Burns (secret) test

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1. You have just received change of shift report for the burn unit. Which client would you assess first?
1. A client with deep partial thickness burns on both legs who is complaining of severe and continuous leg pain.
2. A client who has just arrived from the ER with facial burns associated with a house fire.
3. A client who has just been transferred from the PACU after having skin grafts applied to the anterior chest.
4. A client admitted 3 weeks ago with full-thickness burns who has been waiting for 3 hours to receive discharge teaching

2. You are doing a sterile dressing change for a client with infected deep partial burns of the chest and abdomen. List the steps of the care
plan in the order each should be accomplished.
1. Apply silver sulfadiazine (Silvadene) ointment
2. Obtain aerobic and anaerobic cultures
3. Administer morphine 10 mg IV
4. Debride wound of eschar using gauze sponges

____, ____, ____, ____

3. All of these clients are being discharged from the hospital. In planning discharge teaching, for which are you most concerned about the
need for using sunscreen?
1. A 32-year old with a urinary tract infection who is being discharged with a prescription for tetracycline 250 mg every 6 hours.
2. A fair skinned 55-year-old who has just had neck surgery and who plans to work in the yard for 15 minutes twice daily.
3. A dark skinned 62-year-old who has keloids injected with hydrocortisone.
4. A 78-year-old with pruritic rash due to an allergic reaction to penicillin.

4. A 62-year-old client has extensive blister injuries to the back and both legs caused by exposure to toxic chemicals at work and is admitted
to the ER. Which of these ordered interventions will you perform first?
1. Infuse lactated ringers solution at 250 ml/hr
2. Irrigate the back of the legs with 4 L sterile normal saline
3. Obtain blood for a complete blood count and electrolytes
4. Document the percentage of total body surface area burned

5. You have just received the change of shift report in the burn unit. Which client requires the most immediate assessment or intervention?
1. A 22-year-old admitted 4 days previously with facial burns due to a house fire who has been crying since recent visitors left.
2. A 34-year-old who just returned from skin-graft surgery 3 hours ago and is complaining of a level 8 pain.
3. A 45-year-old with deep partial thickness leg burns who has a temperature of 102.6 and a blood pressure of 98/46
4. A 57-year-old who was admitted for electrical burns 24 hours ago and has a potassium level of 5.6 mEq/L.

6. The extent of a burn is based on:
1. Depth
2. Percent of body area burned
3. Amount of pain experienced
4. Patients gender

7. Which type of severity of burn can be painless as a result of nerves being burnt?
1. Superficial
2. Full-thickness
3. Partial-thickness
4. Epidermal thickness

8. Within 48 hours of a burn, what physiologic responses usually occur?
1. Hypernatremia, pulmonary edema, paralytic ileus
2. Dehydration, edema, oliguria
3. Negative nitrogen balance and weight loss
4. Tremendous increase in urinary output, hypokalemia, and decreased hematocrit

9. What is the major physical complication associated with the musculoskeletal system that is related to burns?
1. Loss of pain tolerance
2. Contractures
3. Fractures
4. Muscle spasms




Burns (secret) test
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1. 2. Facial burns are frequently associated with airway inflammation and swelling, so this client requires the most immediate assessment.
The other clients also require rapid assessment or interventions, but not as urgently as the client with facial burns.
2. 3, 4, 2, 1. Pain medication should be administered prior to dressing changes, since dressing changes for partial thickness burns are
painful, especially if the dressing change involves removal of eschar. The wound should be debrided prior to obtaining wound cultures to
avoid obtaining bacteria that are skin contaminates rather than causes of the wound infection. The cream should be applied to the area
after debridement to gain the maximum effect.
3. 1. Systemic use of tetracycline is associated with severe photosensitivity reactions to ultraviolet light. All individuals should be taught
about the potential risks associated with overexposure to sunlight or UV light, but the client taking tetracycline is at the most immediate
risk for severe effects.
4. 2. With chemical injuries, it is important to remove the chemical from contact with the skin to prevent ongoing damage. The other
actions should be accomplished rapidly; however, rinsing the chemical off is the priority for this client.
5. 3. This clients vital signs indicate that the life-threatening complication of sepsis and septic shock may be developing. The other clients
also need rapid assessments and/or nursing interventions, but their symptoms do not indicate that they need care as urgently as the
febrile and hypotensive client.
6. 2. The rule of 9s is used to determine the percentage or extent of the patients burns. Depth is a determination of the length of healing.
Pain is not a factor of extent because some burns are not painful.
7. 2. Full thickness burns may be painless because nerves can be burnt. All of the other types of burns listed are painful.
8. 2. Dehydration, edema, and oliguria occur as plasma shifts into interstitial fluid. A generalized edema and no ileus can exist. Edema can
cause weight gain with no tremendous output in urine.
9. 2. Contractures are a major complication of the musculoskeletal system in patients who have severe burns. Severe burns have burnt
nerve endings; as a result, no pain is felt.