MATI DOCTORS COLLEGE

NCM 118 (Medical-Surgical Nursing 3)

General Direction: No erasures and superimposition. NFI will not be considered.

2. What are the three zones of a burn injury according to Jackson's theory?

3. What degree of burn affects only the epidermis?

4. What degree of burn extends into subcutaneous tissue and possibly muscle or bone?

5. What classification is used to estimate the total body surface area (TBSA) affected by burns?

6. What degree of burn affects both the epidermis and dermis?

7. What is the name of the burn depth assessment method that uses hand size as reference?

8. What is the primary threat to life from a major burn injury?

9. What is the fluid replacement formula used in burn management?

10. In the Parkland formula, how much fluid is given in the first 8 hours?

11. What solution is commonly used for fluid resuscitation in burns?

12. Which type of burn is characterized by blistering and intense pain?

13. What is the procedure called for relieving pressure caused by circumferential burns?

14. What type of burn is often deceptive in its external appearance but causes deep internal damage?

15. What is the primary goal of the emergent phase of burn care?

16. What is autografting in burn treatment?

17. What is the name of the phase in burn management focused on wound healing and prevention of infection?

18. What is the final phase of burn recovery focused on rehabilitation and long-term outcomes?

19. What is the common name for a muscle injury caused by overstretching or overuse?

20. What orthopedic condition involves partial loss of contact between articulating bones?

21. What physical test is performed by forced wrist flexion to diagnose carpal tunnel syndrome?

22. What type of fracture results in splintering of bone into several fragments?

23. What is the pulling force used to align bones called?

24. Which type of traction uses pins or wires inserted into the bone?

25. What traction is used in children under 3 years old with hip or femur issues?

26. What type of fracture is characterized by a break that twists around the bone shaft?

27. What orthopedic complication involves compression of the median nerve in the wrist?

28. What is the name of the diagnostic sign that involves tapping over the median nerve at the wrist?

29. What is the name for external bone stabilization using pins connected to a frame?

30. What is the recommended cleaning agent for pin site care in skeletal traction?
 II. MULTIPLE CHOICE: Write the letter of the correct 10. Why is Lactated Ringer’s solution preferred in burn
answer before the number in CAPITAL LETTER. fluid resuscitation?
A. It prevents infection
1. A patient presents with red, painful skin after sun B. It corrects hypokalemia
exposure. What degree of burn is this? C. It promotes tissue regeneration
A. Second-degree
D. It closely resembles extracellular fluid ✅
B. Third-degree
C. First-degree ✅ 11. A burn patient needs debridement. What is the main
D. Fourth-degree purpose of this procedure?
A. Cool the wound
2. A burn patient has waxy, white skin with no pain B. Reduce swelling
sensation in the area. What is the burn classification?
C. Remove necrotic tissue ✅
A. Full-thickness ✅ D. Prevent scarring
B. Partial-thickness
C. First-degree 12. Which finding is expected in the emergent phase of
D. Superficial burn injury?
A. Hyperkalemia ✅
3. A nurse is preparing to administer fluids using the
B. Hypoglycemia
Parkland formula. The patient weighs 70 kg and has
C. Hypokalemia
burns over 40% TBSA. How much fluid is required in
D. Hypernatremia
the first 24 hours?
A. 5600 mL 13. A patient with electrical burns becomes confused and
B. 11200 mL ✅ has dark urine. What complication should be
C. 2800 mL suspected?
D. 7000 mL A. Kidney stones
(Answer: 4 mL × 70 kg × 40 = 11200 mL) B. Rhabdomyolysis ✅
C. Stroke
4. A burn patient in the emergency department has singed
D. Sepsis
nasal hairs and hoarseness. What is the nurse’s priority
action? 14. What is the priority nursing action for a burn patient
A. Administer pain medication with signs of compartment syndrome?
B. Start fluid resuscitation A. Apply ice
C. Assess airway and prepare for intubation ✅ B. Elevate the limb
D. Apply oxygen by nasal cannula C. Prepare for escharotomy ✅
D. Administer morphine
5. Which of the following is a major concern for a patient
with electrical burns? 15. During the rehabilitative phase of burn care, which goal
A. Infection is most appropriate?
B. Renal failure due to muscle damage ✅ A. Functional recovery and scar management ✅
C. Fluid overload B. Prevention of infection
D. Photosensitivity C. Fluid resuscitation
