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Quiz Session - Attempts With Random Questions

BCEN CBRN Exam Questions

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1.

A 22-year-old male patient has partial-thickness burns to both of the posterior arms, anterior and posterior of the trunk, and posterior head and neck. 

Using the Rule of Nines, calculate the total body surface area (TBSA) percentage that is burned. 

  • 49.5%

  • 63%

  • 31.5%

  • 54%

Correct answer: 49.5%

According to the Rule of Nines, the posterior right arm is 4.5%, and the posterior left arm is 4.5%. The anterior trunk accounts for 18%, and the posterior trunk is also 18%. Finally, the posterior head and neck are 4.5%. This totals 49.5% TBSA burned. 

2.

During the resuscitative phase of burn injury, thermoregulation is a major challenge secondary to tissue loss and rapid fluid resuscitation. Hypothermia can lead to all the following, except: 

  • Lower cardiac output by up to 50% 

  • Impair neutrophil function, increasing the risk of infection

  • Impair platelet function, increasing the risk of bleeding

  • Impair microcirculatory perfusion  

Correct answer: Lower cardiac output by up to 50% 

Maintaining normothermia is a priority during the early stages of burn care. Evaporative fluid loss from tissue loss and rapid fluid resuscitation can cause hypothermia, which can:

  • impair microcirculatory perfusion  
  • induce shivering, which exacerbates hypermetabolism
  • impair neutrophil function, increasing the risk of infection
  • Impair platelet function, increasing the risk of bleeding
  • lower cardiac output by up to 25%
  • cause low levels of magnesium, potassium, and calcium 

3.

When a burn patient receives fluid resuscitation, over-administration of potassium in an effort to correct hypokalemia can lead to dangerous cardiac arrhythmias. These are often preceded by which of the following findings on electrocardiogram (ECG)? 

  • Peaked T-waves

  • Shortened PR interval 

  • ST-segment elevation 

  • Shortened QRS duration 

Correct answer: Peaked T-waves 

Significant hypokalemia and hypophosphatemia are common during the first days following resuscitation in burn-injured patients. While these should be monitored and supplemented, it is important not to overcorrect. Overcorrection of hypokalemia (and subsequent hyperkalemia) is particularly dangerous, as it can lead to cardiac arrhythmias, including asystole. These are often preceded by large peaked T-waves on the ECG. 

Other ECG changes indicative of hyperkalemia include a flattened P wave, prolonged PR interval, ST depression, and prolonged QRS duration.

4.

You are admitting a pregnant woman who sustained partial-thickness burns to her face, neck, arms, and chest after a motor vehicle crash and subsequent car fire. When considering medications to administer to your patient, you know there is a classification of five pregnancy categories based on possible side effects for the fetus. 

Which category demonstrated no adverse reactions in fetal development in animal studies? 

  • Category B drugs 

  • Category C drugs 

  • Category D drugs

  • Category X drugs 

Correct answer: Category B drugs 

The US Food and Drug Administration (FDA) classifies drug recommendations into five grades or categories (A, B, C, D, and X) according to potential adverse effects on a fetus when administered to pregnant and/or lactating women. Animal studies showed no negative side effects on category B drugs (e.g., macrolides, penicillins, lincomycin, clindamycin, and cephalosporins); they are presumed safe to treat during pregnancy and/or lactation in burn patients. 

Categories C, D, and X have been demonstrated to generate varying negative side effects on fetal development. 

5.

Which of the following statements is accurate about the organic healing of burn wounds (without operation)? 

  • Superficial partial-thickness burns usually heal within 2 weeks without scarring 

  • Deep partial-thickness burns will heal within 3 weeks and will predictably scar 

  • Full-thickness burns will take many weeks to heal and will predictably scar

  • Superficial partial-thickness burns will heal in 3-4 days without scarring 

Correct answer: Superficial partial-thickness burns usually heal within 2 weeks without scarring 

With appropriate wound care, superficial dermal burns (superficial second-degree burns), which extend into the papillary dermis and characteristically form blisters, will heal within 2 weeks without risk of scarring. Therefore, these burn injuries do not require surgical intervention and management. 

