Deck 17: Care of the Acutely Ill Burn Patient

Question 1

In preparing a patient for the rehabilitation phase of burn management, which statement reflects understanding of discharge teaching following a 6-month hospitalization?
1) "I need to begin cutting back on calories to avoid weight gain."
2) "I should have regular osteoporosis screening."
3) "I will likely not tolerate cold weather anymore."
4) "I must avoid getting a flu shot this year."

Answer 1

2
Explanation: 1. Hypermetabolism is sustained for 9 to 12 months following burn injury. The patient's weight should be monitored closely throughout the rehabilitation phase. The patient may still require supplemental enteral nutrition or high-caloric nutritional supplements to maintain a positive energy balance.
2. "I should have regular osteoporosis screening" is correct and reflects understanding of discharge teaching. Large burn injuries have been associated with bone density losses, and these patients may be at increased risk for osteoporosis and pathologic fractures.
3. Thermoregulation disturbances continue throughout the rehabilitation phase, and the patient may experience heat intolerance.
4. Following burn injury, there is an increased susceptibility to infection, and appropriate precautions should be taken. This includes avoiding unnecessary exposure to people with colds or infections and maintaining up-to-date immunizations.

Question 2

A patient complains of increased pain to the area of a third-degree burn covering the entire arm. The nurse suspects compartment syndrome. For which intervention should the nurse prepare the patient?
1) Transportation to the whirlpool
2) Application of multiple Ace wraps over the current gauze dressing
3) An escharotomy performed by the physician
4) Skin grafting performed by the physician

Answer 2

3
Explanation: 1. The whirlpool would provide no remedy for the impaired circulation.
2. Ace wraps would provide no remedy for the impaired circulation.
3. Circumferential burn wounds to the neck, chest, abdomen, and extremities are at risk for developing compartment syndrome. The burn eschar constricts the burned area at the same time that edema is causing subcutaneous fluid expansion. The net result is impaired circulation to the involved area. Compartment syndrome is prevented by performing an escharotomy whereby the physician uses a scalpel or electrocautery to cut through the eschar, which releases tension and permits blood flow to the area. Escharotomies are usually performed at the bedside. The nurse should be prepared to assist in draping and monitoring the patient during the procedure.
4. Skin grafting would provide no remedy for the impaired circulation.

Question 3

The critical care nurse is aware that the depth of burn injury is determined by the depth of tissue destruction and which other factor? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Duration of the burn exposure
2) Additional chronic medical conditions
3) Skin thickness
4) The cause of the burn
5) Body part of the burn injury

Answer 3

1, 3, 4
Explanation: 1. A number of factors contribute to burn depth, including the duration of the burning agent.
2. The presence of other medical conditions may affect healing but is not a factor in determining burn depth.
3. A number of factors contribute to burn depth, including the skin thickness.
4. A number of factors contribute to burn depth, including the etiology.
5. Location of body part burned may affect healing but is not a factor in determining burn depth.

Question 4

A patient comes to the emergency department with thermal burns to the left arm and shoulder. Which finding requires immediate attention by the nurse?
1) Complaint of excessive thirst
2) Loss of range of motion to the affected side
3) Pain rating of 8 on a 1-to-10 scale
4) Presence of coughing and hoarseness

Question 5

A middle-aged male patient weighing 220 pounds incurred burns to 40% of the total body surface area. Using the Parkland formula, what are this patient's fluid needs for the first 24 hours?
1) 3,520 mL
2) 35,200 mL
3) 1,600 mL
4) 16,000 mL

Question 6

A patient in ICU with a burn circling the left upper leg suddenly experiences excruciating pain, pallor in the lower extremity, and loss of pedal pulse. Which health problem is this patient most likely developing?
1) Compartment syndrome
2) Inability to perform ADLs
3) Nosocomial infection
4) A deep vein thrombosis

Question 7

Following establishment of an airway, adequate breathing, and circulation, the nurse should focus next on which assessment following a burn injury?
1) Determining total body surface area of the burn
2) A quick check of neurologic status
3) Psychologic trauma resulting from the incident
4) Details of how the injury occurred

Question 8

When assessing zone of coagulation of a third-degree burn injury, what should the nurse be alert for?
1) The presence of pain
2) Brisk capillary refill
3) Surface of the wound that is dry and firm
4) A bright red wound color

