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?

Accepted Answer

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?

Accepted Answer

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.

Accepted Answer

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?

Accepted Answer

1. Complaint of thirst would be expected due to dehydration.
2. Limited range of motion to the affected side is an expected finding.
3. A high pain rating is an expected finding.
4. Immediate signs of inhalation injury are changes to the mucosal lining of the oropharynx and larynx, including the presence of soot, hoarseness, edema, or blisters. The ABCs of resuscitation should be followed.

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?

Accepted Answer

1. The correct amount of IV fluid for resuscitation is 16,000 mL. The most commonly used formula is the Parkland formula, which recommends 4 mL/kg/% TBSA administered during the first 24 hours following a burn injury. Half of the total resuscitation volume is given in the first 8 hours. To solve the problem, first convert 220 pounds to kilograms: (220 ÷ 2.2 = 100 kg) 4 mL × 100 kg × 40% = 16,000 mL.
2. The correct amount of IV fluid for resuscitation is 16,000 mL. The most commonly used formula is the Parkland formula, which recommends 4 mL/kg/% TBSA administered during the first 24 hours following a burn injury. Half of the total resuscitation volume is given in the first 8 hours. To solve the problem, first convert 220 pounds to kilograms: (220 ÷ 2.2 = 100 kg) 4 mL × 100 kg × 40% = 16,000 mL.
3. The correct amount of IV fluid for resuscitation is 16,000 mL. The most commonly used formula is the Parkland formula, which recommends 4 mL/kg/% TBSA administered during the first 24 hours following a burn injury. Half of the total resuscitation volume is given in the first 8 hours. To solve the problem, first convert 220 pounds to kilograms: (220 ÷ 2.2 = 100 kg) 4 mL × 100 kg × 40% = 16,000 mL.
4. The correct amount of IV fluid for resuscitation is 16,000 mL. The most commonly used formula is the Parkland formula, which recommends 4 mL/kg/% TBSA administered during the first 24 hours following a burn injury. Half of the total resuscitation volume is given in the first 8 hours. To solve the problem, first convert 220 pounds to kilograms: (220 ÷ 2.2 = 100 kg) 4 mL × 100 kg × 40% = 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?

Accepted Answer

1. Circumferential extremity burns are at risk for developing compartment syndrome in which the pressure within the muscle compartments is greater than that within the microvasculature. These symptoms are characteristic of a loss of circulation due to compression of the blood vessels.
2. The ability to perform ADLs would likely not differ based on the location of the burn.
3. All hospitalized patients experiencing burns are at risk for nosocomial infections.
4. The symptoms of a deep vein thrombosis are more likely to be swelling, warmth, and pain in the extremity.

Question 7

Following establishment of an airway, adequate breathing, and circulation, the nurse should focus next on which assessment following a burn injury?

Accepted Answer

1. The TBSA percentage and details of how the burn occurred would also be important assessments but are done after the ABCs are completed.
2. Once the initial ABCs have been assessed, neurologic status should be examined. A burn patient should be awake and able to follow commands. Decreased neurologic status or unconsciousness may indicate anoxic injury or an additional neurologic injury.
3. Physical needs and assessments must be completed prior to psychologic needs.
4. This would be done after the airway has been secured.

Question 8

When assessing zone of coagulation of a third-degree burn injury, what should the nurse be alert for?

Accepted Answer

1. There is no pain sensation in this zone because the nerve endings have been destroyed.
2. Capillary refill is minimal to nonexistent with a third-degree burn.
3. The surface of a third-degree burn is dry, firm, and may have a leathery feel.
4. The second-degree superficial burn wound is often bright red in 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.

Accepted Answer

1. Older patients have a decreased sense of pain.
2. The older patient may delay seeking treatment for the burn due to a diminished sense of pain.
3. Older patients have thinner skin, so when they experience burn injuries they often get more severe burns at lower temperatures and in less time than younger patients.
4. Older adults with impaired hearing (not vision) often do not have fire alarms that compensate for their impairment, they may not hear an alarm, and they may not be able to evacuate a burning building promptly.
5. Older adults are more likely to have concurrent respiratory problems (COPD, asthma, or lung cancer).

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.

Accepted Answer

1. Thermal burns include scald injuries from exposure to steam.
2. Thermal burns include scald injuries from exposure to hot liquids.
3. Drain cleaner represents a chemical source.
4. Thermal burns include fire/flame injuries.
5. Thermal burns include contact/friction injuries.

Question 11

Which patient situation presents the greatest risk for an inhalation injury?

Accepted Answer

1. There is no smoke inhalation associated with an electrical burn.
2. Being trapped on an elevator during a fire in a building poses the greatest risk for an inhalation injury because of exposure to smoke or heat within an enclosed place.
3. There is no smoke inhalation associated with sunburn.
4. A scald injury is associated with hot water, not fire or smoke inhalation.

