NURSING MANAGEMENT: PATIENT WITH BURNS

1. Match the following characteristics of burns with the types of burns (answers may be used more than twice).

​__4___ A. Risk of cardiac arrhythmias or arrest ​ ​ ​1. Thermal

​__1___ B. Hot cooking oil ​ ​ ​ ​ ​2. Chemical
​__2__ C. Tissue adherence with protein hydrolysis ​ ​3. Smoke and inhalation
​___4__ D. Causes coagulation necrosis ​ ​ ​ ​4. Electrical
_1,3_ E. Can be caused by explosive flare
__3___ F. May cause carbon monoxide poisoning
__3___ G. Indicated by facial burns and hoarseness

2. True-False. If the sentence of false, correct the bold word(s) to make it true.

True A. Inhalation injury below the glottis may occur with exposure to toxic fumes.
​Alkaline Substance B. Acid substances that cause chemical burns continue to cause tissue damage even after
neutralized.
Chemical C. Lavage with large amounts of water is important to stop the burning process in scald injuries.
True D. The visible skin injury seen with an electrical burn often does not represent the full extent of tissue
damage.
Electrical Burn E. Metabolic acidosis occurs immediately following an acid chemical burn.

3. When assessing the patient’s full-thickness burn injury during the emergent phase, the nurse would expect to find

A. leathery, dry, hard skin

B. red, fluid-filled vesicles
C. massive edema at the injury site
D. serous exudate on a shiny, dark-brown wound

4. A patient has the following mixed deep partial-thickness and full-thickness burn injuries: face, anterior neck, right
anterior trunk, and anterior surfaces of the right arm and lower leg.

A. According to the Lund-Browder chart, what is the extent of the patient’s burns? 17 1/2% TBSA
B. According to the rule of nines chart, what is the extent of the patient’s burns? 18 TBSA
C. Is it possible to determine the actual extent and depth of burn injury during the emergent phase of the burn?
Why or why not? No, because edema and inflammation obscure the demarcation of zones of injury
D. What would be the American Burn Association classification of this injury?
5. The initial intervention in the emergency management of a burn of any type is to

A. establish and maintain an airway

B. assess for other associated injuries
C. establish an IV line with a large-gauge needle
D. remove the patient from the burn source and stop the burning process

6. Describe the criteria for each of the phases of burn injury and the approximate time frame of each phase.

A. Emergent – Fluid loss and formation of edema (usually 25 to 48 hours but might be up to 5 days) ​
B. Acute – Mobilization of fluid and diuresis (weeks to months)
C. Rehabilitation – Burned are covered and wounds healed (weeks to months)

7. During the early emergent phase of burn injury, the patient’s laboratory results would most likely include

A. Hct, serum Na, serum K, urine Na (ANSWER)

B. Hct, serum albumin, serum Na, serum K

C. Hct, serum Na, serum K, urine specific gravity

D. Hct, serum Na, serum K, urine specific gravity.

8. The initial cause of hypovolemia during the emergent phase of burn injury is

A. increased capillary permeability

B. loss of sodium to the interstitium
C. decreased vascular oncotic pressure
D. fluid loss from denuded skin surfaces

9. The response of the immune system to a burn injury includes

A. decreased activity of neutrophils

B. an increase in T-helper lymphocytes
 C. increased production of interleukin-1 and interleukin-2
D. becoming overwhelmed by microorganisms entering denuded tissue

10. One clinical manifestation that the nurse would expect to find during the emergent phase in a patient with a full-
thickness burn over the lower half of the body is

A. fever
B. severe pain
C. intense thirst
D. unconsciousness

11. A patient has a 20% TBSA deep partial-thickness and full-thickness burn to the right chest and entire right arm. It
is most important that the nurse assess the patient for

A. presence of pain
B. swelling of the arm
C. formation of eschar
D. presence of pulses in the arms

12. Nasotracheal or endotracheal intubation is instituted in burn patients who have

A. electrical burns casing cardiac arrhythmias

B. thermal burn injuries to the face, neck, or airway
C. symptoms of hypoxia secondary to carbon monoxide poisoning
D. respiratory distress to inelastic eschar formation around the chest

13. The condition that occurs when myoglobin released form muscle tissue damaged by burns blocks the renal tubules
is known as

A. nephritis
B. renal ischemia
C. acute renal failure
D. acute tubular necrosis

14. A patient is admitted to the emergency department at 1015 following a flame burn at 0930. The patient has major
40% TBSA burns and weighs 132 lb.

