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Quiz Session - Attempts With Random Questions

BCEN CBRN Exam Questions

Page 6 of 20

101.

You are caring for a two-year-old patient after performing a dressing change for a burn wound and are assessing the child's pain with the FLACC scale. What does the A represent?

  • Activity 

  • Analgesia 

  • Attention 

  • Airway

Correct answer: Activity 

Pain assessment in pediatric patients must be individualized according to the patient's age, clinical condition, and preferences. The FLACC scale is a validated behavioral observational tool and is typically used for children aged 2 months to 7 years. 

FLACC stands for Face, Legs, Activity, Cry, and Consolability. Each category is scored from 0 to 2. 

102.

What is the preferred biochemical indicator of protein status? 

  • Prealbumin

  • Albumin 

  • Transferrin 

  • Vitamin K

Correct answer: Prealbumin

Prealbumin is the best biochemical indicator of protein status; it is the most sensitive and cost-effective method of assessing the severity of illness resulting from malnutrition in patients who are critically ill. Prealbumin levels correlate with patient outcomes and are an acute predictor of patient recovery. Prealbumin's short half-life (2 days versus 20 days for albumin) gives it a more "current event" value. 

Albumin levels have been used as a determinant of nutritional status, but albumin is relatively insensitive to recent changes in nutrition because of its longer half-life and large body pool. The level typically takes 14 days to return to normal when the pool has been depleted. Serum albumin concentrations are also affected by the patient's state of hydration and renal function. Transferrin will be low in patients with liver dysfunction, and it also decreases when there is not enough protein in the diet. It is used more to detect iron deficiency anemia. Vitamin K levels play a role in evaluating clotting abnormalities. 

103.

You are caring for a patient with circumferential burns to both arms and hands. What is the most appropriate way to position this patient? 

  • Extend and elevate the arms

  • Flex the hands and elevate the arms 

  • Extend the arms and keep them below the level of the heart 

  • Flex the hands and keep the arms at heart level 

Correct answer: Extend and elevate the arms

Burn patients tend to assume the position of comfort, which is often responsible for deformities that later require reconstructive surgery. Thus, positioning in bed is one of the most important ways to prevent deformities. Arms should be elevated and fully extended. This position will decrease edema, as well as the risk of compartment syndrome and contracture formation. 

104.

During burn wound healing, angiogenesis is stimulated by all the following factors, except: 

  • Angiostatin 

  • Lactic acid 

  • Hypoxia 

  • Heparin-binding epidermal growth factor 

Correct answer: Angiostatin 

The wound healing process is often described as four overlapping phases of healing:

  1. Hemostasis
  2. Inflammation
  3. Proliferation (angiogenesis occurs in this phase)
  4. Remodeling

The tissue response has several major components, including angiogenesis, which is the growth of new blood vessels. Through angiogenesis and other tissue responses, the process of wound healing is initiated, directed, and finally completed. 

Vascular endothelial growth factor (VEGF), otherwise known as vascular permeability factor, is secreted by keratinocytes in response to hypoxia. It increases in wound healing and is responsible for stimulating angiogenesis. Lactic acid and heparin-binding epidermal growth factor also stimulate angiogenesis. 

Angiostatin is an inhibitor of angiogenesis. 

105.

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

  • They provide thermal insulation 

  • They provide enhanced antimicrobial activity in the wound bed

  • They do not require a secondary dressing to secure them in place 

  • They can be soaked off to avoid unnecessary debriding of the wound 

Correct answer: They provide thermal insulation 

Foam dressings are comfortable and provide padding for dry and superficial wounds to relieve pressure. They also provide thermal insulation and can easily conform to body contours. Foam is highly absorbent, thus reducing maceration while promoting healing. It can be left on for 3-4 days, depending on the amount of drainage. Foam may be used under compressive dressings; while some types of foam dressings have adhesive backings, most require a secondary dressing to keep them in place. 

Foam dressings do not have enhanced antimicrobial activity. Alginates, unlike foam, can be soaked off to avoid unnecessary debriding of the wound. 

106.

Which of the following best describes eschar? 

