NLE Integumentary & Skin Integrity — Burns and Dermatologic DisordersExam Answer Templates

Marks

1

Topic

Burn Classification and Pathophysiology

Difficulty

easy

Template Id

T1

Examiner Tip

Examiners specifically test whether students understand WHY full-thickness burns are painless. The word 'nerve endings destroyed' is what earns the mark — not just saying 'painless.'

Model Answer

A full-thickness (third-degree) burn is painless in the center because nerve endings are completely destroyed, while a superficial partial-thickness (second-degree) burn is the most painful type because nerve endings remain intact.

Question Type

very_short_answer

Answer Structure

• State the distinguishing characteristic of full-thickness burn (painless / nerve destruction) AND contrast with superficial partial-thickness (most painful / intact nerves) — 1 mark for a complete contrasting statement

Scoring Breakdown

Common Mark Deductions

• Writing only 'dry and leathery' without mentioning pain/nerve destruction — this describes appearance, not the key distinguishing characteristic
• Confusing the depth of the wound (which layer) with the key physiologic characteristic (nerve ending status)
• Saying 'numb' without explaining why (nerve destruction) — incomplete answer

Key Phrases To Include

• painless
• nerve endings destroyed
• full-thickness / third-degree
• superficial partial-thickness / most painful

Marks

1

Topic

Parkland Formula and Fluid Resuscitation

Difficulty

easy

Template Id

T2

Examiner Tip

This is a pure recall question. Examiners will not give partial credit if the fluid type is wrong — Lactated Ringer's is non-negotiable for the Parkland formula.

Model Answer

Parkland Formula: 4 mL × body weight (kg) × %TBSA burned = total fluid volume for the first 24 hours, administered as Lactated Ringer's (LR) solution.

Question Type

very_short_answer

Answer Structure

• Write the complete formula with all four elements: 4 mL, kg, %TBSA, 24-hour timeframe — 1 mark (all elements required)

Scoring Breakdown

Common Mark Deductions

• Writing normal saline instead of Lactated Ringer's solution
• Omitting the constant '4 mL' or writing '3 mL' (which is the Brooke formula, not Parkland)
• Forgetting to specify the 24-hour timeframe

Key Phrases To Include

• 4 mL
• body weight in kg
• %TBSA
• 24 hours
• Lactated Ringer's

Marks

2

Topic

Phases of Burn Injury

Difficulty

medium

Template Id

T3

Examiner Tip

The NLE frequently tests this comparison. Remember the memory cue: EMERGENT = 'K goes OUT of cells = HIGH K (hyperK)'; ACUTE = 'K goes BACK IN + lost in urine = LOW K (hypoK).' Always explain the mechanism, not just name the imbalance.

Model Answer

In the emergent phase (first 24–48 hours), increased capillary permeability causes massive fluid shift from the intravascular space into the interstitium. Damaged cells release potassium, resulting in HYPERKALEMIA. Sodium is trapped in edema fluid, causing HYPONATREMIA. In the acute phase (48–72 hours onward), capillary integrity is restored, fluid shifts back into the vascular space (diuresis), and potassium re-enters cells and is excreted in urine, resulting in HYPOKALEMIA.

Question Type

short_answer

Answer Structure

• Line 1–2: Emergent phase — describe fluid shift mechanism and state hyperkalemia + hyponatremia [1 mark]
• Line 3–4: Acute phase — describe reversal of fluid shift and state hypokalemia [1 mark]

Scoring Breakdown

Common Mark Deductions

• Reversing the electrolyte imbalances — saying hypokalemia occurs in the emergent phase (a common and costly error)
• Listing only the electrolyte names without explaining the mechanism (why the shift occurs)
• Omitting hyponatremia from the emergent phase description

Key Phrases To Include

• emergent phase
• hyperkalemia
• hyponatremia
• acute phase
• hypokalemia
• capillary permeability
• diuresis

Marks

2

Topic

Rule of Nines and TBSA Estimation

Difficulty

easy

Template Id

T4

Examiner Tip

Always show your working step by step for numerical questions, even if the arithmetic is simple. Examiners award marks for method, not just the final number. The note about excluding first-degree burns often carries its own mark.

Model Answer

Using the Rule of Nines for adults: - Entire right arm = 9% TBSA - Anterior trunk (chest and abdomen) = 18% TBSA Total TBSA burned = 9% + 18% = 27% Note: Only partial-thickness and full-thickness burns are included in TBSA calculation. Superficial (first-degree) burns are NOT counted.

