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Quiz Session - Attempts With Random Questions

BCEN CBRN Exam Questions

Page 9 of 20

161.

Hydrotherapy is an excellent opportunity to teach a burn patient about wound care and dressing application, as you empower them to do more of their care. What is the recommended method of cleansing a burn wound with hydrotherapy? 

  • Pulse lavage 

  • Whirlpool

  • Wound irrigation

  • Ultrasonic mist 

Correct answer: Pulse lavage 

Hydrotherapy is a mode of mechanical debridement. Pulsed lavage with suction is the recommended method of cleansing a wound with hydrotherapy. The two components of this are pulsing an irrigation solution, usually normal saline, into a wound bed with controlled force and suctioning the contaminated fluids and exudate with negative pressure. 

A pulsatile lavage machine combines intermittent high-pressure lavage with suction to loosen necrotic tissue and facilitate its removal by other methods of debridement. Pulsatile lavage is effective for removing abundant debris and should be discontinued once the wound is clean. The better your patient and family are educated, the better the outcome will be. 

Whirlpool, wound irrigation, and ultrasonic mist are other methods of hydrotherapy. 

162.

You are caring for a patient with a 40% TBSA full-thickness burn injury. Which nursing intervention should be incorporated into the patient's plan of care to optimize nutrition? 

  • Allowing the patient to eat whatever they wish with careful monitoring 

  • Delivering enteral nutrition (EN) that is high in calories 

  • Limiting calories to 3,000 kcal/day 

  • Providing a high-protein, low-fat, low-carbohydrate diet 

Correct answer: Allowing the patient to eat whatever they wish with careful monitoring 

The delivery of appropriate nutrition is a major nursing consideration. For the conscious patient with an intact appetite and swallowing function, direct oral intake is the preferred feeding modality, and you should allow the patient to eat whatever they like. However, providers must continuously monitor and assess for adequate intake to ensure the patient is meeting nutritional needs, as they change during different phases of recovery. 

Direct enteral feeding is the route of choice to supplement or replace oral intake, but only if the patient is not tolerating direct oral intake. Limiting calories is not an appropriate intervention. You should provide a high-protein, high-fat, high-carbohydrate diet for a burn-injured patient. 

163.

Which of the following layers of epidermis is not always present in the skin? 

  • Stratum lucidum 

  • Stratum corneum 

  • Stratum granulosum 

  • Stratum basale 

Correct answer: Stratum lucidum 

The epidermis is the outermost layer of the skin and consists of the stratum basale, spinosum, granulosum, and corneum. The epidermis provides a vapor and bacterial barrier and is constantly renewing from its basal layer, with new keratinocytes undergoing terminal differentiation over approximately 4 weeks. 

The stratum lucidum is directly below the stratum corneum and is found in areas where the epidermis is thicker (soles of the feet and palms of the hands). It is absent from thinner skin, such as the eyelids. 

164.

You are caring for a patient who sustained a high-voltage burn injury, and you suspect compartment syndrome. The patient's pulse is still present in the affected extremity. Which of the following is accurate? 

  • Irreversible ischemia can occur while the pulse is still palpable

  • Ischemia begins to develop once the pulse is absent

  • Pulse quality, not pulse presence, is used to determine whether compartment syndrome is developing

  • Pulse does not need to be assessed in a patient with suspected compartment syndrome

Correct answer: Irreversible ischemia can occur while the pulse is still palpable

Compartment syndrome may result in a decreased or absent pulse, but irreversible ischemia can occur from compartment syndrome while the pulse is still palpable. Intracompartmental pressures above 30 to 40 mm Hg can cause muscle ischemia, and pressures over 55 to 65 mm Hg may result in irreversible muscle death. Systolic blood pressure is often significantly higher than this, causing blood to continue to pass through the compartment even when ischemia is occurring due to pressures inhibiting capillary blood flow. 

Ischemia can begin to develop prior to loss of pulse in the extremity. Both pulse presence and pulse quality can help indicate the presence of compartment syndrome; however, pulse should not be the sole assessment method. Pulse should always be assessed in a patient with suspected compartment syndrome.

165.

A patient arrives at the emergency department with a burn that is red, blanches with pressure, and has a shiny, moist surface with fluid-filled blisters. Which type of burn does the patient most likely have?

  • Second-degree

  • First-degree

  • Third-degree

  • Fourth-degree

Correct answer: Second-degree

A second-degree (superficial or deep partial thickness) burn is red, blanches with pressure, has a shiny surface, and can have fluid-filled blisters. Second-degree burns tend to be moist and very painful, and there is an enormous variability in their depth. 

A first-degree (superficial) burn is pink or red, blanches with pressure, and is dry and intact (i.e., sunburns). These burns often slough the next day. Third- and fourth-degree (full-thickness) burns are deep red, brown, black, or white; do not blanch with pressure; and are sunken due to loss of underlying muscle or fat.

Note that a typical burn injury does not consist of only one degree (or depth). Burns that appear as first-degree injuries in the ED may evolve into deeper burns over the next 72 hours. 

166.

When providing enteral nutrition (EN) to a burn patient, you should start by titrating the enteral formula to deliver carbohydrate calories at approximately what rate?

