EXAM
Exam Solution ga
NCLEX Style Burns Med Surg Burns NCLEX Review Quesga ga ga ga ga ga ga ga
tions Med Surg Exam 3 Burns Questions Med Surg : Chap
ga ga ga ga ga ga ga ga ga ga
ter 25 Burns 2026 A+ GRADE ASSURED COMPLETE SOL
ga ga ga ga ga ga ga ga
UTIONS AND VERIFIED ANSWERS (8A0DC) ga ga ga ga
QUESTION 1 ga
When assessing a patient who spilled hot oil on the right leg and foot, the nurse notes th
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at the skin is dry, pale, hard skin. The patient states that the burn is not painful. What te
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rm would the nurse use to document the burn depth?
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a. First-degree skin destruction
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b. Full-thickness skin destruction
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c. Deep partial-thickness skin destruction
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d. Superficial partial-thickness skin destruction
ga ga ga ga
ANSWER
ANS: B With full-ga ga ga
thickness skin destruction, the appearance is pale and dry or leathery and the area is painless because
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of the associated nerve destruction. Erythema, swelling, and blisters point to a deep partial-
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thickness burn. With superficial partial-
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thickness burns, the area is red, but no blisters are present. First-
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degree burns exhibit erythema, blanching, and pain
ga ga ga ga ga ga
QUESTION 2 ga
A patient with severe burns has crystalloid fluid replacement ordered using the Parklan
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d formula. The initial volume of fluid to be administered in the first 24 hours is 30,000
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mL. The initial rate of administration is 1875 mL/hr. After the first 8 hours, what rate sh
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ould the nurse infuse the IV fluids?
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a. 350 mL/hour
ga ga
b. 523 mL/hour
ga ga
c. 938 mL/hour
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d. 1250 mL/hour
ga ga
ANSWER
,ANS: C Half of the fluid replacement using the Parkland formula is administered in the first 8 hours and
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the other half over the next 16 hours. In this case, the patient should receive half of the initial rate, or
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
938 mL/hr. ga
QUESTION 3 ga
During the emergent phase of burn care, which assessment will be most useful in deter
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mining whether the patient is receiving adequate fluid infusion?
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a. Check skin turgor.
ga ga ga
b. Monitor daily weight.
ga ga ga
c. Assess mucous membranes.
ga ga ga
d. Measure hourly urine output.
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ANSWER
ANS: D When fluid intake is adequate, the urine output will be at least 0.5 to 1 mL/kg/hour. The patien
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t's weight is not useful in this situation because of the effects of third spacing and evaporative fluid loss
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
. Mucous membrane assessment and skin turgor also may be used, but they are not as adequate in dete
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
rmining that fluid infusions are maintaining adequate perfusion.
ga ga ga ga ga ga ga
QUESTION 4 ga
A patient with circumferential burns of both legs develops a decrease in dorsalis pedis p
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ulse strength and numbness in the toes. Which action should the nurse take?
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a. Notify the health care provider.
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b. Monitor the pulses every 2 hours.
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c. Elevate both legs above heart level with pillows.
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d. Encourage the patient to flex and extend the toes on both feet.
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ANSWER
ANS: A The decrease in pulse in a patient with circumferential burns indicates decreased circulation to
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the legs and the need for an escharotomy. Monitoring the pulses is not an adequate response to the dec
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
rease in circulation. Elevating the legs or increasing toe movement will not improve the patient's circul
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ation
QUESTION 5 ga
Esomeprazole (Nexium) is prescribed for a patient who incurred extensive burn injuries
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5 days ago. Which nursing assessment would best evaluate the effectiveness of the medi
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cation?
