Chp. 24: Burns
Which type of burn injury would cause myoglobinuria, long bone fractures, and cardiac dysrhythmias and/or cardiac arrest? A) Thermal B) Electrical C) Chemical D) Smoke and inhalation
B) Electrical
Using the Lund-Browder Chart, estimate the percent of body surface area burned of a man who has partial thickness burns on his entire left arm including the upper and lower arm and the hand and his neck? A) 11% B) 9.5% C) 18% D) 7%
A) 11%
Priority Decision: Number the following actions in the order they should be done in the emergency management of a burn of any type, beginning with number 1 for the first action? ______ A) Establish and maintain an airway ______ B) Assess for other associated injuries ______ C) Establish an IV line with a large-gauge needle ______ D) Remove the patient from the burn source and stop the burning process
A) 2; B) 4; C) 3; D) 1 The first intervention in emergency management of a burn injury is to remove the burn source and stop the burning process. Airway maintenance would be second, then establishing IV access, followed by assessing for other injuries.
A patient has just been admitted with a 40% total body surface area (TBSA) burn injury. To maintain adequate nutrition, the nurse should plan to take which action? A) Insert a feeding tube and initiate enteral feedings B) Infuse total parenteral nutrition via a central catheter C) Encourage an oral intake of at least 5000 kcal per day D) Administer multiple vitamins and minerals in the IV solution
A) Insert a feeding tube and initiate enteral feedings
During the emergent phase of burns, the nurse would anticipate that narcotic analgesics will be given to the patient? A) Intravenously B) Intramuscularly C) Orally D) Subcutaneously
A) Intravenously
A patient has just arrived in the emergency department after an electrical burn from exposure to a high-voltage current. What is the priority nursing assessment? A) Oral temperature B) Peripheral pulses C) Extremity movement D) Pupil reaction to light
C) Extremity movement
How is the immune system altered in a burn injury? A) Bone marrow stimulation B) Increase in immunoglobulin levels C) Impaired function of white blood cells (WBCs) D) Overwhelmed by microorganisms entering denuded tissue
C) Impaired function of white blood cells (WBCs)
On admission to the burn unit, a patient with an approximate 25% total body surface area (TBSA) burn has the following initial laboratory results: Hct 58%, Hgb 18.2 mg/dL (172 g/L), serum K+ 4.9 mEq/L (4.8 mmol/L), and serum Na+ 135 mEq/L (135 mmol/L). Which action will the nurse anticipate taking now? A) Monitor urine output every 4 hours B) Continue to monitor the laboratory results C) Increase the rate of the ordered IV solution D) Type and crossmatch for a blood transfusion
C) Increase the rate of the ordered IV solution
The nurse initially suspects the possibility of sepsis in the burn patient based on what changes? A) Vital signs B) Urinary output C) Gastrointestinal function D) Burn wound appearance
A) Vital signs
Identify one major complication of burns that is believed to be stress related that may occur in each of the following systems during the acute burn phase: 1) Neurologic 2) Gastrointestinal 3) Endocrine
1) Confusion or delirium 2) Curling's (stress) ulcer 3) Hyperglycemia
During the emergent phase of burn care, which assessment will be most useful in determining whether the patient is receiving adequate fluid infusion? A) Check skin turgor B) Monitor daily weight C) Assess mucous membranes D) Measure hourly urine output
D) Measure hourly urine output
Priority Decision: The nurse has received the change-of-shift report on his group of patients. Indicate the priority order in which the nurse should see these patients: ________ A) A 40-year-old female who is returning from the postanesthesia care unit (PACU) following surgical debridement of her back and legs ________ B) A 76-year-old male with partial-thickness burns of his arms and abdomen who is complaining of severe pain ________ C) A 62-year-old female who was just admitted following partial-thickness burns to her anterior chest, face, and neck ________ D) An 18-year-old male with full-thickness burns of his lower extremities who is refusing to go for his scheduled dressing change
A) 3 B) 2 C) 1 D) 4
A patient has the following mixed deep partial-thickness and full-thickness burn injuries: face, anterior neck, right anterior trunk, and anterior surfaces of the right arm and lower leg? A) According to the Lund-Browder chart, what is the extent of the patient's burns? ______% total body surface area (TBSA) B) According to the rule of nines chart, what is the extent of the patient's burns? ______% TBSA C) Is it possible to determine the actual extent and depth of burn injury during the emergent phase of the burn? Why or why not?
