NCLEX Burn RN Community Health Exam 100
Questions And 100% Verified
Answers/AGRADE/Burns Exam 100 Burn / fluid
balance NCLEX Question EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
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EXAM COVERAGE
1. Pathophysiology of Burn Injuries
2. Fluid Resuscitation Protocols (Parkland/Consensus)
3. Airway Management in Inhalation Injuries
4. Burn Wound Classification and Management
5. Electrolyte Imbalances in the Emergent Phase
6. Nutrition and Metabolic Support for Burn Clients
7. Psychosocial Adaptation and Community Reintegration
8. Infection Control and Prevention
9. Pain Management Strategies
10. Rehabilitation and Contracture Prevention
1. A nurse is calculating fluid resuscitation for a client weighing 80 kg with a 40% TBSA deep
partial-thickness burn. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid
should the nurse administer in the first 8 hours?
, A. 3,200 mL
B. 6,400 mL
C. 12,800 mL
D. 16,000 mL
CORRECT ANSWER : B
Rationale: The Parkland formula total is 4 mL × 80 kg × 40 = 12,800 mL. Half of the total
(6,400 mL) must be administered within the first 8 hours post-injury. The remaining 6,400 mL is
given over the following 16 hours.
2. A client arrives in the emergency department with suspected inhalation injury after being trapped
in a house fire. Which clinical finding is the most immediate priority for the nurse to address?
A. Carbonaceous sputum
B. Stridor
C. Singed nasal hairs
D. Hoarseness
CORRECT ANSWER : B
Rationale: Stridor is a high-pitched sound indicating severe upper airway obstruction and is an
impending sign of airway collapse. While sputum, singed hairs, and hoarseness are clinical
indicators of inhalation injury, stridor requires immediate, prioritized intervention.
3. During the first 24 hours after a severe burn, which electrolyte imbalance should the nurse
expect?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
CORRECT ANSWER : B
, Rationale: Cellular damage causes massive potassium release from cells into the extracellular
space, leading to initial hyperkalemia. Hypokalemia typically occurs later, during the diuretic
phase of burn recovery.
4. A client with a large circumferential burn on the chest is exhibiting decreased oxygen saturation
and shallow, rapid respirations. The nurse notes absent pulses in the distal extremity. What is the
nurse's priority action?
A. Administer high-flow oxygen
B. Prepare for an escharotomy
C. Increase IV fluid rate
D. Obtain a stat chest X-ray
CORRECT ANSWER : B
Rationale: Circumferential burns act as a tourniquet, restricting chest expansion and perfusion.
An escharotomy is a surgical incision through the eschar to release constriction and restore
circulation and breathing.
5. A nurse is assessing the urine output of a client in the emergent phase of burn management.
What is the target hourly output for an adult?
A. 10–20 mL/hr
B. 30–50 mL/hr
C. 60–80 mL/hr
D. 100+ mL/hr
CORRECT ANSWER : B
Rationale: Maintaining an hourly urine output of 30–50 mL is the clinical indicator that fluid
resuscitation is adequate for renal perfusion. Higher output might indicate fluid overload, and
lower output indicates inadequate resuscitation.
6. Which medication is most appropriate for pain management in a client with extensive, deep
partial-thickness burns during dressing changes?
A. Oral acetaminophen
B. Intravenous morphine or fentanyl
, C. Intramuscular meperidine
D. Topical lidocaine
CORRECT ANSWER : B
Rationale: IV opioids are the gold standard for managing severe acute burn pain, as they
provide rapid onset and predictable absorption in clients with compromised peripheral
circulation. IM injections are poorly absorbed due to edema, and oral/topical options are
insufficient for acute wound care pain.
7. A nurse is planning care for a client in the rehabilitation phase of a burn injury. What is the
primary focus of nursing interventions?
A. Fluid resuscitation
B. Preventing contractures and promoting mobility
C. Maintaining sterile technique
D. Monitoring hourly urine output
CORRECT ANSWER : B
Rationale: In the rehabilitation phase, the focus shifts to restoring function, preventing scar
tissue contractures through positioning and exercise, and reintegrating the client into the
community. The other options pertain to the emergent or acute phases.
8. Which finding indicates the client is moving from the emergent phase to the acute phase of burn
recovery?
A. A return of bowel sounds
B. Diuresis and stabilization of capillary permeability
C. Increased wound exudate
D. A significant drop in heart rate
CORRECT ANSWER : B
Rationale: The emergent phase ends when capillary permeability stabilizes (usually 24–48
hours) and fluid shift ceases, followed by diuresis as interstitial fluid is reabsorbed. A return of
bowel sounds is a positive sign but does not signify the completion of the emergent phase.
