Nclexrn Quiz: Burns Initial Resuscitation Priorities
20 questions · exam conditions
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Burns Initial Resuscitation PrioritiesQuestion 1 of 20

A 62-year-old client (history: atrial fibrillation on anticoagulation) arrives after an electrical injury with burns on the right hand and scalp; the client briefly lost consciousness at the scene. Vital signs: T 36.6°C (97.9°F), HR 132/min and irregular, RR 20/min, BP 98/60 mm Hg, SpO2 97% on room air. What is the first action the nurse should take upon assessing the client?

Begin continuous cardiac monitoring and obtain a 12-lead electrocardiogram
Apply topical antimicrobial ointment to the burns and cover with sterile gauze
Provide oral intake to prevent dehydration since burns appear small
Delay interventions until coagulation studies are resulted
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Nclexrn Quiz: Burns Initial Resuscitation Priorities

Practice Burns Initial Resuscitation Priorities in Nclexrn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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This quiz focuses on Burns Initial Resuscitation Priorities, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexrn.

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Question 1

A 62-year-old client (history: atrial fibrillation on anticoagulation) arrives after an electrical injury with burns on the right hand and scalp; the client briefly lost consciousness at the scene. Vital signs: T 36.6°C (97.9°F), HR 132/min and irregular, RR 20/min, BP 98/60 mm Hg, SpO2 97% on room air. What is the first action the nurse should take upon assessing the client?

  1. Begin continuous cardiac monitoring and obtain a 12-lead electrocardiogram (correct answer)
  2. Apply topical antimicrobial ointment to the burns and cover with sterile gauze
  3. Provide oral intake to prevent dehydration since burns appear small
  4. Delay interventions until coagulation studies are resulted
Explanation: This question tests initial resuscitation priorities in burn care. It applies the ABC framework extended to cardiac risks in electrical injuries with comorbidities. Beginning continuous cardiac monitoring and obtaining an ECG is the highest priority due to irregular tachycardia and loss of consciousness, heightened by anticoagulation, for early arrhythmia detection and safety. Applying ointment (B), providing oral intake (C), and delaying for labs (D) are lower priorities or unsafe, as cardiac stability precedes them. Principles stress ECG monitoring in electrical burns for dysrhythmias, especially with cardiac history. Fluid management is important but cardiac surveillance is immediate. Integrate comorbidity factors into ABCs for prioritizing monitoring in electrical injuries.

Question 2

A 26-year-old client (history: none) is admitted after an electrical injury with a small burn on the palm and a burn on the heel; the client is alert but reports muscle pain. Vital signs: T 37.1°C (98.8°F), HR 110/min, RR 18/min, BP 118/70 mm Hg, SpO2 99% on room air. Which finding requires immediate intervention by the nurse during initial resuscitation?

  1. Dark, tea-colored urine noted after urinary catheter insertion (correct answer)
  2. Pain rated 7/10 at the entry wound site
  3. Small blistering at the burn edges
  4. Mild anxiety about returning to work
Explanation: This question tests initial resuscitation priorities in burn care. It applies a safety framework to detect complications in electrical injuries. Dark, tea-colored urine requires immediate intervention as it suggests myoglobinuria and rhabdomyolysis, risking kidney failure and necessitating prompt fluid adjustments for safety. Pain (B), blistering (C), and anxiety (D) are expected but lower priorities, not indicating acute systemic threats. Principles emphasize monitoring for internal injuries like muscle breakdown in electrical burns, with aggressive hydration to clear myoglobin. Airway and fluid management are foundational to prevent multiorgan failure. Escalate for urine discoloration in electrical injuries, integrating lab and clinical findings for prioritization.

Question 3

A 70-year-old client (history: diabetes and neuropathy) presents after a chemical exposure to the lower legs from a cleaning solution; the client removed pants but did not rinse the skin. Estimated 5% TBSA chemical burns with redness and blistering; vital signs: T 36.9°C (98.4°F), HR 92/min, RR 18/min, BP 150/82 mm Hg, SpO2 97% on room air. What is the first action the nurse should take upon assessing the client?

