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WorksheetsCBRN Practice Questions 2
Total questions: 50
Worksheet time: 23hrs 2mins
When responding to the scene of a house fire with multiple burn patients, the initial priority is:
Ensuring scene safety
Appropriately triaging patients
Moving patients away from heat and smoke
Establishing a definitive airway on all patients
Two major goals of pre-hospital care with burned patients include stopping the burning process and:
Reducing infection by keeping burned areas covered
Facilitating removal of carbonaceous soot in the airways
Reducing secondary injury through treatment of burn shock
Determining accurate total body surface area burned to facilitate fluid resuscitation
Determination of burn size and depth should be carried out:
Prior to the primary assessment
Between the primary and secondary assessment
During the secondary assessment
Following the secondary assessment
Burns over major joints should result in:
Early escharotomies
Transfer to a burn center
Application of pressure dressings
Less aggressive fluid resuscitation
A 50-year-old patient has partial and full thickness burns circumferentially from the diaphragm to the knees. The lower legs, chest, upper back, head and arms are unaffected. Using the Rule of Nine's, what percentage of the body surface area is burned?
28%
37%
45%
53%
A patient sustains deep burns circumferentially to the complete surface of one hand (from the crease of the wrist to the tip of the fingers). What is the total body surface area burned?
1%
2%
3%
4%
An adult patient, weighing 78 kg, is transported to the burn center immediately after sustaining burns to 36% of the body. How much fluid should be administered in the first hour if utilizing the modified Brooke formula?
234 mL
351 mL
468 mL
702 mL
An adult patient, weighing 62 kg, arrives at the burn center two hours after sustaining superficial burns to 15% of the body, partial thickness burns to 40% of the body and full thickness burns to 28% of the body. The patient receives 1500 mL of fluid prior to arrival. How much fluid should be administered in the first hour if utilizing the Parkland burn formula?
698 mL
866 mL
1155 mL
1465 mL
Which of the following parameters must be known to utilize the Shriner's Cincinnati burn formula?
Hematocrit
Time of Burn
Patient Height
Mean Arterial Pressure
The use of large volumes of normal saline in resuscitation of the burn patient is known to cause which of the following complications?
A-Fib
Hypermagnesemia
Hyperchloremic acidosis
Decreased prothrombin time
A patient sustains partial and full thickness burs over 68% of the body surface area and the Parkland burn formula is used to calculate an estimated hourly fluid requirement of 1000 mL. By the fourth hour after the burn, the patient's urinary output is less than 30 mL/kg and the fluid rate is increased accordingly. This continues for several hours. Which of the following factors would indicate that a colloid such as albumin should be added to the resuscitation?
The patient's generalized edema visually increases
The patient's urinary output increases to 100 mL/hour
The patient's urine has turned to a reddish-brown color
The patient is receiving more than 200 mL per hour of crystalloid solution
Vasopressors are utilized in the treatment of a burned patient in which of the following scenarios?
A reduced cardiac output with indications of normal intravascular
A low blood pressure with indications of inadequate intravascular volume
A normal cardiac output with indication of inadequate intravascular volume
A low blood pressure despite the patient already receiving the calculated hourly fluid volume
Albumin is most likely to be considered in the treatment of a burn patient in which of the following scenarios?
Along with crystalloids in the initial resuscitation of all pediatric patients weighing less than 20 kg
To replace crystalloid intravenous solutions in patients who have received more than
20, 000 mL if crystalloids
As the initial resuscitation fluid for partial and full thickness burns that cover more than 65% of the body surface area
To augment crystalloid resuscitation in patients who remain hypotensive more than 12 hours after the initial burn
A patient is being resuscitated for significant burns to the body from the waist up. The airway has been secured and the patient is being mechanically ventilated. Fluid resuscitation has commenced utilizing an appropriate burn formula calculation. Which of the following interventions would constitute a priority at this time?
initiate warming measures
obtaining arterial blood gases
assessing the depth of the burns
measuring compartment pressures
Oxygen saturations are likely to be lowest in a patient with:
Cyanide poisoning
Hydrofluoric acid burn
Hydrocarbon exposure
Carbon monoxide intoxication
A patient weighs 60 kilograms. According to the Ivy index, what is the maximum amount of fluid the patient should receive in the 24 hours after the burn?
