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Burns NCLEX Question and Burn Injury Nursing Management Quiz #1 (20 Items)
A 23-year-old male client who has had a full-thickness burn is being discharged from the hospital. Which information is most important for the nurse to provide prior to 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
Correct Answer: C. Learning to perform dressing changes
Teaching the patient and his family to perform dressing changes is critical for the goal of progression towards independence. Proper management of burn injury through proper dressing changes helps prevent wound deterioration. Encouragement of the patient and his family members in participating in dressing changes and wound care helps prepare for the patient’s eventual discharge and home care needs. All other choices (below) are important during the rehabilitation stage but dressing changes is a priority.
- Option A: Teach on the importance of installing and maintaining smoke detectors on every level of the home and changing batteries periodically to help prevent fires.
- Option B: Surviving a burn injury has a tremendous psychological impact on the patient and family. The nurse plays a key role in helping the patient adapt. Providing referrals to social services and counseling helps the patient during his rehabilitation phase.
- Option D: Discussion about burn reconstruction treatment after the scars have healed or matured is usually discussed after the first few years after injury. This option is often used to “improve both the function and the cosmetic appearance of burn scars”.
A client who is admitted after a thermal burn injury has the following vital signs: blood pressure, 70/40; heart rate, 140 beats/min; respiratory rate, 25/min. He is pale in color and it is difficult to find pedal pulses. Which action will the nurse take first?
- A. Start intravenous fluids.
- B. Check the pulses using a Doppler device.
- C. Obtain a complete blood count (CBC).
- D. Obtain an electrocardiogram (ECG).
Correct Answer: A. Start intravenous fluids.
Hypovolemic shock is a common cause of death in the emergent phase of clients with serious injuries. Administration of fluids can treat this problem. For burns classified as severe (> 20% TBSA), fluid resuscitation should be initiated to maintain urine output > 0.5 mL/kg/hour.
- Option C: Following a severe burn injury, significant hematologic changes occur that are reflected in complete blood count (CBC) measurements. A CBC will be taken to ascertain if a cardiac or bleeding problem is causing these vital signs. However, these are not actions that the nurse would take immediately.
- Option B: Checking pulses would indicate perfusion to the periphery but this is not an immediate nursing action. Carefully check pulses in any extremity with circumferential burns. These burns can act as tourniquets as burn-associated edema begins, leading to compartment syndrome.
- Option D: In patients with extensive burns, it is sometimes a challenge to monitor the ECG, because the lack of natural skin and application of protective ointments prevent the adherence of the ECG discs.
A 40-year-old male client who was burned was admitted under your care. Assessment reveals he has crackles, respiratory rate of 40/min, and is coughing up blood-tinged sputum. What action will the nurse take first?
- A. Administer digoxin
- B. Perform chest physiotherapy
- C. Monitor urine output
- D. Place the client in an upright position
Correct Answer: D. Place the client in an upright position
Pulmonary edema can result from fluid resuscitation given for burn treatment. This can occur even in a young healthy person. Placing the client in an upright position can relieve lung congestion immediately before other measures can be carried out.
- Option A: Digoxin may be given later to increase cardiac contractility to prevent backup of fluid into the lungs. However, digoxin has the potential to cause bradyarrhythmias.
- Option B: Chest physiotherapy will not get rid of the fluid and is not a priority among the choices. Chest physiotherapy is only applicable during the post-burn management of the patient.
- Option C: Monitoring urine output is important. However, it is not an immediate intervention. Use the patient’s urine output and physiologic response to determine if the volume is adequate for resuscitation.
How will the nurse position a client with a burn wound to the posterior neck to prevent contractures?
- A. Have the client turn the head from side to side.
- B. Keep the client in a supine position without the use of pillows.
- C. Keep the client in a semi-Fowler’s position with her or his arms elevated.
- D. Place a towel roll under the client’s neck or shoulder.
Correct Answer: A. Have the client turn the head from side to side.
Deformities and contractures can often be prevented by proper positioning. Maintaining proper body alignment when the patient is in bed is vital. The function that would be disrupted by a contracture to the posterior neck is flexion. Moving the head from side to side prevents such a loss of flexion. This movement is what would prevent contractures from occurring.
