Numbers Game
A patient is admitted with burns to the entire anterior chest and the entire right arm. Using the Rule of Nines, the nurse calculates the TBSA as:
A. 18%
B. 22.5%
C. 27%
D. 36%
Answer: C
Rationale: According to the Rule of Nines, the anterior torso is 18% and one entire arm is 9%. 18 + 9 = 27%.
A nurse assesses a burn that is red, moist, and has several large fluid-filled vesicles. This is documented as:
A. Superficial
B. Partial-thickness
C. Full-thickness
D. Deep full-thickness
Answer: B
Rationale: Moistness and blisters are classic signs of a partial-thickness (second-degree) burn. Superficial burns don't blister; full-thickness burns are usually dry/leathery.
A client is brought to the Emergency Department with thermal burns to the face and chest. What is the nurse’s priority assessment?
A. Depth of the burn wounds
B. Heart rate and rhythm
C. Patency of the airway
D. Amount of pain reported by the client
Answer: C
Rationale: In any emergency, especially one involving the face and chest, the nurse follows the ABCs. Ensuring a patent airway is the priority because swelling from inhalation injury can lead to rapid airway obstruction.
Which infection control measure is most appropriate when performing a dressing change for a patient with open burn wounds?
A. Clean gloves and a surgical mask.
B. Sterile gloves, gown, and mask.
C. Standard precautions (clean gloves only).
D. No PPE is required if the patient is on antibiotics.
Answer: B
Rationale: Burn patients have lost their primary barrier against infection (the skin). To prevent sepsis, surgical asepsis (sterile everything) is used during wound care.
Which patient should the nurse assess first?
A. A patient with a superficial burn requesting a cold compress.
B. A patient with facial burns who has a hoarse voice.
C. A patient with a 5% TBSA burn who needs a dressing change.
D. A patient complaining of itching under their burn dressings
Answer: B
Rationale: A hoarse voice indicates swelling in the airway (inhalation injury). This is an ABC (Airway) priority.
A 70kg patient has 30% TBSA burns. Using the Parkland Formula, what is the total fluid requirement for the first 24 hours?
A. 2,100 mL
B. 4,200 mL
C. 8,400 mL
D. 12,600 mL
Answer: C
Rationale: 4mL x 70kg x 30 = 8,400 mL
Which finding in a patient who was in a house fire requires the most immediate intervention?
A. Heart rate of 110 bpm
B. Complaint of 10/10 pain
C. Brassy cough and difficulty swallowing
D. Singing of the eyebrows
Answer: C
Rationale: A brassy cough and difficulty swallowing are signs of upper airway edema. This is a medical emergency because the airway can close completely in minutes.
Which laboratory result should the nurse expect to see in a client during the emergent phase (first 24 hours) of a severe burn?
A. Potassium 3.5 mEq/L
B. Potassium 6.0 mEq/L
C. Sodium 143 mEq/L
D. Hematocrit 30%
Answer: B
Rationale: During the emergent phase, Hyperkalemia (high potassium) occurs because potassium is released from the intracellular space as cells are destroyed by the heat.
What medication is best to manage pain for a second-degree partial thickness burn?
A. Quetiapine
B. Lorazepam
C. Acetaminophen
D. Morphine
Answer: D
Rationale: Second-degree (partial-thickness) burns are often considered the most painful because the nerve endings are still intact, making morphine the best choice.
After a shift report on the Burns Unit, which patient is the priority?
A. A patient 3 days post-burn with a temperature of 37.8°C.
B. A patient with an electrical burn whose heart rate is 124 and irregular.
C. A patient who is crying because they are afraid of scarring.
D. A patient with 15% TBSA burns whose urine is pale yellow.
Answer: B
Rationale: An electrical burn patient with an irregular pulse is at risk for cardiac arrest. This is a "Circulation" priority over the other stable or expected findings.
A patient with a 30% TBSA burn was injured at 1000. They arrive at the ED at 1200. If the total 24-hour fluid goal is 8,000 mL, at what time should the first 4,000 mL be finished?
A. 1600
B. 1800
C. 1900
D. 2200
Answer: B
Rationale: The first half of the total volume must be infused within the first 8 hours from the time of injury. Since the injury was at 1000, the first half must be finished by 1800 (1000 + 8 hours = 1800)
A patient with a full-thickness burn to the leg notes they cannot feel the needle when the nurse cleans the area. The nurse understands this is because:
A. The patient is in hypovolemic shock.
B. The dermal nerve endings have been destroyed.
C. The patient has a high pain tolerance.
D. Peripheral neuropathy has developed.
Answer: B
Rationale: Full-thickness (third-degree) burns destroy the epidermis and the entire dermis, where the sensory nerve endings are located, resulting in a lack of pain in those specific areas.
The nurse knows that the fluid of choice for burn resuscitation is:
A. 0.45% Normal Saline
B. 5% Dextrose in Water (D5W)
C. Lactated Ringer's
D. 3% Hypertonic Saline
Answer: C
Rationale: Lactated Ringer's is an isotonic crystalloid that most closely resembles the electrolyte composition of human plasma and helps buffer the metabolic acidosis common in burns.
A client in the rehabilitation phase of a facial burn tells the nurse, "I don't want any visitors. I look like a monster." What is the nurse's best therapeutic response?
A. "Don't worry, the scars will fade significantly over the next few years."
B. "You shouldn't feel that way; your family loves you regardless of how you look."
C. "It sounds like you are concerned about how others will react to your appearance."
D. "I will tell the front desk to put a 'No Visitors' sign on your door."
Answer: C
Rationale: The nurse should validate and reflect the client's feelings. Options A and B provide "false reassurance" or minimize the client's feelings, while Option D avoids the underlying issue.
Which patient should the nurse see first?