5 liters
10 liters
15 liters
20 liters
A patient, weighing 65 kg has received 15,000 mL of fluid within 20 hours of being burned. The amount of fluid administered is based on calculations using a burn resuscitation formula and then adjusting that amount based on urinary output and hemodynamic status. Which of the following parameters is most likely to be elevated in this scenario?
Hematocrit
Pupil reactivity
Bladder pressure
Serum amylase level
Which of the following findings may indicate that a patient with significant torso burns may require escharotomies?
A decrease in the patient's pulse rate
An increase in plasma seepage from burn wounds
High pressure alarms begin sounding on the ventilator
The appearance of crackles when auscultating the chest
A patient reports to the ED covered in an unknown dry white powder that the patient states is causing intense burning of his skin. The skin underneath the powder appears reddened. What is the priority intervention for this patient?
Relocate the patient to the decontamination area, remove all clothing and jewelry and attempt to brush off all the powder
Place the patient in the ED resuscitation area, brush the white powder off all exposed skin and initiate intravenous access
Relocate the patient to the decontamination area, remove his clothing and immediately began flushing him with copious amounts of water
Place the patient in the ED resuscitation area, administer oxygen via non-rebreather masks and contact poison control to determine the most appropriate neutralizing agent
Which of the following parameters should increase with successful treatment for abdominal compartment syndrome?
Tidal volume
Central venous pressure
Systemic vascular resistance
Pulmonary artery wedge pressures
A patients PaO2:FIO2 ratio is calculated as 250. This value:
Is normal
Indicates mild acute respiratory distress syndrome
Is consistent with moderate acute respiratory distress syndrome
Is a sign of severe acute respiratory distress syndrome
When managing a mechanically ventilated patient with acute respiratory distress syndrome, increasing which of the following ventilator settings is most likely to improve the patient's arterial blood gases?
FiO2
Tidal volume
Respiratory rate
Peak and expiratory pressure
Mineral oil is most likely to be used in treatment of which of the following scenarios?
Burns secondary to exposure to tar
Chemical burns caused by alkali substances
Surface burns secondary to electrical current
Deep partial thickness and full thickness burns
Which of the following activities carries the highest priority when caring for a patient with burns in the pre-hospital arena?
Remove all jewelry
Initiate cardiac monitoring
Palpate the head for deformities
Measure oxygen saturation levels
A patient sustains full thickness (third degree) burns to 20% of the body surface area, deep partial thickness burns (second degree) to 20% of the body surface area, superficial partial thickness burns (second degree) to 20% of the body surface area and superficial burns (first degree) to 20% of the body surface area. When calculating the total body surface area burn to determine the amount of fluid resuscitation required, what percentage of body surface area burn should be utilized?
20%
40%
60%
80%
Which of the following medications are used to manage inhalation injury?
Insulin
Heparin
Phenytoin (Dilantin)
Propranolol (Inderal)
After sustaining significant partial and full thickness burns in a fire, a patient jumped several stories to escape the heat, sustaining bilateral fractures of the legs. Which of the following complications is associated with the fractures?
Hypovolemia
Hyperkalemia
Rhabdomyolysis
Abdominal compartment syndrome
Calcium-infused gel is applied to the skin of a patient who was exposed to hydrofluoric acid. Which of the following findings would be expected after this intervention?
The gel will turn a white color
Increase generalized flushing of the skin
The patient's pain will temporarily increase
The patient's level of consciousness will increase
Which of the following findings is most likely to appear 12 hours after ingestion of a chemical substance?
Heart blocks
Elevated creatinine kinase levels
Petechial rash on the trunk and thighs
Subcutaneous emphysema of the neck and chest
The ideal temperature for water used to decontaminate patients exposed to chemical is:
Cold
Cool
Tepid
Hot
Which of the following activities takes place in the "warm zone" of a decontamination area?
Removal of a patient's clothing
Wound care for obvious skin burns
Decontamination with soap and water
Application of warm blankets to prevent hypothermia after decontamination
Which of the following laboratory values can be used to help determine the effectiveness of fluid resuscitation after a burn?
Hematocrit
PaCO2 levels
Platelet count
Carboxyhemoglobin level
Life threatening arrhythmias are more common in which of the following electrical burns?
