NCLEX Style Practice Questions Burns, Med Surg - Burns NCLEX Review / Revised Questions and Answers / Sure A+
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NCLEX Style
A 25-year-old patient is admitted with partial-thickness injuries over 20% of the total body surface area
involving both lower legs. The nurse would classify this injury as being which of the following?
1. a moderate burn
2. a minor burn
3. a major burn
4. a severe burn
5. an intermediate bur...
NCLEX Style Practice Questions Burns,
Med Surg - Burns NCLEX Review /
Revised Questions and Answers / Sure
A+
A 25-year-old patient is admitted with partial-thickness injuries over 20% of the total body surface area
involving both lower legs. The nurse would classify this injury as being which of the following?
1. a moderate burn
2. a minor burn
3. a major burn
4. a severe burn
5. an intermediate burn - Correct Answer: 1
Rationale 1: A moderate burn is a partial-thickness injury that is between 15%-25% of total body surface
area in adults.
A 70-year-old patient has experienced a sunburn over much of the body. What self-care technique is
MOST important to emphasize to an older adult in dealing with the effects of the sunburn?
1. increasing fluid intake
2. applying mild lotions
3. taking mild analgesics
4. maintaining warmth
5. using sunscreen - Correct Answer: 1
Rationale: Older adults are especially prone to dehydration; therefore, increasing fluid intake is
especially important. Other manifestations could include nausea and vomiting. All the measures help
alleviate the manifestations of this minor burn which include pain, skin redness, chills, and headache.
Use of sunscreen is a preventative, not a treatment measure.
A female patient comes into the clinic complaining of nausea and vomiting after spending the weekend
at a seaside resort. Which of the following should be the most important assessment for the nurse?
1. normal rest and sleep pattern
2. typical meal pattern
,3. if the patient had to change time zones when traveling to the resort
4. if the patient has been sunburned - Correct Answer: 4
Rationale: Sunburns result from exposure to ultraviolet light. Because the skin remains intact, the
manifestations in most cases are mild and are limited to pain, nausea, vomiting, skin redness, chills, and
headache. The patient has not reported concerns which will support issues with sleep pattern, diet, and
travel.
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. - ANS: B
The right hand and arm should be elevated to reduce swelling and the fingers extended to avoid flexion
contractures (even though this position may not be comfortable for the patient). The patient with burns
of the ears should not use a pillow for the head because this will put pressure on the ears, and the pillow
may stick to the ears. Patients with neck burns should not use a pillow because the head should be
maintained in an extended position in order to avoid contractures.
A nurse is caring for a patient with second- and third-degree burns to 50% of the body. The nurse
prepares fluid resuscitation based on knowledge of the Parkland (Baxter) formula that includes which
recommendation?
A. The total 24-hour fluid requirement should be administered in the first 8 hours.
B. One half of the total 24-hour fluid requirement should be administered in the first 8 hours.
C. One third of the total 24-hour fluid requirement should be administered in the first 4 hours.
D. One half of the total 24-hour fluid requirement should be administered in the first 4 hours. - B.
One half of the total 24-hour fluid requirement should be administered in the first 8 hours.
Fluid resuscitation with the Parkland (Baxter) formula recommends that one half of the total fluid
requirement should be administered in the first 8 hours, one quarter of total fluid requirement should
be administered in the second 8 hours, and one quarter of total fluid requirement should be
administered in the third 8 hours.
,A nurse is teaching a class of older adults at a senior center about household cleaning agents that may
cause burns. Which agents should be included in these instructions?
Rationale: All of the products except for the furniture polish can cause burns since they are either alkalis
or acids.
A nurse sees a patient get struck by lightning during a thunder storm on a golf course. What should be
the FIRST action by the nurse?
1. Check breathing and circulation.
2. Look for entrance and exit wounds.
3. Cover the patient to prevent heat loss.
4. Move the patient indoors to a dry place.
5. Get the patient up off the ground. - Correct Answer: 1
Rationale: Cardiopulmonary arrest is the most common cause of death from lightening. Respiratory and
cardiac status should be assessed immediately to determine if CPR is necessary. All other actions are
secondary.
A patient arrives at the emergency department with an electrical burn. What assessment questions
should the nurse ask in determining the possible severity of the burn injury? Select all that apply.
1. What type of current was involved?
2. How long was the patient in contact with the current?
3. How much voltage was involved?
4. Where was the patient when the burn occurred?
5. What was the point of contact with the current? - Correct Answer: 1,2,3
, Rationale: The severity of electrical burns depends on the type and duration of the current and amount
of voltage. Location is not important in determining possible severity. Location is not important in
determining possible severity.
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 Ringer's solution.
d. Administer the ordered hydromorphone (Dilaudid). - ANS: A
A patient with facial and chest burns is at risk for inhalation injury, and assessment of airway and
breathing is the priority. The other actions will be completed after airway management is assured.
A patient comes into the clinic to be seen for a burn that appears moist with blisters. The nurse realizes
that this patient most likely has experienced which of the following?
1. first-degree burn
2. superficial second-degree burn
3. deep second-degree burn
4. third-degree burn - Correct Answer: 2
Rationale: Partial-thickness, or second-degree, burns can either be superficial or deep. This patient's
burn, which appears moist with blisters, is consistent with a superficial second-degree burn. A first-
degree burn would involve only the surface layer of skin. Redness would be expected. Deep second-
degree and third-degree burns would be deeper and involve more damage to the dermis, epidermis,
and underlying tissue.
A patient comes into the emergency department with a chemical burn from contact with lye.Assessment
and treatment of this patient will be based on what knowledge regarding this type of burn? (Select all
that apply)
1. This is an alkali burn.
2. This type of burn tends to be deeper.
3. This is an acid burn.
4. This type of burn will be easier to neutralize.
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