Burn Trauma Test Questions and Answers, Exams of Biology

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TCRN - Burn Trauma test

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A patient sustains full thickness (third degree) burns to 20% of the body surface area, deep partial thickness burns (second degree) to 20% of the body surface area, superficial partial thickness burns (second degree) to 20% of the body surface area and superficial burns (first degree) to 20% of the body surface area. When calculating the total body surface area burned to determine the amount of fluid resuscitation required, what percentage of body surface area burned should be utilized? a. 20% b. 40% c. 60% d. 80% Answer: C When determining the body surface area burned to be utilized in a burn fluid resuscitation formula (such as Modified Parkland Burn Formula), second, third and fourth degree burns are utilized. First degree burns are not included. Since this patient has 20% of the body surface area covered with third degree burns and 40% covered with varying depths of second degree burns (superficial and deep partial thickness burns), the amount of body surface area burned for purposes of fluid resuscitation formulas is 60%. The 20% of the body surface area that has first degree burns is not included in this calculation. Which of the following descriptions captures the likely appearance of a deep partial thickness burn? a. A deep red color that blanches when pressure is applied. b. An erythematous area that blanches when pressure is applied.

c. A mottled pink color that does not blanch when pressure is applied. d. Dry, leathery skin that does not blanch when pressure is applied. Answer: C Deep partial thickness burns appear mottled pink or white immediately after the injury. As time progresses, they may blister or appear dry with a cherry red color. Because of altered circulation to the area, deep partial thickness burns do not blanch when pressure is applied. Dry, leathery skin that does not blanch when pressure is applied is more consistent with a full thickness burn. Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0: / 0: Full screen Brainpower Read More The Modified Parkland Burn Formula is used to determine the amount of fluid to deliver to an adult patient weighing 90 kg with burns over 40% of the body surface area. It is determined that 450 mL of fluid should be delivered per hour. After the first hour of fluid resuscitation, the patient's urinary output is noted to be 45 mL. The trauma nurse should: a. Increase the rate of intravenous fluid administration. b. Decrease the rate of intravenous fluid administration. c. Continue with the current rate of intravenous fluid

administration. d. Provide a 500 mL bolus of intravenous fluid then return to the hourly calculated fluid rate. Answer: C The goal of fluid resuscitation when using the Modified Parkland Burn Formula in adults is 0.5 mL/kg/hour. For a 90 kg patient, this would be a urinary output of 45 mL, therefore, no adjustment in the fluid rate would be recommended. There is no need to provide a fluid bolus since the urinary output is at the recommended amount. During a mass casualty incident, a patient who is breathing spontaneously and ambulatory but complains of burning in the airways with audible wheezing secondary to chemical exposure should be: a. Redirected to the "hot zone" b. Redirected to the "cold zone" c. Assigned a triage level of "green" d. Assigned a triage level of "yellow" Answer: A Any patient with a known chemical exposure should be redirected to an area identified as the "hot zone". The "hot zone" is where all chemically contaminated patients are gathered. The "cold zone" is reserved for those patients who are already contaminated. Because this patient has burning and wheezing in the airways, a triage level of "red" (emergent) would be more appropriate than "yellow" (delayed) or "green" (non-urgent). Which of the following statements regarding burns to the perineal area is most accurate? a. The skin of the perineal region tends to heal faster than skin in other areas of the body. b. Perineal burns carry a higher rate of post-burn infection than burns in other areas of the body.

c. Burns of the perineal region tend to be more superficial than burns in other areas of the body. d. The amount of fluid required during resuscitation of burns involving the perineal region tends to be higher than the amount of fluid required for burns in other areas of the body. Answer: B Bacteria normally present in the perineal region, coupled with possible urinary and fecal contamination, result in higher infection rates with perineal burns than burns in other areas of the body. The skin of the perineum does not heal faster than skin in other areas of the body and there is no difference in the depth of burns to the perineal area when compared to the remained of the body. The amount of fluid required during resuscitation for a perineal burn is equal to the amount of fluid used for an equivalent burn in another area of the body. Several patients arrive in the ED stating they were exposed to radiation at a local University. The most appropriate response for the trauma nurse encountering these patients is to: a. Escort the patients to a private treatment room, ask them to undress and place their clothing in a plastic bag which can be sealed. b. Place the patients in a resuscitation room, initiate 100% oxygen via non-rebreather mask and begin monitoring the cardiac rhythm. c. Redirect the patients to the "hot zone" outside the emergency department then ask them to immediately remove all their clothing. d. Redirect the patients to the decontamination shower and have them immediately begin showering, removing their clothing only after they are wet. Answer: D Patients with exposure to radiation may have radiological contamination on their clothing which can contaminate others, therefore they should be redirected to the decontamination showers. The patients clothing should not be removed until it is wet as radiation on dry clothing can be aerosolized, decreasing

