Question 1

Priorities in the rehabilitation phase of burn management include

Accepted Answer

A)  recuperation and healing physically and emotionally. 
B)  hydrotherapy and splinting. 
C)  reverse wound isolation and surgical grafting. 
D)  bed rest and splinting. 
A)  recuperation and healing physically and emotionally. 
B)  hydrotherapy and splinting. 
C)  reverse wound isolation and surgical grafting. 
D)  bed rest and splinting. A

Question 2

Which of the following causes can lead to excessive burn edema and shock in a patient with injuries totaling more than 50% -TBSA burn?

Accepted Answer

A)  The heat from the burn leads to immediate vascular wall destruction and extravasation of intravascular fluid. 
B)  A positive interstitial hydrostatic pressure occurs in the dermis leading to burn wound edema. 
C)  Plasma colloid osmotic pressure is decreased because of protein leakage into the extravascular space. 
D)  Capillary permeability decreases in burned and unburned tissue, leading to hypovolemia. 
A)  The heat from the burn leads to immediate vascular wall destruction and extravasation of intravascular fluid. 
B)  A positive interstitial hydrostatic pressure occurs in the dermis leading to burn wound edema. 
C)  Plasma colloid osmotic pressure is decreased because of protein leakage into the extravascular space. 
D)  Capillary permeability decreases in burned and unburned tissue, leading to hypovolemia. C

Question 3

Using the Parkland formula for fluid resuscitation and your knowledge of injury calculations using the "rule of nines," calculate the estimated fluid requirements during the first 8 hours for a 75-kg patient with full-thickness burns to the anterior chest,perineum,and entire right leg.

Accepted Answer

A)  2775 mL 
B)  5550 mL 
C)  8325 mL 
D)  11,100 mL 
A)  2775 mL 
B)  5550 mL 
C)  8325 mL 
D)  11,100 mL B

Question 4

A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.TBSA burn is estimated at 25% deep partial-thickness burns to areas of the chest,back,and left arm and 20% full-thickness burns to the right arm,right upper leg,and areas on the face.The patient's weight is estimated at 85 kg.What is your initial plan for fluid replacement?

Accepted Answer

A)  5950 mL of Lactated Ringer solution (LR) for the first 8 hours; then 5950 mL of LR over the next 16 hours 
B)  2868 mL of normal saline (NS) for the first 8 hours; then 5737 mL of hypertonic NS over the next 16 hours 
C)  11,900 mL of dextran evenly divided over the first 24 hours 
D)  11,475 mL of LR evenly divided over the first 24 hours 
A)  5950 mL of Lactated Ringer solution (LR) for the first 8 hours; then 5950 mL of LR over the next 16 hours 
B)  2868 mL of normal saline (NS) for the first 8 hours; then 5737 mL of hypertonic NS over the next 16 hours 
C)  11,900 mL of dextran evenly divided over the first 24 hours 
D)  11,475 mL of LR evenly divided over the first 24 hours

Question 5

Using the "rule of nines," calculate the percent of injury in an adult who was injured as follows: the patient sustained partial and full-thickness burns to half of his left arm,his entire left leg,and his perineum.

Accepted Answer

A)  28% 
B)  23.5% 
C)  45.5% 
D)  16% 
A)  28% 
B)  23.5% 
C)  45.5% 
D)  16%

Question 6

A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.TBSA burn is estimated at 25% deep partial-thickness burns to areas of the chest,back,and left arm and 20% full-thickness burns to the right arm,right upper leg,and areas on the face.The patient is placed on mechanical ventilator support.The nurse is aware that inhalation injury predisposes the patient to the development of

Accepted Answer

A)  tension pneumothorax. 
B)  ARDS. 
C)  a collapsed lung. 
D)  methicillin-resistant Staphylococcus aureus. 
A)  tension pneumothorax. 
B)  ARDS. 
C)  a collapsed lung. 
D)  methicillin-resistant Staphylococcus aureus.