D. Airway stabilization
6. A burn wound has blisters and is moist, pink, and
16. Which patient is at highest risk for complications from a
painful. What type of burn is this?
burn injury?
A. First-degree
A. 22-year-old with 10% TBSA
B. Partial-thickness ✅ B. 45-year-old with 20% TBSA
C. Full-thickness
C. 70-year-old with 15% TBSA ✅
D. Deep partial-thickness
D. 35-year-old with 5% TBSA
7. Which intervention is most important in the first 24
17. Why is pain often minimal in third-degree burns?
hours for a major burn patient?
A. Burn area is small
A. Administer tetanus shot
B. Nerve endings are destroyed ✅
B. Prevent infection
C. Pain is masked by shock
C. Initiate fluid resuscitation ✅
D. Skin is still intact
D. Begin physical therapy
18. Which of the following is an early sign of sepsis in burn
8. A client with burns covering 25% TBSA starts showing
patients?
decreased urine output and low blood pressure. What
A. High fever
does this indicate?
B. Hypotension
A. Hypovolemic shock ✅
C. Confusion and restlessness ✅
B. Pain crisis
D. Hypothermia
C. Infection
D. Hyperkalemia 19. A patient with a chemical burn asks what to do first.
What is the correct action?
9. What assessment is most concerning in a patient with
A. Apply ointment
facial burns?
B. Cover the burn
A. Singed eyebrows
C. Irrigate with water immediately ✅
B. Pain on swallowing
D. Apply ice
C. Stridor and wheezing ✅
D. Facial swelling
20. When using the Rule of Nines, how much TBSA is C. Prepare for intubation ✅
assigned to one leg? D. Place in high Fowler's position
A. 4.5% 30. A patient with deep partial-thickness burns reports severe
B. 9% pain. However, the area appears dry, waxy, and without
C. 36% blisters. What should the nurse do first?
D. 18% ✅ A. Reassess the depth of the burn ✅
B. Administer prescribed analgesics
21. Inhalation injury should be suspected if a patient has:
C. Document as full-thickness
A. Burns below the waist
D. Elevate the limb
B. Carbonaceous sputum ✅ 31. A patient with electrical burns has dark brown urine,
C. Blistered skin elevated creatinine, and muscle pain. What complication
D. Bradycardia should the nurse suspect?
22. A burn patient's potassium is elevated in the early A. Septicemia
phase. Why? B. Renal calculi
A. Increased intake C. Myoglobinuria leading to acute tubular necrosis ✅
B. Cell destruction ✅ D. Urinary tract infection
C. Dehydration 32. A nurse is assessing a patient with circumferential burns
D. Renal retention around the chest. The patient is breathing rapidly and using
accessory muscles. What is the immediate concern?
23. A patient with a full-thickness burn has no pain. What is A. Shock
the nurse’s explanation? B. Compartment syndrome
A. Nerve endings are destroyed ✅ C. Restrictive respiratory movement ✅
B. Pain medication is effective D. Pain-induced hyperventilation
C. Pain receptors are intact 33. During resuscitation, a burn patient's IV infiltration is
D. It is a minor burn discovered after 6 hours of fluid administration. What is the
nurse’s next priority?
24. Which dietary intervention is appropriate for a patient in
A. Restart IV and continue fluid at same rate
the acute burn phase?
B. Calculate fluid deficit and notify provider ✅
A. Low-protein diet
C. Wait and reassess urine output
B. High-calorie, high-protein diet ✅
D. Apply warm compress
C. Low-fat diet
34. A patient with 35% TBSA burns suddenly develops fever,
D. Fluid restriction
hypotension, and disorientation on day 5. What is the
25. A patient is burned over the front of the right arm, nurse’s priority?
chest, and abdomen. Using the Rule of Nines, what is A. Culture the wound
the TBSA burned? B. Notify the provider immediately ✅
A. 18% C. Administer IV antibiotics
B. 27% D. Obtain CBC and CRP
C. 36% 35. A nurse is teaching a burn patient about autografting. Which
D. 22.5% ✅ patient statement requires correction?
26. A 30-year-old male arrives at the ER with full-thickness A. “The skin will be taken from another part of my body.”
burns over 30% of his body from a house fire. He is alert, B. “The donor site may be more painful than the graft site.”
with no respiratory distress. However, he later develops C. “There is no risk of infection since it's my own skin.” ✅
confusion and urine output drops. What is the most likely D. “The new skin must be kept clean and protected.”
cause? 36. A nurse is monitoring a burn patient in the acute phase.
A. Pain-induced delirium Which finding indicates that the patient is transitioning to the
B. Inhalation injury rehabilitative phase?
C. Inadequate fluid resuscitation ✅ A. No longer requiring IV fluids
D. Electrolyte imbalance B. Decreased WBC count
