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Quiz Session - Attempts With Random Questions

BCEN CBRN Exam Questions

Page 2 of 20

21.

You assess a patient's burn wound and observe that it is epithelializing. Which of the following characterizes an epithelializing wound?   

  • A pink margin to the wound 

  • Yellow viscous adherent slough 

  • Dark black eschar composed of dead dermis 

  • Highly vascular matrix of collagen and proteoglycans 

Correct answer: A pink margin to the wound 

Epithelialization is the migration of epithelial cells across a wound, which provides protection against the entry of bacteria into the wound and fluid loss and resurfaces the wound defect. The epidermal covering (composed primarily of keratinocytes) begins to migrate from one wound edge until a sheet of cells covers the wound and attaches to the dermal matrix. An epithelializing wound has a pink margin or an isolated pink island on the surface. 

Granulation tissue is a highly vascular matrix of collagen and proteoglycans. Newly formed granulation tissue is very fragile. Viscous adherent slough is characteristic of a sloughy wound. A necrotic wound has dark black eschar composed of the dead dermis. 

22.

What is thought to be the leading cause of mortality in fire victims? 

  • Carbon monoxide toxicity 

  • Pulmonary edema 

  • Hypovolemic shock 

  • Cardiovascular collapse 

Correct answer: Carbon monoxide toxicity 

When flames engulf a room, they consume oxygen and reduce the fraction of inspired oxygen (FIO2) in the room to <10%, causing tissue hypoxia and asphyxia. Carbon monoxide (CO) toxicity is a frequent cause of morbidity and mortality in patients who sustain smoke-induced inhalation injury. Smoke from the fire will reach a victim before the flames can, which can lead to suffocation and death. 

Cardiovascular collapse and hypovolemic shock can affect any burn-injured patient and are not specific to fire victims. Pulmonary edema is not a major complication for fire victims. 

23.

A child is admitted to the emergency department with a burn injury and is accompanied by a non-English-speaking family member. Which of the following is most appropriate when using an in-person interpreter with the family? 

  • Speak directly to the family and ensure eye contact is made

  • Avoid medical terminology the family may not understand

  • Instruct the interpreter on what to tell the family

  • Speak slowly and enunciate 

Correct answer: Speak directly to the family and ensure eye contact is made

Effectively using an interpreter addresses your response to diversity, which can improve outcomes by ensuring effective communication between the healthcare team and the family. Speak directly to the patient and their family, as opposed to instructing the interpreter on what to say. This will facilitate a more natural flow of communication. 

The degree of medical terminology used should be no different than for a native English speaker. The rhythm, tone, and speed of speech used should also be the same as for native English speakers, allowing time between longer statements for interpretation. 

24.

All the following clinical signs are used in the differential diagnosis of necrotizing infections of skin and subcutaneous tissues, except: 

  • Tissue hypoxia 

  • Skin changes 

  • Odor of exudates 

  • Tissue gas 

Correct answer: Tissue hypoxia 

Although correction of tissue hypoxia can help in the treatment of necrotizing soft tissue infections, it is not used for differential diagnosis like the clinical signs of skin changes, tissue gas, odor of exudates, and pain. 

25.

Which of the following causes the least procedural pain when managing burn wounds? 

  • Autolysis 

  • Mechanical debridement 

  • Wet-to-moist gauze 

  • Adhesive dressings 

Correct answer: Autolysis 

Autolytic debridement uses the body's intrinsic debriding mechanisms to remove nonviable tissue. This method supports endogenous healing. Autolysis is accomplished by keeping the wound moist with occlusive or semi-occlusive dressings and is a slow, painless process. 

Mechanical debridement, adhesive dressings, and wet-to-most gauze cause procedural burn wound pain.

26.

Which of the following ethical principles is interpreted to mean that a provider cannot intentionally or unintentionally harm a patient?

  • Nonmaleficence 

  • Beneficence 

  • Veracity 

  • Fidelity 

Correct answer: Nonmaleficence 

Nonmaleficence is the ethical principle that means we do not harm or injure patients, either by intentionally exposing them to unnecessary risk or through carelessness. It asks nurses to avoid taking potentially harmful actions, such as overmedicating confused patients rather than trying to redirect them, or negligent actions, such as failing to check a patient's code status before beginning resuscitation efforts. 

Beneficence is the ethical principle that means a nurse is obligated to only do good, not harm. The principle of veracity states that a nurse is to always tell the truth and not intentionally deceive a patient. Fidelity is the ethical principle that means a nurse has accepted their obligation to be faithful to their responsibilities.

27.

