NUR 258
NUR258 Exam 2 Questions and
Answers 2026
Types of burns
Dry heat, moist heat, direct contact with hot surfaces, chemicals, electricity, ionizing
radiation, hot water, sun burn
Skin layers
Epidermis, dermis, subcutaneous layer
Burn injury common complications
- fluid loss
- electrolyte imbalance
- dehydration
- shock (↓ blood volume, ↓ tissue perfusion)
- infection
Burn: inflammatory response
- vasodilation
- ↑ capillary permeability
- edema
- tissue damage
- release of cytokines & prostaglandins (pain, inflammation)
Burn severity
Type, depth/severity, total body surface area burned
- depth
- age
- cause
- presence of other injuries
- involvement of airway & respiratory
- Overall health
Rule of nines
Determines TBSA% burned
- anatomic regions of the body
- add all affected burn areas
NUR 258
,NUR 258
Palmer method
Size of the clients hand, including fingers, is 1% TBSA
Parkland formula
4 ml x % burn (TBSA) x pt weight in kg = total fluids (ml) for 24 hours
- ½ of the total volume is given over the first 8 hrs
- remaining fluid given over next 16 hrs
What IV fluid is used for burns?
Lactated ringers: contains electrolytes
- fluid resuscitation for dehydration, hypovolemia, blood loss
Weight 75 kg
Deep thickness burns to anterior and posterior torso, and anterior and posterior of both
arms
1. What is the TBSA?
2. What is the total volume of fluid this client requires?
3. How much fluid will be administered during the first 8 hours?
4. How many ml/hr will be administered during the first 8 hours?
5. How many ml/hr will be administered during the next 16 hours?
1. 54%
2. Total fluids = 4 ml × 54% × 75 kg = 16200 ml
3. 8100 ml (half of 16200 ml)
4. 8,100 ml / 8 = 1,012.5 ml/hr
5. 8,100 ml/ 16 = 506 ml/hr
Depth of burn
1st degree
2nd degree
3rd degree
4th degree
First degree burn
- epidermis
NUR 258
,NUR 258
- superficial thickness (no TBSA)
- s/s: pain, NO blister or scar
Second degree burn
- epidermis and dermis
- partial: no surgery, scar, more painful than intermediate b/c nerve endings are
intact(epidermis)
- intermediate: surgery, scar
- s/s: severe pain, blisters, swelling
Third degree burn
- epidermis, dermis, underlying tissue
- full thickness
- s/s: charred, numbness, potential muscle/bone involvement, pain with healing b/c
nerve endings coming back
Fourth degree burn
- epidermis, dermis, underlying tissues, muscle, bone
- loss of the burned part
Burn injury classification
Minor burn
moderate burn
major burn
Minor burn
- local ED
- full thickness <2% TBSA
- partial thickness <10% TBSA
Moderate burn
- transport to burn facility
- full thickness 2-10% TBSA
- partial thickness 15-25% TBSA
Major burn
- immediate tx, transport to burn center
NUR 258
, NUR 258
- full thickness >10% TBSA
- partial thickness >25% TBSA
- other:
□ >60 yrs
□ cardiac, pulmonary, endocrine condition
□ electrical or inhalation injury
□ burns to eyes, face, hands, feet, perineum
Major burn manifestations
Edema, fluid shift, ards, intubated (alveoli damage and bronchoconstriction),
hypoperfusion, hypotension, HR ↑, blood shifts to major organs
Major Burns
•Produce a local and systemic inflammatory response
•Systemic response caused by release of cytokines and other mediators into systemic
circulation
•Resultant fluid shifts and shock cause tissue hypoperfusion and organ hypofunction
Major burn nursing priorities
- airway: patent and adequate oxygenation
- fluid resuscitation: lactated ringers, prevent hypovolemic shock
- thermoregulation (they'll be cooler, warmer later)
- pain management: analgesics, positioning
- nutrition: NG or OG tube (carbs, proteins, fats), keep NPO
Inhalation injury: upper airway
Nose, mouth
- s/s: hoarse voice, drooling, dysphagia, coughing, stridor/absent lung sounds, edema
(mouth, throat, facial, neck), singed facial hair
- tx: 1st intubation immediately, 2nd fluids (airway will swell first)
Inhalation injury: lower airway
NUR 258
NUR258 Exam 2 Questions and
Answers 2026
Types of burns
Dry heat, moist heat, direct contact with hot surfaces, chemicals, electricity, ionizing
radiation, hot water, sun burn
Skin layers
Epidermis, dermis, subcutaneous layer
Burn injury common complications
- fluid loss
- electrolyte imbalance
- dehydration
- shock (↓ blood volume, ↓ tissue perfusion)
- infection
Burn: inflammatory response
- vasodilation
- ↑ capillary permeability
- edema
- tissue damage
- release of cytokines & prostaglandins (pain, inflammation)
Burn severity
Type, depth/severity, total body surface area burned
- depth
- age
- cause
- presence of other injuries
- involvement of airway & respiratory
- Overall health
Rule of nines
Determines TBSA% burned
- anatomic regions of the body
- add all affected burn areas
NUR 258
,NUR 258
Palmer method
Size of the clients hand, including fingers, is 1% TBSA
Parkland formula
4 ml x % burn (TBSA) x pt weight in kg = total fluids (ml) for 24 hours
- ½ of the total volume is given over the first 8 hrs
- remaining fluid given over next 16 hrs
What IV fluid is used for burns?