27. A nurse is monitoring a burn patient during the emergent C. Wound closure and focus on function ✅
phase. Which lab finding requires immediate intervention? D. Absence of fever
A. Sodium: 134 mEq/L 37. A patient with facial burns is placed on 100% humidified
B. Hematocrit: 54% oxygen via non-rebreather mask. ABGs show PaO₂ of 78
C. Potassium: 6.2 mEq/L ✅ mmHg and PaCO₂ of 50 mmHg. What does this indicate?
D. Glucose: 140 mg/dL A. Mild hypoxemia
28. A patient with extensive full-thickness burns has received B. Normal respiratory status
adequate fluid resuscitation and shows stable vital signs. C. Worsening airway injury ✅
However, bowel sounds are absent, and the abdomen is D. Adequate oxygenation
distended. What should the nurse suspect? 38. A patient with a chemical burn asks why water is used
A. Peritonitis instead of neutralizing agents. What is the correct
B. Hypovolemic shock explanation?
C. Paralytic ileus ✅ A. Water increases chemical reaction
D. Internal bleeding B. It’s safer to dilute than risk exothermic reactions ✅
29. A burn patient begins showing signs of respiratory distress 8 C. Neutralizers are faster but toxic
hours after injury, including agitation, stridor, and drooling. D. Water helps the burn heal faster
What is the priority action?
A. Administer oxygen via nasal cannula
B. Notify the respiratory therapist
39. A child with burns is admitted to the pediatric unit. Parents C. Reduces pin site infections
ask why the child is in isolation. What’s the best D. Improves blood circulation
explanation? 49. Which action should the nurse avoid when caring for a
A. “Isolation helps control body temperature.” patient with skin traction?
B. “Children with burns are at high risk of spreading A. Repositioning the patient with log rolling
infection.” B. Allowing wrinkles in the traction bandage ✅
C. “To protect your child from hospital-acquired infections.” C. Performing frequent neurovascular checks
✅ D. Assessing the skin under foam boots
D. “Because your child has an open wound.” 50. A patient with femoral fracture is on skeletal traction. He
40. A patient with burns over the lower limbs is immobilized in develops shortness of breath and chest pain. What is the
bed. The nurse notes increasing pain and numbness in the nurse's priority?
feet, with pale toes and absent dorsalis pedis pulses. What A. Encourage deep breathing
complication is most likely? B. Suspect fat embolism – notify provider immediately ✅
A. Deep vein thrombosis C. Start oxygen and monitor
B. Infection D. Recheck alignment
C. Compartment syndrome ✅ 51. A nurse evaluates a traction setup and notes restricted
D. Peripheral neuropathy pulley movement. What could this affect?
41. A patient presents with a supracondylar fracture of the A. Pressure relief
humerus. Which traction method is most appropriate to B. Pain control
apply? C. Traction effectiveness ✅
A. Dunlop’s traction ✅ D. Circulatory assessment
B. Buck’s traction 52. After pin insertion for skeletal traction, when can the patient
C. Pelvic girdle traction typically start showering?
D. Bryant’s traction A. Immediately
42. A burn patient who also has an open femur fracture is being B. Within 24 hours
prepared for surgery. Which type of fracture management is C. 5 to 10 days post-insertion ✅
best suited in this case? D. Once discharge is planned
A. Closed reduction 53. Which patient is at greatest risk of complications from
B. Internal fixation traction therapy?
C. Skin traction A. A 25-year-old with a spiral fracture
D. External fixation ✅ B. A 60-year-old with history of diabetes and compression
43. A nurse is caring for a patient with skeletal traction. Which fracture ✅
finding requires immediate intervention? C. A 35-year-old in balanced traction
A. Redness at pin site D. A 15-year-old with greenstick fracture
B. Patient unable to perform ankle pumps 54. A nurse is assessing for complications of immobility in a
C. Absence of dorsalis pedis pulse ✅ traction patient. What is the earliest sign of pneumonia?
D. Weight hanging slightly off the floor A. Wheezing
44. A child under 3 years old is diagnosed with a femur fracture. B. Crackles upon auscultation ✅
Which type of traction is appropriate? C. Increased sputum
A. Buck’s traction D. Decreased appetite
B. Bryant’s traction ✅ 55. A post-op fracture patient in external fixation has yellow
C. Dunlop’s traction drainage at a pin site. What is the appropriate
D. Pelvic girdle traction interpretation?
45. A patient with a distal tibia fracture suddenly reports A. Normal healing response
increasing leg pain, tightness, and numbness. What is the B. Expected pin-site exudate
nurse’s immediate priority? C. Possible infection – assess further ✅
