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Quiz Session - Attempts With Random Questions

BCEN CBRN Exam Questions

Page 3 of 20

41.

A newly admitted patient has circumferential burns to both legs. As you perform your initial assessment, you observe a pale, ivory appearance to the burned areas. The skin is dry, contains blisters, and does not blanch with pressure. The patient reports minimal pain. How should you categorize this burn wound? 

  • Deep partial-thickness

  • Superficial partial-thickness

  • Full-thickness

  • Superficial 

Correct answer: Deep partial-thickness

Deep partial-thickness (second-degree) burns involve the deeper dermis. They may appear pink to pale ivory, yellow, or white; are dry; and do not blanch with pressure. Pain with deep partial-thickness burns is variable; there may be hyperalgesia or hypoalgesia. If the patient reports minimal pain, it is due to a decreased sensation. Healing occurs in 3 to 8 weeks with scarring present.

42.

How is the acute phase of burns defined? 

  • A period extending from the onset of burns with shock to the time taken for wound epithelialization

  • A period of transition from the shock phase to the hypermetabolic phase

  • A period immediately following the injury to the time fluid resuscitation is complete 

  • A period extending from the onset of burns to the resolution of outstanding clinical problems resulting from the injury 

Correct answer: A period extending from the onset of burns with shock to the time taken for wound epithelialization

The acute phase of burns is defined as a period extending from the onset of burns with shock to the time taken for wound epithelialization, which normally takes about 12 to 14 days if the management of burns is adequate.

The early post-resuscitation phase is a period of transition from the shock phase to the hypermetabolic phase, and fluid strategies should change radically with the goal of restoring losses due to water evaporation. The phase of rehabilitative care extends from the onset of burns to the complete resolution of all outstanding clinical problems resulting from the injury. The goals are to return the patient to an optimal place in society and to accomplish any remaining functional and cosmetic reconstruction.  

43.

You are caring for a patient with a burn injury who is on bed rest after undergoing a fasciotomy. To decrease the risk of a pressure injury, you should ensure the patient is repositioned at least how often?

  • Every 2 hours

  • Every hour

  • Every 4 hours

  • Every 30 minutes

Correct answer: Every 2 hours

Preventative measures to relieve pressure through frequent turning (i.e., repositioning every 2 hours at a minimum if on bed rest), avoiding shearing forces, and providing meticulous skin care and nutritional support all aid in decreasing the risk of pressure injury to a burn-injured patient on bed rest. In addition, the skin should be kept warm, dry, well moisturized, and protected with lubricants or protective coverings. 

44.

To select an appropriate dressing for a burn injury, all the following factors should be considered, except: 

  • The patient's gender 

  • The patient's age

  • Maintenance of a moist wound environment 

  • Exudate management 

Correct answer: The patient's gender 

The choice of dressing depends on factors such as:

  • Location and depth of the burn wound
  • Age of the patient
  • Frequency of dressing change required
  •  Exudate management
  • Maintenance of a moist (not wet) wound environment 

The patient's gender is not a contributing factor to the type of dressing used. 

45.

Informed consent falls under which of the following ethical principles?

  • Self-determination 

  • Beneficence

  • Justice 

  • Veracity 

Correct answer: Self-determination 

Informed consent is a process through which a healthcare professional provides a patient with the information needed to make an informed choice regarding healthcare services. It is based on patient self-determination, respect, and autonomy. In this context, informed consent is a formalized and written component of the promise of trust between the patient and the healthcare professional. 

46.

You are caring for a patient admitted with approximately 40% TBSA burns from a house fire. You note the patient becoming increasingly restless and agitated 8 hours after admission. What is your priority nursing intervention? 

  • Check oxygen saturation using pulse oximetry 

  • Assess level of consciousness (LOC) and orientation 

  • Administer ordered morphine intravenously 

  • Draw arterial blood gases (ABGs)

Correct answer: Check oxygen saturation using pulse oximetry 

For a patient who was in a house fire, inhalation injury is likely. The immediate life-threatening consequence of inhalation injury is upper airway edema, sometimes shown by agitation and restlessness as the patient becomes hypoxic. Airway management is always the priority, so oxygen saturation should be assessed first. The treatment of inhalation injury primarily consists of supportive care to maintain a patent airway for oxygenation and ventilation while the lungs heal. 

Assessing LOC and orientation is also an appropriate intervention but does not take precedence over determining whether the patient is hypoxemic. If you determine that the reason for the restlessness and agitation is pain-related, then morphine administration would be appropriate. ABGs may need to be drawn after checking oxygen saturation levels. 

47.

Classic characteristics of a first-degree, superficial burn include all the following, except: 

  • Includes the papillary dermis 

  • Extremely red and painful 

  • No blisters present 

  • Skin blanches when pressed 

Correct answer: Includes the papillary dermis 

Superficial, first-degree burns only involve the outer layer of the epidermis. They are erythematous and very painful but do not form blisters. Blanching is present. Most sunburns fit this category of superficial, epidermal injury. Within 2-4 days, the dead epidermis sloughs and is replaced by regenerating keratinocytes. 