  1. Apply neutralizing agents to the skin to stop the chemical reaction
  2. Initiate copious irrigation with tepid water and continue for an extended period per protocol (correct answer)
  3. Obtain baseline pain score and administer oral analgesics
  4. Cover the area with an occlusive dressing to prevent further exposure
Explanation: This question tests initial resuscitation priorities in burn care. It incorporates a decontamination framework for chemical burns, emphasizing immediate action. Initiating copious irrigation with tepid water is the highest priority to remove the chemical and halt damage, especially with delayed rinsing, for client safety. Applying neutralizers (A), assessing pain (C), and using occlusive dressings (D) are incorrect, as neutralizers can worsen reactions and dressings trap agents. Principles require extended irrigation without neutralizers for most chemicals. Airway protection is needed if inhaled, but skin decontamination is first. Prioritize irrigation duration based on chemical type, avoiding delays in similar exposures.

Question 4

A 57-year-old client (history: peripheral vascular disease) has circumferential full-thickness burns to the left forearm and hand after a propane explosion; estimated 9% TBSA. The extremity is cool with delayed capillary refill; the client reports increasing numbness. Vital signs: T 36.8°C (98.2°F), HR 108/min, RR 20/min, BP 134/80 mm Hg, SpO2 96% on room air. Which finding requires immediate intervention by the nurse?

  1. Increasing numbness and coolness distal to a circumferential burn (correct answer)
  2. Heart rate of 108/min after a painful injury
  3. Estimated burn size of 9% TBSA
  4. Client request for family notification
Explanation: This question tests initial resuscitation priorities in burn care. It applies a safety framework to identify compartment syndrome risks. Increasing numbness and coolness distal to circumferential burns require immediate intervention, signaling vascular compromise needing escharotomy for limb salvage and safety. Tachycardia (B), burn size (C), and family requests (D) are lower priorities, not indicating acute ischemia. Principles include frequent neurovascular checks in circumferential burns to detect edema-induced compression early. Fluid management is essential but monitoring prevents complications like amputation. Prioritize escharotomy readiness in limb burns by assessing distal perfusion routinely.

Question 5

A 33-year-old client (history: none) has 24% TBSA partial-thickness burns to both legs after a workplace accident. Current assessment: severe pain; vital signs: T 37.3°C (99.1°F), HR 120/min, RR 24/min, BP 106/68 mm Hg, SpO2 97% on room air. Which analgesia plan should the nurse prioritize during initial resuscitation?

  1. Administer intravenous opioid analgesia and reassess pain and respiratory status frequently (correct answer)
  2. Administer intramuscular opioid analgesia to provide longer duration of action
  3. Encourage oral analgesics with food to prevent nausea
  4. Use nonpharmacologic measures only until fluid resuscitation is completed
Explanation: This question tests initial resuscitation priorities in burn care. It employs a priority intervention framework for pain management in burns. Administering IV opioids with frequent reassessment is the highest priority for severe pain, allowing safe titration without compromising respiration, promoting client comfort and safety. Using IM (B), oral (C), or nonpharmacologic only (D) are less effective or inappropriate, as IM absorption is unreliable and oral unsuitable during resuscitation. Principles stress IV routes for rapid pain control in burns due to high metabolic demands. Fluid management supports stability but pain can exacerbate stress responses. Use multimodal analgesia with vigilant monitoring in burn care for balanced prioritization.

Question 6

A 34-year-old client (history: none) has 36% TBSA partial- and full-thickness burns to the abdomen and both thighs from a camping fuel explosion. Current assessment: anxious, cool clammy skin; vital signs: T 36.6°C (97.9°F), HR 124/min, RR 20/min, BP 90/52 mm Hg, SpO2 98% on 2 L/min nasal cannula. The provider writes several orders. The nurse should question which order regarding the resuscitation plan?

  1. Insert an indwelling urinary catheter and record urine output hourly
  2. Start lactated Ringer solution via two large-bore intravenous catheters and titrate to urine output goals
  3. Administer furosemide intravenously now to increase urine output during the first 8 hours (correct answer)
  4. Maintain the client on a warm environment and use warmed intravenous fluids as available
Explanation: This question tests initial resuscitation priorities in burn care. It employs a clinical judgment framework to identify inappropriate orders in hypovolemic states. Administering furosemide is questionable as it could worsen hypovolemia in this tachycardic, hypotensive client, where fluid resuscitation is needed instead for safety. Inserting a catheter (A), starting fluids (B), and maintaining warmth (D) are appropriate for monitoring and preventing hypothermia. Principles emphasize crystalloid fluids to restore volume, avoiding diuretics that deplete it further. Airway protection and temperature control are key, but fluid overload is rare early on. Question orders that contradict hypovolemia management, applying evidence-based protocols for burns.