Question 7

Your patient has a partial-thickness burn wound that is being treated with porcine xenograft (pigskin).Frozen and then thawed pigskin is used at your institution.The nurse knows that pigskin is removed in 5 to 7 days because

Accepted Answer

A)  of infection. 
B)  of lack of blood supply. 
C)  it is a temporary covering to allow the wound to heal. 
D)  it cannot not be used with silver sulfadiazine. 
A)  of infection. 
B)  of lack of blood supply. 
C)  it is a temporary covering to allow the wound to heal. 
D)  it cannot not be used with silver sulfadiazine.

Question 8

Procedural pain control is best achieved with the use of what strategies during the early phase (first 24-48 hours)of recovery in the patient with a major burn injury?

Accepted Answer

A)  Opioids alone 
B)  Intravenous opioids used in combination with oral antidepressants 
C)  Opioids (oral or intravenous) and guided imagery 
D)  Small doses of intravenous opioids titrated to effect 
A)  Opioids alone 
B)  Intravenous opioids used in combination with oral antidepressants 
C)  Opioids (oral or intravenous) and guided imagery 
D)  Small doses of intravenous opioids titrated to effect

Question 9

What is the likely depth of injury in a patient with injuries described as moist and red with some blister formation and very painful?

Accepted Answer

A)  Superficial, first-degree burn 
B)  Partial-thickness, second-degree burn 
C)  Deep dermal partial-thickness, second-degree burn 
D)  Full-thickness, third-degree burn 
A)  Superficial, first-degree burn 
B)  Partial-thickness, second-degree burn 
C)  Deep dermal partial-thickness, second-degree burn 
D)  Full-thickness, third-degree burn

Question 10

Which of the following is a leading cause of death in the hospitalized burn patient?

Accepted Answer

A)  Smoke inhalation 
B)  Infection 
C)  Burn shock 
D)  Renal failure 
A)  Smoke inhalation 
B)  Infection 
C)  Burn shock 
D)  Renal failure

Question 11

Contracture development leading to impaired physical mobility can occur after a major burn injury.Splints are applied to prevent or correct contractures.Priority nursing actions concerning this therapy include

Accepted Answer

A)  daily assessment for proper fit and effectiveness. 
B)  splints should only be removed during showers and dressing changes. 
C)  allowing for frequent breaks from splint use with a 1 hour on, 1 hour off schedule. 
D)  splints will take the place of passive and active range of motion during the rehabilitation phase. 
A)  daily assessment for proper fit and effectiveness. 
B)  splints should only be removed during showers and dressing changes. 
C)  allowing for frequent breaks from splint use with a 1 hour on, 1 hour off schedule. 
D)  splints will take the place of passive and active range of motion during the rehabilitation phase.

Question 12

Which zone is the site of the most severe damage?

Accepted Answer

A)  Zone of coagulation 
B)  Peripheral zone 
C)  Zone of stasis 
D)  Zone of hyperemia 
A)  Zone of coagulation 
B)  Peripheral zone 
C)  Zone of stasis 
D)  Zone of hyperemia

Question 13

A patient has full-thickness burns to his face,chest,back,and bilateral upper arms.He was injured less than 24 hours ago.He sustained these injuries in a house fire and is presumed to have inhaled smoke and sustained an inhalation injury as well.He was nasally intubated in the emergency department and placed on mechanical ventilatory support.He is now showing signs of increasing agitation and is demonstrating high peak airway (ventilatory)pressures.What is the likely cause in this change in his condition?

