CBRN Infection Prevention & Critical Care Monitoring 3 — Questions and Answers
Question 1: A burn patient on total parenteral nutrition (TPN) develops a fever and erythema around a central line site. What is the priority nursing intervention?
- Slow the TPN infusion rate
- Remove and culture the central line per protocol (Correct answer)
- Administer vancomycin through the existing line
- Apply topical antibiotic ointment to the site
Correct answer: Remove and culture the central line per protocol
Suspected catheter-related bloodstream infection requires removal of the central line and culture of the tip to guide antibiotic therapy.
Question 2: What does a rising serum procalcitonin level specifically indicate in a burn patient?
- Hypovolemia
- Bacterial infection or sepsis (Correct answer)
- Adrenal insufficiency
- Fungal colonization
Correct answer: Bacterial infection or sepsis
Procalcitonin rises significantly in response to bacterial infections and is a useful biomarker for sepsis in burn patients despite the confounding effect of burns on other inflammatory markers.
Question 3: When assessing a burn patient for signs of sepsis using the American Burn Association criteria, which parameter is NOT part of the definition?
- Temperature >39°C or <36.5°C
- Progressive tachycardia >110 bpm
- Blood glucose >200 mg/dL in a non-diabetic patient
- Arterial pH >7.45 (Correct answer)
Correct answer: Arterial pH >7.45
The ABA sepsis criteria include temperature extremes, tachycardia, tachypnea, thrombocytopenia, hyperglycemia, and inability to continue enteral feeds—alkalosis is not a criterion.
Question 4: Which electrolyte abnormality is most frequently monitored in burn patients receiving silver nitrate soaks?
- Hypernatremia
- Hypochloremia and hyponatremia (Correct answer)
- Hyperkalemia
- Hypercalcemia
Correct answer: Hypochloremia and hyponatremia
Silver nitrate is hypotonic and leaches sodium and chloride from wounds, requiring frequent monitoring and replacement of these electrolytes.
Question 5: A burn patient's SpO2 reads 98% but the patient appears cyanotic with a suspected inhalation injury. What explains this discrepancy?
- Equipment malfunction
- Pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin (Correct answer)
- The patient has polycythemia
- The reading reflects venous oxygen saturation
Correct answer: Pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin
Standard pulse oximetry reads carboxyhemoglobin as oxyhemoglobin, giving falsely normal readings in carbon monoxide poisoning; co-oximetry or ABG is required.
Question 6: What is the recommended hand hygiene technique upon leaving a burn patient's room?
- Alcohol-based hand rub only
- Soap and water only, then alcohol rub
- Either soap and water or alcohol-based rub is acceptable unless C. diff is suspected (Correct answer)
- No additional measures beyond standard glove use
Correct answer: Either soap and water or alcohol-based rub is acceptable unless C. diff is suspected
Alcohol-based hand rub is effective for most pathogens; soap and water is mandatory when Clostridioides difficile or visible soiling is present.
Question 7: Which invasive monitoring parameter best reflects preload and guides fluid resuscitation adequacy in a mechanically ventilated burn patient?
- Central venous pressure (CVP) alone
- Pulse pressure variation (PPV) in a sedated, fully ventilated patient (Correct answer)
- Mean arterial pressure (MAP)
- Body weight change over 24 hours
Correct answer: Pulse pressure variation (PPV) in a sedated, fully ventilated patient
Pulse pressure variation is a dynamic preload indicator that accurately predicts fluid responsiveness in mechanically ventilated patients without spontaneous breaths.
CBRN Infection Prevention & Critical Care Monitoring 3
A burn patient on total parenteral nutrition (TPN) develops a fever and erythema around a central line site.
What is the priority nursing intervention?