Question Type

numerical

Answer Structure

• Step 1: State the Rule of Nines values for each body region mentioned [1 mark]
• Step 2: Add the values correctly and state the total; include the note about excluding first-degree burns [1 mark]

Scoring Breakdown

Common Mark Deductions

• Forgetting to mention that first-degree burns are excluded from the TBSA calculation
• Confusing anterior trunk (18%) with the entire trunk (36%) — reading the question carefully is essential
• Not showing the working — writing only '27%' without showing how each region was assigned

Key Phrases To Include

• Rule of Nines
• right arm = 9%
• anterior trunk = 18%
• 27% TBSA
• first-degree burns are NOT counted

Marks

2

Topic

Emergent Phase of Burn Injury / Inhalation Injury

Difficulty

medium

Template Id

T5

Examiner Tip

In any burn emergency scenario, Maslow's hierarchy demands AIRWAY first, always. The presence of facial burns + hoarseness + enclosed space is the classic clinical triad for inhalation injury. Examiners expect you to name these cues and link them to CO poisoning and rapid edema.

Model Answer

First priority: Assess and secure the airway. Administer 100% humidified oxygen immediately via non-rebreather mask. Rationale: The clinical signs — facial burns, hoarseness, and history of enclosed-space fire — indicate probable inhalation injury and carbon monoxide poisoning. Airway edema can develop and progress rapidly, potentially causing complete airway obstruction. Early intubation may be required before swelling closes the airway. Inhalation injury is the leading cause of early death in burn patients.

Question Type

short_answer

Answer Structure

• Line 1: State the first priority action — airway assessment and 100% humidified oxygen [1 mark]
• Line 2–3: Provide correct rationale — inhalation injury, CO poisoning risk, rapid progression of edema, leading cause of early death [1 mark]

Scoring Breakdown

Common Mark Deductions

• Starting with IV fluid resuscitation or the Parkland formula instead of airway — a classic Maslow-based error
• Giving oxygen without specifying the type (100% humidified, non-rebreather mask)
• Providing rationale that is too vague (e.g., 'to help breathing') without naming the specific mechanism

Key Phrases To Include

• airway first priority
• 100% humidified oxygen
• inhalation injury
• carbon monoxide poisoning
• airway edema
• enclosed-space fire

Marks

2

Topic

Pharmacology in Burn Care

Difficulty

medium

Template Id

T6

Examiner Tip

NLE frequently tests the comparison of these two agents. Remember: Silver = Silver (painless but causes leukopenia); Mafenide = 'Makes Acidosis' (painful, metabolic acidosis). The contrast format makes it easy for examiners to allocate marks per drug.

Model Answer

Silver Sulfadiazine (Silvadene): Broad-spectrum antimicrobial used widely for burn wound coverage. Advantage: broad-spectrum coverage, painless on application. Key side effect: transient leukopenia (bone marrow suppression). Contraindicated in sulfa allergy and near-term pregnancy. Mafenide Acetate: Advantage: penetrates eschar effectively, making it useful for deep wounds and over cartilage. Key side effect: painful on application and causes metabolic acidosis by inhibiting carbonic anhydrase.

Question Type

short_answer

Answer Structure

• Silver sulfadiazine: one advantage + one key side effect [1 mark]
• Mafenide acetate: one advantage + one key side effect [1 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing which drug causes which side effect — leukopenia belongs to silver sulfadiazine; metabolic acidosis belongs to mafenide acetate
• Writing 'infection' as a side effect — this is generic and does not earn the mark
• Omitting the mechanism for metabolic acidosis (carbonic anhydrase inhibition) in 2-mark answers that specifically ask for side effect detail

Key Phrases To Include

• silver sulfadiazine
• leukopenia
• sulfa allergy contraindication
• mafenide acetate
• penetrates eschar
• metabolic acidosis
• carbonic anhydrase inhibition
• painful on application

Marks

2

Topic

Fluid Resuscitation and Monitoring

Difficulty

easy

Template Id

T7

Examiner Tip

The NLE tests both the VALUE and the PURPOSE. Do not give just the number — always state WHY urine output is monitored. Examiners give one mark for the purpose and one for the correct value.

