WCC Practice Questions 2026: 8 Exam-Style Items Explained

Answer: B — Dehydration

Every value moves the way hemoconcentration predicts: less plasma water pushes osmolality (normal about 275-295 mOsm/kg) and hematocrit up, and reduced kidney perfusion raises BUN and creatinine, a prerenal picture. Dehydration matters to the wound because it lowers tissue perfusion and makes skin more fragile, which is why the WCC outline pairs hydration with nutrition in Assessment.

• A. Fluid overload dilutes the blood, so osmolality and hematocrit fall - the opposite of this panel.
• C. Infection shows up as a raised white count, CRP or ESR plus local signs; it does not by itself drive osmolality and hematocrit up together.
• D. Malnutrition is judged on intake, weight loss and physical findings; it does not produce a concentrated osmolality and a rising hematocrit within four days.

Answer: D — Necrobiosis lipoidica

Necrobiosis lipoidica classically appears on the anterior shins as yellow-brown atrophic plaques with telangiectasia and a raised red-violet border; it is more common in women and can ulcerate after minor trauma. Recognising it matters because a shin ulcer in a person with diabetes is not automatically venous or arterial, and these lesions heal slowly.

• A. Acanthosis nigricans is velvety, dark thickening in skin folds such as the neck and axillae - a marker of insulin resistance, not atrophic shin plaques.
• B. Bullosis diabeticorum is sudden, tense, usually painless blisters on the feet or lower legs on otherwise normal-looking skin, with no yellow atrophic center.
• C. Diabetic dermopathy ('shin spots') is small, round, light-brown, slightly depressed macules; they do not form large plaques with a raised violet border and rarely ulcerate.

Answer: C — Refer for vascular assessment for revascularization

An ABI below 0.5 signals severe arterial disease: the ulcer cannot heal until inflow improves, so the priority is a vascular referral to assess for angioplasty, stenting or bypass. Until perfusion is restored, stable dry eschar on an ischemic limb is left intact and kept dry, and smoking cessation is addressed.

• A. Hyperbaric oxygen is an adjunct for selected wounds, such as certain diabetic foot ulcers that fail standard care; it does not replace a vascular work-up when arterial inflow is this poor.
• B. Compression is contraindicated at an ABI this low because it further reduces arterial flow and can cause pressure necrosis.
• D. Removing stable dry eschar from an ischemic limb opens a wound the body cannot heal or defend against infection; debridement waits until perfusion is restored.

Answer: C — Sustained graduated compression, such as a multilayer bandage system

Gaiter-area location, hemosiderin staining, edema and heavy exudate point to a venous leg ulcer, and an ABI of 0.95 rules out significant arterial disease. Sustained graduated compression is the evidence-based treatment because it counters venous hypertension, reduces edema and exudate and speeds healing; multilayer systems are a standard way to deliver it.

• A. The only FDA-approved growth factor gel (becaplermin) is labeled for neuropathic diabetic foot ulcers, and no topical agent replaces compression for a venous ulcer.
• B. Debridement is used only when the bed holds necrotic tissue or slough; the driver here is venous hypertension, which debridement does not treat.
• D. Whirlpool keeps a venous leg dependent in warm water, which worsens edema, and it is a nonselective cleansing method that is no longer recommended for this wound.

Answer: C — Proliferation

The healing ridge is new collagen laid down by fibroblasts and usually becomes palpable between days 5 and 9, which marks the proliferative phase. Its presence is reassuring; a missing ridge by about day 9 suggests a higher risk of dehiscence.

• A. Hemostasis (vasoconstriction and clot formation) is complete within minutes to hours of surgery.
• B. Inflammation dominates roughly the first 3-6 days and produces redness, warmth and swelling, not a firm collagen ridge.
• D. Maturation (remodeling) begins around day 21 and lasts up to 1-2 years as the scar flattens and pales; day 9 is too early.

Answer: A — His neuropathy may be masking pain, so pain cannot be used to judge tissue tolerance

Loss of protective sensation means pain no longer warns of tissue damage, so tolerance has to be judged on what you see - bleeding, viable tissue, depth - and on the plan, not on the patient's report. The same sensory loss is why plantar ulcers form and why offloading and daily foot inspection are taught.

• B. Comfort is not a measure of how well debridement works, and nothing in the scenario suggests the method is failing.
• C. Nothing suggests he is under-reporting; a known sensory deficit is the likelier explanation, and giving analgesia does not address the safety problem.
• D. Painless removal does not prove tissue is nonviable - an insensate foot gives no pain signal even when viable tissue is cut.

Answer: B — 30 degrees

Keeping the head of the bed at or below 30 degrees, unless a medical condition requires more, limits the sliding that creates shear and friction over the sacrum and coccyx (NPIAP/EPUAP/PPPIA 2019 guideline). The same number appears in the 30-degree lateral tilt used for side-lying.

• A. Lower elevations are allowed, but 15 degrees is not the stated limit; the question asks for the maximum routine elevation.
• C. At 45 degrees the patient slides down the bed, increasing sacral shear; higher elevations are reserved for meals, tube feeding or ventilation and kept time-limited.
• D. Sixty degrees produces even more sliding and sacral loading and is used only for specific medical needs such as eating or respiratory distress.

Answer: D — The social worker

Social workers, often alongside case management, find financial assistance, community resources and home-health or supply programs, turning a clinically correct plan into one the patient can actually follow. Administration items on the WCC test knowing whom to involve: a plan the patient cannot pay for is a plan he will not follow.

• A. The physician can change the orders, but finding funding and community resources is outside the usual medical role.
• B. The payer's representative explains what the plan covers; they do not look for outside resources on the patient's behalf.
• C. A pharmacist can suggest lower-cost products but does not coordinate financial aid or discharge services.