  • 5-7 g/kg/day 

  • 2-4 g/kg/day

  • 8-10 g/kg/day

  • 1-3 g/kg/day 

Correct answer: 5-7 g/kg/day 

The acute metabolic response to burn injury significantly alters carbohydrate metabolism and demands. Multiple studies have demonstrated that approximately 5 g/kg/day for a burned adult and 7 g/kg/day for a burned child are a good starting point. All further calories are then provided in the form of protein supplementation. Careful and continuous monitoring should be maintained to ensure appropriate nutritional needs are met. 

167.

Which of the following burn patients should not be transferred and treated at a burn center? 

  • Burns of >10% in TBSA patients in patients under 12 years old 

  • Burns of >10% in patients over 50 years old 

  • Any second- or third-degree burns involving the hands or feet 

  • Any second- or third-degree burns involving the perineum 

Correct answer: Burns of >10% in TBSA patients in patients under 12 years old 

Second- and third-degree burns that are greater than 10% TBSA in patients under 10 or over 50 years of age should qualify for transfer and admission to a burn center. These types of burns carry particular morbidity and mortality. In addition, burns involving the hands, feet, perineum, face, or neck are technically demanding because of the high stakes involved and the challenges in optimizing long-term outcomes.  

168.

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

  • Administer intramuscular pain mediation as ordered 

  • Initiate intravenous (IV) fluid resuscitation 

  • Assess respiratory status 

  • Keep the patient warm 

Correct answer: Administer intramuscular pain medication as ordered 

Intramuscular (IM) or subcutaneous routes for medication delivery should never be used because fluid resuscitation could result in unpredictable patterns of uptake. NPO (nothing by mouth) status should be implemented because of the altered gastrointestinal function from a burn injury. 

The other actions should be a part of the initial burn care process. 

169.

Cellular and/or tissue-based products (CTPs) are indicated for use in which of the following scenarios? 

  • Deep partial-thickness burns to the face of a 15-year-old male

  • Managing pain from sunburn in a 22-year-old female

  • A lye burn to the perineal area of an 18-year-old male with schizophrenia

  • A full-thickness scald burn of the lower abdomen and mons pubis in a 69-year-old female 

Correct answer: Deep partial-thickness burns to the face of a 15-year-old male

The excision of normal facial skin is rarely indicated in burn reconstruction; facial burns are often not excised to avoid sacrificing specialized skin. Deep partial-thickness burns may be best managed with CTPs to reduce pain and accelerate healing. 

170.

What is the preferred method of airway control for a burn victim with a compromised airway? 

  • Endotracheal tube 

  • Standard tracheostomy 

  • Nasopharyngeal airway 

  • Oropharyngeal airway 

Correct answer: Endotracheal tube 

Endotracheal intubation and mechanical ventilation have salvaged many thousands of burn patients since being widely employed in the late 1950s. It is the preferred method of airway control, providing a stable airway, protecting against aspiration, and permitting mechanical ventilation to be utilized. Endotracheal tubes also decrease gastric distention associated with bag-mask ventilation. 

Endotracheal tubes should be used with caution in laryngotracheal injuries (i.e., of the glottis, subglottis, and upper trachea).  

171.

In the burn operating room, how should autologous tissue intended for delayed autotransplantation be handled after removal from the sterile field? 

  • It should be contained and labeled.

  • It should be refrigerated.

  • It should be disinfected prior to storing in a tissue bank.

  • It should be cryopreserved. 

Correct answer: It should be contained and labeled.

Autografts are the primary wound-covering method used for deep burns. Autologous tissue that is not immediately transplanted to a viable wound bed must be placed into a sterile container that has a barrier to resist contamination from outside sources. This container must allow for content removal in an aseptic manner. This container should be immediately labeled. 

172.

The Health Insurance Portability and Accountability Act (HIPAA) does which of the following in burn care settings? 

  • Protects each patient's privacy in regard to identifiable health information

  • Ensures that all patients receive the same level of care 

  • Ensures that all patients are protected from unfair treatment on the basis of race, religion, origin, age, gender, or disability

  • Ensures that all practitioners are qualified to perform their duties

Correct answer: Protects each patient's privacy in regard to identifiable health information

The Health Insurance Portability and Accountability Act (HIPAA) protects each patient's privacy in regard to identifiable health information. It directs the ways in which health information may be stored, shared, or released.

The Civil Rights Act ensures that all patients receive the same level of care regardless of their race, religion, origin, age, gender, or disability. It is the responsibility of the state's governing board to ensure that all practitioners are qualified to perform their duties.

173.

A burn wound to an abdomen that is left open to allow for granulation and healing is considered which type of wound healing? 

  • Secondary intention

  • Primary intention

  • Tertiary intention 

  • Quaternary intention 

Correct answer: Secondary intention

Wounds that heal by secondary intention do so through granulation tissue formation, contraction, and epithelial migration. These wounds are left open or possibly packed and dressed to allow for granulation and healing. 

Healing by primary intention involves suturing a wound closed, and tertiary intention healing involves delayed closure or possible skin grafting. 

