Welcome future nurses. Let’s get started on Burn NCLEX Questions
Question A nurse is assessing a patient who has sustained a chemical burn from a spill of sodium hydroxide. Which of the following actions should the nurse prioritize?
A) Applying a neutralizing agent to the burn
B) Covering the burn with a sterile, dry dressing
C) Initiating intravenous (IV) access for fluid resuscitation
D) Flushing the affected area with large amounts of water
E) Administering pain medication
Correct Answer: D) Flushing the affected area with large amounts of water
Rationale: In the event of a chemical burn, immediate flushing of the area with large amounts of water is crucial to dilute and remove the chemical, potentially reducing the severity of the burn. Applying a neutralizing agent can cause a chemical reaction that might worsen the injury. While covering the burn, initiating IV access, and administering pain medication are important steps, they follow initial decontamination to prevent further chemical injury.
Question Which personal protective equipment (PPE) is most important for a healthcare provider to wear when treating a patient with chemical burns to prevent secondary contamination?
A) Gloves
B) Goggles
C) Face shield
D) Gown
E) All of the above
Correct Answer: E) All of the above
Rationale: When treating a patient with chemical burns, healthcare providers must wear comprehensive personal protective equipment (PPE) to prevent secondary contamination. This includes gloves to protect the hands, goggles and a face shield to protect the eyes and face, and a gown to protect the skin and clothing. Each piece of PPE serves a critical role in ensuring the safety of the healthcare provider while providing care.
Question A patient arrives in the emergency department with a chemical burn on the arm caused by an industrial acid. After decontamination, what is the next most appropriate step in management?
A) Apply a cold compress to the burn area
B) Assess the patient’s tetanus immunization status
C) Administer a broad-spectrum antibiotic
D) Apply a thick layer of petroleum jelly on the burn
E) Measure the patient’s range of motion in the affected arm
Correct Answer: B) Assess the patient’s tetanus immunization status
Rationale: Following decontamination of a chemical burn, it is important to assess the patient’s tetanus immunization status, as burns can serve as entry points for tetanus bacteria. Cold compresses, while soothing, are not a priority in chemical burn management. Antibiotics are not immediately necessary unless there is evidence of infection. Petroleum jelly can trap heat and chemicals, potentially worsening the injury. Assessing range of motion is important for long-term management but not immediately following decontamination.
Question When providing education to a community group about chemical safety, which of the following is the most important advice to prevent chemical burns?
A) Wear protective clothing when handling chemicals
B) Keep chemicals in their original containers
C) Read and follow the instructions on chemical labels
D) Know the location of the nearest eye wash station
E) Store chemicals in a secure, locked cabinet
Correct Answer: C) Read and follow the instructions on chemical labels
Rationale: Reading and following the instructions on chemical labels is critical for the safe handling and use of chemicals, as this ensures that individuals are aware of the specific hazards and safety precautions associated with each chemical. While wearing protective clothing, keeping chemicals in their original containers, knowing the location of eye wash stations, and storing chemicals securely are important safety measures, adherence to the instructions on labels addresses a broad range of safety concerns, including the prevention of chemical burns.
Question A nurse is caring for a patient with a severe chemical burn who is showing signs of systemic toxicity. Which of the following symptoms would indicate systemic involvement?
A) Localized pain at the site of the burn
B) Redness and swelling of the burn area
C) Difficulty breathing
D) Formation of blisters at the burn site
E) Increased local temperature
Correct Answer: C) Difficulty breathing
Rationale: Systemic toxicity from chemical burns can manifest as symptoms beyond the local effects of the burn, such as difficulty breathing, which may indicate respiratory involvement or systemic absorption of the chemical. Localized pain, redness, swelling, blister formation, and increased temperature are common local reactions to chemical burns but do not necessarily indicate systemic involvement. Difficulty breathing requires immediate medical attention to address potential complications.
Question In the case of a chemical eye burn, what is the FIRST step a healthcare provider should take?
A) Check the pH of the eye
B) Start antibiotic eye drops
C) Flush the eye with saline or water for at least 15-20 minutes
D) Cover the eye with a sterile patch
E) Administer pain medication
Correct Answer: C) Flush the eye with saline or water for at least 15-20 minutes
Rationale: Immediate flushing of the eye with saline or water for at least 15-20 minutes is the first and most critical step in the case of a chemical eye burn. This action helps to dilute and remove the chemical substance, potentially reducing damage to the eye. Checking the pH, starting antibiotics, covering the eye, and administering pain medication are subsequent steps that should follow initial decontamination to ensure the best possible outcome for the patient.
