NURS 272 Exam 4: Tissue Integrity
and Mobility with correct answers
2025
Which prevention strategy would the nurse include when teaching about home fire safety?
v v v v v v v v v v v v
a. Set hot water temperature at 140°F.
v v v v v v
b. Use only hardwired smoke detectors.
v v v v v
c. Encourage regular home fire exit drills.
v v v v v v
d. Do not allow older adults to cook unattended. - correct-answers-
v v v v v v v v v v
C. Encourage regular home fire exit drills
v v v v v v
The injury that is least likely to result in a full-thickness burn is
v v v v v v v v v v v v
a. sunburn.
v
b. scald injury.
v v
c. chemical burn.
v v
,d. electrical injury. - correct-answers-A. Sunburn
v v v v v
When assessing a patient with a partial-
v v v v v v
thickness burn, the nurse would expect to find (select all that apply)
v v v v v v v v v v v
a. blisters.
v
b. exposed fascia.
v v
c. exposed muscles.
v v
d. intact nerve endings.
v v v
e. red, shiny, wet appearance. - correct-answers-a. blisters.
v v v v v v v
d. intact nerve endings.
v v v
e. red, shiny, wet appearance.
v v v v
A patient is admitted to the burn center with burns to his head, neck, and anterior and posterior ches
v v v v v v v v v v v v v v v v v v
t after an explosion in his garage. On assessment, the nurse auscultates wheezes throughout the lun
v v v v v v v v v v v v v v v
g fields. On reassessment, the wheezes are gone, and the breath sounds are greatly decreased. Whi
v v v v v v v v v v v v v v v
ch action is the most appropriate for the nurse to take next?
v v v v v v v v v v v
a. Encourage the patient to cough and auscultate the lungs again.
v v v v v v v v v v
b. Obtain vital signs, oxygen saturation, and a STAT arterial blood gas.
v v v v v v v v v v v
c. Document the findings and continue to monitor the patient's breathing.
v v v v v v v v v v
d. Anticipate the need for endotracheal intubation and notify the provider. - correct-answers-
v v v v v v v v v v v v
d. Anticipate the need for endotracheal intubation and notify the provider.
v v v v v v v v v v
Fluid and electrolyte shifts that occur during the early emergent phase of a burn injury include
v v v v v v v v v v v v v v v
a. adherence of albumin to vascular walls.
v v v v v v
,b. movement of potassium into the vascular space.
v v v v v v v
c. movement of sodium and water into the interstitial space.
v v v v v v v v v
d. hemolysis of red blood cells from large volumes of rapidly administered fluid. - correct-answers-
v v v v v v v v v v v v v v
c. movement of sodium and water into the interstitial space.
v v v v v v v v v
To maintain a positive nitrogen balance in a major burn, the patient must
v v v v v v v v v v v v
a. eat a high-protein, high-carbohydrate diet.
v v v v v
b. increase normal caloric intake by about four times.
v v v v v v v v
c. eat at least 1500 calories/day in small, frequent meals.
v v v v v v v v v
d. eat a gluten-free diet for the chemical effect on nitrogen balance. - correct-answers-a. eat a high-
v v v v v v v v v v v v v v v v
protein, high-carbohydrate diet. v v
A patient has 25% TBSA burn from a car fire. His wounds have been debrided and covered with a silve
v v v v v v v v v v v v v v v v v v v
r-impregnated dressing. The nurse's priority intervention for wound care would be to
v v v v v v v v v v v
a. reapply a new dressing without disturbing the wound bed.
v v v v v v v v v
b. observe the wound for signs of infection during dressing changes.
v v v v v v v v v v
c. apply cool compresses for pain relief in between dressing changes.
v v v v v v v v v v
d. wash the wound aggressively with soap and water three times a day. - correct-answers-
v v v v v v v v v v v v v v
b. observe the wound for signs of infection during dressing changes.
v v v v v v v v v v
Pain management for the burn patient is most effective when (select all that apply)
v v v v v v v v v v v v v
a. a pain rating tool is used to monitor the patient's level of pain.
v v v v v v v v v v v v v
b. painful dressing changes are delayed until the patient's pain is completely relieved.