A. According to the Parkland formula, the type of fluid prescribed for the patient would be lactated ringer’s and the
total amount to be administered during the first 24 hours would be 9600 ml.
B. The schedule for the fluid administration would be 4800 ml between 10:15pm and 5:30 am (time),
2400 ml between 5:30 am and 1:30pm , and 2400ml between 1:30 pm and 9:00pm.
C. Dextrose and water is given the second 24 hours at a rate determined by the ________ .
D. The three parameters used to determine the adequacy of the patient’s fluid replacement are Urine Output, Vital
Signs and _______________________.
15. A patient’s deep partial-thickness burns are treated with the open method. The nurse plans to

A. ensure that sterile water is used in the debridement tank

B. apply topical silver sulfadiazine (Silvadene) with clean gloves
C. use clean gloves to remove the dressings and wash the wounds
D. wear a cap, mask, gown, and gloves when caring for the patient

16. A patient with deep partial-thickness burns over 45% of his trunk and legs is going for debridement in a
hydrotherapy tank 48 hours postburn. The drug of choice to control the patient’s pain during this activity is

A. IV morphine
B. oral methadone
C. IM meperidine (Demerol)
D. Long-acting morphine

17. The nurse assesses absent bowel sounds and abdominal distention in a patient 12 hours postburn. The nurse
notifies the physician and prepares to

A. withhold all oral intake except water

B. insert a nasogastric tube for decompression
C. administer a histamine- block agent such as cimetidine (Tagamet)
D. administer nutritional supplements through a feeding tube placed in the duodenum

18. The nurse positions the patient with ear, face, and neck burns

A. prone
B. on the side
C. without pillows
D. with extra padding around the head

19. During the early acute phase of burn injury, a patient has a serum sodium of 153 mEq/L (152 mmol/L) and a
serum potassium of 2.8 mEq/L (2.8 mmol/L). The nurse recognizes that these imbalances could occur as a result
of ​
A. prolonged hydrotherapy
B. treatment with topical silver nitrate
C. the in the acute phase diuresis brought about by fluid mobilization
D. excessive fluid replacement with dextrose in water without potassium supplementation

20. A burn patient has a nursing diagnosis of impaired physical mobility related to joint contractures secondary to
pain. An appropriate nursing intervention for this patient is to
 A. have the patient perform ROM exercises when pain is not present
B. teach the patient the importance of exercise to prevent contractures
C. provide analgesic medications before physical activity and exercise
D. arrange for the physical therapists to encourage exercise during hydrotherapy

21. The nurse suspects the possibility of sepsis in the burn patient based on changes in

A. vital signs
B. urinary output
C. gastrointestinal function
D. burn wound appearance

22. Identify one major complication of burns that is believed to be stress related that may occur in each of the
following systems during the acute burn phase

A. Neurologic - Delirium

B. Gastrointestinal – Ulcer ​
C. Endocrine - Hyperglycemia

23. Complete the following sentences.

A. A permanent skin graft that may be available for the patient with large body surface area burns who has limited
skin for donor harvesting is Cultured epithelial autograft.
B. Early excision and grafting of burn wounds involves excising Eschar down to clean viable tissue and applying
Split-Thickness grafts.
C. During the acute burn phase, the daily caloric requirements for a 158 lb patient with a 50% TBSA burn is
___________________________.

24. To help a burn patient who has develop an increasing dread of painful dressing changes, it would be most
appropriate to ask the physician to prescribe

A. midazolam (Versed) to be used with morphine before dressing changes

B. morphine in a dosage range so that more may be given before dressing changes
C. buprenorphine (Buprenex) to be administered with morphine before dressing changes
D. patient-controlled analgesia so that the patient may have control over analgesic administration

25. During the rehabilitation phase of wound injury, the contour of scarring can be controlled with

A. pressure garments
B. avoidance of sunlight
C. splinting joints in extension
D. application of emollient lotions