Deck 28: Care of Patients With Burns

Question 1

On assessment,the nurse notes that a client has burns inside the mouth and is wheezing.Several hours later,the wheezing is no longer heard.What is the nurse's next action?

A) Document the findings and reassess in 1 hour.
B) Loosen any constrictive dressings on the chest.
C) Raise the head of the bed to a semi-Fowler's position.
D) Gather appropriate equipment and prepare for intubation.

Answer 1

Gather appropriate equipment and prepare for intubation.

Question 2

A client who is receiving fluid resuscitation per the Parkland formula after a serious burn continues to have urine output ranging from 0.2 to 0.25 mL/kg/hour.After the health care provider checks the client,which order does the nurse question?

A) Increase IV fluids by 100 mL/hr.
B) Administer furosemide (Lasix) 40 mg IV push.
C) Continue to monitor urine output hourly.
D) Draw blood for serum electrolytes stat.

Answer 2

Administer furosemide (Lasix) 40 mg IV push.

Question 3

A client is 24 hours post burn and has the following laboratory results.Which result does the nurse report to the health care provider immediately?

A) Arterial pH, 7.32
B) Hematocrit, 52%
C) Serum potassium,7.5 mEq/L
D) Serum sodium, 131 mEq/L

Answer 3

Serum potassium,7.5 mEq/L

Question 4

A client who is burned is drooling and is having difficulty swallowing.Which action does the nurse take first?

A) Assess level of consciousness and pupillary reactions.
B) Ascertain the time food or liquid was last consumed.
C) Auscultate breath sounds over the trachea and mainstem bronchi.
D) Measure abdominal girth and auscultate bowel sounds.

Question 5

A client who was burned has crackles in both lung bases and a respiratory rate of 40 breaths/min and is coughing up blood-tinged sputum.Which action by the nurse takes priority?

A) Administer digoxin.
B) Perform chest physiotherapy.
C) Document and reassess in an hour.
D) Place the client in an upright position.

Question 6

When providing care for a client with an acute burn injury,which nursing intervention is most important to prevent infection by autocontamination?

A) Avoid sharing equipment such as blood pressure cuffs between clients.
B) Change gloves between wound care on different parts of the client's body.
C) Use the closed method of burn wound management for all wound care.
D) Use proper and consistent handwashing by all members of the staff.

Question 7

The nurse has provided instruction on the facial pressure garment to a client with facial burns.Which statement indicates that the client understands these instructions?

A) "My scars should be less severe with the use of this mask."
B) "The mask will help protect my skin from sun damage."
C) "This treatment will help prevent infection."
D) "Using the mask will keep scars from being permanent."

Question 8

A client has burns on both legs.These areas appear white and leather-like.No blisters or bleeding is present,and the client describes just a "small amount of pain." How does the nurse categorize this injury?

A) Partial thickness deep
B) Partial thickness superficial
C) Full thickness
D) Superficial

Question 9

The nurse is teaching burn prevention to a community group.Which information shared by a member of the group causes the nurse the greatest concern?

A) "I get my chimneys swept every other year."
B) "My hot water heater is set at about 120 degrees."
C) "Sometimes I wake up at night and smoke."
D) "I use a space heater when it gets below zero."

Question 10

A client who is admitted after a thermal burn injury has the following vital signs: blood pressure,70/40; heart rate,140 beats/min; and respiratory rate,25 breaths/min.He is pale,and it is difficult to find pedal pulses.Which action does the nurse take first?

A) Begin intravenous fluid resuscitation.
B) Check pulses with a Doppler device.
C) Obtain a complete blood count (CBC).
D) Obtain an electrocardiogram (ECG).

Question 11

Which finding indicates to the nurse that a client understands the psychosocial impact of a severe burn injury?

A) "It is normal to feel some depression."
B) "I will go back to work immediately."
C) "I will not feel anger about my situation."
D) "Once I get home, things will be normal."

Question 12

The RN has assigned a client who has an open burn wound to the LPN.Which instruction is most important for the RN to provide the LPN?

