Burns Practice Questions

Burns Practice Questions 10 studiers today Leave the first rating Students also studied Terms in this set (35) Des Moines Area Community College BIO 168 Save pharm 35 terms kh90Preview BoardVitals NCLEX Prep RN 40 terms Chelsea_Brown361 Preview ATI comprehensive predictor STUDY...198 terms h_trtPreview Boardv 81 terms tku Which client is most at risk for compartment syndrome due to a burn?

• A 25 year old with circumferential burn of the anterior

& posterior left arm

• A 7 year old with a burn of the left & right ear
• A 54 year old with an electrical burn on the neck
• A 16 year old with a chemical burn to the right foot

A Circumferential burns of the extremities are more likely to cause compartment syndrome, because they produce a tourniquet-like effect, which can lead to vascular problems.The client has experienced an electrical injury of the lower extremities. Which are the priority assessment data to obtain from this client?

• Current ROM in all extremities
• HR & rhythm
• Resp. rate & pulse ox
• Orientation to time, place, person

B Dysrhythmias can happen from electrical burns 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?

• Hip maintained in 30-degree flexion
• Hip at zero flexion with leg flat
• Knee flexed at 30-degree angle
• Leg abducted with a foam wedge

B Max function with hip & leg at full extension with neutral rotation

The patient you are caring for has an electrical burn and has developed thick eschar over the burn wound. Which of the following topical antibacterial agents will the nurse expect the physician to order for the wound?

• Silver sulfadiazine 1% (Silvadene) water-soluble cream
• Mafenide acetate 10% (Sulfamylon) hydrophilic-based

cream

• Silver nitrate 0.5% aqueous solution
• Acticoat

B - Mafenide acetate is the agent of choice for electrical burns because of its ability to penetrate thick eschar The nurse is admin mafenide acetate to a pt with burns.Which statements about this drug is correct?

• Effective for 1st degree burns
• Used to eradicate Pseudomonas aeruginosa
• Causes pain
• Contains sulfonamide
• The brand name is Silvadene
• Causes ototoxicity
• Is diffused gradually & slowly in the skin

B, C, D

Mafenide acetate is administered to eradicate infectious agents such as Pseudomonas aeruginosa. Its applied as a topical cream for 2nd-3rd degree burns. It causes pain upon application & is rapidly diffused & absorbed systemically. It can cause renal failure & hypersensitivity in some pts. Monitor for hyperventilation & ABGs for metabolic acidosis.Nurse is caring for a school age child who has a major burn & is experiencing severe pain. Which of the following actions should the nurse implement to manage this client's pain?

• Admin morphine sulfate IV via continuous infusion
• Admin meperidine IV around the clock prn
• Admin acetaminophen PO every 4 hr
• Admin hydrocode PO q 6 hour

A Opioids IV continuous infusion are recommended for pts who have major burns, regardless of age. Oral acetaminophen is recommended for clients who have minor burns.A nurse is collecting data from a toddler who has major burns & suspected septic shock. Which of the following findings indicate the toddler is experiencing septic shock? Select all that apply.

• Increased body temp
• Altered sensorium
• Rapid cap refill
• Decreased urine output
• Chills

A, B, D, E

Prolonged cap refill is a sign of septic shock.A nurse is caring for a school age child who has severe burn. Which of the following actions should the nurse take?

• Initiate a high protein, low calorie diet
• Expose affected area to the air
• Establish an airway
• Implement contact precautions

C Severe burn patients should get high protein, high calorie diet. A dressing should be applied to the burned area to prevent infection. Reverse isolation precautions are recommended to prevent wound infections. Pt's with severe burns, pulmonary hygiene is importation to maintain adequate O2 & promote tissue healing. To

promote pulmonary hygiene nurse should: maintain pt in semi-fowlers position,

admin bronchodilators prn, use incentive spirometry/reposition/postural drainage, admin high flow humidified O2

A client is admitted with 2nd degree burns on face, neck,

anterior chest, & hands. The nurse priority would be:

• Cover the burned area with sterile dressings
• Initiate intravenous fluid admin
• Administer pain medication as ordered
• Assess for dyspnea & stridor

D A nurse is caring for an adolescent who has superficial partial-thickness burn to the thigh. Which of the following actions should the nurse take?

• Prepare the adolescent for transport to burn facility
• Cleanse the affected area with tepid water
• Scrub the affected area using a soft-bristle brush
• Administer morphine sulfate

B Morphine sulfate is indicated for clients who have sustained moderate to major burns.A nurse is caring for a client with extensive 2nd & 3rd degree burn injuries. Which of the following laboratory values should be reported immediately to the healthcare provider?

• Glucose of 200
• K+ of 6.1
• Hemoglobin of 19
• Hematocrit of 55%

B A guardian reports his child ingested kerosene. Which of the following assessments is the nurse's priority?

• RR
• Burns of the mouth
• Pain
• Sensorium

A Look for signs of respiratory distress with poison ingestion A nurse is caring for a client who has a 3rd degree burn.Which of the following would the nurse expect to find when assessing the burn? Select all that apply

• Pain
• Erythema
• Edema
• Eschar
• Fluid-filled vesicles

C, D Third degree findings include eschar, edema, & usually painless. Second degree = pain, erythema, oozing vesicles that rupture to expose shiny/wet subcutaneous tissue. 1st degree = erythema, edema, pain & blanching

A nurse is caring for a client with 3rd degree burns over 15% of his body surface. Which of the following indicates adequate fluid replacement during the 1st 24 hours post- burn?

• Hematocrit level rising from 50 to 55
• Slowing of a previously rapid HR
• Falling CVP readings
• Urinary output of 15 to 20 ml/hr

B Hematocrit level rising 50 to 55 would indicate low blood volume & hemo- concentration Nurse is administering silver sulfadiazine to an older adult client. Which of the following is true about this drug?Select all that apply.

• It causes black stains of the skin
• Its causes leukopenia
• It causes flushing & tingling sensation
• It forms sulfa crystals in the urine
• Sulfamylon is the brand name
• It interferes with liver function

B, D Silver sulfadiazine can elevate osmolarity & urine specific gravity of urine. It can cause leukopenia. Sulfa crystals are also formed. Concentrated urine & sulfa crystals can be corrected with large intake of fluids.A nurse is planning care for a client who is in the acute phase of recovery from major burn injuries. Which of the following interventions should the nurse include in the plan of care? Select all that apply.

• Limit visitors in the client's room
• Encourage raw vegetable in the client's diet
• Instruct the client to increase protein intake
• Instruct the client to consume a max of 2,000 calories

per day

• Encourage the client to perform ROM exercises daily

A, C, E

Limit visitors to decrease infection. Prevent infection by using aseptic technique when caring for wounds, avoid eating vegetables, provide assigned equipment & carefully monitor burns during dressing changes.A nurse is caring for a client who presents a large blistered burn from hot water. The area is reddened & painful with mild edema. Which of the following depth classifications should the nurse use to document this burn?

• Superficial thickness
• Superficial partial thickness
• Deep partial thickness
• Full thickness

B