Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1167
Management of Patients
Chapter 62: Managements of Patients with Burn Injury
1. A patient is brought to the emergency department from the site of a chemical fire, where he suffered a
burn that involves the epidermis, dermis, and the muscle and bone of the right arm. On inspection, the
skin appears charred. Based on these assessment findings, what is the depth of the burn on the patients
arm?
A) Superficial partial-thickness
B) Deep partial-thickness
C) Full partial-thickness
D) Full-thickness
Ans: D
Feedback:
A full-thickness burn involves total destruction of the epidermis and dermis and, in some cases,
underlying tissue as well. Wound color ranges widely from white to red, brown, or black. The burned
area is painless because the nerve fibers are destroyed. The wound can appear leathery; hair follicles and
sweat glands are destroyed. Edema may also be present. Superficial partial-thickness burns involve the
epidermis and possibly a portion of the dermis; the patient will experience pain that is soothed by
cooling. Deep partial-thickness burns involve the epidermis, upper dermis, and portion of the deeper
dermis; the patient will complain of pain and sensitivity to cold air. Full partial thickness is not a depth
of burn.
2. The current phase of a patients treatment for a burn injury prioritizes wound care, nutritional support,
and prevention of complications such as infection. Based on these care priorities, the patient is in what
phase of burn care?
A) Emergent
B) Immediate resuscitative
C) Acute
D) Rehabilitation
Ans: C
Feedback:
The acute or intermediate phase of burn care follows the emergent/resuscitative phase and begins 48 to
72 hours after the burn injury. During this phase, attention is directed toward continued assessment and
,Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1168
maintenance of respiratory and circulatory status, fluid and electrolyte balance, and gastrointestinal
function. Infection prevention, burn wound care (i.e., wound cleaning, topical antibacterial therapy,
wound dressing, dressing changes, wound dbridement, and wound grafting), pain management, and
nutritional support are priorities at this stage. Priorities during the emergent or immediate resuscitative
phase include first aid, prevention of shock and respiratory distress, detection and treatment of
concomitant injuries, and initial wound assessment and care. The priorities during the rehabilitation
phase include prevention of scars and contractures, rehabilitation, functional and cosmetic
reconstruction, and psychosocial counseling.
3. A patient in the emergent/resuscitative phase of a burn injury has had blood work and arterial blood
gases drawn. Upon analysis of the patients laboratory studies, the nurse will expect the results to indicate
what?
A) Hyperkalemia, hyponatremia, elevated hematocrit, and metabolic acidosis
B) Hypokalemia, hypernatremia, decreased hematocrit, and metabolic acidosis
C) Hyperkalemia, hypernatremia, decreased hematocrit, and metabolic alkalosis
D) Hypokalemia, hyponatremia, elevated hematocrit, and metabolic alkalosis
Ans: A
Feedback:
Fluid and electrolyte changes in the emergent/resuscitative phase of a burn injury include hyperkalemia
related to the release of potassium into the extracellular fluid, hyponatremia from large amounts of
sodium lost in trapped edema fluid, hemoconcentration that leads to an increased hematocrit, and loss of
bicarbonate ions that results in metabolic acidosis.
4. A patient has experienced an electrical burn and has developed thick eschar over the burn site. Which of
the following topical antibacterial agents will the nurse expect the physician to order for the wound?
A) Silver sulfadiazine 1% (Silvadene) water-soluble cream
B) Mafenide acetate 10% (Sulfamylon) hydrophilic-based cream
C) Silver nitrate 0.5% aqueous solution
D) Acticoat
Ans: B
Feedback:
Mafenide acetate 10% hydrophilic-based cream is the agent of choice when there is a need to penetrate
thick eschar. Silver products do not penetrate eschar; Acticoat is a type of silver dressing.
, Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1169
5. An occupational health nurse is called to the floor of a factory where a worker has sustained a flash burn
to the right arm. The nurse arrives and the flames have been extinguished. The next step is to cool the
burn. How should the nurse cool the burn?
A) Apply ice to the site of the burn for 5 to 10 minutes.
B) Wrap the patients affected extremity in ice until help arrives.
C) Apply an oil-based substance or butter to the burned area until help arrives.
D) Wrap cool towels around the affected extremity intermittently.
Ans: D
Feedback:
Once the burn has been sustained, the application of cool water is the best first-aid measure. Soaking the
burn area intermittently in cool water or applying cool towels gives immediate and striking relief from
pain, and limits local tissue edema and damage. However, never apply ice directly to the burn, never
wrap the person in ice, and never use cold soaks or dressings for longer than several minutes; such
procedures may worsen the tissue damage and lead to hypothermia in people with large burns. Butter is
contraindicated.
6. An emergency department nurse has just admitted a patient with a burn. What characteristic of the burn
will primarily determine whether the patient experiences a systemic response to this injury?
A) The length of time since the burn
B) The location of burned skin surfaces
C) The source of the burn
D) The total body surface area (TBSA) affected by the burn
Ans: D
Feedback:
Systemic effects are a result of several variables. However, TBSA and wound severity are considered the
major factors that affect the presence or absence of systemic effects.
7. A nurse on a burn unit is caring for a patient in the acute phase of burn care. While performing an
assessment during this phase of burn care, the nurse recognizes that airway obstruction related to upper
airway edema may occur up to how long after the burn injury?