Accepted Answer

A)  Uncontrolled pain 
B)  Hypovolemia 
C)  Hypoxemia and confusion 
D)  Decreased pulmonary compliance 
A)  Uncontrolled pain 
B)  Hypovolemia 
C)  Hypoxemia and confusion 
D)  Decreased pulmonary compliance

Question 14

Split-thickness skin grafts (autografts)are used to cover deep partial-thickness burn injuries because

Accepted Answer

A)  deep partial-thickness burns will never heal without surgical intervention. 
B)  surgeons cannot tell deep partial-thickness injuries from full-thickness injuries, and full-thickness injuries require surgical intervention to heal. 
C)  fascial excision is required in deep partial-thickness injuries. 
D)  split-thickness skin grafts provide a better cosmetic and functional result than does the natural healing in these injuries. 
A)  deep partial-thickness burns will never heal without surgical intervention. 
B)  surgeons cannot tell deep partial-thickness injuries from full-thickness injuries, and full-thickness injuries require surgical intervention to heal. 
C)  fascial excision is required in deep partial-thickness injuries. 
D)  split-thickness skin grafts provide a better cosmetic and functional result than does the natural healing in these injuries.

Question 15

A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.TBSA burn is estimated at 25% deep partial-thickness burns to areas of the chest,back,and left arm and 20% full-thickness burns to the right arm,right upper leg,and areas on the face.Other important nursing interventions for this patient in the resuscitation phase include

Accepted Answer

A)  intravenous opiates and assessment of pulses in both arms. 
B)  oral anti-inflammatory drugs and preparation for insertion of a right radial arterial line. 
C)  measurement of sedimentation rate and systemic antibiotics. 
D)  application of splints and initiation of total parenteral nutrition. 
A)  intravenous opiates and assessment of pulses in both arms. 
B)  oral anti-inflammatory drugs and preparation for insertion of a right radial arterial line. 
C)  measurement of sedimentation rate and systemic antibiotics. 
D)  application of splints and initiation of total parenteral nutrition.

Question 16

A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.What do you do first?

Accepted Answer

A)  Clean the wounds and remove blisters. 
B)  Assess the airway and provide 100% oxygen. 
C)  Place a Foley catheter and assess for myoglobin. 
D)  Place a central intravenous access and provide antibiotics. 
A)  Clean the wounds and remove blisters. 
B)  Assess the airway and provide 100% oxygen. 
C)  Place a Foley catheter and assess for myoglobin. 
D)  Place a central intravenous access and provide antibiotics.

Question 17

A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.TBSA burn is estimated at 25% deep partial-thickness burns to areas of the chest,back,and left arm and 20% full-thickness burns to the right arm,right upper leg,and areas on the face.The patient is now in the intensive care burn unit with a heart rate of 140 beats/min,a urine output of 25 mL/hr,and clear lung sounds.The fluid resuscitation plan

Accepted Answer

A)  should continue as planned; everything looks good. 
B)  IV rate should be decreased and more narcotics given. 
C)  IV rate should be increased and fluid status closely watched. 
D)  should be switched to packed red blood cells. 
A)  should continue as planned; everything looks good. 
B)  IV rate should be decreased and more narcotics given. 
C)  IV rate should be increased and fluid status closely watched. 
D)  should be switched to packed red blood cells.

Question 18

Which of the following would prevent cross-contamination by direct contact and decrease the risk of infection in the burn-injured patient?

Accepted Answer

A)  Gloves are the only personal protective equipment worn when changing dressings that are in direct contact of body fluids. 
B)  Family members only have to wear a gown when visiting a patient because masks will increase anxiety in the patient. 
C)  Changing gloves and hand washing should be done when moving from area to area on the same patient. 
D)  Sharing of equipment between patients in the same room does not show evidence of cross-contamination. 
A)  Gloves are the only personal protective equipment worn when changing dressings that are in direct contact of body fluids. 
B)  Family members only have to wear a gown when visiting a patient because masks will increase anxiety in the patient. 
C)  Changing gloves and hand washing should be done when moving from area to area on the same patient. 
D)  Sharing of equipment between patients in the same room does not show evidence of cross-contamination.

Question 19

Which of the topical antimicrobial agents is commonly used as a broad-spectrum and fights against gram-positive and -negative bacteria?