A partial-thickness (second-degree) burn wound is a superficial dermal burn that extends to the papillary dermis, usually forming blisters.  

48.

You are assessing a 12-year-old male who arrived in the emergency department via ambulance with severe thermal burns after attempting to escape an apartment fire. Per emergency medical services (EMS), he fell from a five-story balcony, was intubated in the field, and is not responsive. Upon arrival, his pupils are fixed bilaterally. 

This pupil assessment best indicates which of the following?

  • Severe brainstem injury 

  • Third cranial nerve impairment 

  • Transtentorial herniation

  • Use of opiates 

Correct answer: Severe brainstem injury 

In addition to assigning a Glasgow coma score (GCS) for a patient with a head injury, you should also assess pupillary response with a bright, focused pen light, providing at least 10 seconds between assessments of each eye. This allows consensual response to diminish. 

Bilateral fixed pupils indicate severe brainstem injury with possible brain death. A dilated, fixed pupil (unilateral) indicates early third cranial nerve involvement and possible transtentorial herniation. Fixed, pinpoint pupils indicate pons involvement or the use of opiates.

49.

You are collecting the medical history of a male patient who experienced 50% TBSA partial-thickness burns. A tetanus vaccine will be needed, as the patient has not had one in many years. What is the primary purpose for this patient to receive this immunization?

  • Provide protection against a tetanus infection 

  • Prevent infection in the burn sites 

  • Provide passive immunity

  • Promote wound healing and tissue repair 

Correct answer: Provide protection against a tetanus infection 

Burns are tetanus-prone wounds. Tetanus is a disease that can be prevented with immunization. Routine prophylaxis at admission with 0.5 mL tetanus toxoid is given, if it has not been administered in the previous 3 years. This is done to provide protection against a tetanus infection, which can occur from contaminated wounds. 

50.

For a severely burned patient, all the following signs and symptoms would be expected to be present, except: 

  • Hypernatremia

  • Hyperkalemia

  • Peaked T waves on ECG

  • Elevated hemoglobin and hematocrit 

Correct answer: Hypernatremia

Major burns can be described as massive tissue damage and cellular destruction, leading to widespread systemic inflammation. This increases vascular permeability (leaky blood vessels that fill the body like a water balloon) and results in low fluid volume within the blood vessels. Without urgent and appropriate nursing interventions, this could lead to hypovolemic shock or can even be fatal. 

Within the first 24 hours of a severe burn injury, a patient will likely exhibit:

  • Hyperkalemia (>5 mEq/L)
  • Tall, peaked T waves on ECG
  • Hyponatremia (<135 mmol/L)
  • Elevated H/H 

51.

Which of the following is most likely involved in the pathogenesis of a keloid scar? 

  • Transforming growth factor-beta (TGF-beta)

  • Interleukin 1 (IL-1)

  • Vascular endothelial growth factor (VEGF)

  • Matrix metalloprotease 9 (MMP-9)

Correct answer: Transforming growth factor-beta (TGF-beta)

Keloids are overgrowths of scar tissue caused by skin trauma. Unlike hypertrophic scars, keloids exceed the margins of the original trauma (e.g., burn wound) and can reach enormous dimensions in exceptional cases. 

Transforming growth factor-beta (TGF-beta) and platelet-derived growth factors may be the primary driving forces of keloid development. TGF-beta promotes the chemotaxis of fibroblasts to the site of inflammation, causing collagen production. Dysregulation of this pathway leads to fibrosis and an abnormal scar response.

52.

Which of the following procedures is considered to be a form of mechanical debridement? 

  • Hydrotherapy

  • Application of DuoDERM

  • Application of negative pressure wound therapy 

  • Application of collagenase 

Correct answer: Hydrotherapy 

Mechanical debridement is a nonselective procedure, meaning that both healthy granulation tissue and necrotic tissue are removed. Hydrotherapy is considered a means of mechanical debridement. Irrigation uses mechanical force to remove debris and bacteria from the surface of wounds. The pressure the irrigation delivers is critical in determining the removal of contaminants and particles. 

The application of collagenase is an example of enzymatic, or chemical, debridement. Collagenase is effective for a dry wound with fibrinous slough. DuoDERM and negative pressure wound therapy are types of autolytic debridement. 

53.

When collagen synthesis and lysis are out of balance at a wound site, what happens? 

  • Proliferative scarring

  • Wound dehydration

  • Rapid healing

  • Inflammation 

Correct answer: Proliferative scarring

Excessive or hyperproliferative scarring is a complication of acute full-thickness wound healing that primarily is not well understood. When collagen synthesis and lysis are out of balance, they fail to reach equilibrium, resulting in proliferative scarring or excessive healing. The repair process continues without an apparent "turn-off switch." 

The two types of hyperproliferative scarring are hypertrophic scars and keloid scars. Biochemical analysis of keloid scars reveals increased receptor sites for growth factors and major abnormalities in the behavior of fibroblasts and keratinocytes, which may explain the excessive production of extracellular matrix.

54.

As an emergency nurse, your work includes advocating for every patient under your care. An uninsured patient has as much right to the same emergency care as the chief executive officer of the hospital. What is this ethical principle?