- Option B: The client should not only be in a supine position but there should be a movement to avoid contractures. Splinting and proper positioning will also help achieve the prevention of contractures. As a matter of importance, movement should be incorporated into the patient’s daily routine from their inception to the hospital.
- Option C: The burns are in the client’s posterior neck. Performing active or passive range of motion (ROM) exercises, depending on the patient’s level of consciousness is crucial in the prevention of these complications.
- Option D: Placing a towel roll under the neck might not help prevent contractures. Immobilization is only allowed when a part of the body has just been grafted. Even then, the area must be kept in an antideformity position.
On assessment, the nurse notes that the 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. Documenting the findings
- B. Loosening any dressings on the chest
- C. Raising the head of the bed
- D. Preparing for intubation
Correct Answer: D. Preparing for intubation
Clients with severe inhalation injuries may sustain such progressive obstruction that they may lose the effective movement of air. When this occurs, wheezing is no longer heard and neither are breath sounds. The client requires the establishment of an emergency airway. The swelling usually precludes intubation.
- Option A: Documentation of findings should be done after the interventions. There may be only a small window of opportunity to easily place an ET tube because edema from burn shock may obstruct the airway.
- Option B: Loosening any dressings on the chest should be done right after the assessment of wheezes. If there is edema or evidence of burn in the upper airways, assessment for whether an endotracheal (ET) tube is needed to maintain the airway should be done immediately.
- Option C: The head of the bed should be flat to prepare for intubation. Emergency airway intubation should be done immediately after assessment to avoid complete obstruction of the airway due to edema.
Ten hours after the client with 50% burns is admitted, her blood glucose level is 142 mg/dL. What is the nurse’s best action?
- A. Documents the finding
- B. Obtains a family history of diabetes
- C. Repeats the glucose measurement
- D. Stop IV fluids containing dextrose
Correct Answer: A. Documents the finding
Neural and hormonal compensation to the stress of the burn injury in the emergent phase increases liver glucose production and release. An acute rise in the blood glucose level is an expected client response and is helpful in the generation of energy needed for the increased metabolism that accompanies this trauma.
- Option B: A family history of diabetes could make her more of a risk for the disease, but this is not a priority at this time. The secondary assessment shouldn’t begin until the primary assessment is complete; resuscitative efforts are underway; and lines, tubes, and catheters are placed.
- Option C: The glucose level is not high enough to warrant retesting. A variety of laboratory tests will be needed within the first 24 hours of a patient’s admission (some during the initial resuscitative period and others after the patient is stabilized).
- Option D: The cause of her elevated blood glucose is not the IV fluid. Rapid and aggressive fluid resuscitation is needed to replace intravascular volume and maintain end-organ perfusion.
The client has a large burned area on the right arm. The burned area appears pink, has blisters, and is very painful. How will the nurse categorize this injury?
- A. Full-thickness
- B. Partial-thickness superficial
- C. Partial-thickness deep
- D. Full-thickness deep
Correct Answer: C. Partial-thickness deep
Deep partial-thickness burns are pink or red in color, swollen, painful, with blisters that may ooze a clear fluid. Deep partial-thickness (second-degree) involves the deeper dermis. Healing occurs in 3 to 8 weeks with scarring present.
- Option A: Third-degree involves the full thickness of skin and subcutaneous structures. It appears white or black/brown. With pressure, no blanching occurs. The burn is leathery and dry. There is minimal to no pain because of decreased sensation.
- Option B: The characteristics of the wound meet the criteria for a superficial partial-thickness injury: color that is red; without blisters and pain present. Superficial (first-degree) involves the epidermis of the skin only. It appears pink to red, there are no blisters, and it is dry. It is moderately painful. Superficial burns heal without scarring within 5 to 10 days.
- Option D: Blisters are not seen with full-thickness burns and are rarely seen with deep partial-thickness burns. Full-thickness burns heal by contracture and take greater than 8 weeks. Full-thickness burns require skin grafting.