A. Apply ice D. Serous drainage from inflammation
B. Notify the physician – suspect compartment syndrome ✅ 56. A patient is admitted with a comminuted open tibial fracture
C. Elevate the leg and is scheduled for external fixation. Which nursing priority
D. Reposition the traction weights is most critical post-op?
46. A nurse notices that the traction weight is resting on the A. Performing meticulous pin site care ✅
floor. What is the correct action? B. Monitoring for fat embolism
A. Document and continue C. Encouraging early ambulation
B. Remove the weights D. Administering NSAIDs regularly
C. Lift the bed to realign 57. A nurse assesses a patient with a newly applied cast who
D. Reposition the patient to ensure free-hanging weights ✅ reports increasing pain unrelieved by opioids. What should
47. A patient with a leg fracture in Buck’s traction complains of a the nurse do first?
burning sensation under the foam boot. What should the A. Document the pain
nurse suspect? B. Elevate the limb
A. Nerve damage ✅ C. Perform neurovascular checks for compartment
B. Normal response syndrome ✅
C. Infection D. Apply cold compress
D. Skin rash 58. A patient with a Colles’ fracture presents with pain, edema,
48. In patients undergoing balanced suspension traction, why is and a “dinner fork” wrist deformity. Which intervention is
proper alignment critical? most appropriate initially?
A. Prevents skin irritation A. Start isometric hand exercises
B. Ensures effective bone healing ✅ B. Apply heat to reduce swelling
 C. Encourage active range of motion D. Re-apply the bandage tightly
D. Immobilize the wrist and apply ice ✅ 65. A nurse assesses a limb in traction and notes absent
59. After a femur fracture, a patient develops sudden shortness capillary refill and cold extremity. What is the priority action?
of breath, tachycardia, and petechiae on the chest. What A. Elevate the extremity
condition should the nurse suspect? B. Notify the physician immediately ✅
A. Pulmonary embolism C. Apply heat
B. Fat embolism syndrome ✅ D. Adjust the traction weight
C. Cardiac arrest 66. Which of the following findings after application of skeletal
D. Pneumothorax traction should be reported immediately?
60. A patient with a dislocated shoulder receives a reduction A. Serous pin site drainage
under sedation. Which post-procedure instruction is most B. Pin movement of less than 1mm
important? C. Absence of sensation distal to the pin site ✅
A. Start pendulum shoulder exercises immediately D. Local pin site tenderness
B. Immobilize with a sling and avoid active motion initially ✅ 67. A patient with a tibial fracture reports sudden calf pain and
C. Apply traction for 12 hours swelling. What should the nurse do first?
D. Apply a compression bandage to reduce pain A. Elevate the leg and apply ice
61. In managing a high-ankle sprain, which clinical sign B. Assess for Homans’ sign
differentiates it from a lower ankle sprain? C. Check for rebound tenderness
A. Medial malleolus tenderness D. Suspect DVT and notify the physician ✅
B. Positive drawer test 68. A patient with pelvic traction reports urinary retention and
C. Pain with external rotation stress ✅ constipation. What is the cause?
D. Absence of edema A. Poor dietary intake
62. A patient with wrist pain is suspected to have carpal tunnel B. Loss of muscle tone
syndrome. What finding supports this diagnosis? C. Immobility affecting pelvic nerves ✅
A. Tingling in the thumb and index finger on Tinel’s sign ✅ D. Medication side effects
B. Weak radial pulse 69. A nurse caring for a patient in balanced suspension traction
C. Pain worsens with forearm elevation finds the weights resting on the floor. What is the best
D. Bruising over the wrist immediate action?
63. A nurse is caring for a patient in skeletal traction. Which A. Inform the provider
intervention helps prevent foot drop? B. Readjust the ropes to allow weights to hang freely ✅
A. Encourage deep breathing C. Remove the weights and reassess
B. Provide high-fiber diet D. Increase the weight slightly
C. Place a foot board and do ankle exercises ✅ 70. A patient with a spiral fracture of the femur is undergoing
D. Massage the calves daily skin traction. Which observation indicates correct traction
64. A patient with external fixation has foul-smelling drainage setup?
and pin site redness. What is the priority nursing A. Ropes are taut and aligned ✅
intervention? B. Weight is resting on the bed
A. Increase the frequency of pin care C. Boot padding is wrinkled
B. Notify the physician – possible infection ✅ D. There is tension at the knee joint only
C. Flush the area with sterile water