PPP Test #2 Lewis - Chapter 24 Burns
Exam Questions with Correct Answers
A patient who was found unconscious in a burning house is brought to the emergency
department by ambulance. The nurse notes that the patient's skin color is bright red.
Which action should the nurse take first?
a. Insert two large-bore IV lines.
b. Check the patient's orientation.
c. Assess for singed nasal hair and dark oral mucous membranes.
d. Place the patient on 100% oxygen using a non-rebreather mask. - Answer-ANS: D
The patient's history and skin color suggest carbon monoxide poisoning, which should
be treated by rapidly starting oxygen at 100%.
SHORT ANSWER
An 80-kg patient with burns over 30% of total body surface area (TBSA) is admitted to
the burn unit. Using the Parkland formula of 4 mL/kg/%TBSA, what is the IV infusion
rate (mL/hour) for lactated Ringer's solution that the nurse will administer during the first
8 hours? - Answer-ANS:
600 mL
The Parkland formula states that patients should receive 4 mL/kg/%TBSA burned
during the first 24 hours. Half of the total volume is given in the first 8 hours and then
the last half is given over 16 hours: 4 × 80 × 30 = 9600 mL total volume; 9600/2 = 4800
mL in the first 8 hours; 4800 mL/8 hr = 600 mL/hr.
The nurse estimates the extent of a burn using the rule of nines for a patient who has
been admitted with deep partial-thickness burns of the anterior trunk and the entire left
arm. What percentage of the patient's total body surface area (TBSA) has been injured?
- Answer-ANS: 27%
When using the rule of nines, the anterior trunk is considered to cover 18% of the
patient's body and each arm is 9%.
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? (Put a comma and a space between
each answer choice [A, B, C, D, E].)
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. - Answer-ANS:
D, E, C, A, B
Because partial-thickness burns are very painful, the nurse's first action should be to
administer pain medications. The wound will then be cleaned, antibacterial cream
applied, and covered with a new sterile dressing. The last action should be to document
the appearance of the wound.
,A patient is brought to the emergency department from the site of a chemical fire, where
he suffered a burn that involves the epidermis, dermis, and the muscle and bone of the
right arm. On inspection, the skin appears charred. Based on these assessment
findings, what is the depth of the burn on the patient's arm?
A) Superficial partial-thickness
B) Deep partial-thickness
C) Full partial-thickness
D) Full-thickness - Answer-Ans: D
Feedback:
A full-thickness burn involves total destruction of the epidermis and dermis and, in
some cases, underlying tissue as well. Wound color ranges widely from white to red,
brown, or black. The burned area is painless because the nerve fibers are destroyed.
The wound can appear leathery; hair follicles and sweat glands are destroyed. Edema
may also be present.
The current phase of a patient's treatment for a burn injury prioritizes wound care,
nutritional support, and prevention of complications such as infection. Based on these
care priorities, the patient is in what phase of burn care?
A) Emergent
B) Immediate resuscitative
C) Acute
D) Rehabilitation - Answer-Ans: C
Feedback:
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.
A patient in the emergent/resuscitative phase of a burn injury has had blood work and
arterial blood gases drawn. Upon analysis of the patient's laboratory studies, the nurse
will expect the results to indicate what?
A) Hyperkalemia, hyponatremia, elevated hematocrit, and metabolic acidosis
B) Hypokalemia, hypernatremia, decreased hematocrit, and metabolic acidosis
C) Hyperkalemia, hypernatremia, decreased hematocrit, and metabolic alkalosis
D) Hypokalemia, hyponatremia, elevated hematocrit, and metabolic alkalosis - Answer-
Ans: A
Feedback:
Fluid and electrolyte changes in the emergent/resuscitative phase of a burn injury
include hyperkalemia related to the release of potassium into the extracellular fluid,
hyponatremia from large amounts of sodium lost in trapped edema fluid,
hemoconcentration that leads to an increased hematocrit, and loss of bicarbonate ions
that results in metabolic acidosis.
,A patient has experienced an electrical burn and has developed thick eschar over the
burn site. 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 - Answer-Ans: B
Feedback:
Mafenide acetate 10% hydrophilic-based cream is the agent of choice when there is a
need to penetrate thick eschar. Silver products do not penetrate eschar; Acticoat is a
type of silver dressing.
An occupational health nurse is called to the floor of a factory where a worker has
sustained a flash burn to the right arm. The nurse arrives and the flames have been
extinguished. The next step is to ìcool the burn.î How should the nurse cool the burn?
A) Apply ice to the site of the burn for 5 to 10 minutes.
B) Wrap the patient's affected extremity in ice until help arrives.
C) Apply an oil-based substance or butter to the burned area until help arrives.
D) Wrap cool towels around the affected extremity intermittently. - Answer-Ans: D
Feedback:
Once the burn has been sustained, the application of cool water is the best first-aid
measure. Soaking the burn area intermittently in cool water or applying cool towels
gives immediate and striking relief from pain, and limits local tissue edema and damage.
An emergency department nurse has just admitted a patient with a burn. What
characteristic of the burn will primarily determine whether the patient experiences a
systemic response to this injury?
A) The length of time since the burn
B) The location of burned skin surfaces
C) The source of the burn
D) The total body surface area (TBSA) affected by the burn - Answer-Ans: D
Feedback:
Systemic effects are a result of several variables. However, TBSA and wound severity
are considered the major factors that affect the presence or absence of systemic
effects.
A nurse on a burn unit is caring for a patient in the acute phase of burn care. While
performing an assessment during this phase of burn care, the nurse recognizes that
airway obstruction related to upper airway edema may occur up to how long after the
burn injury?
A) 2 days
B) 3 days
C) 5 days
D) 1 week - Answer-Ans: A
Feedback:
, Airway obstruction caused by upper airway edema can take as long as 48 hours to
develop. Changes detected by x-ray and arterial blood gases may occur as the effects
of resuscitative fluid and the chemical reaction of smoke ingredients with lung tissues
become apparent.
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 best 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 - Answer-Ans: A
Feedback:
If the intestinal mucosa receives some type of protection against permeability change,
infection could be avoided. Early enteral feeding is one step to help avoid this increased
intestinal permeability and prevent early endotoxin translocation.
A patient has been admitted to a burn intensive care unit with extensive full-thickness
burns over 25% of the body. After ensuring cardiopulmonary stability, what would be the
nurse's immediate, priority concern when planning this patient's care?
A) Fluid status
B) Risk of infection
C) Nutritional status
D) Psychosocial coping - Answer-Ans: A
Feedback:
During the early phase of burn care, the nurse is most concerned with fluid
resuscitation, to correct large-volume fluid loss through the damaged skin.
The nurse is preparing the patient for mechanical dÈbridement and informs the patient
that this will involve which of the following procedures?
A) A spontaneous separation of dead tissue from the viable tissue
B) Removal of eschar until the point of pain and bleeding occurs
C) Shaving of burned skin layers until bleeding, viable tissue is revealed
D) Early closure of the wound - Answer-Ans: B
Feedback:
Mechanical dÈbridementcan be achieved through the use of surgical scissors, scalpels,
or forceps to remove the eschar until the point of pain and bleeding occurs. Mechanical
dÈbridement can also be accomplished through the use of topical enzymatic
dÈbridement agents.
A patient with a partial-thickness burn injury had Biobrane applied 2 weeks ago. The
nurse notices that the Biobrane is separating from the burn wound. What is the nurse's
most appropriate intervention?
A) Reinforce the Biobrane dressing with another piece of Biobrane.
B) Remove the Biobrane dressing and apply a new dressing.