A) Administer the prescribed tetanus toxoid vaccine.
B) Assess wounds for signs of infection.
C) Have the client cough and breathe deeply.
D) Wash hands on entering the client's room.

Question 13

Which finding indicates to the nurse that a client with a burn injury has a positive perception of his appearance?

A) Allowing family members to change the dressings
B) Discussing future surgical reconstruction
C) Performing morning care independently
D) Wearing the pressure dressings as ordered

Question 14

A client is in the emergency department after being rescued from a house fire.After the initial assessment,the client develops a loud,brassy cough.What intervention by the nurse takes priority?

A) Apply oxygen and continuous pulse oximetry.
B) Allow the client to suck on small quantities of ice chips.
C) Request an antitussive medication from the physician.
D) Have the respiratory therapist provide humidified room air.

Question 15

A client with a new burn injury asks the nurse why he is receiving intravenous cimetidine (Tagamet).What is the nurse's best response?

A) "Tagamet will stimulate intestinal movement so you can eat more."
B) "Tagamet can help prevent hypovolemic shock, which can be fatal."
C) "This will help prevent stomach ulcers, which are common after burns."
D) "This drug will help prevent kidney damage caused by dehydration."

Question 16

Ten hours after a client with 50% burns is admitted,her blood glucose level is 152 mg/dL.What action by the nurse is most appropriate?

A) Document the finding.
B) Obtain a family history for diabetes.
C) Repeat the glucose measurement.
D) Stop IV fluids containing dextrose.

Question 17

A client with facial burns asks the nurse if he will ever look the same.Which response is best for the nurse to provide?

A) "With reconstructive surgery, you can look the same."
B) "We can remove the scars with the use of a pressure dressing."
C) "You will not look exactly the same but cosmetic surgery will help."
D) "You shouldn't start worrying about your appearance right now."

Question 18

Which statement best exemplifies a client's understanding of rehabilitation after a full-thickness burn injury?

A) "I am fully recovered when all the wounds are closed."
B) "I will eventually be able to perform all my former activities."
C) "My goal is to achieve the highest level of functioning that I can."
D) "Full recovery from a major burn injury never occurs."

Question 19

A client has a large burned area on the right arm.The burned area appears pink,has blisters,and is very painful.How does the nurse categorize this injury?

A) Full thickness
B) Partial thickness superficial
C) Partial thickness deep
D) Superficial

Question 20

The nurse is conducting a home safety class.It is most important for the nurse to include which information in the teaching plan?

A) Have an escape route everyone knows about.
B) Keep a smoke detector in each bedroom.
C) Use space heaters instead of gas heaters.
D) Use carbon monoxide detectors in the garage.

Question 21

The family of a client who has been burned asks when the client will no longer be at greater risk for infection.What is the nurse's best response?

A) "As soon as the antibiotics have been finished."
B) "As soon as albumin levels returns to normal."
C) "When fluid remobilization has started."
D) "When the burn wounds are closed."

Question 22

Which intervention by the nurse is most appropriate to reduce a client's pain after a burn injury?

A) Administering morphine sulfate 4 mg intravenously
B) Administering morphine sulfate 4 mg intramuscularly
C) Applying ice to the burned area for 20 minutes
D) Avoiding tactile stimulation near the burned area

Question 23

A client is receiving fluid resuscitation after a burn.Which finding indicates that fluid resuscitation is adequate for this client?

A) Hematocrit = 60%
B) Heart rate = 130 beats/min
C) Increased peripheral edema
D) Urine output = 50 mL/hr

Question 24

A client has severe burns around the right hip.Which position does the nurse instruct the nursing assistant to use to maintain maximum function of this joint?

A) Hip maintained in 30-degree flexion
B) Hip at zero flexion with leg flat
C) Knee flexed at 30-degree angle
D) Leg abducted with foam wedge

Question 25

A client with open burn wounds begins to have diarrhea.The client is found to have a below-normal temperature,with a white blood cell count of 4000/mm³.Which action by the nurse is most appropriate?

A) Continue to monitor the client.
B) Increase the temperature in the room.
C) Increase the rate of intravenous fluids.
D) Prepare to do a workup for sepsis.

