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Quiz Session - Attempts With Random Questions

BCEN CBRN Exam Questions

Page 4 of 20

61.

A patient presents to the emergency department with partial-thickness burns to the face, neck, arms, and chest after attempting to put out a kitchen fire. Which of the following nursing actions should not be implemented for this patient? 

  • Place a cooling blanket on the patient

  • Administer supplemental oxygen as indicated

  • Elevate extremities if no fractures are present

  • Assess for airway patency 

Correct answer: Place a cooling blanket on the patient

The primary goal for a burn injury is to identify any immediately life-threatening problems; ensure a stable, controlled, and patent airway; and initiate intravenous (IV) fluid resuscitation to prevent hypovolemic shock and preserve vital organ functioning. Oxygen is necessary to perfuse vital tissue and organs and should be administered as ordered. The extremities are elevated to assist in preventing shock and decrease the amount of fluid moving to the extremities (especially in the burn-injured upper extremities). 

Virtually all patients with loss of the epidermal barrier will become hypothermic and need to be kept warm. Thus, a cooling blanket is an inappropriate intervention. 

62.

You are caring for a patient with a full-thickness burn wound to the left lower extremity. Based on this patient's burn severity, what is the most effective method of healing and closure of this wound? 

  • Secondary intention 

  • Primary intention 

  • Tertiary intention 

  • Sutures 

Correct answer: Secondary intention 

Full-thickness wound repair (or secondary-intention healing) is the most effective method of healing for full-thickness wounds (such as burn injuries) that have damaged the epidermis and the dermis and into the subcutaneous tissue or beyond. 

When a large amount of tissue is removed or destroyed, a gap occurs; the wound edges cannot be approximated, nonviable wound margins are present, or both occur. Full-thickness secondary-intention healing principally happens by contraction and reepithelialization, resulting in scar formation. The wound is left open to heal, and dressings are applied to protect the wound from contamination. 

Healing by first (primary) intention, or primary closure, refers to wound healing in which the edges are closely re-approximated. In this type of wound healing, union or restoration of continuity occurs directly with minimal granulation tissue and scar formation. For primary closure, sutures are used most commonly. Tertiary healing (third intention) is delayed primary wound healing after 4–6 days. This occurs when the process of secondary intention is intentionally interrupted and the wound is mechanically closed. This usually takes place after granulation tissue has formed and may include closing the wound bed using a skin graft, a skin flap, or a skin substitute. 

63.

You are admitting a patient with frostbite to various areas of both feet. You note full-thickness skin freezing with erythema and marked edema. There are vesicles of clear fluid present. The patient reports numbness in the affected areas. 

What degree of severity is this patient's frostbite?

  • Second-degree

  • First-degree

  • Third-degree

  • Fourth-degree

Correct answer: Second-degree

The traditional classification of frostbite is similar to that for a burn injury. Frostbite may be characterized as superficial, traditionally known as first and second degree, or deep, traditionally known as third or fourth degree. This patient has second-degree frostbite based on clinical appearance and symptoms. The blisters present in second-degree frostbite may desquamate, and eschar formation may occur. 

First-degree frostbite is described as superficial partial-thickness involvement of the epidermis that presents with erythema and edema; hyperemia is possible with skin desquamation. Symptoms include transient burning with throbbing in the area. Third-degree frostbite involves subcutaneous tissue and is characterized by violaceous or hemorrhagic blisters with thickened areas of skin necrosis and no sensation in the area initially; this progresses to shooting or burning pain that is throbbing and aching as the area thaws. Fourth-degree frostbite involves muscle, tendon, or bone, and the patient may complain of joint pain. 

64.

S 55-year-old patient has sustained full-thickness electrical burns on all four extremities. This patient is at risk for all the following complications, except: 

  • Hypernatremia 

  • Cardiac dysrhythmia

  • Cataract formation 

  • Acute renal injury 

Correct answer: Hypernatremia 

Electrical current passing through the tissues can cause injury to the skin, muscles, and bones. The primary early complications of electrical injury include renal, septic, cardiac, neurologic, and ocular manifestations. Neurologic deficits may be present on admission or develop days to weeks after injury. 

Cataract formation is the most frequent ocular complication of electrical injury, although ocular manifestations may affect all portions of the eye. Renal injury is possible because when muscles are affected they release myoglobin, and the red blood cells release hemoglobin in the blood, which can collect in the kidneys and lead to damage. The heart's electrical system can become damaged, leading to dysrhythmias. Fluid volume deficit is an early complication that provokes hyponatremia, not hypernatremia. 

