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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 patient's 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.

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2. The current phase of a patient's 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 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 débridement, 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.

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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 patient's 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.

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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.

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