174.

Carbon monoxide (CO) intoxication is managed with effective ventilation with 100% oxygen for how long?

  • 6 hours

  • 4 hours

  • 2 hours

  • 8 hours

Correct answer: 6 hours

The major treatment approach for a burn patient with evidence of smoke inhalation injury secondary to carbon monoxide (CO) intoxication is the administration of 100% oxygen and, in severe cases, hyperbaric treatment to increase the partial pressure of oxygen in the blood. 

The standard of care is 6 hours of 100% normobaric oxygen. If there is more severe exposure to CO, as indicated by a carboxyhemoglobin level greater than 30% or neurologic changes, hyperbaric oxygen is recommended to reduce the incidence of long-term neurological complications. 

175.

For burn-injured patients, colloid administration for fluid resuscitation should be initiated approximately how many hours after the initial injury? 

  • 12 hours

  • 4 hours

  • 8 hours

  • 24 hours

Correct answer: 12 hours

The use of colloids in early burn resuscitation remains controversial. Initiating colloids in the first 12 hours has been associated with less favorable outcomes; therefore, albumin administration is traditionally not recommended until at least 12 hours after the burn. 

176.

What is the best indicator of adequate fluid resuscitation for a burn-injured patient?

  • Urine output 

  • Stable blood pressure 

  • Absence of fevers 

  • Arterial blood gases in a normal range

Correct answer: Urine output

The goal of fluid resuscitation for a burn patient is to maintain tissue perfusion and organ function. Over-resuscitation can lead to significant edema, which can compromise blood flow to burned tissue, while under-resuscitation can cause shock and organ damage. 

The single best indicator of proper fluid replacement is urine output, which should be closely monitored and managed. The recommended fluid of choice is lactated Ringer solution.

177.

A pediatric patient is admitted for trauma and burn injuries sustained in a motor vehicle accident (MVA). Upon initial assessment, you note paradoxical chest movement and immediately suspect which of the following? 

  • Flail chest 

  • Sternal fracture 

  • Compound rib fracture 

  • Diaphragm rupture 

Correct answer: Flail chest 

Traumatic rib fractures are due to significant forces impacting the chest wall, most commonly from blunt injuries such as MVAs. Flail chest consists of fractures of three or more ribs in two or more places, creating a floating segment that loses its mechanical continuity with the remainder of the chest wall. The flail segment moves paradoxically, and paradoxical chest wall motion may be noted during spontaneous breathing. This appears clinically as a "caving in" of the flail segment on inspiration followed by a "bulging out" on exhalation. 

Diaphragm rupture does not present with paradoxical chest movement, although it does cause respiratory distress. Sternal fracture is characterized by pain, bruising, swelling, and possible cardiac injury. A compound rib fracture does not always cause paradoxical chest movement with breathing; this movement depends on where the fracture is. 

178.

When choosing the best donor site for skin grafting, providers would be unlikely to select which site? 

  • Scalp

  • Thigh

  • Hip

  • Back

Correct answer: Scalp

Many factors are considered when choosing the best donor site for skin grafting. The scalp may represent an ideal donor site because it is associated with less pain and faster healing, but the most common sites to use are the back, hip, and thigh. The skin in these areas is flat for easy procurement, and scars can be easily hidden under clothing. 

179.

You are caring for a patient with a full-thickness burn wound to the abdomen that is healing by secondary intention and is draining large amounts of exudate. What category of dressings is most appropriate for this wound? 

  • Alginates

  • Collagen matrix

  • Tegaderm absorbent clear acrylic dressing 

  • Gauze impregnated with dry sodium chloride 

Correct answer: Alginates

Alginates are the calcium or calcium/sodium salts of alginic acid and are composed of mannuronic and guluronic acids obtained from seaweed. When applied to a wound, sodium ions in the wound exchange for the calcium ions in the dressing, absorbing serous fluid or exudate and forming a nonadhesive, nonocclusive hydrophilic gel that conforms to the shape of the wound. Since calcium acts as a clotting factor (factor IV), this mechanism enables some alginates to act as a hemostat. 

Alginates are indicated for moderately to highly exudative full-thickness wound cavities and may also be considered for infected wounds, as long as appropriate concurrent treatment for infection is implemented. 

180.

Which of the following factors does not contribute to the development of intestinal ileus in burn patients?

  • Dependence on total parenteral nutrition (TPN) 

  • Prolonged immobilization 

  • Narcotic use

  • Electrolyte imbalances 

Correct answer: Dependence on total parenteral nutrition (TPN) 

Gastric stasis and intestinal (paralytic) ileus begin to develop immediately following the initial burn injury; this condition is commonly encountered after large burns. Prompt decompression of the stomach and appropriate gastric acid ulcer prophylaxis should be initiated. Multiple factors contribute to the development of ileus, including:

  • electrolyte imbalances
  • narcotic use
  • prolonged immobilization
  • abdominal trauma
  • sepsis
  • surgery

These can all lead to decreased GI motility in burn patients. Dependence on total parenteral nutrition (TPN) places the patient at an increased risk of a rare complication known as acute acalculous cholecystitis (AAC). 

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