a. Bowel sounds
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b. Stool frequency
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c. Abdominal distention
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d. Stools for occult blood
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ANSWER
, ANS: D H2 blockers and proton pump inhibitors are given to prevent Curling's ulcer in the patient who
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has suffered burn injuries. Proton pump inhibitors usually do not affect bowel sounds, stool frequency,
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
or appetite
ga
QUESTION 6 ga
The nurse is reviewing the medication administration record (MAR) on a patient with p
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artial-
thickness burns. Which medication is best for the nurse to administer before scheduled
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wound debridement? ga
a. Ketorolac (Toradol)
ga ga
b. Lorazepam (Ativan)
ga ga
c. Gabapentin (Neurontin)
ga ga
d. Hydromorphone (Dilaudid)
ga ga
ANSWER
ANS: D Opioid pain medications are the best choice for pain control. The other medications are used as
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adjuvants to enhance the effects of opioids. ga ga ga ga ga ga
QUESTION 7 ga
A patient with burns covering 40% total body surface area (TBSA) is in the acute phase
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of burn treatment. Which snack would be best for the nurse to offer to this patient?
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a. Bananas
ga
b. Orange gelatin
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c. Vanilla milkshake
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d. Whole grain bagel
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ANSWER
ANS: C A patient with a burn injury needs high protein and calorie food intake, and the milkshake is th
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e highest in these nutrients. The other choices are not as nutrient-
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dense as the milkshake. Gelatin is likely high in sugar. The bagel is a good carbohydrate choice, but low
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in protein. Bananas are a good source of potassium, but are not high in protein and calories.
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QUESTION 8 ga
A patient has just arrived in the emergency department after an electrical burn from ex
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
posure to a high-voltage current. What is the priority nursing assessment?
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a. Oral temperature
ga ga
b. Peripheral pulses
ga ga
c. Extremity movement
ga ga
d. Pupil reaction to light
ga ga ga ga
ANSWER
Exam Solution ga
NCLEX Style Burns Med Surg Burns NCLEX Review Quesga ga ga ga ga ga ga ga
tions Med Surg Exam 3 Burns Questions Med Surg : Chap
ga ga ga ga ga ga ga ga ga ga
ter 25 Burns 2026 A+ GRADE ASSURED COMPLETE SOL
ga ga ga ga ga ga ga ga
UTIONS AND VERIFIED ANSWERS (8A0DC) ga ga ga ga
QUESTION 1 ga
When assessing a patient who spilled hot oil on the right leg and foot, the nurse notes th
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
at the skin is dry, pale, hard skin. The patient states that the burn is not painful. What te
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
rm would the nurse use to document the burn depth?
ga ga ga ga ga ga ga ga ga
a. First-degree skin destruction
ga ga ga
b. Full-thickness skin destruction
ga ga ga
c. Deep partial-thickness skin destruction
ga ga ga ga
d. Superficial partial-thickness skin destruction
ga ga ga ga
ANSWER
ANS: B With full-ga ga ga
thickness skin destruction, the appearance is pale and dry or leathery and the area is painless because
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
of the associated nerve destruction. Erythema, swelling, and blisters point to a deep partial-
ga ga ga ga ga ga ga ga ga ga ga ga ga
thickness burn. With superficial partial-
ga ga ga ga
thickness burns, the area is red, but no blisters are present. First-
ga ga ga ga ga ga ga ga ga ga ga
degree burns exhibit erythema, blanching, and pain
ga ga ga ga ga ga
QUESTION 2 ga
A patient with severe burns has crystalloid fluid replacement ordered using the Parklan
ga ga ga ga ga ga ga ga ga ga ga ga
d formula. The initial volume of fluid to be administered in the first 24 hours is 30,000
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
mL. The initial rate of administration is 1875 mL/hr. After the first 8 hours, what rate sh
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ould the nurse infuse the IV fluids?
ga ga ga ga ga ga
a. 350 mL/hour
ga ga
b. 523 mL/hour
ga ga
c. 938 mL/hour
ga ga
d. 1250 mL/hour
ga ga
ANSWER
,ANS: C Half of the fluid replacement using the Parkland formula is administered in the first 8 hours and
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
the other half over the next 16 hours. In this case, the patient should receive half of the initial rate, or
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
938 mL/hr. ga
QUESTION 3 ga
During the emergent phase of burn care, which assessment will be most useful in deter
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
mining whether the patient is receiving adequate fluid infusion?
