NCLEX-RN Study Guide

NCLEX Integumentary Questions: Burns and Wounds (2026)

November 2, 2026 · 5 min read

Short answer. Integumentary NCLEX questions are about protecting the barrier. With burns the priority is airway and fluid loss; with pressure injuries it is prevention and accurate staging. Infection is the complication behind both.

What the 2026 NCLEX tests in this area

Physiological Adaptation: burns, wound healing, infection
Basic Care and Comfort: skin care, repositioning, wound management

Key facts to know

Rule of nines, adult	Each arm 9 percent, each leg 18 percent, anterior trunk 18, posterior trunk 18, head 9, perineum 1
Parkland formula	4 mL per kg per percent total body surface area in the first 24 hours, half in the first 8
Airway priority in burns	Suspect inhalation injury with facial burns, singed nares or hoarseness
Stage 1 pressure injury	Intact skin with non blanchable redness
Stage 3 pressure injury	Full thickness loss with visible subcutaneous tissue, no exposed bone or tendon
Turning schedule for prevention	Reposition at least every 2 hours and offload heels

Practice question from this chapter

A client has a stage 3 pressure injury on the sacrum with a wound bed that is 60% yellow slough, scant serosanguineous drainage, and macerated surrounding skin. Which intervention should the nurse implement?

Leave the wound open to air to dry
Scrub the wound bed vigorously during cleansing
Clean the wound and apply a moisture-retentive dressing per protocol
Apply a heat lamp to the wound

Show answer and rationale

Correct answer: C. Clean the wound and apply a moisture-retentive dressing per protocol

A wound with slough and macerated edges needs gentle cleansing and a moisture-retentive dressing to support autolytic debridement and protect periwound skin. Open-to-air drying impedes healing, vigorous scrubbing damages granulating tissue, and heat lamps increase moisture loss and burn risk.

Second practice question

A client with a stage 3 pressure injury on the sacrum has wound drainage that is yellow and foul-smelling, and the surrounding skin is red and warm. Which action should the nurse implement first?

Cover the wound with dry gauze only
Obtain a wound culture per protocol and notify the provider
Leave the wound open to air
Apply a heat lamp to the wound

Show answer and rationale

Correct answer: B. Obtain a wound culture per protocol and notify the provider

The correct option is to obtain a wound culture and notify the provider because foul-smelling drainage with surrounding redness and warmth indicates infection that requires targeted treatment. Dry gauze alone does not treat infection. Leaving the wound open to air promotes drying but not healing and does not address infection. A heat lamp can further damage tissue.

Burns: airway before fluid

A client with facial burns, soot in the sputum or a hoarse voice has an airway that is closing. Intubation is decided early, because waiting for stridor means waiting too long. Fluid resuscitation follows, calculated from the burn surface area and the client weight, with urine output as the guide to adequacy.

Do not apply ice or ointments to a significant burn, and do not remove adherent clothing. Cool running water for a minor burn, sterile cover for a major one, and transport for anything deep or large.

Staging and prevention

Staging is about depth, not size. Stage 1 is intact skin with redness that does not blanch. Stage 2 is partial thickness loss with a shallow open wound. Stage 3 reaches subcutaneous tissue. Stage 4 exposes bone, tendon or muscle. Unstageable means covered by slough or eschar, and deep tissue injury looks like a bruise that has not opened.

Assess the whole surface, not the wound

Pressure injury and wound items are won by describing what you see with the right vocabulary: location, size in centimetres, tissue type, exudate, and whether the edges are undermining. Staging follows depth, and an injury you cannot see the base of is unstageable until the slough clears.

Then assess the whole client. Nutrition, mobility, moisture and sensation are the four factors that created the wound, and a client with a low albumin will not heal no matter how good the dressing is.

Burns as a time critical event

The first hour decides the outcome. Airway from inhalation injury, then circulation with fluid calculated by surface area and weight, then pain, then temperature control. Do not apply ice, do not remove adherent clothing, and do not underestimate a burn that looks small but is deep, circumferential or on the face, hands or perineum.

Expect an item on circumferential burns and escharotomy, because a tight eschar acts like a tourniquet as oedema develops.

Frequently asked questions

What is the first priority in a major burn?

Airway assessment and support. Inhalation injury kills before fluid loss does.

How is the rule of nines used?

To estimate total body surface area burned in adults, which then drives fluid resuscitation calculations.

Can you stage a pressure injury covered in eschar?

No. It is unstageable until the eschar or slough is removed so the base can be seen.

How often should an immobile client be turned?

At least every 2 hours, with heel offloading and a skin check at each turn.

What is the difference between a stage 2 and a stage 3 pressure injury?

A stage 2 is partial thickness with a shallow open wound or a blister. A stage 3 is full thickness tissue loss reaching subcutaneous fat, without exposed bone, tendon or muscle.

How is burn surface area estimated?

The rule of nines in adults, or the Lund and Browder chart in children. The estimate drives fluid resuscitation, so an inaccurate count is a safety error.

Practise this chapter with rationales

NCLEXDeck gives you practice questions for every body system, with a rationale for the correct answer and for each distractor. Start on the free tier, no card required.

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