A) 3½ + 1 + 6½ + 2 + 1½ + 3½ = 18% TBSA B) 4½ + 9 + 4½ + 4½ = 22½% TBSA C) No, because edema and inflammation obscure the demarcation of zones of injury
Which patient is most appropriate for the burn unit charge nurse to assign to a registered nurse (RN) who has floated from the hospital medical unit? A) A 34-year-old patient who has a weight loss of 15% from admission and requires enteral feedings B) A 67-year-old patient who has blebs under an autograft on the thigh and has an order for bleb aspiration C) A 46-year-old patient who has just come back to the unit after having a cultured epithelial autograft to the chest D) A 65-year-old patient who has twice-daily burn debridements and dressing changes to partial-thickness facial burns
A) A 34-year-old patient who has a weight loss of 15% from admission and requires enteral feedings
Which patient should the nurse assess first? A) A patient with smoke inhalation who has wheezes and altered mental status B) A patient with full-thickness leg burns who has a dressing change scheduled C) A patient with abdominal burns who is complaining of level 8 (0 to 10 scale) pain D) A patient with 40% total body surface area (TBSA) burns who is receiving IV fluids at 500 mL/hour
A) A patient with smoke inhalation who has wheezes and altered mental status
A patient arrives in the emergency department with facial and chest burns caused by a house fire. Which action should the nurse take first? A) Auscultate the patient's lung sounds B) Determine the extent and depth of the burns C) Infuse the ordered lactated Ringers solution D) Administer the ordered hydromorphone (Dilaudid)
A) Auscultate the patient's lung sounds
The nurse caring for a patient admitted with burns over 30% of the body surface assesses that urine output has dramatically increased. Which action by the nurse would best ensure adequate kidney function? A) Continue to monitor the urine output B) Monitor for increased white blood cells (WBCs) C) Assess that blisters and edema have subsided D) Prepare the patient for discharge from the burn unit
A) Continue to monitor the urine output
Complete the following sentences A) A permanent skin graft that may be available for the patient with large body surface area burns who has limited skin for donor harvesting is ________ B) Early excision and grafting of burn wounds involve excising down to clean viable tissue and applying an whenever possible ________ C) Blebs can be removed from skin grafts by ________
A) Cultured epithelial autograft B) Eschar (or necrotic tissue); autograft C) Aspirating the fluid with a tuberculosis syringe, performed by individuals instructed in this skill
A patient spilled industrial acids on his arms and legs at work. Which is the priority action that the occupational health nurse at the facility should take? A) Flush the burned area with large amounts of tap water B) Place cool compresses on the area of exposure C) Cover the affected area with dry, sterile dressings D) Apply an alkaline solution to the affected area
A) Flush the burned area with large amounts of tap water
A patient with deep partial-thickness burns over 45% of his trunk and legs is going for debridement in the cart shower 48 hours post burn. What is the drug of choice to control the patient's pain during this activity? A) IV morphine B) Midazolam (Versed) C) IM meperidine (Demerol) D) Long-acting oral morphine
A) IV morphine
What is the initial cause of hypovolemia during the emergent phase of burn injury? A) Increased capillary permeability B) Loss of sodium to the interstitium C) Decreased vascular oncotic pressure D) Fluid loss from denuded skin surfaces