Cyanide is considered one of the most likely agents of chemical terrorism. All the following are characteristics of cyanide, except: 

  • Easily transmitted between individuals

  • Difficult to identify

  • Readily available 

  • Quickly causing potentially fatal symptoms

Correct answer: Easily transmitted between individuals

Cyanide is a chemical that can be incredibly deadly when inhaled or ingested and affects the body's ability to transport oxygen to tissues through a chemical effect. The US Centers for Disease Control and Prevention and the Department of Homeland Security consider cyanide among the most likely agents of chemical terrorism. It possesses all the attributes of an ideal terrorist weapon. A cyanide attack would be difficult to identify and is likely to quickly cause potentially fatal symptoms. Cyanide is used in many different industries and laboratories, making it relatively easy to access. In addition, the use of cyanide does not require any special knowledge and is capable of causing mass incapacitation and casualties. It can provoke mass confusion, panic, and social disruption. 

Cyanide is not a potential contagion (not easily transmitted between individuals). 

28.

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. What is the benchmark for fetal viability for which every attempt at fetal resuscitation should be initiated? 

  • 24 weeks and 500 g

  • 24 weeks at 1,000 g

  • 24 weeks and 1,500 g

  • 22 weeks and >500 g

Correct answer: 24 weeks and 500 g

Obstetrical complications (e.g., placental abruption and uterine rupture) are potential mechanisms of preterm delivery following acute maternal trauma. Most obstetricians will attempt resuscitation on a fetus at 22 weeks, but 24 weeks and 500 g remains the benchmark for viability; fetal mortality at 22 weeks remains very high. 

29.

Which of the following characterizes calcium alginate as a wound dressing? 

  • Is derived from seaweed

  • Causes trauma to the wound during removal 

  • Is an occlusive dressing 

  • Does not cause desiccation 

Correct answer: Is derived from seaweed

Calcium alginate is manufactured from seaweed; it absorbs wound exudate and forms a moisture/vapor-permeable, gel-like covering over the wound. Alginates maintain a moist environment while absorbing excess exudate and are useful for packing wounds with moderate to large amounts of exudate. They can cause desiccation around the wound. 

These wound dressings conform to the wound contours and can be removed in one piece without causing trauma. They are not classified as occlusive dressings. 

30.

You are caring for a patient with a full-thickness burn injury. Which of the following vitamins will your patient most likely need to have supplemented long-term due to burn-related deficiency? 

  • Vitamin D

  • Vitamin C

  • Vitamin B

  • Vitamin A

Correct answer: Vitamin D

Vitamin D is activated when the skin is exposed to sunlight. However, after a burn injury, the injured skin cannot synthesize normal amounts of epidermal vitamin D regardless of the amount of sun exposure received. Activation of vitamin D is lost completely in full-thickness (third-degree) burns. Thus, progressive deficiency in vitamin D will result without adequate supplementation. 

31.

You are triaging a burn victim with multiple trauma after a motor vehicle crash in which the vehicle caught on fire. The patient is developing acute respiratory distress syndrome (ARDS) as evidenced by which of the following early signs? 

  • Tachypnea

  • Intercostal retractions 

  • Inspiratory crackles 

  • Cyanosis 

Correct answer: Tachypnea

The earliest detectable sign of ARDS is an increased respiratory rate, which can begin from 1 to 96 hours after initial injury to the body. This is followed by increasing dyspnea, air hunger, nasal flaring, retractions, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.

32.

You have been asked by the physician to attend a family meeting with a burn patient. The patient's discharge has been delayed due to the family's limited resources. What is your role in this meeting? 

  • Assist the family in ensuring all their questions are addressed

  • Assess the family's understanding of the cost of outpatient care

  • Educate the family on community financial resource options

  • Assess the family's social and emotional support system

Correct answer: Assist the family in ensuring all their questions are addressed

Resources that are limited leave a patient and family in vulnerable situations after hospital discharge. Nurses spend the most time with patients and their families, making them excellent advocates (in collaboration with the multidisciplinary team) to ensure goals are realistic and obtainable. During the meeting, your role is to ensure the patient's and family's questions are all adequately addressed. 

A case manager or social worker will assess the family's social and emotional support system, as well as provide education on community financial resource options. They can also address the cost of outpatient care. 

33.

You are caring for a patient in the emergent/resuscitative phase of a burn injury and are drawing labs. Upon analysis of the patient’s laboratory studies, you expect the results to indicate all the following, except: 

  • Metabolic alkalosis 

  • Elevated hematocrit 

  • Hyperkalemia

  • Hyponatremia 

Correct answer: Metabolic alkalosis 

Fluid and electrolyte changes in the emergent/resuscitative phase of a burn injury include hyperkalemia related to the release of potassium into the extracellular fluid, hyponatremia from significant sodium lost in trapped edema fluid, hemoconcentration that leads to an increased hematocrit, and loss of bicarbonate ions that results in metabolic acidosis.

34.

Evidence demonstrates that long-term vitamin D supplementation is necessary to overcome postburn deficiency. What is the recommended daily intake of supplemental vitamin D for post-burn patients?

  • >400 IU/day 

  • 200-400 IU/day 

  • 1,000 IU/day

  • >500 IU/day

Correct answer: >400 IU/day 

Burn scar and adjacent areas of unburned skin can only convert approximately 25% of its 7-dehydrocholesterol precursor to vitamin D3 on exposure to sunlight. This indicates that the burn-injured skin cannot synthesize normal amounts of vitamin D regardless of the amount of sun exposure received. Thus, progressive deficiency in vitamin D will result without supplementation. 