The client has burns on both legs. These areas appear white and leather-like. No blisters or bleeding are present, and there is just a “small amount of pain.” How will the nurse categorize this injury?
- A. Full-thickness
- B. Partial-thickness superficial
- C. Partial-thickness deep
- D. Superficial
Correct Answer: A. Full-thickness
The characteristics of the wounds meet the criteria for a full-thickness injury: color that is black, brown, yellow, white, or red; no blisters; pain minimal; outer layer firm and inelastic. The burn is leathery and dry. There is minimal to no pain because of decreased sensation. Full-thickness burns heal by contracture and take greater than 8 weeks. Full-thickness burns require skin grafting.
- Option B: Superficial partial-thickness (second-degree) involves the superficial dermis. It appears red with blisters and is wet. The erythema blanches with pressure. The pain associated with superficial partial-thickness is severe. Healing typically occurs within 3 weeks with minimal scarring.
- Option C: Deep partial-thickness (second-degree) involves the deeper dermis. It appears yellow or white, is dry, and does not blanch with pressure. There is minimal pain due to a decreased sensation. Healing occurs in 3 to 8 weeks with scarring present.
- Option D: Superficial (first-degree) involves the epidermis of the skin only. It appears pink to red, there are no blisters, and it is dry. It is moderately painful. Superficial burns heal without scarring within 5 to 10 days.
The client has experienced an electrical injury of the lower extremities. Which is the priority assessment data to obtain from this client?
- A. Current range of motion in all extremities
- B. Heart rate and rhythm
- C. Respiratory rate and pulse oximetry reading
- D. Orientation to time, place, and person
Correct Answer: B. Heart rate and rhythm
Electric current travels through the body from the entrance site to the exit site and can seriously damage all tissues between the two sites. Early cardiac damage from electrical injury includes irregular heart rate, rhythm, and ECG changes. It is also important to obtain the patient’s cardiac history, including any history of prior arrhythmias.
- Option A: Range of motion is also important. However, the priority is to make sure that the heart rate and rhythm are adequate to support perfusion to the brain and other vital organs.
- Option C: The airway is not at any particular risk with this injury. Therefore, respiratory rate and pulse oximetry are not priority assessments. Any patient that was in contact with a high voltage source should have continuous cardiac monitoring during evaluation.
- Option D: These patients are specifically at risk for cardiac damage if the path of the current traversed the heart. One may also consider CT imaging of the head if the patient has altered mental status or associated head trauma from a fall or being thrown in a blast.
A 35-year-old male client was admitted due to severe burns around his right hip. Which position is most important to use to maintain the 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 a foam wedge
Correct Answer: B. Hip at zero flexion with leg flat
The maximum function for ambulation occurs when the hip and leg are maintained at full extension with neutral rotation. Although the client does not have to spend 24 hours in this position, he or she should be in this position (in bed or standing) longer than with the hip in any degree of flexion.
- Option A: Anti-contracture positioning and splinting must start from day one and may continue for many months post-injury. Legs should be positioned in a neutral position ensuring that the patient is not externally rotating at the hips.
- Option C: Patients rest in a position of comfort; this is generally a position of flexion and also the position of contracture. Without ongoing advice and help with positioning, the patient will continue to take the position of contracture and can quickly lose ROM in multiple joints. Once contracture starts to develop it can be a constant battle to achieve full movement, so preventative measures to minimize contracture development are necessary.
- Option D: Splinting helps maintain anti-contracture positioning particularly for those patients experiencing a great deal of pain, difficulty with compliance, or with burns in an area where positioning alone is insufficient. If the injured site is over joint surfaces, special precautions should be taken to identify all possible joint contractures.
The client with burns is drooling and having difficulty swallowing. Which action will the nurse take first?
- A. Assesses level of consciousness and pupillary reactions.
- B. Ascertain the time food or liquid was last consumed.
- C. Auscultates breath sounds over the trachea and mainstem bronchi.
- D. Measures abdominal girth and auscultates bowel sounds.
Correct Answer: C. Auscultates breath sounds over the trachea and mainstem bronchi.
