Chapter 62 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

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Chapter 62  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

1. A patient is brought to the emergency department from the site of a chemical fire, where he suffered a burn that involves the epidermis, dermis, and the muscle and bone of the right arm. On inspection, the skin appears charred. Based on these assessment findings, what is the depth of the burn on the patient’s arm?

  1. A)  Superficial partial-thickness
  2. B)  Deep partial-thickness
  3. C)  Full partial-thickness
  4. D)  Full-thickness

Ans: D

Feedback:

A full-thickness burn involves total destruction of the epidermis and dermis and, in some cases, underlying tissue as well. Wound color ranges widely from white to red, brown, or black. The burned area is painless because the nerve fibers are destroyed. The wound can appear leathery; hair follicles and sweat glands are destroyed. Edema may also be present. Superficial partial-thickness burns involve the epidermis and possibly a portion of the dermis; the patient will experience pain that is soothed by cooling. Deep partial-thickness burns involve the epidermis, upper dermis, and portion of the deeper dermis; the patient will complain of pain and sensitivity to cold air. Full partial thickness is not a depth of burn.

2. The current phase of a patient’s treatment for a burn injury prioritizes wound care, nutritional support, and prevention of complications such as infection. Based on these care priorities, the patient is in what phase of burn care?

  1. A)  Emergent
  2. B)  Immediate resuscitative
  3. C)  Acute
  4. D)  Rehabilitation

Ans: C

Feedback:

The acute or intermediate phase of burn care follows the emergent/resuscitative phase and begins 48 to 72 hours after the burn injury. During this phase, attention is directed toward continued assessment and maintenance of respiratory and circulatory status, fluid and electrolyte balance, and gastrointestinal function. Infection prevention, burn wound care (i.e., wound cleaning, topical antibacterial therapy, wound dressing, dressing changes, wound débridement, and wound grafting), pain management, and nutritional support are priorities at this stage. Priorities during the emergent or immediate resuscitative phase include first aid, prevention of shock and respiratory distress, detection and treatment of concomitant injuries, and initial wound assessment and care. The priorities during the rehabilitation phase include prevention of scars and contractures, rehabilitation, functional and cosmetic reconstruction, and psychosocial counseling.

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3. A patient in the emergent/resuscitative phase of a burn injury has had blood work and arterial blood gases drawn. Upon analysis of the patient’s laboratory studies, the nurse will expect the results to indicate what?

  1. A)  Hyperkalemia, hyponatremia, elevated hematocrit, and metabolic acidosis
  2. B)  Hypokalemia, hypernatremia, decreased hematocrit, and metabolic acidosis
  3. C)  Hyperkalemia, hypernatremia, decreased hematocrit, and metabolic alkalosis
  4. D)  Hypokalemia, hyponatremia, elevated hematocrit, and metabolic alkalosis

Ans: A

Feedback:

Fluid and electrolyte changes in the emergent/resuscitative phase of a burn injury include hyperkalemia related to the release of potassium into the extracellular fluid, hyponatremia from large amounts of sodium lost in trapped edema fluid, hemoconcentration that leads to an increased hematocrit, and loss of bicarbonate ions that results in metabolic acidosis.

4. A patient has experienced an electrical burn and has developed thick eschar over the burn site. Which of the following topical antibacterial agents will the nurse expect the physician to order for the wound?

  1. A)  Silver sulfadiazine 1% (Silvadene) water-soluble cream
  2. B)  Mafenide acetate 10% (Sulfamylon) hydrophilic-based cream
  3. C)  Silver nitrate 0.5% aqueous solution
  4. D)  Acticoat

Ans: B

Feedback:

Mafenide acetate 10% hydrophilic-based cream is the agent of choice when there is a need to penetrate thick eschar. Silver products do not penetrate eschar; Acticoat is a type of silver dressing.

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5. An occupational health nurse is called to the floor of a factory where a worker has sustained a flash burn to the right arm. The nurse arrives and the flames have been extinguished. The next step is to “cool the burn.” How should the nurse cool the burn?

  1. A)  Apply ice to the site of the burn for 5 to 10 minutes.
  2. B)  Wrap the patient’s affected extremity in ice until help arrives.
  3. C)  Apply an oil-based substance or butter to the burned area until help arrives.
  4. D)  Wrap cool towels around the affected extremity intermittently.

Ans: D

Feedback:

Once the burn has been sustained, the application of cool water is the best first-aid measure. Soaking the burn area intermittently in cool water or applying cool towels gives immediate and striking relief from pain, and limits local tissue edema and damage. However, never apply ice directly to the burn, never wrap the person in ice, and never use cold soaks or dressings for longer than several minutes; such procedures may worsen the tissue damage and lead to hypothermia in people with large burns. Butter is contraindicated.

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