65.

In acute burn wound healing, which of the following statements is accurate regarding polyurethane film dressings? 

  • They reduce the risk of hypertrophic scarring 

  • They absorb moderate amounts of fluid 

  • They provide autolytic debridement 

  • They provide antimicrobial activity in the wound bed 

Correct answer: They reduce the risk of hypertrophic scarring 

Several types of semiocclusive/occlusive dressings may be used to heal a partial-thickness wound. Polyurethane film dressings trap fluid next to the wound, do not adhere to the wound surface, and do not absorb fluid. They do reduce the risk of hypertrophic scars in patients at risk for those lesions. 

Hydrocolloid and hydrogel dressings absorb moderate amounts of fluid and provide autolytic debridement. Silver-impregnated dressings provide antimicrobial activity in the wound bed. 

66.

Which of the following statements is false regarding crystalloids for fluid resuscitation in burn shock patients? 

  • They increase the intravascular osmotic pressure to reduce fluid loss through the capillaries.

  • They are effective most of the time.

  • They are significantly less expensive than colloids and much easier to store.

  • There is little risk of transmitting infectious organisms compared to human-derived products. 

Correct answer: They increase the intravascular osmotic pressure to reduce fluid loss through the capillaries.

Colloids, not crystalloids, increase the intravascular osmotic pressure to reduce fluid loss through the capillaries. Crystalloids have been favored for many years because they are effective most of the time, there is little risk for infectious transmission, and they are less expensive and much easier to store than colloids. 

67.

Burn patients are at particular risk of corneal inflammation due to lost eyelid function, smoke exposure to the ocular surface, and local skin wound contamination. What is the term for inflammation of the cornea?

  • Keratitis 

  • Blepharitis 

  • Hordeolum

  • Uveitis 

Correct answer: Keratitis 

Burn patients are susceptible to keratitis, which is the generic term for inflammation of the cornea. Patients present with pain and photophobia, purulent drainage, pus, decreased vision, and a reddened sclera. Treatment depends on the cause (bacterial, fungal, or viral), although topical cycloplegic and systemic analgesics are recommended for pain control.

68.

Prior to a scheduled dressing change, which of the following intravenous medications is most appropriate to administer to a burn patient? 

  • Morphine 

  • Ketorolac 

  • Lorazepam 

  • Pregabalin 

Correct answer: Morphine 

Opioids are the best choice for pain control. Morphine has been described as the gold standard for treating burn pain and remains the first choice in many burn units. 

The other medications can be used as adjunctive therapy to enhance the effects of opioids to treat burn pain. 

69.

You are admitting a 45-year-old male patient with an erythematous, painful thermal burn that involves the entire surface of the posterior left leg with good capillary refill. What total burn surface area (TBSA) is involved? 

  • 9%

  • 18%

  • 4.5%

  • 16%

Correct answer: 9%

When caring for a patient with a burn wound, nurses should estimate/calculate the affected TBSA of the burn injury. The Rule of Nines can be used to get an estimate. The anterior and posterior surface of an adult leg is approximately 9%; if both the front and back of the leg are affected, that accounts for 18%. The anterior or posterior surface of an arm is 4.5% each. 

An adult patient with a burn over the entire surface of the posterior leg would have an estimated TBSA of 9% affected by the burn injury. 

70.

You are caring for a patient with circumferential deep thermal burns to both arms. What clinical manifestation indicates that an escharotomy is needed? 

  • A weakened radial pulse and paresthesia of the patient's fingers are noted

  • The patient is unable to pronate and supinate the extremity fully

  • The patient's injury is a full-thickness (third-degree) burn

  • The patient cannot distinguish between sharp and dull sensations in the affected extremity 

Correct answer: Weakened radial pulse and paresthesia of the patient's fingers are noted 

Extremities with circumferential thermal or electrical burns are at risk of ischemia. Circumferential eschar can act as a tourniquet when edema forms from the fluid shift, increasing tissue pressure, preventing blood flow to the distal extremities, and increasing the risk for tissue necrosis. Perfusion compliance can be compromised severely by progressive soft tissue edema during burn resuscitation. A decreased radial pulse, paresthesia in the fingers, and a slow capillary refill indicate reduced circulation to the arms and the need for an escharotomy. The physician should be notified immediately in this scenario. 

