TNCC Burn and Thermal Trauma 1 — Questions and Answers
Question 1: When using the Rule of Nines to estimate total body surface area (TBSA) burned in an adult, what percentage is assigned to the entire head and neck?
- 9% (Correct answer)
- 18%
- 4.5%
- 1%
Correct answer: 9%
In adults, the Rule of Nines assigns 9% of total body surface area to the head and neck combined.
Question 2: A burn wound that is moist, blistered, and extremely painful with a red or pink base is classified as which type?
- Superficial (first-degree) burn
- Superficial partial-thickness (second-degree) burn (Correct answer)
- Deep partial-thickness burn
- Full-thickness (third-degree) burn
Correct answer: Superficial partial-thickness (second-degree) burn
Superficial partial-thickness burns involve the epidermis and superficial dermis, presenting with blisters, moisture, and intense pain due to exposed nerve endings.
Question 3: Using the Parkland formula, how much Lactated Ringer's should be administered in the first 8 hours after injury for a 70 kg patient with 30% TBSA burns?
- 2,100 mL
- 4,200 mL (Correct answer)
- 8,400 mL
- 6,300 mL
Correct answer: 4,200 mL
The Parkland formula (4 mL × kg × %TBSA) gives 8,400 mL total; half is given in the first 8 hours from time of injury, equaling 4,200 mL.
Question 4: What is the highest priority intervention when managing a patient with facial burns, singed nasal hairs, and hoarseness?
- Initiating IV access and beginning fluid resuscitation
- Calculating the total body surface area burned
- Securing the airway with early endotracheal intubation (Correct answer)
- Applying cool water to burned facial areas
Correct answer: Securing the airway with early endotracheal intubation
Singed nasal hairs and hoarseness indicate inhalation injury; early intubation is critical because progressive airway edema can make later intubation impossible.
Question 5: A patient rescued from a house fire presents with headache, nausea, and confusion but has a pulse oximetry reading of 99%. Which explanation is most accurate?
- The patient is hyperventilating and is not hypoxic
- Standard pulse oximetry cannot differentiate carboxyhemoglobin from oxyhemoglobin, yielding a falsely normal reading (Correct answer)
- The confusion is caused by pain and not carbon monoxide
- A normal SpO2 rules out significant carbon monoxide poisoning
Correct answer: Standard pulse oximetry cannot differentiate carboxyhemoglobin from oxyhemoglobin, yielding a falsely normal reading
Pulse oximetry measures light absorption but cannot distinguish carboxyhemoglobin from oxyhemoglobin, so readings appear falsely normal despite significant CO poisoning.
Question 6: A patient with chemical burns from a strong acid should receive which immediate decontamination treatment?
- Application of a neutralizing alkaline agent to the skin
- Copious water irrigation for a minimum of 15–30 minutes (Correct answer)
- Application of baking soda paste to neutralize the acid
- Dry brushing to mechanically remove the chemical
Correct answer: Copious water irrigation for a minimum of 15–30 minutes
Copious water irrigation is the standard immediate treatment for chemical burns; neutralizing agents can cause exothermic reactions and worsen the injury.
Question 7: A patient with circumferential full-thickness burns of the chest has increasing respiratory distress with rising peak airway pressures. What intervention should the trauma nurse anticipate?
- Administration of nebulized bronchodilators
- Application of silver sulfadiazine dressings to the chest
- Chest escharotomy to release the constrictive eschar (Correct answer)
- Needle decompression for tension pneumothorax
Correct answer: Chest escharotomy to release the constrictive eschar
Circumferential full-thickness chest burns create rigid eschar that restricts chest wall expansion; escharotomy relieves constrictive pressure and restores ventilatory capacity.
TNCC Burn and Thermal Trauma 1
When using the Rule of Nines to estimate total body surface area (TBSA) burned in an adult, what percentage is assigned to the entire head and neck?