Question 7

A 52-year-old client (history: alcohol use disorder) presents 2 hours after a garage fire with 28% TBSA partial- and full-thickness burns to the back and posterior legs. Current assessment: awake, thirsty, capillary refill delayed; vital signs: T 36.5°C (97.7°F), HR 132/min, RR 22/min, BP 88/54 mm Hg, SpO2 95% on 2 L/min nasal cannula. Which intervention should the nurse prioritize to evaluate adequacy of fluid resuscitation?

  1. Measure and document burn wound size and depth every 8 hours
  2. Insert an indwelling urinary catheter and monitor urine output hourly (correct answer)
  3. Obtain a daily weight after the first 24 hours of resuscitation
  4. Auscultate bowel sounds every 4 hours for signs of ileus
Explanation: This question tests initial resuscitation priorities in burn care. It applies a priority intervention framework for evaluating fluid resuscitation efficacy. Inserting an indwelling urinary catheter for hourly output monitoring is the highest priority to assess resuscitation adequacy, as low output indicates hypovolemia in this tachycardic, hypotensive client, promoting safety through guided fluid adjustments. Measuring wound size (A), obtaining daily weights (C), and auscultating bowel sounds (D) are lower priorities, as they do not directly evaluate acute fluid status like urine output does. Burn resuscitation principles underscore urine output as a key indicator of perfusion, targeting 0.5-1 mL/kg/hr in adults. Airway protection and fluid balance are foundational to prevent complications like acute kidney injury. In similar situations, prioritize objective monitoring tools like urine output to titrate interventions effectively.

Question 8

A 29-year-old client (history: none) is brought in after an electrical injury at a construction site; there are small full-thickness burns on the right hand and left foot (suspected entry/exit wounds), and the client reports chest tightness. Vital signs: T 36.9°C (98.4°F), HR 56/min and irregular, RR 18/min, BP 102/66 mm Hg, SpO2 98% on room air. Which intervention should the nurse prioritize?

  1. Apply dry sterile dressings to the entry and exit wounds to reduce contamination
  2. Initiate continuous cardiac monitoring and obtain a 12-lead electrocardiogram (correct answer)
  3. Start oral fluids to maintain hydration because the external burns are small
  4. Assess tetanus immunization status and administer a booster if indicated
Explanation: This question tests initial resuscitation priorities in burn care. It incorporates the ABC framework with emphasis on circulation and cardiac monitoring in electrical injuries. Initiating continuous cardiac monitoring and obtaining an ECG is the highest priority due to risks of arrhythmias from electrical current, evidenced by irregular heart rate and chest tightness, ensuring early detection for client safety. Applying dressings (A), starting oral fluids (C), and assessing tetanus (D) are lower priorities, as wound care and prophylaxis follow cardiac stabilization. Principles of burn resuscitation for electrical injuries stress monitoring for internal damage beyond visible burns, including cardiac and neurological effects. Fluid management is vital but secondary to arrhythmia risks. Use a systematic approach like ABCs extended to include dysrhythmia surveillance in electrical burns for timely interventions.

Question 9

A 5-year-old child (history: none) is brought in after spilling hot tea on the face and neck; estimated 10% TBSA partial-thickness scald burns. The child has audible wheezing and increasing work of breathing; vital signs: T 37.4°C (99.3°F), HR 156/min, RR 38/min, BP 90/54 mm Hg, SpO2 89% on room air. Which intervention should the nurse prioritize?

  1. Begin intravenous fluids after obtaining the child's weight
  2. Provide humidified oxygen and prepare for escalation of airway support (correct answer)
  3. Apply topical antimicrobial ointment to the burns
  4. Cover burns with dry sterile gauze and reassess in 30 minutes
Explanation: This question tests initial resuscitation priorities in burn care. It employs the ABC framework, prioritizing airway and breathing in pediatric facial burns. Providing humidified oxygen and preparing for airway support is the highest priority for wheezing and hypoxia, indicating edema risk, to prevent failure and ensure safety. Starting fluids (A), applying ointment (C), and covering burns (D) are lower priorities, as airway precedes them. Principles note children's proneness to rapid airway compromise in facial scalds. Fluid management is crucial but secondary to oxygenation. Always address respiratory distress first in pediatric burns using ABCs for escalation.

