NMNC 4510: Concept Synthesis Exam 2
- Shock states, Burns, Perfusion, Brain
Death and Donor Services-Study Guide
And Actual Answers.
A 65 year old male patient has experienced full-thickness electrical burns on the legs and arms.
As the nurse you know this patient is at risk for the following: Select all that apply:
A. Acute kidney injury
B. Dysrhythmia
C. Iceberg effect
D. Hypernatremia
E. Bone fractures
F. Fluid volume overload - Answer The answers are A, B, C, and E. Electric burns are due to an
electrical current passing through the body that leads to damage to the skin but also the
muscles and bones that are underneath the skin. The patient is at risk for AKI (acute kidney
injury) because when the muscles become affected they release myoglobin and the red blood
cells release hemoglobin in the blood, which can collect in the kidneys leading to injury. In
addition, the heart's electrical system can become damaged leading to dysrhythmia. The
iceberg effect can present as well because the extent of damage is not clearly visible on the skin
(there can be severe damage underneath). In addition, if the electrical current is strong enough
it can lead to bone fractures (specifically cervical spine injuries) due to the severe contraction of
the muscles involved.
Select the patient below who is at MOST risk for complications following a burn:
A. A 42 year old male with partial-thickness burns on the front of the right and left arms and
legs.
B. A 25 year old female with partial-thickness burns on the front of the head and neck and front
and back of the torso.
C. A 36 year old male with full-thickness burns on the front of the left arm.
D. A 10 year old with superficial burns on the right leg. - Answer The answer is B. When
thinking about which patient will have the MOST complications following a burn think about:
percentage of the total body surface area that is burned (use the rule of nine to calculate),
depth of the burn, age, location of the burn, and patient's medical history. The patient in option
B has 40.5% TSBA burned (option A 27%, C: 4.5%, D: 9%). Remember that the higher the total of
the body surface area that is burned the higher the risk of complications due to an increase in
capillary permeability (swelling, hypovolemic shock etc.). In addition, the location of the burn is
a major issue with the patient in option B. The burns are on the head and neck and front and
back of the torso. Therefore, with head and neck burns always think about respiratory issues
because the airway can become compromised due to swelling or an inhalation injury. And with
torso burns that are on the front and back, the patient is at risk for circumferential burns that
can lead to further respiratory compromise. The other options have burns that are isolated.
,The _____________ layer of the skin helps regulate our body temperature.
A. Epidermis
B. Dermis
C. Hypodermis
D. Fascia - Answer The answer is C. This layer contains fatty tissue, veins, arteries, nerves and
helps insulate the muscles, bones, organs and helps REGULATE our body temperature.
True or False: A patient who experiences an alkali chemical burn is easier to treat because the
skin will neutralize the chemical rather than with an acidic chemical burn. - Answer False:
Alkali burns are harder to treat than acidic chemical burns because the skin will neutralize the
acidic burn.
As the nurse providing care to a patient who experienced a full-thickness electrical burn you
know to monitor the patient's urine for:
A. Hemoglobin and myoglobin
B. Free iron and white blood cells
C. Protein and red blood cells
D. Potassium and Urea - Answer The answer is A. Patients who've experienced a severe
electrical burn or full-thickness burns are at risk for acute kidney injury. This is because the
muscles can experience damage from the electrical current leading them to release myoglobin.
In addition, the red blood cells will release hemoglobin. These substances will collect in the
kidneys leading to acute tubular necrosis (hence leading to AKI). Therefore, the nurse should
monitor the patient's urine for these substances.
You receive a patient who has experienced a burn on the right leg. You note the burn contains
small blisters and is extremely pinkish red and shiny/moist. The patient reports severe pain. You
document this burn as:
A. 1st Degree (superficial)
B. 2nd Degree (partial-thickness)
C. 3rd Degree (full-thickness)
D. 4th Degree (deep full-thickness) - Answer The answer is B. These are the classic
characteristics of a 2nd degree (partial-thickness) burn.
A 58 year old female patient has superficial partial-thickness burns to the anterior head and
neck, front and back of the left arm, front of the right arm, posterior trunk, front and back of
the right leg, and back of the left leg. Using the Rule of Nines, calculate the total body surface
area percentage that is burned?
A. 63%
B. 81%
C. 72%
,D. 54% - Answer The answer is A. Anterior head and neck (4.5%), front and back of the left
arm (9%), front of the right arm (4.5%), posterior trunk (18%), front and back of the right leg
(18%), back of the left leg (9%) which equals 63%.