Management of Patients
Chapter 62: Managements of Patients with Burn Injury
1. A patient is brought to the emergency department from the site of a chemical fire, where he suffered a
burn that involves the epidermis, dermis, and the muscle and bone of the right arm. On inspection, the
skin appears charred. Based on these assessment findings, what is the depth of the burn on the patients
arm?
A) Superficial partial-thickness
B) Deep partial-thickness
C) Full partial-thickness
D) Full-thickness
Ans: D
Feedback:
A full-thickness burn involves total destruction of the epidermis and dermis and, in some cases,
underlying tissue as well. Wound color ranges widely from white to red, brown, or black. The burned
area is painless because the nerve fibers are destroyed. The wound can appear leathery; hair follicles and
sweat glands are destroyed. Edema may also be present. Superficial partial-thickness burns involve the
epidermis and possibly a portion of the dermis; the patient will experience pain that is soothed by
cooling. Deep partial-thickness burns involve the epidermis, upper dermis, and portion of the deeper
dermis; the patient will complain of pain and sensitivity to cold air. Full partial thickness is not a depth
of burn.
2. The current phase of a patients treatment for a burn injury prioritizes wound care, nutritional support,
and prevention of complications such as infection. Based on these care priorities, the patient is in what
phase of burn care?
A) Emergent
B) Immediate resuscitative
C) Acute
D) Rehabilitation
Ans: C
Feedback:
The acute or intermediate phase of burn care follows the emergent/resuscitative phase and begins 48 to
72 hours after the burn injury. During this phase, attention is directed toward continued assessment and
,Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1168
maintenance of respiratory and circulatory status, fluid and electrolyte balance, and gastrointestinal
function. Infection prevention, burn wound care (i.e., wound cleaning, topical antibacterial therapy,
wound dressing, dressing changes, wound dbridement, and wound grafting), pain management, and
nutritional support are priorities at this stage. Priorities during the emergent or immediate resuscitative
phase include first aid, prevention of shock and respiratory distress, detection and treatment of
concomitant injuries, and initial wound assessment and care. The priorities during the rehabilitation
phase include prevention of scars and contractures, rehabilitation, functional and cosmetic
reconstruction, and psychosocial counseling.
3. A patient in the emergent/resuscitative phase of a burn injury has had blood work and arterial blood
gases drawn. Upon analysis of the patients laboratory studies, the nurse will expect the results to indicate
what?
A) Hyperkalemia, hyponatremia, elevated hematocrit, and metabolic acidosis
B) Hypokalemia, hypernatremia, decreased hematocrit, and metabolic acidosis
C) Hyperkalemia, hypernatremia, decreased hematocrit, and metabolic alkalosis
D) Hypokalemia, hyponatremia, elevated hematocrit, and metabolic alkalosis
Ans: A
Feedback:
Fluid and electrolyte changes in the emergent/resuscitative phase of a burn injury include hyperkalemia
related to the release of potassium into the extracellular fluid, hyponatremia from large amounts of
sodium lost in trapped edema fluid, hemoconcentration that leads to an increased hematocrit, and loss of
bicarbonate ions that results in metabolic acidosis.
4. A patient has experienced an electrical burn and has developed thick eschar over the burn site. Which of
the following topical antibacterial agents will the nurse expect the physician to order for the wound?
A) Silver sulfadiazine 1% (Silvadene) water-soluble cream
B) Mafenide acetate 10% (Sulfamylon) hydrophilic-based cream
C) Silver nitrate 0.5% aqueous solution
D) Acticoat
Ans: B
Feedback:
Mafenide acetate 10% hydrophilic-based cream is the agent of choice when there is a need to penetrate
thick eschar. Silver products do not penetrate eschar; Acticoat is a type of silver dressing.
, Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1169
5. An occupational health nurse is called to the floor of a factory where a worker has sustained a flash burn
to the right arm. The nurse arrives and the flames have been extinguished. The next step is to cool the
burn. How should the nurse cool the burn?
A) Apply ice to the site of the burn for 5 to 10 minutes.
B) Wrap the patients affected extremity in ice until help arrives.
C) Apply an oil-based substance or butter to the burned area until help arrives.
D) Wrap cool towels around the affected extremity intermittently.
Ans: D
Feedback:
Once the burn has been sustained, the application of cool water is the best first-aid measure. Soaking the
burn area intermittently in cool water or applying cool towels gives immediate and striking relief from
pain, and limits local tissue edema and damage. However, never apply ice directly to the burn, never
wrap the person in ice, and never use cold soaks or dressings for longer than several minutes; such
procedures may worsen the tissue damage and lead to hypothermia in people with large burns. Butter is
contraindicated.
6. An emergency department nurse has just admitted a patient with a burn. What characteristic of the burn
will primarily determine whether the patient experiences a systemic response to this injury?
A) The length of time since the burn
B) The location of burned skin surfaces
C) The source of the burn
D) The total body surface area (TBSA) affected by the burn
Ans: D
Feedback:
Systemic effects are a result of several variables. However, TBSA and wound severity are considered the
major factors that affect the presence or absence of systemic effects.
7. A nurse on a burn unit is caring for a patient in the acute phase of burn care. While performing an
assessment during this phase of burn care, the nurse recognizes that airway obstruction related to upper
airway edema may occur up to how long after the burn injury?