Questions And 100% Verified
Answers/AGRADE/Burns Exam 100 Burn / fluid
balance NCLEX Question EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Pathophysiology of Burn Injuries
2. Fluid Resuscitation Protocols (Parkland/Consensus)
3. Airway Management in Inhalation Injuries
4. Burn Wound Classification and Management
5. Electrolyte Imbalances in the Emergent Phase
6. Nutrition and Metabolic Support for Burn Clients
7. Psychosocial Adaptation and Community Reintegration
8. Infection Control and Prevention
9. Pain Management Strategies
10. Rehabilitation and Contracture Prevention
1. A nurse is calculating fluid resuscitation for a client weighing 80 kg with a 40% TBSA deep
partial-thickness burn. Using the Parkland formula (4 mL × kg × %TBSA), how much fluid
should the nurse administer in the first 8 hours?
, A. 3,200 mL
B. 6,400 mL
C. 12,800 mL
D. 16,000 mL
CORRECT ANSWER : B
Rationale: The Parkland formula total is 4 mL × 80 kg × 40 = 12,800 mL. Half of the total
(6,400 mL) must be administered within the first 8 hours post-injury. The remaining 6,400 mL is
given over the following 16 hours.
2. A client arrives in the emergency department with suspected inhalation injury after being trapped
in a house fire. Which clinical finding is the most immediate priority for the nurse to address?
A. Carbonaceous sputum
B. Stridor
C. Singed nasal hairs
D. Hoarseness
CORRECT ANSWER : B
Rationale: Stridor is a high-pitched sound indicating severe upper airway obstruction and is an
impending sign of airway collapse. While sputum, singed hairs, and hoarseness are clinical
indicators of inhalation injury, stridor requires immediate, prioritized intervention.
3. During the first 24 hours after a severe burn, which electrolyte imbalance should the nurse
expect?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
CORRECT ANSWER : B
, Rationale: Cellular damage causes massive potassium release from cells into the extracellular
space, leading to initial hyperkalemia. Hypokalemia typically occurs later, during the diuretic
phase of burn recovery.
4. A client with a large circumferential burn on the chest is exhibiting decreased oxygen saturation
and shallow, rapid respirations. The nurse notes absent pulses in the distal extremity. What is the
nurse's priority action?
A. Administer high-flow oxygen
B. Prepare for an escharotomy
C. Increase IV fluid rate
D. Obtain a stat chest X-ray
CORRECT ANSWER : B
Rationale: Circumferential burns act as a tourniquet, restricting chest expansion and perfusion.
An escharotomy is a surgical incision through the eschar to release constriction and restore
circulation and breathing.
5. A nurse is assessing the urine output of a client in the emergent phase of burn management.
What is the target hourly output for an adult?
A. 10–20 mL/hr
B. 30–50 mL/hr
C. 60–80 mL/hr
D. 100+ mL/hr
CORRECT ANSWER : B
Rationale: Maintaining an hourly urine output of 30–50 mL is the clinical indicator that fluid
resuscitation is adequate for renal perfusion. Higher output might indicate fluid overload, and
lower output indicates inadequate resuscitation.
6. Which medication is most appropriate for pain management in a client with extensive, deep
partial-thickness burns during dressing changes?
A. Oral acetaminophen
B. Intravenous morphine or fentanyl
, C. Intramuscular meperidine
D. Topical lidocaine
CORRECT ANSWER : B
Rationale: IV opioids are the gold standard for managing severe acute burn pain, as they
provide rapid onset and predictable absorption in clients with compromised peripheral
circulation. IM injections are poorly absorbed due to edema, and oral/topical options are
insufficient for acute wound care pain.
7. A nurse is planning care for a client in the rehabilitation phase of a burn injury. What is the
primary focus of nursing interventions?
A. Fluid resuscitation
B. Preventing contractures and promoting mobility
C. Maintaining sterile technique
D. Monitoring hourly urine output
CORRECT ANSWER : B
Rationale: In the rehabilitation phase, the focus shifts to restoring function, preventing scar
tissue contractures through positioning and exercise, and reintegrating the client into the
community. The other options pertain to the emergent or acute phases.
8. Which finding indicates the client is moving from the emergent phase to the acute phase of burn
recovery?
A. A return of bowel sounds
B. Diuresis and stabilization of capillary permeability
C. Increased wound exudate
D. A significant drop in heart rate
CORRECT ANSWER : B
Rationale: The emergent phase ends when capillary permeability stabilizes (usually 24–48
hours) and fluid shift ceases, followed by diuresis as interstitial fluid is reabsorbed. A return of
bowel sounds is a positive sign but does not signify the completion of the emergent phase.