Lactated ringers: contains electrolytes
- fluid resuscitation for dehydration, hypovolemia, blood loss
Weight 75 kg
Deep thickness burns to anterior and posterior torso, and anterior and posterior of both
arms
1. What is the TBSA?
2. What is the total volume of fluid this client requires?
3. How much fluid will be administered during the first 8 hours?
4. How many ml/hr will be administered during the first 8 hours?
5. How many ml/hr will be administered during the next 16 hours?
1. 54%
2. Total fluids = 4 ml × 54% × 75 kg = 16200 ml
3. 8100 ml (half of 16200 ml)
4. 8,100 ml / 8 = 1,012.5 ml/hr
5. 8,100 ml/ 16 = 506 ml/hr
Depth of burn
1st degree
2nd degree
3rd degree
4th degree
First degree burn
- epidermis
NUR 258
,NUR 258
- superficial thickness (no TBSA)
- s/s: pain, NO blister or scar
Second degree burn
- epidermis and dermis
- partial: no surgery, scar, more painful than intermediate b/c nerve endings are
intact(epidermis)
- intermediate: surgery, scar
- s/s: severe pain, blisters, swelling
Third degree burn
- epidermis, dermis, underlying tissue
- full thickness
- s/s: charred, numbness, potential muscle/bone involvement, pain with healing b/c
nerve endings coming back
Fourth degree burn
- epidermis, dermis, underlying tissues, muscle, bone
- loss of the burned part
Burn injury classification
Minor burn
moderate burn
major burn
Minor burn
- local ED
- full thickness <2% TBSA
- partial thickness <10% TBSA
Moderate burn
- transport to burn facility
- full thickness 2-10% TBSA
- partial thickness 15-25% TBSA
Major burn
- immediate tx, transport to burn center
NUR 258
, NUR 258
- full thickness >10% TBSA
- partial thickness >25% TBSA
- other:
□ >60 yrs
□ cardiac, pulmonary, endocrine condition
□ electrical or inhalation injury
□ burns to eyes, face, hands, feet, perineum
Major burn manifestations
Edema, fluid shift, ards, intubated (alveoli damage and bronchoconstriction),
hypoperfusion, hypotension, HR ↑, blood shifts to major organs
Major Burns
•Produce a local and systemic inflammatory response
•Systemic response caused by release of cytokines and other mediators into systemic
circulation
•Resultant fluid shifts and shock cause tissue hypoperfusion and organ hypofunction
Major burn nursing priorities
- airway: patent and adequate oxygenation
- fluid resuscitation: lactated ringers, prevent hypovolemic shock
- thermoregulation (they'll be cooler, warmer later)
- pain management: analgesics, positioning
- nutrition: NG or OG tube (carbs, proteins, fats), keep NPO
Inhalation injury: upper airway
Nose, mouth
- s/s: hoarse voice, drooling, dysphagia, coughing, stridor/absent lung sounds, edema
(mouth, throat, facial, neck), singed facial hair
- tx: 1st intubation immediately, 2nd fluids (airway will swell first)
Inhalation injury: lower airway
NUR 258