v v v v v v v v v v v v
c. the patient is informed about and has some control over the management of the pain.
v v v v v v v v v v v v v v v
, d. a multimodal approach is used (e.g., sustained-release and short-
v v v v v v v v v
acting opioids, NSAIDs, adjuvant analgesics).
v v v v
e. nonpharmacologic therapies (e.g., music therapy, distraction) replace opioids in the rehabilitatio
v v v v v v v v v v v
n phase of a burn injury. - correct-answers-
v v v v v v v
a. a pain rating tool is used to monitor the patient's level of pain.
v v v v v v v v v v v v v
c. the patient is informed about and has some control over the management of the pain.
v v v v v v v v v v v v v v v
d. a multimodal approach is used (e.g., sustained-release and short-
v v v v v v v v v
acting opioids, NSAIDs, adjuvant analgesics).
v v v v
A therapeutic measure used to prevent hypertrophic scarring during the rehabilitation phase of bur
v v v v v v v v v v v v v
n recovery is
v v
a. applying pressure garments.
v v v
b. repositioning the patient every 2 hours.
v v v v v v
c. performing active ROM at least every 4 hours.
v v v v v v v v
d. massaging the new tissue with water-based moisturizers. - correct-answers-
v v v v v v v v v
a. applying pressure garments.
v v v
A patient is recovering from second- and third-
v v v v v v v
degree burns over 30% of his body, and the burn care team is planning for discharge. The first action t
v v v v v v v v v v v v v v v v v v v
he nurse should take when meeting with the patient would be to
v v v v v v v v v v v
a. arrange a return-to-clinic appointment and prescription for pain medications.
v v v v v v v v v
b. teach the patient and the caregiver proper wound care to be performed at home.
v v v v v v v v v v v v v v
c. review the patient's current health care status and readiness for discharge to home.
v v v v v v v v v v v v v
d. give the patient written information and websites for information for burn survivors. - correct-
v v v v v v v v v v v v v v
answers-c. review the patient's current health care status and readiness for discharge to home.
v v v v v v v v v v v v v
and Mobility with correct answers
2025
Which prevention strategy would the nurse include when teaching about home fire safety?
v v v v v v v v v v v v
a. Set hot water temperature at 140°F.
v v v v v v
b. Use only hardwired smoke detectors.
v v v v v
c. Encourage regular home fire exit drills.
v v v v v v
d. Do not allow older adults to cook unattended. - correct-answers-
v v v v v v v v v v
C. Encourage regular home fire exit drills
v v v v v v
The injury that is least likely to result in a full-thickness burn is
v v v v v v v v v v v v
a. sunburn.
v
b. scald injury.
v v
c. chemical burn.
v v
,d. electrical injury. - correct-answers-A. Sunburn
v v v v v
When assessing a patient with a partial-
v v v v v v
thickness burn, the nurse would expect to find (select all that apply)
v v v v v v v v v v v
a. blisters.
v
b. exposed fascia.
v v
c. exposed muscles.
v v
d. intact nerve endings.
v v v
e. red, shiny, wet appearance. - correct-answers-a. blisters.
v v v v v v v
d. intact nerve endings.
v v v
e. red, shiny, wet appearance.
v v v v
A patient is admitted to the burn center with burns to his head, neck, and anterior and posterior ches
v v v v v v v v v v v v v v v v v v
t after an explosion in his garage. On assessment, the nurse auscultates wheezes throughout the lun
v v v v v v v v v v v v v v v
g fields. On reassessment, the wheezes are gone, and the breath sounds are greatly decreased. Whi
v v v v v v v v v v v v v v v
ch action is the most appropriate for the nurse to take next?
v v v v v v v v v v v
a. Encourage the patient to cough and auscultate the lungs again.
v v v v v v v v v v
b. Obtain vital signs, oxygen saturation, and a STAT arterial blood gas.
v v v v v v v v v v v
c. Document the findings and continue to monitor the patient's breathing.
v v v v v v v v v v
d. Anticipate the need for endotracheal intubation and notify the provider. - correct-answers-
v v v v v v v v v v v v
d. Anticipate the need for endotracheal intubation and notify the provider.
