C HAPTER 35: B URNS
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. Which topical antimicrobial agent is commonl y used as a broad -spectrum
and fights against gram -positive and -negative bacteria?
a. Pure silver
b. Bacitracin
c. Mafenide acetate cream
d. Silver sulfadiazine
ANS: D
Silver sulfadiazine (SSD; Silvadene cream) is a broad -spectrum
antimicrobial agent with bactericidal action against many gram -
negative and -positive bacteria associated with burn wound infection.
Mafenide acetate cream penetrate s through burn eschar and is
bacteriostatic against many gram -negative and -positive organisms. Its
use is limited because the application is uncomfortable for the patient
because it creates a burning sensation, and it is rapidl y absorbed,
requiring dressi ng changes two or three times dail y. It is used routinel y
for coverage of small wounds. Bacitracin ointment is a topical agent
applied to superficial burns and facial burns. Bacitracin is effective
against gram-positive organisms but not against gram -negative
organisms or fungal organisms. Silver has long been used for the
treatment of wounds because of its broad -spectrum bacteriostatic
properties. The wound moisture activates the silver and releases it into
the wound. An advantage of silver dressings is th at the dressing does
, not need to be changed dail y because of the sustained release of silver.
Silver dressings should be used judiciously and limited to 4 to 6 weeks
despite the current absence of negative systemic or local consequences.
DIF: Cognitive Le vel: Appl ying REF: p. 855 | Table 35 -2
OBJ: Nursing Process Step: Intervention TOP:
Burns MSC: NC LEX: Physiologic Integrit y
2. A patient is admitted after being burned in a car fire. The wound surface
is red with patchy white areas that blanch with pres sure but no blister
formation. What kind of burn would the nurse document in the patient’s
record?
a. Superficial partial -thickness burn
b. Moderate partial -thickness burn
c. Deep dermal partial -thickness burn
d. Full-thickness burn
ANS: C
Deep-dermal partial-thickness (second -degree) burns involve the entire
epidermal layer and deeper layers of the dermis. A deep -dermal partial -
thickness burn usually is not characterized by blister formation. Onl y a
modest plasma surface leakage occurs because of severe impairment i n
blood suppl y. The wound surface usuall y is red with patchy white areas
that blanch with pressure.
DIF: Cognitive Level: Remembering REF: p. 842 | p. 862
OBJ: Nursing Process Step: Assessment TOP: Burns
MSC: NC LEX: Physiologic Integrit y
, 3. A patient is brought to the emergency department after a house fire. He
fell asleep with a lit cigarette, and the couch ignited. What is the nurse’s
first priorit y?
a. Clean the wounds and remove blisters.
b. Assess the airway and provide 100% ox ygen.
c. Place a urinary drain age catheter and assess for m yoglobin.
d. Place a central intravenous access and provide antibiotics.
ANS: B
The first priorit y of emergency burn care is to secure and protect the
airway. All patients with major burns or suspected inhalation injury are
initiall y administered 100% ox ygen.
DIF: Cognitive Level: Appl ying REF: p. 846 OBJ:
Nursing Process Step: Intervention TOP: Burns MSC:
NCLEX: Physiologic Integrit y
4. A patient is brought to the emergency department after a house fire. He
fell asleep with a lit cigarette, and the couch ignited. Total body surface
area (TBSA) burn is estimated at 25% deep partial -thickness burns to
areas of the chest, back, and left arm and 20% full -thickness burns to the
right arm, right upper leg, and areas on the face. Th e patient’s weight is
estimated at 85 kg. What is the initial plan for fluid replacement?
a. 5950 mL of Lactated Ringer (LR) solution for the first 8 hours; then
5950 mL of LR over the next 16 hours
b. 2868 mL of normal saline (NS) for the first 8 hours; then 57 37 mL
of hypertonic NS over the next 16 hours
c. 11,900 m L of dextran evenl y divided over the first 24 hours
d. 11,475 m L of LR evenl y divided over the first 24 hours
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. Which topical antimicrobial agent is commonl y used as a broad -spectrum
and fights against gram -positive and -negative bacteria?
a. Pure silver
b. Bacitracin
c. Mafenide acetate cream
d. Silver sulfadiazine
ANS: D
Silver sulfadiazine (SSD; Silvadene cream) is a broad -spectrum
antimicrobial agent with bactericidal action against many gram -
negative and -positive bacteria associated with burn wound infection.