Question A patient with a chemical burn is experiencing severe pain. Which of the following pain management strategies is appropriate AFTER the initial decontamination has been completed?
A) Oral nonsteroidal anti-inflammatory drugs (NSAIDs)
B) Intravenous opioid analgesics
C) Topical steroid creams
D) Topical antibiotic ointments
E) Intramuscular sedatives
Correct Answer: B) Intravenous opioid analgesics
Rationale: For severe pain from a chemical burn, intravenous opioid analgesics may be necessary after initial decontamination has been completed, especially if the pain is intense and not managed by less potent analgesics. Oral NSAIDs can be useful for mild to moderate pain but might not be sufficient for severe chemical burn pain. Topical treatments such as steroid creams and antibiotic ointments are important for wound care but are not primarily used for pain management. Intramuscular sedatives may be used in specific circumstances but are not the first line for pain management in chemical burn victims.
Question When assessing a chemical burn, what is the most important factor to determine the severity of the burn?
A) The patient’s pain level
B) The chemical’s pH level
C) The depth of the burn
D) The size of the burn area
E) The location of the burn
Correct Answer: C) The depth of the burn
Rationale: The depth of the burn is the most critical factor in determining the severity of a chemical burn, as it affects the potential for regeneration of the skin and the overall healing process. The chemical’s pH level, while important for initial treatment decisions, does not solely determine severity. The size of the burn area and the location are also significant factors but are secondary to the depth in terms of immediate impact on treatment strategy and prognosis. The patient’s pain level is a subjective measure and, while important for comfort and symptom management, does not directly indicate the burn’s severity.
Question A nurse is preparing to decontaminate a chemical burn caused by an alkali substance. Which of the following is the MOST appropriate action?
A) Apply a neutralizing agent immediately
B) Rinse the affected area with a mild acidic solution
C) Flush the affected area with copious amounts of water
D) Cover the area with a dry, sterile dressing without rinsing
E) Apply ice to the affected area to reduce swelling
Correct Answer: C) Flush the affected area with copious amounts of water
Rationale: Flushing the affected area with copious amounts of water is the most appropriate action when decontaminating a chemical burn, especially one caused by an alkali substance. This method helps to dilute and remove the chemical, minimizing further tissue damage. Applying a neutralizing agent or a mild acidic solution can cause a chemical reaction that may exacerbate the injury. Covering the area with a dressing without rinsing or applying ice before decontamination can trap the chemical against the skin, increasing the risk of further injury.
Question Following initial treatment of a chemical burn, which of the following is an important aspect of ongoing care?
A) Keeping the wound dry at all times
B) Monitoring for signs of infection
C) Avoiding the use of any dressings on the burn area
D) Applying heat to promote circulation
E) Limiting fluid intake to prevent edema
Correct Answer: B) Monitoring for signs of infection
Rationale: Monitoring for signs of infection is an important aspect of ongoing care for a chemical burn. Chemical burns can compromise the skin’s integrity, making it more susceptible to infection. Keeping the wound clean and appropriately dressed, rather than keeping it dry or avoiding dressings, supports healing. Applying heat is not generally recommended as it can increase swelling and discomfort. Limiting fluid intake is not advised as adequate hydration is crucial for healing. Monitoring for infection involves observing for increased redness, swelling, warmth, pain, or discharge, and is critical for timely
What are Chemical Burns?
Chemical burns occur when a substance comes into contact with the skin and causes a burn injury. In the management of chemical burns, safety is important. To avoid personal contact with the chemical and further complications, it is equally essential that the health care provider or decontamination team members wear gloves, eye, and protective clothing (PPE), or military Mission-Oriented Protective Posture, MOPP (gear) level – 4. Healthcare providers, including doctors, nurses, and ancillary staff have been injured from exposure to chemicals during decontamination and medical care of victims of chemical burns.
First aid for chemical burns
Health care providers recommend gently debriding burns after copiously irrigating the wounds with water. Burn wound care for chemical burns is similar to that of other burns. Initially, the appearance of the burn may appear superficial. Still, the extent of tissue destruction becomes evident several hours or days later. The severity of a chemical injury is related to the following: agent (type of chemical), concentration, volume, duration of exposure, and most importantly, contact with strong acids or bases.
Several typical household or industrial cleaning chemicals (bleach and ammonia) exist. Moreover, preventing upper airway irritation or edema that may cause respiratory complications is also essential.
