Burns NCLEX Question and Burn Injury Nursing Management Exam Pack Part 3 Updated 2022

1. 1. Question Nurse Malcolm is performing a sterile dressing change on a client with a superficial partial-thickness burn on the shoulder and back. Arrange the steps in the order in which each should be performed. View Answers: o Administer Tramadol (Tramal) 50 mg IV. o Cover the wound using a sterile gauze dressing. o Debride the wound of eschar using gauze sponges. o Apply silver nitrate ointment. o Obtain a sample for wound culture. The correct order is shown above Rationale: • Pain medication is administered prior to the dressing change since the type of burn will be painful during the procedure. Opioids may be required initially to control pain, but once first aid measures have been effective non-steroidal anti-inflammatory drugs such as ibuprofen or co-dydramol taken orally will suffice. • Then the wound is debrided before getting the sample for culture to prevent other bacteria that can contaminate the actual wound. It is important to realize that a new burn is essentially sterile, and every attempt should be made to keep it so. The burn wound should be thoroughly cleaned with soap and water or mild antibacterial wash such as dilute chlorhexidine. • Obtain a sample for wound culture. Burn wound infections are one of the most important and potentially serious complications that occur in the acute period following injury • An antibacterial cream such as silver nitrate is applied to the area to attain the maximum effect of the medication. Flamazine is silver sulfadiazine cream and is applied topically on the burn wound. It is effective against gram-negative bacteria including Pseudomonas. • Lastly, cover the wound using a sterile dressing. Depending on how healing is progressing, dressing changes thereafter should be every three to five days. If the Jelonet dressing has become adherent, it should be left in place to avoid damage to the delicate healing epithelium. If Flamazine is used it should be changed on alternate days. 2. 2. Question Which of the following medications given to a 12-year-old client for the treatment of deep partial-thickness burn is the most important to double-check with another licensed nurse before administering it? • A. Aloe Vera Relief Burn spray. • B. Silver Sulfadiazine ointment. • C. Omeprazole 20 mg slow IV push. • D. Amitriptyline (Elavil) 50 mg PO. Correct Answer: D. Amitriptyline (Elavil) 50 mg PO. Amitriptyline (Elavil) is useful in the management of neuropathic pain following burn injury and since it is an antidepressant if given with a child, utmost precaution is given. The FDA has issued a black box warning regarding the use of amitriptyline in adolescents and young adults (ages less than 24 years). It can increase the risk of suicidal ideation and behavior. • Option A: Omeprazole is indicated for the short-term treatment of peptic ulcer disease in adults where most patients heal within four weeks. Patients with duodenal ulcer disease and H. pylori infection disease that is active for up to one year may benefit from combination therapy that includes omeprazole with clarithromycin, amoxicillin, and metronidazole. • Option B: Silver sulfadiazine is a medication used in the prevention, management, and treatment of burn wound infections. It is a heavy metal topical agent with antibacterial properties. Typically burn dressings consist of topical silver sulfadiazine combined with fine mesh gauze and are usable in both the inpatient and outpatient settings. • Option C: All health facilities practice double-checking of medications prior to administration, Of all the medications given, Amitriptyline is the most important to double-check with another licensed nurse.