CERTIFIED WOUND
OSTOMY NURSE CWON
PRACTICE TEST
COMPLETE
Question 1: A patient with an intact sacral area has persistent nonblanchable
redness over a bony prominence. How should the �nding be classi�ed?
Choices:
1) Stage 2 pressure injury 2) Deep tissue pressure injury 3) Stage 1 pressure injury 4) Unstageable pressure injury
Correct Answer: Stage 1 pressure injury
Explanation: Stage 1 pressure injury is intact skin with localized nonblanchable erythema. There is no partial-thickness skin loss or obscuring tissue.Page 1
Question 2: A heel wound is completely covered by adherent tan slough and black
eschar so the depth cannot be seen. What is the most accurate classi�cation?
Choices:
1) Unstageable pressure injury 2) Deep tissue pressure injury 3) Stage 3 pressure injury 4) Stage 4 pressure injury
Correct Answer: Unstageable pressure injury
Explanation: When slough or eschar obscures the extent of full-thickness tissue loss, the pressure injury is unstageable until enough devitalized tissue is removed to expose the wound base, unless stable heel or ischemic eschar should remain intact.Question 3: Which �nding is most characteristic of a deep tissue pressure injury?
Choices:
1) Dry black eschar limited to the heel 2) Persistent maroon or purple discoloration that may precede skin breakdown 3) A shallow pink wound bed without slough 4) Exposed tendon with visible adipose tissue
Correct Answer: Persistent maroon or purple discoloration that may precede skin
breakdown Explanation: Deep tissue pressure injury presents as persistent nonblanchable deep red, maroon, or purple discoloration or epidermal separation that re�ects deeper pressure and shear damage.Page 2
Question 4: A pressure injury has full-thickness skin loss with visible adipose tissue and granulation tissue, but no exposed fascia, muscle, tendon, cartilage, or bone.Which stage is most appropriate?
Choices:
1) Stage 4 2) Stage 2 3) Unstageable 4) Stage 3
Correct Answer: Stage 3
Explanation: Stage 3 pressure injury involves full-thickness skin loss with visible adipose tissue and may include granulation or epibole, but deeper supporting structures are not exposed.Question 5: A pressure injury has exposed tendon and palpable bone. Which stage is most appropriate?
Choices:
1) Stage 3 2) Stage 2 3) Deep tissue pressure injury 4) Stage 4
Correct Answer: Stage 4
Explanation: Exposed or directly palpable fascia, muscle, tendon, cartilage, or bone indicates a Stage 4 pressure injury.Page 3