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Quiz Session - Attempts With Random Questions

BCEN CBRN Exam Questions

Page 5 of 20

81.

What is the most prevalent type of burns in adults admitted to burn centers in the USA?

  • Flame and flash burns 

  • Scald burns 

  • Contact burns 

  • Chemical burns 

Correct answer: Flame and flash burns 

Flash and flame burn injuries represent approximately 40% of the admissions to American regional burn centers and are a major source of morbidity and mortality across all age groups. Scald burn injuries (hot water) are the second most common cause of burns in adults in the USA and the most common cause of burns in children under the age of four years. Hot water scalds represent approximately one-third of cases. 

Contact and chemical burns are less common types of burn injuries. 

82.

Of the following medications used to treat burn victims, which is not an opioid analgesic?

  • Propofol 

  • Remifentanil 

  • Methadone 

  • Morphine 

Correct answer: Propofol

Propofol is not an opioid. It is a nonbarbiturate intravenous anesthetic (without analgesic activity) used in induction, maintenance, and also in just sedation. It has a rapid onset and rapid emergence with little cumulative effect after a prolonged infusion time.

Morphine, methadone, and remifentanil are all opioids commonly used as burn pain drug therapy. The use of adjuvant drugs and a multimodal approach to pain control can increase the quality of pain control in part by reducing the dose and thereby limiting the adverse effects of any opiates needed.

83.

You are the triage burn nurse on duty. You receive a phone call from a 30-year-old female who has sustained a hot oil splash on her abdomen while cooking. The affected area has redness, blisters, and intense pain. She reports no known drug allergies. 

What should you instruct the patient to do as an initial step in managing her injuries? 

  • Cover the burn loosely with a clean, non-stick sterile dressing

  • Apply vinegar to the burn to prevent infection

  • Use adhesive tape to seal the burn blisters

  • Scrub the burn gently to remove any oil residue

Correct answer: Cover the burn loosely with a clean, non-stick sterile dressing

Prehospital care of wounds is basic and fairly simple; it requires only protection from the environment with the application of a clean dressing or sheet to cover the involved part. Covering the burn with a clean, non-stick sterile dressing helps protect the area from infection and reduces pain. The patient should be advised to wrap herself in a blanket to minimize heat loss and get to the closest emergency department for further assessment and management of her burn injury. 

Applying vinegar, sealing blisters with adhesive tape, and scrubbing the burn are not recommended. 

84.

You are collecting a medical history for a male patient who experienced 50% TBSA partial-thickness burns. A tetanus shot will be needed if the vaccine has not been administered in which timeframe?

  • Past 3-5 years

  • Past 10 years

  • Past 2 years

  • Past 5-7 years

Correct answer: Past 3-5 years

Burns are tetanus-prone wounds. Tetanus is a disease that can be prevented with immunization. This patient's tetanus status should be documented and supplemented if indicated. If in doubt, active immunization should be administered. 

The best clinical practice for trauma patients with potentially contaminated wounds who have not received tetanus immunization within 3-5 years is to administer 0.5 mL tetanus toxoid intramuscular injection. If the patient's last booster was more than 10 years prior, 250 U of tetanus antitoxin is also given. 

85.

A patient has a burn to the torso that is diagnosed as a first-degree burn injury. Which of the following statements is accurate? 

  • The burn will take less than a week to heal and will heal spontaneously without scarring

  • The burn will take 1-3 weeks to heal and may heal spontaneously or may require intervention

  • The burn will take more than 3 weeks to heal and will require skin grafting if the wound is 4 cm or deeper

  • The burn will take less than 2 weeks to heal and may scar

Correct answer: The burn will take less than a week to heal and will heal spontaneously without scarring

Burns involving only the outer layers of the epidermis (first-degree burns) are erythematous and very painful but do not form blisters. Most sunburns fit this category of superficial, epidermal injury. Within 3-4 days, the dead epidermis sloughs off and is replaced by regenerating keratinocytes. This type of burn heals spontaneously without scarring. 

A burn that is diagnosed as a deeper partial-thickness burn will take between a week and a month to heal. These burns may heal spontaneously or may require skin grafting. A burn that is diagnosed as a full-thickness burn will take more than three weeks to heal and will require excision and skin grafting if the wound is 4 cm or deeper.

86.