Inhalation injuries are present in 7% of clients admitted to burn centers. Drooling and difficulty swallowing can mean that the client is about to lose his airway because of this injury. The absence of breath sounds over the trachea and mainstem bronchi indicates impending airway obstruction and demands immediate intubation.
- Option A: Knowing the level of consciousness is important to assess oxygenation to the brain. In most cases, neurologic status won’t be altered in the early stages of burn injury. Use the Glasgow Coma Scale to trend the patient’s neurologic status throughout resuscitation.
- Option B: Ascertaining time of last food intake is important in case intubation is necessary (the nurse would be more alert for the signs of aspiration). However, assessing air exchange is the most important intervention at this time.
- Option D: Measuring abdominal girth is not relevant in this situation. If there is edema or evidence of burn in the upper airways, assess whether an endotracheal (ET) tube is needed to maintain the airway.
A 22-year-old female client with a full-thickness burn is being discharged to home after a month in the hospital. Her wounds are minimally opened and she will be receiving home care. Which nursing diagnosis has the highest priority?
- A. Acute Pain
- B. Deficient Diversional Activity
- C. Impaired Adjustment
- D. Imbalanced Nutrition: Less than Body Requirements
Correct Answer: C. Impaired Adjustment
Recovery from a burn injury requires a lot of work on the part of the client and significant others. The client is seldom restored to her pre-burn level of functioning. Adjustments to changes in appearance, family structure, employment opportunities, role, and functional limitations are only a few of the numerous life-changing alterations that must be made or overcome by the client.
- Option A: By the rehabilitation phase, acute pain from the injury or its treatment is no longer a problem. This stage starts with the closure of the burn and ends when the patient has reached the optimal level of functioning. The focus is on helping the patient return to a normal injury-free life. Helping the patient adjust to the changes the injury has imposed is also a priority.
- Option B: Diversional activity for pain is applicable during the intermediate phase of the burn injury. Provide diversional activities appropriate for age and condition. This helps lessen concentration on pain experience and refocus attention.
- Option D: Imbalanced nutrition is more appropriate during the emergent and intermediate phases of the burn injury. Appropriate guides to proper caloric intake include 25 kcal/kg body weight, plus 40 kcal per percentage of TBSA burn in the adult. As the burn wound heals, the percentage of burned areas is reevaluated to calculate prescribed dietary formulas, and appropriate adjustments are made.
The 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.”
- B. “Tagamet can help prevent hypovolemic shock.”
- C. “This will help prevent stomach ulcers.”
- D. “This drug will help prevent kidney damage.”
Correct Answer: C. “This will help prevent stomach ulcers.”
Ulcerative gastrointestinal disease may develop within 24 hours after a severe burn as a result of increased hydrochloric acid production and decreased mucosal barrier. This process occurs because of the sympathetic nervous system stress response. Cimetidine inhibits the production and release of hydrochloric acid.
- Option A: Gastrointestinal stimulants are drugs that increase motility of the gastrointestinal smooth muscle, without acting as a purgative. These drugs have different mechanisms of action but they all work to move the contents of the gastrointestinal tract faster.
- Option B: Patients with burns of more than 20% – 25% of their body surface should be managed with aggressive IV fluid resuscitation to prevent “burn shock.” Four mL lactated ringers solution × percentage total body surface area (%TBSA) burned × patient’s weight in kilograms = total amount of fluid given in the first 24 hours.
- Option D: Cimetidine does not prevent kidney damage. Acute renal failure is one of the major complications of burns and it is accompanied by a high mortality rate. Most renal failures occur either immediately after the injury or at a later period when sepsis develops.
A 12-year-old male 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.”
- D. “You shouldn’t start worrying about your appearance right now.”
Correct Answer: C. “You will not look exactly the same.”
Many clients have unrealistic expectations of reconstructive surgery and envision an appearance identical or equal in quality to the preburn state. Denial may be prolonged and be an adaptive mechanism because the patient is not ready to cope with personal problems.
- Option A: Be realistic and positive during treatments, in health teaching, and in setting goals within limitations. This enhances trust and rapport between patient and nurse.
