Burn the House Down
Multiple choice
A 45-year-old male arrives in the emergency department after a house fire, with full-thickness burns to his anterior torso and both arms, estimated ~30% TBSA. According to best practice guidelines, the nurse’s immediate priority is:
A. Administering high dose analgesics for pain control.
B. Applying silver sulfadiazine cream to the burned areas.
C. Starting fluid resuscitation based on burn size and patient weight.
D. Elevating the burn limbs above the heart to reduce swelling.
What is "C. Starting fluid resuscitation based on burn size and patient weight"?
Rationale: In the acute phase of major burns, the airway-breathing-circulation (ABC) priorities apply and fluid resuscitation is critical to restore perfusion and prevent burn shock. While pain control and wound care are important, they follow stabilization of circulation. Elevation may help edema but is not the first priority in a large burn.
In the context of burn injuries, the nurse uses the _________ to estimate the total body surface area (TBSA) burned in adults, which is especially helpful in fluid resuscitation calculations.
What is "Rule of Nines"?
Rationale: The Rule of Nines is commonly used in adult burn assessment to estimate TBSA involved.
Which assessment findings indicate hypovolemic shock in a burn patient? (Select all that apply)
A. BP 90/50
B. HR 128 BPM
C. Cool, clammy skin
D. Increased urine output
E. Confusion
What is "A. BP 90/50, B. HR 128 BPM, C. Cool, clammy skin, E. Confusion"?
Rationale: These are classic signs of poor perfusion. Urine output decreases, not increases.
True/False
The first step in any burn simulation scenario should be to check the patient’s airway and breathing.
What is "True"?
Rationale: Airway and breathing are always the top priorities, especially if smoke inhalation may have occurred.
Fill in the blank
Burn patients need extra _________ and _________ in their diet to heal.
What is "calories, protein"?
Rationale: Burns increase metabolism; protein and calories help rebuild tissue.
Multiple choice
During the burn simulation, your patient has deep burns to the chest and arms. What is your first priority as a nurse?
A. Apply burn ointment to the wounds
B. Give IV fluids as ordered
C. Give the patient food and water
D. Wrap the burns tightly to prevent swelling
What is "B. Give IV fluids as ordered?"
Rationale: In serious burns, the body loses a lot of fluid. Replacing fluids keeps blood pressure and organs working.
When a patient has a burn, pain should be treated before doing a _________ change.
What is "dressing"?
Rationale: Burns are painful. Giving pain medication before a dressing change helps comfort and cooperation.
Which of these are appropriate nurse-led education points for the patient and family upon discharge after significant burns? (Select all that apply)
A. How to perform wound dressing changes and recognise signs of infection.
B. Pressure garment use for scar management.
C. High-protein, high-calorie diet to support healing and rehabilitation.
D. That once healed, no further mobility or physical therapy is needed.
E. When to return to the hospital for emergent concerns (e.g., fever, wound changes).
What is "A. How to perform wound dressing changes and recognize signs of infection, B. Pressure garment use for scar management, C. High-protein, high-calorie diet to support healing and rehabilitation, E. When to return to the hospital for emergent concerns".
Rationale: Patient and family education should include wound care, scar management (pressure garments), nutrition (burn patients have increased metabolic demands), and discharge instructions for when to seek care. Option D is incorrect because ongoing mobility and physical therapy are essential.
True/False
The nurse caring for a burn patient should always apply ice or very cold compresses to the burned area to quickly reduce tissue damage.
What is False?
Rationale: Applying ice is contraindicated because it can worsen tissue damage and cause hypothermia.
Multiple choice
A patient has burns on both legs and can’t feel their toes. What is the most important action?
A. Elevate the legs and check pulses
B. Give extra fluids
C. Wrap tightly with gauze
D. Ignore it, since loss of feeling is normal
What is "A. Elevate the legs and check pulses?"
Rationale: Burns can cause swelling that cuts off circulation; checking pulses helps detect poor blood flow early.
Multiple choice
A nurse in the burn unit notes that a patient’s dressing change is scheduled, and the patient complains of severe pain preceding the dressing change. According to best practice for pain management in burn care, the nurse should:
A. Proceed with the dressing change, as delaying may lead to infection.
B. Only use non-pharmacologic techniques (such as distraction) because analgesics could mask infection signs.
C. Administer a prescribed analgesic 15–30 minutes before the dressing change and implement non-pharmacologic comfort measures.
D. Cancel the dressing change until the patient reports 0 pain.
What is "C. Administer a prescribed analgesic 15–30 minutes before the dressing change and implement non-pharmacologic comfort measures?"
Rationale: Burn wound care is extremely painful; analgesics should be timed prior to painful procedures and complemented with non-pharmacologic interventions. Delaying indefinitely is risky; solely using non-pharmacologic is inadequate for major pain.
Which nursing actions help prevent infection in burn patients? (Select all that apply.)
A. Wash hands before and after touching the patient
B. Use clean or sterile gloves when changing dressings
C. Leave wounds uncovered to get more air
D. Monitor the patient’s temperature and wound drainage
What is "A. Wash hands before and after touching the patient, B. Use clean or sterile gloves when changing dressings, D. Monitor the patient’s temperature and wound drainage?"
Rationale: Hand hygiene, clean technique, and monitoring for infection are key safety actions. Leaving wounds open increases infection risk.
