TNCC Burn Management 3 — Questions and Answers
Question 1: A burn patient's urine output drops to 0.3 mL/kg/hr despite adequate fluid resuscitation. The most appropriate intervention is:
- Administer a diuretic to increase urine output
- Increase IV fluid rate to achieve target output of 0.5–1 mL/kg/hr (Correct answer)
- Restrict fluids to prevent pulmonary edema
- Obtain a renal ultrasound
Correct answer: Increase IV fluid rate to achieve target output of 0.5–1 mL/kg/hr
Target urine output for burn patients is 0.5–1 mL/kg/hr; inadequate output indicates under-resuscitation requiring increased fluid administration.
Question 2: Which electrolyte abnormality is most commonly seen in the first 24–48 hours following a major burn injury?
- Hypernatremia
- Hypokalemia
- Hyperkalemia (Correct answer)
- Hypercalcemia
Correct answer: Hyperkalemia
Cell lysis from burn injury releases intracellular potassium, causing hyperkalemia in the acute phase of major burns.
Question 3: A patient sustains a hydrofluoric acid burn to the hand. After copious irrigation, which specific treatment is required?
- Silver sulfadiazine dressing
- Calcium gluconate gel application (Correct answer)
- Sodium bicarbonate soaks
- Immediate skin grafting
Correct answer: Calcium gluconate gel application
Hydrofluoric acid causes systemic fluoride toxicity and hypocalcemia; calcium gluconate neutralizes fluoride ions and is the antidote.
Question 4: When transferring a major burn patient, which criterion from the American Burn Association meets criteria for transfer to a burn center?
- Superficial burns greater than 5% TBSA in an adult
- Partial-thickness burns greater than 10% TBSA (Correct answer)
- Any burn requiring a dressing change
- Full-thickness burns less than 1% TBSA without complications
Correct answer: Partial-thickness burns greater than 10% TBSA
The ABA recommends burn center transfer for partial-thickness burns >10% TBSA, among other criteria including full-thickness burns and special area involvement.
Question 5: In a burn patient with suspected cyanide poisoning from smoke inhalation, what is the recommended antidote?
- N-acetylcysteine
- Hydroxocobalamin (Correct answer)
- Sodium thiosulfate alone
- Amyl nitrite inhalation
Correct answer: Hydroxocobalamin
Hydroxocobalamin (Cyanokit) is the preferred antidote for cyanide poisoning in burn patients as it does not cause methemoglobinemia unlike nitrite-based antidotes.
Question 6: Which topical agent is contraindicated in burn patients with sulfonamide allergy?
- Bacitracin ointment
- Silver sulfadiazine (Silvadene) (Correct answer)
- Mafenide acetate (Sulfamylon)
- Petroleum gauze
Correct answer: Silver sulfadiazine (Silvadene)
Silver sulfadiazine contains a sulfonamide component and is contraindicated in patients with sulfa drug allergies.
Question 7: A child presents with scald burns in a stocking-glove distribution with clear demarcation and no splash marks. The nurse should prioritize:
- Immediate IV fluid resuscitation per Galveston formula
- Documenting and reporting suspected non-accidental trauma (Correct answer)
- Applying silver sulfadiazine and arranging outpatient follow-up
- Transferring immediately to the burn center
Correct answer: Documenting and reporting suspected non-accidental trauma
Symmetric, sharply demarcated scald burns without splash marks in a stocking-glove pattern are classic signs of forced immersion and non-accidental trauma in children.
TNCC Burn Management 3
A burn patient's urine output drops to 0.3 mL/kg/hr despite adequate fluid resuscitation.
The most appropriate intervention is: