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Quiz Session - Attempts With Random Questions

BCEN CBRN Exam Questions

Page 10 of 20

181.

The Parkland formula for burn resuscitation stipulates which of the following? 

  • Lactated Ringer's 4 mL/kg of body weight/percent of TBSA for second- and third-degree burns; half to be given in the first eight hours after injury, and the remaining half to be distributed over the next 16 hours

  • Lactated Ringer's 4 mL/kg of body weight/percent of TBSA for second- and third-degree burns; half to be given in the first eight hours after arrival at the hospital and the remaining half to be distributed over the next 16 hours

  • Normal saline 4 mL/kg of body weight/percent of TBSA for second- and third-degree burns; half to be given in the first eight hours after arrival at the hospital and the remaining half to be distributed over the next 16 hours

  • Normal saline 4 mL/kg of body weight/percent of TBSA for second- and third-degree burns; half to be given in the first eight hours after injury, and the remaining half to be distributed over the next 16 hours

Correct answer: Lactated Ringer's 4 mL/kg of body weight/percent of TBSA for second- and third-degree burns; half to be given in the first eight hours after injury, and the remaining half to be distributed over the next 16 hours

Isotonic crystalloid is still the most commonly used fluid for resuscitation in US burn centers. The Parkland Formula for volume resuscitation uses isotonic crystalloid solutions and estimates the fluid requirements in the first 24 hours to be 4 mL/kg per TBSA burned. 

"The first eight hours" refers to the first 8 hours after injury. If this is misinterpreted by the healthcare team to mean the first eight hours after presentation to the hospital, volume resuscitation could be seriously delayed. 

182.

Which of the following best describes when colloids should be used for burn shock?

  • Colloids should be used if a patient's initial response to crystalloids is insufficient 

  • Colloids should be used for sepsis 

  • Colloids should be used for burns during the first 24 hours post-injury

  • Colloids are predominantly used for burn resuscitation in the United States 

Correct answer: Colloids should be used if a patient's initial response to crystalloids is insufficient 

Colloids are large molecule solutions that are used when a patient's initial response to crystalloids is insufficient. Colloids stay in the vascular space better than crystalloids and may be used in hypovolemic shock or neurogenic shock. Colloids should not be used in the first 24 hours when capillary permeability is increased, such as with sepsis, anaphylaxis, or burns. 

Crystalloids are the mainstay of burn shock resuscitation in US burn centers, and lactated Ringer's (LR) is the most frequently used crystalloid solution. 

183.

A 39-year-old male was rescued from a house fire and brought into the emergency department (ED) via ambulance. He is diagnosed with carbon monoxide (CO) poisoning and currently has a COHb level of 32%. 

Which of the following will most likely improve this patient's outcome?

  • Hyperbaric oxygen therapy

  • 100% oxygen via non-rebreather mask

  • No treatment at this time 

  • Intubation and mechanical ventilation 

Correct answer: Hyperbaric oxygen therapy

Hyperbaric oxygen therapy should be considered for patients with a COHb level of >25%. While intubation or 100% oxygen via a non-rebreather mask may be an ideal treatment for lower COHb levels, higher levels will benefit from administering high amounts of oxygen at increased pressure. Hyperbaric oxygen therapy is the safest and most effective way to do this. 

A COHb level of 32% has a high risk of being fatal, and the patient must be treated effectively.

184.

You are caring for a burn victim with a tracheostomy and need to suction the patient. Prior to suctioning, you should perform which nursing intervention? 

  • Hyperoxygenate the patient 

  • Assist the patient into a side-lying position 

  • Disconnect pulse oximetry 

  • Have the patient cough 

Correct answer: Hyperoxygenate the patient 

Before a patient with a tracheostomy receives suctioning, they will need to be hyperoxygenated because, during suctioning, the patient's oxygen supply will be decreased. 

The other choices are incorrect. 

185.

Which of the following statements is accurate regarding informed consent?

  • It is not just a document; it is a process. 

  • It is synonymous with general consent. 

  • It is the burn nurse's duty to obtain informed consent.