  • Justice 

  • Autonomy

  • Beneficence 

  • Nonmaleficence 

Correct answer: Justice 

Justice in healthcare is generally defined as a form of fairness; adhering to this principle demonstrates humanity and professionalism. However, circumstances and triage decisions in the emergency department require the provider to decide who will get care first based on some criteria such as the availability of providers and treatment resources, patient acuity, or time to the nearest facility. 

Autonomy refers to an individual's freedom of choice without being coerced. Beneficence means doing what is in the patient's best interest, always. Nonmaleficence simply means that we do not harm or injure patients, either by intentionally exposing them to unnecessary risk or through carelessness. 

55.

A new nurse wheels the crash cart into the room where procedural sedation is being provided to your burn patient. Knowledge of which of the following should guide the experienced nurse's response?

  • The crash cart should be present as a precaution but is not typically used

  • The crash cart is not necessary to have present for procedural sedation

  • The crash cart should be present, and the patient should be attached to the defibrillator as a precaution

  • The crash cart is likely to be used while providing procedural sedation

Correct answer:  The crash cart should be present as a precaution but is not typically used

The crash cart should be present as a precaution whenever procedural sedation is being provided. However, the crash cart will only be utilized to maintain a patient's airway or hemodynamic stability, which should typically be unaffected by procedural sedation. It is not necessary to attach the patient to the defibrillator as a precaution unless there is a strong indicator that cardiac dyrhythmias are likely. 

The crash cart is necessary to have on hand because there is a higher risk of inability to maintain an airway or hemodynamic instability during procedural sedation.

56.

A burn-injured patient whose lung has rapidly reinflated following chest tube insertion to treat a pneumothorax suddenly develops orthopnea, tachypnea, and pink, frothy sputum. 

Which of the following best explains these symptoms?

  • Noncardiogenic pulmonary edema

  • Cardiogenic pulmonary edema 

  • Tension pneumothorax 

  • Procedure-related anxiety 

Correct answer: Noncardiogenic pulmonary edema

Noncardiogenic pulmonary edema can occur after rapid lung re-inflation. It manifests with symptoms that can include orthopnea, tachypnea, and pink, frothy sputum. 

Pulmonary edema caused by rapid lung reinflation is noncardiogenic, as it is not caused by a heart-related pathology. Tension pneumothorax is unlikely to occur following the rapid re-expansion of a lung and while a chest tube is present. Tension pneumothorax also does not commonly cause pink, frothy sputum or orthopnea. Procedure-related anxiety will not cause sputum changes or orthopnea.

57.

The skin is composed of the epidermis and the dermis, with each layer containing multiple types of cells. Which cell type is found predominantly in the epidermis?  

  • Keratinocytes

  • Mast cells

  • Macrophages

  • Neutrophils 

Correct answer: Keratinocytes

The epidermis (outermost layer) and dermis (innermost layer) are separated by the basement membrane. Beneath the dermis is a layer of loose connective tissue called the hypodermis, or subcutis. 

The epidermis varies in thickness, has no blood supply of its own, and is composed of several layers of cells, 90% of which are keratinocytes (synthesize keratin). The dermis is the thickest tissue layer of the skin. Dermal cells include mast cells, neutrophils, macrophages, and lymphocytes. 

58.

You are caring for a severely burned patient who has an AB blood type and requires a blood transfusion. Which red blood cells (RBCs) are compatible?

  • O, A, B, and AB

  • O and B

  • O and A

  • Only O

Correct answer: O, A, B, and AB

There are eight different blood types, which are defined by the presence or absence of certain antigens. If a patient has an AB blood type, they are compatible with red blood cells O, A, B, and AB. 

Blood type A is compatible with O and A red blood cells, and blood type B is compatible with O and B red blood cells. Type O is considered the "universal donor," which means these patients can donate to anyone.

59.

A 42-year-old male patient has superficial partial-thickness burns to the posterior head and neck, entire right arm, back of the left arm, posterior trunk, entire left leg, and posterior right leg. Using the Rule of Nines, what total body surface area (TBSA) percentage is burned? 

  • 63%

  • 54%

  • 45%

  • 72%

Correct answer: 63%

According to the Rule of Nines, the posterior head and neck account for 4.5%, the entire right arm is 9% (front and back), the back of the left arm is 4.5%, the posterior trunk is 18%, the entire left leg is 18% (front and back), and the posterior right leg is 9%. This totals 63% TBSA burned. 

60.

Enzymatic agents for the debridement of burn wounds possess all the following properties, except: 

  • Allowing endogenous enzymes to break down devitalized tissue 

  • Slow-acting

  • Highly selective 

  • Debriding only devitalized tissue 

Correct answer: Allowing endogenous enzymes to break down devitalized tissue 

Enzymatic (or chemical) debridement may be indicated when a patient cannot tolerate sharp debridement and removing necrotic, devitalized tissue can be achieved more gradually. Enzymatic agents are highly selective and slow-acting. They promote wound healing by causing debridement of only the devitalized tissue. 

Autolytic debridement occurs when the wound is kept moist, allowing endogenous enzymes to break down nonviable tissue. 

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