Model Answer

Urine output is the primary indicator of adequate fluid resuscitation and end-organ perfusion in burn patients. The kidneys require sufficient renal blood flow to produce urine; low output indicates hypovolemia and inadequate perfusion, while high output may indicate over-resuscitation. Target urine output for adults: 0.5 mL/kg/hour, which corresponds to approximately 30–50 mL/hour for an average adult. For pediatric patients, the target is 1 mL/kg/hour.

Question Type

short_answer

Answer Structure

• Line 1–2: Explain purpose — primary indicator of resuscitation adequacy and renal perfusion [1 mark]
• Line 3: State correct target — 0.5 mL/kg/hr or 30–50 mL/hr for adults; 1 mL/kg/hr for children [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating only '30 mL/hr' without the weight-based formula (0.5 mL/kg/hr) — the weight-based value is the clinically correct standard
• Describing urine output only as a 'kidney function test' without linking it to fluid resuscitation adequacy
• Confusing adult and pediatric targets (writing 1 mL/kg/hr for adults)

Key Phrases To Include

• primary indicator
• fluid resuscitation adequacy
• renal perfusion
• 0.5 mL/kg/hour
• 30–50 mL/hour
• end-organ perfusion
• hourly monitoring

Marks

3

Topic

Dermatologic Disorders

Difficulty

medium

Template Id

T8

Examiner Tip

This comparison question is a perennial NLE favorite. The highest-yield contrast is the border (well-defined vs. poorly defined) and the cause (autoimmune vs. bacterial). Always use a parallel structure when comparing two conditions — it makes scoring easier for examiners.

Model Answer

PSORIASIS: - Etiology: Chronic autoimmune disorder with accelerated epidermal cell turnover; genetic predisposition; not contagious. - Clinical Presentation: Well-demarcated, raised, red plaques covered with silvery-white scales; located on extensor surfaces (elbows, knees, scalp, sacrum); may have nail pitting. - Management: Topical corticosteroids, vitamin D analogues (calcipotriene), coal tar, phototherapy (UVB), and systemic agents (methotrexate, biologics) for severe cases. CELLULITIS: - Etiology: Acute bacterial infection (Streptococcus, Staphylococcus including MRSA) entering through a break in the skin. - Clinical Presentation: Erythema with warmth, edema, tenderness, and POORLY DEFINED (diffuse) borders; may have fever and lymphangitic streaking. - Management: Systemic antibiotics (e.g., cephalexin for non-MRSA; add MRSA coverage if suspected), elevation of affected limb, warm compresses, and border marking to track spread.

Question Type

short_answer

Answer Structure

• Psoriasis — Etiology: autoimmune, accelerated cell turnover [0.5 mark]
• Psoriasis — Presentation: silvery plaques, extensor surfaces, not contagious [0.5 mark]
• Psoriasis — Management: topical corticosteroids, phototherapy, systemic agents [0.5 mark]
• Cellulitis — Etiology: bacterial infection, Streptococcus/Staphylococcus, break in skin [0.5 mark]
• Cellulitis — Presentation: warm erythema, poorly defined borders, fever, lymphangitic streaking [0.5 mark]
• Cellulitis — Management: systemic antibiotics, limb elevation, border marking [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing the border characteristics: psoriasis has WELL-DEFINED borders; cellulitis has POORLY DEFINED borders — this is a classic NLE distractor
• Saying psoriasis is contagious — this is incorrect and examiners specifically look for 'not contagious'
• Writing only topical treatment for cellulitis — systemic antibiotics are required for true cellulitis
• Not mentioning limb elevation for cellulitis — this is a high-yield nursing intervention

Key Phrases To Include

• autoimmune
• silvery-white scales
• well-demarcated
• extensor surfaces
• not contagious
• bacterial infection
• poorly defined borders
• systemic antibiotics
• limb elevation
• border marking

Marks

3

Topic

Emergent Phase of Burn Injury

Difficulty

medium

Template Id

T9

Examiner Tip

Structure your answer with three clear, labeled priorities using the nursing process. Examiners follow a checklist — if your answer is structured, they can easily allocate marks. The IV vs. IM analgesia distinction is a classic NLE question stem.