Long-term vitamin D supplementation with levels exceeding 400 IU/day may be necessary to overcome progressive deficiency associated with burn-injured skin. 

35.

Which of the following factors is not a component of the lethal trauma triad in burn shock patients? 

  • Hyperglycemia 

  • Coagulopathy 

  • Hypothermia 

  • Acidosis 

Correct answer: Hyperglycemia 

The goals of treating traumatic shock are to restore perfusion and tissue oxygenation and to prevent the development of the life-threatening triad, which includes the trinity of hypothermia, acidosis, and coagulopathy. This is known as the lethal triad in a trauma setting and is a well-known risk factor associated with a high risk of death.

Hyperglycemia is not a component of this deadly trauma triad. 

36.

While caring for a burn patient, you administer cimetidine (Tagament) via the patient's feeding tube to help prevent the formation of a Curling (stress) ulcer. 

Which of the following is a primary risk factor for stress ulcer bleeding in a burn patient? 

  • Intubation with mechanical ventilation for >48 hours

  • Sepsis 

  • Liver failure 

  • History of peptic ulcers 

Correct answer: Intubation with mechanical ventilation for >48 hours

Curling ulcers are classically associated with burn injury secondary to the extreme physical stress that takes place within the body; they are caused by a breakdown of the lining of the stomach (gastric mucosa). These ulcers can lead to massive hemorrhage and shock, resulting in a high mortality rate and causing perforation and hemorrhage more often than other forms of intestinal ulceration.

Primary risk factors for stress ulcer bleeding include:

  • Intubation with mechanical ventilation for over 48 hours
  • Coagulopathy (bleeding disorder)

Secondary risk factors include:

  • Sepsis
  • Liver failure
  • Kidney failure

A person who has had a peptic ulcer in the past is usually not at additional risk of developing a Curling ulcer.

37.

You are monitoring a patient with severe burn injuries to the head and neck for signs of increased intracranial pressure (ICP). If the patient's ICP is rising, vital sign trends would include all the following, except: 

  • Increasing pulse 

  • Increasing temperature 

  • Increasing blood pressure 

  • Decreasing respirations 

Correct answer: Increasing pulse

A change in vital signs may be a late sign of increased ICP. Trends include increasing temperature and blood pressure (increased systolic blood pressure with a widening of the pulse pressure) and decreasing pulse (bradycardia) and respirations. Respiratory irregularities also may occur.

38.

A burn-injured patient with circumferential burns to both extremities and a femur fracture to the left leg reports calf pain in the unaffected (right) leg. After you ensure a patent airway, what intervention is the next priority? 

  • Assess neurovascular status 

  • Massage the calf

  • Apply ice to the leg 

  • Elevate the extremity 

Correct answer: Assess neurovascular status 

This assessment finding is consistent with deep vein thrombosis (DVT). Burn wounds create a hypercoagulable environment due to the procoagulant effects created by the release of subendothelial collagen and tissue thromboplastin, leading to a high risk of venothromboembolism (VTE) and pulmonary embolus. Other clinical features of DVT include increased or unequal lower extremity girth, redness or warmth, and body temperature elevation. 

Once the airway is managed, a neurovascular assessment is necessary to assess pulse, color, and sensation to intervene rapidly. Massaging the calf is contraindicated, as this could disturb or dislodge a DVT. Applying ice is inappropriate and ineffective. The extremity should be elevated, but the priority in this scenario is to assess the patient's neurovascular status. 

39.

Under the regulations of the Health Insurance Portability and Accountability Act (HIPAA), individuals are entitled to do all the following, except:

  • Access their spouse's personal medical records 

  • Receive information regarding how their health data will be used and disclosed

  • Authorize the use of their medical records

  • Access a list of nonroutine disclosures of their information

Correct answer: Access their spouse's personal medical records 

The Health Insurance Portability and Accountability Act (HIPAA) provides for the protection of personal health information (PHI) by directing ways it may be stored, shared, or released. Individuals are entitled to access and authorize the use of their personal medical records. If they wish to access their spouse's personal medical records, the spouse must agree to and sign a release form allowing access to their records. 

The other choices are correct uses of HIPAA.

40.

You are caring for a burn victim who is being evaluated for brain death by the physician. Which of the following assessment findings indicates the patient is not clinically brain dead? 

  • Withdrawal from painful stimuli

  • Absent corneal, papillary, and gag reflexes

  • Glasgow coma scale (GCS) score of 3

  • Absent cerebral functioning

Correct answer: Withdrawal from painful stimuli

If the patient withdraws from painful stimuli in any way, this indicates some level of brainstem activity; thus, the patient has not clinically died. 

A brain-dead patient will manifest no spontaneous respiratory effort, no pain response, and no movements in response to external stimuli; absent corneal, papillary, and gag reflexes; absent cerebral functions; and a GCS score of 3 all indicate brain death.

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