Deck 36: Burns

Question 1

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.

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

Answer 1

5550 mL

Question 2

Which zone is the site of the most severe damage?

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

Answer 2

Zone of coagulation

Question 3

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?

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

Answer 3

5950 mL of Lactated Ringer solution (LR) for the first 8 hours; then 5950 mL of LR over the next 16 hours

Question 4

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

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 5

A patient involved in a house fire is brought by ambulance to your emergency department.He is breathing spontaneously but appears agitated.He does not respond appropriately to questions.You assume he has inhaled carbon monoxide and has carbon monoxide (CO)poisoning.Your first action is to

A) ask the physician to order a STAT chest radiograph to rule out a pneumothorax.
B) apply a pulse oximeter to one of his unburned fingers.
C) call the local hyperbaric chamber to check on its availability.
D) administer 100% high-flow oxygen via a nonrebreathing mask.

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.What do you do first?

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 7

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?

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

Question 8

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

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 9

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

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 10

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

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 11

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

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.

Question 12

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

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 13

A red and white wound surface with blanching but no blister formation describes what depth of burn injury?

A) Superficial partial-thickness burn
B) Moderate partial-thickness burn
C) Deep dermal partial-thickness burn
D) Full-thickness burn

Question 14

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

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 15

Which of the following is most important when determining whether or not to refer a patient to a burn center?

A) The size and depth of burn injury and the burning agent
B) The age and present medical history of the patient
C) The depth of the burn injury and the presence of soot in the sputum
D) The medical history of the patient and the size and depth of the burn injury

Question 16

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.

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

Question 17

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

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

Question 18

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

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 19

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?

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 20

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

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

Question 21

From the surface inward,identify in the correct order the five layers of the skin:
1)Stratum granulosum
2)Stratum corneum
3)Stratum germinativum
4)Stratum lucidum
5)Stratum spinosum

A) 2, 4, 1, 5, 3
B) 2, 4, 5, 1, 3
C) 4, 2, 5, 1, 3
D) 4, 5, 1, 3, 2

Question 22

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

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

Question 23

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

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

Question 24

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 nurse should have a high suspicion for myoglobinuria with which type of burn injury?

A) Chemical burn
B) Tar burn
C) Electrical burn
D) Carbon monoxide poisoning

Question 25

Priorities in the rehabilitation phase of burn management include

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

Question 26

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 patient's symptoms are most likely attributable to

A) blood loss associated with burns and wound care.
B) hemodynamic stability related to adequate fluid resuscitation.
C) over-resuscitation related to overestimation of the TBSA involved.
D) under-resuscitation because of probable inhalation injury.

Question 27

Management of full-thickness burns includes

A) daily wound care without premedication of narcotics because the pain fibers are destroyed.
B) daily wound care with premedication of narcotics.
C) weekly wound care until all eschar is debrided.
D) surgical skin grafting within 8 hours of admission.

Question 28

This phase occurs 4 to 20 days after injury and involves rapid synthesis of collagen.

A) Wound phase
B) Inflammatory phase
C) Proliferative phase
D) Maturation phase

Question 29

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 nurse is unable to obtain a palpable pulse or a Doppler pulse signal in the right arm on admission of this patient.What immediate intervention is needed?

A) Escharotomy
B) Silvadene application
C) Splint application
D) Xenograft application

Question 30

Roughly 80% of burns in children are classified as

A) radiation burns.
B) chemical burns.
C) electrical burns.
D) thermal burns.