HCA HEALTHTRUST EXAM COMPREHENSIVE REVIEW GUIDE
// A+ GRADED PRESENTATION // HEALTHCARE COMPLIANCE
SAFETY PROTOCOLS CLINICAL STANDARDS AND
ORGANIZATIONAL TRAINING ESSENTIALS FOR STUDENT
SUCCESS // ACADEMIC YEAR 2025/2026
When assessing a patient who spilled hot oil on the right leg and foot, the
nurse notes that the skin is dry, pale, hard skin. The patient states that the
burn is not painful. What term would the nurse use to document the 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-
ANS: B
With full-thickness skin destruction, the appearance is pale and dry or
leathery and the area is painless because of the associated nerve
destruction. Erythema, swelling, and blisters point to a deep partial-
thickness burn. With superficial partial-thickness burns, the area is red, but
no blisters are present. First-degree burns exhibit erythema, blanching, and
pain
A young adult patient who is in the rehabilitation phase after having deep
partial-thickness face and neck burns has a nursing diagnosis of disturbed
body image. Which statement by the patient indicates that the problem is
resolving?
a. "I'm glad the scars are only temporary."
b. "I will avoid using a pillow, so my neck will be OK."
c. "I bet my boyfriend won't even want to look at me anymore."
,d. "Do you think dark beige makeup foundation would cover this scar on my
cheek?" - CORRECT ANSWER-ANS: D
The willingness to use strategies to enhance appearance is an indication
that the disturbed body image is resolving. Expressing feelings about the
scars indicates a willingness to discuss appearance, but not resolution of
the problem. Because deep partial-thickness burns leave permanent scars,
a statement that the scars are temporary indicates denial rather than
resolution of the problem. Avoiding using a pillow will help prevent
contractures, but it does not address the problem of disturbed body image
The nurse caring for a patient admitted with burns over 30% of the body
surface assesses that urine output has dramatically increased. Which
action by the nurse would best ensure adequate kidney function?
a. Continue to monitor the urine output.
b. Monitor for increased white blood cells (WBCs).
c. Assess that blisters and edema have subsided.
d. Prepare the patient for discharge from the burn unit. - CORRECT
ANSWER-ANS: A
The patient's urine output indicates that the patient is entering the acute
phase of the burn injury and moving on from the emergent stage. At the
end of the emergent phase, capillary permeability normalizes and the
patient begins to diurese large amounts of urine with a low specific gravity.
Although this may occur at about 48 hours, it may be longer in some
patients. Blisters and edema begin to resolve, but this process requires
more time. White blood cells may increase or decrease, based on the
patient's immune status and any infectious processes. The WBC count
does not indicate kidney function. The patient will likely remain in the burn
unit during the acute stage of burn injury
A patient with burns covering 40% total body surface area (TBSA) is in the
acute phase of burn treatment. Which snack would be best for the nurse to
offer to this patient?
,a. Bananas
b. Orange gelatin
c. Vanilla milkshake
d. Whole grain bagel - CORRECT ANSWER-ANS: C
A patient with a burn injury needs high protein and calorie food intake, and
the milkshake is the highest in these nutrients. The other choices are not as
nutrient-dense as the milkshake. Gelatin is likely high in sugar. The bagel is
a good carbohydrate choice, but low in protein. Bananas are a good source
of potassium, but are not high in protein and calories.
A patient has just arrived in the emergency department after an electrical
burn from exposure to a high-voltage current. What is the priority nursing
assessment?
a. Oral temperature
b. Peripheral pulses
c. Extremity movement
d. Pupil reaction to light - CORRECT ANSWER-ANS: C
All patients with electrical burns should be considered at risk for cervical
spine injury, and assessments of extremity movement will provide baseline
data. The other assessment data are also necessary but not as essential
as determining the cervical spine status
An employee spills industrial acids on both arms and legs at work. What is
the priority action that the occupational health nurse at the facility should
take?
a. Remove nonadherent clothing and watch.
b. Apply an alkaline solution to the affected area.
c. Place cool compresses on the area of exposure.
, d. Cover the affected area with dry, sterile dressings. - CORRECT
ANSWER-ANS: A
With chemical burns, the initial action is to remove the chemical from
contact with the skin as quickly as possible. Remove nonadherent clothing,
shoes, watches, jewelry, glasses, or contact lenses (if face was exposed).
Flush chemical from wound and surrounding area with copious amounts of
saline solution or water. Covering the affected area or placing cool
compresses on the area will leave the chemical in contact with the skin.
Application of an alkaline solution is not recommended.
A patient who has burns on the arms, legs, and chest from a house fire has
become agitated and restless 8 hours after being admitted to the hospital.
Which action should the nurse take first?
a. Stay at the bedside and reassure the patient.
b. Administer the ordered morphine sulfate IV.
c. Assess orientation and level of consciousness.
d. Use pulse oximetry to check the oxygen saturation. - CORRECT
ANSWER-ANS: D
Agitation in a patient who may have suffered inhalation injury might indicate
hypoxia, and this should be assessed by the nurse first. Administration of
morphine may be indicated if the nurse determines that the agitation is
caused by pain. Assessing level of consciousness and orientation is also
appropriate but not as essential as determining whether the patient is
hypoxemic. Reassurance is not helpful to reduce agitation in a hypoxemic
patient
A patient arrives in the emergency department with facial and chest burns
caused by a house fire. Which action should the nurse take first?
a. Auscultate the patient's lung sounds.
b. Determine the extent and depth of the burns.
c. Infuse the ordered lactated Ringer's solution.