Model Answer

The emergent (resuscitative) phase spans from the time of injury to approximately 24–48 hours. The greatest threats are hypovolemic shock, airway obstruction, and electrolyte imbalances. Nursing Management: 1. AIRWAY — Assess for inhalation injury (facial burns, singed nasal hairs, hoarseness, sooty sputum). Administer 100% humidified oxygen. Anticipate early intubation as airway edema can progress rapidly. 2. FLUID RESUSCITATION — Establish large-bore IV access and initiate Lactated Ringer's solution per the Parkland formula (4 mL × kg × %TBSA). Insert urinary catheter and monitor hourly urine output (target: 0.5 mL/kg/hr or 30–50 mL/hr in adults). 3. SUPPORTIVE CARE — Administer IV opioids (NOT intramuscular) for pain due to unreliable IM absorption with edema. Keep the patient warm to prevent hypothermia. Maintain NPO status due to risk of paralytic ileus. Assess circumferential burns for signs of circulatory compromise — prepare for escharotomy if needed.

Question Type

short_answer

Answer Structure

• Priority 1: Airway management — assessment of inhalation injury, 100% O2, anticipate intubation [1 mark]
• Priority 2: Fluid resuscitation — large-bore IV, Parkland formula, hourly urine output monitoring with target values [1 mark]
• Priority 3: Supportive care — IV opioids (not IM), warmth, NPO, escharotomy for circumferential burns [1 mark]

Scoring Breakdown

Common Mark Deductions

• Beginning with fluid resuscitation before airway — fails Maslow's hierarchy and loses the first mark
• Writing IM opioids for pain management — this is specifically incorrect during the emergent phase
• Omitting the specific urine output target — giving a vague answer like 'monitor urine' without the value
• Forgetting escharotomy for circumferential burns — a high-yield intervention examiners look for

Key Phrases To Include

• airway first priority
• 100% humidified oxygen
• Parkland formula
• Lactated Ringer's
• hourly urine output
• 0.5 mL/kg/hr
• IV opioids not IM
• escharotomy
• circumferential burns
• NPO
• hypothermia prevention

Marks

3

Topic

Rule of Nines and Parkland Formula — Combined Calculation

Difficulty

hard

Template Id

T10

Examiner Tip

Show every calculation step. For multi-part numerical questions, even if your TBSA in part (a) is wrong, you can still earn full marks in parts (b) and (c) if your formula application is correct — examiners use error-carry-forward marking. Always note that timing is 'from injury.'

Model Answer

(a) TBSA Calculation using Rule of Nines: - Posterior right lower leg = 9% (posterior leg = half of each leg's 18%) → but NOTE: the question states 'both lower legs posterior only.' Each entire leg = 18%, so posterior of each leg = 9%. Both posterior legs = 9% + 9% = 18% - Perineum = 1% - Total TBSA = 18% + 1% = 19% (b) Parkland Formula: 4 mL × 60 kg × 19% TBSA = 4,560 mL total in 24 hours (using Lactated Ringer's) (c) First 8-hour infusion rate: Half of 4,560 mL = 2,280 mL to be given in the FIRST 8 HOURS from time of injury. Infusion rate = 2,280 mL ÷ 8 hours = 285 mL/hour

Question Type

numerical

Answer Structure

• Step (a): Correctly apply Rule of Nines — posterior of each leg = 9% × 2 legs = 18%, plus perineum 1% = 19% TBSA [1 mark]
• Step (b): Apply Parkland formula correctly — 4 × 60 × 19 = 4,560 mL LR [1 mark]
• Step (c): Divide total by 2 = 2,280 mL in first 8 hours; rate = 285 mL/hr; specify 'from time of injury' [1 mark]

Scoring Breakdown

Common Mark Deductions

• Using 18% for one leg instead of 9% for the posterior portion only — read the question carefully
• Forgetting to include perineum (1%) in the TBSA
• Calculating the 8-hour rate from the time the IV is started rather than from the time of injury
• Writing normal saline instead of Lactated Ringer's

Key Phrases To Include

• Rule of Nines
• posterior leg = 9% each
• perineum = 1%
• 19% TBSA
• 4 mL × 60 kg × 19%
• 4,560 mL
• Lactated Ringer's
• 2,280 mL first 8 hours
• 285 mL/hr
• from time of injury

Marks

5

Topic

Acute Phase of Burn Injury

Difficulty

hard

Template Id

T11

Examiner Tip

A 5-mark answer must demonstrate depth, not breadth alone. Examiners want to see that you understand WHY each intervention is done, not just what to do. Use clear headings or numbered sections — examiners score faster on organized answers and are less likely to miss points you made. Include the NANDA nursing diagnosis term to show NCM-level competence.

