NR574 LATEST 2026 COMPREHENSIVE EXAMS
QUESTIONS AND SOLUTIONS GUARANTEE A+
✔✔Active internal rewarming - ✔✔-An esophageal warming probe can be used to heat
the core blood supply through warmed circulating water.-Central venous warming
catheters use warmed water circulation to rewarm blood as it flows through a central
vessel.
-Extracorporeal Membrane Oxygenation (ECMO) circulates blood outside the body
through a warmer and then returns the warmed blood to the client. This method requires
systemic anticoagulation and insertion of a specialized ECMO catheter. ECMO is not
available at all hospitals.
✔✔common causes for hypothermia - ✔✔Environment: Immersion; Freezing temper-
atures; Inadequate thermal insulation; Prolonged indoor exposure to cold elements such
as air conditioning (elderly) or ice baths (athletes) Drug-induced: Alcohol;
Phenothiazines; Sedative-hypnoticsDisruption of skin integrity: Burns; Severe trauma
Metabolic: Hypoadrenalism; Hypopituitarism; Hypothyroidism Iatrogenic: Aggressive
fluid resuscitation; Heatstroke treatment Neurologic: Traumatic brain injury; Stroke;
Brain tumor
✔✔Rule of 9's - ✔✔Head and neck = 9% Upper Ex = 9% each Lower Ex = 9% each
Front trunk = 18% Back trunk = 18%
✔✔classifications of burns: minor - ✔✔total body surface area (TBSA) < 10% in an
adultTBSA < 5% in children or the elderly the amount of full-thickness burn < 2%
✔✔classifications of burns: moderate - ✔✔TBSA 10-20% in an adultTBSA 5-10% in
children or the elderly the amount of full-thickness burn is 2-5%high-voltage injury
possible inhalation injury circumferential burn co-existing health problems
✔✔classifications of burns: Major - ✔✔TBSA > 20% in an adultTBSA > 10% in children
or the elderly the amount of full-thickness burn is > 5% high voltage injury known
inhalation injury significant burns to the face, joints, hands, or feet associated injuries
from trauma/event
✔✔what is optimal urine output for a burn patient - ✔✔The optimal urine output is at
least 0.5 milliliter/kilogram/hour (mL/kg/hr).
✔✔when should a patient be transfered to a burn center? - ✔✔burns > 20% TBSA
burns to face/head/neck burns to genitals circumferential extremity or chest burns full-
thickness burns > 5% burns over joints burns with inhalation injury electrical burns
✔✔Symptoms of CO poisoning - ✔✔headache, dizziness, loss of consciousness,
nausea/vomiting, chest pain, confusion
,✔✔Treatment of CO poisoning - ✔✔High flow oxygen (100%) is appropriate treatment
✔✔Parkland formula for fluid resuscitation - ✔✔PARKLAND FORMULA = TBSA x
Weight (kg) x 4 = Total amount of fluid needed
✔✔you calculated your burn patients total fluid rescusitation, half the amount should be
given - ✔✔half should be given in the first 8 hours, which is calculated from the time of
injury NOT the time of arrival. The other half of the fluid is given over the next 16 hours.
✔✔preferred fluids for burn patient fluid resuscitation - ✔✔Lactated Ringer's solution is
the recommended crystalloid used in burn resuscitation,
✔✔how often should a BMP be drawn for burn patients? - ✔✔-q4-8hrs in large burns.-
assessing renal and electrolytes-Electrolytes must be replaced often due to large fluid
shifts and fluid resuscitation. Hypokalemia is common.
✔✔what is the CBC used for at baseline of a burn pt - ✔✔-initial hemoconcentration. As
fluids are provided, a decrease in hemoglobin and hematocrit should be expected due
to the administration of large fluid volumes. Transfusion may also be necessary.
