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Quiz Session - Attempts With Random Questions

BCEN CBRN Exam Questions

Page 7 of 20

121.

In the resuscitative phase of burn injury management, what is the most reliable and most sensitive noninvasive assessment parameter for cardiac output and tissue perfusion? 

  • Urinary output 

  • Stable vital signs 

  • Palpable peripheral pulses

  • Intact level of consciousness 

Correct answer: Urinary output 

Optimizing resuscitation and ensuring volume administration is sufficient to achieve organ perfusion at the lowest physiologic cost will require hourly monitoring of urine output, hemodynamics, and clinical signs of adequate perfusion. The titration of fluids is based on these parameters. The primary index of adequacy of resuscitation is most often the urinary output (UO), as it is a surrogate metric for glomerular filtration rate (GFR), renal blood flow, and cardiac output (CO). 

Successful fluid resuscitation is also measured by the other choices, but UO remains the most reliable and most sensitive indicator. 

122.

Circumferential burns of the extremities can produce a tourniquet-like effect and lead to which of the following complications? 

  • Compartment syndrome 

  • Sepsis 

  • Pulmonary insufficiency 

  • Neuropathic pain 

Correct answer: Compartment syndrome 

Compartment syndrome occurs when pressure builds within the muscles to dangerous levels. Special consideration should be given to burns that are completely circumferential around a part of the body, such as a limb or the trunk. These types of wounds can cause increased pressure if tissue beneath the wound becomes edematous, resulting in vascular compromise (compartment syndrome) and leading to ischemia.

123.

What primarily occurs during the first phase of wound healing? 

  • Clotting 

  • Granulation 

  • Inflammation 

  • Angiogenesis 

Correct answer: Clotting 

There are four primary phases of wound healing:

  1. Hemostasis (vascular): platelets seal the bleeding vessels, and thrombin is produced to stimulate the clotting mechanism.
  2. Inflammatory: inflammation occurs (erythema and edema along with pain) as the blood vessels release plasma and neutrophils to begin phagocytosis to remove debris and prevent infection.
  3. Proliferative/granulation (fibroblastic): fibroblasts produce collagen to provide support, and granulation tissue starts to form.
  4. Maturation (differentiation, remodeling, or plateau): fibroblasts leave the wound, and collagen tightens to reduce scarring.

124.

You are providing care to a severely burned adult patient in the resuscitative phase. Which of the following electrolyte imbalances would be least likely to cause a cardiac rhythm disturbance?

  • Hyponatremia 

  • Hyperkalemia

  • Hypercalcemia

  • Hypophosphatemia 

Correct answer: Hyponatremia

Major electrolyte disturbances can alter the heart's electrical conduction activity and, in some cases, may become life-threatening. Electrolytes are ions that conduct electrical current and are essential for proper cell function. While most electrolyte disturbances have the potential to alter cardiovascular rhythm, hyponatremia and hypernatremia are not typically a direct cause of rhythm changes. 

Hyponatremia is common within the first 24 hours of a severe burn injury and is associated with cerebral edema and secondary seizures. However, this can be avoided by minimizing the use of hypotonic fluid during resuscitation. 

125.

You are triaging a burn victim who has been struck by lightning. The patient is pulseless and experiencing dysrhythmia. You should prepare to implement all the following interventions, except: 

  • Prepare for cardioversion 

  • Provide cardiopulmonary resuscitation (CPR)

  • Prepare to administer epinephrine 

  • Prepare to administer amiodarone 

Correct answer: Prepare for cardioversion 

Up to 30% of patients who sustain electrical injury (including lightning strikes) present with cardiac complications, and death most commonly results from current-induced cardiac arrest. 

CPR with immediate defibrillation is indicated for a patient who presents with pulseless ventricular tachycardia (PVT), and the ACLS algorithm should be initiated. Medication therapy, with agents such as epinephrine, amiodarone, and others, is also indicated. 

126.

What chemical is commonly used in industrial processes and is also associated with terrorist attacks and homicides?

  • Cyanide 

  • Anthrax

  • Sulfur

  • Polypropylene 

Correct answer: Cyanide 

Cyanide is a chemical that is used in several industrial processes and has been associated with terrorist attacks and homicides. The US Centers for Disease Control and Prevention and the Department of Homeland Security consider cyanide among the most likely agents of chemical terrorism. 

