NCLEX BURNS REVIEW: HIGH-YIELD PRACTICE
QUESTIONS & RATIONALES
Q: A patient spills hot oil on the right leg and foot. The nurse observes dry, pale,
and firm skin. The patient reports no pain. What is the correct term for this burn
depth?
a. First-degree skin destruction
b. Full-thickness skin destruction
c. Deep partial-thickness skin destruction
d. Superficial partial-thickness skin destruction
✅ Correct Answer: b. Full-thickness skin destruction
🩺 Explanation:
In full-thickness burns, all skin layers (epidermis, dermis, and underlying tissue)
are destroyed. The skin often appears dry, white, leathery, or charred, and the area
is painless due to nerve damage.
Superficial partial-thickness burns: Red, moist skin with blisters.
Deep partial-thickness burns: Pale, moist skin with blisters and pain.
First-degree burns: Redness, mild swelling, blanching, and pain (similar to a
sunburn).
,Q: A burn patient with 25% TBSA has labs showing Hct 58%, Hgb 18.2 g/dL, K⁺
4.9 mEq/L, and Na⁺ 135 mEq/L. What action should the nurse anticipate?
a. Monitor urine output every 4 hours
b. Continue to observe laboratory results
c. Increase the rate of IV fluids
d. Prepare for a blood transfusion
✅ Correct Answer: c. Increase the rate of IV fluids
🩺 Explanation:
The elevated hematocrit and hemoglobin indicate hemoconcentration, suggesting
fluid loss from the vascular space. To restore adequate perfusion and prevent
microcirculatory collapse, IV fluids must be increased.
Blood transfusions are not appropriate at this stage.
Urine output should be monitored hourly, not every 4 hours, in the early burn
phase.
Q: A patient with burns to the head, face, and hands initially has wheezes, but an
hour later, breath sounds are diminished and wheezes are absent. What is the
nurse’s best action?
a. Encourage coughing and recheck breath sounds
,b. Notify the healthcare provider and prepare for intubation
c. Document findings and continue monitoring
d. Place the patient in high-Fowler’s position and reassess
✅ Correct Answer: b. Notify the healthcare provider and prepare for intubation
🩺 Explanation:
The loss of wheezing and decreased breath sounds indicate airway edema and
impending obstruction. Immediate intubation is critical to maintain a patent
airway.
Repositioning or coughing will not address airway swelling, and delaying
intervention could lead to respiratory arrest.
Q: A patient requires 30,000 mL of IV fluids in 24 hours per the Parkland formula.
If 1875 mL/hour is infused in the first 8 hours, what rate should be used for the
next 16 hours?
a. 350 mL/hour
b. 523 mL/hour
c. 938 mL/hour
d. 1250 mL/hour
✅ Correct Answer: c. 938 mL/hour
, 🩺 Explanation:
The Parkland formula delivers half of the total fluid volume during the first 8 hours
and the remaining half over the next 16 hours.
Total fluid = 30,000 mL
First 8 hours: 15,000 mL → 1875 mL/hour
Next 16 hours: Remaining 15,000 mL → 938 mL/hour
Q: During the emergent phase of burn care, which parameter best reflects adequate
fluid resuscitation?
a. Skin turgor
b. Daily weight
c. Mucous membrane moisture
d. Hourly urine output
✅ Correct Answer: d. Hourly urine output
🩺 Explanation:
Urine output is the most accurate indicator of perfusion and hydration status in
burn patients. The goal is 0.5–1 mL/kg/hr.
Weight is unreliable due to third spacing and evaporative losses.
QUESTIONS & RATIONALES
Q: A patient spills hot oil on the right leg and foot. The nurse observes dry, pale,
and firm skin. The patient reports no pain. What is the correct term for this burn
depth?
a. First-degree skin destruction
b. Full-thickness skin destruction
c. Deep partial-thickness skin destruction
d. Superficial partial-thickness skin destruction
✅ Correct Answer: b. Full-thickness skin destruction
🩺 Explanation:
In full-thickness burns, all skin layers (epidermis, dermis, and underlying tissue)
are destroyed. The skin often appears dry, white, leathery, or charred, and the area
is painless due to nerve damage.
Superficial partial-thickness burns: Red, moist skin with blisters.
Deep partial-thickness burns: Pale, moist skin with blisters and pain.
First-degree burns: Redness, mild swelling, blanching, and pain (similar to a
sunburn).
,Q: A burn patient with 25% TBSA has labs showing Hct 58%, Hgb 18.2 g/dL, K⁺
4.9 mEq/L, and Na⁺ 135 mEq/L. What action should the nurse anticipate?
a. Monitor urine output every 4 hours
b. Continue to observe laboratory results
c. Increase the rate of IV fluids
d. Prepare for a blood transfusion
✅ Correct Answer: c. Increase the rate of IV fluids
🩺 Explanation:
The elevated hematocrit and hemoglobin indicate hemoconcentration, suggesting
fluid loss from the vascular space. To restore adequate perfusion and prevent
microcirculatory collapse, IV fluids must be increased.
Blood transfusions are not appropriate at this stage.
Urine output should be monitored hourly, not every 4 hours, in the early burn
phase.
Q: A patient with burns to the head, face, and hands initially has wheezes, but an
hour later, breath sounds are diminished and wheezes are absent. What is the
nurse’s best action?
a. Encourage coughing and recheck breath sounds
,b. Notify the healthcare provider and prepare for intubation
c. Document findings and continue monitoring
d. Place the patient in high-Fowler’s position and reassess
✅ Correct Answer: b. Notify the healthcare provider and prepare for intubation
🩺 Explanation:
The loss of wheezing and decreased breath sounds indicate airway edema and
impending obstruction. Immediate intubation is critical to maintain a patent
airway.
Repositioning or coughing will not address airway swelling, and delaying
intervention could lead to respiratory arrest.
Q: A patient requires 30,000 mL of IV fluids in 24 hours per the Parkland formula.
If 1875 mL/hour is infused in the first 8 hours, what rate should be used for the
next 16 hours?
a. 350 mL/hour
b. 523 mL/hour
c. 938 mL/hour
d. 1250 mL/hour
✅ Correct Answer: c. 938 mL/hour
, 🩺 Explanation:
The Parkland formula delivers half of the total fluid volume during the first 8 hours
and the remaining half over the next 16 hours.
Total fluid = 30,000 mL
First 8 hours: 15,000 mL → 1875 mL/hour
Next 16 hours: Remaining 15,000 mL → 938 mL/hour
Q: During the emergent phase of burn care, which parameter best reflects adequate
fluid resuscitation?
a. Skin turgor
b. Daily weight
c. Mucous membrane moisture
d. Hourly urine output
✅ Correct Answer: d. Hourly urine output
🩺 Explanation:
Urine output is the most accurate indicator of perfusion and hydration status in
burn patients. The goal is 0.5–1 mL/kg/hr.
Weight is unreliable due to third spacing and evaporative losses.
