CBRN Practice UPDATED ACTUAL Questions and CORRECT Answers
- 25% TBSA and a hemoglobin A1C of 5.2%
The dietician arrives to evaluate patients on the burn unit.
Comments: Larger burns, burns with >20% TBSA, lead
Which patient should the nurse recommend that the di-
to a hypermetabolic state which substantially increases
etician see FIRST?
the body's need for calories and protein. The registered
- 15% TBSA and a transferrin of 300 mg/dL
dietician provides crucial support to help ensure the pa-
- 25% TBSA and a hemoglobin A1C of 5.2%
tient is meeting their nutritional needs to promote optimal
- 10% TBSA and a prealbumin of 20 mg/dL
wound healing. All labs are within normal limits. Ref-
- 19% TBSA and albumin of 4.0 g/dL
erence: Burn Nursing: Injury Prevention to Rehabilitation
and After Care, 1st Ed. (2023), p. 513
5)
A previously healthy, independent elderly patient with -Acetaminophen (Tylenol)
a 22% TBSA scald burn is now agitated, disoriented to
time and place and is attempting to pull out intravenous Comments: In addition to early mobilization and promot-
catheters and their feeding tube. After reorienting the ing sleep hygiene, managing pain is critical in minimizing
patient and ensuring their safety, what pharmacological the incidence of delirium. The use of benzodiazepines
management should the nurse anticipate? has been proven to worsen delirium as well -Lorazepam
-Acetaminophen (Tylenol) (Ativan)as Ambien and Haldol, especially in the older pop-
-Zolpidem (Ambien) ulation. Reference: Burn Nursing: Injury Prevention
-Haloperidol (Haldol) to Rehabilitation and After Care, 1st Ed. (2023), p. 488
-Lorazepam (Ativan)
swelling of the upper airway
During the initial phase of burn injury, what is the PRIMA-
Airway concerns in burn patients can lead to death with-
RY concern regarding a patient's airway?
in minutes. Upper airway swelling can lead to total ob-
-bronchospasm
struction of the airway. Airway edema can occur with
-swelling of the lower airway
mucosal injury and fluid shifts with a large volume re-
- sloughing of the oropharynx
suscitation. Reference: Jeschke, M.G., Gauglitz, G.G.
- swelling of the upper airway
(2020). Early management of Burn Patients and Fluid Re-
suscitation. M.G. Jeschke, L.P. Kamolz, F. Sjoberg, S.E. Wolf.
, Handbook of Burns Volume 1: Acute Burn Care (Second
Edition, pp. 199-209). Springer, p. 199
A 45 year-old male sustained a 9% TBSA partial thickness
burn to the right forearm, right shoulder and upper back
-Type of burn
by contact with a 1200 volt electrical wire. The burns are
non-circumferential. The patient is awake and alert and
Criteria for referral include electrical injury. Burn Cen-
appears to be answering questions appropriately. What
ter referral include greater than 10% TBSA, burns involv-
criteria would qualify this patient for immediate consulta-
ing the face, hands, feet, genitalia, perineum or major
tion with a burn center?
joints. Age is primarily considered for the care of children
-Location of burn
not adults. Reference: Advanced Burn Life Support
-Patient's age
Course Provider Manual (2023), p. 18
-Type of burn
-TBSA burned
A nurse is caring for a patient following tangential excision
and skin grafting for a 10% TBSA burn to both arms and
hands. The donor site dressings on the thighs display
-Assess the patient for pain.
three areas of frank blood, each approximately 3cm in
diameter. The vital signs are as follows:
This patient is moaning, and vital signs are elevated. This
indicates pain, which is common following burn excision
BP 156/92 mm HgHR 122 beats/minRR 22 breaths/min- and grafting. A blood transfusion is not indicated at this
SpO2 95% (2L nasal cannula)Temp 36.1 C time, as EBL was low and small areas of bleeding on donor
sites is to be expected postoperatively. A 12 lead ECG is
not indicated, as pain is the cause of this patient's elevated
The patient is moaning. Estimated blood loss in surgery HR. Removing the dressing would disturb the wound bed
was 150mL. What is the nurse's FIRST action? and cause more bleeding. This is not indicated at this
time. Reference: Burn Nursing: Injury Prevention to
-Assess the patient for pain.
Rehabilitation and After Care, 1st Ed. (2023), p. 83
-Remove the dressing and assess the site.