Model Answer

INTRODUCTION: The acute phase of burn injury begins at 48–72 hours post-injury, when capillary integrity is restored and fluid shifts back into the intravascular space, and lasts until wound closure. The primary threats during this phase are infection and sepsis, fluid overload, hypokalemia, and hypermetabolic complications including Curling ulcer. I. INFECTION PREVENTION (Priority per Maslow: Safety and Security needs) Burn wounds are highly susceptible to infection because the skin barrier is destroyed. Nursing actions include: - Strict aseptic technique during all wound care procedures. - Protective (reverse) isolation if indicated based on the patient's immune status and burn extent. - Apply prescribed topical antimicrobials: silver sulfadiazine (Silvadene) or mafenide acetate as ordered. - Monitor for signs of sepsis: subtle indicators in burn patients include altered sensorium, new ileus, glucose instability, and temperature instability (hypothermia may be more concerning than hyperthermia in severe burns). - Use systemic antibiotics ONLY for documented infection — prophylactic antibiotics are NOT recommended due to risk of resistance. - Monitor WBC count: silver sulfadiazine may cause transient leukopenia. II. WOUND CARE - Perform wound cleansing and debridement as ordered to remove necrotic tissue and facilitate healing. - Apply topical antimicrobial dressings; change per protocol using aseptic technique. - Assess wound healing daily: monitor for signs of infection (increased exudate, odor, discoloration, delayed healing). - Prepare the patient for skin grafting as needed for full-thickness wounds: autograft (patient's own skin) is the permanent solution; temporary biological dressings (allograft, xenograft) may be used. - Handle wounds gently to protect granulation tissue. III. NUTRITIONAL SUPPORT (Priority: Physiologic — healing and immunity) Burn injuries create a hypermetabolic state with markedly increased caloric demands: - Provide HIGH-CALORIE, HIGH-PROTEIN diet to support tissue repair, immune function, and wound healing. - Initiate enteral feeding EARLY (within 24–48 hours) to maintain gut integrity and prevent bacterial translocation. - Supplement with Vitamin C (collagen synthesis), Vitamin A (epithelialization), and Zinc (wound healing and immune function). - Monitor nutritional status: body weight, albumin, prealbumin, nitrogen balance. - Administer prophylactic proton pump inhibitors (PPIs) or H2-receptor antagonists to prevent Curling ulcer (stress-related gastric ulcer common in major burns). IV. ADDITIONAL ACUTE PHASE NURSING CARE - Monitor fluid and electrolyte status: as diuresis occurs, watch for hypokalemia; monitor for fluid overload (now that fluid is shifting back into vascular space). - Begin POSITIONING AND SPLINTING: position joints in extension and apply splints to prevent contracture formation — the most common long-term complication. - Initiate early mobilization and range-of-motion exercises as tolerated. - Provide psychosocial support: begin addressing body-image disturbance (NANDA diagnosis: Disturbed Body Image); refer to social worker and mental health services. CONCLUSION: During the acute phase, the nurse functions as the primary coordinator of a multidisciplinary team. Vigilant infection surveillance, meticulous wound care, aggressive nutritional support, and early rehabilitation initiation collectively determine the patient's functional outcome and survival.

Question Type

long_answer

Answer Structure

• Introduction: Define the acute phase, timeframe, and primary threats [0.5 mark]
• Section I: Infection prevention — aseptic technique, topical agents, sepsis monitoring, antibiotic rationale [1 mark]
• Section II: Wound care — debridement, dressings, grafting (autograft), wound assessment [1 mark]
• Section III: Nutrition — hypermetabolic state, high-calorie/high-protein, early enteral feeding, supplements, Curling ulcer prophylaxis [1.5 marks]
• Section IV: Additional care — electrolyte monitoring, positioning/splinting for contracture prevention, psychosocial support [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing a generic infection control answer without burn-specific details (e.g., sepsis signs in burns, topical agents)
• Omitting Curling ulcer and its prophylaxis — this is a very specific burn complication examiners look for
• Writing only 'increase protein intake' for nutrition without specifying the hypermetabolic state, enteral route, or specific supplements
• Not mentioning that systemic antibiotics should NOT be given prophylactically
• Failing to include early positioning/splinting for contracture prevention — this is the bridge to the rehabilitation phase
• Writing a list of interventions without any rationale — 5-mark answers require explanations, not just bullet points

