BURNS NCLEX QUESTION AND BURN
INJURY NURSING MANAGEMENT
(PART 3: 20 ITEMS)
1. Question
Nurse Malcolm is performing a sterile dressing change on a client
with a superficial partial-thickness burn on the shoulder and
back. Arrange the steps in the order in which each should
be performed.
View Answers:
o Apply silver nitrate ointment.
o Obtain a sample for wound culture.
o Administer Tramadol (Tramal) 50 mg IV.
o Debride the wound of eschar using gauze sponges.
o Cover the wound using a sterile gauze dressing.
The correct order is shown above
Rationale:
Pain medication is administered prior to the dressing
change since the type of burn will be painful during
the procedure. Opioids may be required initially to
control pain, but once first aid measures have been
effective non-steroidal anti-inflammatory drugs such
as ibuprofen or co-dydramol taken orally will suffice.
Then the wound is debrided before getting the sample
for culture to prevent other bacteria that can
contaminate the actual wound. It is important to
realize that a new burn is essentially sterile, and every
attempt should be made to keep it so. The burn wound
should be thoroughly cleaned with soap and water or
mild antibacterial wash such as dilute chlorhexidine.
Obtain a sample for wound culture. Burn wound
infections are one of the most important and
potentially serious complications that occur in the
acute period following injury
, An antibacterial cream such as silver nitrate is applied
to the area to attain the maximum effect of the
medication. Flamazine is silver sulfadiazine cream and
is applied topically on the burn wound. It is effective
against gram-negative bacteria including
Pseudomonas.
Lastly, cover the wound using a sterile dressing.
Depending on how healing is progressing, dressing
changes thereafter should be every three to five days.
If the Jelonet dressing has become adherent, it should
be left in place to avoid damage to the delicate
healing epithelium. If Flamazine is used it should be
changed on alternate days.
2. 2. Question
Which of the following medications given to a 12-year-old client
for the treatment of deep partial-thickness burn is
the most important to double-check with another licensed nurse
before administering it?
A. Aloe Vera Relief Burn spray.
B. Silver Sulfadiazine ointment.
C. Omeprazole 20 mg slow IV push.
D. Amitriptyline (Elavil) 50 mg PO.
Correct Answer: D. Amitriptyline (Elavil) 50 mg PO.
Amitriptyline (Elavil) is useful in the management of neuropathic
pain following burn injury and since it is an antidepressant if
given with a child, utmost precaution is given. The FDA has
issued a black box warning regarding the use of amitriptyline in
adolescents and young adults (ages less than 24 years). It can
increase the risk of suicidal ideation and behavior.
Option A: Omeprazole is indicated for the short-term
treatment of peptic ulcer disease in adults where most
patients heal within four weeks. Patients with
duodenal ulcer disease and H. pylori infection disease
that is active for up to one year may benefit from
, combination therapy that includes omeprazole with
clarithromycin, amoxicillin, and metronidazole.
Option B: Silver sulfadiazine is a medication used in
the prevention, management, and treatment of burn
wound infections. It is a heavy metal topical agent
with antibacterial properties. Typically burn dressings
consist of topical silver sulfadiazine combined with fine
mesh gauze and are usable in both the inpatient and
outpatient settings.
Option C: All health facilities practice double-
checking of medications prior to administration, Of all
the medications given, Amitriptyline is the most
important to double-check with another licensed
nurse.
3. 3. Question
The nurse is administering fluids intravenously as ordered to a
client who acquired a full-thickness burn injury on the abdomen.
To determine the sufficiency of fluid resuscitation, the nurse
would monitor which of the following would provide
the most reliable parameter for determining adequacy?
A. Level of consciousness
B. Peripheral pulses
C. Urine output
D. Vital signs
Correct Answer: C. Urine output
Of all the options, urine output is the most reliable indicator for
determining the adequacy of fluid resuscitation. Urine output of
0.5 mL/kg or about 30 – 50 mL/hr in adults and 0.5-1.0 mL/kg/hr
in children less than 30kg is a good target for adequate fluid
resuscitation.