v v v v v v v v v v
Fluid and electrolyte shifts that occur during the early emergent phase of a burn injury include
v v v v v v v v v v v v v v v
a. adherence of albumin to vascular walls.
v v v v v v
,b. movement of potassium into the vascular space.
v v v v v v v
c. movement of sodium and water into the interstitial space.
v v v v v v v v v
d. hemolysis of red blood cells from large volumes of rapidly administered fluid. - correct-answers-
v v v v v v v v v v v v v v
c. movement of sodium and water into the interstitial space.
v v v v v v v v v
To maintain a positive nitrogen balance in a major burn, the patient must
v v v v v v v v v v v v
a. eat a high-protein, high-carbohydrate diet.
v v v v v
b. increase normal caloric intake by about four times.
v v v v v v v v
c. eat at least 1500 calories/day in small, frequent meals.
v v v v v v v v v
d. eat a gluten-free diet for the chemical effect on nitrogen balance. - correct-answers-a. eat a high-
v v v v v v v v v v v v v v v v
protein, high-carbohydrate diet. v v
A patient has 25% TBSA burn from a car fire. His wounds have been debrided and covered with a silve
v v v v v v v v v v v v v v v v v v v
r-impregnated dressing. The nurse's priority intervention for wound care would be to
v v v v v v v v v v v
a. reapply a new dressing without disturbing the wound bed.
v v v v v v v v v
b. observe the wound for signs of infection during dressing changes.
v v v v v v v v v v
c. apply cool compresses for pain relief in between dressing changes.
v v v v v v v v v v
d. wash the wound aggressively with soap and water three times a day. - correct-answers-
v v v v v v v v v v v v v v
b. observe the wound for signs of infection during dressing changes.
v v v v v v v v v v
Pain management for the burn patient is most effective when (select all that apply)
v v v v v v v v v v v v v
a. a pain rating tool is used to monitor the patient's level of pain.
v v v v v v v v v v v v v
b. painful dressing changes are delayed until the patient's pain is completely relieved.
v v v v v v v v v v v v
c. the patient is informed about and has some control over the management of the pain.
v v v v v v v v v v v v v v v
, d. a multimodal approach is used (e.g., sustained-release and short-
v v v v v v v v v
acting opioids, NSAIDs, adjuvant analgesics).
v v v v
e. nonpharmacologic therapies (e.g., music therapy, distraction) replace opioids in the rehabilitatio
v v v v v v v v v v v
n phase of a burn injury. - correct-answers-
v v v v v v v
a. a pain rating tool is used to monitor the patient's level of pain.
v v v v v v v v v v v v v
c. the patient is informed about and has some control over the management of the pain.
v v v v v v v v v v v v v v v
d. a multimodal approach is used (e.g., sustained-release and short-
v v v v v v v v v
acting opioids, NSAIDs, adjuvant analgesics).
v v v v
A therapeutic measure used to prevent hypertrophic scarring during the rehabilitation phase of bur
v v v v v v v v v v v v v
n recovery is
v v
a. applying pressure garments.
v v v
b. repositioning the patient every 2 hours.
v v v v v v
c. performing active ROM at least every 4 hours.
v v v v v v v v
d. massaging the new tissue with water-based moisturizers. - correct-answers-
v v v v v v v v v
a. applying pressure garments.
v v v
A patient is recovering from second- and third-
v v v v v v v
degree burns over 30% of his body, and the burn care team is planning for discharge. The first action t
v v v v v v v v v v v v v v v v v v v
he nurse should take when meeting with the patient would be to
v v v v v v v v v v v
a. arrange a return-to-clinic appointment and prescription for pain medications.
v v v v v v v v v
b. teach the patient and the caregiver proper wound care to be performed at home.
v v v v v v v v v v v v v v
c. review the patient's current health care status and readiness for discharge to home.
v v v v v v v v v v v v v
d. give the patient written information and websites for information for burn survivors. - correct-
v v v v v v v v v v v v v v
answers-c. review the patient's current health care status and readiness for discharge to home.
v v v v v v v v v v v v v