A 30 year old female patient has deep partial thickness burns on the front and back of the right
and left leg, front of right arm, and anterior trunk. The patient weighs 63 kg. Use the Parkland
Burn Formula: What is the flow rate during the FIRST 8 hours (mL/hr) based on the total you
calculated?
A. 921 mL/hr
B. 938 mL/hr
C. 158 mL/hr
D. 789 mL/hr - Answer The answer is A: 921 mL/hr....First calculate the total amount of fluid
needed with the formula: Total Amount of LR = 4 mL x BSA % x pt's weight in kg. The pt's weight
63 kg. BSA percentage: 58.5%...Front and back of right and left leg (36%), front of right arm
(4.5%), anterior trunk (18%) which equals 58.5%. ......4 x 58.5 x 63 = 14,742 mL......Remember
during the FIRST 8 hours 1/2 of the solution is infused, which will be 14,742 divided by 2 = 7371
mL......Hourly Rate: 7371 divide by 8 equals 921 mL/hr
Based on the depth of the burn in figure 1 (picture is above), you would expect to find:
A. report of sensation to only pressure
B. blanching
C. anesthetization to feeling
D. extreme pain - Answer The answer is C. This is a 3rd degree to 4th degree burn (full-
thickness) and the nerves that detect pain are destroyed. The patient would have no feeling or
experiences an extreme decrease sensation to pain.
A patient has a burn on the back of the torso that is extremely red and painful but no blisters
are present. When you pressed on the skin it blanches. You document this as a:
A. 1st degree (superficial) burn
B. 2nd degree (partial-thickness) burn
C. 3rd degree (full-thickness) burn
D. 4th degree (deep full-thickness) burn - Answer The answer is A. These are the classic
characteristics of a 1st degree, superficial burn.
The nurse notes a patient has full-thickness circumferential burns on the right leg. The nurse
would: select all that apply
A. Place cold compressions on the burn and elevate the right leg below the heart level
B. Assess the distal pulses in the right extremity
C. Elevate the right leg above the heart level
, D. Place gauze securely around the leg to prevent infection - Answer The answer is B and C.
The patient has burns that completely surround the front and back of the right leg. This can lead
to compartment syndrome where the edema from the burn compromises circulation to the
distal extremity. The nurse should elevate the extremity ABOVE heart level to decrease swelling
and assess distal pulses in the extremity to confirm circulation is present.
A patient has experienced full-thickness burns to the face and neck. As the nurse it is priority to:
A. Prevent hypothermia
B. Assess the blood pressure
C. Assess the airway
D. Prevent infection - Answer The answer is C. Due to the location of the burns (face and
neck), the patient is at major risk for respiratory issues due to damage to the upper airways and
the risk of an inhalation injury.
A patient is in the acute phase of burn management. The patient experienced full-thickness
burns to the perineum and sacral area of the body. In the patient's plan of care, which nursing
diagnosis is priority at this time?
A. Impaired skin integrity
B. Risk for fluid volume overload
C. Risk for infection
D. Ineffective coping - Answer The answer is C. The patient is now in the acute phase where
fluid resuscitation was successful and ends with wound closure. Therefore, during this stage
diuresis occurs (so fluid volume deficient could occur NOT overload) and INFECTION. The
location of the burns increases the risk of infection because these areas naturally harbor
bacteria. Therefore, this takes priority because during this phase wound healing is promoted.
A patient arrives to the ER with full-thickness burns on the front and back of the torso and neck.
The patient has no spinal injuries but is disoriented and coughing up black sooty sputum. Vital
signs are: oxygen saturation 63%, heart rate 145, blood pressure 80/56, and respiratory rate 39.
As the nurse you will:
A. Place the patient in High Fowler's positon.
B. Prep the patient for escharotomy.
C. Prep the patient for fasciotomy.
D. Prep the patient for intubation.
E. Place a pillow under the patient's neck.
F. Obtain IV access at two sites.
G. Restrict fluids. - Answer The answers are A, B, D, and F. After reading this scenario the
location of the burns and the patient's presentation should be jumping out at you. The patient is
at risk for circumferential burns due to the location of the burns and the depth (full-
thickness....will have eschar present that will restrict circulation or here in this example the
ability of the patient to breathe in and out). Based on the patient's VS, we see that the
- Shock states, Burns, Perfusion, Brain
Death and Donor Services-Study Guide
And Actual Answers.