  • As soon as the form is signed, the patient cannot withdraw consent.

Correct answer: It is not just a document; it is a process. 

Informed consent is not just a document. It is a process through which a healthcare professional provides the patient with the information needed to make an informed choice regarding healthcare services. This includes explaining the risks, benefits, and alternative therapies of the procedure. It also involves an explanation of the procedure at a level that the patient can understand. 

It is ultimately the surgeon's responsibility to get informed consent and the form signed. If informed consent is not obtained, the surgeon can be considered negligent and liable. The patient should be a legal adult and mentally sound at the time of explanation and signing. If, at any time, the patient changes their mind, the consent form is invalid. The same guidelines apply to anesthesia consent and the anesthesia provider. General consent is a form signed at the beginning of a patient's admission to a healthcare facility for day-to-day necessary care.

186.

As a certified burn registered nurse working in the emergency department setting, you are performing your duties in a way that will benefit others. This adheres to what ethical concept? 

  • Beneficence 

  • Autonomy 

  • Justice 

  • Nonmaleficence 

Correct answer: Beneficence 

Beneficence is an ethical concept that means one is acting in a manner that will do good or benefit others. The principle of beneficence asks healthcare workers to act to promote the good or welfare of those for whom they provide care and treatment. 

Autonomy is an ethical principle that means a patient is using their ideas or beliefs to make medical decisions. Justice is fairness with respect to treatment. The principle of nonmaleficence requires that we do not do harm or impose our beliefs on our patients.

187.

You are caring for a patient with 60% TBSA full-thickness electrical burns. As a part of the patient's care, you must monitor their urine for which of the following? 

  • Myoglobin and hemoglobin 

  • Urea and potassium 

  • White blood cells (WBCs) and free iron 

  • Red blood cells (RBCs) and protein 

Correct answer: Myoglobin and hemoglobin 

Both myoglobinuria and hemoglobinuria may play a role in acute renal injury following an acute burn. Myoglobinuria is more common in electrical burns, while hemoglobinuria is more common following cutaneous burns. Any patient who has sustained a severe electrical burn and/or full-thickness burn is at risk of acute kidney injury. 

Clinically significant myoglobinuria is indicated by visibly pigmented urine (darker than light pink) and means significant muscle damage (muscles release myoglobin) and potentially ongoing ischemia is present. In addition, RBCs will release hemoglobin. Myoglobinuria and hemoglobinuria secondary to rhabdomyolysis present a risk of acute renal failure and must be treated promptly. These conditions are managed by the administration of added crystalloids (Ringer's lactate) until the urine appears clear. 

188.

You are caring for a burn patient with a chest tube. You assist in repositioning the patient when the chest tube accidentally disconnects from the water seal chamber. What is the first intervention you should perform?  

  • Place the tube in sterile water 

  • Immediately replace the chest tube system 

  • Notify the physician immediately and stay at the patient's bedside 

  • Cover the site with a sterile dressing 

Correct answer: Place the tube in sterile water 

If a chest drainage system is accidentally disconnected, the end of the tube is placed in a bottle of sterile water held below the level of the chest. The system is replaced if it breaks or cracks or if the collection chamber is full.  

The physician may need to be notified, but this is not the first action. Placing a sterile dressing over the disconnection site will not prevent complications resulting from the disconnection.

189.

A patient presents to the emergency department with a painful and blistering thermal burn involving the big, index, and middle toes of the left foot. What is the most appropriate plan of care for this patient? 

  • Refer to a burn center 

  • Apply topical anesthetic agent to the area and open blisters

  • Apply silver sulfadiazine cream to the area and cover with a sterile dressing

  • Wrap loosely with a nonadherent dressing and administer analgesics for pain management 

Correct answer: Refer to a burn center 

Criteria for transferring a burn patient to a burn center include any burn that involves the face, hands, feet, genitalia, perineum, and major joints. Burns to the toes require immediate referral to a burn specialty center to prevent loss of function and provide appropriate management. 

The other choices may be part of the plan of care once evaluation by a burn specialist has been completed. 

190.

