CARE OF THE CLIENTS WITH BURNS

Prepared by: ROBERT C. REÑA, BSN, RN, MAN (ue)

6




 

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A nursing instructor has just completed a lecture
to nursing students regarding care of the client
with a burn injury, and a major aspect of the
lecture was care of the client at the scene of a
fire. Which statement if made by a nursing
student indicates a need for further instruction?

   
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The client sustains a burn injury to the entire
right and left arms, the right leg, and the anterior
thorax. According to the Rule of Nines, the nurse
would assess that this injury constitutes which
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An emergency department nurse is performing

      
    


A community health nurse is providing a
an assessment on a client who sustained
circumferential burns of both legs. Which of the
following assessments would be the initial
priority in caring for this client?
teaching session to firefighters in a small 
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community regarding care of a burn victim at the
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scene of injury. The nurse instructs the 
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firefighters that in the event of a tar burn, the 
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immediate action should be:

  
  
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A client who is being evaluated for thermal burn


  
 
injuries to the arms and leg complains of thirst


     

and asks the nurse for a drink. Which action by


 
 
      
the nurse is appropriate?


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An industrial nurse is providing instructions to a 

group of employees regarding care to a client in 
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the event of a chemical burn injury. The nurse 
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instructs the employees that the first
consideration in immediate care is: 3
There has been a fire in an apartment building.


   
 
  
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burned. Which client should be transported to a


  
 

  
 burn center for treatment?

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A client who sustained an inhalation injury    

arrives in the emergency department. On initial &
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assessment, the nurse notes that the client is   (  &.   67#*

confused and combative. The nurse determined
that the client is experiencing: 
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The nurse in the immediate care clinic is
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An emergency department nurse is caring for a assessing an 80-year-old client who lives with
client who has sustained chemical burns to the his son¶s family and has scald burns on his
esophagus after ingestion of lye. The nurse hands and both forearms (first- and second-
reviews the physician¶s orders and plans to degree burns on 10% of his body surface area).
question an order for which of the following? What should the nurse do first?

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The nurse assesses the client for fluid shifting.

Fluid shifts that occur during the emergent

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When an individual is burned, there is massive
cell destruction resulting in a disruption of the
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The nurse should recognize that fluid shift in a normal homeostasis of the body. The nurse
client with a burn injury results from an increase anticipates that the client will be susceptible to
in the: which of the following in the early phase of burn

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care?

   
 

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A priority nursing diagnosis for a client with
burns during the emergent period would be: •
Endotracheal or tracheostomy tubes are place in

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Which of the following activities should the 
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nurse include in the plan of care for a client with
burn injuries to be carried out about one-half 
A nurse has developed a nursing diagnosis of
hour before the daily whirlpool bath and ineffective airway clearance for a client who
dressing change? sustained an inhalation burn injury. Which of the

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following nursing interventions should the nurse

  

include in the plan of care of this client?

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The client with a major burn injury receives total 
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parenteral nutrition (TPN). The primary reason 
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for this therapy is to help: " 


  
   



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A newly burned client is admitted to the unit. The

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nurse measures the client¶s urine output on an

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hourly basis. Which of the following hourly urine
output rates will alert the nurse to potential
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The client asks the nurse what the word |
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means. Which of the following descriptions by 
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the nurse best defines eschar?
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The nurse is caring for a client who sustained


; superficial partial-thickness burns on the

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      anterior lower legs and anterior thorax. Which of

; the following does the nurse expect to note
during the emergent phase of the burn injury?
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An advantage of using biologic burn grafts such 
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as porcine (pigskin) grafts is that they appear to
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help: 
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After the initial phase of the burn injury, the

 
   
 
client¶s plan of care will focus primarily on:

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Which of the following factors would have the 


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of a burn victim¶s porcine graft? 
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The burned client needs fluid replacement
because massive amounts of fluids are lost. The
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The nurse should plan to begin rehabilitation rate at which I.V. fluids are infused is based on
efforts for the burn client: the burn client¶s:

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reliable indicator for determining the adequacy?

   
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A client sustained a burn injury at 7 AM. The
client¶s spouse states that before the burn, his
body weight was 198 pounds (90 kg). The
physician has estimated that the total body
surface area burned is 83%. Using the Parkland
(Baxter) formula, the nurse determines that the
total amount of intravenous lactated Ringer¶s

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The head nurse is observing a newly registered
nurse caring for a burn client in protective
isolation. The head nurse intervenes if the newly
registered nurse planned to implement which
incorrect component of protective isolation
technique?
solution that the client will receive by 3 PM of the 
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same day that the burn occurred is which of the
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following? 
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A client is undergoing fluid replacement after
being burned on 20% of her body 12 hours ago.
The nursing assessment reveals a blood
pressure of 90/50 mm Hg, a pulse rate of 110
beats/min, and a urine output of 20 mL over the
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The nurse is caring for a client following an
autograft and grafting to a burn wound on the
right knee. Which of the following would the
nurse anticipate to be prescribed for the client?

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past hour. The nurse reports the findings to the
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physician and anticipates which of the following 
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orders to be prescribed? 
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A nurse is performing an assessment on a client



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 being admitted to the nursing unit who has

  

 
 
 sustained an extensive burn injury involving

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   (TBSA). In performing the assessment, the nurse
knows that the maximum amount of edema that
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When caring for a client with extensive burns, occurs from a burn normally is seen:
the nurse anticipates that pain medication will be 
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administered via which route?
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The nurse is caring for a client with a burn injury
and understands that stress reactions can result
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The client arrives at the emergency room in hypersecretion of gastric acids. Therefore, the
following a burn injury that occurred in the at nurse must assess the client for signs and
home and an inhalation injury is suspected. symptoms of which of the following potential
Which of the following would the nurse complications?
anticipate to be prescribed for the client? 
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The nurse is caring for a client who suffered an 

 
inhalation injury from a wood stove. The carbon 
monoxide blood report reveals a level of 12%.
Based on this level, the nurse would anticipate
which of the following signs in the client?






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The nurse is administering fluids intravenously

as prescribed to a client who sustained
superficial partial-thickness burn injuries of the
back and legs. In evaluating the adequacy of
fluid resuscitation, the nurse understands that

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