Burns Practice Questions

A patient has been admitted to a burn intensive care unit with extensive full-thickness burns over 25% of the body. What would be the nurse's priority concern about this patient? A) Fluid status B) Risk of infection C) Body image D) Level of pain

A

A nurse in the ED is caring for a client who has experienced an electrical burn. Which of the following nursing interventions is most important in this situation? A. Brush off dirt particles & debris B. Monitor for cardiac arrhythmias C. Cool the client with water D. Lower the clients head

B

The client has experienced an electrical injury of the lower extremities. Which are the priority assessment data to obtain from this client? A. Current ROM in all extremities B. HR & rhythm C. Resp. rate & pulse ox D. Orientation to time, place, person

B Dysrhythmias can happen from electrical burns

A nurse begins the workday with reports on several clients. Which of the following clients should the nurse assess first? A. a post appendectomy client with bleeding B. A client with severe pain 8/10 after hip replacement surgery C. A client after an inhalation of toxic chemical fumes at work who has voice changes & noisy stridor when breathing with increased effort D. A client with deep vein thrombosis who complains of increased swelling while on anticoagulants

C

A nurse is caring for a client who has sustained full-thickness burns on the arms, face, neck, & shoulders and is in the resuscitation phase. The nurse notes that the client's voice has become hoarse with a brassy cough & drooling. The nurse should identify these findings as indication that the client has which of the following? A. Pulmonary edema B. Bacterial pneumonia C. Inhalation injury D. Carbon monoxide poisoning

C

The nursing students are doing clinical hours on the burn unit. A nurse is developing a care plan for a patient with a partial-thickness burn, and determines that an appropriate goal is to maintain position of joints in alignment. A nursing student asks why this goal is important when the patient is fighting for his life. What should the burn nurse respond? A) To prevent neuropathies B) To prevent wound breakdown C) To prevent contractures D) To prevent heterotopic ossification

C

The acute phase of the burn begins 48 to 72 hours after the burn. What begins at this time? A) Cardiac output decreases B) Renal failure begins C) Diuresis D) Fluid moves from intravascular compartment to interstitial spaces

C As capillaries regain integrity, 48 or more hours after the burn, fluid moves from the interstitial to the intravascular compartment and diuresis begins. Cardiac output should increase and renal output should increase

A nurse is caring for a client who has a 3rd degree burn. Which of the following would the nurse expect to find when assessing the burn? Select all that apply A. Pain B. Erythema C. Edema D. Eschar E. Fluid-filled vesicles

C, D Third degree findings include eschar, edema, & usually painless. Second degree = pain, erythema, oozing vesicles that rupture to expose shiny/wet subcutaneous tissue. 1st degree = erythema, edema, pain & blanching

A nurse is caring for a client who has admitted to the burn unit with burns over 35% of his body. For which of the following findings will the nurse monitor this client? Select all that apply A. Hyperkalemia B. Metabolic alkalosis C. Hypoglycemia D. Elevated hematocrit E. Hypernatremia

A, D A pt with extensive burns will usually have elevated K+, elevated hematocrit, & hyponatremia, metabolic acidosis & fever. Hyperglycemia occurs as a result of decreased insulin production & transport.

A nurse is caring for a client who is experiencing the second (acute) phase of burn recovery. Which of the following clinical findings would the nurse expect to be increased during this phase of recovery? A. Serum sodium B. Urinary output C. Hematocrit level D. Serum potassium

B As fluid returns to the vascular system, increased renal flow & diuresis occurs. Hematocrit level would decrease as a sign of recovery, not increase.

A nurse is caring for a client who presents a large blistered burn from hot water. The area is reddened & painful with mild edema. Which of the following depth classifications should the nurse use to document this burn? A. Superficial thickness B. Superficial partial thickness C. Deep partial thickness D. Full thickness

B

A nurse is caring for a client who was just admitted to the ED with severe burn injury. Which of the following orders would the nurse question for this client? A. Water B. Potassium C. Lactated ringers D. Plasma expanders

B

A nurse is caring for a client with extensive 2nd & 3rd degree burn injuries. Which of the following laboratory values should be reported immediately to the healthcare provider? A. Glucose of 200 B. K+ of 6.1 C. Hemoglobin of 19 D. Hematocrit of 55%

B

A nurse is caring for an adolescent who has superficial partial-thickness burn to the thigh. Which of the following actions should the nurse take? A. Prepare the adolescent for transport to burn facility B. Cleanse the affected area with tepid water C. Scrub the affected area using a soft-bristle brush D. Administer morphine sulfate

B Morphine sulfate is indicated for clients who have sustained moderate to major burns.