✔✔what does a serum lactate tell us with burn patients? - ✔✔-elevated lactate is an
indicator of hypoperfusion, which occurs with under-resuscitation, poor end-organ
perfusion, and/or heavy necrotic tissue burden
✔✔CO levels great than ___ indicate ____? - ✔✔-5-consistent w/ CO exposure
✔✔at what level would a patient be symptomatic with CO exposure? - ✔✔10
✔✔what is a fatal level of CO - ✔✔50
✔✔If urine output is below 0.5 mL/kg/hr for two consecutive hours, what does it mean? -
✔✔the client is likely under resuscitated and requires more fluids.
✔✔Jerome has 75% TBSA 2nd and 3rd degree burn injuries. He weighs 80 kilograms
(kg). Based on the Parkland formula how much fluid should Jerome receive in the first 8
hours? - ✔✔12 L
Parkland formula is TBSA x weight x 4ml. Half of this is given in the first 8 hours. 75 x
80 x 4= 24L/2= 12L.
✔✔Neal was involved in a house fire. He sustained burns to the head, neck, face,
chest, and bilateral upper extremities. Neal was intubated by EMS before arrival. What
are the AGACNP's priority diagnostic studies for Neal? - ✔✔Carboxyhemoglobin (CO)
level & ABGs
, ✔✔Harleen sustained a 50% TBSA burn injury. The time of injury was 6 hours ago. The
nurse reports that Harleen's urine output has decreased to 10ml/hr for the last two
hours. What is the most appropriate intervention by the nurse practitioner? - ✔✔Provide
1L rapid bolus of lactated ringers (LR)
Rationale: Urine decrease in a burn injury in the first 24 hours is generally going to be
met with a fluid challenge. Burns require a large volume of fluids; some require upwards
of 30L of fluid in just the first24 hours. Thermal injury causes an overwhelming fluid shift
with most intravascular fluid shifting into the tissues and the third space. That fluid has
to be replaced quickly. Urine output, lactic, CVP, acidosis are all signs of change in fluid
status in a burn client.
✔✔Hepatorenal syndrome (HRS) - ✔✔functional form of renal failure that occurs
primarily in pt with cirrhosis and ascites.
✔✔Type 1 hepatorenal syndrome is characterized by... - ✔✔-rapidly progressive renal
impairment-doubling of initial serum Cr to greater than 2.5mg/dL over a period less than
2 weeks -without liver transplant prognosis is very poor
✔✔Type 2 hepatorenal syndrome is characterized by... - ✔✔moderate form of renal
failure-serum Cr levels between 1.5 to 2.5 mg/dLreduction in GFR with elevation in
serum creatinine-associated with a more indolent course and improved survival
compared to type 1
✔✔Risk Factors of hepatorenal syndrome - ✔✔Dilutional hyponatremia Previous
episodes of ascites Presence of esophageal varices Poor nutritional statusInfections
such as spontaneous bacterial peritonitisSevere urinary sodium retention (urine sodium
< 5 milliequivalents/liter [mEq/L]) Large-volume paracentesis without albumin
replacementAcute alcoholic hepatitisLow mean arterial blood pressure (map <80 mm
Hg)
✔✔subjective clinical presentation of hepatorenal syndrome - ✔✔Most clients with HRS
have a known diagnosis of acute or chronic liver disease and present with nonspecific
symptoms including:-dysgeusia (altered taste perception)-malaise
-fatigue-decreased urine output.
✔✔objective clinical presentation of hepatorenal syndrome - ✔✔HRS has no
characteristic physical exam findings.It is important to assess the client for stigmata of
chronic liver disease including: -spider nevi-scleral icterus-lower extremity edema
asterixis-abdominal distention-fluid wave-paraumbilical hernia-bruits.
✔✔Diagnostic criteria in hepatorenal syndrome - ✔✔1.cirrhosis with ascites 2.increase
in Cr >0.3 mg/dL within 48 hrs or >50% increase from baseline within a7 day period
3.no response to a 2 consecutive day diuretic withdrawal and volume expansion
w/albumin 1g/kg body wt4.absence of shock5.no nephrotoxic drug use6.no macroscopic
QUESTIONS AND SOLUTIONS GUARANTEE A+
✔✔Active internal rewarming - ✔✔-An esophageal warming probe can be used to heat
the core blood supply through warmed circulating water.-Central venous warming
catheters use warmed water circulation to rewarm blood as it flows through a central
vessel.