But remember, the victim may be unaware that they have been exposed to a chemical. Sometimes, the wounds may appear superficial. Progressive damage may occur before the removal of an agent and avoid delays in care. Remove all clothing from the patient. Avoid personal contact with the chemical, and use PPE to avoid injury to medical staff.
Above all, acidic chemicals are generally less destructive than bases. They usually have a pH < 2.0, causing coagulation (cell death) necrosis. and have a leathery texture (full thickness). Use water to dilute the chemicals to a skin pH of 7.0 (use pH pHydrion paper, if pH paper is not available, and when in doubt, irrigate continuously for at least 1 – 4 hours). Remember that it takes several hours to have a skin pH of 7.0 to decrease pain or burning.
Chemical Acid Burns
Formic Acid Burns
Formic acid is an organic acid in industry and agriculture that can cause full-thickness chemical bums and systemic toxicity. This acid will cause acidosis. Copious water irrigation is effective in removing surface accumulations.
Hydrofluoric acid skin burns
Hydrofluoric Acid is present in computer chips, solvents, and paint removers and causes airway edema and respiratory distress. Moreover, this acid can cause ventricular fibrillation, tachycardia, and cardiac death. Rapid absorption through the skin results in protein coagulation and tissue destruction. It forms a white or gray-brown eschar. The fluoride ion binds to the tissue components. Progressive tissue destruction with deep pain and edema can damage tendons if in direct contact. Treatment of hydrofluoric acid burns involves copious irrigation with water, and topical calcium gluconate gel applied to the affected area (2.5 gm in 100 ml water-soluble lubricant, K-Y jelly) Additional considerations include dermal injection of 10% calcium gluconate solution to the affected area, and intravenous calcium gluconate.
Nitric acid burns
Nitric Acid is an industrial acid. It is highly corrosive and causes a yellow eschar when it contacts the skin. Copious irrigation with water is crucial for burn treatment.
Oxalic acid burns
Oxalic Acid burns appear as white lesions. Treatment includes local treatment and intravenous infusion with calcium gluconate and copious irrigation with water is crucial for burns.
phenol skin burns
Phenol is a highly corrosive acid that causes coagulation necrosis (cell death) and forms a firm, thickened light gray or light brown eschar. The wound surface appears dry with well-defined borders. Treatment includes flushing the skin with copious amounts of water irrigation until the smell of Phenol on the wound disappears.
Less common acid burns
Cresol is common in several household cleaning products and may produce some of the toxic effects of Phenol. Treatment includes copious irrigation with water. The toxic effects of phenol include depression of the CNS, seizures, and coma may occur within minutes and may be delayed up to 18 hours after exposure, hypothermia, acute tubular necrosis, cardiac arrhythmias, and pulmonary edema.
Sulfuric Acid is a dehydrating acid. It produces severe pain due to the extensive heat in contact with water and the amount used. It extends into subcutaneous tissue and causes a deep dry black or brown eschar. Treatment includes copious irrigation with water is vital for burns.
Alkali Burns
Alkali (basic) chemicals bind to tissue and are difficult to remove; generally, they cause more severe damage than acids. Liquefaction necrosis occurs due to the heat produced, and this can cause further damage to the deeper tissues. Burns may appear superficial in the early stages, and the burn depth sometimes needs to be more understood. Third-degree burns in the early stage are invasive and require long periods of water irrigation (several hours). Usually, basic chemical burns have a pH > 11.0. Edema is very noticeable and wound sepsis is common.
What happens When ammonia gets on your skin?
Ammonia dissolves in water to form ammonia hydroxide, a corrosive alkaline solution. Ammonia is common in several industrial and household-cleaning products for daily use. It is an irritant gas that produces airway edema and some toxic effects. It may cause death by laryngospasm, respiratory distress, and asphyxia. Treatment involves irrigation with water or saline irrigation. Irrigation with copious running water dilutes the chemicals to a skin pH of 7.0. use pH (pHydrion) paper. If pH paper is not available and when in doubt, irrigate continuously for at least 4 to 5 hours). It May take up to 12 hours to have a skin pH of 7.0 or until pain or burning decreases.
Cement chemical burns
Cement: Wet cement causes a chemical burn. The pH of cement may be >12 Serious signs of injury may take hours to appear.
