CBRN Infection Prevention & Critical Care Monitoring 2 — Questions and Answers
Question 1: Which organism is most commonly responsible for burn wound sepsis in the first 72 hours post-injury?
- Pseudomonas aeruginosa
- Staphylococcus aureus (Correct answer)
- Candida albicans
- Acinetobacter baumannii
Correct answer: Staphylococcus aureus
Gram-positive organisms, especially Staphylococcus aureus, predominate in the early post-burn period before gram-negative colonization occurs.
Question 2: A burn patient develops a temperature of 38.5°C on day 3. What is the most appropriate initial nursing action?
- Administer antipyretics immediately
- Obtain blood, wound, and urine cultures before starting antibiotics (Correct answer)
- Start broad-spectrum antibiotics empirically
- Apply cooling blankets
Correct answer: Obtain blood, wound, and urine cultures before starting antibiotics
Cultures must be collected before initiating antibiotics to identify the causative organism and guide therapy.
Question 3: What is the significance of a wound biopsy count exceeding 10^5 organisms per gram of tissue in a burn patient?
- It indicates superficial colonization only
- It predicts wound healing within 5 days
- It is the threshold associated with invasive burn wound infection (Correct answer)
- It requires immediate skin grafting
Correct answer: It is the threshold associated with invasive burn wound infection
A bacterial count >10^5 organisms per gram of tissue indicates invasive infection that can impede graft take and cause systemic sepsis.
Question 4: Which type of isolation is recommended for a burn patient with confirmed MRSA wound infection?
- Reverse (protective) isolation
- Contact precautions (Correct answer)
- Airborne precautions
- Droplet precautions
Correct answer: Contact precautions
Contact precautions, including gown and gloves, are required to prevent MRSA transmission via direct or indirect contact.
Question 5: A nurse observes that a burn patient's urine output has decreased to 0.3 mL/kg/hr. What does this most likely indicate?
- Adequate fluid resuscitation
- Impending acute kidney injury (Correct answer)
- Hypervolemia
- Normal diuretic phase response
Correct answer: Impending acute kidney injury
Urine output below 0.5 mL/kg/hr in a burn patient signals inadequate perfusion and risk of acute kidney injury requiring prompt intervention.
Question 6: Which antimicrobial agent is applied topically and is known to penetrate eschar most effectively?
- Silver sulfadiazine
- Bacitracin
- Mafenide acetate (Correct answer)
- Mupirocin
Correct answer: Mafenide acetate
Mafenide acetate (Sulfamylon) is the only topical agent that penetrates burn eschar, making it effective against deep infections.
Question 7: In a ventilated burn patient, which bundle element is most critical for preventing ventilator-associated pneumonia (VAP)?
- Daily sedation vacation and elevation of head of bed to 30–45° (Correct answer)
- Continuous nebulized antibiotics
- Routine bronchoscopy every 48 hours
- Keeping the cuff pressure below 15 cmH2O
Correct answer: Daily sedation vacation and elevation of head of bed to 30–45°
Daily sedation interruption combined with semi-recumbent positioning (30–45°) are core VAP bundle elements proven to reduce pneumonia incidence.
CBRN Infection Prevention & Critical Care Monitoring 2
Which organism is most commonly responsible for burn wound sepsis in the first 72 hours post-injury?