Cyanide poisoning can be deadly, and early identification and intervention are essential for survival. The first-line treatment for cyanide is appropriate resuscitation. Commercial cyanide antidote kits are readily available and consist of amyl nitrite, sodium nitrite, and sodium thiosulfate. Some kits may also contain hydroxocobalamin. The use of antidotes for cyanide toxicity requires close and intensive monitoring after administration and should be restricted to patients with persistent metabolic acidosis after appropriate resuscitation is confirmed. 

127.

When providing education to a patient on home burn wound management, you explain the process of autolytic debridement. This therapy is most effective for which type of wound? 

  • Small uninfected wounds 

  • Large uninfected wounds 

  • Small infected wounds 

  • Large infected wounds 

Correct answer: Small, uninfected wounds 

Autolytic debridement uses the body's intrinsic debriding mechanisms to remove nonviable tissue (lysis of necrotic tissue by the body's white blood cells and natural enzymes), supporting endogenous healing. It begins with adequate wound cleansing (washing the partially degraded nonviable tissue) followed by the application of a moisture-retentive dressing. Maintaining a moist wound environment allows the collection of fluid at the wound site, which promotes rehydration of the dead tissue and allows enzymes within the wound to digest necrotic tissue. 

It is effective for small wounds without infection but slower than other types of debridement. Because of drainage and odor, surrounding tissue must be protected with a skin barrier to prevent maceration. Autolytic debridement should not be used when a wound is infected. 

128.

Which of the following antibiotic ointments is reserved for confirmed methicillin-resistant staphylococcal infection in minor burn patients?

  • Mupirocin 

  • Gentamycin 

  • Triple antibiotic ointment 

  • Bacitracin 

Correct answer: Mupirocin 

Mupirocin (Bactroban) is a topical antimicrobial that works by blocking the activity of the enzyme in bacteria responsible for making proteins. It may be used in patients known to be colonized with MRSA, beta-hemolytic streptococcus, and Streptococcus pyogenes. 

Mupirocin is contraindicated for large burns; it contains polyethylene glycol, which may damage the kidneys if absorbed through the skin. 

129.

You are caring for a pediatric burn patient with a new tracheostomy who remains ventilated. A social worker is involved in this patient's care due to the family's limited financial resources and informs you that discharge has been delayed until the patient can safely go home with everything necessary for tracheostomy care. 

During a meeting with the family and the multidisciplinary care team, what is your role? 

  • Ensure all questions are addressed 

  • Educate the patient and their family on community financial resource options 

  • Assess the patient's and their family's understanding of the cost of home nursing care

  • Assess the patient's emotional support system

Correct answer: Ensure all questions are addressed 

Limited resource availability leaves the patient and their family in a vulnerable situation. A comprehensive discharge plan adequately prepares the family and child to go home and streamlines the transition.

Nurses are key in preparing families for the transition from hospital to home; since you spend the most time with patients and families, you are a great advocate (in collaboration with the multidisciplinary team) to obtain optimal/realistic goals for your patients. Your role during a family meeting is to ensure all questions are addressed adequately.

The social worker will educate the family on community resources and assess their understanding of the cost of home care. While assessing the emotional support system is a part of caring practices, it is not a part of your role during a family meeting. 

130.

You are caring for a patient with a deep full-thickness burn injury who is exhibiting signs of bloodstream sepsis. Which clinical finding is not consistent with sepsis diagnostic criteria?

  • Hypoactive bowel sounds 

  • Temperature of 101.5 °F (38.6 °C)

  • Heart rate of 99 beats/min

  • Urine output 40 mL/hr 

Correct answer: Hypoactive bowel sounds 

Sepsis diagnostic criteria with regard to signs and symptoms include the following: 

  • Fever (temperature >100.9 °F [38.3 °C]) or hypothermia (core temperature <97 °F [36 °C])
  •  Tachycardia (heart rate >90 beats per minute)
  • Tachypnea (respiratory rate >22 breaths per minute)
  • Systolic blood pressure (SBP) ≤100 mm Hg
  • Altered mental status (Glasgow Coma Scale score <15)
  • Edema or positive fluid balance
  • Oliguria (≤30 mL/hr) 
  • Ileus (absent bowel sounds)
  • Decreased capillary refill or mottling of skin

131.

