(Osborn) Chapter 68: Learning Outcomes (Number and Title)

[Osborn] chapter 68
Learning Outcomes [Number and Title ]

Learning Outcome 1
Differentiate between the three classifications of burn injury:
mild, moderate, and major
Learning Outcome 2
Compare and contrast the causes, incidence, prevalence, types,
and prevention of burn injuries.
Learning Outcome 3
Describe the pathophysiological response of burn injury at the
tissue and organ level.
Learning Outcome 4
Compare and contrast the three periods of burn care.
Learning Outcome 5
Describe the significance and components of burn severity
assessment, including size and depth of injury, impact of
patient's age on injury, part of the body burned, and past
medical history.
Learning Outcome 6
Describe the components of a comprehensive burn treatment
plan for each of the three periods of burn care, including fluid
resuscitation, pain management, wound care, surgical
management, contracture prevention, nutritional needs, and
emotional adjustment.
Learning Outcome 7
Describe the discharge teaching needed to facilitate an optimal
recovery and return to society.
Learning Outcome 8
Identify the potential complications associated with each period
of burn injury.
Osborn, et al., Test Item File for Medical-Surgical Nursing:

Preparation for Practice Copyright 2010 by Pearson Education,
Inc.
1. In order to determine the correct classification of a burn injury, it is essential to know:

Select all that apply.
1.
2.
3.
4.
5.
The history of the event and location where the injury occurred.
The time the injury occurred.
The causative agent and the duration of exposure.
Any concurrent injuries.
Location of burns on the body.
Correct Answer:
1. The history of the event and location where the injury occurred.
2. The time the injury occurred.
3. The causative agent and the duration of exposure.
4. Any concurrent injuries.
5. Location of burns on the body.
Rationale: The history of the event and location where the injury occurred. If the
injury occurred in an enclosed area, such as a house, there also may be inhalation injuries
that require special consideration and treatment. The time the injury occurred. Fluid
resuscitation calculations are based on the time of the injury as opposed to the time of
admission to the hospital. The causative agent and the duration of exposure. The
causative agent is especially important with chemical burns such as from strong acids or
alkaline agents, which may require neutralization to stop the ongoing burning effect. Any
concurrent injuries. Concurrent injuries, such as fractures, often are associated with
burns and require a treatment plan for stabilization. Location of burns on the body. The
location of the burns on the body is one of the important determinates of classification.
For example, burns of the face and hands are always considered major burns.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 1

Inc.
2. The nurse is admitting a 25-year-old client to the emergency department with partialthickness injuries over 20% of the total body surface area, involving both lower
legs. This injury is classified as:
1.
2.
3.
4.
A moderate burn.
A minor burn.
A major.
A severe burn.
Correct Answer: A moderate burn.

Rationale: A minor burn is a partial-thickness injury that is less than 15% of total body
surface area (TBSA) in adults. A moderate injury is a partial-thickness injury that is
between 15% and 25% of total body surface area in adults. The terms major and severe
burn are used interchangeably. They include all electrical injuries, inhalation injury,
complicated injuries (multiple trauma), high-risk clients such as older adults and those
with chronic illnesses, and all burns involving the ears, eyes, face, hands, feet, and
perineum. A major burn also is a partial-thickness injury that is greater than 25% of total
body surface area in adults and full-thickness injuries 10% or greater.
Cognitive Level: Analysis
LO: 1

Inc.
3. The nurse is admitting a client who has sustained partial-thickness injury of 28% of
total body surface area (TBSA) and full-thickness injury of 30% or greater of TBSA.
What is the classification of this burn injury?
1. Major
2. Moderate
3. Minor
4. Superficial
Correct Answer: Major
Rationale: Partial-thickness injuries of greater than 25% of total body surface area in
adults and full-thickness injuries 10% or greater of TBSA are considered major burns.
Partial-thickness injuries between 15% and 25% of total body surface area in adults and
full-thickness injuries greater than 10% of TBSA not involving the ears, eyes, face,
hands, feet, and perineum are moderate injuries. Partial-thickness injuries of less than
15% of total body surface area (TBSA) in adults and full-thickness injuries less than 2%
of TBSA not involving the ears, eyes, face, hands, feet, and perineum are considered
minor injuries.
LO: 1