ga ga ga ga ga ga ga ga
a. Check skin turgor.
ga ga ga
b. Monitor daily weight.
ga ga ga
c. Assess mucous membranes.
ga ga ga
d. Measure hourly urine output.
ga ga ga ga
ANSWER
ANS: D When fluid intake is adequate, the urine output will be at least 0.5 to 1 mL/kg/hour. The patien
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
t's weight is not useful in this situation because of the effects of third spacing and evaporative fluid loss
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
. Mucous membrane assessment and skin turgor also may be used, but they are not as adequate in dete
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
rmining that fluid infusions are maintaining adequate perfusion.
ga ga ga ga ga ga ga
QUESTION 4 ga
A patient with circumferential burns of both legs develops a decrease in dorsalis pedis p
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ulse strength and numbness in the toes. Which action should the nurse take?
ga ga ga ga ga ga ga ga ga ga ga ga
a. Notify the health care provider.
ga ga ga ga ga
b. Monitor the pulses every 2 hours.
ga ga ga ga ga ga
c. Elevate both legs above heart level with pillows.
ga ga ga ga ga ga ga ga
d. Encourage the patient to flex and extend the toes on both feet.
ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
ANS: A The decrease in pulse in a patient with circumferential burns indicates decreased circulation to
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
the legs and the need for an escharotomy. Monitoring the pulses is not an adequate response to the dec
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
rease in circulation. Elevating the legs or increasing toe movement will not improve the patient's circul
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ation
QUESTION 5 ga
Esomeprazole (Nexium) is prescribed for a patient who incurred extensive burn injuries
ga ga ga ga ga ga ga ga ga ga ga
5 days ago. Which nursing assessment would best evaluate the effectiveness of the medi
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
cation?
a. Bowel sounds
ga ga
b. Stool frequency
ga ga
c. Abdominal distention
ga ga
d. Stools for occult blood
ga ga ga ga
ANSWER
, ANS: D H2 blockers and proton pump inhibitors are given to prevent Curling's ulcer in the patient who
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
has suffered burn injuries. Proton pump inhibitors usually do not affect bowel sounds, stool frequency,
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
or appetite
ga
QUESTION 6 ga
The nurse is reviewing the medication administration record (MAR) on a patient with p
ga ga ga ga ga ga ga ga ga ga ga ga ga
artial-
thickness burns. Which medication is best for the nurse to administer before scheduled
ga ga ga ga ga ga ga ga ga ga ga ga ga
wound debridement? ga
a. Ketorolac (Toradol)
ga ga
b. Lorazepam (Ativan)
ga ga
c. Gabapentin (Neurontin)
ga ga
d. Hydromorphone (Dilaudid)
ga ga
ANSWER
ANS: D Opioid pain medications are the best choice for pain control. The other medications are used as
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
adjuvants to enhance the effects of opioids. ga ga ga ga ga ga
QUESTION 7 ga
A patient with burns covering 40% total body surface area (TBSA) is in the acute phase
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
of burn treatment. Which snack would be best for the nurse to offer to this patient?
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
a. Bananas
ga
b. Orange gelatin
ga ga
c. Vanilla milkshake
ga ga
d. Whole grain bagel
ga ga ga
ANSWER
ANS: C A patient with a burn injury needs high protein and calorie food intake, and the milkshake is th
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
e highest in these nutrients. The other choices are not as nutrient-
ga ga ga ga ga ga ga ga ga ga ga
dense as the milkshake. Gelatin is likely high in sugar. The bagel is a good carbohydrate choice, but low
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
in protein. Bananas are a good source of potassium, but are not high in protein and calories.
a ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 8 ga
A patient has just arrived in the emergency department after an electrical burn from ex
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
posure to a high-voltage current. What is the priority nursing assessment?
ga ga ga ga ga ga ga ga ga ga
a. Oral temperature
ga ga
b. Peripheral pulses
ga ga
c. Extremity movement
ga ga
d. Pupil reaction to light
ga ga ga ga
ANSWER
