The nurse is monitoring the nutritional status of a burn patient. Which indicators does the nurse use?

The nurse is monitoring the nutritional status of a burn patient. Which indicators does the nurse use?

a. amount of food that is eaten
b. weight to height ratio
c. serum albumin
d. amount of water the patient drinks
e. blood glucose
f. serum K

Answer: A, B, C & E.

What method does the nurse use to correctly weigh a burn patient?

What method does the nurse use to correctly weigh a burn patient?

a. weigh once a week after morning hygiene and compare previous weight
b. weight daily at the same time of day and compare to preburn weight
c. use a bed scale and subtract the estimated weight of linens
d. weigh daily without dressings or splints and compare to preburn weight.

Answer: D

The nurse is caring for a burn patients about to undergo hydrotherapy. Which complementary therapies are appropriate for pain management in this patient?

The nurse is caring for a burn patients about to undergo hydrotherapy. Which complementary therapies are appropriate for pain management in this patient?

a. administration of IV opioids
b. allowing the patient to make decisions regarding pain control
c. playing background music
d. use of meditative breathing
e. use of guided imagery

Answer: C, D & E.

The vasodilating effects of carbon monoxide in patients with carbon monoxide poisoning causes what clinical manifestation?

The vasodilating effects of carbon monoxide in patients with carbon monoxide poisoning causes what clinical manifestation?

a. cyanosis around the lips
b. generalized pallor
c. cherry red skin color
d. mottled skin color

Answer: C

A burn patient in the fluid resuscitation phase is experiencing dyspnea. What are the priority interventions for this patient?

A burn patient in the fluid resuscitation phase is experiencing dyspnea. What are the priority interventions for this patient?

a. elevate HOB to 45 degrees
b. maintain patient in the supine position
c. notify the rapid response team
d. administer an analgesic to calm the patient
e. apply humidified oxygen

Answer: A, C & E.

The release of myoglobin from damaged muscle in patients with major burns can result in which potential complication?

The release of myoglobin from damaged muscle in patients with major burns can result in which potential complication?

a. paralytic ileus
b. AKI
c. limited mobility
d. hypovolemia

Answer: B

Which statement about the resuscitation phase of a burn injury is accurate?

Which statement about the resuscitation phase of a burn injury is accurate?

a. it occurs in the prehospital timeframe
b. it continues for about 4 hours after the burn
c. it continues for about 48 hours after the burn
d. it continues until the patient is stable

Answer: C

The priority expected outcome during the resuscitation phase of a burn injury is to maintain which factor?

The priority expected outcome during the resuscitation phase of a burn injury is to maintain which factor?

a. airway
b. CO
c. fluid replacement
d. comfort

Answer: A

A patient was admitted for burns to the upper extremities after being trapped in a burning structure. The patient is also at risk for inadequate oxygenation r/t inhalation of smoke and superheated fumes. Which diagnostic test best monitors this patient's gas exchange?

A patient was admitted for burns to the upper extremities after being trapped in a burning structure. The patient is also at risk for inadequate oxygenation r/t inhalation of smoke and superheated fumes. Which diagnostic test best monitors this patient's gas exchange?

a. CBC
b. myoglobin level
c. carboxyhemoglobin level
d. CXR

Answer: C

A burn patient with which condition is most likely to have mannitol ordered as part of the drug therapy?

A burn patient with which condition is most likely to have mannitol ordered as part of the drug therapy?

a. peripheral edema associated with burns on the lower extremities
b. inhalation burns around the mouth causing mucosal swelling
c. electrical burns and myoglobin in the urine
b. smoke inhalation and superficial burns to the forearm

Answer: C

The nurse is caring for several patients on the unit. Which of the patients has the most acute need for cardiac monitoring?

The nurse is caring for several patients on the unit. Which of the patients has the most acute need for cardiac monitoring?

a. older adult woman who spilled hot water over her legs while boiling noodles
b. teenager with facial burns that occurred when he threw gasoline on a campfire
c. middle-aged man who fell asleep while smoking and sustained burns on his chest.
d. young woman who was struck by lightning while jogging on the beach

Answer: D

The nurse is caring for a burn patient who was stabilized by and transferred from another hospital. The patient develops a new complaint of SOB. On auscultation, the nurse hears crackles throughout the lung field. What does the nurse suspect is causing the patients symptoms?

The nurse is caring for a burn patient who was stabilized by and transferred from another hospital. The patient develops a new complaint of SOB. On auscultation, the nurse hears crackles throughout the lung field. What does the nurse suspect is causing the patients symptoms?

a. pulmonary fluid overload due to fluid resuscitation
b. exposure to carbon monoxide that was undiagnosed
c. fat emboli secondary to extensive injury
d. excessive oxygen therapy at the first facility

Answer: A

The nurse is caring for a firefighter who was trapped for a prolonged period of time by burning debris. During the shift, the nurse notes a progressive hoarseness, a brassy cough, and the patient reports increased difficulty with swallowing. How does the nurse interpret these changes?

The nurse is caring for a firefighter who was trapped for a prolonged period of time by burning debris. During the shift, the nurse notes a progressive hoarseness, a brassy cough, and the patient reports increased difficulty with swallowing. How does the nurse interpret these changes?

a. temporary discomfort that can be treated with sips of cool fluids
b. s/s of probable carbon monoxide poisoning
c. signs indicating a pulmonary injury and possible airway obstruction
d. expected findings considering the mechanism of injury

Answer: C

A patient has sustained a burn which appears red and moist. The nurse gently applies pressure to the area to assess for what s/s?

A patient has sustained a burn which appears red and moist. The nurse gently applies pressure to the area to assess for what s/s?

a. intensity of pain
b. blanching
c. pitting edema
d. fluid-filled blisters

Answer: B

Which vaccine is routinely administered when a burn patient is admitted to the hospital?

Which vaccine is routinely administered when a burn patient is admitted to the hospital?

a. Hep B
b. tetanus
c. influenza
d. pneumonia

Answer: B

An adult patient is admitted to the burn unit after being burned in a house fire. Assessment findings reveal burns to the entire face, back of the head, anterior torso, and circumferential burns to both arms. What is the extent of the burn injury?

An adult patient is admitted to the burn unit after being burned in a house fire. Assessment findings reveal burns to the entire face, back of the head, anterior torso, and circumferential burns to both arms. What is the extent of the burn injury?

a. 18%
b. 24%
c. 45%
d. 54%

Answer: C

During the early phase of the burn injury, there is a drastic increase in capillary permeability. What does this physiologic change place the patient at risk for?

During the early phase of the burn injury, there is a drastic increase in capillary permeability. What does this physiologic change place the patient at risk for?

a. AKI
b. fluid overload
c. increased CO
d. hypovolemic shock

Answer: D

Which type of burn destroys the sweat glands, resulting in decreased excretory glands?

Which type of burn destroys the sweat glands, resulting in decreased excretory glands?

a. superficial
b. partial thickness
c. full-thickness
d. deep full-thickness

Answer: C

Which type of burn wound damages the epidermis, dermis, fascia, and tissues?

Which type of burn wound damages the epidermis, dermis, fascia, and tissues?

a. superficial
b. partial thickness
c. full-thickness
d. deep full-thickness

Answer: D

The nurse observes peeling of dead skin on the legs of a patient with a superficial thickness burn wound. What is the most accurate description of this assessment finding?

The nurse observes peeling of dead skin on the legs of a patient with a superficial thickness burn wound. What is the most accurate description of this assessment finding?

a. blanching
b. desquamation
c. slough
d. fluid shift





Answer: B