Any burn involving either the head or face
Burn wounds are noted on the left arm and the left foot
Burn wounds are noted on the right arm and the right foot
Burn wounds are noted on both left arm and the right arm
The need for aggressive fluid resuscitation to combat burn shock elevates the likelihood of:
Sepsis
Intubation
Hypoglycemia
Hypertrophic Scarring
A patient with known dependence on heroin who frequently uses the drug is admitted to the burn unit for inpatient care burns. When this when should the burn team expect the symptoms of withdrawal to first occur if the patient used heroin shortly before arriving in the burn unit?
1 hour
6 hours
24 hours
72 hours
Fluid resuscitation for patients with toxic epidermal necrolysis:
Is usually unnecessary
Should be based on hemodynamic parameters
Should be judicious due to the risk of pulmonary edema
Is based on fluid resuscitation formulas such as the Parkland burn formula
Which of the following complications is most likely in a patient with a friction injury covering more than 25% of the body surface?
Hypothermia
Dysrhythmias
Hypercalcemia
Compartment syndrome
Thrombolytics are used in the treatment of a patient with severe frostbite. At what time after the injury will it most will it be most effective?
4 hours
72 hours
1 week
2 months
A patient arrives in the burn center with third degree frostbite to all four extremities what is the priority of care while awaiting rewarming?
Administer intravenous analgesia
Gently massaged affected areas
Began fluid resuscitation based on fluid resuscitation formulas
Have the patient continually move affected extremities until rewarming efforts begin
The fluid inside the blisters of a third-degree frostbite will be:
Clear
Milky
Green
Hemorrhagic
A patient, who is 22 weeks pregnant, sustains partial and full thickness burns over 35% of the body. Wound debridement should:
Proceed as though the patient were not pregnant
Be carried out in a smaller increments over several days to decrease fetal stress
Be done as soon after the burn as possible to reduce the incidence of fetal demise
Be deferred until the fetus is 24 weeks gestation to increase the chance of survival
Tocolytic therapy is initiated on a pregnant patient with burns. What else is likely to be delivered with this treatment?
Calcium
Propranolol
Corticosteroids
Packed red blood cells
One method of determining the onset of premature contractions in the unconscious pregnant patient with burns is:
Abdominal palpation
Inspection of pelvis
Ultrasound of the abdomen
Monitoring for six cyclical changes in maternal blood pressure
A patient who is 37 weeks pregnant becomes apneic following an inhalation injury and requires bag-mask ventilation while awaiting intubation. The burned nurse knows that because this patient is pregnant:
Greater resistance will be noted when compressing the bag-mask device
The oxygen flow rate should be reduced to 8 Liters/minute to decrease oxygen toxicity in the fetus
The head of the bed should be elevated 30° to compensate for the increased size of the uterus
The rate of bag bag-mask ventilation should be about 4 breaths-per-minute slower to allow for a longer exhalatory phase
Which of the following findings would be used to calculate a FLACC pain scale score?
An infant’s skin color is flushed
Quivering of the patient's chin is noted
An infant spits out a pacifier when it is offered to them
An Infant’s systolic pressures 20 mm Hg above the normal for that child's age
A pediatric patient weighing 40 kg is being resuscitated using the Shriner’s Cincinnati burn formula. What is the minimal urinary output that would indicate the amount of fluid being administered is adequate?
0.5 mL/kg/hour
1.0 mL/kg/hour
2.0 mL/kg/hour
5.0 mL/kg/hour
A six-year-old child requires intubation following a burn. What size endotracheal tube should be utilized?
3.5
4.5
5.5
6.5
One indication that a burn is intentional rather than accidental is:
Asymmetrical burns involving the head and torso
Greater involvement of the posterior surfaces compared to the anterior surfaces
Lack of burns in the popliteal space despite burns on the rest of the lower body
The presence of blisters in the center of the burn back but lack of blistering to the peripheral areas of the burn
The hands of a patient with second degree frostbite have been thawed. What type of dressing should be applied at this point?
A loose-fitting dry gauze wrap dressing
Gauze soaked in saline cover with dry absorbent dressings
Dry gauze protective layer followed by splinting in anatomical position
Antibiotic impregnated gauze covered with an elastic wrap bandage
A patient with frostbite who presents with fluid filled blisters over reddened tissue complaining of decreased sensation should be suspected of having what degree of frostbite?
First degree
Second degree
Third degree
Fourth degree
