Nokea
The nurse caring for a patient who is recovering from full-thickness burns is aware of the patients risk for contracture and hypertrophic scarring. How can the nurse best mitigate this risk?
- A. Apply skin emollients as ordered after granulation has occurred.
- B. Keep injured areas immobilized whenever possible to promote healing.
- C. Administer oral or IV corticosteroids as ordered.
- D. Encourage physical activity and range of motion exercises.
Correct Answer: D
Rationale: Physical activity and range of motion exercises prevent contractures and hypertrophic scarring by maintaining joint mobility and reducing tissue shortening. Emollients and immobilization are not standard, and corticosteroids slow healing.
You may also like to solve these questions
A nurse has reported for a shift at a busy burns and plastics unit in a large university hospital. Which patient is most likely to have life-threatening complications?
- A. A 4-year-old scald victim burned over 24% of the body
- B. A 27-year-old male burned over 36% of his body in a car accident
- C. A 39-year-old female patient burned over 18% of her body
- D. A 60-year-old male burned over 16% of his body in a brush fire
Correct Answer: A
Rationale: Young children, like the 4-year-old, have higher morbidity and mortality risk due to physiological immaturity, making their burns more life-threatening despite smaller TBSA compared to adults.
A patient has experienced burns to his upper thighs and knees. Following the application of new wound dressings, the nurse should perform what nursing action?
- A. Instruct the patient to keep the wound site in a dependent position.
- B. Administer PRN analgesia as ordered.
- C. Assess the patients peripheral pulses distal to the dressing.
- D. Assist with passive range of motion exercises to set the new dressing.
Correct Answer: C
Rationale: Checking peripheral pulses ensures dressings are not too tight, preventing circulatory compromise. Dependent positioning is avoided, analgesia is given before dressing changes, and ROM exercises are not typically post-dressing.
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?
- A. Apply ice to the site of the burn for 5 to 10 minutes.
- B. Wrap the patients affected extremity in ice until help arrives.
- C. Apply an oil-based substance or butter to the burned area until help arrives.
- D. Wrap cool towels around the affected extremity intermittently.
Correct Answer: D
Rationale: Cool towels or water applied intermittently relieve pain and limit tissue damage without causing hypothermia, which ice can induce. Oil-based substances like butter trap heat, worsening the burn.
A nurse who provides care on a burn unit is preparing to apply a patients ordered topical antibiotic ointment. What action should the nurse perform when administering this medication?
- A. Apply the new ointment without disturbing the existing layer of ointment.
- B. Apply the ointment using a sterile tongue depressor.
- C. Apply a layer of ointment approximately 1/16 inch thick.
- D. Gently irrigate the wound bed after applying the antibiotic ointment.
Correct Answer: C
Rationale: A 1/16-inch layer of topical antibiotic ointment, applied with clean gloves after removing old ointment, ensures effective coverage. Old ointment is removed, tongue depressors are not standard, and irrigation follows application.
A nurse on a burn unit is caring for a patient in the acute phase of burn care. While performing an assessment during this phase of burn care, the nurse recognizes that airway obstruction related to upper airway edema may occur up to how long after the burn injury?
- A. 2 days
- B. 3 days
- C. 5 days
- D. 1 week
Correct Answer: A
Rationale: Upper airway edema from burns can develop up to 48 hours post-injury due to inflammation and fluid shifts, requiring vigilant monitoring. Later onset is less likely.