Inc.
4. There has been a decline in burn injury deaths in the last two decades. The most
significant factor that impacted this decline is:
1. Early excision and closure of the burn wound.
2. Improved resuscitation.
3. Control of infection.
4. Support of the hypermetabolic response.
Correct Answer: Early excision and closure of the burn wound.
Rationale: The decline in the death rate from burn injuries is mostly attributed to early
excision and closure of the burn wound. Less significant reasons are improved
resuscitation, control of infection, and support of the hypermetabolic response.
LO: 2

Inc.
5. The depth of a radiation injury occurring from an industrial accident at a nuclear power
plant depends on:
1. How close the individual was to the source.
2. The length of time of exposure to the source.
3. The temperature of the source.
4. The entry and exit sites on the body.
5. The amount of steam produced.
Correct Answer:
1. How close the individual was to the source.
2. The length of time of exposure to the source.
Rationale: How close the individual was to the source. The depth of a radiation injury
depends on how close the individual was to the source. The length of time of exposure
to the source. The depth of a radiation injury also depends on the length of time of
exposure. The temperature of the source. The temperature of the source is related to
thermal and scald injuries. The entry and exit sites on the body. Entry and exit wounds
occur with electrical injuries. The amount of steam produced. Steam is related to scald
injuries.
LO: 2

Inc.
6. Radiation burns can result from overexposure during radiation treatments for cancer.
Which cells are most susceptible to this type of radiation injury?
Select all that apply
1. Bone marrow
2. Skin
3. Gastrointestinal tract
4. Muscle
5. Kidney
Correct Answer:
1. Bone marrow
2. Skin
3. Gastrointestinal tract
Rationale: Bone marrow. The cells most susceptible to injury are those that divide
rapidly, such as bone marrow cells. Skin. The cells most susceptible to injury are those
that divide rapidly, such as skin cells. Gastrointestinal tract. The cells most susceptible
to injury are those that divide rapidly, such as calls of the gastrointestinal tract. Muscle.
Muscle cells are not as susceptible because they do not divide as rapidly as cells of the
bone marrow, skin, and gastrointestinal tract. Kidney. Cells of the kidney are not as
susceptible because they do not divide as rapidly as cells of the bone marrow, skin, and
gastrointestinal tract.
LO: 2

Inc.
7. In
the outermost portion of the injured area, there is minor cell damage; this area is
referred to as the zone of hyperemia. What provides blood flow to the zone of
hyperthermia?
1. Vasoactive mediators
2. Fibrinolysis mediators
3. Coagulation mediators
4. Tissue mediators
Correct Answer: Vasoactive mediators

Rationale: Due
to the vasoactive mediators, there is prominent blood flow to the zone of

hyperthermia. Fibrinolysis mediators, coagulation mediators, and tissue mediators do not
provide increased blood flow to the zone of hyperthermia.
LO: 3

Inc.
8. Which of the following laboratory results would not be expected in the first 24 hours
after a major burn injury?
1. Potassium level of 3.0 mEq/L
2. Hematocrit of 48%
3. Hemoglobin 19 g/dL
4. Sodium 148 mEq/L
Correct Answer: Potassium level of 3.0 mEq/L
Rationale: Cell damage, which occurs due to the burn injury, causes the release of
intracellular potassium, which causes hyperkalemia. Therefore, the potassium level is
increased, not decreased, in the first 24 hours. It is normal to have an elevated hematocrit,
hemoglobin, and sodium due to dehydration and hemoconcentration.
LO: 3

