NURS_6551: Advanced Pediatric Primary Care
Burns 7th Edition Midterm Exam Prep Kit
Course Code: NURS_6551
Course Name: Advanced Pediatric Primary Care
Topic: Comprehensive Pediatric Burns Clinical Management & High-Yield
Blueprint
Academic Year: 2026/2027
1. A nurse practitioner is assessing a 4-year-old child presenting with a scald
burn on the right anterior thigh. The skin is bright red, blistered, moist,
and exquisitely tender to a light touch. Which classification represents the
correct answer for this burn wound?
A. Superficial (First degree)
B. Superficial partial-thickness (Second degree)
C. Deep partial-thickness (Second degree)
D. Full-thickness (Third degree)
CORRECT ANSWER: B. Superficial partial-thickness (Second degree)
RATIONALE: Superficial partial-thickness burns involve the
epidermis and the upper layers of the dermis. They are characteristically
bright red, moist, blistered, and extremely painful because the nerve
endings remain intact and exposed. Superficial (first-degree) burns involve
only the epidermis and are dry, red, and without blisters. Deep partial-
thickness burns extend into the deeper dermis, appearing more mottled
white-to-pink, dry or less moist, and are less sensitive to light touch. Full-
thickness burns involve the entire dermis and subcutaneous tissue,
presenting as leathery, white, brown, or charred, and are completely
anesthetic.
2. A 14-month-old infant is brought to the pediatric primary care clinic with a
splash burn across the anterior chest wall. To estimate the Total Body
Surface Area (TBSA) burned in this infant, which validation tool represents
the correct answer as the most accurate method for pediatric populations?
A. Rule of Nines
B. Lund-Browder chart
, C. Parkland Formula calculator
D. PALs Resuscitation wheel
CORRECT ANSWER: B. Lund-Browder chart
RATIONALE: The Lund-Browder chart is the gold standard and most
accurate tool for estimating Total Body Surface Area (TBSA) burned in
children. This chart explicitly accounts for pediatric developmental
changes in body proportions, such as the relatively larger head and smaller
lower extremities of infants and toddlers compared to adults. The standard
Rule of Nines significantly miscalculates pediatric fluid requirements
because it assumes fixed adult body proportions. The Parkland formula
calculates fluid volumes based on the TBSA percentage but does not
calculate the initial burn percentage itself.
3. A nurse practitioner is evaluating a 2-year-old child with a circumferential
scald burn on the left forearm. The child’s mother states, "He accidentally
pulled a cup of hot coffee off the counter." On examination, the burn has a
clear, demarcated linear border around the wrist without splash marks.
Which dynamic interpretation represents the correct answer or priority
clinical reasoning response?
A. Accept the maternal history and prescribe a topical antibiotic dressing
taper.
B. Recognize the pattern as highly suspicious for non-accidental trauma
(child abuse) and immediately notify Child Protective Services (CPS).
C. Order an emergency outpatient occupational therapy referral for scar
management.
D. Reassure the parent that coffee burns always form perfectly clean
geometric borders.
CORRECT ANSWER: B. Recognize the pattern as highly suspicious for
non-accidental trauma (child abuse) and immediately notify Child
Protective Services (CPS).
RATIONALE: Burns with a clear, sharply demarcated linear edge,
uniform depth, and an absence of splash or drip marks (especially in a
stocking or glove distribution on extremities) are classic indicators of non-
accidental immersion trauma (child abuse). Accidental splash burns from
a pulled cup almost always demonstrate irregular margins, downward
running drip marks, and varying depths. In advanced pediatric primary care,
, the nurse practitioner is a mandatory reporter and must prioritize child
safety by reporting suspected abuse to CPS or law enforcement
immediately.
4. A 6-year-old child presents to the clinic 48 hours after sustaining a minor
superficial partial-thickness burn to the right hand. The nurse practitioner
reinforces proper dressing change instructions with the caregiver. Which
selection represents the correct answer for optimal wound healing and
infection prevention?
A. Apply direct ice packs hourly and leave the wound exposed to open
ambient air.
B. Cleanse gently with mild soap and water, apply a thin layer of silver
sulfadiazine or bacitracin ointment, and cover with a non-adherent
sterile gauze dressing.
C. Apply a thick layer of high-potency topical corticosteroid ointment to
lower inflammation.
D. Immerse the hand in an undiluted hydrogen peroxide bath twice daily.
CORRECT ANSWER: B. Cleanse gently with mild soap and water, apply
a thin layer of silver sulfadiazine or bacitracin ointment, and cover with
a non-adherent sterile gauze dressing.
RATIONALE: Minor pediatric burns require a moist wound-healing
environment to facilitate re-epithelialization while preventing bacterial
colonization. The proper clinical care involves gentle cleansing with mild
soap and water, applying a topical antimicrobial ointment (bacitracin or
silver sulfadiazine), and protecting the site with a non-adherent sterile
dressing. Ice packs can cause vasoconstriction and worsen tissue ischemia.
Corticosteroids delay wound healing and increase infection risk. Hydrogen
peroxide is cytotoxic to newly granulating tissue. Note: Silver sulfadiazine is
avoided on the face or if the child has a sulfa allergy.
5. A 10-year-old child is brought to the clinic following an accidental contact
burn from an iron on the right forearm. The nurse practitioner determines
that the burn is a deep partial-thickness burn covering approximately
12% Total Body Surface Area (TBSA). Based on standard pediatric burn
triage guidelines, what is the correct clinical decision?