danger to those around the patients. Although redirecting the patients to a “hot zone” is appropriate, the clothing should not be removed until it is wet. Taking the patient into the department (either a treatment or resuscitation room) is not appropriate until the patient is decontaminated to reduce the risk of contaminating other patients or staff. The goal of treatment for a patient with smoke inhalation should be: a. A serum pH above 7. b. Normal deep tendon reflexes c. An SpO2 between 94 and 98% d. A respiratory rate above 16 breaths per minute Answer: C Smoke inhalation tends to cause hypoxia and acidosis. A goal of treatment is to oxygenate the patient to a SpO2 between 94 and 98%. Smoke inhalation tends to cause acidosis, marked by a serum pH below 7.35. Although elevation of the serum pH above 7. would be desirable, a serum pH above 7.45 indicates alkalosis and this would not be a goal of treatment. Smoke inhalation does not directly impact deep tendon reflexes and normal deep tendon reflexes do not indicate successful treatment. Smoke inhalation tends to increase respiratory rate, therefore a goal of treatment is not to increase the respiratory rate. The priority of care for a patient who presents to the hospital after having hot tar spilled on over 40% of the body surface would be to: a. Relocate the patient to a shower. b. Cover the patient in warm blankets. c. Prepare for endotracheal intubation. d. Use towels or another absorbent material to wipe away as much of the tar as possible. Answer: A

When tar is liquid, the temperature can cause significant burns. Because tar is oily, it will seal the heat underneath of it, continuing the burning process. Initial treatment is to reduce the temperature of the tar through a cooling process such as a shower. This will help reduce the depth of the burn. Covering the patient in warm blankets will not accomplish the goal of cooling the tar and stopping the burning process. Burns secondary to tar do not automatically require endotracheal intubation unless there are complicating factors such as secondary trauma (which is not discussed in this question). Tar should be cooled down before attempting to remove it. Attempting to remove tar before it is cool with absorbent material may simply spread the heated oil and increase the surface area of the burn. The trauma nurse applies calcium gluconate gel to the skin of a trauma patient. The patient was most likely exposed to which of the following substances? a. Phenol b. Asphalt c. Kerosene d. Hydrofluoric acid Answer: D The fluoride ion in hydrofluoric acid may be inactivated by the calcium in topical calcium gluconate, therefore calcium gluconate gel is part of the treatment for patients exposed to hydrofluoric acid. 50% polyethylene glycol (PEG) is used for exposure to phenol A fat emollient such as petroleum jelly or Medisol is used to treat burns due to asphalt. Kerosene is decontaminated with water rather than treated with application of calcium gluconate gel. The Modified Parkland Burn Formula is used to determine that a 3- year-old child weighing 14 kg should receive 2100 mL of fluid in the first 24 hours following the burn. What percentage of this child's

body is burned? a. 10% b. 30% c. 50% d. 75% Answer: C When using the Modified Parkland Burn Formula in pediatric patients, the patient's weight in kilograms (14 kg in this example) is multiplied by 3 mL which is then multiplied by the body surface area burned. When these three numbers of are multiplied together, the calculated amount is the recommended amount of fluid the child should receive in the first 24 hours after the burn. Since 2100 mL of fluid is the calculated amount, this number should be divided by 3 mL to determine the body surface area burned. Pediatric: kg x TBSA x 3 = total ml 24 hour Adult: kg x TBSA x 2 = total ml 24 hour The trauma nurse knows that symptoms of radiation sickness likely to develop in patients exposed to radiation includes: a. Nausea, vomiting and diarrhea b. Ascending paralysis and hemoptysis c. Severe headaches and muscle tremors d. A generalized pustular rash and a burning sensation on the skin Answer: A Symptoms of radiation sickness, nausea, vomiting, diarrhea, malaise, anorexia and gastrointestinal bleeding. Ascending paralysis, hemoptysis, severe headaches, muscle tremors, a generalized pustular rash and a burning sensation on the skin are not associated with radiation sickness.

