©FYNDLAY EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
HESI RN Case Study: Burns Exam
Questions And Answers (Guaranteed A+)
Which action is included when a Level I disaster is declared? - answer✔All local hospitals
prepare to receive casualties.
Which action should the nurse implement to help these family members cope with this
tragedy? - answer✔Designate specific family areas that are staffed with counselors.
EMS personnel triage clients, with multiple casualties noted. Which action should the triage
nurse implement first? - answer✔Place a disaster tag securely on each victim.
Triage determines in what order a client is seen by a healthcare provider (HCP). Which of the
following clients would the nurse identify with a red tag? - answer✔-A client whose vital signs
include respirations at 22 breaths/min , pulse at 120 beats/min, and blood pressure at 85/52
mmHg.
-A client with a pulsating femur wound.
-A client with full thickness burns over 50% of the body.
Which triage category should the nurse assign to James? - answer✔Priority 1, Color Red.
1|Page
, ©FYNDLAY EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
The client has many physical, emotional, and psychosocial needs. Which intervention is most
important for the nurse to implement upon admission? - answer✔Establish and maintain an
open airway.
The nurse should document which percentage of body surface? - answer✔45%
James grimaces in pain as the nurse assesses James' red and blistered wounds that are affecting
his epidermis and dermis. Based on this assessment, which finding best describes the James'
burns? - answer✔Partial thickness or second degree burns.
Based on the nurse's understanding of the Parkland Formula, which rate correctly describes the
time the fluid is given to the client? - answer✔The nurse administers the first half of the fluid
from the time the burn occurred over 8 hours, and the second half over the following 16 hours.
Which action should the nurse take? - answer✔Inform the officer that he must first speak to
James' parents.
The police officer then asks to see James' ED medical record. Which action should the nurse
take concerning this request? - answer✔Allow the police officer access to the requested
medical records.
Burn clients who surpass 20% Total Body Surface Area (TBSA) have massive shifts of fluid and
electrolytes from intravascular to extravascular spaces, which can lead to cardiovascular
collapse. Which assessment relates most directly to a diagnosis of Curling's ulcer? -
answer✔Assess the gastric aspirate for pH and blood the color of coffee grounds.
2|Page
ALL RIGHTS RESERVED.
HESI RN Case Study: Burns Exam
Questions And Answers (Guaranteed A+)
Which action is included when a Level I disaster is declared? - answer✔All local hospitals
prepare to receive casualties.
Which action should the nurse implement to help these family members cope with this
tragedy? - answer✔Designate specific family areas that are staffed with counselors.
EMS personnel triage clients, with multiple casualties noted. Which action should the triage
nurse implement first? - answer✔Place a disaster tag securely on each victim.
Triage determines in what order a client is seen by a healthcare provider (HCP). Which of the
following clients would the nurse identify with a red tag? - answer✔-A client whose vital signs
include respirations at 22 breaths/min , pulse at 120 beats/min, and blood pressure at 85/52
mmHg.
-A client with a pulsating femur wound.
-A client with full thickness burns over 50% of the body.
Which triage category should the nurse assign to James? - answer✔Priority 1, Color Red.
1|Page
, ©FYNDLAY EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
The client has many physical, emotional, and psychosocial needs. Which intervention is most
important for the nurse to implement upon admission? - answer✔Establish and maintain an
open airway.
The nurse should document which percentage of body surface? - answer✔45%
James grimaces in pain as the nurse assesses James' red and blistered wounds that are affecting
his epidermis and dermis. Based on this assessment, which finding best describes the James'
burns? - answer✔Partial thickness or second degree burns.
Based on the nurse's understanding of the Parkland Formula, which rate correctly describes the
time the fluid is given to the client? - answer✔The nurse administers the first half of the fluid
from the time the burn occurred over 8 hours, and the second half over the following 16 hours.
Which action should the nurse take? - answer✔Inform the officer that he must first speak to
James' parents.
The police officer then asks to see James' ED medical record. Which action should the nurse
take concerning this request? - answer✔Allow the police officer access to the requested
medical records.
Burn clients who surpass 20% Total Body Surface Area (TBSA) have massive shifts of fluid and
electrolytes from intravascular to extravascular spaces, which can lead to cardiovascular
collapse. Which assessment relates most directly to a diagnosis of Curling's ulcer? -
answer✔Assess the gastric aspirate for pH and blood the color of coffee grounds.
2|Page
