adult health

Question 1

Total body surface area (TBSA)

Answer 1

burned is calculated using the rule of 9s: 36% torso, 18% each leg, 9% each
arm, 9% head, and 1% genitalia.

Question 2

Burns

Answer 2

Singed nasal hair and hoarse voice indicate inhalation injury. Administer 100% oxygen via
face mask and anticipate intubation.

Question 3

Burns

Answer 3

In the emergent phase, giving isotonic IV fluids
is the priority intervention to treat hypovolemia.
Perfusion is adequate if the client has a urine
output ≥30 mL/hr, pulse <120, and SBP ≥90.

Question 4

Burns

Answer 4

Do not administer PO, IM, or SQ medications to burn clients. Administer medications via IV only.

Question 5

Burns

Answer 5

1 priority for carbon monoxide poisoning is 100% oxygen via face mask, even if pulse oximetry is normal.

Question 6

Chemical burns

Answer 6

Chemical burns occur when corrosive substances (drain
cleaner, ammonia) come into contact with the skin or eyes.
Interventions:
#1 priority if the client is stable = brush off chemicals and remove contaminated clothing.
Flush skin or eyes with water

Question 7

Debridement
Removal of
necrotic tissue to
promote healing

Answer 7

Administer analgesics
before debridement.
Apply topical antimicrobials
to reduce infection risk.

Question 8

Skin graft
Autograft:
Client’s skin
Allograft:
Donor skin

Answer 8

Monitor for graft infection
or rejection (odor, dusky
appearance).

Question 9

2nd
degree

Superficial
Partial
Thickness
(Dermis)

Answer 9

Moist, weeping, blisters
Pink to red
Severe pain

Question 9

1st
degree

Superficial
(Epidermis)

Answer 9

Dry
Pink to red
Mild swelling
and pain

Question 10

Deep Partial
Thickness
(Deep Dermis)

Answer 10

Waxy and dry with
blisters that rupture easily
White to red
Severe pain

Question 11

3rd & 4th
degree

Full Thickness
(Hypodermis)

Answer 11

Dry and elastic
Waxy white to black
No pain (from damaged
nerve endings)