COMPREHENSIVE PROFESSIONAL NURSING
EXAMINATION:
CARE OF THE ADOLESCENT CLIENT WITH SEVERE
BURNS
Focus: Resuscitative Phase Physiology, Fluid Resuscitation,
Complications, and Management (200 Questions with Rationales)
Module 1: Pathophysiology and Fluid Resuscitation in the
Emergent/Resuscitative Phase
Question 1: A nurse is caring for an adolescent client who has severe
burns over 30% of total body surface area (TBSA). During the
resuscitation phase, which of the following physiological shifts
should the nurse monitor for primarily?
A) Massive intracellular fluid shift into the interstitial space causing
hypovolemia
B) Rapid movement of intravascular fluid into the intracellular space
causing cellular dehydration
C) Immediate renal retention of sodium and water leading to fluid
volume excess
D) Decreased capillary permeability resulting in rapid reabsorption of
interstitial edema
Correct Answer: A
Rationale: During the initial emergent/resuscitative phase of severe
burns (>20-25% TBSA), increased systemic capillary permeability leads
to a massive shift of intravascular fluid into the interstitial space (third-
spacing), resulting in severe hypovolemic burn shock and generalized
edema.
,Question 2: An adolescent with a 35% TBSA burn is receiving fluid
resuscitation using the Parkland formula. Which of the following IV
fluids is the standard initial fluid of choice during the first 24 hours
post-burn?
A) 5% Dextrose in 0.9% Sodium Chloride
B) Lactated Ringer's solution
C) 0.45% Sodium Chloride with 20 mEq KCl
D) 5% Albumin solution
Correct Answer: B
Rationale: Lactated Ringer's (LR) solution is the crystalloid fluid of
choice during the first 24 hours of burn resuscitation because its pH and
electrolyte composition closely approximate extracellular fluid,
minimizing the risk of hyperchloremic metabolic acidosis.
Question 3: When calculating the total fluid requirement for a 60-kg
adolescent with a 40% TBSA burn using the consensus (Parkland)
formula (4 mL/kg/% TBSA), what is the total volume of fluid to be
administered in the first 24 hours?
A) 4,800 mL
B) 7,200 mL
C) 9,600 mL
D) 12,000 mL
,Correct Answer: C
Rationale: Parkland formula = 4 mL × weight (kg) × % TBSA burned.
Calculation: 4 × 60 kg × 40 = 9,600 mL total in the first 24 hours. Half
(4,800 mL) is given in the first 8 hours post-burn, and the remaining half
over the next 16 hours.
Question 4: According to the Parkland resuscitation formula, how
should the calculated total 24-hour fluid volume be distributed over
time following the time of the burn injury?
A) One-third in the first 8 hours, two-thirds in the remaining 16 hours
B) Half in the first 8 hours, half in the remaining 16 hours
C) Equal quarters every 6 hours
D) Three-quarters in the first 12 hours, one-quarter in the next 12
hours
Correct Answer: B
Rationale: Standard burn resuscitation guidelines dictate that 50% of
the calculated total 24-hour fluid requirement is administered within the
first 8 hours post-injury (calculated from the time of injury, not arrival),
and the remaining 50% is infused over the subsequent 16 hours.
Question 5: A nurse is monitoring the hourly urine output of an
adolescent client (weight 50 kg) undergoing fluid resuscitation for a
45% TBSA burn. Which of the following urine output values
indicates adequate fluid resuscitation?
A) 15 mL/hr
, B) 25 mL/hr
C) 50 mL/hr
D) 90 mL/hr
Correct Answer: B
Rationale: The target urine output for an adolescent/adult burn client
during resuscitation is 0.5 to 1.0 mL/kg/hr. For a 50-kg client, this
equals 25 to 50 mL/hr. Urine output is the most sensitive and reliable
clinical indicator of adequate organ perfusion and intravascular
volume.
Question 6: During the first 12 hours post-burn in an adolescent
with a 35% TBSA thermal injury, laboratory results reveal a serum
potassium level of 6.2 mEq/L. Which pathophysiological mechanism
explains this finding?
A) Renal failure secondary to decreased glomerular filtration rate
B) Massive destruction of red blood cells and cellular destruction
releasing intracellular potassium
C) Excessive administration of potassium-containing maintenance IV
fluids
D) Hyperaldosteronism induced by renin-angiotensin-aldosterone
system activation
Correct Answer: B
Rationale: In the emergent phase of severe burns, massive cellular
trauma, hemolysis, and destruction of cell membranes release large
amounts of intracellular potassium into the extracellular fluid, resulting
in acute hyperkalemia.