Question 10

A 44-year-old client (history: none) arrives 2 hours after a warehouse fire with 42% TBSA partial- and full-thickness burns to the torso and both legs. Current assessment: restless; peripheral pulses weak; vital signs: T 36.3°C (97.3°F), HR 138/min, RR 26/min, BP 82/48 mm Hg, SpO2 96% on 4 L/min nasal cannula. Which intervention should the nurse prioritize first to address circulation?

  1. Start a second large-bore intravenous line and rapidly infuse warmed isotonic crystalloid per protocol (correct answer)
  2. Administer intravenous albumin to expand intravascular volume immediately
  3. Obtain a complete blood count and basic metabolic panel before starting fluids
  4. Elevate the head of the bed and encourage deep breathing to reduce anxiety
Explanation: This question tests initial resuscitation priorities in burn care. It utilizes a circulation-focused framework for addressing hypovolemic shock in major burns. Starting a second IV line and rapidly infusing warmed crystalloids is the highest priority to restore volume in this restless, hypotensive client, ensuring perfusion and safety. Administering albumin (B), obtaining labs first (C), and elevating the bed (D) are incorrect, as albumin is not first-line and delays are risky. Principles advocate large-volume crystalloids per formulas to counter fluid shifts. Airway protection supports resuscitation but circulation is the focus. Escalate fluid rates based on vital signs, using protocols for timely shock reversal.

Question 11

A 36-year-old client (history: none) arrives after a flame burn with 33% TBSA partial- and full-thickness burns to the chest, abdomen, and both arms. Current assessment: alert; vital signs: T 36.8°C (98.2°F), HR 124/min, RR 22/min, BP 100/62 mm Hg, SpO2 97% on 2 L/min nasal cannula. Which nursing action best supports initial burn resuscitation priorities?

  1. Start isotonic intravenous fluids via large-bore access and titrate based on urine output and vital signs (correct answer)
  2. Delay fluids until burn center transfer is arranged and let the receiving team set the rate to avoid over-resuscitation
  3. Apply ice packs directly to burned areas and keep them in place to decrease pain and edema while awaiting transfer
  4. Administer prophylactic antibiotics to prevent burn wound sepsis and reduce infection risk during the first 24 hours of resuscitation
Explanation: The most urgent problem in this client is hypovolemia from a 33% TBSA burn, shown by tachycardia and borderline low blood pressure. Starting an isotonic crystalloid through large-bore IV access and titrating it to urine output and vital signs supports perfusion and is the correct first action. Delaying fluids until transfer so the receiving team can set the rate is unsafe because fluid loss continues during transport and hypotension can worsen. Applying ice packs directly to burned areas and keeping them in place may cause vasoconstriction and additional tissue injury; it also does not restore circulating volume. Giving prophylactic antibiotics within the first 24 hours targets infection, not the immediate threat of inadequate perfusion, and routine prophylactic antibiotics are not recommended. Therefore, crystalloid resuscitation begun immediately and adjusted by ongoing assessment is the best initial priority.

Question 12

A 55-year-old client (history: none) has 27% TBSA partial-thickness burns to both arms and the anterior torso. After 2 hours of fluid resuscitation, assessment shows increasing restlessness and a urine output of 15 mL/hr. Vital signs: T 36.7°C (98.1°F), HR 130/min, RR 24/min, BP 86/50 mm Hg, SpO2 96% on 2 L/min nasal cannula. Which finding requires immediate intervention by the nurse?

  1. Urine output of 15 mL/hr during the resuscitation phase (correct answer)
  2. Restlessness related to pain and anxiety during the current assessment
  3. Temperature reading of 36.7°C (98.1°F) in the current assessment
  4. Need to plan dressing changes with sterile technique to prevent infection
Explanation: The correct choice is the 15 mL/hr urine output. During adult burn resuscitation, the target urine output is about 30 to 50 mL/hr. A reading of 15 mL/hr after 2 hours of fluid resuscitation indicates under-resuscitation and poor renal perfusion, so the nurse must intervene immediately to adjust the fluid volume before worsening injury. Restlessness may be assessed, but the restlessness described here is attributed to pain and anxiety and does not provide the direct perfusion warning that the urine output does. The temperature of 36.7°C (98.1°F) is within normal range and does not require immediate intervention. A dressing-change plan with sterile technique is important for infection prevention, but it is not the immediate resuscitation priority while the urine output is low. Only the low urine output identifies the acute fluid resuscitation problem.