Question 9

An 80-year-old patient is admitted for 39% TBSA burns. The nurse should assess for which risk factors that apply to this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Higher sensitivity to pain
2) Delay seeking treatment
3) Thinner skin
4) Impaired vision
5) Concurrent respiratory problems

Question 10

The nurse providing an overview of burns to a community group teaches the causes for thermal burns. What causes should the nurse include? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Contact with steam
2) Exposure to hot liquids
3) Being splashed with drain cleaner
4) Stepping on hot charcoal
5) Friction injuries

Question 11

Which patient situation presents the greatest risk for an inhalation injury?
1) Second-degree electrical burn of the hand
2) Trapped on an elevator during a fire in a building
3) History of asthma who has extensive first-degree sunburn
4) Scalding injury from liquid splashed on the legs

Question 12

A patient rescued from a small house fire is brought to the emergency department. There is no burn injury to the skin; however, laboratory results show a CO level of 22%. Which intervention should the nurse expect to implement?
1) Administer high-flow nebulizer treatment.
2) Infuse a fluid bolus of lactated Ringer's solution.
3) Begin a sodium bicarbonate drip.
4) Give 100% oxygen by mask.

Question 13

What should the nurse explain to a family member about the reason why older patients are at risk for scalding by hot water?
1) This age group's adversity to taking showers
2) An inclination to test the water's temperature
3) Overall slower reaction time
4) Loss of elasticity of skin tissue

Question 14

What should the nurse teach a patient with a burn injury about skin changes that occur following a large burn?
1) Regulating body temperature returns with healing.
2) Healed burn areas are more susceptible to mechanical injury.
3) Sensory perception never returns once healing of a burn is complete.
4) Vitamin D from sun exposure facilitates the healing process.

Question 15

An alert patient at the scene of an explosion has a respiratory rate of 24 breaths per minute, a faint stridor, and soot on the face. The patient's heart rate is 120 beats per minute. Which action should be implemented first?
1) Administering humidified oxygen
2) Placing on a cardiac monitor
3) Inserting a large-bore angiocatheter
4) Prophylactically intubating the patient

Question 16

Which statement should the nurse use to explain skin-covering procedures to a burn patient?
1) Autografts are permanent skin replacements for burns.
2) Meshed autografts are used for the face and hands.
3) Tissue typing is necessary for use of an allograft.
4) Cultured autologous epithelial cells provide a temporary wound covering.

Question 17

The burn unit nurse teaches a new staff nurse the priority nursing actions during the resuscitation phase of burn management. Which statement made by the inexperienced nurse indicates a need for further teaching?
1) "We should promote an increased oral fluid intake."
2) "A urinary catheter is usually inserted."
3) "I'll get a nasogastric tube and suction equipment ready."
4) "All patients should have a large-bore IV access if possible."

Question 18

Which assessment finding by the nurse would be suggestive of a minor burn?
1) The involved skin is deep reddish-brown in color and edematous.
2) Blisters begin to form on the skin within the first hour of exposure.
3) The skin remains intact because only the epidermal layer is involved.
4) Scarring will be evident on the edges of the burn in a matter of hours.

Question 19

The nurse reviews plans for wound and scar management for the rehabilitation phase with a patient recovering from an extensive burn. What complication should the nurse explain to the patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Neuropathies
2) Wound breakdown
3) Contractures
4) Hypertrophic scarring
5) Osteomyelitis

Question 20

The nurse plans care for a client with a major burn injury. What should the goal be for initial burn management? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Decrease the risk of developing compartment syndrome.
2) Promote physical/psychological comfort.
3) Prevent infection.
4) Reduce the degree of scarring.
5) Decrease fluid and electrolyte loss.

Question 21

A patient is admitted with a chemical burn caused by a malfunctioning oven-cleaner container. What should the nurse keep in mind about this type of burn? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Tissue damage will be deeper.
2) The agent is more difficult to neutralize.
3) Extent of damage depends upon the duration on the skin.
4) There is less risk of contamination to the nurse and other people
5) Contact the poison control center for information on how neutralize the agent.

Question 22

What interventions should the nurse plan to prevent the onset of contractures for a patient in the rehabilitation phase of burn care? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Conduct exercises.
2) Splint joints.
3) Follow body positioning recommendations.
4) Perform range-of-motion exercises.
5) Schedule surgery to release the joints.