Inc.
9. The nurse is admitting a 50-year-old female who was involved in a car accident whose
only injuries were burns over 50% of her body. Identify the highest-priority nursing
diagnosis for this client.
1. Deficient Fluid Volume
2. Acute Pain
3. Disturbed Body Image
4. Coping, family, compromised
Correct Answer: Deficient Fluid Volume
Rationale: Immediately after a burn injury, fluid begins to shift from the intracellular and
intravascular compartment into the interstitial space. This is commonly referred to as
third spacing of fluid and, if left untreated, will lead to hypovolemia and burn shock,
which is life threatening. Additionally, edema develops in unburned tissues and organs
distant from the site of injury when the burn size exceeds 20% of total body surface area.
Acute Pain, Disturbed Body Image, and Coping, family, compromised are all important
nursing diagnoses, but are not as critical as Deficient Fluid Volume at this time.
LO: 3

Inc.
10. During the immediate postburn period, the nurse assesses the client for injuries other
than burns. Which of the following assessments indicates a potential problem?
1.
2.
3.
4.
Coughing
Urine output of 30 ml/hour
Presence of eschar
Presence of edema
Correct Answer: Coughing

Rationale: Coughing could indicate either an inhalation injury or a cold. Urine output of
30 ml/hour is a normal finding. The presence of eschar and edema are normal
manifestations of burn injuries.
LO: 4

Inc.
11. During the acute phase of burn treatment, important goals of client care include:
1.
2.
3.
4.
5.
6.
Cleansing the wound.

Preventing loss of body heat through the wounds.
Providing for client comfort.
Preventing infection.
Providing adequate nutrition for healing to occur.
Splinting, positioning, and exercising affected joints.
Correct Answer:
1. Cleansing the wound.
2. Preventing loss of body heat through the wounds.
3. Providing for client comfort.
4. Preventing infection.
5. Providing adequate nutrition for healing to occur.
6. Splinting, positioning, and exercising affected joints.
Rationale: Cleansing the wound. The goals of treatment for the acute period include
wound cleansing and healing. Preventing loss of body heat through the wounds. The
goals of treatment for the acute period include preserving body heat. Providing for client
comfort. The goals of treatment for the acute period include pain relief. Preventing
infection. The goals of treatment for the acute period include preventing infection.
Providing adequate nutrition for healing to occur. The goals of treatment for the acute
period include promoting nutrition. Splinting, positioning, and exercising affected
joints. The goals of treatment for the acute period include splinting, positioning, and
exercising affected joints.
Nursing Process: Implementation
LO: 4

Inc.
12. During the acute period of burn care, the focus of care is to promote healing of fullthickness burn wounds. In order for this to occur, the wound must:
1. Be free of eschar.
2. Have decreased tissue perfusion.
3. Have the edema decreased with diuretics.
4. Be pain free.
Correct Answer: Be free of eschar.
Rationale: In order for the wound to heal, it must be free of the dead tissue that is a result
of burn injury. In order for a burn to heal it needs increased tissue perfusion to get the
nutrients needed for the healing process. Diuretics are not used to decease the edema. The
client will not be pain free until the wound is completely closed.
LO: 4

Inc.
13. The mortality rate for burns is highest in the very young and in the elderly population.
What factors put the very young at a higher risk?
1. Infants and young children have an immature immune system with a weak
antibody response.
2. The very young have a greater proportion of body surface area per amount
of body mass, resulting in a higher risk for fluid-volume loss.
3. The very young have an increased risk for the development of
hypovolemic shock.
4. In the very young, burns tend to exacerbate previous medical problems.
5. The very young tend to heal more slowly.
Correct Answer:
1. Infants and young children have an immature immune system with a weak
antibody response.
2. The very young have a greater proportion of body surface area per amount
of body mass, resulting in a higher risk for fluid-volume loss.
3. The very young have an increased risk for the development of
hypovolemic shock.
Rationale: Infants and young children have an immature immune system with a
weak antibody response. Infants and young children have an immature immune
system with a weak antibody response to infection and tend to die of septicemia.
The very young have a greater proportion of body surface area per amount
of body mass, resulting in a higher risk for fluid-volume loss. The very young
have greater proportion of body surface area per amount of body mass, and as a
result there is a higher risk for fluid-volume loss as compared to adults. The very
young have an increased risk for the development of hypovolemic shock. As a
result of a higher risk for fluid-volume loss, there is an increased risk for the
development of hypovolemic shock. In the very young, burns tend to
exacerbate previous medical problems. This is true of the elderly, not the very
young. The very young tend to heal more slowly. This is true of the elderly, not
the very young.
LO: 5