Superficial (first-degree) burns will heal in 3-4 days without scarring. Deep partial-thickness, or deep dermal, burns (deep second-degree burns) extend into the reticular dermis and generally take more than 3 weeks to heal. Most deep partial-thickness burns that have not healed by 3 weeks should be excised and grafted. Scarring is likely. Full-thickness burns (third-degree burns) require grafting and should undergo early excision and grafting to minimize infection and hypertrophic scarring and to expedite patient recovery. Healing time varies depending on how the patient tolerates surgical interventions. 

6.

The majority of gas gangrene infections, a particularly virulent type of necrotizing soft tissue infection (NSTI), are caused by which pathogen? 

  • Clostridium perfringens 

  • Escherichia coli

  • Streptococcus pyogenes 

  • Staphylococcus aureus 

Correct answer: Clostridium perfringens 

Gas gangrene develops from a sudden interruption in blood supply, such as burn injuries, or certain other types of traumas (e.g., open bone fractures, crush injuries, and agricultural or industrial incidents). Patients generally develop symptoms within 24 hours of the injury, but symptoms can also appear several days later. Initial symptoms include pain and fevers, and malodor is often the most obvious sign. 

Gas gangrene (occurring after a deep penetrating injury) creates the anaerobic conditions ideal for clostridial proliferation. The majority of infections are caused by C. perfringens, but other species of Clostridium have also been implicated. The tissue becomes discolored and blistered, leading to progressive necrosis of involved tissues and a high mortality rate. 

7.

A child is admitted for asphyxia caused by smoke inhalation. You anticipate which of the following findings on an assessment of this patient? 

  • Confusion 

  • Tachypnea 

  • Cyanosis 

  • Cardiovascular collapse 

Correct answer: Confusion

Acute asphyxia is an inhalation injury often seen in burn patients because of carbon monoxide poisoning. Airway injury is caused by the chemical inhalation of the byproducts of combustion. Cerebral hypoxemia from smoke leads to neurologic dysfunction in the form of confusion. 

Tachypnea and cyanosis may be absent because the body's peripheral chemoreceptors perceive normal partial pressure of oxygen in arterial blood (PaO2). If the patient does experience either of these symptoms, they would be the result of direct damage to the lung parenchyma, not a result of asphyxia. Cardiovascular collapse is due to fluid shifts from burn injuries, not asphyxia. 

8.

To obtain a pediatric trauma patient's history, the Emergency Nurses Association (ENA) recommends using which of the following assessment strategies? 

  • CIAMPEDS

  • OPQRST

  • AMPLE

  • ABCDE

Correct answer: CIAMPEDS

During the early evaluation of a child who has sustained trauma, obtaining and documenting a thorough history can provide key insight into the potential nature and severity of the injury and can assist in formulating a plan of care. The ENA recommends using the CIAMPEDS mnemonic:

  • C: Chief complaint
  • I: Immunizations/isolation
  • A: Allergies
  • M: Medications
  • P: Past medical history
  • E: Events surrounding the illness or injury
  • D: Diet
  • S: Symptoms associated with the illness or injury 

9.

What is the role of vitamin D in burn wound healing? 

  • Calcium metabolism 

  • Coagulation

  • Collagen synthesis 

  • Epithelialization and angiogenesis

Correct answer: Calcium metabolism 

Vitamin D is a fat-soluble micronutrient that has been implicated in a wide array of physiological systems; it is essential for calcium regulation and bone health, as well as for cell differentiation and healthy immune function. Although it can be synthesized by the body in response to adequate sunlight exposure, many people lack sufficient sun exposure to avoid deficiency. 

Vitamin C, protein, iron, and zinc all play roles in collagen synthesis/formation. Vitamin K is important in blood clotting and supports effective wound healing. Vitamin A plays a role in epithelialization and angiogenesis.  

10.

What is the most appropriate intervention for a patient with a Braden scale score of 15? 

  • Implement a turning schedule and reposition the patient every 2 hours

  • Continue to monitor since the score is within normal limits 

  • Apply a skin barrier paste to major pressure ulcer sites 

  • Request a specialized low-air-loss bed to minimize the risk of skin breakdown

Correct answer: Implement a turning schedule and reposition the patient every 2 hours

The Braden Scale for Predicting Pressure Injury Risk (or Braden score) is used to quantify a patient's risk of developing pressure injuries. It consists of six risk factor subscales that conceptually reflect the degrees of sensory perception, skin moisture, physical activity, nutritional intake, friction and shear, and inability to change and control body position. The scores are grouped according to the patient's level of risk: not at risk (>18), mild risk (15-18), moderate risk (13-14), high risk (10-12), and very high risk (≤9). 