-Perform a 12 lead ECG.
-Administer a unit of packed red blood cells.
,An adult patient is admitted to the burn center following
-barotrauma
an explosion that occurred while the patient was welding
the inside of a fuel transport tank. Assessment reveals Comments: Blast injuries can occur with any explosive
burns to the right leg and right hand as well as a right event. However, the enclosed space increases the risk
femur fracture. EMS intubated the patient on scene due for these injuries. A patient presenting with shortness
to shortness of breath. The nurse recognizes the MOST of breath and chest pain following this should be as-
likely need for intubation was due to: sessed for injury to their lungs/heart. A blast injury is
priority in this situation over an inhalation injury in re-
-extensive burns.
gards to treatment as it may require urgent chest tube
-severe pain.
placement. Reference: Advanced Burn Life Support
-barotrauma
Course Provider Manual (2023), p. 46
-inhalation injury.
The nurse is receiving a patient who sustained a burn
injury 8 hours prior to arrival. The patient was initially -over-resuscitation
transported by EMS to a critical access hospital, then
transferred to the burn unit. The patient is short of breath Improper resuscitation is often a product of inaccurate
with expiratory wheezes, has facial edema, and has a percent TBSA calculations, which can lead to excessive
urine output of 150 mL in the past hour. The burn nurse fluid resuscitation and poor patient outcomes. Result-
understands their assessment findings are related to: ing complications encountered with over-resuscitation in-
- under-resuscitation clude extremity and airway edema, limb and abdominal
- systemic inflammatory response compartment syndromes, tissue hypoxia, burn depth pro-
-over-resuscitation gression, and increased risk of death.
- hypermetabolic response
A type II necrotizing soft tissue injury (NSTI) is most often
- Group A streptococcus
caused by which microbe?
- Group A streptococcus
Comments: Type II NSTIs are mono microbial and typically
- Candida albicans
caused by GAS. Type I NSTIs are polymicrobial, a combi-
- Enterobacter aerogenes
nation of aerobic and anaerobic bacteria.
- Staphylococcus epidermidis
130 degrees Fahrenheit
, Comments: Children under 2 years old have thinner skin
An 18-month-old is brought in to the burn center with a than adults. At 130 degrees, the child needs only 10 sec-
full thickness burn. The caregiver states that the child was onds of exposure to the hot water to get a full thickness
exposed for approximately 10 seconds. The burn nurse burn. 120 degrees is the recommended temperature for
recognizes that the hot water heater is MOST likely set to: a water heater and it would take longer to sustain a burn
- 100 degrees Fahrenheit at this temperature. Adults and children can safely be
- 130 degrees Fahrenheit exposed to 110 degree temperature water for extended
- 120 degrees Fahrenheit amounts of time without getting burned. Refer-
- 110 degrees Fahrenheit ence: Advanced Burn Life Support Course Provider Man-
ual (2023), p. 57
45-year-old with a 32% TBSA
Which of the following patients injured in a burn mass
Comments: According to the American Burn Association
casualty incident should be prioritized FIRST for transfer
triage guidelines, the 45-year-old with 32% TBSA falls into
to a burn center?
the Immediate/Red category. The 18-year-old falls into
- 45-year-old with a 32% TBSA
the Delayed/Yellow category, the 10 year old is triaged
- 84-year-old with a 60% TBSA
as Minimal/Green. The 84-year-old is considered Expec-
- 18-year-old with a 45% TBSA
tant/Black meaning survival is <10%. Two of the three
- 10-year-old with a 9% TBSA
critical factors in determining survivability are age and
TBSA size (third is inhalation). R
A utility worker sustained a high voltage (30,000v) injury
and has a 1% TBSA wound to their right hand. The nurse
notices increased swelling of the right arm and the patient
reports feeling "pins and needles" in this extremity. Which Creatine phosphokinase level of 7200 IU/L
of the following clinical indicators should the nurse expect
in this patient? Comments: Elevated CPK levels are reflective of underlying
- Procalcitonin level of 0.2 ng/mL but extensive muscle damage in electrical injuries.
- Magnesium level of 1.1 mEq/L
- Creatine phosphokinase level of 7200 IU/L
- Potassium level of 3.0 mEq/L
A patient is admitted from a house fire with facial burns
and singed nasal hair. Pulse oximetry reads 97% on room
air and carboxyhemoglobin is 24%. The burn nurse's PRI-
- 25% TBSA and a hemoglobin A1C of 5.2%
The dietician arrives to evaluate patients on the burn unit.