Key Phrases To Include

• hypermetabolic state
• high-calorie high-protein
• early enteral feeding
• aseptic technique
• autograft
• topical antimicrobials
• silver sulfadiazine
• Curling ulcer
• proton pump inhibitor
• contracture prevention
• positioning in extension
• splinting
• Vitamin C, A, Zinc
• Disturbed Body Image
• systemic antibiotics for documented infection only

Marks

5

Topic

Burn Classification and Pathophysiology

Difficulty

hard

Template Id

T12

Examiner Tip

Use a consistent parallel structure for each burn degree — list the same categories in the same order. This shows systematic thinking and makes it easy for examiners to mark. The key clinical distinguishers (blanching, blisters, pain, and eschar) are the high-yield terms. Always include the TBSA exclusion note for first-degree burns.

Model Answer

Burns are classified by depth — how many layers of skin and underlying tissue are destroyed. 1. SUPERFICIAL (FIRST-DEGREE) BURNS - Layers involved: Epidermis only - Clinical features: Red, dry, painful, blanches with pressure, NO blisters (e.g., sunburn) - Healing: 3–6 days, no scarring - Grafting required: NO - NOTE: These are EXCLUDED from TBSA calculation 2. SUPERFICIAL PARTIAL-THICKNESS (SUPERFICIAL SECOND-DEGREE) BURNS - Layers involved: Epidermis and upper dermis - Clinical features: BLISTERS present, moist red weeping surface, MOST PAINFUL (nerve endings intact), blanches with pressure - Healing: 2–3 weeks, usually without scarring - Grafting required: Usually NOT required 3. DEEP PARTIAL-THICKNESS (DEEP SECOND-DEGREE) BURNS - Layers involved: Epidermis and deeper dermis - Clinical features: Red to waxy white appearance, DRIER surface, LESS PAINFUL than superficial partial-thickness (some nerve damage), slower capillary refill - Healing: Slower, high risk of scarring - Grafting required: MAY require grafting 4. FULL-THICKNESS (THIRD-DEGREE) BURNS - Layers involved: Entire epidermis and dermis, possibly into subcutaneous fat - Clinical features: Dry, leathery, inelastic (ESCHAR), colored white/waxy/tan/brown/charred; PAINLESS in center (nerve endings destroyed); does NOT blanch - Healing: Cannot self-heal - Grafting required: YES — REQUIRES skin grafting (autograft for permanent closure) 5. FOURTH-DEGREE BURNS - Layers involved: Extends into muscle, fascia, and bone - Clinical features: Charred appearance, complete tissue destruction - Healing: Cannot self-heal; may require amputation - Grafting required: YES — may require amputation in addition to grafting SUMMARY: As burn depth increases, pain DECREASES (nerve destruction), wound appearance changes from moist/red to dry/leathery, and the need for surgical intervention INCREASES.

Question Type

long_answer

Answer Structure

• Each burn degree: name, layers, clinical features, healing, grafting status [1 mark each = 5 marks for all five degrees described completely]
• Summary statement distinguishing pain and grafting trends across degrees [included in final mark]

Scoring Breakdown

Common Mark Deductions

• Combining superficial and deep partial-thickness into one category — they are distinct and earn separate marks
• Stating that first-degree burns are included in TBSA — this is a classic NLE trick and students lose marks for it
• Describing full-thickness as 'very painful' — it is PAINLESS due to nerve destruction
• Failing to link pain level to nerve ending status (intact vs. destroyed)
• Not mentioning that full-thickness burns require grafting — this is mandatory content

Key Phrases To Include

• epidermis only
• blisters
• most painful
• nerve endings intact
• eschar
• painless
• nerve endings destroyed
• does not blanch
• autograft
• excluded from TBSA
• muscle fascia bone
• amputation

Marks

2

Topic

Dermatologic Disorders — Dermatitis

Difficulty

easy

Template Id

T13

Examiner Tip

For dermatology questions, definition marks require BOTH the cause AND the clinical presentation. Simply saying 'skin inflammation' is too vague. Pair cause + clinical feature for a complete definition.