For a patient with a score of 15 (mild risk), a turning schedule should be implemented. A score of >18 is considered normal and would not require anything other than close monitoring of the patient. A low-air-loss bed should be ordered for very high-risk patients (score of ≤9). A skin barrier paste would be necessary if the patient was incontinent. 

11.

Which of the following assessment findings indicates inadequate fluid resuscitation in an adult burn-injured patient? 

  • Decreased urine output 

  • Increased blood pressure 

  • Decreased pulse 

  • Increased serum sodium 

Correct answer: Decreased urine output 

A decreased urine output is an indication of inadequate fluid resuscitation and ongoing hypovolemia. The recommended urine output is 30-50 mL/hr in adults. Hourly monitoring is recommended to ensure the administration of sufficient fluid volume. 

Tachycardia, hypotension, and hyponatremia are other clinical and laboratory findings associated with hypovolemia and indicative of insufficient fluid volume resuscitation in a burn patient. 

12.

A 68-year-old female patient has deep partial-thickness burns to the anterior and posterior right and left legs, the posterior left arm, and the posterior trunk. 

Using the Rule of Nines, calculate the total body surface area (TBSA) percentage that is burned. 

  • 58.5%

  • 63%

  • 49.5%

  • 40.5%

Correct answer: 58.5%

According to the Rule of Nines, the entire right leg is 18% (front and back), the entire left leg is 18% (front and back), the posterior left arm is 4.5%, and the posterior trunk is 18%. This totals 58.5% TBSA burned. 

13.

You are caring for a patient who has a chest tube and are observing for signs of air leaks. You note the water seal chamber has continuous bubbling. What intervention is indicated?

  • Notify the physician because there is a leak in the system

  • Continue to monitor, as this is a normal and expected finding

  • Increase the suction by 2-5 mm Hg until bubbling stops 

  • Reposition the patient

Correct answer: Notify the physician because there is a leak in the system 

A spontaneously breathing patient may only have a minor leak represented by bubbling during a forced cough (which raises intrathoracic pressure, thus forcing air out). A more serious leak would be present during a normal expiratory phase, whereas continuous bubbling is consistent with the most significant leak. If continuous bubbling is noted, the physician must be notified. 

Intermittent bubbling in the water seal chamber is expected for a patient who has a pneumothorax. Increasing suctioning and repositioning the patient are not indicated.

14.

Outcomes of necrotizing soft tissue infections (NSTI) are determined by all the following factors, except: 

  • Gender

  • Early recognition of tissue necrosis 

  • Appropriate antibiotics

  • Radical surgical intervention 

Correct answer: Gender

NSTIs are extensive infections of the skin, subcutaneous fat, and soft tissue that extend to the fascial plane (i.e., the tissue sheath covering muscle). They are characteristically abrupt in onset and can spread, often visibly, in a matter of hours. 

All age groups and genders can be affected by NSTIs, although higher rates are observed in older patients (>60 years old). Outcomes are determined by early recognition of tissue necrosis, prompt and radical surgical intervention, appropriate antibiotic coverage, and adjunctive hyperbaric oxygen therapy. 

15.

You are caring for a burn-injured patient who will receive negative pressure wound therapy (NPWT) for closure of their burn wound. Which of the following interventions will decrease the risk of tissue damage from the drainage system? 

  • Ensure the tubing is positioned away from bony prominences 

  • Administer prescribed intravenous (IV) analgesics on schedule 

  • Apply a silver-impregnated dressing 

  • Ask the physician to decrease the negative-pressure settings on the device 

Correct answer: Ensure the tubing is positioned away from bony prominences 

Tubing from medical devices can cause unnecessary pressure and tissue injury; this is referred to as a medical device-related pressure injury (MDRPI). Nursing interventions that can help reduce MDRPIs include daily inspection of the medical devices to relieve pressure, positioning the drainage tubing away from bony prominences, rotating the device, and advocating for the removal of the device when it is no longer medically necessary.  

