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NAWCO WCCFree Wound Care Certified practice test
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10 real NAWCO WCC practice questions with instant answers and explanations — no account, no credit card, no email. Score yourself, then unlock the full bank of 80 questions whenever you’re ready. The NAWCO WCC passing score is Scaled score of 600 (on a 100-800 scale).
A 78-year-old woman admitted with hip fracture scores the following on the Braden Scale: Sensory Perception 2, Moisture 3, Activity 2, Mobility 2, Nutrition 3, Friction/Shear 2. What is her total score and corresponding risk category?
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Q1. A 78-year-old woman admitted with hip fracture scores the following on the Braden Scale: Sensory Perception 2, Moisture 3, Activity 2, Mobility 2, Nutrition 3, Friction/Shear 2. What is her total score and corresponding risk category?
Correct answer: A. Score 14 — moderate risk
Summing the subscores (2+3+2+2+3+2) yields 14, which falls in the moderate-risk range (13–14) on the Braden Scale. A score of 12 would be high risk, while mild/low risk is typically 15–18. Accurate score calculation is essential because the risk category drives the intensity of preventive interventions.
Q2. A wound care nurse is developing a repositioning protocol for a ventilated ICU patient on vasopressors. Which repositioning approach best balances pressure-injury prevention with hemodynamic stability concerns?
Correct answer: B. 30-degree lateral tilt alternated with supine every 2 hours, with temporary hold if mean arterial pressure drops below 65 mmHg during the turn
The 30-degree lateral tilt offloads the trochanter and sacrum while producing less hemodynamic instability than a full 90-degree turn, and a temporary hold when MAP dips below 65 mmHg prevents ischemic complications. Strict 90-degree turns increase shear and hemodynamic stress in critical care. Continuous lateral rotation does not replace manual assessment and repositioning. Vasopressors worsen — not protect — skin perfusion by causing peripheral vasoconstriction.
Q3. A hospice nurse notices a dark, irregular, necrotic wound on the sacrum of a terminal cancer patient that appeared suddenly over 24–48 hours despite excellent repositioning compliance. The most appropriate clinical interpretation is:
Correct answer: B. Kennedy Terminal Ulcer, which is an expected skin failure associated with end-of-life physiology
A Kennedy Terminal Ulcer (KTU) is a recognized end-of-life skin change that typically appears suddenly on the sacrococcygeal area, is pear- or butterfly-shaped, and may be dark purple, maroon, or necrotic — often despite good care. Attributing it to inadequate repositioning is clinically inaccurate and distressing to families. MASD from fecal incontinence presents differently (superficial erosion with satellite lesions, not deep necrosis). Surgical debridement is contraindicated in palliative patients with KTU because wound healing is not achievable.
Q4. A bariatric patient (BMI 54) is admitted post-operatively. Which skin assessment site is MOST commonly missed during routine pressure injury prevention rounds in this population?
Correct answer: C. Intertriginous skin folds (pannus, under breasts)
Intertriginous areas — abdominal pannus, skin folds under the breasts, groin creases, and under arm folds — trap moisture, create friction, and are frequently overlooked during standard repositioning checks in bariatric patients, making them high-risk sites for intertriginous dermatitis and pressure injury. The sacrum and heels are standard assessment points that clinicians routinely check. The occiput is a relevant site in bedbound patients but is not uniquely missed in the bariatric population.
Q5. A nurse is implementing an incontinence-associated dermatitis (IAD) prevention bundle for a patient with double incontinence. Which sequence correctly reflects the structured skin care protocol?
Correct answer: B. Cleanse with a pH-balanced no-rinse cleanser → apply moisturizer → apply a skin protectant/barrier product
The evidence-based structured skin care sequence for IAD prevention is: cleanse (remove irritants with a pH-balanced, no-rinse cleanser), moisturize (restore the lipid barrier), and protect (apply a barrier cream, film, or paste to repel urine and feces). Alkaline soaps disrupt the skin's acid mantle (pH 4.5–5.5) and worsen IAD. Applying barrier cream before cleansing traps irritants against the skin. Liquid skin barrier film applied before cleansing is the reverse of the correct order.
Q6. A patient with a cervical spinal cord injury (C5 ASIA A) is being discharged home in a power wheelchair. Which preventive intervention is MOST critical to include in the discharge teaching plan to reduce pressure injury risk?
