatory signs is moderate (grade 3). Mild infection is limited to erythema of 2 cm or less. Severe infection requires two or more systemic inflammatory response findings, which she does not have.
Question 6 · Wound Healing Environment
A 64-year-old woman with diabetic peripheral neuropathy cannot feel a vibrating 128-Hz tuning fork at the great toe, although she still perceives light stroking of the skin. Which cutaneous mechanoreceptor, located in the deep dermis and subcutaneous tissue, is MOST responsible for sensing this vibration?
- A.Pacinian (lamellar) corpuscles
- B.Ruffini (bulbous) corpuscles
- C.Meissner (tactile) corpuscles
- D.Merkel cell-neurite complexes
Show answer and explanation
Answer: A. Pacinian (lamellar) corpuscles
Pacinian corpuscles are large onion-like receptors in the deep dermis and hypodermis that adapt rapidly and respond best to high-frequency vibration, which is why loss of tuning-fork vibration sense is an early sign of large-fiber neuropathy. Meissner corpuscles sit in the dermal papillae and detect light touch and low-frequency flutter, Merkel cell-neurite complexes detect sustained pressure and texture, and Ruffini corpuscles respond to skin stretch.
Question 7 · Assessment and Diagnosis
A 57-year-old man with long-standing diabetic neuropathy has had a warm, swollen, red midfoot for 2 weeks. He has no fever, and the affected foot is 3°C warmer than the other foot. Which additional examination finding MOST strongly favors active Charcot neuroarthropathy over cellulitis?
- A.Intact skin with no ulcer or other portal of entry
- B.Loss of protective sensation on monofilament testing
- C.Bounding dorsalis pedis and posterior tibial pulses
- D.Little pain despite marked swelling and warmth
Show answer and explanation
Answer: A. Intact skin with no ulcer or other portal of entry
Foot infection in diabetes almost always begins at a break in the skin, so a red, hot, swollen neuropathic foot with intact skin and a temperature difference of more than 2°C should be treated as active Charcot neuroarthropathy until proven otherwise and confirmed with radiographs and, if those are normal, MRI. Bounding pulses, loss of protective sensation, and little pain are typical of any neuropathic foot and occur with both conditions, so they do not separate them.
Question 8 · Assessment and Diagnosis
A 68-year-old man with a Braden score of 19 on admission undergoes a 6-hour spinal fusion and returns to the unit sedated and on bed rest. When should his pressure injury risk be reassessed?
- A.At the next scheduled weekly reassessment
- B.Now, because his condition has changed
- C.At discharge from the acute care unit
- D.Only if new skin redness is found
Show answer and explanation
Answer: B. Now, because his condition has changed
Risk assessment is done on admission, at regular intervals, and whenever the patient's condition changes; prolonged surgery, sedation, and bed rest are significant changes that require immediate reassessment. Waiting for the routine schedule or for visible redness allows injury to occur before prevention begins. Reassessing only at discharge is too late.
Question 9 · Patient Management
A dehisced ankle wound has a narrow tunnel and a segment of exposed Achilles tendon. Negative pressure wound therapy is ordered. Which wound filler is MOST appropriate in contact with the tendon and tunnel?
- A.Hydrocolloid paste under black foam
- B.Dry gauze packed tightly into the tunnel
- C.Denser white polyvinyl alcohol foam
- D.Black polyurethane foam packed firmly
Show answer and explanation
Answer: C. Denser white polyvinyl alcohol foam
White polyvinyl alcohol foam is denser, has smaller pores, and limits tissue ingrowth, so it is used for tunnels, fragile tissue, and exposed tendon or nerve. Black polyurethane foam in direct contact with tendon promotes ingrowth and trauma, and packing any filler firmly is avoided. Tightly packed dry gauze can adhere and create pressure, and hydrocolloid paste would block the transmission of negative pressure.
Question 10 · Etiological Considerations
Finding Result
Erythema beyond wound edge 1.2 cm
Tissue involved Skin and subcutaneous tissue
Temperature / heart rate 37.1°C / 80 per min
WBC 8,200/mm³
Probe-to-bone test Negative
ABI 1.02
A 63-year-old man with diabetes has a plantar forefoot ulcer with purulent drainage. Findings are shown above. He has taken no antibiotics in the past year, has no history of MRSA, and lives in a temperate climate. Which antibiotic approach is MOST appropriate?
- A.Oral agent for gram-positive cocci for 1 to 2 weeks
- B.Oral agent covering Pseudomonas for 1 to 2 weeks
- C.IV broad-spectrum agent with anaerobes for 2 weeks
- D.Oral agent for gram-positive cocci for 6 weeks
Show answer and explanation
Answer: A. Oral agent for gram-positive cocci for 1 to 2 weeks
Purulence with erythema of 2 cm or less, limited to skin and subcutaneous tissue and without systemic signs, is a mild (IWGDF grade 2) infection. Current IWGDF/IDSA guidance treats it with an oral agent active against aerobic gram-positive cocci such as Staphylococcus aureus and streptococci, usually for 1 to 2 weeks. Empiric Pseudomonas coverage is reserved for warm climates, prior isolation, or a frequently wet foot, IV broad-spectrum therapy is for severe infection, and about 6 weeks is the course for osteomyelitis.

Braden subscale	Score
Sensory perception	3
Moisture	2
Activity	2
Mobility	2
Nutrition	2
Friction and shear	1

Finding	Result
Erythema beyond wound edge	1.2 cm
Tissue involved	Skin and subcutaneous tissue
Temperature / heart rate	37.1°C / 80 per min
WBC	8,200/mm³
Probe-to-bone test	Negative
ABI	1.02

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