Mafenide acetate cream penetrate s through burn eschar and is
bacteriostatic against many gram -negative and -positive organisms. Its
use is limited because the application is uncomfortable for the patient
because it creates a burning sensation, and it is rapidl y absorbed,
requiring dressi ng changes two or three times dail y. It is used routinel y
for coverage of small wounds. Bacitracin ointment is a topical agent
applied to superficial burns and facial burns. Bacitracin is effective
against gram-positive organisms but not against gram -negative
organisms or fungal organisms. Silver has long been used for the
treatment of wounds because of its broad -spectrum bacteriostatic
properties. The wound moisture activates the silver and releases it into
the wound. An advantage of silver dressings is th at the dressing does
, not need to be changed dail y because of the sustained release of silver.
Silver dressings should be used judiciously and limited to 4 to 6 weeks
despite the current absence of negative systemic or local consequences.
DIF: Cognitive Le vel: Appl ying REF: p. 855 | Table 35 -2
OBJ: Nursing Process Step: Intervention TOP:
Burns MSC: NC LEX: Physiologic Integrit y
2. A patient is admitted after being burned in a car fire. The wound surface
is red with patchy white areas that blanch with pres sure but no blister
formation. What kind of burn would the nurse document in the patient’s
record?
a. Superficial partial -thickness burn
b. Moderate partial -thickness burn
c. Deep dermal partial -thickness burn
d. Full-thickness burn
ANS: C
Deep-dermal partial-thickness (second -degree) burns involve the entire
epidermal layer and deeper layers of the dermis. A deep -dermal partial -
thickness burn usually is not characterized by blister formation. Onl y a
modest plasma surface leakage occurs because of severe impairment i n
blood suppl y. The wound surface usuall y is red with patchy white areas
that blanch with pressure.
DIF: Cognitive Level: Remembering REF: p. 842 | p. 862
OBJ: Nursing Process Step: Assessment TOP: Burns
MSC: NC LEX: Physiologic Integrit y
, 3. A patient is brought to the emergency department after a house fire. He
fell asleep with a lit cigarette, and the couch ignited. What is the nurse’s
first priorit y?
a. Clean the wounds and remove blisters.
b. Assess the airway and provide 100% ox ygen.
c. Place a urinary drain age catheter and assess for m yoglobin.
d. Place a central intravenous access and provide antibiotics.
ANS: B
The first priorit y of emergency burn care is to secure and protect the
airway. All patients with major burns or suspected inhalation injury are
initiall y administered 100% ox ygen.
DIF: Cognitive Level: Appl ying REF: p. 846 OBJ:
Nursing Process Step: Intervention TOP: Burns MSC:
NCLEX: Physiologic Integrit y
4. A patient is brought to the emergency department after a house fire. He
fell asleep with a lit cigarette, and the couch ignited. Total body surface
area (TBSA) burn is estimated at 25% deep partial -thickness burns to
areas of the chest, back, and left arm and 20% full -thickness burns to the
right arm, right upper leg, and areas on the face. Th e patient’s weight is
estimated at 85 kg. What is the initial plan for fluid replacement?
a. 5950 mL of Lactated Ringer (LR) solution for the first 8 hours; then
5950 mL of LR over the next 16 hours
b. 2868 mL of normal saline (NS) for the first 8 hours; then 57 37 mL
of hypertonic NS over the next 16 hours
c. 11,900 m L of dextran evenl y divided over the first 24 hours
d. 11,475 m L of LR evenl y divided over the first 24 hours