Model Answer

Contact dermatitis is an inflammatory skin reaction caused by direct contact with an irritant (irritant contact dermatitis) or an allergen (allergic contact dermatitis), presenting with erythema, pruritus, scaling, and vesicles at the site of exposure. Key nursing interventions: 1. Identify and eliminate the causative agent (allergen/irritant) — the most important management step. 2. Apply topical corticosteroids as prescribed for flares and instruct the patient on correct application (thin layer, avoid prolonged use on face and skin folds); administer antihistamines for pruritus relief.

Question Type

short_answer

Answer Structure

• Line 1–2: Correct definition including cause (irritant or allergen), mechanism (inflammatory), and key clinical features [1 mark]
• Line 3–4: Two specific and accurate nursing interventions [1 mark]

Scoring Breakdown

Common Mark Deductions

• Defining contact dermatitis only as 'allergy' without including irritant as a separate cause
• Writing systemic corticosteroids as first-line treatment instead of topical agents
• Not including trigger identification/elimination — this is the number one intervention

Key Phrases To Include

• irritant or allergen
• inflammatory reaction
• erythema, pruritus
• identify and eliminate causative agent
• topical corticosteroids
• antihistamines for pruritus

Marks

2

Topic

Dermatologic Disorders — Skin Infections

Difficulty

medium

Template Id

T14

Examiner Tip

Infection control questions require both the TYPE of precaution and the specific scientific rationale. Examiners deduct marks for incomplete answers. The disseminated vs. localized distinction often appears as a follow-up question — always include it proactively.

Model Answer

For a patient with herpes zoster (shingles), the nurse should implement: - CONTACT PRECAUTIONS: to prevent transmission of varicella-zoster virus through direct contact with active vesicular lesions. - AIRBORNE PRECAUTIONS: required if the patient is immunocompromised or has disseminated (widespread) herpes zoster, because the virus can be transmitted via airborne droplet nuclei. Rationale: Herpes zoster results from reactivation of varicella-zoster virus (VZV) in a single dermatome. Active vesicles contain live virus that can cause primary varicella (chickenpox) in susceptible, non-immune individuals, including healthcare workers and other patients.

Question Type

short_answer

Answer Structure

• Correct isolation type(s): contact precautions for localized; add airborne for disseminated or immunocompromised [1 mark]
• Rationale: VZV in vesicles, risk to non-immune contacts, chickenpox risk [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating only airborne precautions without mentioning contact precautions for localized shingles
• Not distinguishing between localized (contact only) and disseminated/immunocompromised (contact + airborne) cases
• Giving rationale only in vague terms ('to prevent spread') without specifying the virus and the risk to non-immune contacts

Key Phrases To Include

• contact precautions
• airborne precautions
• disseminated or immunocompromised
• varicella-zoster virus
• active vesicles
• chickenpox in susceptible individuals

Marks

5

Topic

Rehabilitation Phase of Burn Injury

Difficulty

hard

Template Id

T15

Examiner Tip

Five-mark long-answer questions in the NLE are scored holistically as well as analytically. Examiners reward answers that: (1) demonstrate clinical depth, (2) use correct NANDA and nursing process language, (3) show awareness of the Philippine healthcare context, and (4) are clearly organized. Starting with a brief definition and ending with a synthesizing conclusion also signals competence. Always include at least one RA 9173 or Filipino healthcare reference in 5-mark answers.