  • Devitalized tissue 

  • Viable tissue 

  • Fibrin 

  • Granulation tissue 

Correct answer: Devitalized tissue 

Eschar is necrotic, devitalized, or nonviable tissue. This tissue is black or brown and can be loose or firmly adherent; it may be hard, soft, or boggy. Eschar can impair healing and inhibit keratinocyte migration over the wound bed. 

107.

Using the Braden Scale for Predicting Pressure Injury Risk, you screen a burn patient at admission and document a moderate risk for the development of a pressure injury during hospitalization.

What score range is indicative of "moderate risk"?

  • 13 to 14

  • 9 or below

  • 15 to 18

  • 10 to 12

Correct answer: 13 to 14

One of the most widely used and researched pressure injury risk tools is the Braden Scale for the Prediction of Pressure Injury Risk (or Braden score). It is composed of six risk subscales that conceptually reflect degrees of sensory perception, skin moisture, physical activity, nutritional intake, friction and shear, and the ability to change and control body positions. All subscales are rated from 1 (most risk) to 4 (least risk), except the friction and shear subscale, which is rated from 1 to 3. Scores are summed with a range of 6 to 23; lower scores indicate lower function and a higher risk of developing a pressure ulcer. 

Braden scale scores are grouped according to the level of risk: not at risk (19 to 23), mild risk (15-18), moderate risk (13-14), high risk (10-12), and very high risk (≤9). 

108.

A severely burned patient is experiencing fecal incontinence, and you note perirectal breakdown. Which of the following interventions should you implement? 

  • Use a barrier cream with every position change 

  • Apply bandages to affected areas

  • Apply a fecal incontinence pouch 

  • Use talcum powder with every position change 

Correct answer: Use a barrier cream with every position change 

A barrier cream will allow the skin to heal properly and will decrease the risk of stool infecting the wound. 

Bandages will likely become saturated with stool and not adhere to the skin properly. A fecal incontinence pouch is not appropriate for perirectal area skin breakdown. Talcum powder is not recommended for use in healthcare facilities. 

109.

While caring for a patient with a burn injury, you observe an area on the patient's sacrum that consists of non-blanchable redness over intact skin. Since this has most likely been caused by pressure from prolonged bedrest, how would you classify this injury?

  • Grade I

  • Grade II

  • Grade III

  • Grade IV

Correct answer: Grade I

A pressure injury consists of localized skin and underlying soft tissue damage usually over a bony prominence or related to a medical device. These injuries most often occur in areas where pressure, shearing force, and moisture have damaged the epidermis, dermis, and underlying tissue layers. 

Grading for pressure injuries consists of a four-grade scale, with grade I ulcers being the least extensive and grade IV being the most extensive. A pressure injury with non-blanchable erythema and no breaks in the skin would represent a grade I injury.

110.

You are caring for a patient with a high-voltage electrical burn and suspect the patient may be developing compartment syndrome. What is the most reliable indicator of this syndrome? 

  • Severe pain with passive motion 

  • Pulselessness in the affected extremity 

  • Delayed capillary refill time and swelling 

  • Decreased distal sensation, paresthesia, or burning

Correct answer: Severe pain with passive motion 

High-voltage injuries place the patient at high risk of compartment syndrome, as damaged muscle and swelling in the affected extremity's fascia may cause increased pressure, compromising blood flow. This syndrome can affect nerves, circulation, and muscles. Patients most often experience severe pain with passive motion that tends to be out of proportion to the injury and is unrelieved by pain medications. The pain increases with passive stretching of the muscles. For example, flexion of the ankle and foot or the toes causes increased pain in the lower leg.

Capillary refill time may be delayed, and swelling generally does happen rapidly in compartment syndrome. The compression leads to muscle and nerve damage and must be treated quickly. A surgical consult should be placed immediately, and any restrictive dressings, casts, and coverings should be removed. Pulses are usually present; pulselessness, paresthesia, and paralysis are late signs. These findings are not as reliable, however, as severe pain with passive motion.

111.

 A full-thickness burn injury is best characterized by which of the following descriptions? 