Accepted Answer

A)  Pure silver 
B)  Bacitracin 
C)  Mafenide acetate cream 
D)  Silver sulfadiazine 
A)  Pure silver 
B)  Bacitracin 
C)  Mafenide acetate cream 
D)  Silver sulfadiazine

Question 20

According to the American College of Surgeons,burns to which body surfaces are best treated in a burn center?

Accepted Answer

A)  Arms 
B)  Perineum 
C)  Chest 
D)  Genitalia 
E)  Face 
A)  Arms 
B)  Perineum 
C)  Chest 
D)  Genitalia 
E)  Face

Exam 36: Burns

Priorities in the rehabilitation phase of burn management include

Which of the following causes can lead to excessive burn edema and shock in a patient with injuries totaling more than 50% -TBSA burn?

Using the Parkland formula for fluid resuscitation and your knowledge of injury calculations using the "rule of nines," calculate the estimated fluid requirements during the first 8 hours for a 75-kg patient with full-thickness burns to the anterior chest,perineum,and entire right leg.

Using the "rule of nines," calculate the percent of injury in an adult who was injured as follows: the patient sustained partial and full-thickness burns to half of his left arm,his entire left leg,and his perineum.

Your patient has a partial-thickness burn wound that is being treated with porcine xenograft (pigskin).Frozen and then thawed pigskin is used at your institution.The nurse knows that pigskin is removed in 5 to 7 days because

Procedural pain control is best achieved with the use of what strategies during the early phase (first 24-48 hours)of recovery in the patient with a major burn injury?

What is the likely depth of injury in a patient with injuries described as moist and red with some blister formation and very painful?

Which of the following is a leading cause of death in the hospitalized burn patient?

Contracture development leading to impaired physical mobility can occur after a major burn injury.Splints are applied to prevent or correct contractures.Priority nursing actions concerning this therapy include

Which zone is the site of the most severe damage?

Split-thickness skin grafts (autografts)are used to cover deep partial-thickness burn injuries because

A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.What do you do first?

Which of the following would prevent cross-contamination by direct contact and decrease the risk of infection in the burn-injured patient?

Which of the topical antimicrobial agents is commonly used as a broad-spectrum and fights against gram-positive and -negative bacteria?

According to the American College of Surgeons,burns to which body surfaces are best treated in a burn center?

Critical Care Nursing Practice

Ethical Issues

Legal Issues

Genetics and Genomics in Critical Care

Patient and Family Education

Psychosocial and Spiritual Alterations and Management

Sleep Alterations and Management

Nutrition Alterations and Management

Pain and Pain Management

Sedation,Agitation,Delirium: Assessment and Management

End-Of-Life Issues

Cardiovascular Anatomy and Physiology

Cardiovascular Clinical Assessment

Cardiovascular Diagnostic Procedures

Cardiovascular Disorders

Cardiovascular Therapeutic Management

Pulmonary Anatomy and Physiology

Pulmonary Clinical Assessment

Pulmonary Diagnostic Procedures

Pulmonary Disorders

Pulmonary Therapeutic Management

Neurologic Anatomy and Physiology

Neurologic Clinical Assessment and Diagnostic Procedures

Neurologic Disorders and Therapeutic Management

Kidney Anatomy and Physiology

Kidney Clinical Assessment and Diagnostic Procedures

Kidney Disorders and Therapeutic Management

Gastrointestinal Anatomy and Physiology

Gastrointestinal Clinical Assessment and Diagnostic Procedures

Gastrointestinal Disorders and Therapeutic Management

Endocrine Anatomy and Physiology

Endocrine Clinical Assessment and Diagnostic Procedures

Endocrine Disorders and Therapeutic Management

Trauma

Shock,sepsis,and Multiple Organ Dysfunction Syndrome

Organ Donation and Transplantation

Hematologic Disorders and Oncologic Emergencies

The Obstetric Patient

The Pediatric Patient

The Older Adult Patient

The Perianesthesia Patient

Filters