-Extracorporeal Membrane Oxygenation (ECMO) circulates blood outside the body
through a warmer and then returns the warmed blood to the client. This method requires
systemic anticoagulation and insertion of a specialized ECMO catheter. ECMO is not
available at all hospitals.
✔✔common causes for hypothermia - ✔✔Environment: Immersion; Freezing temper-
atures; Inadequate thermal insulation; Prolonged indoor exposure to cold elements such
as air conditioning (elderly) or ice baths (athletes) Drug-induced: Alcohol;
Phenothiazines; Sedative-hypnoticsDisruption of skin integrity: Burns; Severe trauma
Metabolic: Hypoadrenalism; Hypopituitarism; Hypothyroidism Iatrogenic: Aggressive
fluid resuscitation; Heatstroke treatment Neurologic: Traumatic brain injury; Stroke;
Brain tumor
✔✔Rule of 9's - ✔✔Head and neck = 9% Upper Ex = 9% each Lower Ex = 9% each
Front trunk = 18% Back trunk = 18%
✔✔classifications of burns: minor - ✔✔total body surface area (TBSA) < 10% in an
adultTBSA < 5% in children or the elderly the amount of full-thickness burn < 2%
✔✔classifications of burns: moderate - ✔✔TBSA 10-20% in an adultTBSA 5-10% in
children or the elderly the amount of full-thickness burn is 2-5%high-voltage injury
possible inhalation injury circumferential burn co-existing health problems
✔✔classifications of burns: Major - ✔✔TBSA > 20% in an adultTBSA > 10% in children
or the elderly the amount of full-thickness burn is > 5% high voltage injury known
inhalation injury significant burns to the face, joints, hands, or feet associated injuries
from trauma/event
✔✔what is optimal urine output for a burn patient - ✔✔The optimal urine output is at
least 0.5 milliliter/kilogram/hour (mL/kg/hr).
✔✔when should a patient be transfered to a burn center? - ✔✔burns > 20% TBSA
burns to face/head/neck burns to genitals circumferential extremity or chest burns full-
thickness burns > 5% burns over joints burns with inhalation injury electrical burns
✔✔Symptoms of CO poisoning - ✔✔headache, dizziness, loss of consciousness,
nausea/vomiting, chest pain, confusion
,✔✔Treatment of CO poisoning - ✔✔High flow oxygen (100%) is appropriate treatment
✔✔Parkland formula for fluid resuscitation - ✔✔PARKLAND FORMULA = TBSA x
Weight (kg) x 4 = Total amount of fluid needed
✔✔you calculated your burn patients total fluid rescusitation, half the amount should be
given - ✔✔half should be given in the first 8 hours, which is calculated from the time of
injury NOT the time of arrival. The other half of the fluid is given over the next 16 hours.
✔✔preferred fluids for burn patient fluid resuscitation - ✔✔Lactated Ringer's solution is
the recommended crystalloid used in burn resuscitation,
✔✔how often should a BMP be drawn for burn patients? - ✔✔-q4-8hrs in large burns.-
assessing renal and electrolytes-Electrolytes must be replaced often due to large fluid
shifts and fluid resuscitation. Hypokalemia is common.
✔✔what is the CBC used for at baseline of a burn pt - ✔✔-initial hemoconcentration. As
fluids are provided, a decrease in hemoglobin and hematocrit should be expected due
to the administration of large fluid volumes. Transfusion may also be necessary.