- Option B: Pressure dressings prevent further scarring. They cannot remove scars. The client and family should be taught the expected cosmetic outcomes. Provide hope within the parameters of the individual situation; do not give false reassurance. This promotes a positive attitude and provides opportunities to set goals and plan for the future based on reality.
- Option D: Acknowledge and accept the expression of feelings of frustration, dependency, anger, grief, and hostility. Note withdrawn behavior and use of denial. Acceptance of these feelings as a normal response to what has occurred facilitates resolution. It is not helpful or possible to push the patient before he is ready to deal with the situation.
The 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 is the nurse’s best action?
- A. Continuing to monitor the client.
- B. Increasing the temperature in the room.
- C. Increasing the rate of the intravenous fluids.
- D. Preparing to do a workup for sepsis.
Correct Answer: D. Preparing to do a workup for sepsis.
These findings are associated with systemic gram-negative infection and sepsis. To verify that sepsis is occurring, cultures of the wound and blood must be taken to determine the appropriate antibiotic to be started.
- Option A: Continuing just to monitor the situation can lead to septic shock. Indicators of sepsis (often occurs with full-thickness burn) requiring prompt evaluation and intervention. Changes in sensorium, bowel habits, and the respiratory rate usually precede fever and alteration of laboratory studies.
- Option B: Increasing the temperature in the room may make the client more comfortable, but the priority is finding out if the client has sepsis and treating it before it becomes a shock situation.
- Option C: Increasing the rate of intravenous fluids may be done to replace fluid losses with diarrhea, but is not the priority action. Fluid resuscitation replaces lost fluids and electrolytes and helps prevent complications (shock, acute tubular necrosis). Replacement formulas vary but are based on the extent of injury, amount of urinary output, and weight.
The family of a client who has been burned asks at what point the client will no longer be at greater risk for infection. What is the nurse’s best response?
- A. “As soon as he finishes his antibiotic prescription.”
- B. “As soon as his albumin level returns to normal.”
- C. “When fluid remobilization has started.”
- D. “When the burn wounds are closed.”
Correct Answer: D. “When the burn wounds are closed.”
Intact skin is a major barrier to infection and other disruptions in homeostasis. No matter how much time has passed since the burn injury, the client remains at high risk for infection as long as any area of skin is open.
- Option A: Even after the course of treatment of antibiotics, the patient is still at risk for infection if the wounds remain open. Examine wounds daily, note and document changes in appearance, odor, or quantity of drainage.
- Option B: Albumin levels are monitored if there is significant edema. Implement appropriate isolation techniques as indicated. Depending on the type or extent of wounds and the choice of wound treatment (open versus closed), isolation may range from a simple wound and/or skin to complete or reverse to reduce the risk of cross-contamination and exposure to multiple bacterial flora.
- Option C: Fluid resuscitation replaces lost fluids and electrolytes and helps prevent complications (shock, acute tubular necrosis). Once initial fluid resuscitation has been accomplished, a steady rate of fluid administration is preferred to boluses, which may increase interstitial fluid shifts and cardiopulmonary congestion.
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 chimneys swept every 2 years.
- B. Keep a smoke detector in each bedroom.
- C. Use space heaters instead of gas heaters.
- D. Use carbon monoxide detectors only in the garage.
Correct Answer: B. Keep a smoke detector in each bedroom.
Everyone should use smoke detectors and carbon monoxide detectors in their home environment (just not in a garage). Recommendations are that each bedroom has a separate smoke detector. Test smoke alarms every month. If they’re not working, change the batteries.
- Option A: If there is a fireplace, make sure the chimney is checked and cleaned by a professional once a year. Use a metal or glass screen that is large enough to prevent escaping embers. Make sure home heating sources are clean and in working order. Many home fires are started by poorly maintained furnaces or stoves, cracked or rusted furnace parts, or chimneys with creosote buildup.
- Option C: Space heaters can be a cause of fire if clothing, bedding, and other flammable objects are nearby. Make sure to always keep anything that gives off heat at least 3 feet away from flammable materials or items. Heating equipment, like space heaters, are involved in 1 of every 6 home fires. Furthermore, 1 in every 5 home fire deaths and half of all fires caused by home heating occur between December and February.