A nurse is caring for a client with 3rd degree burns over 15% of his body surface. Which of the following indicates adequate fluid replacement during the 1st 24 hours post-burn? A. Hematocrit level rising from 50 to 55 B. Slowing of a previously rapid HR C. Falling CVP readings D. Urinary output of 15 to 20 ml/hr

B Hematocrit level rising 50 to 55 would indicate low blood volume & hemo-concentration

A patient in the rehabilitation phase of the burn injury is setting goals with the nurse. What goals would be appropriate at this time? (Select all that apply.) A) Increased participation in activities of daily living B) Increased understanding of the planned follow-up care C) Increased control of treatment D) Adjustment to alterations in lifestyleE) Recognition of complications

A, B, D

A nurse is collecting data from a toddler who has major burns & suspected septic shock. Which of the following findings indicate the toddler is experiencing septic shock? Select all that apply. A. Increased body temp B. Altered sensorium C. Rapid cap refill D. Decreased urine output E. Chills

A, B, D, E Prolonged cap refill is a sign of septic shock.

A nurse is assessing a client who is in the resuscitation phase of a deep partial thickness burn over 40% of his body. Which of the following findings should the nurse expect during this phase of the burn injury. Select all that apply. A. Dyspnea B. Bradycardia C. Hyperkalemia D. Hyponatremia E. Decreased hematocrit

A, C, D Dyspnea b/c of direct or indirect airway injury. Hematocrit increases due to hemo-concentration as a result of fluid loss.

Nurse is administering silver sulfadiazine to an older adult client. Which of the following is true about this drug? Select all that apply. A. It causes black stains of the skin B. Its causes leukopenia C. It causes flushing & tingling sensation D. It forms sulfa crystals in the urine E. Sulfamylon is the brand name F. It interferes with liver function

B, D Silver sulfadiazine can elevate osmolarity & urine specific gravity of urine. It can cause leukopenia. Sulfa crystals are also formed. Concentrated urine & sulfa crystals can be corrected with large intake of fluids.

A guardian reports his child ingested kerosene. Which of the following assessments is the nurse's priority? A. RR B. Burns of the mouth C. Pain D. Sensorium

A Look for signs of respiratory distress with poison ingestion

A client is admitted after severe burn injury & is undergoing fluid resuscitation. Which of the following is the most accurate assessment of successful fluid resuscitation? A. Urine output of >30 ml/hr B. Weight gain of 1 kg in 8 hours with good cap refill C. HR of 94/min with blood pressure 95/55 D. Serum K+ level decrease from 5.8 to 5.2

A

A patient has sustained a severe burn injury and is thought to have an impaired intestinal mucosal barrier. Since this patient is considered at an increased risk for infection, what intervention will assist in avoiding increased intestinal permeability and prevent early endotoxin translocation? A) Early enteral feeding B) Administration of prophylactic antibiotics C) Bowel cleansing procedures D) Administration of stool softeners

A

Nurse is caring for a school age child who has a major burn & is experiencing severe pain. Which of the following actions should the nurse implement to manage this client's pain? A. Admin morphine sulfate IV via continuous infusion B. Admin meperidine IV around the clock prn C. Admin acetaminophen PO every 4 hr D. Admin hydrocode PO q 6 hour

A Opioids IV continuous infusion are recommended for pts who have major burns, regardless of age. Oral acetaminophen is recommended for clients who have minor burns.

A patient is admitted to the burn unit after being transported from a facility 1000 miles away. The patient has burns to the groin area and both legs. The burns to the lower legs are circumferential. The nurse knows to monitor closely for what as the edema in this patient increases? A) Ischemia B) Eschar C) Hyper-profusion to the burned area D) Increased fluid loss through the burned area

A As edema increases, pressure on small blood vessels and nerves in the distal extremities causes an obstruction of blood flow and consequent ischemia. This complication is similar to compartment syndrome.

Which client is most at risk for compartment syndrome due to a burn? A. A 25 year old with circumferential burn of the anterior & posterior left arm B. A 7 year old with a burn of the left & right ear C. A 54 year old with an electrical burn on the neck D. A 16 year old with a chemical burn to the right foot

A Circumferential burns of the extremities are more likely to cause compartment syndrome, because they produce a tourniquet-like effect, which can lead to vascular problems.

A burn patient is transitioning from the acute phase of the injury to the rehabilitation phase. The patient tells the nurse "I can't wait to have surgery to reconstruct my face so I look normal again." What would be the nurse's best response? A) "You know, nothing can be done until your scars mature. It is something the doctor will talk to you about in the first few years after discharge." B) "That is something for you to talk to your doctor about." C) "I know this is really important to you, but you have to realize that no one can make you look like you used to." D) "You will have most of these scars for the rest of your life."