Question 13

A 49-year-old client (history: none) arrives 45 minutes after a gasoline fire with 35% TBSA partial- and full-thickness burns to the chest, abdomen, and both arms. Current assessment: alert; no soot noted; vital signs: T 36.7°C (98.1°F), HR 126/min, RR 22/min, BP 92/60 mm Hg, SpO2 98% on room air. Which intervention should the nurse prioritize first?

  1. Begin high-calorie enteral nutrition within the first 24 hours to support healing and reduce catabolic losses
  2. Establish two large-bore intravenous lines and start warmed isotonic crystalloid fluids per protocol (correct answer)
  3. Debride loose blistered skin using sterile technique to reduce infection risk and promote wound healing
  4. Apply topical antimicrobial therapy and cover burns with sterile dressings to prevent infection and further contamination
Explanation: This patient shows signs of hypovolemic shock from major burns (tachycardia, hypotension). The immediate priority is to restore circulating volume by establishing large-bore IV access and starting warmed isotonic crystalloids per protocol. Airway is already protected (alert, no soot, SpO2 98%), so circulation is the focus. High-calorie enteral nutrition is important but should begin after hemodynamic stability is achieved. Debridement of blisters is not done during initial resuscitation because intact blisters protect against infection and fluid loss. Likewise, applying antimicrobial dressings is a later wound-care step; the patient must be stabilized first. Thus, the best first intervention is fluid resuscitation via large-bore IV lines.

Question 14

A 67-year-old client (history: chronic obstructive pulmonary disease) presents after a chemical splash to the eyes and face from an industrial cleaner; facial erythema is present and the client is tearing and blinking rapidly. Vital signs: T 36.8°C (98.2°F), HR 96/min, RR 22/min, BP 142/78 mm Hg, SpO2 93% on room air. What is the first action the nurse should take upon assessing the client?

  1. Apply a topical anesthetic eye drop to the affected eye if prescribed to reduce pain before beginning irrigation
  2. Begin immediate continuous irrigation of both eyes with isotonic solution and remove contact lenses if present (correct answer)
  3. Obtain visual acuity using a Snellen chart and document baseline findings in the health record before irrigation begins
  4. Place a sterile eye patch over the affected eye to prevent further injury and reduce tearing while waiting for evaluation
Explanation: Chemical exposure to the eye is a time-sensitive injury: the chemical continues to damage the cornea until it is diluted and removed. Therefore the first action is immediate continuous irrigation with an isotonic solution, and contact lenses should be removed because they can trap the chemical against the eye. Applying a topical anesthetic before irrigation is not the priority; it delays decontamination and can mask pain, so it should be considered only once irrigation is underway. Measuring visual acuity and documenting baseline findings are important, but doing them first lets the chemical stay in contact with the eye and risks worsening injury. Patching the eye initially is contraindicated because a patch traps the chemical and prevents the irrigation needed. Each of these actions may have a role after decontamination, but none precedes irrigation in a chemical eye exposure.

Question 15

A 45-year-old client (history: type 2 diabetes) presents to the emergency department 1 hour after a kitchen explosion with 40% TBSA partial- and full-thickness burns to the torso and both legs. Current assessment: alert but restless; burns are circumferential on the right leg; urine output has not yet been measured; vital signs: T 36.8°C (98.2°F), HR 122/min, RR 24/min, BP 94/58 mm Hg, SpO2 97% on 2 L/min nasal cannula. Which intervention should the nurse prioritize for this burn client?

  1. Insert a urinary catheter and begin hourly urine output monitoring to guide ongoing fluid needs
  2. Administer tetanus toxoid prophylaxis as indicated by the client's immunization history to prevent wound infection
  3. Start warmed lactated Ringer solution through two large-bore intravenous lines using a burn resuscitation protocol (correct answer)
  4. Obtain wound cultures from open burn areas before applying dressings using sterile technique to prevent contamination
Explanation: After a major burn, the immediate threat is hypovolemic shock from capillary leak. Tachycardia, hypotension, and restlessness indicate this is developing, so the priority is to start warmed lactated Ringer solution through two large-bore IV lines using a burn resuscitation protocol. Inserting a urinary catheter and beginning hourly urine output monitoring is an important later step, but it cannot restore circulating volume, and urine values have less meaning before fluid resuscitation is underway. Tetanus toxoid prophylaxis is standard burn care, but it is infection prevention and is not the first-hour life threat. Wound cultures from open burn areas are not urgently indicated; even with sterile technique, they do not treat shock and would not precede hemodynamic stabilization in the priority sequence. Airway is stable, so circulation is the focus.