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?

Accepted Answer

1. This treatment will only open airways but not displace the carbon monoxide.
2. This treatment would be used for fluid resuscitation, not gas exchange treatment.
3. A bicarbonate drip is only used for severe metabolic acidosis that is not responsive to other treatment.
4. Carbon monoxide has a stronger affinity for hemoglobin than oxygen does, so it displaces oxygen as it binds with the hemoglobin. This impairs oxygen transport and tissue perfusion. The treatment is high-flow 100% oxygen.

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?

Accepted Answer

1. It is easier for older people to take a shower because they do not have to risk slipping and falling while getting in and out of a bathtub.
2. Older people can have a decrease in memory and forget to test the water temperature.
3. Older and disabled individuals are at risk for scalding by hot bath water due to impaired sensation, slower reaction times, and decreased mobility.
4. Loss of skin elasticity is not a risk factor but could affect the severity.

Question 14

What should the nurse teach a patient with a burn injury about skin changes that occur following a large burn?

Accepted Answer

1. Patients with large burns are more susceptible to infection and have difficulty regulating body temperature even after the burn wound is healed.
2. Healed burned areas are more susceptible to mechanical injury as a consequence of changes in the texture of the skin and decrease of sensory perception.
3. Sensation will eventually return, but it may be altered.
4. Sun exposure should be avoided because burned areas are more susceptible to ultraviolet radiation.

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?

Accepted Answer

1. Providing humidified oxygen would be appropriate after an airway is secured.
2. Placing on a cardiac monitor would be appropriate after an airway is secured.
3. Obtaining intravenous access would be appropriate after an airway is secured.
4. This is the most appropriate first action because the first assessment of a burn patient, whether at the scene or in the emergency department, would be a primary trauma survey beginning with the ABCs (airway, breathing, circulation). In order to secure an airway, this patient may be prophylactically intubated because there are signs of progressing respiratory stress and airway edema related to the tachypnea, stridor, and presence of soot, which places the patient at increased risk for inhalation injury. Procuring a secure endotracheal tube is very important because it is very difficult to reintubate a burn patient due to severe airway edema and neck swelling.

Question 16

Which statement should the nurse use to explain skin-covering procedures to a burn patient?

Accepted Answer

1. Autografting is a procedure that involves removing thin slices of unburned skin from an unburned "donor" site and placing it on top of the excised burn wound as a permanent means of coverage.
2. Meshed autografts result in more scarring and are placed, when possible, on the back, buttocks, and thighs.
3. Cadaver skin (allograft) is often used to temporarily cover excised skin, and tissue typing is not performed. Therefore, allograft results in a temporary coverage until it sloughs from the wound bed.
4. Cultured autologous epithelial cells manufactured by Genzyme are the only commercially available permanent skin covering available in the United States. The cost of autologous epithelial autograft is considerable, and use is reserved for patients with very large burns and few donor sites.

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?

Accepted Answer

1. "We should promote an increased oral fluid intake" is a statement that indicates that further teaching is required. A nasogastric tube should be placed and suction applied to prevent aspiration; therefore, the patient will be NPO. This is also done to reduce the risk of the development of paralytic ileus.
2. A urinary catheter should be placed prior to administering large boluses of fluids.
3. This statement reflects an appropriate action and preparation.
4. Patients with major burns entering this phase should have large-bore intravenous access for fluid administration.

Question 18

Which assessment finding by the nurse would be suggestive of a minor burn?

Accepted Answer

1. The color of a minor burn is not deep reddish-brown. The skin will be slightly edematous in a minor burn.
2. Blisters will not form until after 24 hours, if at all.
3. Superficial, or first-degree, burns involve only the epidermal layer of the skin, leaving the skin intact. The involved skin is pink to red in color and slightly edematous.
4. These burns will heal without scarring in 3 to 6 days.

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.

Accepted Answer

1. Neuropathies can develop as a result of scar formation, edema, or improper positioning of splints or dressings.
2. The maturing burn scar is fragile and susceptible to wound breakdown from shearing and pressure.
3. Wound contractures occur as a result of scar formation over joints, which limit joint movement.
4. In areas of the wound with granulation tissue, collagen deposition can be disorganized, resulting in the development of a hypertrophic scar, which is erythematous and raised.
5. Osteomyelitis (bone infection) is not considered a typical wound or scar complication during the rehab phase.

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.

Accepted Answer

1. The goals of wound management at this stage include decreasing the risk of developing compartment syndrome.
2. Comfort is an important issue for treatment; however, it is a secondary measure.
3. The goals of wound management at this stage include preventing infection.
4. Reduction of scarring is an issue that can be addressed at a later time.
5. The goals of wound management at this stage are to decrease fluid and electrolyte losses.

Quiz 17: Care of the Acutely Ill Burn Patient