Abnormal sensations are a normal part of nerve regeneration after burn injuries. The inability to pronate and supinate the extremity fully indicates a likely contracture, not the need for an escharotomy. A full-thickness burn alone does not warrant an escharotomy. 

71.

A two-year-old child sustained scald burns to both hands after pulling a boiling pot of hot water off the stove. What is the most appropriate initial treatment for this patient? 

  • Irrigate with normal saline, tap dry, and cover the wounds 

  • Allow both hands to soak in cool water

  • Wrap each finger in Vaseline gauze 

  • Cover burned areas with gauze and splint fingers straight 

Correct answer: Irrigate with normal saline, tap dry, and cover the wounds 

Initial treatment of a scald burn injury includes a pain assessment, irrigating the area(s) and cooling the tissue (do not rub or soak the tissue), keeping the area clean, and awaiting further assessment and initial burn management. 

72.

The physician has ordered the removal of a chest tube from your burn-injured patient. Which of the following activities should you ask the patient to perform to decrease the risk of pneumothorax during the tube removal?

  • Valsalva maneuver 

  • Sellick maneuver 

  • Coughing 

  • Holding their breath

Correct answer: Valsalva maneuver 

Studies have found that asking the patient to perform a Valsalva maneuver (bearing down like they are having a bowel movement) during the removal of a chest tube may decrease the risk of pneumothorax. 

The other choices are incorrect. 

73.

According to Erikson's theory of psychosocial development, a school-age child (six to 12 years) is undergoing which developmental task? 

  • Industry vs. inferiority

  • Trust vs. mistrust

  • Initiative vs. guilt 

  • Identity vs. role confusion 

Correct answer: Industry vs. inferiority 

According to Erikson, an individual must go through a series of psychosocial developmental stages that must be balanced throughout the lifespan. Each stage is characterized by a psychosocial conflict that must reach a resolution to allow the individual to move to the next phase of development. 

During the school-age years, a child undergoes the stage of industry vs. inferiority in which they are developing physical, social, and learning skills. Achieving self-confidence and competence is a successful outcome. However, if the child exhibits feelings of inferiority and a poor self-concept, the child has failed to complete this stage. 

Trust vs. mistrust is a milestone the infant must meet (birth to 1 year). Initiative vs. guilt is a task for a preschool child (3-6 years). An adolescent (12-18 years) goes through the identity vs. role confusion stage. 

74.

Hydrogels are a good dressing choice for painful burn wounds but should not be used on heavily exudating burn wounds. Why is this? 

  •  They can cause maceration of the surrounding tissues. 

  • They cause the debridement of necrotic tissues.

  • They adhere to the base of the wound. 

  • They leave residue in the wound bed. 

Correct answer: They can cause maceration of the surrounding tissues. 

Hydrogel dressings are water- or glycerin-based. They are available as impregnated gauze, amorphous gels, and sheets and have limited absorptive capacity. They assist in maintaining a moist wound environment, act as insulators, and rehydrate the wound bed. They are indicated for dry to minimally exudative wounds, with or without depth. They are a good choice for painful wounds because hydrogel dressings do not adhere to the base of the wound. 

Hydrogel dressings assist in maintaining a moist wound environment and thus facilitate autolytic debridement (an indication for use). They should not be used on heavily exudative wounds because they may cause maceration if exudate increases. Hydrogel dressings do not leave residue in wounds. 

75.

A trauma nurse has several immediate priorities during the acute phase of trauma resuscitation, including airway and adequate ventilation, control of hemorrhage, and which of the following?   

  • Circulation, perfusion, and initiation of fluid administration

  • Circulation, perfusion, and obtaining a type and cross to begin colloid administration

  • Circulation, perfusion, and bilateral intravenous (IV) access for pain control

  • Achieving hemodynamic stability and minimizing hypothermia

Correct answer: Circulation, perfusion, and initiation of fluid administration

A resuscitation nurse plays a vital role in the rapid assessment and stabilization of patients upon their arrival. The primary assessment must be completed quickly and efficiently and is comprised of priority-based trauma protocols that provide the framework for detecting and treating life-threatening injuries. 

The initial priorities in trauma resuscitation are always the ABCs:

  • A: Airway and alertness
  • B: Breathing and ventilation 
  • C: Circulation and control of hemorrhage 

76.

A patient has a 50% TBSA burn. During the emergent phase of burn care, what should be included in the plan of care to ensure adequate nutrition is maintained? 