A. A patient with 40% TBSA burns and a blood pressure of 102/68.
B. A patient with a chest burn who is suddenly more agitated and restless.
C. A patient 48 hours post-burn with significant edema in the burned limbs.
D. A patient who needs pre-medication for physical therapy in 1 hour.
Answer: B
Rationale: Restlessness and agitation are the earliest signs of hypoxia (lack of oxygen). This suggests the patient's airway or breathing is compromised.
A nurse is resuscitating a 15kg pediatric patient. Which hourly urine output indicates that the fluid resuscitation rate is effective?
A. 3-6 mL/hr
B. 7.5-15 mL/hr
C. 20–30 mL/hr
D. 30–50 mL/hr
Answer: B
Rationale: In children less than 30kg, a urine output of 0.5-1mL/kg/hr (0.5-1mL/15/hr = 7.5-15mL) is the most reliable indicator that organs are being perfused and fluid resuscitation is successful.
A patient is admitted with an electrical burn from a high-voltage wire. The nurse should prioritize monitoring for which complication?
A. Solar keratitis
B. Ventricular fibrillation
C. Metabolic alkalosis
D. Hypernatremia
Answer: B
Rationale: Electrical current travels through the body and often disrupts the heart's electrical system, leading to immediate or delayed lethal dysrhythmias like V-Fib
A patient with a circumferential burn to the left arm has a diminished radial pulse and numbness in the fingers. Which procedure does the nurse anticipate?
A. Amputation
B. Dialysis
C. Escharotomy
D. Skin grafting
Answer: C
Rationale: A circumferential burn acts like a tight tourniquet as edema develops. An escharotomy (incising the leathery "eschar") is required to restore circulation or chest expansion.
A nurse is preparing a discharge teaching plan for a client who is entering the rehab phase of recovery following severe burns. Which instructions should the nurse include? Select all that apply.
A. "Wear the pressure garments whenever you feel like it."
B. "Apply water-based moisturizers to the healed skin several times daily."
C. "Avoid direct sunlight on the scarred areas for at least one year."
D. "Massage the new scar tissue firmly to help it stay soft."
E. "Limit protein intake now that the wounds are primarily closed."
Answer: B, C, D
A is Incorrect: Pressure garments must be worn nearly 23.5 hours a day for 12–24 months to flatten scars and prevent hypertrophic scarring.
B is Correct: New scar tissue does not have oil or sweat glands. It becomes dry, itchy, and prone to cracking, so frequent moisturizing with water-based lotions is essential.
C is Correct: New scar tissue is hypersensitive and will burn easily. Hyperpigmentation from sun exposure can also become permanent.
D is Correct: Firm massage (often called scar remodeling) helps keep the tissue supple and prevents the scar from adhering to underlying structures.
E is Incorrect: The client still needs a high-protein, high-calorie diet during the rehab phase to continue tissue repair and support the increased metabolic demands of physical therapy.
The nurse has four patients. Which one is the highest priority?
A. A patient with a chemical burn who is currently being flushed with water.
B. A patient with a neck burn who is drooling and cannot swallow secretions.
C. A patient with 50% TBSA burns who has not voided in 2 hours.
D. A patient with a full-thickness burn who is reporting 0/10 pain.
Answer: B
Rationale: Drooling indicates the patient cannot swallow their own saliva, usually because the upper airway is so swollen it is nearly obstructed.
A 50kg patient with 40% TBSA burns is 4 hours post-injury. The total 24-hour fluid requirement is 8,000 mL. If no fluids have been given yet, at what rate (mL/hr) should the nurse set the pump to complete the first half of the volume on time?
A. 500 mL/hr
B. 800 mL/hr
C. 1,000 mL/hr
D. 2,000 mL/hr
Answer: C
Rationale: The first half (4,000 mL) must be given by 8 hours post-injury. Four hours have already passed, so the nurse has 4 hours left to infuse 4,000 mL. 4,000/ 4 = 1,000 mL/hr.
A nurse is teaching a community health class about minor burns. Which characteristics should the nurse include when describing a superficial (first-degree) burn? Select all that apply.
A. The skin appears pink or red.
B. There is a lack of sensation in the area.
C. The area is painful to the touch.
D. The skin blanches when pressure is applied.
E. Large blisters are present immediately.
Answer: A, C, D
Rationale: First-degree burns only involve the epidermis. They are red, very painful (nerves are intact), and blanchable because blood flow is still reaching the surface. Blisters and lack of sensation occur in deeper burns.
A worker is splashed with a dry chemical powder. What is the nurse’s first step in decontamination?
A. Flush with large amounts of sterile water.
B. Apply a neutralizing alkaline solution.
C. Brush the powder off the skin and clothing.
D. Cover the area with a wet sterile dressing
Answer: C
Rationale: Adding water to a dry chemical can activate the chemical or cause a heat-producing reaction. Brushing the powder off first is the safety priority.
A patient is scheduled for a mechanical debridement in 30 minutes. What is the priority nursing action?
A. Ensure the patient has been NPO for 6 hours.
B. Verify the surgical consent is signed.
C. Administer the prescribed IV opioid analgesic.
D. Change the patient’s bed linens.
Answer: C
Rationale: Wound debridement is excruciating. IV pain medication should be timed so it reaches peak effect during the procedure to ensure patient tolerance.
Which task can the nurse safely delegate to the Unlicensed Assistive Personnel (UAP)?
A. Assessing the wound bed for signs of infection.
B. Explaining the Parkland formula to the family.
C. Measuring the hourly urine output from a Foley catheter.
D. Titrating the IV fluid rate based on urine output.
Answer: C
Rationale: UAPs can perform routine tasks, such as emptying a catheter bag and recording the volume. Assessment and titration require the judgment of an RN.