Inc.

Inc.
14. What factors decrease the rate of survival of burn injuries?

1.
2.
3.
4.
5.
Cardiac disease
Renal disease
Endocrine diseases
History of substance abuse
Age
Correct Answer:
1. Cardiac disease
2. Renal disease
3. Endocrine diseases
4. History of substance abuse
5. Age
Rationale: Cardiac and respiratory diseases. Previous cardiac disease increases the
mortality rate because the added insult of burn injury is overwhelming.
Stimulation of the sympathetic nervous system causes the release of
catecholamines (epinephrine and norepinephrine), increases systemic vascular
resistance, and thus increases cardiac workload. Renal disease. The hypovolemia
that occurs as a result of fluid shifts causes a decrease in renal blood flow and
filtration rates, which increases the risk for renal failure. There is a higher risk for
renal failure when any of the following is also present: dehydration, acidosis,
massive presence of necrotic tissue after third- and fourth-degree electrical and
chemical burns, hypercatabolic state, and/or shock. Renal failure increases the
mortality rate of burn injuries. Endocrine diseases. In the presence of endocrine
abnormalities such as diabetes, the added insult of a burn injury exacerbates the
disease and impacts wound healing and the immune response. These patients tend
to die from overwhelming infection. History of substance abuse. Preinjury status
is a major factor in an individuals ability to survive a burn injury. Age. The very
young and the elderly have higher mortality rates than a young adult with the
same percentage of burn injury. In the younger population (usually under 2 years
of age), there are two specific reasons for increased mortality. First, infants and
young children have an immature immune system with a weak antibody response
to infection and tend to die of septicemia. Second, the very young have a greater
proportion of body surface area per amount of body mass. As a result, there is a
higher risk for fluid-volume loss, requiring greater fluid resuscitation for total
percent burn as compared to adults. Therefore, there is an increased risk for the
development of hypovolemic shock. In the older population (over 60 years of

Inc.
age), burns tend to exacerbate previous medical problems such as cardiovascular

disease, renal insufficiency, diabetes, and chronic obstructive pulmonary disease.
This population tends to have decreased physiological reserves, which are needed
to respond to the stress of a burn injury; therefore, older adults are at a higher risk
for shock and multisystem organ failure. Additionally, the older population tends
to heal more slowly, resulting in a greater risk for the development of infection
and pneumonia.
LO: 5

Inc.
15. Escharotomies were performed on the arms of a client because of circumferential

burn injuries. The nurse's first priority assessment would be to assess the arms for:
1.
2.
3.
4.
Circulation in the extremity distal to the escharotomy.

Wound infection in the escharotomy site.
The extent of the clients ability to perform range-of-motion exercises.
The contracture formation.
Correct Answer: Circulation in the extremity distal to the escharotomy.

Rationale: Frequent monitoring of the circulation distal to the escharotomy site is part of
the ongoing nursing assessment and includes pulses, tissue color including
paleness and cyanosis, sensation, increased pain, capillary refill, and decreased
temperature. Often it is necessary to monitor circulation every 15 to 20 minutes.
Wound infection would not occur immediately; therefore is not the first priority.
Range of motion decreases as the wounds heal, not immediately. Contracture
formation occurs later, as the wounds heal.
LO: 5

Inc.
16. The purpose of meshing the donor skin for grafting is to:
1.
2.
3.
4.
Increase the size of the graft.