A

A nurse is planning care for a client who is in the acute phase of recovery from major burn injuries. Which of the following interventions should the nurse include in the plan of care? Select all that apply. A. Limit visitors in the client's room B. Encourage raw vegetable in the client's diet C. Instruct the client to increase protein intake D. Instruct the client to consume a max of 2,000 calories per day E. Encourage the client to perform ROM exercises daily

A, C, E Limit visitors to decrease infection. Prevent infection by using aseptic technique when caring for wounds, avoid eating vegetables, provide assigned equipment & carefully monitor burns during dressing changes.

A 35-year-old male client was admitted due to severe burns around his right hip. Which position is most important to use to maintain the maximum function of this joint? A. Hip maintained in 30-degree flexion B. Hip at zero flexion with leg flat C. Knee flexed at 30-degree angle D. Leg abducted with a foam wedge

B Max function with hip & leg at full extension with neutral rotation

The patient you are caring for has an electrical burn and has developed thick eschar over the burn wound. Which of the following topical antibacterial agents will the nurse expect the physician to order for the wound? A) Silver sulfadiazine 1% (Silvadene) water-soluble cream B) Mafenide acetate 10% (Sulfamylon) hydrophilic-based cream C) Silver nitrate 0.5% aqueous solution D) Acticoat

B - Mafenide acetate is the agent of choice for electrical burns because of its ability to penetrate thick eschar

The nurse is admin mafenide acetate to a pt with burns. Which statements about this drug is correct? A. Effective for 1st degree burns B. Used to eradicate Pseudomonas aeruginosa C. Causes pain D. Contains sulfonamide E. The brand name is Silvadene F. Causes ototoxicity G. Is diffused gradually & slowly in the skin

B, C, D Mafenide acetate is administered to eradicate infectious agents such as Pseudomonas aeruginosa. Its applied as a topical cream for 2nd-3rd degree burns. It causes pain upon application & is rapidly diffused & absorbed systemically. It can cause renal failure & hypersensitivity in some pts. Monitor for hyperventilation & ABGs for metabolic acidosis.

A nurse is caring for a school age child who has severe burn. Which of the following actions should the nurse take? A. Initiate a high protein, low calorie diet B. Expose affected area to the air C. Establish an airway D. Implement contact precautions

C Severe burn patients should get high protein, high calorie diet. A dressing should be applied to the burned area to prevent infection. Reverse isolation precautions are recommended to prevent wound infections. Pt's with severe burns, pulmonary hygiene is importation to maintain adequate O2 & promote tissue healing. To promote pulmonary hygiene nurse should: maintain pt in semi-fowlers position, admin bronchodilators prn, use incentive spirometry/reposition/postural drainage, admin high flow humidified O2

The nurse is teaching a patient with a partial-thickness wound how to wear his elastic pressure garment. How would the nurse instruct the patient to wear this garment? A) 4 to 6 hours a day for 6 months B) Daily for 2 to 3 months after the injury C) Continuously D) At night while sleeping for a year after the injury

C (ie 23 hours)

The nursing instructor is going over burn injuries. The instructor tells the students that the nursing care priorities for a patient with a burn injury include wound care, nutritional support, and prevention of complications such as infection. Based upon these care priorities, the instructor is most likely discussing a patient in what phase of burn care? A) Emergent B) Immediate resuscitative C) Acute D) Rehabilitation

C - Acute phase The acute or intermediate phase of burn care follows the emergent/resuscitative phase and begins 48 to 72 hours after the burn injury. During this phase, attention is directed toward continued assessment and maintenance of respiratory and circulatory status, fluid and electrolyte balance, and gastrointestinal function. Infection prevention, burn wound care (ie, wound cleaning, topical antibacterial therapy, wound dressing, dressing changes, wound debridement, and wound grafting), pain management, and nutritional support are priorities at this stage and are discussed in detail in the following sections.

A client with major burns of the buttocks is scheduled for treatment with silver nitrate. Which statements about this drug are correct? Select all that apply. A. It is effective for more than 72 hours B. It causes hyperchloremia C. It causes cellular toxicity D. It does not stain dressing E. It improves visual inspection F. It causes hypertonicity G. It interacts with chloride ions

C, G It has limited penetrating ability & becomes ineffective if used for more than 72 hours. It causes hypochloremia, hypotonia (less tension, stiffness, muscle tone), hyponatremia & black stains. Due to black stains, visual inspection becomes ineffective.

A client is admitted with 2nd degree burns on face, neck, anterior chest, & hands. The nurse priority would be: A. Cover the burned area with sterile dressings B. Initiate intravenous fluid admin C. Administer pain medication as ordered D. Assess for dyspnea & stridor

D