Question 23

A patient has a superficial partial-thickness burn over the anterior portion of the right lower leg. What care should the nurse plan for this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Grafting
2) Splinting
3) Wound care
4) Escharotomy
5) Pain management

Question 24

The nurse cares for a patient who was in a house fire. The patient currently has a hoarse voice and has soot in the sputum. Over the next 24 hours, what might the patient experience as manifestations of a lower airway injury? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Increased mucous production
2) Bronchospasm
3) Alteration in breath sounds
4) Chest pain
5) Peripheral neuropathy

Question 25

A patient is admitted with burns to both legs and one arm after being electrocuted while replacing a transformer during a thunderstorm. Since these limbs appear mummified, which treatment should the nurse anticipate being prescribed for this patient?
1) Amputation
2) Debridement
3) Whirlpool and wet dressings
4) Escharotomy and colloid dressings

Question 26

The nurse assists with the initial debridement of a patient's burn wounds. What will be done during this debridement? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Cleaning the wounds with warm water and wound cleanser
2) Removing loose skin with gauze
3) Trimming skin tags with scissors
4) Shaving the hair around the wound
5) Washing the debrided wound with hot water and liquid soap

Question 27

A patient weighing 80 kg is receiving resuscitative care for a burn to 46% of total body surface area. What finding indicates that resuscitation is effective? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Urine output 50 mL/hour
2) Heart rate 96 beats per minute
3) Blood pressure 138/88 mm Hg
4) Clear lung sounds
5) Bladder pressure 15 mm Hg

Question 28

A patient with 50% total body surface burns is recovering from graft surgery. What should the nurse identify as major goals of care for this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Control infection.
2) Avoid wound breakdown.
3) Prevent hypertrophic scarring.
4) Ensure adequate fluid balance.
5) Encourage prescribed exercise.

Question 29

During the acute phase of burn injury, the patient has the risk of developing complications. For what should the nurse assess the patient during this phase?
1) Hypovolemic shock
2) Septic shock
3) Wound scarring
4) Urinary tract infection

Question 30

The critical care nurse is concerned that a patient in the acute phase of a burn injury is experiencing metabolic changes because of which assessment finding? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Drop in body weight
2) Elevated creatinine levels
3) Urine output of 20 mL/hr
4) Abdominal pain
5) Stridor

Question 31

The nurse suspects that a patient with 40% total body surface area burned is developing gastrointestinal problems. What did the nurse assess to make this clinical determination? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Hematemesis
2) Abdominal pain
3) Board-like abdomen
4) Absent bowel sounds
5) Abdominal distention

Question 32

The intensive care nurse assesses a patient for cardiovascular system changes related to a burn injury. Which findings are associated with a burn injury? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Hypertension
2) Altered capillary refill
3) Hypovolemic burn shock
4) Peripheral extremity vascular compromise
5) Cardiac dysrhythmias

Question 33

The nurse cares for a patient who was brought into the emergency department after being struck by lightning. This patient's injuries will most likely be to which body areas? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Heart
2) Soft tissue
3) Bones
4) Kidneys
5) Lungs

Question 34

A patient experiences high levels of anxiety following a house fire. The nurse should administer which medication to help reduce the anxiety?
1) Fentanyl
2) Lorazepam
3) Hydromorphone
4) Sertraline

Question 35

The nurse plans a burn prevention program for older persons at a neighborhood association meeting. Which visual aid should the nurse use to emphasize the most common cause of burn injuries in an older adult?
1) A lit cigarette
2) A bathtub of hot water
3) Pots and pans on a stove
4) Frayed electrical wires

Question 36

After the initial assessment of burn injuries, it is determined that the patient will be transferred to a burn center for care. What assessment finding contributed to this decision? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Burns on the face
2) Burns on the hands
3) Burns to both hips
4) Burn to the perineum
5) Burns to the upper left arm and lower right leg

Question 37

The nurse cares for an older patient with a burn injury. Because preexisting health conditions influence how the older patient responds to the resuscitative treatment, what should be the priority when caring for this patient?
1) Calculating nutritional needs
2) Coordinating physical therapy
3) Managing pain
4) Fluid resuscitation

Question 38

A patient sustained burns to the following body areas: both upper anterior arms, both lower anterior legs, and the anterior face and neck. Using the rule of nines, what is this patient's total body surface area burned? Record your answer rounding to one decimal place.