Option A: Heart rate, mental status, and capillary
refill may be affected by the underlying disease
process and are less reliable markers. The actual
endpoint of fluid therapy in shock is to optimize tissue
perfusion. However, this parameter is not measured
INJURY NURSING MANAGEMENT
(PART 3: 20 ITEMS)
1. Question
Nurse Malcolm is performing a sterile dressing change on a client
with a superficial partial-thickness burn on the shoulder and
back. Arrange the steps in the order in which each should
be performed.
View Answers:
o Apply silver nitrate ointment.
o Obtain a sample for wound culture.
o Administer Tramadol (Tramal) 50 mg IV.
o Debride the wound of eschar using gauze sponges.
o Cover the wound using a sterile gauze dressing.
The correct order is shown above
Rationale:
Pain medication is administered prior to the dressing
change since the type of burn will be painful during
the procedure. Opioids may be required initially to
control pain, but once first aid measures have been
effective non-steroidal anti-inflammatory drugs such
as ibuprofen or co-dydramol taken orally will suffice.
Then the wound is debrided before getting the sample
for culture to prevent other bacteria that can
contaminate the actual wound. It is important to
realize that a new burn is essentially sterile, and every
attempt should be made to keep it so. The burn wound
should be thoroughly cleaned with soap and water or
mild antibacterial wash such as dilute chlorhexidine.
Obtain a sample for wound culture. Burn wound
infections are one of the most important and
potentially serious complications that occur in the
acute period following injury
, An antibacterial cream such as silver nitrate is applied
to the area to attain the maximum effect of the
medication. Flamazine is silver sulfadiazine cream and
is applied topically on the burn wound. It is effective
against gram-negative bacteria including
Pseudomonas.
Lastly, cover the wound using a sterile dressing.
Depending on how healing is progressing, dressing
changes thereafter should be every three to five days.
If the Jelonet dressing has become adherent, it should
be left in place to avoid damage to the delicate
healing epithelium. If Flamazine is used it should be
changed on alternate days.
2. 2. Question
Which of the following medications given to a 12-year-old client
for the treatment of deep partial-thickness burn is
the most important to double-check with another licensed nurse
before administering it?
A. Aloe Vera Relief Burn spray.
B. Silver Sulfadiazine ointment.
C. Omeprazole 20 mg slow IV push.
D. Amitriptyline (Elavil) 50 mg PO.
Correct Answer: D. Amitriptyline (Elavil) 50 mg PO.
Amitriptyline (Elavil) is useful in the management of neuropathic
pain following burn injury and since it is an antidepressant if
given with a child, utmost precaution is given. The FDA has
issued a black box warning regarding the use of amitriptyline in
adolescents and young adults (ages less than 24 years). It can
increase the risk of suicidal ideation and behavior.
Option A: Omeprazole is indicated for the short-term
treatment of peptic ulcer disease in adults where most
patients heal within four weeks. Patients with
duodenal ulcer disease and H. pylori infection disease
that is active for up to one year may benefit from
, combination therapy that includes omeprazole with
clarithromycin, amoxicillin, and metronidazole.
Option B: Silver sulfadiazine is a medication used in
the prevention, management, and treatment of burn
wound infections. It is a heavy metal topical agent
with antibacterial properties. Typically burn dressings
consist of topical silver sulfadiazine combined with fine
mesh gauze and are usable in both the inpatient and
outpatient settings.
Option C: All health facilities practice double-
checking of medications prior to administration, Of all
the medications given, Amitriptyline is the most
important to double-check with another licensed
nurse.
3. 3. Question
The nurse is administering fluids intravenously as ordered to a
client who acquired a full-thickness burn injury on the abdomen.
To determine the sufficiency of fluid resuscitation, the nurse
would monitor which of the following would provide
the most reliable parameter for determining adequacy?
A. Level of consciousness
B. Peripheral pulses
C. Urine output
D. Vital signs
Correct Answer: C. Urine output
Of all the options, urine output is the most reliable indicator for
determining the adequacy of fluid resuscitation. Urine output of
0.5 mL/kg or about 30 – 50 mL/hr in adults and 0.5-1.0 mL/kg/hr
in children less than 30kg is a good target for adequate fluid
resuscitation.
Option A: Heart rate, mental status, and capillary
refill may be affected by the underlying disease
process and are less reliable markers. The actual
endpoint of fluid therapy in shock is to optimize tissue
perfusion. However, this parameter is not measured