Providing pain medication is important for reducing pain and ensuring the patient is comfortable, but it will not affect the tissue in or surrounding the wound. Applying silver-impregnated dressings will decrease bacterial contamination but will not prevent damage from the device. Asking the physician to decrease the negative-pressure settings on the device is not warranted, as no setting is defined in this scenario. 

16.

The initiation of prophylactic anticoagulation therapy for prevention of deep vein thrombosis (DVT) for a burn-injured patient is recommended within what timeframe? 

  • The first 72 hours post-injury 

  • The first 24 hours post-injury 

  • The first 48 hours post-injury 

  • The first 12 hours post-injury 

Correct answer: The first 72 hours post-injury 

Burn wounds create a hypercoagulable state within the body due to the procoagulant effects created by the release of tissue thromboplastin and subendothelial collagen. This places the patient at high risk of thromboembolism formation. Adding to this, any immobilized patient is going to be at an increased risk for deep vein thrombosis (DVT) formation. 

Since prevention is key to DVT management, prophylactic anticoagulation therapy (with low-molecular-weight heparin [LMWH] or heparin if LMWH is contraindicated) should be initiated within the first 72 hours post burn injury). 

17.

Which of the following wound dressings would be appropriate for a moderately to highly exudative full-thickness burn wound?

  • Calcium alginates 

  • Film dressings

  • Gauze with a secondary dressing 

  • Hydrogel sheet dressings 

Correct answer: Calcium alginates 

Alginates are the calcium or calcium/sodium salts of alginic acid and are composed of mannuronic and guluronic acids obtained from seaweed. When applied to a wound, sodium ions in the wound exchange for the calcium ions in the dressing, absorbing serous fluid or exudate and forming a nonadhesive, nonocclusive hydrophilic gel that conforms to the shape of the wound. Since calcium acts as a clotting factor (factor IV), this mechanism enables some alginates to act as a hemostat. 

Alginates are indicated for moderately to highly exudative full-thickness wound cavities and may also be considered for infected wounds, as long as appropriate concurrent treatment for infection is implemented. 

Gauze should be used for low to moderate exudate. Transparent film dressings and hydrogel sheet dressings are minimally absorptive. 

18.

You are triaging an eight-year-old child in the emergency department with thermal burn injuries. Which of the following assessment findings is the most concerning?

  • Erythematous inflamed throat

  • Hypertension 

  • Shivering 

  • Clothing burned into the skin 

Correct answer: Erythematous inflamed throat

Inhalation injury is the most severe and life-threatening complication of a burn injury. Inhalation injuries can include carbon monoxide (CO) poisoning, upper airway injury, lower airway injury, and restrictive defects. 

Diagnosing inhalation injury is usually a subjective decision based on a history of smoke exposure in a closed space and is made after a thorough assessment of the patient's clinical presentation. Inhalation injury can occur anywhere along the patient's airway passages and can be classified based on the primary area of injury. Direct visualization of the airways will help confirm the diagnosis. A red inflamed throat (upper airway edema) indicates a potentially compromised airway. Other signs of respiratory compromise associated with inhalation injury include hoarseness, stridor, increased frequency of coughing, tachypnea, nasal flaring, retractions, and shortness of breath. 

19.

Keloids are caused by an abnormality in which of the following phases of wound healing? 

  • Fibroblastic phase

  • Inflammatory phase

  • Proliferative phase

  • Remodeling phase 

Correct answer: Fibroblastic phase

Pathologic wound healing can result from impaired remodeling of the granulation tissue, leading to abnormal cutaneous repair. In keloids, the fibroblastic phase continues unchecked, resulting in clinical and histopathological findings. The histologic hallmark of a keloid is increased whorls of thickened, hyalinized collagen bundles that are widely known as keloidal collagen.

20.

The process of collagen synthesis occurs mainly in the cells of which structure?

  • Fibroblasts

  • Platelets

  • Macrophages

  • Neutrophils

Correct answer: Fibroblasts

Collagen is the major constituent of the extracellular matrix (ECM) and provides a scaffold for cells and mechanical strength for tissues. In postburn hypertrophic scars (HTS), the quantity of collagen per unit surface area is increased. Fibroblasts are specialized cells that synthesize collagen.

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