Mandys' Thermo/Burn Questions

A client receives a scalding burn to the chest and arms. The nurse assesses that the burned areas are painful, red to white, and edematous. How will the nurse classify these burns? A) Eschar B) Deep full-thickness burns C) Deep partial-thickness burns D) Superficial partial thickness burns

C) Deep partial-thickness burns

A patient is undergoing fluid replacement after being burned on 20% of her body 12 hours ago. The nursing assessment reveals a blood pressure of 90/50 mm Hg, a pulse rate of 110 bpm, and a urine output of 20 ml over the past hour. The nurse reports the findings to the health care provider and anticipates which prescription? A) Transfusing 1 unit of packed red blood cells B) Administering a diuretic to increase urine output C) Increasing the amount of intravenous (IV) Lactated Ringer's solution administered per hour D) Changing the IV lactated Ringer's solution to one that contains 5% dextrose in water

C) Increasing the amount of intravenous (IV) Lactated Ringer's solution administered per hour

A nurse is caring for a client with severe burns. The nurse determines that this client is at risk for hypovolemic shock. Which physiologic finding supports the nurse's conclusion? A) Decreased rate of glomerular filtration B) Excessive blood loss through the burned tissues C) Plasma proteins moving out of the intravascular compartment D) Sodium retention occurring as a result of the aldosterone mechanism

C) Plasma proteins moving out of the intravascular compartment

The disaster management team is caring for workers of a factory who survived a thermal blast. Which findings in the workers would the nurse consider as confirmation of second degree burns? A) Presence of dry eschar and skin appears waxy white B) Presence of leathery bleb and skin appears dark brown C) Presence of moist blebs and skin appears mottled white or pink D) Presence of pain and redness with moderate to severe tenderness

C) Presence of moist blebs and skin appears mottled white or pink

A nurse is administering a histamine H 2 antagonist to a client who has extensive burns. The nurse explains to the client that this drug is given prophylactically during the first few weeks after extensive burns. What complication of burns will it prevent? A) Colitis B) Gastritis C) Stress Ulcer D) Metabolic acidosis

C) Stress Ulcer

Which type of burn/injury may cause a client to have a cervical spine injury? A) Electronic burns B) Chemical burns C) Inhalation injury D) Cold thermal injury

A) Electronic burns

The nurse is preparing to care for a burn patient scheduled for an escharotomy procedure being performed for a third-degree circumferential arm burn. The nurse understands that which finding is the anticipated therapeutic outcome of the escharotomy? A) Return of distal pulses B) Brisk bleeding from the site C) Decreasing edema formation D) Formation of granulation tissue

A) Return of distal pulses

A nurse who is assessing intake and output for a client with severe burns notes that the patient's intake is 2,000 mL greater than output. Which rationales should the nurse associate with this discrepancy? Select ALL that APPLY. A) The patient is experiencing vasoconstriction. B) The patient is experiencing increased insensible output. C) The patient has been incontinent of urine and stool. D) The patient has been dangerously overhydrated. E) The patient is experiencing third spacing

A) The patient is experiencing vasoconstriction B) The patient is experiencing increased insensible output. E) The patient is experiencing third spacing

What is the nurse's initial action immediately after assisting with a precipitous birth in the triage area of the emergency department? A) Warming the newborn B) Clamping the umbilical cord C) Assessing maternal bleeding D) Monitoring expulsion of the placenta

A) Warming the newborn

A patient is brought to the emergency department with partial-thickness burns to his face, neck, arms, and chest after trying to put out a car fire. The nurse should implement which nursing actions for this patient? Select ALL that apply. A) Restrict fluids B) Assess for airway patency C) Administer oxygen as prescribed D) Place a cooling blanket on the patient E) Elevate extremities if no fractures are present F) Prepare to give oral pain medication as prescribed

B) Assess for airway patency C) Administer oxygen as prescribed E) Elevate extremities if no fractures are present

During a first aid class, a student asks what should be done if a person's clothes catch on fire. The nurse explains that after the flames are extinguished it is most important to perform this action. Which action did the nurse describe? A) Give the person sips of water. B) Assess the person's breathing. C) Cover the person with a warm blanket. D) Calculate the extent of the person's burns.

B) Assess the person's breathing.

The nurse is caring for a patient who suffered an inhalation injury from a wood stove. The carbon monoxide blood report reveals a level of 12%. Based on this level, the nurse would anticipate noting which sign in the patient? A) Coma B) Flushing C) Dizziness D) Tachycardia

B) Flushing

What is the most appropriate measure for a nurse to use when assessing core body temperature when there are suspected problems with thermoregulation? A) Oral thermometer B) Rectal thermometer C) Temporal thermometer scan D) Tympanic membrane sensor

B) Rectal thermometer

A nurse is caring for a client who is experiencing the second (acute) phase of burn recovery. The common client response the nurse expects to identify during this phase of burn recovery is an increase in what? A) Serum sodium B) Urinary output C) Hematocrit level D) Serum potassium

B) Urinary output

A patient arrives at the emergency department following a burn injury that occurred in the basement at home, and an inhalation injury is suspected. What would the nurse anticipate to be prescribed for the patient? A) 100% Oxygen via an aerosol mask B) Oxygen via nasal cannula at 6 L/minute C) Oxygen via nasal cannula at 15 L/minute D) 100% Oxygen via a tight-fitting, non-rebreather face mask

D) 100% Oxygen via a tight-fitting, non-rebreather face mask

A burn victim has waxy white areas interspersed with pink and red areas on the anterior trunk and all of both arms. The nurse calculates the percentage of total body surface area (TBSA). Which percentage will the nurse report? A) 20 B) 25 C) 30 D) 36

D) 36

The nurse is caring for a patient who sustained superficial partial-thickness burns on the anterior lower legs and anterior thorax. Which findings does the nurse expect to note during the resuscitation/emergent phase of the burn injury? A) Decreased heart rate B) Increased urine output C) Increased blood pressure D) Elevated hematocrit levels

D) Elevated hematocrit levels

The nurse should identify which newborn to be at significant risk for hypothermic alteration in thermoregulation? A) Large for gestational age B) Born at term C) Well nourished D) Low birth weight

D) Low birth weight

While obtaining the vital signs of a client, the nurse finds that the body temperature of the client is 98.6 °F. The nurse concludes that the client is experiencing what? A) Hypothermia B) Hyperpyrexia C) Hyperthermia D) Normothermia

D) Normothermia