CBRN Infection Prevention & Critical Care Monitoring 4 — Questions and Answers
Question 1: A patient with a 40% TBSA burn develops candidal wound colonization. Which antifungal topical agent is most commonly used?
- Fluconazole cream
- Nystatin powder (Correct answer)
- Clotrimazole ointment
- Amphotericin B lotion
Correct answer: Nystatin powder
Nystatin powder is the preferred topical antifungal for burn wound candidal colonization because it is well tolerated and does not interfere with wound care.
Question 2: During a dressing change, the nurse notes green discoloration and a fruity odor from a burn wound. Which pathogen is most likely responsible?
- Klebsiella pneumoniae
- Pseudomonas aeruginosa (Correct answer)
- Escherichia coli
- Proteus mirabilis
Correct answer: Pseudomonas aeruginosa
Pseudomonas aeruginosa produces pyocyanin, causing characteristic blue-green wound discoloration, and secretes enzymes that produce a fruity (grape-like) odor.
Question 3: What is the primary reason burn nurses use strict sterile technique rather than clean technique during wound debridement?
- Sterile technique is hospital policy only
- Burn wounds lack skin barrier, making them highly susceptible to exogenous contamination (Correct answer)
- Sterile technique accelerates healing by reducing inflammation
- Clean technique is reserved for chronic wounds only
Correct answer: Burn wounds lack skin barrier, making them highly susceptible to exogenous contamination
Absence of the skin barrier in burn wounds creates a direct portal for microorganism entry, necessitating sterile technique to prevent infection.
Question 4: A burn patient's morning labs show WBC 2,800 cells/µL (down from 18,000 yesterday). What does this leukopenia suggest?
- Successful treatment of infection
- Bone marrow suppression or overwhelming sepsis (Correct answer)
- Normal inflammatory resolution
- Steroid therapy effect
Correct answer: Bone marrow suppression or overwhelming sepsis
A sudden drop in WBC to leukopenic levels in a burn patient is an ominous sign indicating bone marrow suppression from overwhelming sepsis or severe systemic illness.
Question 5: Which monitoring interval is recommended for blood glucose in critically ill burn patients receiving insulin infusions?
- Every 15–30 minutes during titration, then every 1–2 hours when stable (Correct answer)
- Every 6 hours regardless of infusion rate
- Once per shift
- Only if symptoms of hypoglycemia appear
Correct answer: Every 15–30 minutes during titration, then every 1–2 hours when stable
Frequent glucose monitoring every 1–2 hours (or every 15–30 min when adjusting doses) is required to prevent hypoglycemia while achieving glycemic targets.
Question 6: A nurse caring for a burn patient notices the thermostat in the room is set to 28°C (82°F). What is the rationale for this elevated ambient temperature?
- To reduce patient anxiety
- To minimize evaporative heat loss and decrease metabolic demand (Correct answer)
- To promote bacterial growth suppression
- To improve staff comfort during procedures
Correct answer: To minimize evaporative heat loss and decrease metabolic demand
Burn patients lose massive amounts of heat through evaporation from open wounds; maintaining a warm environment reduces metabolic demand and hypothermia risk.
Question 7: Which laboratory finding is most consistent with early disseminated intravascular coagulation (DIC) in a burn patient?
- Elevated fibrinogen and platelet count
- Prolonged PT/PTT, decreased fibrinogen, and thrombocytopenia (Correct answer)
- Isolated thrombocytosis with normal coagulation
- Elevated D-dimer with normal PT/PTT
Correct answer: Prolonged PT/PTT, decreased fibrinogen, and thrombocytopenia
DIC is characterized by consumption of clotting factors and platelets, resulting in prolonged PT/PTT, decreased fibrinogen, and low platelet counts.
CBRN Infection Prevention & Critical Care Monitoring 4
A patient with a 40% TBSA burn develops candidal wound colonization.
Which antifungal topical agent is most commonly used?