management of patients with burn injury

11. A man suffers leg burns from spilled charcoal lighter fluid. His son extinguishes the flames. While waiting for an ambulance, the burn victim should: a. have someone assist him into a bath of cool water, where he can wait for emergency personnel. b. lie down, have someone cover him with a blanket, and cover his legs with petroleum jelly. c. remove his burned pants so that the air can help cool the wound. d. sit in a chair, elevate his legs, and have someone cut his pants off around the burned area.

a

12. As the first priority of care, a patient with a burn injury will initially need: a. a patent airway established. b. an indwelling catheter inserted. c. fluids replaced. d. pain medication administered.

a

13. Eyes that have been irritated or burned with a chemical should be flushed with cool, clean water: a. immediately. b. in 5 to 10 minutes. c. after an eye examination. d. after 24 hours.

a

14. Decreased urinary output during the first 48 hours of a major burn is secondary to all of the following except: a. decreased adrenocortical activity. b. hemolysis of red blood cells. c. hypovolemia. d. sodium retention.

a

15. Electrolyte changes in the first 48 hours of a major burn include: a. base bicarbonate deficit. b. hypernatremia. c. hypokalemia. d. all of the above.

a

23. Wound cleansing and surgical debridement may begin as early as: a. 72 hours. b. 1 week. c. 1.5 to 2 weeks. d. 1 month.

a

1. A full-thickness burn is: a. classified by the appearance of blisters. b. identified by the destruction of the dermis and epidermis. c. not associated with edema formation. d. usually very painful because of exposed nerve endings.

b

17. A sample consensus formula for fluid replacement recommends that a balanced salt solution be administered in the first 24 hours of a burn in the range of 2 to 4 mL/kg/% of burn with 50% of the total given in the first 8 hours postburn. A 176-lb (80-kg) man with a 30% burn should receive a minimum of how much fluid replacement in the first 8 hours? a. 1,200 mL b. 2,400 mL c. 3,600 mL d. 4,800 mL

b

2. With partial-thickness (second-degree) burns, skin regeneration begins to take place: a. within 7 days. b. in 2 to 4 weeks. c. after 2 months. d. between the third and sixth month.

b

20. One parameter of adequate fluid replacement is an hourly urinary output in the range of: a. 10 to 30 mL. b. 30 to 50 mL. c. 80 to 120 mL. d. 100 to 200 mL.

b

22. Fluid remobilization usually begins: a. within the first 24 hours, when massive amounts of fluid are being administered intravenously. b. after 48 hours, when fluid is moving from the interstitial to the intravascular compartment. c. after 1 week, when capillary permeability has returned to normal. d. after 1 month, when scar tissue covers the wound and prevents evaporative fluid loss.

b

26. The nurse knows to monitor sodium and potassium levels (drug is hypotonic) when a burn patient is being treated with: a. Silvadene. b. silver nitrate 0.5%. c. Sulfamylon. d. all of the above

b

27. After an occlusive dressing is applied to a burned foot, the foot should be placed in the position of: a. adduction. b. dorsiflexion. c. external rotation. d. plantar flexion.

b

30. The recommended route for administration of low-dose narcotics is: a. intramuscular. b. intravenous. c. oral. d. subcutaneous.

b

32. Early indicators of late-stage septic shock include all of the following except: a. decreased pulse pressure. b. a full, bounding pulse. c. pale, cool skin. d. renal failure.

b

7. Plasma leakage produces edema, which increases: a. circulating blood volume. b. the hematocrit level. c. systolic blood pressure. d. all of the above.

b

8. The leading cause of death in fire victims is believed to be: a. cardiac arrest. b. carbon monoxide intoxication. c. hypovolemic shock. d. septicemia.

b

10. A child tips a pot of boiling water onto his bare legs. The mother should: a. avoid touching the burned skin, and take the child to the nearest emergency department. b. cover the child's legs with ice cubes secured with a towel. c. immerse the child's legs in cool water. d. liberally apply butter or shortening to the burned area.

c

18. Fluid and electrolyte changes in the emergent phase of burn injury include all of the following except: a. base-bicarbonate deficit. b. elevated hematocrit level. c. potassium deficit.

c

21. During the fluid remobilization phase, the nurse knows to expect all of the following except: a. hemodilution. b. increased urinary output. c. metabolic alkalosis. d. sodium deficit.

c

24. Leukopenia within 48 hours is a side effect associated with the topical antibacterial agent: a. cerium nitrate solution. b. gentamicin sulfate. c. sulfadiazine, silver (Silvadene). d. mafenide (Sulfamylon).

c

25. The nurse knows that the topical antibacterial agent that does not penetrate eschar is: a. Acticoat. b. mafenide acetate. c. silver nitrate 0.5%. d. silver sulfadiazine 1%.

c

28. Biologic dressings that use skin from living or recently deceased humans are known as: a. autografts. b. heterografts. c. homografts. d. xenografts.

c

29. The nurse knows that the physician will most likely prescribe the analgesic of choice for treatment of acute burn pain which is: a. Demerol. b. Fentanyl. c. morphine sulfate. d. OxyContin.

c

4. As fluid is reabsorbed after injury, renal function maintains a diuresis for up to: a. 3 days. b. 1 week. c. 2 weeks. d. 1 month.

c

5. Fluid shifts during the first week of the acute phase of a burn injury that cause massive cell destruction result in: a. hypernatremia. b. hypokalemia. c. hyperkalemia. d. hypercalcemia.

c

9. A serious gastrointestinal disturbance that frequently occurs with a major burn is: a. diverticulitis. b. hematemesis. c. paralytic ileus. d. ulcerative colitis.

c

31. To meet his early nutritional demands for protein, a 198-lb (90-kg) burned patient will need to ingest a minimum of how much of protein every 24 hours? a. 90 g/day. b. 110 g/day. c. 180 g/day. d. 270 g/day.

c (minimum protein requirement should be 2 g/kg)

16. The resuscitation formula for replacing fluid lost during the first 24 to 48 hours recommends the administration of: a. colloids. b. electrolytes. c. crystalloids. d. all of the above.

d

19. During the acute phase of burn injury, the nurse knows to assess for signs of potassium shifting: a. within 24 hours. b. between 24 and 48 hours. c. at the beginning of the third day. d. beginning on day 4 or day 5.

d

3. Plasma seeps out into surrounding tissues after a burn. The greatest amount of fluid leaks out in: a. the first 2 hours. b. 4 to 8 hours. c. 12 hours. d. 24 to 36 hours.

d

6. An unexpected laboratory value during the fluid remobilization phase of a major burn is a: a. hematocrit level of 45%. b. a pH of 7.20; PaO2 of 38 mm Hg; and bicarbonate level of 15 mEq/L. c. serum potassium level of 3.2 mEq/L. d. serum sodium level of 140 mEq/L.

d