Correct answer: B. Instruct the patient to use the wheelchair's tilt-in-space and recline functions for pressure relief every 15–30 minutes and to schedule daily skin inspections with a caregiver or adaptive mirror
A C5 complete (ASIA A) spinal cord injury leaves the patient without sufficient upper extremity strength for independent push-up pressure reliefs (triceps function requires C7), making tilt-in-space/recline functions essential for redistributing pressure at appropriate intervals (every 15–30 minutes per SCI clinical guidelines). Daily skin inspection with an adaptive mirror or caregiver assistance is critical because the patient lacks sensory feedback to detect developing injury. Standard foam cushions are inadequate for SCI patients who require specialized pressure-redistributing cushions. Limiting wheelchair time arbitrarily restricts quality of life and is not guideline-based.
Q7. A wound care specialist is assessing nutritional risk in a 68-year-old patient with a Stage 3 sacral pressure injury. Current weight is 70 kg. Which protein intake target is consistent with current wound care nutritional guidelines for patients with pressure injuries?
Correct answer: C. 1.2–1.5 g/kg/day
Current guidelines (EPUAP/NPIAP/PPPIA 2019) recommend 1.2–1.5 g/kg/day of protein for adults with pressure injuries to support tissue repair and immune function; for this 70 kg patient, that equates to 84–105 g of protein daily. The standard RDA of 0.8 g/kg/day is insufficient for wound healing. A target of 1.0 g/kg/day may be adequate for healthy older adults but falls short for pressure injury management. Intakes of 2.5–3.0 g/kg/day exceed recommendations and pose renal stress risks without additional benefit.
Q8. A patient with diabetes mellitus is seen in the outpatient wound clinic for routine diabetic foot care education. Which statement by the patient indicates a need for further teaching?
Correct answer: B. "I soak my feet in hot water for 20 minutes each night to improve circulation."
Soaking feet in hot water is contraindicated in diabetic patients because peripheral neuropathy impairs temperature sensation, placing the patient at high risk for thermal burns; prolonged soaking also macerates skin and promotes fissuring and fungal overgrowth. Daily foot inspection including interdigital spaces, therapeutic footwear use, and tight glycemic control are all correct and essential elements of diabetic foot care education.
Q9. A neonatal ICU patient has a pulse oximetry probe that has been on the same digit for 12 hours. On assessment, the nurse notes redness and indentation at the probe site. Which action should the wound care consultant recommend?
Correct answer: B. Rotate the probe site every 2–4 hours, use a properly sized probe, and document the finding as a medical device-related pressure injury (MDRPI) if skin damage is present
Pulse oximetry probes are a well-recognized cause of medical device-related pressure injuries (MDRPIs), particularly in neonates whose thin skin tolerates sustained focal pressure poorly. Rotating the probe site every 2–4 hours and ensuring proper probe sizing are the primary prevention strategies. Any resulting skin damage must be documented as an MDRPI per NPIAP classification. Leaving the probe in place with a barrier ointment does not relieve the causative pressure. A hydrocolloid dressing under an adhesive probe adds bulk, may alter readings, and does not address the frequency of site rotation.
Q10. A patient with chronic venous insufficiency (CVI) develops new shallow erosions on the medial gaiter area after being non-compliant with compression for 3 weeks. The patient's ABI is 0.92. Which prevention strategy is MOST appropriate to prevent recurrence once the erosions heal?
Correct answer: B. Sustained graduated compression (30–40 mmHg) combined with regular calf-muscle pump exercise and leg elevation above heart level when at rest
For patients with CVI and an ABI ≥0.8, sustained graduated compression (30–40 mmHg for venous disease management) is the cornerstone of recurrence prevention; calf-muscle pump activation through ambulation and elevation reduce ambulatory venous hypertension — the root cause of skin damage. Avoiding compression in a patient with adequate arterial flow (ABI 0.92) allows venous hypertension to persist and guarantees recurrence. Non-compressive moisturizing wraps do not address the hemodynamic problem. Oral corticosteroids have no evidence-based role in CVI-related skin prevention and carry significant systemic risk.
Exam facts and objectives sourced from the official NAWCO certification page. Last reviewed June 2026.
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