A) Increased capillary permeability
When assessing a patient's full-thickness burn injury during the emergent phase, what would the nurse expect to find? A) Leathery, dry, hard skin B) Red, fluid-filled vesicles C) Massive edema at the injury site D) Serous exudate on a shiny, dark brown wound
A) Leathery, dry, hard skin
The burn patient has developed an increasing dread of painful dressing changes. What would be the most appropriate treatment to ask the health care provider to prescribe? A) Midazolam (Versed) to be used with morphine before dressing changes B) Morphine in a dosage range so that more may be given before dressing changes C) Buprenorphine (Buprenex) to be administered with morphine before dressing changes D) Patient-controlled analgesia so that the patient may have control of analgesic administration
A) Midazolam (Versed) to be used with morphine before dressing changes
A patient with circumferential burns of both legs develops a decrease in dorsalis pedis pulse strength and numbness in the toes. Which action should the nurse take? A) Notify the health care provider B) Monitor the pulses every 2 hours C) Elevate both legs above heart level with pillows D) Encourage the patient to flex and extend the toes on both feet
A) Notify the health care provider
During the rehabilitation phase of a burn injury, what can control the contour of the scarring? A) Pressure garments B) Avoidance of sunlight C) Splinting joints in extension D) Application of emollient lotions
A) Pressure garments
An employee spills industrial acids on both arms and legs at work. What is the priority action that the occupational health nurse at the facility should take? A) Remove nonadherent clothing and watch B) Apply an alkaline solution to the affected area C) Place cool compresses on the area of exposure D) Cover the affected area with dry, sterile dressings
A) Remove nonadherent clothing and watch
The charge nurse observes the following actions being taken by a new nurse on the burn unit. Which action by the new nurse would require an intervention by the charge nurse? A) The new nurse uses clean latex gloves when applying antibacterial cream to a burn wound B) The new nurse obtains burn cultures when the patient has a temperature of 95.2 F (35.1 C) C) The new nurse administers PRN fentanyl (Sublimaze) IV to a patient 5 minutes before a dressing change D) The new nurse calls the health care provider for a possible insulin order when a nondiabetic patients serum glucose is elevated
A) The new nurse uses clean latex gloves when applying antibacterial cream to a burn wound
During the early emergent phase of burn injury, the patient's laboratory results would most likely include? A) ↑ Hct, ↓ serum albumin, ↓ serum Na, ↑ serum K B) ↓ Hct, ↓ serum albumin, ↓ serum Na, ↓ serum K C) ↓ Hct, ↑ serum albumin, ↑ serum Na, ↑ serum K D) ↑ Hct, ↑ serum albumin, ↓ serum Na, ↓ serum K
A) ↑ Hct, ↓ serum albumin, ↓ serum Na, ↑ serum K
A young adult patient who is in the rehabilitation phase 6 months after a severe face and neck burn tells the nurse, "I'm sorry that Im still alive. My life will never be normal again." Which response by the nurse is best? A) "Most people recover after a burn and feel satisfied with their lives." B) "It's true that your life may be different. What concerns you the most?" C) "It is really too early to know how much your life will be changed by the burn." D) "Why do you feel that way? You will be able to adapt as your recovery progresses"
B) "It's true that your life may be different. What concerns you the most?"