You are collecting a medical history of a male patient who experienced 50% TBSA partial-thickness burns. Which of the following conditions should alert you to modify the patient's burn fluid resuscitation plan? 

  • Coronary artery disease (CAD)

  • Seasonal asthma 

  • Renal calculi in the past year 

  • Hepatitis B virus infection 5 years ago

Correct answer: Coronary artery disease (CAD)

Patients with significant comorbidities (e.g., heart failure, cirrhosis, preexisting renal insufficiency, morbid obesity) often do not respond in the usual way to fluid resuscitation and may benefit from closer monitoring.  In this scenario, the patient likely has a diminished cardiac output secondary to his medical history of CAD and would be at greater risk for the development of congestive heart failure and pulmonary edema during fluid resuscitation. Because of this, the patient's plan of care should be modified. 

The other choices do not warrant a modification of the fluid resuscitation plan. 

87.

A patient sustained a superficial partial-thickness burn to the anterior and posterior torso and neck. You are preparing to perform a sterile dressing change. You start the procedure by administering pain medication and allowing it to take effect. 

What is your next step?  

  • Debride the wound of eschar using gauze sponges 

  • Obtain a sample of tissue from the wound to send for culture 

  • Apply topical silver nitrate ointment as ordered 

  • Cover the wound using a sterile gauze dressing 

Correct answer: Debride the wound of eschar using gauze sponges 

After administering pain medication, the next step in performing a sterile dressing change is to debride the wound before getting the sample for culture to prevent other bacteria from contaminating the wound. A new burn is essentially sterile, and every attempt should be made to keep it so. The burn wound should be thoroughly cleaned with soap and water or a mild antibacterial wash such as dilute chlorhexidine.

You should next obtain a sample for wound culture, followed by applying silver nitrate ointment and re-covering the area with sterile gauze. 

88.

You are caring for a patient with deep partial-thickness thermal burn injuries who is receiving morphine sulfate for pain control. Which of the following is a priority action in the care of this patient? 

  • Encourage coughing and deep breathing exercises

  • Monitor stool

  • Encourage fluid intake

  • Monitor urine output

Correct answer: Encourage coughing and deep breathing exercises 

Morphine has been described as the gold standard for treating burn pain and remains the first choice in many burn units for pain management. However, this medication can suppress the respiratory and cough reflexes, and a common side effect is respiratory depression. Therefore, incorporating coughing and deep breathing exercises into this patient's plan of care is a priority to ensure adequate oxygenation. 

The other choices are components of the plan of care but not the priority in this scenario. 

89.

Which of the following is not an indication of early intubation for a burn patient?

  • The suspicion of an inhalation injury (either upper or lower) 

  • The presence of >30% TBSA burn injury 

  • An elevated carboxyhemoglobin level >10%

  • A decreased level of consciousness (DLOC)

Correct answer: The suspicion of an inhalation injury (either upper or lower) 

Although suspicion of an inhalation injury is often enough of an indication for intubation, not all patients exposed to smoke will require intubation. Close observation of these patients with preparation to intervene immediately is prudent.

Patients with evidence of upper or lower airway and lung injury (e.g., an elevated carboxyhemoglobin level >10%, stridor, or hoarseness) should be promptly intubated. Another major indication for early intubation in burn patients is the presence of a large TBSA burn injury. While there is no mandatory cut-off for TBSA above which intubation is necessary, 30% TBSA is the cut-off recommended by Acute Burn Life Support. A last indication for intubation is a DLOC. These patients should be immediately intubated, and a thorough work-up should be initiated. 

90.

A patient exposed to carbon monoxide (CO) from a house fire has dizziness, vomiting, and dim vision. To what elevated level of carbon monoxide was the patient most likely exposed?

  • 30% to 40%

  • 10% to 20% 

  • <3% 

  • 60% to 70% 

Correct answer: 30% to 40%

Carbon monoxide (CO) poisoning and asphyxiation account for the majority of fatalities at the scene of a fire. When individuals are subjected to carbon monoxide levels at 30% to 40%, they will experience irritability, severe headaches, weakness and fatigue, syncope, nausea and vomiting, dizziness, and vision changes.  

Non-smokers have CO levels normally at 0% to 3%. Exposure to carbon monoxide levels at 10% to 20% will cause mild headaches, flushing, dizziness, and/or nausea. Carbon monoxide levels at 60% to 70% will cause respiratory failure, shock, coma, or death.