Question 26

A client who suffered burns in a house fire reports a headache and is not consistently oriented to time.Which intervention by the nurse is most appropriate?

A) Increase the client's oxygen and obtain blood gases.
B) Draw blood for a carboxyhemoglobin level.
C) Increase the client's intravenous fluid rate.
D) Perform a thorough Mini-Mental Status Examination.

Question 27

The nurse uses topical gentamicin sulfate (Garamycin)on a client's burn injury.Which laboratory value does the nurse monitor?

A) Creatinine
B) Red blood cells
C) Sodium
D) Magnesium level

Question 28

An older adult client with burns has a white blood cell count of 10,000/mm³.The client is afebrile with a heart rate of 110 beats/min,a respiratory rate of 20 breaths/min,and blood pressure of 112/68 mm Hg.The client's wound is pale,and edema is noted in the surrounding tissues.Which intervention by the nurse is most appropriate?

A) Assess the client's skin for signs of adequate perfusion.
B) Calculate intake and output ratio for the last 24 hours.
C) Prepare to obtain blood and wound cultures.
D) Place the client in an isolation room.

Question 29

A client is in the emergency department with a burn calculated to be 35% TBSA.The nurse prepares the client for an IV insertion in which location?

Question 30

Which nursing intervention is likely to be most helpful in providing adequate nutrition while a client is recovering from a thermal burn injury?

A) Allowing the client to eat whenever he or she wants
B) Beginning parenteral nutrition high in calories
C) Including 3000 kcal/day of calories with meals
D) Providing a low-protein, high-fat diet

Question 31

A client suffered a 45% total body surface area (TBSA)burn and was intubated.Twelve hours later,bowel sounds were absent in all four abdominal quadrants.Which is the nurse's best action?

A) Administer a laxative.
B) Document the finding.
C) Prepare to insert a nasogastric (NG) tube.
D) Reposition the client on the right side.

Question 32

A client has experienced an electrical injury of the lower extremities.Which priority assessment data should be obtained from this client?

A) Range of motion in all extremities
B) Heart rate, rhythm, and electrocardiogram (ECG)
C) Respiratory rate and pulse oximetry
D) Orientation to time, place, and person

Question 33

A client is brought to the emergency department by an emergency medical services (EMS)squad after being burned with unknown chemicals.The client's body is covered with a white,powdery substance,and the client cries out,"Get this stuff off me! It's burning me!" Which action by the nurse is most appropriate?

A) Have the client take a shower, and bag all clothing.
B) Brush the substance off the client and remove clothes.
C) Call poison control to try to identify the chemical.
D) Start an IV line and prepare to administer analgesics.

Question 34

A client who has had a full-thickness burn is being discharged from the hospital.Which information is most important for the nurse to provide before discharge?

A) How to maintain home smoke detectors
B) Joining a community reintegration program
C) Learning to perform dressing changes
D) Options available for scar removal

Question 35

The nurse assesses a client in the burn unit after the client was repositioned by the nursing assistant.The nurse intervenes after finding the client repositioned in what manner?

A) Supine with one pillow behind the head
B) Semi-Fowler's position with arms elevated
C) Wrists extended to 30 degrees in a splint
D) A towel roll placed under the neck or shoulder

Question 36

The nurse provides wound care for a client 48 hours after a burn injury.To achieve the desired outcome of the procedure,which action does the nurse perform first?

A) Apply silver sulfadiazine (Silvadene) ointment.
B) Cover the area with an elastic wrap.
C) Place a synthetic dressing over the area.
D) Remove loose nonviable tissue.

Question 37

A client who weighs 90 kg and had a 50% burn injury at 10 AM arrives at the hospital at noon.Using the Parkland formula,calculate the rate that the nurse should use to deliver fluid when the IV is started at noon.

Question 38

The nurse has been teaching a client about skin grafting procedures.What statement indicates that the client needs further education about allografts?

A) "Because the graft is my own skin, there is no chance it won't 'take.'"
B) "For a few days after surgery, the donor sites will be painful."
C) "I will have some scarring in the area where the skin is removed."
D) "I am still at risk for infection after the procedure until the burn heals."