Question 16

A 40-year-old client (history: none) arrives after a house fire with 25% TBSA partial-thickness burns to the arms and upper back. The client is confused and has a headache; there is soot in the mouth. Vital signs: T 37.1°C (98.8°F), HR 112/min, RR 24/min, BP 124/72 mm Hg, SpO2 99% on a nonrebreather mask. Which intervention should the nurse prioritize based on the assessment?

  1. Request an order for carboxyhemoglobin level and continue high-flow oxygen therapy (correct answer)
  2. Titrate the oxygen down to room air because the pulse oximetry reading is normal
  3. Provide oral fluids to correct the dehydration presumed to be causing the headache and confusion
  4. Apply topical antimicrobial cream to the burns and begin wound care to prevent infection
Explanation: The client has confusion, headache, and soot in the mouth after a house fire, which are indicators of carbon monoxide poisoning even when a standard pulse oximetry reading is 99%. Carbon monoxide binds to hemoglobin and reduces oxygen-carrying capacity without necessarily lowering the measured SpO2, so the nurse is required to continue high-flow oxygen and request a carboxyhemoglobin level. Titrating the oxygen down to room air is dangerous because a normal SpO2 does not rule out carbon monoxide toxicity and lowering oxygen delays CO elimination. Providing oral fluids does not address the oxygen-carrying problem and is unsafe for a confused client; if fluid replacement is needed, it should be intravenous. Applying topical antimicrobial cream and beginning wound care are important later in burn management, but they do not take priority over treating possible inhalation injury. Therefore, continue high-flow oxygen and obtain the carboxyhemoglobin level.

Question 17

A 27-year-old construction worker is brought to the emergency department after an electrical injury from a high-voltage line. The client has small entry and exit wounds on the right hand and left foot and reports muscle pain; history is unremarkable. Assessment: irregular pulse noted on palpation; vital signs: T 37.0°C (98.6°F), HR 52/min and irregular, RR 18/min, BP 102/64 mm Hg, SpO2 99% on room air. Which intervention should the nurse prioritize for this burn client?

  1. Prepare the client for immediate surgical debridement of the entry wound
  2. Initiate continuous cardiac monitoring and obtain a 12-lead electrocardiogram (correct answer)
  3. Apply ice packs to the entry and exit wounds to reduce swelling
  4. Collect a detailed pain history and reassess neurovascular status in 30 minutes
Explanation: This question tests initial resuscitation priorities in burn care, specifically recognizing cardiac complications from electrical injury. The clinical judgment framework prioritizes life-threatening cardiac dysrhythmias in electrical burns. The correct answer (B) represents the highest priority because electrical injuries can cause immediate cardiac dysrhythmias (evidenced by irregular pulse and bradycardia at 52/min), which can deteriorate to lethal rhythms without warning. Option A (surgical debridement) is premature and not immediately indicated; option C (ice packs) is contraindicated as it can worsen tissue damage; option D (pain history) delays critical cardiac monitoring. Electrical burns are unique because the visible skin damage often underestimates internal injury, and cardiac effects can be immediate or delayed. High-voltage injuries frequently cause cardiac dysrhythmias due to disruption of the heart's electrical conduction system. A transferable strategy is to recognize that any electrical injury requires immediate cardiac monitoring as the first priority, regardless of the apparent severity of external burns.

Question 18

A 79-year-old client is brought in after a household cleaning accident with a strong alkali drain cleaner splashed on the left forearm and hand; the client removed a sweater but did not rinse the area. History includes type 2 diabetes and chronic kidney disease stage 3. Assessment shows whitening and blistering of the skin with severe pain; vital signs: T 36.9°C (98.4°F), HR 104/min, RR 20/min, BP 146/78 mm Hg, SpO2 97% on room air. Which intervention should the nurse prioritize for this burn client?

