Burn questions
When using the Palmer method to estimate the extent of a small or scattered burn injury, the nurse recognizes the palm is equal to which percentage of total body surface area?
1%
The nurse recognizes that which of the following provide clues about fluid volume status? Select all that apply
-hourly UO -skin turgor -daily weights
A client with a severe electrical burn injury is treated in the burn unit. Which laboratory result would cause the nurse the most concern?
BUN of 28
In a client who has been burned, which medication should the nurse expect to use to prevent infection?
Mafenide (Sulfamylon)
The nurse is planning the care of a patient with a major thermal burn. What outcome will the nurse understand will be optimal during fluid replacement?
a UO of 30ml/hr
In an industrial accident, a client who weighs 155 lb (70 kg) sustained full-thickness burns over 40% of his body. He's in the burn unit receiving fluid resuscitation. Which finding shows that the fluid resuscitation is benefiting the client?
a urine output consistently above 40ml/hr
Which of the following measures can be used to cool a burn?
application of cool water
Initial first aid rendered at the scene of a fire includes preventing further injury through heat exposure. Which intervention could contribute to tissue hypoxia and necrosis and therefore should be avoided?
application of ice
Which complication is common for victims of electrical burns?
cardiac dysrtyhmia
A client presents with blistering wounds caused by an unknown chemical agent. How should the nurse intervene?
irrigate wounds with water
A client with deep partial-thickness and full-thickness burns on the arms receives autografts. Two days later, the nurse finds the client doing arm exercises. The nurse provides additional client teaching because these exercises may:
dislodge the autografts
The spouse of a client who was struck by lightning asks the nurse why the areas involved seems so small but the damage is extensive. Which is the best explanation from the nurse?
electrical burns follow an internal path
A nurse practitioner administers first aid to a patient with a deep partial-thickness burn on his left foot. The nurse describes the skin involvement as the
epidermis and a small portion of the dermis
A patient has a burn injury that has destroyed all of the dermis and extends into the subcutaneous tissue, involving the muscle. This type of burn injury would be documented as which of the following?
full thickness
A client has a burn on the leg related to an engine fire. When the burn area was assessed, it was determined that the client felt no pain in the area and that it appeared leathery. How would the nurse document the depth of burn injury this client has?
full thickness -3rd degree
A client with a burn injury is in acute stress. Which of the following complications is prone to develop in this client?
gastric ulcers
Which of the following neuroendocrine changes occur within the first 24 hours of a serious burn?
hypergyclemia
A nurse is developing a care plan for a client recovering from a serious thermal burn. After maintaining respirations, the nurse knows that the most important immediate goal of therapy is:
maintaining the client's fluid, electrolyte, and acid-base balance.
Which type of debridement occurs when nonliving tissue sloughs away from uninjured tissues?
natural
A client recovering from burn injuries over both forearms reports itching of the wounds. Which action will the nurse take to enhance the client's comfort?
pat the areas -DONT scratch
A client brought to the emergency department has been exposed to smoke and flames from a house fire. What assessment finding is most important to the nurse in determining care of the client?
presence of soots around nasal pathways
Following a burn injury, the nurse determines which area is the priority for nursing assessment?
pulmonary system
A client with a burn over the lower leg asks why surgery is planned to remove the dead burned tissue. Which response will the nurse make?
reduces risk of infection
A client who has sustained burns to the anterior chest and upper extremities is brought to the burn center. During the initial stage of assessment, which nursing diagnosis is primary?
risk for impaired gas exchange
Which intervention helps to minimize the risk of further injury to an affected person at the scene of a fire?
roll the client in a blanket
Which antimicrobials is not commonly used to treat burns?
tetraclyine
When the area of burn is irregular in shape and is scattered over multiple areas of the body, which is the best method for the nurse to obtain a quick assessment of the total body surface area of the burn?
use clients palm size
An emergency department nurse is evaluating a client with partial-thickness burns to the entire surfaces of both legs. Based on the rule of nines, what is the percentage of the body burned?
36%
The nurse provides care for a client with a full-thickness, circumferential burn of the left lower leg. During the nurse's initial shift assessment, the client is resting and the physical assessment of the left lower extremity is unremarkable. One hour later, the nurse notes the pulses of the left lower leg cannot be obtained by a Doppler ultrasound device, and the capillary refill of the left great toe is greater than 2 seconds. What is the nurse's best response based on the clinical findings?
Contact the primary care provider and prepare for an escharotomy.
A client has partial-thickness burns on both lower extremities and portions of the trunk. Which IV fluid does the nurse plan to administer first?
Lactated ringer
A client receiving emergency treatment for severe burns has just been assessed to establish the burn depth. Why is a nurse asked to reassess the burn depth after 72 hours?
The early appearance of the burn injury may change.
When assessing a client with partial-thickness burns over 60% of the body, which finding should the nurse report immediately?
hoarsness of the voice
Which of the following types of shock will a nurse observe in a client with extensive burns?
hypovelemic shock
Which of the following is a potential cause of a superficial partial-thickness burn?
sun burn
A patient has a burn injury that has damaged the epidermis. There are no blisters, and the skin is pink in color. This type of burn injury would be documented as which of the following?
superficial