- Option D: Carbon monoxide detectors should also be placed inside the house, not only in the garage. A person can be poisoned by a small amount of CO over a longer period of time or by a large amount of CO over a shorter amount of time.
The nurse provides wound care for a client 48 hours after a burn injury. To achieve the desired outcome of the procedure, which nursing action will be carried out first?
- A. Applies silver sulfadiazine (Silvadene) ointment
- B. Covers the area with an elastic wrap
- C. Places a synthetic dressing over the area
- D. Removes loose nonviable tissue
Correct Answer: D. Removes loose nonviable tissue
The first step in this process is removing exudates and necrotic tissue. Burn patients are at high risk for infection, especially drug-resistant infection, which often results in significantly longer hospital stays, delayed wound healing, higher costs, and higher mortality
- Option A: Since the adoption of topical antibiotics, such as mafenide in the 1960s and silver sulfadiazine in the 1970s, and of early excision and grafting in the 1970s and thereafter, systemic infections and mortality have consistently decreased. However, Gram-positive and Gram-negative bacterial infections still remain one of the most common causes of mortality following burn injury.
- Option B: While many factors must be considered in dressing selection, the goals in selecting the most appropriate dressing should include providing protection from contamination (bacterial or otherwise) and from physical damage, allowing gas exchange and moisture retention, and providing comfort to enhance functional recovery.
- Option C: The selection of an appropriate dressing depends on several factors, including depth of burn, condition of the wound bed, wound location, desired moisture retention and drainage, required frequency of dressing changes, and cost.
The nurse should teach the community that a minor burn injury could be caused by what common occurrence?
- A. Chimney sweeping every year
- B. Cooking with a microwave oven
- C. Use of sunscreen agents
- D. Use of space heaters
Correct Answer: D. Use of space heaters
Minor burns are common occurrences. The use of space heaters can cause a fire if clothing, bedding, and other flammable objects are near them. Make sure to always keep anything that gives off heat at least 3 feet away from flammable materials or items.
- Option A: Chimneys should be swept each year to prevent creosote build-up and resultant fire. If there is a fireplace, make sure the chimney is checked and cleaned by a professional once a year. Use a metal or glass screen that is large enough to prevent escaping embers.
- Option B: Burn injuries do not commonly occur from microwave cooking, but rather when taking food from it. Thermal burns are skin injuries caused by excessive heat, typically from contact with hot surfaces, hot liquids, steam, or flame. Most burns are minor and patients can be treated as outpatients or at local hospitals.
- Option C: Lastly, sunscreen agents are recommended to prevent sunburn. A broad-spectrum sunscreen with an SPF of at least 30 should be applied 30 minutes before sun exposure and every 90 minutes after that.
The nurse uses topical gentamicin sulfate (Garamycin) on a client’s burn injury. Which laboratory value will the nurse monitor?
- A. Creatinine
- B. Red blood cells
- C. Sodium
- D. Magnesium level
Correct Answer: A. Creatinine
Gentamicin is nephrotoxic and sufficient amounts can be absorbed through burn wounds to affect kidney function. Any client receiving gentamicin by any route should have kidney function monitored. In burn patients, the systemic absorption of topical gentamicin may be enhanced, and one should be watchful for the potential repercussions.
- Option B: Topical gentamicin will not affect the red blood cell count. The gentamicin is prone to accumulate in the renal proximal tubular cells and can cause damage. Hence, mild proteinuria and reduction of the glomerular filtration rate are potential consequences of gentamicin use, achieving 14% of gentamicin users in a review.
- Option C: Topical gentamicin will not affect sodium. In cases of renal impairment, dosing adjustment should be made based on the glomerular filtration rate (GFR); for high-dose, extended interval dosing approach, the dose can be preserved, but the interval between doses should increase in line with GFR decrease.
- Option D: Topical gentamicin will not affect the magnesium level. Renal function should be evaluated twice-weekly in patients without previous renal disease through serum creatinine and blood urea nitrogen. Periodic microscopic urinalysis is also vital to detect proteinuria and casts, which may indicate kidney injury.