  • Initiate enteral feeds via a feeding tube 

  • Administer total parenteral nutrition (TPN) via a central catheter 

  • Encourage oral (PO) intake of at least 3,000 kcal/day

  • Ensure appropriate intravenous (IV) resuscitation via crystalloid fluids 

Correct answer: Initiate enteral feeds via a feeding tube 

Burn victims, especially those suffering from larger burns, often cannot eat sufficient quantities to meet their nutritional needs. Enteral nutrition (EN), or direct enteral feeding ("tube feeding"), is the route of choice to supplement or replace oral intake. 

EN provides direct high-concentration nutrients, stimulates enteric blood flow, maintains barrier function by preserving tight-junction integrity, and induces the production and release of mucosal immunoglobulin and critical endogenous growth factors. These functions are not replaced with TPN. Intravenous (IV) resuscitation with crystalloids is indicated in the initial resuscitation phase but does not assist in meeting the patient's caloric needs.  

77.

You are caring for a patient with toxic epidermal necrolysis (TEN). Proper management of this patient includes all the following interventions, except: 

  • Systemic corticosteroids

  • Antimicrobial non-adherent dressings

  • Low-friction surface support

  • Referral to a burn center 

Correct answer: Systemic corticosteroids

TEN is a rare severe exfoliating disorder characterized by epidermal sloughing at the dermal-epidermal junction. Most cases are caused by a reaction to a medication; a milder form is Stevens-Johnson syndrome. This is a potentially deadly skin disease due to infection resulting from a drug reaction (Cox-2 inhibitor Bextra penicillin) and affects over 30% of a patient's total body surface area (TBSA). 

TEN is characterized by epidermal detachment and lesions (blisters) in the mucosal tissue—including the mouth, eyes, respiratory tract, and genitourinary tract—that are painful. Generalized erythema and macules initially appear on the trunk and then spread to the neck, face, and upper arms (the palms and soles can be affected as well). A macular rash develops, and the macules gradually coalesce. These mucosal lesions in conjunction with the macular rash are strongly suspicious of TEN. 

Treatment involves the prompt cessation of suspicious medications and supportive care. The standard of care is a transfer to a burn center to best manage complex and life-threatening complications, such as temperature dysregulation, electrolyte disturbances, significant nutrition needs, and propensity to wound or skin infections. In general, systemic corticosteroids are not recommended. A sloughed epidermis can be debrided, but a temporary skin substitute (biologic or biosynthetic) or non-adherent antimicrobial dressings should be applied. A low-friction support surface should be provided for a hospitalized patient to prevent further tissue damage. 

78.

Which of the following types of burn is the most urgent type of ocular emergency?

  • Chemical burns 

  • Thermal burns 

  • Radiation burns 

  • Steam burns 

Correct answer: Chemical burns

Chemical burns are the most urgent type of ocular emergency of the options available, as some chemical burns can create ongoing damage until addressed. 

Steam burns are a type of thermal burn. Thermal burns and radiation burns may damage the globe, but these types of injuries rarely lead to ongoing damage that must be neutralized after the event.

79.

What are the first inflammatory cells to reach a burn site injury? 

  • Leukocytes 

  • Platelets 

  • Macrophages 

  • Fibroblasts 

Correct answer: Leukocytes 

Leukocytes are a key player in the inflammatory phase of wound healing. They are the first inflammatory cells to reach the site of injury and depend on oxygen for effective phagocytosis. 

Leukocytes escape the vasculature and enter the tissues, causing edema. They migrate from inside the blood vessels to the site of injury. These effects can be visible within seconds but are relatively short-lived. 

80.

In the OPQRST mnemonic for eliciting a careful pain history, what does the "P" represent? 

  • Palliative factors 

  • Pain quality 

  • Past medical history 

  • Psychiatric symptoms 

Correct answer: Palliative factors 

OPQRST is a helpful mnemonic for first responders to assess a patient's symptoms and pain due to an incident. It stands for the following: 

  • Onset: What was the patient doing when the injury occurred? When did it happen? Was the onset of pain gradual or rapid?
  • Provocative or palliative factors: What triggers or makes the pain worse?
  • Quality: Describe the pain. What does it feel like? 
  • Radiation and region of the pain: Where is the pain? Does it seem to exist in one place, or travel to include another?
  • Severity: Rate the pain 
  • Time or temporal aspects of the pain: What is the timing of onset? How long has the pain persisted? Has there been any change in the pain since the onset? 
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