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Exam Prep Questions

1.The nurse is caring for a client with an electrical burn. Which structures have the greatest risk for soft tissue injury?

A.Fat, tendons, and bones
B.Skin and hair
C.Nerves, muscle, and blood vessels
D.Skin, fat, and muscle


2.Which laboratory result would be expected during the emergent phase of a burn injury?

A.Glucose 100 mg/dL
B.Potassium 3.5 mEq/L
C.Sodium 142 mEq/L
D.Albumin 4.2 gm/dL


3.An African American client is admitted with full thickness burns over 40% of his body. In addition to the CBC and complete metabolic panel, the physician is likely to request which additional blood-work?

A.Erythrocyte sedimentation rate
B.Indirect Coombs
C.C reactive protein
D.Sickledex


4.A client weighing 76 kg is admitted at 0600 with a TBSA burn of 40%. Using the Parkland formula, the client’s 24-hour intravenous fluid replacement should be:

A.6,080 mL
B.9,120 mL
C.12,160 mL
D.15,180 mL


5.On the third post-burn day, the nurse finds that the client’s hourly urine output is 26 ml. The nurse should continue to assess the client and notify the doctor for an order to:

A.Decrease the rate of the intravenous infusion.
B.Change the type of intravenous fluid being administered.
C.Change the urinary catheter.
D.Increase the rate of the intravenous infusion.


6.A Jewish client requires grafting to promote burn healing. Which graft is most likely to be unacceptable to the client?

A.Isograft
B.Autograft
C.Homograft
D.Xenograft


7.During the rehabilitative phase, the client’s burns become infected with pseudomonas. The topical dressing most likely to be ordered for the client is:

A.Silver sulfadiazine (Silvadene)
B.Poviodine (Betadine)
C.Mafenide acetate (Sulfamylon)
D.Silver nitrate


8.The CVP reading of a client with partial thickness burns is 6 mm H2O. The nurse recognizes that the client:

A.Needs additional fluids
B.Has a normal CVP reading
C.May show signs of congestive failure
D.Would benefit from a diuretic


9.The physician has prescribed Protonix (pantoprazole) for a client with burns. The nurse recognizes that the medication will help prevent the development of:

A.Curling’s ulcer
B.Myoglobinuria
C.Hyperkalemia
D.Paralytic ileus


10.The nurse has just completed the dressing change for a client with burns to the lower legs and ankles. The nurse should place the client’s ankles in which position?

A.Internal rotation
B.Abduction
C.Dorsiflexion
D.Hyperextension


Answer Rationales

1.Answer A is correct. Fat, tendon, and bone have the most resistance. The higher the resistance, the greater the heat generated by the current, thereby increasing the risk for soft tissue injury. Answer B has intermediate resistance, so it is incorrect. Answer C is incorrect because it has very low resistance. Answer D has low to intermediate resistance, so it is incorrect.
2.Answer A is correct. Glucose levels rise as a result of the stress response during the emergent phase. Answers B, C, and D are within normal range. K+ and Na+ would be elevated, whereas albumin would be lowered during the emergent period due to increased permeability.
3.Answer D is correct. Sickle cell anemia and sickle cell trait are more prevalent in African American clients. The Sickledex test detects the presence of sickle cell anemia and sickle cell trait. Trauma can trigger a sickle cell crisis, which would complicate the treatment of the client. Answers A and C indicate inflammation, so they are incorrect. Answer B is incorrect because it detects circulating antibodies against RBCs.
4.Answer C is correct. The Parkland formula is 4 ml × kg × TBSA = 24-hr. fluid requirement, or 4 × 76 × 40 = 12,160 mL. Answer A is the fluid requirement for the first 8 hours after burn injury, so it’s incorrect. Answer B is incorrect because it’s the fluid requirement for 16 hours after burn injury. Answer D is an excessive amount given the client’s weight and TBSA, so it’s incorrect.
5.Answer D is correct. The urinary output should be maintained between 30 mL and 50 mL per hour. The first action should be to increase the IV rate to prevent increased acidosis. Answer A would lead to diminished output, so it is incorrect. There is no indication that the type of IV fluid is not appropriate as is suggested by answer B, making it incorrect. Answer C would not increase the client’s output and would place the client at greater risk for infection, so it is incorrect.
6.Answer D is correct. Xenografts are taken from nonhuman sources. The most common sources are porcine, or pigskin, which would be offensive to both Jews and Muslims. Answer A refers to a graft taken from an identical twin, making it incorrect. Answer B is incorrect because it refers to a graft taken from the client’s own skin. Answer C refers to a graft taken from a cadaver, making it incorrect.
7.Answer C is correct. Sulfamylon is effective in treating wounds infected with pseudomonas. The client should receive pain medication prior to dressing changes because the medication produces a burning sensation when applied to the wound. Answers A, B, and D are incorrect because they are used in the treatment of burns but are not effective against pseudomonas infections.
8.Answer B is correct. The normal CVP reading is 5–12 mm H2O. Answer A is incorrect because the client does not need additional fluids. Answers C and D would be appropriate only if the CVP reading were greater than 12 mm H2O.
9.Answer A is correct. Curling’s ulcer, a stress ulcer, is a common occurrence in clients with burns. Protonix, a proton pump inhibitor, is effective in preventing ulcer formation. Answers B, C, and D are common in clients with burns but are not prevented by the use of Protonix, so they are incorrect.
10.Answer C is correct. Placing the ankles in dorsiflexed position helps prevent contractures. Answers A, B, and D will lead to contractures that may require surgical intervention, so they are incorrect.


  

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