A. Treat the client in the primary care clinic with daily outpatient visits.
B. Prescribe oral antibiotics and instruct the parent to recheck in 2 weeks.
Burns 7th Edition Midterm Exam Prep Kit
Course Code: NURS_6551
Course Name: Advanced Pediatric Primary Care
Topic: Comprehensive Pediatric Burns Clinical Management & High-Yield
Blueprint
Academic Year: 2026/2027
1. A nurse practitioner is assessing a 4-year-old child presenting with a scald
burn on the right anterior thigh. The skin is bright red, blistered, moist,
and exquisitely tender to a light touch. Which classification represents the
correct answer for this burn wound?
A. Superficial (First degree)
B. Superficial partial-thickness (Second degree)
C. Deep partial-thickness (Second degree)
D. Full-thickness (Third degree)
CORRECT ANSWER: B. Superficial partial-thickness (Second degree)
RATIONALE: Superficial partial-thickness burns involve the
epidermis and the upper layers of the dermis. They are characteristically
bright red, moist, blistered, and extremely painful because the nerve
endings remain intact and exposed. Superficial (first-degree) burns involve
only the epidermis and are dry, red, and without blisters. Deep partial-
thickness burns extend into the deeper dermis, appearing more mottled
white-to-pink, dry or less moist, and are less sensitive to light touch. Full-
thickness burns involve the entire dermis and subcutaneous tissue,
presenting as leathery, white, brown, or charred, and are completely
anesthetic.
2. A 14-month-old infant is brought to the pediatric primary care clinic with a
splash burn across the anterior chest wall. To estimate the Total Body
Surface Area (TBSA) burned in this infant, which validation tool represents
the correct answer as the most accurate method for pediatric populations?
A. Rule of Nines
B. Lund-Browder chart
, C. Parkland Formula calculator
D. PALs Resuscitation wheel
CORRECT ANSWER: B. Lund-Browder chart
RATIONALE: The Lund-Browder chart is the gold standard and most
accurate tool for estimating Total Body Surface Area (TBSA) burned in
children. This chart explicitly accounts for pediatric developmental
changes in body proportions, such as the relatively larger head and smaller
lower extremities of infants and toddlers compared to adults. The standard
Rule of Nines significantly miscalculates pediatric fluid requirements
because it assumes fixed adult body proportions. The Parkland formula
calculates fluid volumes based on the TBSA percentage but does not
calculate the initial burn percentage itself.
3. A nurse practitioner is evaluating a 2-year-old child with a circumferential
scald burn on the left forearm. The child’s mother states, "He accidentally
pulled a cup of hot coffee off the counter." On examination, the burn has a
clear, demarcated linear border around the wrist without splash marks.
Which dynamic interpretation represents the correct answer or priority
clinical reasoning response?
A. Accept the maternal history and prescribe a topical antibiotic dressing
taper.
B. Recognize the pattern as highly suspicious for non-accidental trauma
(child abuse) and immediately notify Child Protective Services (CPS).
C. Order an emergency outpatient occupational therapy referral for scar
management.
D. Reassure the parent that coffee burns always form perfectly clean
geometric borders.
CORRECT ANSWER: B. Recognize the pattern as highly suspicious for
non-accidental trauma (child abuse) and immediately notify Child
Protective Services (CPS).
RATIONALE: Burns with a clear, sharply demarcated linear edge,
uniform depth, and an absence of splash or drip marks (especially in a
stocking or glove distribution on extremities) are classic indicators of non-
accidental immersion trauma (child abuse). Accidental splash burns from
a pulled cup almost always demonstrate irregular margins, downward
running drip marks, and varying depths. In advanced pediatric primary care,
, the nurse practitioner is a mandatory reporter and must prioritize child
safety by reporting suspected abuse to CPS or law enforcement
immediately.
4. A 6-year-old child presents to the clinic 48 hours after sustaining a minor
superficial partial-thickness burn to the right hand. The nurse practitioner
reinforces proper dressing change instructions with the caregiver. Which
selection represents the correct answer for optimal wound healing and
infection prevention?
A. Apply direct ice packs hourly and leave the wound exposed to open
ambient air.
B. Cleanse gently with mild soap and water, apply a thin layer of silver
sulfadiazine or bacitracin ointment, and cover with a non-adherent
sterile gauze dressing.
C. Apply a thick layer of high-potency topical corticosteroid ointment to
lower inflammation.
D. Immerse the hand in an undiluted hydrogen peroxide bath twice daily.
CORRECT ANSWER: B. Cleanse gently with mild soap and water, apply
a thin layer of silver sulfadiazine or bacitracin ointment, and cover with
a non-adherent sterile gauze dressing.
RATIONALE: Minor pediatric burns require a moist wound-healing
environment to facilitate re-epithelialization while preventing bacterial
colonization. The proper clinical care involves gentle cleansing with mild
soap and water, applying a topical antimicrobial ointment (bacitracin or
silver sulfadiazine), and protecting the site with a non-adherent sterile
dressing. Ice packs can cause vasoconstriction and worsen tissue ischemia.
Corticosteroids delay wound healing and increase infection risk. Hydrogen
peroxide is cytotoxic to newly granulating tissue. Note: Silver sulfadiazine is
avoided on the face or if the child has a sulfa allergy.
5. A 10-year-old child is brought to the clinic following an accidental contact
burn from an iron on the right forearm. The nurse practitioner determines
that the burn is a deep partial-thickness burn covering approximately
12% Total Body Surface Area (TBSA). Based on standard pediatric burn
triage guidelines, what is the correct clinical decision?
A. Treat the client in the primary care clinic with daily outpatient visits.
B. Prescribe oral antibiotics and instruct the parent to recheck in 2 weeks.
