Burns NCLEX Questions
1. A 65 year old male patient has experienced full-thickness electrical burns on the legs and arms. As the nurse you know this
patient is at risk for the following: Select all that apply:
A. Acute kidney injury
B. Dysrhythmia
C. Iceberg effect
D. Hypernatremia
E. Bone fractures
F. Fluid volume overload
The answers are A, B, C, and E. Electric burns are due to an electrical current passing through the body that leads to damage to the
skin but also the muscles and bones that are underneath the skin. The patient is at risk for AKI (acute kidney injury) because when the
muscles become affected they release myoglobin and the red blood cells release hemoglobin in the blood, which can collect in the
kidneys leading to injury. In addition, the heart’s electrical system can become damaged leading to dysrhythmia. The iceberg effect
can present as well because the extent of damage is not clearly visible on the skin (there can be severe damage underneath). In
addition, if the electrical current is strong enough it can lead to bone fractures (specifically cervical spine injuries) due to the severe
contraction of the muscles involved.
2. True or False: A patient who experiences an alkali chemical burn is easier to treat because the skin will neutralize the
chemical rather than with an acidic chemical burn.
False: Alkali burns are harder to treat than acidic chemical burns because the skin will neutralize the acidic burn.
3. As the nurse providing care to a pt. who experienced a full-thickness electrical burn you know to monitor the patient’s urine for:
A. Hemoglobin and myoglobin
B. Free iron and white blood cells
C. Protein and red blood cells
D. Potassium and Urea
The answer is A. Patients who’ve experienced a severe electrical burn or full-thickness burns are at risk for acute kidney injury. This
is because the muscles can experience damage from the electrical current leading them to release myoglobin. In addition, the red blood
cells will release hemoglobin. These substances will collect in the kidneys leading to acute tubular necrosis (hence leading to AKI).
Therefore, the nurse should monitor the patient’s urine for these substances.
4. Select the patient below who is at MOST risk for complications following a burn:
A. A 42 year old male with partial-thickness burns on the front of the right and left arms and legs.
B. A 25 year old female with partial-thickness burns on the front of the head and neck and front and back of the torso.
C. A 36 year old male with full-thickness burns on the front of the left arm.
D. A 10 year old with superficial burns on the right leg.
The answer is B. When thinking about which patient will have the MOST complications following a burn think about: percentage of the
total body surface area that is burned (use the rule of nine to calculate), depth of the burn, age, location of the burn, and patient’s medical
history. The patient in option B has 40.5% TSBA burned (option A 27%, C: 4.5%, D: 9%). Remember that the higher the total of the
body surface area that is burned the higher the risk of complications due to an increase in capillary permeability (swelling, hypovolemic
shock etc.). In addition, the location of the burn is a major issue with the patient in option B. The burns are on the head and neck and
front and back of the torso. Therefore, with head and neck burns always think about respiratory issues because the airway can become
compromised due to swelling or an inhalation injury. And with torso burns that are on the front and back, the patient is at risk for
circumferential burns that can lead to further respiratory compromise. The other options have burns that are isolated.
5. The _____________ layer of the skin helps regulate our body temperature.
A. Epidermis
B. Dermis
C. Hypodermis
D. Fascia
The answer is C. This layer contains fatty tissue, veins, arteries, nerves and helps insulate the muscles, bones, organs and helps
REGULATE our body temperature.
6. You receive a patient who has experienced a burn on the right leg. You note the burn contains small blisters and is
extremely pinkish red and shiny/moist. The patient reports severe pain. You document this burn as:
A. 1st Degree (superficial)
B. 2nd Degree (partial-thickness)
C. 3rd Degree (full-thickness)
D. 4th Degree (deep full-thickness)
The answer is B. These are the classic characteristics of a 2nd degree (partial-thickness) burn.
7. Based on the depth of the burn in figure 1 (picture is above), you would expect to find:
A. report of sensation to only pressure
B. blanching
C. anesthetization to feeling
D. extreme pain
The answer is C. This is a 3rd degree to 4th degree burn (full-thickness) and the nerves that detect pain are destroyed. The patient
would have no feeling or experiences an extreme decrease sensation to pain.