A 65 year old male patient has experienced full-thickness electrical burns on the legs and arms.
As the nurse you know this patient is at risk for the following: Select all that apply:
A. Acute kidney injury
B. Dysrhythmia
C. Iceberg effect
D. Hypernatremia
E. Bone fractures
F. Fluid volume overload - Answer The answers are A, B, C, and E. Electric burns are due to an
electrical current passing through the body that leads to damage to the skin but also the
muscles and bones that are underneath the skin. The patient is at risk for AKI (acute kidney
injury) because when the muscles become affected they release myoglobin and the red blood
cells release hemoglobin in the blood, which can collect in the kidneys leading to injury. In
addition, the heart's electrical system can become damaged leading to dysrhythmia. The
iceberg effect can present as well because the extent of damage is not clearly visible on the skin
(there can be severe damage underneath). In addition, if the electrical current is strong enough
it can lead to bone fractures (specifically cervical spine injuries) due to the severe contraction of
the muscles involved.
Select the patient below who is at MOST risk for complications following a burn:
A. A 42 year old male with partial-thickness burns on the front of the right and left arms and
legs.
B. A 25 year old female with partial-thickness burns on the front of the head and neck and front
and back of the torso.
C. A 36 year old male with full-thickness burns on the front of the left arm.
D. A 10 year old with superficial burns on the right leg. - Answer The answer is B. When
thinking about which patient will have the MOST complications following a burn think about:
percentage of the total body surface area that is burned (use the rule of nine to calculate),
depth of the burn, age, location of the burn, and patient's medical history. The patient in option
B has 40.5% TSBA burned (option A 27%, C: 4.5%, D: 9%). Remember that the higher the total of
the body surface area that is burned the higher the risk of complications due to an increase in
capillary permeability (swelling, hypovolemic shock etc.). In addition, the location of the burn is
a major issue with the patient in option B. The burns are on the head and neck and front and
back of the torso. Therefore, with head and neck burns always think about respiratory issues
because the airway can become compromised due to swelling or an inhalation injury. And with
torso burns that are on the front and back, the patient is at risk for circumferential burns that
can lead to further respiratory compromise. The other options have burns that are isolated.
,The _____________ layer of the skin helps regulate our body temperature.
A. Epidermis
B. Dermis
C. Hypodermis
D. Fascia - Answer The answer is C. This layer contains fatty tissue, veins, arteries, nerves and
helps insulate the muscles, bones, organs and helps REGULATE our body temperature.
True or False: A patient who experiences an alkali chemical burn is easier to treat because the
skin will neutralize the chemical rather than with an acidic chemical burn. - Answer False:
Alkali burns are harder to treat than acidic chemical burns because the skin will neutralize the
acidic burn.
As the nurse providing care to a patient who experienced a full-thickness electrical burn you
know to monitor the patient's urine for:
A. Hemoglobin and myoglobin
B. Free iron and white blood cells
C. Protein and red blood cells
D. Potassium and Urea - Answer The answer is A. Patients who've experienced a severe
electrical burn or full-thickness burns are at risk for acute kidney injury. This is because the
muscles can experience damage from the electrical current leading them to release myoglobin.
In addition, the red blood cells will release hemoglobin. These substances will collect in the
kidneys leading to acute tubular necrosis (hence leading to AKI). Therefore, the nurse should
monitor the patient's urine for these substances.
You receive a patient who has experienced a burn on the right leg. You note the burn contains
small blisters and is extremely pinkish red and shiny/moist. The patient reports severe pain. You
document this burn as:
A. 1st Degree (superficial)
B. 2nd Degree (partial-thickness)
C. 3rd Degree (full-thickness)
D. 4th Degree (deep full-thickness) - Answer The answer is B. These are the classic
characteristics of a 2nd degree (partial-thickness) burn.
A 58 year old female patient has superficial partial-thickness burns to the anterior head and
neck, front and back of the left arm, front of the right arm, posterior trunk, front and back of
the right leg, and back of the left leg. Using the Rule of Nines, calculate the total body surface
area percentage that is burned?
A. 63%
B. 81%
C. 72%
,D. 54% - Answer The answer is A. Anterior head and neck (4.5%), front and back of the left
arm (9%), front of the right arm (4.5%), posterior trunk (18%), front and back of the right leg
(18%), back of the left leg (9%) which equals 63%.