Of the following burn patients, which one presents with the most worrisome clinical scenario that could be consistent with carbon monoxide poisoning? A) A women who splattered hot oil to her face when she was cooking over a gas stove at home B) An unconscious factory worker who was rescued from a closed office space C) A conscious farmer who was rescued from a burning barn and who has singed nasal hairs D) A firefighter who was wearing appropriate protective gear while fighting a blaze but is now presenting to the emergency room with some scattered expiratory wheezes
B) An unconscious factory worker who was rescued from a closed office space
A nurse is caring for a patient who has burns of the ears, head, neck, and right arm and hand. The nurse should place the patient in which position? A) Place the right arm and hand flexed in a position of comfort B) Elevate the right arm and hand on pillows and extend the fingers C) Assist the patient to a supine position with a small pillow under the head D) Position the patient in a side-lying position with rolled towel under the neck
B) Elevate the right arm and hand on pillows and extend the fingers
he patient was admitted to the burn center with a full-thickness burn 42 hours after the thermal burn occurred. The nurse will apply actions related to which phase of burn management for this patient's care? A) Acute B) Emergent C) Postacute D) Rehabilitative
B) Emergent
When assessing a patient who spilled hot oil on the right leg and foot, the nurse notes that the skin is dry, pale, hard skin. The patient states that the burn is not painful. What term would the nurse use to document the burn depth? A) First-degree skin destruction B) Full-thickness skin destruction C) Deep partial-thickness skin destruction D) Superficial partial-thickness skin destruction
B) Full-thickness skin destruction
The nurse assesses that bowel sounds are absent and abdominal distention is present in a patient 12 hours post burn. The nurse notifies the health care provider and anticipates doing what action? A) Withhold all oral intake except water B) Insert a nasogastric tube for decompression C) Administer a H2-histamine blocker such as ranitidine (Zantac) D) Administer nutritional supplements through a feeding tube placed in the duodenum
B) Insert a nasogastric tube for decompression
A patient is admitted to the burn unit with burns to the head, face, and hands. Initially, wheezes are heard, but an hour later, the lung sounds are decreased and no wheezes are audible. What is the best action for the nurse to take? A) Encourage the patient to cough and auscultate the lungs again. B) Notify the health care provider and prepare for endotracheal intubation C) Document the results and continue to monitor the patients respiratory rate D) Reposition the patient in high-Fowlers position and reassess breath sounds
B) Notify the health care provider and prepare for endotracheal intubation
Priority Decision: A burn patient has a nursing diagnosis of impaired physical mobility due to a limited range of motion (ROM) resulting from pain. What is an appropriate nursing intervention for this patient? A) Have the patient perform ROM exercises when pain is not present B) Provide analgesic medications before physical activity and exercise C) Teach the patient the importance of exercise to prevent contractures D) Arrange for the physical therapist to encourage exercise during hydrotherapy
B) Provide analgesic medications before physical activity and exercise
What is one clinical manifestation the nurse would expect to find during the emergent phase in a patient with a full-thickness burn over the lower half of the body? A) Fever B) Shivering C) Severe pain D) Unconsciousness
B) Shivering
Which nursing action is a priority for a patient who has suffered a burn injury while working on an electrical power line? A) Obtain the blood pressure B) Stabilize the cervical spine C) Assess for the contact points D) Check alertness and orientation
B) Stabilize the cervical spine
The nurse is administering IV fluids to a patient with superficial partial-thickness burn injuries to the back and legs. Which of the following would provide the most reliable indicator of adequacy of fluid resuscitation? A) Blood pressure of 90/60 B) Urine output of 1 mL/kg/hr C) Alert and oriented to person, place, and time D) Peripheral pulses bounding in all 4 extremities
B) Urine output of 1 mL/kg/hr
A patient's deep partial-thickness burns are treated with the open method. What should the nurse do when caring for the patient? A) Ensure that sterile water is used in the debridement tank B) Wear a cap, mask, gown, and gloves during patient contact C) Use sterile gloves to remove the dressings and wash the wounds D) Apply topical antimicrobial ointment with clean gloves to prevent wound trauma
B) Wear a cap, mask, gown, and gloves during patient contact
While the patients full thickness burn wounds to the face are exposed, what is the best nursing action to prevent cross contamination? A) Use sterile gloves when removing old dressings B) Wear gowns, caps, masks, and gloves during all care of the patient C) Administer IV antibiotics to prevent bacterial colonization of wounds D) Turn the room temperature up to at least 70 F (20 C) during dressing changes
B) Wear gowns, caps, masks, and gloves during all care of the patient
Identify the factors that increase nutritional needs of the patient during the emergent and acute phases of burn injury (select all that apply)? A) Electrolyte imbalance B) Core temperature elevation C) Calories and protein are used for tissue repair D) Hypometabolic state secondary to decreased gastrointestinal (GI) function E) Massive catabolism characterized by protein breakdown and increased gluconeogenesis
B, C, E
The nurse administers IV cimetidine, an H2 histamine blocking agent, to the burned patient during the emergent phase. When the patient's family asks why this drug is being given, what is the nurse's best response? A) "To increase the urine output and prevent kidney damage." B) "To stimulate intestinal movement and prevent abdominal bloating." C) "To decrease hydrochloric acid production in the stomach and prevent ulcers." D) "To inhibit loss of fluid from the circulatory system and prevent heart failure."