8. A 58 year old female patient has superficial partial-thickness burns to the anterior head and neck, front and back of the left
arm, front of the right arm, posterior trunk, front and back of the right leg, and back of the left leg. Using the Rule of Nines,
calculate the total body surface area percentage that is burned?
A. 63%
B. 81%
C. 72%
D. 54%
The answer is A. Anterior head and neck (4.5%), front and back of the left arm (9%), front of the right arm (4.5%), posterior trunk
(18%), front and back of the right leg (18%), back of the left leg (9%) which equals 63%.
9. A 30 year old female patient has deep partial thickness burns on the front and back of the right and left leg, front of right
arm, and anterior trunk. The patient weighs 63 kg. Use the Parkland Burn Formula: What is the flow rate during the FIRST 8
hours (mL/hr) based on the total you calculated?
A. 921 mL/hr
B. 938 mL/hr
C. 158 mL/hr
D. 789 mL/hr
The answer is A: 921 mL/hr….First calculate the total amount of fluid needed with the formula: Total Amount of LR = 4 mL x BSA
% x pt’s weight in kg. The pt’s weight 63 kg. BSA percentage: 58.5%…Front and back of right and left leg (36%), front of right arm
(4.5%), anterior trunk (18%) which equals 58.5%. ……4 x 58.5 x 63 = 14,742 mL……Remember during the FIRST 8 hours 1/2 of the
solution is infused, which will be 14,742 divided by 2 = 7371 mL……Hourly Rate: 7371 divide by 8 equals 921 mL/hr
10. A patient has a burn on the back of the torso that is extremely red and painful but no blisters are present. When you
pressed on the skin it blanches. You document this as a:
A. 1st degree (superficial) burn
B. 2nd degree (partial-thickness) burn
C. 3rd degree (full-thickness) burn
D. 4th degree (deep full-thickness) burn
The answer is A. These are the classic characteristics of a 1st degree, superficial burn.
11. A patient has experienced full-thickness burns to the face and neck. As the nurse it is priority to:
A. Prevent hypothermia
B. Assess the blood pressure
C. Assess the airway
D. Prevent infection
The answer is C. Due to the location of the burns (face and neck), the patient is at major risk for respiratory issues due to damage to
the upper airways and the risk of an inhalation injury.
12. A patient is in the acute phase of burn management. The patient experienced full-thickness burns to the perineum and
sacral area of the body. In the patient’s plan of care, which nursing diagnosis is priority at this time?
A. Impaired skin integrity
B. Risk for fluid volume overload
C. Risk for infection
D. Ineffective coping
The answer is C. The patient is now in the acute phase where fluid resuscitation was successful and ends with wound closure.
Therefore, during this stage diuresis occurs (so fluid volume deficient could occur NOT overload) and INFECTION. The location of
the burns increases the risk of infection because these areas naturally harbor bacteria. Therefore, this takes priority because during this
phase wound healing is promoted.
13. The nurse notes a patient has full-thickness circumferential burns on the right leg. The nurse would: select all that apply
A. Place cold compressions on the burn and elevate the right leg below the heart level
B. Assess the distal pulses in the right extremity
C. Elevate the right leg above the heart level
D. Place gauze securely around the leg to prevent infection
The answer is B and C. The patient has burns that completely surround the front and back of the right leg. This can lead to
compartment syndrome where the edema from the burn compromises circulation to the distal extremity. The nurse should elevate the
extremity ABOVE heart level to decrease swelling and assess distal pulses in the extremity to confirm circulation is present.
14. A patient arrives to the ER with full-thickness burns on the front and back of the torso and neck. The patient has no spinal
injuries but is disoriented and coughing up black sooty sputum. Vital signs are: oxygen saturation 63%, heart rate 145,
blood pressure 80/56, and respiratory rate 39. As the nurse you will:
A. Place the patient in High Fowler’s position.
B. Prep the patient for escharotomy.
C. Prep the patient for fasciotomy.
D. Prep the patient for intubation.
E. Place a pillow under the patient’s neck.
F. Obtain IV access at two sites.
G. Restrict fluids.
The answers are A, B, D, and F. After reading this scenario the location of the burns and the patient’s presentation should be jumping
out at you. The patient is at risk for circumferential burns due to the location of the burns and the depth (full-thickness….will have
eschar present that will restrict circulation or here in this example the ability of the patient to breathe in and out). Based on the
patient’s VS, we see that the respiratory effort is compromised majorly AND that there is a risk of inhalation injury since the patient is
coughing up black sooty sputum. Therefore, the nurse should place the patient in high Fowler’s position to help with respiratory effort
(unless contraindicated with spinal injuries), prep the patient for escharotomy (this will cut the eschar and help relieve pressure and
allow for breathing) and prep for intubation to help with the respiratory distress. In addition, obtain IV access in at least two sites for
fluid replacement….remember the first 24 hours after a burn a patient is at risk for hypovolemic shock.