Which of the following nursing interventions align with the ANA scope/standards for specialty burn nursing care for a patient with extensive burns? (Select all that apply)
A. Advocacy for the patient’s psychological and social reintegration.
B. Monitoring for signs of infection and coordinating wound‐care interdisciplinary team.
C. Delegating all wound dressing changes to unlicensed personnel without supervision.
D. Educating family and caregivers on home care of burn wounds and scars.
E. Documenting and participating in research to improve burn nursing outcomes.
What is "Advocacy for the patient’s psychological and social reintegration", "Monitoring for signs of infection and coordinating wound‐care interdisciplinary team", "Educating family and caregivers on home care of burn wounds and scars, "Documenting and participating in research to improve burn nursing outcomes"?
Rationale: The American Nurses Association recognizes burn nursing as a specialty, emphasizing independent nursing judgment, multidisciplinary collaboration, prevention, community reintegration, patient/family education, and research.
True/False
The primary cause of hypovolemia in burn patients is plasma loss through damaged capillaries.
What is "True"?
Rationale: Capillary permeability increases after burns, causing plasma to leak into interstitial spaces, leading to hypovolemia.
What are common complications that the nurse should monitor for after major burns? (Select all that apply)
A. Shock (low blood pressure)
B. Infection
C. Kidney problems
D. Dehydration
What is "A. Shock (low blood pressure), B. Infection, C. Kidney problems, D. Dehydration?"
Rationale: Large burns affect the whole body — all these are possible complications.
Multiple choice
Using the parkland formula (4 mL x kg x %TBSA), how much fluid should a 70 kg man with 35% burns receive in the first 8 hours?
A. 3,500 mL
B. 4,900 mL
C. 9,800 mL
D. 4,000 mL
What is "C. 9,800 mL"?
Rationale: Total= 4 mL x70 kg x 35= 9,800 mL. Half (4,900 mL) in first 8 h; remainder in next 16h.
Multiple choice
During the simulation, a patient with deep facial burns exhibits singed nasal hairs and hoarseness. The nurse recognizes this as a possible inhalation injury. According to standard burn-care practice, what is the next best action?
A. Wait to see if respiratory distress develops before intervening.
B. Administer humidified oxygen and prepare for possible endotracheal intubation.
C. Immediately apply topical antimicrobial cream to the face.
D. Elevate the head of the bed and begin oral fluids.
What is "B. Administer humidified oxygen and prepare for possible endotracheal intubation."?
Rationale: Burns involving the face, neck, or chest, especially when accompanied by singed nasal hairs, soot around the nose/mouth, or hoarseness, suggest a potential inhalation injury. This is a medical emergency because airway swelling can develop quickly and obstruct breathing.
When teaching a patient about burn wound care, which points should the nurse include? (Select all that apply)
A. Keep wounds clean and dry
B. Report fever or new redness
C. Stop exercising the burned limb
D. Avoid sun exposure on new skin
What is "A. Keep wounds clean and dry, B. Report fever or new redness, D. Avoid sun exposure on new skin?"
Rationale: Infection prevention and protecting healing skin are key. Exercise helps healing — it should continue as ordered.
True/False
Burn patients are at risk for hypothermia due to loss of skin integrity.
What is "True"?
Rationale: The skin regulates body temperature; loss of integrity increases heat loss.
Place in the correct order of priority for emergency burn care:
1. Remove clothing/jewelry near burn
2. Airway assessment
3. Cover burn with clean sheet
4. Establish IV access
What is "2. Airway assessment,1. Remove clothing/jewelry near burn, 4. Establish IV access, and 3. Cover burn with clean sheet"?
Rationale: Airways always first (ABC); remove constricting items before edema; IV for fluids; then cover.
Multiple choice
During fluid resuscitation of a burn patient, the nurse monitors urine output as a key indicator of perfusion. The target urine output for an adult burn patient is:
A. 0.5 mL/kg/hr
B. 0.1 mL/kg/hr
C. 1.0 mL/kg/hr
D. 2.0 mL/kg/hr
What is "A. 0.5 mL/kg/hr"?
Rationale: In adult burn patients undergoing fluid resuscitation, the goal is often ~0.5 mL/kg/hr urine output (or 30–50 mL/hr) to assess adequate perfusion.
Fill in the blank
The nurse expects to administer ______________ as the fluid of choice during the resuscitation phase.
What is "Lactated Ringer's solution"?
Rationale: Isotonic crystalloid solution that replaces fluid and electrolyte losses.
Which interventions promote optimal wound healing for a burn patient? (Select all that apply)
A. Adequate protein intake
B. Strict glycemic control
C. High humidity environment
D. Vitamin C supplementation
E. Early ambulation
What is "A. Adequate protein intake, B. Strict glycemic control, D. Vitamin C supplementation, E. Early ambulation"?
Rationale: Nutrition, glucose control, vitamin C (collagen synthesis), and mobility support healing. Excess humidity may foster infection.
True/False
Morphine sulfate is commonly used for pain management in acute burn injury.
What is "True"?
Rationale: IV opioids like morphine are preferred for severe burn pain due to rapid action and controllability.
After a burn, which interprofessional referral is most appropriate?
A. Physical therapy for ROM exercises
B. Dentist for oral hygiene
C. Respiratory therapy after wound closure
D. Audiology screening
What is "A. Physical therapy for ROM exercises"?
Rationale: Early ROM prevents contractures and preserves mobility.