Model Answer

INTRODUCTION: The rehabilitation phase begins when burn wounds are closed and continues for months to years. It focuses on restoring the patient's functional capacity, preventing disfigurement from scarring and contractures, and supporting psychosocial recovery. Under RA 9173 (Philippine Nursing Act of 2002), the nurse has the professional responsibility to implement holistic, individualized care plans and to coordinate with the multidisciplinary team throughout this phase. I. CONTRACTURE PREVENTION Contractures — the abnormal shortening of scar tissue across joints — are the MOST COMMON and functionally devastating late complication of burns. Nursing interventions: 1. Position affected limbs and joints in EXTENSION (anti-contracture position) at all times, especially during rest and sleep. Example: neck burns → position in hyperextension; axillary burns → arms abducted at 90 degrees. 2. Apply thermoplastic SPLINTS to maintain anti-contracture positioning, particularly during sleep when patients cannot voluntarily maintain position. 3. Encourage and assist with ACTIVE RANGE-OF-MOTION (ROM) exercises at least twice daily; progress to active-assisted and resistive exercises as tolerated. 4. Coordinate with Physical Therapy (PT) and Occupational Therapy (OT) for individualized exercise programs and functional rehabilitation. 5. Teach the patient and family the importance of consistent exercise and positioning compliance — gaps in therapy accelerate contracture formation. II. SCAR MANAGEMENT Hypertrophic scarring — raised, firm, red scars — is common after deep partial-thickness and full-thickness burns and can cause both functional limitation and significant distress. Nursing interventions: 1. Apply PRESSURE GARMENTS (custom-fitted elastic compression garments) over healed burn areas as soon as tolerated. These garments must be worn for 23 HOURS per day, every day, for up to 12–24 months (until scar maturation), being removed only for bathing. 2. Teach the patient that scar maturation takes 12–24 months — early cessation of pressure therapy causes scar rebound. 3. Apply silicone gel sheets over scars as prescribed — these are used in conjunction with pressure garments to soften and flatten scars. 4. Protect healed skin from sunlight (use high-SPF sunscreen) to prevent hyperpigmentation and scar darkening, which is especially important in darker-skinned Filipino patients. 5. Monitor for and report signs of scar contraction affecting mobility or causing pain — may require surgical revision (release and re-grafting). III. PSYCHOSOCIAL SUPPORT Burn survivors face profound psychosocial challenges: altered body image, depression, post-traumatic stress disorder (PTSD), social withdrawal, and loss of role function. NANDA Nursing Diagnoses applicable include: Disturbed Body Image, Impaired Social Interaction, and Ineffective Coping. Nursing interventions: 1. Establish a therapeutic nurse-patient relationship built on trust and non-judgmental communication — especially important during dressing changes and mirror viewing. 2. Encourage gradual exposure to mirrors and the changed appearance; allow the patient to express feelings of grief, anger, and loss. 3. Refer to a CLINICAL PSYCHOLOGIST or PSYCHIATRIST if signs of PTSD, major depression, or suicidal ideation are present. 4. Connect the patient with BURN SURVIVOR SUPPORT GROUPS — peer support from other survivors has demonstrated effectiveness in improving coping and social reintegration in the Philippine context (DOH-affiliated burn centers). 5. Involve FAMILY in all aspects of care and education: family support is the most powerful predictor of successful psychosocial rehabilitation in the Filipino cultural context. 6. Address return-to-work, return-to-school, and social reintegration goals with the Social Worker; facilitate PhilHealth and social protection coverage for ongoing needs under the Philippine healthcare system. CONCLUSION: Successful rehabilitation after a major burn requires consistent, multidisciplinary, and patient-centered nursing care extending well beyond hospital discharge. The nurse serves as coordinator, educator, and advocate — roles recognized under RA 9173 Section 28. Early and aggressive rehabilitation interventions are essential to maximize the patient's return to full functional and social life.

Question Type

long_answer

Answer Structure

• Introduction: Define the rehabilitation phase and state its goals [0.5 mark]
• Section I: Contracture prevention — positioning in extension, splinting, active ROM, PT/OT coordination, patient teaching [1.5 marks]
• Section II: Scar management — pressure garments (23 hr/day, duration), silicone sheets, sun protection, scar maturation timeframe [1.5 marks]
• Section III: Psychosocial support — therapeutic relationship, body image, PTSD/psychological referral, support groups, family involvement, social reintegration [1.5 marks]

Scoring Breakdown

Common Mark Deductions

• Mentioning pressure garments without specifying the 23-hour/day wearing schedule or duration — the specific values are what earn the mark
• Listing psychosocial interventions without NANDA diagnosis labels — NLE examiners expect nursing diagnosis language
• Omitting PT/OT coordination — rehabilitation is inherently multidisciplinary, and the nurse's coordinating role must be explicit
• Writing only generic psychological support without naming PTSD and body image disturbance
• Not applying the Philippine healthcare context (DOH burn centers, PhilHealth, Filipino family values) in a 5-mark answer that provides space for contextual depth

Key Phrases To Include

• anti-contracture positioning
• extension
• pressure garments
• 23 hours per day
• 12–24 months
• scar maturation
• active range-of-motion
• splinting
• Disturbed Body Image
• PTSD
• burn survivor support groups
• multidisciplinary team
• RA 9173
• PT and OT referral
• silicone gel sheets