  1. Apply a neutralizing acidic solution to stop the chemical reaction
  2. Begin continuous irrigation of the affected area with copious tepid water after removing contaminated clothing (correct answer)
  3. Cover the affected area with dry sterile dressings and elevate the extremity
  4. Administer intravenous antibiotics after obtaining a provider prescription
Explanation: This question tests initial resuscitation priorities in burn care, specifically managing chemical burns. The clinical judgment framework focuses on stopping ongoing tissue damage as the immediate priority. The correct answer (B) represents the highest priority because alkali burns continue to cause tissue damage until the chemical is completely removed, and immediate copious irrigation is the only effective way to dilute and remove the caustic substance. Option A (neutralizing solution) is contraindicated as it can cause an exothermic reaction worsening the burn; option C (dry dressings) would trap the chemical against the skin; option D (antibiotics) addresses infection prevention but is not the immediate priority. Chemical burn management differs from thermal burns in that the burning process continues until the agent is removed or neutralized through dilution. Alkali burns are particularly dangerous as they cause liquefactive necrosis and penetrate deeper than acid burns. A transferable strategy is to remember that for any chemical burn, immediate and prolonged irrigation (at least 20-30 minutes) takes precedence over all other interventions to limit tissue damage.

Question 19

A 38-year-old client (history: hypertension) arrives 30 minutes after a house fire with approximately 32% total body surface area (TBSA) partial- and full-thickness burns to the anterior chest, abdomen, and both arms; soot is noted around the nares and the client is hoarse with singed nasal hairs. Current assessment: anxious, audible stridor; vital signs: T 37.2°C (99.0°F), HR 128/min, RR 30/min, BP 146/88 mm Hg, SpO2 92% on room air. What is the first action the nurse should take upon assessing the client?

  1. Insert two large-bore intravenous catheters and begin lactated Ringer solution per burn resuscitation protocol
  2. Prepare for early endotracheal intubation and notify the provider/rapid response team of impending airway compromise (correct answer)
  3. Obtain the client's weight and calculate the 24-hour fluid requirement using a burn formula
  4. Apply silver-based topical antimicrobial cream to the burned areas and cover with dry sterile dressings
Explanation: This question tests initial resuscitation priorities in burn care. It utilizes the ABC clinical judgment framework, emphasizing airway, breathing, and circulation. Preparing for early endotracheal intubation and notifying the provider represents the highest priority because signs of inhalation injury, such as hoarseness, stridor, singed nasal hairs, and soot, indicate impending airway compromise that could lead to rapid deterioration and client safety risks. Inserting IV catheters and starting fluids (A), obtaining weight for fluid calculation (C), and applying antimicrobial cream (D) are important but lower priorities compared to securing the airway, as fluid resuscitation and wound care can follow airway stabilization. In burn resuscitation, protecting the airway is critical due to the risk of edema and obstruction from inhalation injuries. Fluid management is essential to prevent hypovolemic shock, but it must not delay airway interventions. When prioritizing care in burn scenarios, always apply the ABC framework to address life-threatening issues first, such as airway patency before circulation or wound management.

Question 20

A 2-year-old child is brought to the emergency department after pulling a pot of hot soup from a stove, sustaining scald burns estimated at 18% total body surface area to the anterior chest and upper arms. The child is crying with drooling and a harsh cough; there are burns around the mouth. Vital signs: T 37.2°C (99.0°F), HR 160/min, RR 40/min with stridor, BP 86/50 mm Hg, SpO2 90% on room air. What is the first action the nurse should take upon assessing the child?

  1. Weigh the child to calculate fluid needs and begin maintenance intravenous fluids
  2. Apply cool (not cold) wet compresses to the burned areas for pain relief
  3. Provide high-flow oxygen and notify the provider to prepare for airway stabilization (possible intubation) (correct answer)
  4. Insert a urinary catheter to monitor urine output every hour
Explanation: This question tests initial resuscitation priorities in burn care, specifically recognizing airway emergency in a pediatric patient. The clinical judgment framework prioritizes airway management when signs of respiratory distress are present. The correct answer (C) represents the highest priority because the child shows clear signs of upper airway obstruction including stridor, drooling, harsh cough, and burns around the mouth, indicating immediate risk of complete airway obstruction. Option A (weighing for fluids) is important but secondary to airway management; option B (cool compresses) is contraindicated as it can cause hypothermia; option D (urinary catheter) is needed for monitoring but comes after airway stabilization. In pediatric burn care, the smaller airway diameter means edema causes proportionally greater obstruction, and deterioration can be rapid. The presence of oral burns, drooling, and stridor are ominous signs requiring immediate intervention. A transferable strategy is to recognize that any burns to the face, mouth, or signs of respiratory distress in children mandate immediate airway assessment and protection before addressing other burn care needs.