C) "To decrease hydrochloric acid production in the stomach and prevent ulcers."
A patient with severe burns has crystalloid fluid replacement ordered using the Parkland formula. The initial volume of fluid to be administered in the first 24 hours is 30,000 mL. The initial rate of administration is 1875 mL/hr. After the first 8 hours, what rate should the nurse infuse the IV fluids? A) 350 mL/hour B) 523 mL/hour C) 938 mL/hour D) 1250 mL/hour
C) 938 mL/hour
At the end of the emergent phase and the initial acute phase of burn injury, a patient has a serum sodium level of 152 mEq/L (152 mmol/L) and a serum potassium level of 2.8 mEq/L (2.8 mmol/L). What could have caused these imbalances? A) Free oral water intake B) Prolonged hydrotherapy C) Mobilization of fluid and electrolytes in the acute phase D) Excessive fluid replacement with dextrose in water without potassium supplementation
C) Mobilization of fluid and electrolytes in the acute phase
A patient with extensive electrical burn injuries is admitted to the emergency department. Which prescribed intervention should the nurse implement first? A) Assess oral temperature B) Check a potassium level C) Place on cardiac monitor D) Assess for pain at contact points
C) Place on cardiac monitor
During the acute phase of a burn injury, which of the following is a priority nursing diagnosis for the patient with 9% full-thickness burn to the left leg? A) Pain, Acute B) Potential for ineffective gas exchange C) Potential for infection D) Fluid volume deficit
C) Potential for infection
The nurse is reviewing laboratory results on a patient who had a large burn 48 hours ago. Which result requires priority action by the nurse? A) Hematocrit 53% B) Serum sodium 147 mEq/L C) Serum potassium 6.1 mEq/L D) Blood urea nitrogen 37 mg/dL
C) Serum potassium 6.1 mEq/L
A 24-year-old female patient does not want the wound cleansing and dressing change to take place. She states, "What difference will it make anyway?" What will the nurse encourage the patient to do? A) Have the wound cleaned and the dressing changed B) Have a snack before having the treatments completed C) Talk about what is troubling her with the nurse and/or her family D) Call the chaplain to come and talk to her and convince her to have the care
C) Talk about what is troubling her with the nurse and/or her family
Which burn patient should have nasotracheal or endotracheal intubation? A) Carbon monoxide poisoning B) Electrical burns causing cardiac dysrhythmias C) Thermal burn injuries to the face, neck, or airway D) Respiratory distress from eschar formation around the chest
C) Thermal burn injuries to the face, neck, or airway
A patient with burns covering 40% total body surface area (TBSA) is in the acute phase of burn treatment. Which snack would be best for the nurse to offer to this patient? A) Bananas B) Orange gelatin C) Vanilla milkshake D) Whole grain bagel
C) Vanilla milkshake
How should the nurse position the patient with ear, face, and neck burns? A) Prone B) On the side C) Without pillows D) With extra padding around the head
C) Without pillows
Which action will the nurse include in the plan of care for a patient in the rehabilitation phase after a burn injury to the right arm and chest? A) Keep the right arm in a position of comfort B) Avoid the use of sustained-release narcotics C) Teach about the purpose of tetanus immunization D) Apply water-based cream to burned areas frequently
D) Apply water-based cream to burned areas frequently
A young adult patient who is in the rehabilitation phase after having deep partial-thickness face and neck burns has a nursing diagnosis of disturbed body image. Which statement by the patient indicates that the problem is resolving? A) "I'm glad the scars are only temporary." B) "I will avoid using a pillow, so my neck will be OK." C) "I bet my boyfriend wont even want to look at me anymore." D) "Do you think dark beige makeup foundation would cover this scar on my cheek?"
D) "Do you think dark beige makeup foundation would cover this scar on my cheek?"