Comments: Larger burns, burns with >20% TBSA, lead
Which patient should the nurse recommend that the di-
to a hypermetabolic state which substantially increases
etician see FIRST?
the body's need for calories and protein. The registered
- 15% TBSA and a transferrin of 300 mg/dL
dietician provides crucial support to help ensure the pa-
- 25% TBSA and a hemoglobin A1C of 5.2%
tient is meeting their nutritional needs to promote optimal
- 10% TBSA and a prealbumin of 20 mg/dL
wound healing. All labs are within normal limits. Ref-
- 19% TBSA and albumin of 4.0 g/dL
erence: Burn Nursing: Injury Prevention to Rehabilitation
and After Care, 1st Ed. (2023), p. 513
5)
A previously healthy, independent elderly patient with -Acetaminophen (Tylenol)
a 22% TBSA scald burn is now agitated, disoriented to
time and place and is attempting to pull out intravenous Comments: In addition to early mobilization and promot-
catheters and their feeding tube. After reorienting the ing sleep hygiene, managing pain is critical in minimizing
patient and ensuring their safety, what pharmacological the incidence of delirium. The use of benzodiazepines
management should the nurse anticipate? has been proven to worsen delirium as well -Lorazepam
-Acetaminophen (Tylenol) (Ativan)as Ambien and Haldol, especially in the older pop-
-Zolpidem (Ambien) ulation. Reference: Burn Nursing: Injury Prevention
-Haloperidol (Haldol) to Rehabilitation and After Care, 1st Ed. (2023), p. 488
-Lorazepam (Ativan)
swelling of the upper airway
During the initial phase of burn injury, what is the PRIMA-
Airway concerns in burn patients can lead to death with-
RY concern regarding a patient's airway?
in minutes. Upper airway swelling can lead to total ob-
-bronchospasm
struction of the airway. Airway edema can occur with
-swelling of the lower airway
mucosal injury and fluid shifts with a large volume re-
- sloughing of the oropharynx
suscitation. Reference: Jeschke, M.G., Gauglitz, G.G.
- swelling of the upper airway
(2020). Early management of Burn Patients and Fluid Re-
suscitation. M.G. Jeschke, L.P. Kamolz, F. Sjoberg, S.E. Wolf.
, Handbook of Burns Volume 1: Acute Burn Care (Second
Edition, pp. 199-209). Springer, p. 199
A 45 year-old male sustained a 9% TBSA partial thickness
burn to the right forearm, right shoulder and upper back
-Type of burn
by contact with a 1200 volt electrical wire. The burns are
non-circumferential. The patient is awake and alert and
Criteria for referral include electrical injury. Burn Cen-
appears to be answering questions appropriately. What
ter referral include greater than 10% TBSA, burns involv-
criteria would qualify this patient for immediate consulta-
ing the face, hands, feet, genitalia, perineum or major
tion with a burn center?
joints. Age is primarily considered for the care of children
-Location of burn
not adults. Reference: Advanced Burn Life Support
-Patient's age
Course Provider Manual (2023), p. 18
-Type of burn
-TBSA burned
A nurse is caring for a patient following tangential excision
and skin grafting for a 10% TBSA burn to both arms and
hands. The donor site dressings on the thighs display
-Assess the patient for pain.
three areas of frank blood, each approximately 3cm in
diameter. The vital signs are as follows:
This patient is moaning, and vital signs are elevated. This
indicates pain, which is common following burn excision
BP 156/92 mm HgHR 122 beats/minRR 22 breaths/min- and grafting. A blood transfusion is not indicated at this
SpO2 95% (2L nasal cannula)Temp 36.1 C time, as EBL was low and small areas of bleeding on donor
sites is to be expected postoperatively. A 12 lead ECG is
not indicated, as pain is the cause of this patient's elevated
The patient is moaning. Estimated blood loss in surgery HR. Removing the dressing would disturb the wound bed
was 150mL. What is the nurse's FIRST action? and cause more bleeding. This is not indicated at this
time. Reference: Burn Nursing: Injury Prevention to
-Assess the patient for pain.
Rehabilitation and After Care, 1st Ed. (2023), p. 83
-Remove the dressing and assess the site.
-Perform a 12 lead ECG.