15. A patient arrives to the ER due to experiencing burns while in an enclosed warehouse. Which assessment findings below
demonstrate the patient may have experienced an inhalation injury?
A. Carbonaceous sputum
B. Hair singeing on the head and nose
C. Lhermitte’s Sign
D. Bright red lips
E. Hoarse voice
F. Tachycardia
The answers are A, B, D, E, and F. These are all signs of a possible inhalation injury. Bright red lips & tachycardia are present in
carbon monoxide poisoning as well.
16. You’re providing education to a group of local firefighters about carbon monoxide poisoning. Which statement is correct
about the pathophysiology regarding this condition?
A. “Patients are most likely to present with cyanosis around the lips and face.”
B. “In this condition, carbon monoxide binds to the hemoglobin of the RBC leading to a decrease in the ability of the
hemoglobin to carry oxygen to the body.”
C. “Carbon monoxide poisoning leads to a hyperoxygenated state, which causes hypercapnia.”
D. “Carbon monoxide binds to the hemoglobin of the RBC& prevents the transport of carbon dioxide out of the blood, which
leads to poisoning.”
The answer is B. This is the only correct statement about carbon monoxide poisoning.
17. A patient experienced a full-thickness burn 72 hours ago. The patient’s vital signs are within normal limits and urinary
output is 50 mL/hr. This is known as what phase of burn management?
A. Emergent
B. Acute
C. Rehabilitative
The answer is B. This phase starts when capillary permeability has returned to normal and the patient’s vitals are within normal limits
and ends with wound closure. The phase after this is rehabilitative.
18. What are some patient priorities during the emergent phase of burn management?
A. Fluid volume
B. Respiratory status
C. Psychosocial
D. Wound closure
E. Nutrition
The answer is A and B. This phase starts from the onset of the burn and ends with the restoration of capillary permeability. Wound
closure, and nutrition would be during the acute phase, and would continue into the rehabilitative phase. Psychosocial would be in the
rehab phase.
19. During the emergent phase of burn management, you would expect the following lab values:
A. Low sodium, low potassium, high glucose, low hematocrit
B. High sodium, low potassium, low glucose, high hematocrit
C. High sodium, high potassium, high glucose, low hematocrit
D. Low sodium, high potassium, high glucose, high hematocrit
The answer is D. Think about the increase in the capillary permeability that happens with severe burns, which causes the plasma to
leave the intravascular system and enter the interstitial tissue: Low sodium..why: sodium leaves with the plasma to the interstitial
tissue and drops the levels in the blood; High potassium…why? damaged cells lysis and leak potassium which increases the leave in
the blood; high glucose…why? stress response leads the liver to release glycogen and this increases levels; high hematocrit…why?
when the plasma leaves the intravascular system (the fluid) it causes the blood to become more concentrated so hematocrit increases
(this will decrease when the patient’s fluid is replaced).
20. A patient is receiving IV Lactated Ringers 950 mL/hr post 18 hours after a receiving a severe burn. The patient urinary
output is 20 mL/hr. As the nurse your next nursing action is to:
A. Increase the IV fluids
B. Continue to monitor the patient
C. Decrease the IV fluids
D. Notify the physician of this finding
The answer is D. The patient’s urinary output is too low and needs more fluids. It should be at least 30 mL/hr. Therefore, the nurse
must notify the physician for further orders. The nurse can NOT increase or decrease IV fluids without a physician’s order.
21. A patient who is being treated for partial thickness burns on 60% of the body is now in the acute phase of burn management.
The nurse assesses the pt. for a possible Curling’s Ulcer. What signs & symptoms can present w/ this condition?