Which of the following topical agents is most appropriate for superficial (first-degree) burns? 

  • Bacitracin

  • Aloe vera

  • Mupirocin

  • Silver sulfadiazine cream 

Correct answer: Bacitracin

Topical antimicrobial ointments as single or combination agents are commonly used for superficial burn wounds. Bacitracin is a topical antimicrobial agent that is suitable for minor (first-degree) burns. 

Silver sulfadiazine cream is often used for superficial partial-thickness (second-degree) burns. Aloe vera is not supported by clinical evidence but can be used as a home remedy for comfort. Mupirocin should be reserved for methicillin-resistant staphylococcal infections.

191.

All the following are factors for analyzing multidisciplinary burn team effectiveness and function, except:  

  • Age of team members 

  • Size of team

  • Specific responsibilities 

  • Leadership style(s)

Correct answer: Age of team members 

To assess the dynamics and functioning of a burn team, many factors come into play. The process of bringing a group of experts from diverse disciplines to work together to accomplish a primary goal is a challenging and demanding one. Clearly defining the various components of these teams will allow improved analysis. 

Some useful factors for assessing how well a team is functioning include the size and composition of the team, specific responsibilities, leadership styles, scope of work, organizational support, communication and interactional patterns within the team, and contact with the patient and family (or care system). 

The age of the team members is not a useful factor for analyzing the effectiveness of a multidisciplinary burn team. 

192.

A trauma case was selected as an internal peer review process. This is an example of which level of review in the performance improvement process? 

  • Tertiary 

  • Primary

  • Secondary 

  • Quaternary 

Correct answer: Tertiary 

There are multiple ways to structure a review of clinical care. A tertiary review is retrospective, meaning it occurs after the patient has been discharged. During the secondary review, decisions are made to determine where in the performance process the case/issues should go next. This could include analysis by a peer review judgment determination process (tertiary review). In difficult situations, or if a case review cannot be determined internally, it may be necessary to refer a case for quaternary review, which is completed by an external peer review group. 

Data collection for performance improvement can occur concurrently with data abstraction while care is being provided (primary review).   

193.

A burn-injured patient exhibits signs and symptoms of hypoxia upon admission to the emergency department (ED). Which of the following assessment findings is not an indication of hypoxia? 

  • Bradypnea

  • Tachypnea

  • Dyspnea

  • Tachycardia

Correct answer: Bradypnea

Bradypnea is an indication of hypercapnia, not hypoxia. Hypercapnia occurs when carbon dioxide is increased in the blood. Retained carbon dioxide decreases the respiratory drive, leading to slowed breathing. 

Hypoxia occurs when oxygen is decreased in the tissues and causes an increased respiratory rate. Restlessness, tachycardia, tachypnea, and dyspnea are all indications of hypoxia.

194.

You are caring for a burn-injured patient and suspect Ogilvie's syndrome. Which of the following is not an appropriate initial nursing intervention for this condition? 

  • Prepare the patient for surgical intervention 

  • Withhold all oral intake 

  • Place a nasogastric (NG) tube if the patient does not already have one 

  • Reposition the patient frequently 

Correct answer: Prepare the patient for surgical intervention 

Ogilvie’s syndrome is a massive dilation of the colon in the absence of mechanical obstruction and has been well-described in burn patients. The clinical presentation includes insidious and progressive abdominal distention. Abdominal X-rays reveal colonic air in all colonic segments (including the rectum); they are crucial to diagnosis. 

Initially, conservative measures should be instituted for a patient without significant abdominal pain, severe colonic distention, or signs of peritonitis. If this condition is suspected, expect the physician to order the placement of an NG tube attached to suction. Additionally, the patient should be placed on NPO status and repositioned frequently.

Surgery is reserved for patients with evidence of persistent, severe colonic distention (which increases the risk of colonic ischemia, perforation, and peritonitis), or when other attempts to manage Ogilvie’s syndrome fail.

195.

Burn wounds managed with delayed closure are classified as healing by which method?