-Administer a unit of packed red blood cells.
,An adult patient is admitted to the burn center following
-barotrauma
an explosion that occurred while the patient was welding
the inside of a fuel transport tank. Assessment reveals Comments: Blast injuries can occur with any explosive
burns to the right leg and right hand as well as a right event. However, the enclosed space increases the risk
femur fracture. EMS intubated the patient on scene due for these injuries. A patient presenting with shortness
to shortness of breath. The nurse recognizes the MOST of breath and chest pain following this should be as-
likely need for intubation was due to: sessed for injury to their lungs/heart. A blast injury is
priority in this situation over an inhalation injury in re-
-extensive burns.
gards to treatment as it may require urgent chest tube
-severe pain.
placement. Reference: Advanced Burn Life Support
-barotrauma
Course Provider Manual (2023), p. 46
-inhalation injury.
The nurse is receiving a patient who sustained a burn
injury 8 hours prior to arrival. The patient was initially -over-resuscitation
transported by EMS to a critical access hospital, then
transferred to the burn unit. The patient is short of breath Improper resuscitation is often a product of inaccurate
with expiratory wheezes, has facial edema, and has a percent TBSA calculations, which can lead to excessive
urine output of 150 mL in the past hour. The burn nurse fluid resuscitation and poor patient outcomes. Result-
understands their assessment findings are related to: ing complications encountered with over-resuscitation in-
- under-resuscitation clude extremity and airway edema, limb and abdominal
- systemic inflammatory response compartment syndromes, tissue hypoxia, burn depth pro-
-over-resuscitation gression, and increased risk of death.
- hypermetabolic response
A type II necrotizing soft tissue injury (NSTI) is most often
- Group A streptococcus
caused by which microbe?
- Group A streptococcus
Comments: Type II NSTIs are mono microbial and typically
- Candida albicans
caused by GAS. Type I NSTIs are polymicrobial, a combi-
- Enterobacter aerogenes
nation of aerobic and anaerobic bacteria.
- Staphylococcus epidermidis
130 degrees Fahrenheit
, Comments: Children under 2 years old have thinner skin
An 18-month-old is brought in to the burn center with a than adults. At 130 degrees, the child needs only 10 sec-
full thickness burn. The caregiver states that the child was onds of exposure to the hot water to get a full thickness
exposed for approximately 10 seconds. The burn nurse burn. 120 degrees is the recommended temperature for
recognizes that the hot water heater is MOST likely set to: a water heater and it would take longer to sustain a burn
- 100 degrees Fahrenheit at this temperature. Adults and children can safely be
- 130 degrees Fahrenheit exposed to 110 degree temperature water for extended
- 120 degrees Fahrenheit amounts of time without getting burned. Refer-
- 110 degrees Fahrenheit ence: Advanced Burn Life Support Course Provider Man-
ual (2023), p. 57
45-year-old with a 32% TBSA
Which of the following patients injured in a burn mass
Comments: According to the American Burn Association
casualty incident should be prioritized FIRST for transfer
triage guidelines, the 45-year-old with 32% TBSA falls into
to a burn center?
the Immediate/Red category. The 18-year-old falls into
- 45-year-old with a 32% TBSA
the Delayed/Yellow category, the 10 year old is triaged
- 84-year-old with a 60% TBSA
as Minimal/Green. The 84-year-old is considered Expec-
- 18-year-old with a 45% TBSA
tant/Black meaning survival is <10%. Two of the three
- 10-year-old with a 9% TBSA
critical factors in determining survivability are age and
TBSA size (third is inhalation). R
A utility worker sustained a high voltage (30,000v) injury
and has a 1% TBSA wound to their right hand. The nurse
notices increased swelling of the right arm and the patient
reports feeling "pins and needles" in this extremity. Which Creatine phosphokinase level of 7200 IU/L
of the following clinical indicators should the nurse expect
in this patient? Comments: Elevated CPK levels are reflective of underlying
- Procalcitonin level of 0.2 ng/mL but extensive muscle damage in electrical injuries.
- Magnesium level of 1.1 mEq/L
- Creatine phosphokinase level of 7200 IU/L
- Potassium level of 3.0 mEq/L
A patient is admitted from a house fire with facial burns
and singed nasal hair. Pulse oximetry reads 97% on room
air and carboxyhemoglobin is 24%. The burn nurse's PRI-