Improve the cosmetic effect.
Increase the rejection rate of the graft.
Increase the thickness of the graft.
Correct Answer: Increase the size of the graft.

Rationale: Meshing a graft means cutting holes in the harvested skin, which allows it to
be stretched over a greater surface area. The meshed skin graft can be increased
from two to nine times its original size, depending on the size of the holes.
Meshed skin grafts heal with the diamond pattern remaining for the rest of the
clients life, and therefore they are not as cosmetically pleasing as sheet grafts.
Mesh grafts have a decreased rejection rate. Meshing the graft does not increase
the thickness of the graft.
LO: 6

Inc.
17. After the dressing change, the client needs to be positioned in bed. Which of the
following measures would be inappropriate nursing care for reducing contractures?
1. Placing a pillow under the knee of a client with burns on the posterior
legs.
2. Splinting the affected extremity in a functional position.
3. Daily physical therapy and range-of-motion exercises.
4. Hyperextending the neck of a client with burns of the anterior chest and
neck.
Correct Answer: Placing a pillow under the knee of a client with burns on the posterior
legs.
Rationale: The correct position for the legs is to be hyperextended. Placing a pillow under
the legs would promote contracture formation. Splinting and daily physical therapy are
indicated for preventing contracture formation. Hyperextending the neck of a client with
burns of the anterior chest and neck will help decrease contracture formation.
Client Need: Safe, Effective Care Environment
LO: 6

Inc.
18. When caring for a burn client, the nurse knows that nutrition is essential for burn
wounds to heal. Which of the following nutrition plans would be ideal to increase wound
healing?
1. A daily balanced diet, high in calories and protein, additional 1.5calorie/cc liquid supplements, and vitamin replacement
2. A daily balanced diet that is high in calories and protein
3. A daily balanced diet, high in protein, and additional 1.5-calorie/cc liquid
supplements
4. A daily balanced diet, high in calories, additional 1.5-calorie/cc liquid
supplements, and vitamin replacement
Correct Answer: A daily balanced diet, high in calories and protein, additional 1.5calorie/cc liquid supplements, and vitamin replacement
Rationale: The diet must be high in calories and protein. Typically, food alone does not
supply the needed calories; therefore, supplementing with high-calorie drinks and
vitamins is necessary. Food alone, high-calorie drinks alone, and vitamins alone will not
provide adequate nutrients
LO: 6

Inc.
19. The nurse is preparing a client for discharge from the hospital following a major burn
injury. The nurse is developing a plan for his nutrition and understands that:
1. The hypermetabolic state continues until all the wounds are healed.
2. The hypermetabolic state is only present in the emergency and acute
periods of burn care.
3. No extra calories are necessary once discharged from the hospital.
4. The calorie intake should be decreased so as not to gain weight.
Correct Answer: The hypermetabolic state continues until all the wounds are healed.
Rationale: The hypermetabolic state continues until the burn wounds are completely
healed, which can take up to 12 to 18 months after the injury. Therefore, it is essential
that the client continue with increased calorie and vitamin intake after discharge from the
hospital. Decreasing calorie intake is inappropriate.
Cognitive Level: Evaluation
LO: 7

Inc.
20. List the factors that affect the grief reaction to a burn injury that a client faces on
discharge from the hospital.
1. Body image change
2. Loss of physical functioning
3. Potential change in vocation
4. Separation from home and family
5. Change in family role patterns
Correct Answer:
1. Body image change
2. Loss of physical functioning
3. Potential change in vocation
4. Separation from home and family
5. Change in family role patterns
Rationale: Body image change. The change in body image is the primary reason for the
grief response. Loss of physical functioning. Loss of psychical functioning impacts
many aspects of the grief reaction, such as change in vocation and change in family role
patters. Potential change in vocation. This is included in the grief response because it
poses a threat to financial independence. Separation from home and family. Recovering
from a major burn injury necessitates a prolonged hospitalization. This means separation
form loved ones, which causes grief. Change in family role patterns. A shift in family
role patterns, especially the bread-winner role, upsets family structure and is a factor in
the grief process.
LO: 7