The nurse is reviewing the medication administration record (MAR) on a patient with partial-thickness burns. Which medication is best for the nurse to administer before scheduled wound debridement? A) Ketorolac (Toradol) B) Lorazepam (Ativan) c) Gabapentin (Neurontin) D) Hydromorphone (Dilaudid)
D) Hydromorphone (Dilaudid)
A patient who was found unconscious in a burning house is brought to the emergency department by ambulance. The nurse notes that the patients skin color is bright red. Which action should the nurse take first? A) Insert two large-bore IV lines B) Check the patients orientation C) Assess for singed nasal hair and dark oral mucous membranes D) Place the patient on 100% oxygen using a non-rebreather mask
D) Place the patient on 100% oxygen using a non-rebreather mask
A patient has a 20% TBSA deep partial-thickness and full-thickness burn to the right anterior chest and entire right arm. What is important for a nurse to assess in this patient? A) Presence of pain B) Swelling of the arm C) Formation of eschar D) Presence of pulses in the arms
D) Presence of pulses in the arms
Esomeprazole (Nexium) is prescribed for a patient who incurred extensive burn injuries 5 days ago. Which nursing assessment would best evaluate the effectiveness of the medication? A) Bowel sounds B) Stool frequency C) Abdominal distention D) Stools for occult blood
D) Stools for occult blood
Eight hours after a thermal burn covering 50% of a patients total body surface area (TBSA) the nurse assesses the patient. Which information would be a priority to communicate to the health care provider? A) Blood pressure is 95/48 per arterial line B) Serous exudate is leaking from the burns C) Cardiac monitor shows a pulse rate of 108 D) Urine output is 20 mL per hour for the past 2 hours
D) Urine output is 20 mL per hour for the past 2 hours
A patient who has burns on the arms, legs, and chest from a house fire has become agitated and restless 8 hours after being admitted to the hospital. Which action should the nurse take first? A) Stay at the bedside and reassure the patient B) Administer the ordered morphine sulfate IV C) Assess orientation and level of consciousness D) Use pulse oximetry to check the oxygen saturation
D) Use pulse oximetry to check the oxygen saturation
Which characteristics are true about chemical burns (select all that apply)? A) Metabolic asphyxiation may occur B) Metabolic acidosis occurs immediately following the burn C) The visible skin injury often does not represent the full extent of tissue damage D) Lavaging with large amounts of water is important to stop the burning process with these injuries E) Alkaline substances that cause these burns continue to cause tissue damage even after being neutralized
D, E
In which order will the nurse take these actions when doing a dressing change for a partial-thickness burn wound on a patient's chest? A) Apply sterile gauze dressing B) Document wound appearance C) Apply silver sulfadiazine cream D) Administer IV fentanyl (Sublimaze) E) Clean wound with saline-soaked gauze
D, E, C, A, B
A patient is admitted to the emergency department at 10:15 pm following a flame burn at 9:30 pm. The patient has 40% TBSA deep partial-thickness and full-thickness burns and weighs 132 lb. A) According to the Parkland formula, the type of fluid prescribed for the patient would be ________ and the total amount to be administered during the first 24 hours would be ________ mL B) The schedule for the fluid administration would be mL between and ________ (time), ________ mL between ________ and ________, and ________ mL between ________ and ________ C) Colloidal solutions are given in the second 24 hours. Based on the patient's body weight, what amount of these solutions will be given during this time? D) The adequacy of the patient's fluid replacement is determined by ________ and ________
To calculate fluid replacement, the patient's weight in pounds must be converted to kilograms: 132 lb = 60 kg A) Lactated Ringer's solution; 4 mL × 60 × 40 = 9600 mL B) 4800 mL between 10:15 pm and 5:30 am; 2400 mL between 5:30 am and 1:30 pm; 2400 mL between 1:30 pm and 9:30 pm C) 720-1200 mL (0.3-0.5 mL/kg/%/TBSA or 0.3 or 0.5 mL × 60 × 40) D) Urine output (0.5 to 1 mL/kg/hr = 30-50 mL/hr) and vital signs (systolic BP 90, HR <120 bpm, RR 16-20)