91.

Using the qSOFA score, which of the following assessment data would be positive for sepsis in a burn-injured patient? 

  • GCS = 12, BP = 90/52, RR = 25/min

  • GCS = 10, HR = 120, RR = 22/min

  • Lactate = 3 mmol/L, WBC = 12,000/mm3, temperature = 39 °C (102.2 °F) 

  • Lactate = 4.5 mmol/L, HR = 112, BP = 89/45

Correct answer: GCS = 12, BP = 90/52, RR = 25/min

Although many scoring systems exist for sepsis, the sequential organ failure assessment (SOFA) score has good predictive validity and is recommended for quantifying organ dysfunction associated with sepsis in critically ill patients. 

An abbreviated easy-to-use version of the SOFA score called the qSOFA is often used. It is positive if 2 or more of the following indicators are present: 

  • systolic blood pressure ≤100 mm Hg
  • respiratory rate ≥22/min
  • altered mental status (Glasgow Coma Scale score <15)

92.

You are caring for a patient with a deep full-thickness burn injury who is exhibiting signs of bloodstream sepsis. All the following manifestations indicate sepsis, except: 

  • Hypoglycemia

  • Thrombocytopenia

  • Hyperventilation

  • Hypothermia

Correct answer: Hypoglycemia

A burn wound is often the source of bloodstream infection due to both the high bacterial loads on burn eschar and the loss of protection normally provided by the skin. The five cardinal signs of sepsis are:

  • Thrombocytopenia
  • Hyperglycemia
  • Disorientation
  • Hyperventilation
  • Hyperthermia or hypothermia

Cultures and/or biopsies should be performed to identify the type and number of organisms, and infected wounds should be treated with a specific systemic antibiotic, topical dressing, soak, or a combination of all treatments. 

93.

You are triaging a patient in the emergency department (ED) who sustained a chemical burn after spilling a can of paint on their legs. The label on the can shows lye as the primary ingredient. Which of the following statements is accurate regarding this type of burn? 

  • This type of burn tends to be deeper 

  • This is an acidic burn

  • This type of burn will be easier to neutralize 

  • This patient is at risk for compartment syndrome

Correct answer: This type of burn tends to be deeper 

Alkalis (lyes) are highly corrosive and tend to penetrate more deeply than chemical burns caused by an acidic agent. Wounds caused by alkalis appear superficial initially but often become full-thickness in 2-3 days. Neutralizing an alkali burn is more difficult than an acidic burn. 

Compartment syndrome is more characteristic of electrical burns. 

94.

Which water-soluble vitamin is helpful for collagen synthesis? 

  • Vitamin C

  • Vitamin A 

  • Vitamin E

  • Vitamin B complex 

Correct answer: Vitamin C

Vitamins B and C are water-soluble. Vitamin C is essential for collagen synthesis, while vitamin B is necessary for the production of energy from glucose, amino acids, and fat. 

Vitamins A, D, E, and K are fat-soluble. While vitamins A and E are also helpful for collagen formation, they are not water-soluble. 

95.

You would expect to see all the following laboratory trends in a patient who sustained a severe thermal burn injury approximately 24 hours ago, except: 

  • Increased testosterone levels 

  • Increased antidiuretic hormone (ADH) levels 

  • Increased cortisol levels 

  • Increased catecholamines 

Correct answer: Increased testosterone levels 

The stress associated with thermal injury, as well as the subsequent fluid shifts, induces endocrine responses similar to other critical illnesses. Testosterone, dehydroepiandrosterone (DHEA), and triiodothyronine (T3) levels decline, while ADH, cortisol, catecholamines, and the renin-angiotensin system (RAS) increase. 

Replacement of testosterone with analogs has been shown to reduce the length of hospital stay, reduce lean body mass loss, improve body composition, and increase hepatic protein synthesis. 

96.

You are admitting a patient with clinical characteristics indicating toxic epidermal necrolysis (TEN). A diagnosis of this condition can be confirmed by which of the following? 