Inc.
21. The nurse is teaching a burn client about the need for continued stretching exercises
after discharge from the hospital. The nurse knows that the client understands what is
necessary when he states:
1. Stretching exercises are used to elongate shortened soft tissue and
increase range of motion.
2. A progressive exercise program will not increase my overall stamina.
3. Blanching of the scar means I have stretched too far.
4. If I stretch, I dont need to use my splints.
Correct Answer: Stretching exercises are used to elongate shortened soft tissue and
increase range of motion.
Rationale: Stretching can be a passive or an active activity, and clients must learn to
perform self-stretching exercises as they prepare for discharge. The stretch should
be gentle, slow, and sustained. Blanching of the scar represents appropriate
stretch. Immediately after a stretching session, positioning and splinting are used
effectively to maintain the elongation of the tissue.
Nursing Process: Evaluation
LO: 7

Inc.
22. What factor would put the client at a risk for converting a partial-thickness injury to a
full-thickness injury?
1.
2.
3.
4.
Wound infection
Fluid overload
Kidney disease
Pneumonia
Correct Answer: Wound infection

Rationale: Infection, trauma, and a decreased blood supply increase the risk of a partialthickness injury converting to a full-thickness injury. Fluid overload, kidney disease, and
pneumonia are not specifically related to converting a partial-thickness injury to a fullthickness injury.
Nursing Process: Evaluation
LO: 8

Inc.
23. When the nurse is attempting to manipulate the burn client's environment to diminish
stress in order to promote wound healing, which of the following is not appropriate for a
burn client?
1.
2.
3.
4.
Keeping the room cool

Pain medication
Closing the curtains
Noise control
Correct Answer: Keeping the room cool

Rationale: Burn clients have ineffective thermoregulation related to epithelial skin loss.
Therefore, heat shields, warm blankets, and increased room temperature are methods
used to help maintain body temperature. Therefore, keeping the room cool is
inappropriate. Pain control, noise control, and closing the curtains would all be
therapeutic for a burn client.
LO: 8

Inc.
24. Which complication of burn injuries is common to all three periods of burn
management for a client with a major injury?
1. Psychological problems
2. Wound infection
3. Contractures
4. Stress ulcers
Correct Answer: Psychological problems
Rationale: Psychological problems span all three periods of burn recovery. The problems
begin with the initial realization of the critical nature of the injury in the emergency
period to the final realization of the permanent scarring. Wound infection occurs
primarily in the acute period. Contractures occur in the rehabilitative period, and stress
ulcers occur primarily in the emergency period.
LO: 8

Inc.

(Osborn) Chapter 68: Learning Outcomes (Number and Title)

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[Osborn] chapter 68

Learning Outcomes [Number and Title ]

Osborn, et al., Test Item File for Medical-Surgical Nursing:

1. In order to determine the correct classification of a burn injury, it is essential to know:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: A moderate burn.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Vasoactive mediators

to the vasoactive mediators, there is prominent blood flow to the zone of

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Coughing

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Cleansing the wound.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

14. What factors decrease the rate of survival of burn injuries?

Osborn, et al., Test Item File for Medical-Surgical Nursing:

age), burns tend to exacerbate previous medical problems such as cardiovascular

Osborn, et al., Test Item File for Medical-Surgical Nursing:

15. Escharotomies were performed on the arms of a client because of circumferential

Circulation in the extremity distal to the escharotomy.

Correct Answer: Circulation in the extremity distal to the escharotomy.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Increase the size of the graft.

Correct Answer: Increase the size of the graft.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Wound infection

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Keeping the room cool

Correct Answer: Keeping the room cool

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

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