A. Swelling and pain on the area distal to the burn
B. Burning, gnawing sensation pain in the stomach and vomiting
C. Dark red or gray sores on the soles of the feet
D. Difficulty swallowing and gagging
The answer is B. This is a type of ulcer that occurs in the stomach, duodenum, due to a high amount of stress on the body from a burn.
The blood supply to the factors that help protect the stomach lining from gastric erosion decreases and this allows for ulcers to form.
22. During the acute phase of burn management, what is the best diet for a patient who has experienced severe burns?
A. High fiber, low calories, and low protein
B. High calorie, high protein and carbohydrate
C. High potassium, high carbohydrate, and low protein
D. Low sodium, high protein, and restrict fluids to 1 liter per day
The answer is B. This type of diet promotes wound healing and meets the caloric demands of the body.
23. You’re assisting the nursing assistant with repositioning a patient with full-thickness burns on the neck. Which action by
the nursing assistant requires you to intervene?
A. The nursing assistant elevates the head of the bed above 30 degrees.
B. The nursing assistant places a pillow under the patient’s head.
C. The nursing assistant places rolled towels under the patient’s shoulders.
D. The nursing assistant covers the patient with sterile linens.
The answer is B. If a patient has severe burns to the neck (head as well) a pillow should NOT be used under the head because this can
cause wound contractions. Instead rolled towels should be placed under the shoulders.
24. A patient has full-thickness burns on the front and back of both arm and hands. It is nursing priority to:
A. Elevate and extend the extremities
B. Elevate and flex the extremities
C. Keep extremities below heart level and extended
D. Keep extremities level with the heart level and flexed
The answer is A. This position will decrease edema, which will help prevent compartment syndrome.
25. A patient has an emergency escharotomy performed on the right leg. The patient has full-thickness circumferential burns
on the leg. Which finding below demonstrates the procedure was successful?
A. The patient can move the extremity.
B. The right foot’s capillary refill is less than 2 seconds.
C. The patient reports a new sensation of extreme pain.
D. The patient has a positive babinski reflex.
The answer is B. Escharotomy is performed when a full-thickness burn, due to eschar (which is burned tissue that is hard), is
compromising blood flow to the distal extremity. The eschar is cut and this relieves pressure and allows blood to flow to the extremity.
26. Your patient with severe burns is due to have a dressing change. You will pre-medicate the patient prior to the dressing
change. The patient has standing orders for all the medications below. Which medication is best for this patient?
A. IM morphine
B. PO morphine
C. IV morphine
D. Subq morphine
The answer is C. The best route that is predictable and easily absorbed is via the IV route in burn victims.
27. After receiving report on a patient receiving treatment for severe burns, you perform your head-to-toe assessment. On
arrival to the patient’s room you note the room temperature to be 75’F. You will:
A. Decrease the temperature by 5-10 degrees to prevent hyperthermia.
B. Leave the temperature setting.
C. Increase the temperature to a minimum of 85’F.
The answer is C. pt.’s w/ severe burns can NOT regulate their temp. & are at risk for hypothermia. Room temp. should be a min. of 85℉.
28. You are about to provide care to a patient with severe burns. You will don:
A. gloves
B. goggles
C. gown
D. N-95 mask
E. surgical mask
F. shoe covers
G. hair cover
The answer is A, C, E, F, and G. Before providing care to a patient with severe burns the nurse would want to wear protective
isolation apparel like: gloves, gown, surgical mask, shoe covers, and hair cover. This protects the patient from potential infection.
29. While collecting a medical history on a patient who experienced a severe burn, which statement by the patient’s family
member requires nursing intervention?
A. “He takes medication for glaucoma”.
B. “I think it has been 10 years or more since he had a tetanus shot.”
C. “He was told he had COPD last year.”
D. “He smokes 2 packs of cigarettes a day.”
The answer is B. Patients who have had burns need a tetanus shot if they have not had a vaccine within the past 5 to 10 years.
30. A patient is presenting with bright red lips, headache, and nausea. The physician suspects carbon monoxide poisoning. As
the nurse, you know the patient needs:
A. Oxygen nasal cannula 5-6 Liters
B. 100% oxygen via non-rebreather mask
C. Continuous Bipap
D. Venturi mask 6 L oxygen
The answer is B. This is the treatment for carbon monoxide poisoning.
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