Which of the following types of tissue grafts is considered the "gold standard" for temporary wound closures? 

  • Allograft 

  • Xenograft 

  • Human amnion

  • Subcutaneous fat 

Correct answer: Allograft 

Human allograft skin was the first type of membranous wound coverage used and is generally indicated as a split-thickness graft after being procured from organ donors. When used in a viable fresh or cryopreserved state, it vascularizes and remains the "gold standard" of temporary wound closures. 

Viable split-thickness allograft provides a durable biologic cover until it is rejected by the host (usually within 3 to 4 weeks). 

132.

A burn-injured patient develops an anaphylactic reaction after receiving a dose of morphine for burn pain. Which of the following nursing actions should not be implemented? 

  • Start an intravenous (IV) infusion of D5W and administer a 500-mL bolus

  • Administer supplemental oxygen 

  • Promptly assess the patient's respiratory status 

  • Document the event, interventions, and the patient's response 

Correct answer: Start an intravenous (IV) infusion of D5W and administer a 500-mL bolus

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. 

If an anaphylactic reaction occurs, you should take immediate action, including assessing the patient's respiratory status and notifying the Rapid Response Team if necessary. Supplemental oxygen is given, and an IV of normal saline (NS) is infused per physician orders. Documentation of the event, actions taken, and patient outcomes needs to be done once the patient is stable. 

133.

You are caring for a burn patient who is experiencing shock and develops a central venous pressure (CVP) of 2 mm Hg. Which intervention should you implement first? 

  • Increase the rate of intravenous (IV) fluids 

  • Obtain arterial blood gases (ABGs) 

  • Increase the rate of supplemental oxygen flow

  • Administer intravenous (IV) morphine 

Correct answer: Increase the rate of intravenous (IV) fluids 

The CVP is low for this patient, indicating a rapidly decreasing circulating volume and inadequate tissue perfusion. Frequent adjustments of infusion rates to balance individual changes in physiology are needed for each patient; in this scenario, fluid volume needs to be increased to provide adequate perfusion. This is the first priority.

Increasing the oxygen flow rate, obtaining ABGs, and providing pain relief may be necessary interventions, but perfusion via restoring fluid volume is the first priority. 

134.

A 68-year-old male with a history of peripheral vascular disease, hypertension, type 2 diabetes mellitus, and end-stage kidney disease has developed hot water burns. He underwent complete sloughing of the epidermis and dermis. 

What degree of burn does this patient have? 

  • Third-degree burn

  • First-degree burn

  • Second-degree burn

  • Fourth-degree burn

Correct answer: Third-degree burn

Burn depth is classified as first, second, third, or fourth degree. First-degree burns are red, dry, and uncomfortable and are often deeper than they appear, sloughing the next day. They involve loss of the epidermis only. Second-degree burns tend to be moist and very painful, but there is a lot of variability in their depth, ability to heal, and propensity to hypertrophic scar formation. They extend into the papillary dermis, but the dermis is preserved, meaning sensory innervation is not destroyed.

Loss of the epidermis and dermis is characteristic of a third-degree burn. This type tends to be leathery, dry, insensate, and waxy. Fourth-degree burns involve underlying subcutaneous tissue, tendon, or bone. 

135.

Which of the following dressings is not an appropriate choice for autolytic debridement of a burn wound? 

  • Gauze 

  • Hydrocolloids

  • Film dressings

  • Hydrogels 

Correct answer: Gauze 

Autolysis is a natural, highly selective, painless method of debridement involving the breakdown of necrotic tissue by the body's white blood cells and natural enzymes. They enter the wound site during the normal inflammatory process. Autolysis is a selective method of debridement, meaning only the necrotic tissue is removed. 

As a naturally occurring physiologic process, autolysis is stimulated by a moist, vascular environment with adequate leukocyte function count. This moist environment is facilitated by the application of a moisture-retentive dressing left undisturbed for 24 to 72 hours. Maintaining a moist wound environment allows the cellular structures that are essential for phagocytosis to remain intact and avoid premature destruction through desiccation. 