When determining fluid requirements for patients with a burn covering 50% of the body area, the trauma nurse knows that adult patients generally require: a. Less fluid per kilogram of body weight than pediatric patients during the first 24 hours. b. More fluid per kilogram of body weight than pediatric patients during the first 24 hours. c. The same amount of fluid per kilogram of body weight as pediatric patients during the first 24 hours. d. Less fluid per kilogram of body weight than the pediatric patient during the first eight hours after a burn but more fluid per kilogram of body weight than the pediatric patient after the 8th hour after the burn. Answer: A Because of the high water content in the pediatric patient, the pediatric patient generally requires more fluid per kilogram of body weight than their adult counterparts with the same sized burn. When using the Modified Parkland Burn Formula, fluid requirements for an adult are calculated by multiplying the patient's body weight (in kilograms) by the total body surface area burned by two. To use the Modified Parkland Burn Formula for pediatric patients, the child's body weight is multiplied by the total body surface burned by three. A patient presents to the hospital with electrical burns. Significant surface burns are noted to the scalp as well as the right leg. The trauma nurse knows that which of the following findings is most likely for this patient? a. Frank hematuria b. Metabolic alkalosis c. Decreased platelet count d. Elevated serum potassium

Answer: D Electrical burns tend to cause extensive muscular damage. Because much of the body's potassium is found inside of the cells, including muscle cells, the destruction of muscle tissue causes the release of potassium into the tissue and ultimately into the serum. Although the patient's urine may turn red, this is from myoglobin rather than blood, therefore frank hematuria is not anticipated. Rhabdomyolysis is more likely to cause acidosis rather than alkalosis. Electrical burns do not impact the platelet count. Four patients are treated in the hospital after experiencing surface burns related to exposure to dry chemical. Following patient treatment, the trauma team reviews the care of these patients. Which of the following findings indicates that a major goal of care was met? a. Contamination is limited to the four patients. b. The patient's urinary output exceeds 2.0 mL/kg/hour. c. The patients are transported to a burn unit within 2 hours of arrival. d. The powder is identified and a neutralizing agent is identified before inpatient admission. Answer: A The major goal in caring for any contaminated patients (including those contaminated with dry chemicals) is to reduce exposure of others. If the patients can be isolated and properly decontaminated without contaminating others, a major goal of care has been met. Not all chemically contaminated patients require admission to a burn unit and a goal of care is not necessarily to have transfer accomplished within 2 hours. Fluid resuscitation is not a priority in chemically contaminated patients, therefore UOP is not a major goal of care. Many chemicals do not have neutralizing agents and neutralizing agents are rarely used in chemical exposures, therefore identification of the chemical and its neutralizing agent is not as high of a priority as limiting contamination. A patient presents to the hospital with burns caused by carbolic acid. Which of the following treatment modalities is most

appropriate for this patient? a. Urgently apply calcium gluconate gel liberally to all exposed areas of the skin. b. Irrigate copiously with water followed by followed by topical application of 50% polyethylene glycol (PEG). c. Thoroughly protect the skin with mineral oil before decontaminating the patient with ample amount of water. d. Utilize a dry powder (e.g. baby powder) on exposed skin to absorb the acid before gently blotting it away with absorbent towels. Answer: B Carbolic acid (a phenol) should be immediately decontaminated with water after which 50% polyethylene glycol (PEG) should be applied to neutralize the substance. Calcium gluconate gel is used in the treatment of hydrofluoric acid burns. Mineral oil is used to remove tar or asphalt. The patient should be decontaminated with water instead of using a dry powder to absorb the substance. A patient is admitted to the inpatient unit after sustaining being doused with propane. Which of the following parameters should be most closely monitored in the days following admission of this patient? a. Visual acuity b. Liver function tests c. Deep tendon reflexes d. Width of the PR interval Answer: B Absorption of hydrocarbons such as propane are known to cause hepatic failure in the days following exposure. Therefore it is essential to monitor liver function tests in the days following admission.

Propane does not impact visual acuity, deep tendon reflexes or the width of the PR interval.