✔✔what does a serum lactate tell us with burn patients? - ✔✔-elevated lactate is an
indicator of hypoperfusion, which occurs with under-resuscitation, poor end-organ
perfusion, and/or heavy necrotic tissue burden
✔✔CO levels great than ___ indicate ____? - ✔✔-5-consistent w/ CO exposure
✔✔at what level would a patient be symptomatic with CO exposure? - ✔✔10
✔✔what is a fatal level of CO - ✔✔50
✔✔If urine output is below 0.5 mL/kg/hr for two consecutive hours, what does it mean? -
✔✔the client is likely under resuscitated and requires more fluids.
✔✔Jerome has 75% TBSA 2nd and 3rd degree burn injuries. He weighs 80 kilograms
(kg). Based on the Parkland formula how much fluid should Jerome receive in the first 8
hours? - ✔✔12 L
Parkland formula is TBSA x weight x 4ml. Half of this is given in the first 8 hours. 75 x
80 x 4= 24L/2= 12L.
✔✔Neal was involved in a house fire. He sustained burns to the head, neck, face,
chest, and bilateral upper extremities. Neal was intubated by EMS before arrival. What
are the AGACNP's priority diagnostic studies for Neal? - ✔✔Carboxyhemoglobin (CO)
level & ABGs
, ✔✔Harleen sustained a 50% TBSA burn injury. The time of injury was 6 hours ago. The
nurse reports that Harleen's urine output has decreased to 10ml/hr for the last two
hours. What is the most appropriate intervention by the nurse practitioner? - ✔✔Provide
1L rapid bolus of lactated ringers (LR)
Rationale: Urine decrease in a burn injury in the first 24 hours is generally going to be
met with a fluid challenge. Burns require a large volume of fluids; some require upwards
of 30L of fluid in just the first24 hours. Thermal injury causes an overwhelming fluid shift
with most intravascular fluid shifting into the tissues and the third space. That fluid has
to be replaced quickly. Urine output, lactic, CVP, acidosis are all signs of change in fluid
status in a burn client.
✔✔Hepatorenal syndrome (HRS) - ✔✔functional form of renal failure that occurs
primarily in pt with cirrhosis and ascites.
✔✔Type 1 hepatorenal syndrome is characterized by... - ✔✔-rapidly progressive renal
impairment-doubling of initial serum Cr to greater than 2.5mg/dL over a period less than
2 weeks -without liver transplant prognosis is very poor
✔✔Type 2 hepatorenal syndrome is characterized by... - ✔✔moderate form of renal
failure-serum Cr levels between 1.5 to 2.5 mg/dLreduction in GFR with elevation in
serum creatinine-associated with a more indolent course and improved survival
compared to type 1
✔✔Risk Factors of hepatorenal syndrome - ✔✔Dilutional hyponatremia Previous
episodes of ascites Presence of esophageal varices Poor nutritional statusInfections
such as spontaneous bacterial peritonitisSevere urinary sodium retention (urine sodium
< 5 milliequivalents/liter [mEq/L]) Large-volume paracentesis without albumin
replacementAcute alcoholic hepatitisLow mean arterial blood pressure (map <80 mm
Hg)
✔✔subjective clinical presentation of hepatorenal syndrome - ✔✔Most clients with HRS
have a known diagnosis of acute or chronic liver disease and present with nonspecific
symptoms including:-dysgeusia (altered taste perception)-malaise
-fatigue-decreased urine output.
✔✔objective clinical presentation of hepatorenal syndrome - ✔✔HRS has no
characteristic physical exam findings.It is important to assess the client for stigmata of
chronic liver disease including: -spider nevi-scleral icterus-lower extremity edema
asterixis-abdominal distention-fluid wave-paraumbilical hernia-bruits.
✔✔Diagnostic criteria in hepatorenal syndrome - ✔✔1.cirrhosis with ascites 2.increase
in Cr >0.3 mg/dL within 48 hrs or >50% increase from baseline within a7 day period
3.no response to a 2 consecutive day diuretic withdrawal and volume expansion
w/albumin 1g/kg body wt4.absence of shock5.no nephrotoxic drug use6.no macroscopic