  • Sloughed skin histology showing necrosis 

  • Evidence of infection 

  • Serum blood urea nitrogen of 30

  • Serum glucose of 300 mg/dL 

Correct answer: Sloughed skin histology showing necrosis 

Patients often exhibit symptoms (i.e., a low-grade fever, malaise, coughing, conjunctivitis, and dysuria) that precede cutaneous manifestations by up to 3 weeks. A frank rash appears next, with possible patches of tender erythema and inflamed mucosal membranes. TEN's rash is extremely painful. 

An early skin biopsy is essential for the diagnosis of TEN, which will show necrotic epithelium (keratinocytes). The other choices would not confirm the diagnosis.

97.

You are caring for a burn victim who requires daily dressing changes. You observe thick yellow exudate on the dressing and the wound bed during your patient's routine dressing change. 

How should you document this drainage? 

  • Purulent 

  • Seropurulent 

  • Serosanguineous 

  • Sanguineous 

Correct answer: Purulent 

Purulent drainage is thick, translucent to opaque in consistency and yellow, tan, or green. Purulent drainage signals infection and may have a foul odor. Do not mistake purulent with seropurulent, which is thin and watery and can be an early indicator of impending wound infection. 

Sanguineous drainage is normal, signaling new blood vessel growth. It is thin and watery in consistency and red. Serosanguineous drainage is also normal during the inflammatory and proliferative phases of healing. It is thin, watery, and light pink to red. 

98.

You are providing care to a burn-injured patient suffering from upper gastrointestinal bleeding (GI) secondary to a Curling ulcer. In developing the plan of care, which priority problem should you note for this patient? 

  • Fluid volume deficit related to acute blood loss

  • Risk for aspiration related to acute bleeding in the GI tract

  • Risk for infection related to acute disease process 

  • Imbalanced nutrition, less than body requirements, related to lack of nutrients and increased metabolism

Correct answer: Fluid volume deficit related to acute blood loss

Curling ulcer is a stress-induced ulcer of the stomach or duodenum that occurs in relation to extreme physical stress, such as in massively burned patients. This is because an extensive burn causes more stress on the entire body than any other injury.

This condition is clinically recognized in most cases only by the onset of upper GI bleeding, which may be evidenced by vomiting blood or blood in the stool. Fluid volume deficit is the priority problem associated with acute GI bleeding, which can result in decreased cardiac output and hypovolemic shock if not managed properly. Nutrition, aspiration, and infection are concerns, but the priority is ensuring sufficient fluid volume. 

99.

You are caring for a patient who sustained deep partial-thickness burns and is receiving treatment with topical mafenide acetate (Sulfamylon) cream. Which finding indicates that a systemic effect has taken place? 

  • Rapid breathing 

  • Decreased blood pressure 

  • Localized pain to the burn injury 

  • Localized itching to the burn injury 

Correct answer: Rapid breathing 

Mafenide acetate (Sulfamylon) is a topical agent that has antibacterial and bacteriostatic activity against most gram-positive and gram-negative pathogens and has limited antifungal activity. It is one of the most commonly utilized topical agents for burn injuries. It penetrates eschar well and is typically used for short-term treatment of infection. 

Since mafenide can inhibit carbonic anhydrase and suppress renal excretion of acid, metabolic acidosis can develop. Patients should be monitored for metabolic effects, including hyperventilation. If this occurs, the medication will likely be discontinued for 1 to 2 days. 

Pain and itching at the injury site are local effects of this medication, not systemic effects. Hypotension is not a systemic effect of this medication. 

100.

Upon assessment of a burn injury on your patient's right lower extremity, you note red granulation tissue. The wound edges are firm and soft, and the wound is beginning to contract into a rectangular shape. Which of the following phases of wound healing is this? 

  • Proliferation 

  • Inflammation 

  • Maturation 

  • Hemostasis 

Correct answer: Proliferation 

The third phase of acute full-thickness wound healing is the proliferative phase. Signs of acute proliferation indicate a healthy response and normal healing. During this phase, peri-wound skin regains color and contour symmetry with that of adjacent skin (i.e., edema is resolved). Granulation tissue starts to form at the wound perimeter, contracting the wound, and reepithelialization results in scar formation. 

Hemostasis occurs immediately as platelets seal the vessels and the clotting cascade begins. Inflammation—the second phase of wound healing—is characterized by erythema and edema as phagocytosis removes debris. Maturation (or remodeling) is the final stage of wound healing, as the scar continues to form and the wound closes. This phase can continue for up to two years as the underlying tissue continues to remodel. 

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