EXAMINATION:
CARE OF THE ADOLESCENT CLIENT WITH SEVERE
BURNS
Focus: Resuscitative Phase Physiology, Fluid Resuscitation,
Complications, and Management (200 Questions with Rationales)
Module 1: Pathophysiology and Fluid Resuscitation in the
Emergent/Resuscitative Phase
Question 1: A nurse is caring for an adolescent client who has severe
burns over 30% of total body surface area (TBSA). During the
resuscitation phase, which of the following physiological shifts
should the nurse monitor for primarily?
A) Massive intracellular fluid shift into the interstitial space causing
hypovolemia
B) Rapid movement of intravascular fluid into the intracellular space
causing cellular dehydration
C) Immediate renal retention of sodium and water leading to fluid
volume excess
D) Decreased capillary permeability resulting in rapid reabsorption of
interstitial edema
Correct Answer: A
Rationale: During the initial emergent/resuscitative phase of severe
burns (>20-25% TBSA), increased systemic capillary permeability leads
to a massive shift of intravascular fluid into the interstitial space (third-
spacing), resulting in severe hypovolemic burn shock and generalized
edema.
,Question 2: An adolescent with a 35% TBSA burn is receiving fluid
resuscitation using the Parkland formula. Which of the following IV
fluids is the standard initial fluid of choice during the first 24 hours
post-burn?
A) 5% Dextrose in 0.9% Sodium Chloride
B) Lactated Ringer's solution
C) 0.45% Sodium Chloride with 20 mEq KCl
D) 5% Albumin solution
Correct Answer: B
Rationale: Lactated Ringer's (LR) solution is the crystalloid fluid of
choice during the first 24 hours of burn resuscitation because its pH and
electrolyte composition closely approximate extracellular fluid,
minimizing the risk of hyperchloremic metabolic acidosis.
Question 3: When calculating the total fluid requirement for a 60-kg
adolescent with a 40% TBSA burn using the consensus (Parkland)
formula (4 mL/kg/% TBSA), what is the total volume of fluid to be
administered in the first 24 hours?
A) 4,800 mL
B) 7,200 mL
C) 9,600 mL
D) 12,000 mL
,Correct Answer: C
Rationale: Parkland formula = 4 mL × weight (kg) × % TBSA burned.
Calculation: 4 × 60 kg × 40 = 9,600 mL total in the first 24 hours. Half
(4,800 mL) is given in the first 8 hours post-burn, and the remaining half
over the next 16 hours.
Question 4: According to the Parkland resuscitation formula, how
should the calculated total 24-hour fluid volume be distributed over
time following the time of the burn injury?
A) One-third in the first 8 hours, two-thirds in the remaining 16 hours
B) Half in the first 8 hours, half in the remaining 16 hours
C) Equal quarters every 6 hours
D) Three-quarters in the first 12 hours, one-quarter in the next 12
hours
Correct Answer: B
Rationale: Standard burn resuscitation guidelines dictate that 50% of
the calculated total 24-hour fluid requirement is administered within the
first 8 hours post-injury (calculated from the time of injury, not arrival),
and the remaining 50% is infused over the subsequent 16 hours.
Question 5: A nurse is monitoring the hourly urine output of an
adolescent client (weight 50 kg) undergoing fluid resuscitation for a
45% TBSA burn. Which of the following urine output values
indicates adequate fluid resuscitation?
A) 15 mL/hr
, B) 25 mL/hr
C) 50 mL/hr
D) 90 mL/hr
Correct Answer: B
Rationale: The target urine output for an adolescent/adult burn client
during resuscitation is 0.5 to 1.0 mL/kg/hr. For a 50-kg client, this
equals 25 to 50 mL/hr. Urine output is the most sensitive and reliable
clinical indicator of adequate organ perfusion and intravascular
volume.
Question 6: During the first 12 hours post-burn in an adolescent
with a 35% TBSA thermal injury, laboratory results reveal a serum
potassium level of 6.2 mEq/L. Which pathophysiological mechanism
explains this finding?
A) Renal failure secondary to decreased glomerular filtration rate
B) Massive destruction of red blood cells and cellular destruction
releasing intracellular potassium
C) Excessive administration of potassium-containing maintenance IV
fluids
D) Hyperaldosteronism induced by renin-angiotensin-aldosterone
system activation
Correct Answer: B
Rationale: In the emergent phase of severe burns, massive cellular
trauma, hemolysis, and destruction of cell membranes release large
amounts of intracellular potassium into the extracellular fluid, resulting
in acute hyperkalemia.