  • Dry and leathery wound surface, marked tissue edema, no pain to touch 

  • Moist wound surface, broken blisters, minimal to moderate edema, painful to touch

  • No blisters, minimal tissue edema, painful to touch, moist wound surface 

  • Erythematous wound surface, no pain to touch, marked tissue edema 

Correct answer: Dry and leathery wound surface, marked tissue edema, no pain to touch 

In full-thickness (third-degree) burns, thermal injury extends deep enough to destroy all the hair follicles that have the capacity to regenerate the epidermis, and some of the upper subcutaneous tissue may also become necrotic. Their appearance may be charred, leathery, dry, firm, and depressed when compared to adjoining normal skin. They will not blanch to the touch or be sensate or painful. It is still possible to elicit pain because manipulation of a full-thickness burn may stimulate the edges of the burn, which is inflamed with marked tissue edema and sensate. 

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

112.

You are caring for a burn patient who has a chest tube. As you assess the functioning of the chest tube drainage system, which of the following findings would not be expected? 

  • Vigorous bubbling in the suction control chamber

  • The drainage system resting below the patient's chest

  • Occlusive dressing placed over the chest tube insertion site

  • Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation

Correct answer: Vigorous bubbling in the suction control chamber

In a burn-injured patient with thoracic trauma that requires the insertion of a chest tube, nursing management of pleural space drainage is pertinent to intermediate and acute care settings. When assessing the functioning of the drainage system, gentle (not vigorous) bubbling should be observed in the suction control chamber. 

The drainage system should be kept below the level of the chest to prevent siphoning of contents back into the pleural space. Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation is expected. The chest tube insertion site should be covered with an occlusive (airtight) dressing to prevent air from entering the pleural space.

113.

You are caring for a male burn victim who sustained deep partial-thickness burns to the head, neck, ears, left arm, hand, and fingers. Which of the following positions is most appropriate? 

  • Rest the arm and hand on pillows with the fingers extended, ensuring the entire limb is elevated

  • Rest the arm in a comfortable position for the patient and flex the hand 

  • Place the patient in a supine position with a small pillow under his head

  • Place the patient in a side-lying position with a rolled towel under his neck 

Correct answer: Rest the arm and hand on pillows with the fingers extended, ensuring the entire limb is elevated

Positioning affected extremities above the level of the heart will reduce swelling and minimize edema associated with resuscitation. Fingers should be extended to avoid flexion contractures. 

With burn injuries to the ears, you should avoid placing the patient's head on a pillow because this will put pressure on the ears and could cause the injuries to stick to the pillow fabric. With burn injuries to the neck, a rolled towel should be avoided, and the head should be maintained in an extended position to avoid neck contractures. 

114.

You are caring for a two-year-old child in the burn intensive care unit (BICU) who is scheduled for a surgical excision of a burn wound. A positive outcome for reduced separation anxiety from the patient's parents is enhanced by which of the following interventions? 

  • Providing the child with a favorite toy or transition item for comfort

  • Playing the child's favorite music in the burn operating room suite 

  • Having the family and healthcare team discuss the plan of care away from the child

  • Talking to the child about the surgery in medical terms

Correct answer: Providing the child with a favorite toy or transition item for comfort

A child's comprehension of and responses to the environment are based on developmental age. Nursing care should be tailored to the developmental age of the child to optimize the child's ability to understand the situation, to minimize the child's and family's stress and anxiety, and to facilitate the development of a trusting and supportive medical relationship. 

The types of fears are also related to the child's level of psychological development. A toddler fears separation. Thus, an appropriate nursing intervention would be to allow a personal item into the burn operating room for comfort/security. In combination with other measures, this may reduce separation anxiety and create a more positive experience for the child. 

The other choices are not as helpful for a two-year-old patient. 

115.

In a well-resuscitated adult with extensive burns, what is an adequate heart rate range? 

  • 100-130/min

  • 60-90/min

  • 80-110/min

  • 70-100/min

Correct answer: 100-130/min

An adult patient who sustained severe burns should have a heart rate of 100-130 beats/min if fluid resuscitation has been adequate. This is because of the relative hypovolemia that characterizes a careful resuscitation, and because of the tremendous catecholamine release caused by the injury. 