  • Tertiary intention 

  • Primary intention

  • Secondary intention 

  • Partial-thickness repair 

Correct answer: Tertiary intention 

Wound healing occurs through primary or secondary intention or by delayed primary closure (also called tertiary intention). Delayed primary closure may be used for contaminated wounds in which infection and dehiscence are often avoided. 

The use of delayed primary closure allows the wound to be left open for cleansing, promotes the development of a healthy granulation bed that resists infection, and is prepared for subsequent skin grafting or closure. 

196.

Which statement best reflects the definition of autonomy in relation to patient care?

  • The patient's right to make decisions about their own treatment and body

  • The patient's right to leave facilities against medical advice (AMA)

  • The patient's automatic right to be able to say and do whatever they want in a health facility

  • The healthcare worker's right to a harassment-free workplace

Correct answer: The patient's right to make decisions about their own treatment and body

Autonomy is a patient's right to determine their own treatment and plan of care. Every patient deserves dignity, respect, and the ability to make decisions based on their values and preferences without outward interference.

197.

What is one of the last signs of true compartment syndrome?

  • Loss of pulses 

  • Pain

  • Pallor

  • Delayed capillary refill 

Correct answer: Loss of pulses 

Compartment syndrome occurs when pressure builds within the muscles to dangerous levels. Special consideration should be given to burns that are completely circumferential around a part of the body, such as a limb or the trunk. These types of wounds can cause increased pressure due to the tissue beneath the wound becoming edematous, resulting in compartment syndrome and ischemia.

The most reliable indicator of this condition is severe pain with passive motion. The pain tends to be out of proportion with the injury and unrelieved by pain medications. Capillary refill time may be delayed. The patient may experience decreased distal sensations, paresthesia, or a "burning" sensation. Pulses are usually present; pulselessness is a late sign of compartment syndrome, along with paresthesia and paralysis. 

198.

What is a hallmark sign of toxic epidermal necrolysis (TEN)? 

  • Nikolsky's sign 

  • Auspitz's sign

  • Crowe's sign

  • Darier's sign

Correct answer: Nikolsky's sign 

Gentle pressure applied to intact skin next to blisters causes the skin to wrinkle and slide laterally (epidermal separation), which indicates a positive Nikolsky sign. Although not specific to TEN, a positive Nikolsky sign is a hallmark sign for TEN. Large sheets of skin are sloughed, exposing the fragile, bleeding dermis.

Crowe's sign is the presence of axillary freckling in people with neurofibromatosis type I. Darier's sign is a change observed after stroking lesions on the skin of a person with systemic mastocytosis or urticaria pigmentosa. In general, the skin becomes swollen, itchy, and red. Auspitz's sign is the appearance of punctate bleeding spots when psoriasis scales are scraped.

199.

When assessing a burn injury, a nurse should delineate the zone of injury. What is the area of the wound that can potentially necrose with inadequate treatment or heal if the area is properly perfused and treated?

  • Zone of stasis 

  • Zone of coagulation 

  • Zone of hyperemia 

  • Zone of distribution 

Correct answer: Zone of stasis 

Burn injuries can be divided into three zones:

  1.  Zone of coagulation: The point of greatest damage, in which there is irreversible tissue damage 
  2.  Zone of stasis: Surrounds the zone of coagulation; an area of the wound that can either necrose if not treated properly or heal if proper management is initiated
  3.  Zone of hyperemia: Will likely heal with treatment if the region maintains perfusion and infection is not involved

A zone of distribution does not exist. 

200.

Which of the following is a characteristic feature of a full-thickness injury? 

  • It involves the subcutaneous tissue

  • It extends into the papillary dermis 

  • It contains necrotic tissue 

  • It is limited to the outer layers of the epidermis 

Correct answer: It involves the subcutaneous tissue 

Full-thickness burns extend at least to the subcutaneous tissue layer and possibly as deep as the fascia-muscle layer or bone (the epidermis, dermis, and subcutaneous tissues). Their appearance may be charred, leathery, dry, firm, and depressed when compared to adjoining normal skin. 

Most full-thickness burns should undergo early excision and grafting to minimize infection and hypertrophic scarring and to expedite patient recovery. 

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