A 30 year old female patient has deep partial thickness burns on the front and back of the right
and left leg, front of right arm, and anterior trunk. The patient weighs 63 kg. Use the Parkland
Burn Formula: What is the flow rate during the FIRST 8 hours (mL/hr) based on the total you
calculated?
A. 921 mL/hr
B. 938 mL/hr
C. 158 mL/hr
D. 789 mL/hr - Answer The answer is A: 921 mL/hr....First calculate the total amount of fluid
needed with the formula: Total Amount of LR = 4 mL x BSA % x pt's weight in kg. The pt's weight
63 kg. BSA percentage: 58.5%...Front and back of right and left leg (36%), front of right arm
(4.5%), anterior trunk (18%) which equals 58.5%. ......4 x 58.5 x 63 = 14,742 mL......Remember
during the FIRST 8 hours 1/2 of the solution is infused, which will be 14,742 divided by 2 = 7371
mL......Hourly Rate: 7371 divide by 8 equals 921 mL/hr
Based on the depth of the burn in figure 1 (picture is above), you would expect to find:
A. report of sensation to only pressure
B. blanching
C. anesthetization to feeling
D. extreme pain - Answer The answer is C. This is a 3rd degree to 4th degree burn (full-
thickness) and the nerves that detect pain are destroyed. The patient would have no feeling or
experiences an extreme decrease sensation to pain.
A patient has a burn on the back of the torso that is extremely red and painful but no blisters
are present. When you pressed on the skin it blanches. You document this as a:
A. 1st degree (superficial) burn
B. 2nd degree (partial-thickness) burn
C. 3rd degree (full-thickness) burn
D. 4th degree (deep full-thickness) burn - Answer The answer is A. These are the classic
characteristics of a 1st degree, superficial burn.
The nurse notes a patient has full-thickness circumferential burns on the right leg. The nurse
would: select all that apply
A. Place cold compressions on the burn and elevate the right leg below the heart level
B. Assess the distal pulses in the right extremity
C. Elevate the right leg above the heart level
, D. Place gauze securely around the leg to prevent infection - Answer The answer is B and C.
The patient has burns that completely surround the front and back of the right leg. This can lead
to compartment syndrome where the edema from the burn compromises circulation to the
distal extremity. The nurse should elevate the extremity ABOVE heart level to decrease swelling
and assess distal pulses in the extremity to confirm circulation is present.
A patient has experienced full-thickness burns to the face and neck. As the nurse it is priority to:
A. Prevent hypothermia
B. Assess the blood pressure
C. Assess the airway
D. Prevent infection - Answer The answer is C. Due to the location of the burns (face and
neck), the patient is at major risk for respiratory issues due to damage to the upper airways and
the risk of an inhalation injury.
A patient is in the acute phase of burn management. The patient experienced full-thickness
burns to the perineum and sacral area of the body. In the patient's plan of care, which nursing
diagnosis is priority at this time?
A. Impaired skin integrity
B. Risk for fluid volume overload
C. Risk for infection
D. Ineffective coping - Answer The answer is C. The patient is now in the acute phase where
fluid resuscitation was successful and ends with wound closure. Therefore, during this stage
diuresis occurs (so fluid volume deficient could occur NOT overload) and INFECTION. The
location of the burns increases the risk of infection because these areas naturally harbor
bacteria. Therefore, this takes priority because during this phase wound healing is promoted.
A patient arrives to the ER with full-thickness burns on the front and back of the torso and neck.
The patient has no spinal injuries but is disoriented and coughing up black sooty sputum. Vital
signs are: oxygen saturation 63%, heart rate 145, blood pressure 80/56, and respiratory rate 39.
As the nurse you will:
A. Place the patient in High Fowler's positon.
B. Prep the patient for escharotomy.
C. Prep the patient for fasciotomy.
D. Prep the patient for intubation.
E. Place a pillow under the patient's neck.
F. Obtain IV access at two sites.
G. Restrict fluids. - Answer The answers are A, B, D, and F. After reading this scenario the
location of the burns and the patient's presentation should be jumping out at you. The patient is
at risk for circumferential burns due to the location of the burns and the depth (full-
thickness....will have eschar present that will restrict circulation or here in this example the
ability of the patient to breathe in and out). Based on the patient's VS, we see that the