Any moisture-retentive dressing can achieve autolysis, but it is preferable to use a transparent dressing over a dry wound or dry eschar and hydrocolloids or hydrogels over moist wounds. Gauze is not effective for this type of debridement. 

136.

You are caring for a patient with extensive deep thermal burns who is receiving total parenteral nutrition (TPN). The patient complains of right upper quadrant (RUQ) pain, and their vital signs are significant for a temperature of 39 °C. 

What diagnostic study should be performed first? 

  • Abdominal ultrasound 

  • Computed tomography (CT) scan

  • Hepato-iminodiacetic acid (HIDA) scan 

  • Magnetic resonance cholangiopancreatography (MRCP)

Correct answer: Abdominal ultrasound 

Acute acalculous cholecystitis (AAC) is a rare complication of burn injury and results from gallbladder stasis and ischemia, which cause a local inflammatory response in the gallbladder wall. The condition commonly presents with fever, RUQ tenderness, leukocytosis, and elevated liver enzymes. AAC is a surgical emergency because complications including perforation or gangrenous cholecystitis may rapidly develop. 

Ultrasonography is usually the first diagnostic study performed when cholecystitis is suspected; it's noninvasive and can be performed at the bedside. If the diagnosis is unclear, a HIDA scan can confirm the diagnosis. CT scanning can also be used to diagnose AAC, but an abdominal ultrasound is typically done prior to other imaging scans. MRI with MRCP is a reliable evaluation for the detection of common bile duct (CBD) stones. Treatment of AAC consists of initiation of antibiotics and either cholecystectomy or the placement of a cholecystostomy tube. 

137.

A nurse is caring for a patient with a burn injury who is at risk for a pressure ulcer. In the plan of care, how often should the patient be encouraged to shift weight or change positions when sitting in a chair? 

  • Every 1 hour

  • Every 2 hours

  • Every 30 minutes

  • Every 4 hours

Correct answer: Every 1 hour

Repositioning reduces the duration and intensity of pressure exerted over a bony prominence. Individuals at risk for pressure ulcer development should avoid uninterrupted sitting in chairs and should be repositioned every hour. Although repositioning does not reduce the intensity of pressure, it does reduce the duration, which is the more critical element of pressure ulcer formation. 

Repositioning contributes to the patient's comfort, dignity, and functional ability. Chair sitting should be limited to ≤2 hours per session. 

138.

Postburn hypertrophic scars (HTS) can develop due to which of the following?

  • Overabundance of myofibroblasts 

  • Excessive growth factor 

  • Increased keratinocyte production 

  • Elevated levels of matrix metalloproteinases

Correct answer: Overabundance of myofibroblasts 

Fibroblast to myofibroblast differentiation represents a key event during wound healing and tissue repair. Myofibroblasts are important for connective tissue remodeling, which takes place during wound healing and fibrosis development. The high contractile force generated by myofibroblasts is beneficial for physiological tissue remodeling but detrimental to tissue function when it becomes excessive, such as in postburn HTS. 

139.

What single practice has been shown to decrease the risk of infection transmission to a hospitalized burn patient? 

  • Frequent handwashing 

  • Intravenous antimicrobial prophylaxis at hospital admission 

  • Prohibiting acrylic fingernail overlays and the wearing of rings

  • Use of personal protective equipment (PPE)

Correct answer: Frequent handwashing 

Compliance with hand hygiene protocols, meticulous aseptic techniques, and proper cleaning and maintenance of equipment counteract environmental infection risks. Healthcare workers need to maintain strict compliance with infection prevention guidelines and wash their hands frequently to reduce the incidence of infection transmission. 

While the other choices are strategies for preventing infection, compliance with hand hygiene protocols has been shown to reduce the risk of infection transmission most drastically. 

140.

What is the primary goal of peer review within a healthcare institution? 

  • Ensure standards of care are being met

  • Recognize peers for possible promotion or demotion

  • Allow peers to review standard practices 

  • Document recent corrections due to cases of malpractice litigation 

Correct answer: Ensure standards of care are being met

A peer review provides a comprehensive assessment of overall care, reveals trends in data, and supports efforts to compile statistics on groups of patients for analysis. Routine peer review within a healthcare facility can be a useful practice to evaluate the quality of care provided by colleagues and to ensure that standards of care are being met. 

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