Heart rate is only one variable that should be considered in the context of burn shock physiology. Other parameters that indicate cardiovascular status include blood pressure, central venous pressure, and echocardiography. 

116.

Which of the following statements is accurate regarding tissue injury and the body's immunologic response? 

  • The pathophysiologic effects related to a burn injury are both local and systemic 

  • Circulatory compromise is greatest 24 to 72 hours after a burn is sustained

  • Activation of the stress response causes severe respiratory acidosis and hypoxemia

  • The main goal of therapy is to restore microcirculatory perfusion of tissues 

Correct answer: The pathophysiologic effects related to a burn injury are both local and systemic 

Any burn injury greater than 20% TBSA involves acute inflammatory processes that are both local and systemic; microcirculatory compromise is greatest at 12 to 24 hours post-burn injury. Activation of the stress response causes mild respiratory alkalosis and hypoxemia, which are complicated by increased pulmonary capillary permeability. The result is decreased lung compliance and decreased respiratory function. 

There are two goals of therapy: to restore microcirculatory perfusion of tissues and to control the exaggerated inflammatory cytokine cascade response. 

117.

To assess pain in pediatric patients and patients with limited understanding, which pain scale is recommended? 

  • Wong-Baker FACES scale 

  • Visual analog scale (VAS) 

  • Verbal descriptor scale (VDS) 

  • Numeric pain intensity scale 

Correct answer: Wong-Baker FACES scale 

To manage pain effectively, nurses must be able to assess pain levels and a patient's response to initiated therapies. Pain assessment in children is challenging and must be individualized according to the patient's age, clinical condition(s), and preferences. Frequent, diligent assessments are required to titrate medication dosages appropriately. There is no single appropriate tool for the assessment of all age groups, so one should be selected based on age and developmental appropriateness. 

The Wong-Baker FACES scale is the most validated tool available for ages four to 15 and is the best scale for interactive, nonverbal patients and/or children who are unable to count. 

118.

A multiple-trauma patient is transported to the emergency department via ambulance after a motor vehicle crash. The patient is unconscious at the scene of the accident with no verifiable identification present. Upon arrival at the hospital, the patient requires immediate surgical intervention and is taken to the operating room (OR). This is an example of which type of consent? 

  • Implied

  • Involuntary

  • Expressed

  • Uninformed 

Correct answer: Implied

Informed consent is a unique challenge in trauma and emergency nursing because an unconscious patient cannot verbalize their wishes, and often there is no time to seek consent from a family member. When a patient is in need of life-saving measures but is unable to consent verbally, it is assumed by the healthcare team that the patient would consent to life-saving treatments via implied consent. 

119.

Slough can be described as which of the following?

  • Necrotic tissue

  • Viable tissue

  • Granulation tissue

  • Collagen

Correct answer: Necrotic tissue

Slough is soft, moist, avascular (nonviable) tissue (necrotic/devitalized). It may be white, yellow, tan, or green and loosely or firmly adherent to the wound bed. It consists of fibrin debris and has a moderate to high water content. Necrotic tissue can impair healing and impede keratinocyte migration over the wound bed.

Granulation tissue is pink/red moist tissue composed of new blood vessels, connective tissue, fibroblasts, and inflammatory cells that fill an open wound when it starts to heal. Granulation tissue typically appears deep pink or red with a granular surface that is berry-like or cobblestoned.

120.

The primary migratory cells during the proliferative phase of wound healing include all the following, except: 

  • Platelets 

  • Keratinocytes

  • Fibroblasts

  • Endothelial cells 

Correct answer: Platelets 

When a vascular injury occurs, the body's initial response is (a) to prevent hemorrhage and promote hemostasis by activating platelets and the clotting cascade and (b) to initiate an inflammatory response. 

Once the wound is clotted and free of debris (hemostasis and inflammatory phases), the processes of cell migration and proliferation can begin to heal the open wound. The primary migratory cells are fibroblasts, endothelial cells, and epithelial cells (keratinocytes). 

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