// A+ GRADED PRESENTATION // HEALTHCARE COMPLIANCE
SAFETY PROTOCOLS CLINICAL STANDARDS AND
ORGANIZATIONAL TRAINING ESSENTIALS FOR STUDENT
SUCCESS // ACADEMIC YEAR 2025/2026
When assessing a patient who spilled hot oil on the right leg and foot, the
nurse notes that the skin is dry, pale, hard skin. The patient states that the
burn is not painful. What term would the nurse use to document the 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-
ANS: B
With full-thickness skin destruction, the appearance is pale and dry or
leathery and the area is painless because of the associated nerve
destruction. Erythema, swelling, and blisters point to a deep partial-
thickness burn. With superficial partial-thickness burns, the area is red, but
no blisters are present. First-degree burns exhibit erythema, blanching, and
pain
A young adult patient who is in the rehabilitation phase after having deep
partial-thickness face and neck burns has a nursing diagnosis of disturbed
body image. Which statement by the patient indicates that the problem is
resolving?
a. "I'm glad the scars are only temporary."
b. "I will avoid using a pillow, so my neck will be OK."
c. "I bet my boyfriend won't even want to look at me anymore."
,d. "Do you think dark beige makeup foundation would cover this scar on my
cheek?" - CORRECT ANSWER-ANS: D
The willingness to use strategies to enhance appearance is an indication
that the disturbed body image is resolving. Expressing feelings about the
scars indicates a willingness to discuss appearance, but not resolution of
the problem. Because deep partial-thickness burns leave permanent scars,
a statement that the scars are temporary indicates denial rather than
resolution of the problem. Avoiding using a pillow will help prevent
contractures, but it does not address the problem of disturbed body image
The nurse caring for a patient admitted with burns over 30% of the body
surface assesses that urine output has dramatically increased. Which
action by the nurse would best ensure adequate kidney function?
a. Continue to monitor the urine output.
b. Monitor for increased white blood cells (WBCs).
c. Assess that blisters and edema have subsided.
d. Prepare the patient for discharge from the burn unit. - CORRECT
ANSWER-ANS: A
The patient's urine output indicates that the patient is entering the acute
phase of the burn injury and moving on from the emergent stage. At the
end of the emergent phase, capillary permeability normalizes and the
patient begins to diurese large amounts of urine with a low specific gravity.
Although this may occur at about 48 hours, it may be longer in some
patients. Blisters and edema begin to resolve, but this process requires
more time. White blood cells may increase or decrease, based on the
patient's immune status and any infectious processes. The WBC count
does not indicate kidney function. The patient will likely remain in the burn
unit during the acute stage of burn injury
A patient with burns covering 40% total body surface area (TBSA) is in the
acute phase of burn treatment. Which snack would be best for the nurse to
offer to this patient?
,a. Bananas
b. Orange gelatin
c. Vanilla milkshake
d. Whole grain bagel - CORRECT ANSWER-ANS: C
A patient with a burn injury needs high protein and calorie food intake, and
the milkshake is the highest in these nutrients. The other choices are not as
nutrient-dense as the milkshake. Gelatin is likely high in sugar. The bagel is
a good carbohydrate choice, but low in protein. Bananas are a good source
of potassium, but are not high in protein and calories.
A patient has just arrived in the emergency department after an electrical
burn from exposure to a high-voltage current. What is the priority nursing
assessment?
a. Oral temperature
b. Peripheral pulses
c. Extremity movement
d. Pupil reaction to light - CORRECT ANSWER-ANS: C
All patients with electrical burns should be considered at risk for cervical
spine injury, and assessments of extremity movement will provide baseline
data. The other assessment data are also necessary but not as essential
as determining the cervical spine status
An employee spills industrial acids on both arms and legs at work. What is
the priority action that the occupational health nurse at the facility should
take?
a. Remove nonadherent clothing and watch.
b. Apply an alkaline solution to the affected area.
c. Place cool compresses on the area of exposure.
, d. Cover the affected area with dry, sterile dressings. - CORRECT
ANSWER-ANS: A
With chemical burns, the initial action is to remove the chemical from
contact with the skin as quickly as possible. Remove nonadherent clothing,
shoes, watches, jewelry, glasses, or contact lenses (if face was exposed).
Flush chemical from wound and surrounding area with copious amounts of
saline solution or water. Covering the affected area or placing cool
compresses on the area will leave the chemical in contact with the skin.
Application of an alkaline solution is not recommended.
A patient who has burns on the arms, legs, and chest from a house fire has
become agitated and restless 8 hours after being admitted to the hospital.
Which action should the nurse take first?
a. Stay at the bedside and reassure the patient.
b. Administer the ordered morphine sulfate IV.
c. Assess orientation and level of consciousness.
d. Use pulse oximetry to check the oxygen saturation. - CORRECT
ANSWER-ANS: D
Agitation in a patient who may have suffered inhalation injury might indicate
hypoxia, and this should be assessed by the nurse first. Administration of
morphine may be indicated if the nurse determines that the agitation is
caused by pain. Assessing level of consciousness and orientation is also
appropriate but not as essential as determining whether the patient is
hypoxemic. Reassurance is not helpful to reduce agitation in a hypoxemic
patient
A patient arrives in the emergency department with facial and chest burns
caused by a house fire. Which action should the nurse take first?
a. Auscultate the patient's lung sounds.
b. Determine the extent and depth of the burns.
c. Infuse the ordered lactated Ringer's solution.