Hydrocarbon toxicity
In answer to the question, what is the management of chemical burns, it is important to consider hydrocarbons. Hydrocarbons (not flames burns) can occur after motor vehicle accidents or spills cause gasoline bumps and are evident within 4-6 hours. It may cause chemical pneumonitis and bronchitis. Tetraethyl lead in gasoline can cause liver disease. Consequently, it may cause renal and hepatic failure.
Tar Burns
Tar bums can be caused by hot liquid tar, 400–500 ºF. It sticks to the skin and may be difficult to remove. Removing hot tar may increase the severity of the injury. Hot tar causes deep thermal injury and 2nd & 3rd-degree burns. Treatment includes, first and foremost, the rapid cooling of the area. After that, remove the tar with a petroleum-based ointment to solubilize it, making it easier to remove.
White Phosphorus Burns
White Phosphorus is used in incendiary military munitions, fireworks, and agriculture fertilizers use white phosphorus. When spontaneous oxidation occurs, the phosphorus ignites a yellow flame and white smoke, giving a classic garlic smell. The particles in the clothing may ignite causing extensive burns. The recommended treatment of white phosphorus is first, to brush off the powder. Then, irrigate with copious running water (it will prevent aggravation of the burn due to lime/water contact heat). Make sure to cover the wound with water or saline-soaked dressings. Remember that phosphorus is fluorescent and visible under ultraviolet light (wood’s light).
Ocular Injuries are an emergency. Immediately lavage chemically-injured eyes with water or saline solution. If available and applicable, place a Morgan catheter over the eye for irrigation. Everting the eyelids is essential for irrigation. Last but not least, alkaline injuries often cause scar formation on the cornea. All patients should be evaluated and treated by an ophthalmologic specialist.
Chemical Warfare
In combat operations, including acts of terrorism, healthcare personnel must prepare themselves for triage and initial medical care. They must plan the evacuation to a burn center for the thousands of burned and injured patients. Take precautions and use protective devices. The chemical Hazmat team should take special precautions. When initial decontamination of the patient is in process, the attendants should wear a military MOPP-4, butyl rubber gloves, and an apron.
Blistering Agents
Mustard Burns
Vesicants such as mustard is an oily liquid colorless (pure) to dark brown colored. That smells like garlic, mustard, or horseradish. The hazard from a mustard vapor or liquid depends upon the contamination. The important thing is that there is no pain at initial contact. ABCs are the PRIORITIES! Always maintain a patent and open airway. Remove all contaminated clothing. Decontaminate with the M291 SDK. If M291 SDK is not available, you may use 0.5 chlorine solution for decontamination of skin and scalp (within 3-4 minutes. Remember that the therapy and treatment are similar to thermal burns. It is important to, examine the cornea for possible lesions with fluorescein solution, and carefully irrigate with a 0.9% sterile saline solution. You may place a Morgan catheter over the globe for irrigation.
Lewsite Burns
Lewisite is a blistering agent and produces immediate deep skin burns and blisters within 12 hours with pain and itching lasting 2-3 days. There is severe Edema of the burned extremities, lung edema, nasal secretions, and sneezing. Systemic poisoning causes restlessness, weakness, subnormal temperature, and low blood pressure. The recommended treatment of a blister agent requires protective gloves: military MOPP-4, Butyl Rubber gloves, and an apron, if available for the protection of personnel. The primary mode for decontamination of chemical agents is the M291 SDK (skin decontaminating kit) and soap and water. In addition, 0.5% hypochlorite solution is helpful if provided.
Nuclear Burns
The consequences of radiation, blast (trauma), and thermal burn injuries are manifold. As a result, nuclear explosions produce exceptionally high temperatures. First, the energy released travels at the speed of light, causing severe burns at large distances. During initial triage after a traumatic mass casualty event (military war operations, civilian crises, or acts of terrorism). For that reason, prior contact with the burn center is necessary to coordinate initial care and adequate fluid resuscitation to prevent complications during transport and aeromedical evacuation of the patients. Consequently, these patients will have high morbidity and mortality due to under-fluid resuscitation, respiratory distress, primary infection, possible leukopenia, and complications due to chemical warfare.
Frequently Asked Questions
What are chemical burns?
A: Chemical burns are injuries to the skin or body tissues caused by exposure to chemical substances. Most chemicals causing burns are classified as acids or bases.
What are the common causes of chemical burns in healthcare settings?
A: Common causes of chemical burns in healthcare settings include spills or splashes of caustic chemicals used in cleaning or disinfecting, exposure to irritants such as soaps or disinfectants, and accidents involving hazardous chemicals used in medical procedures.
How can healthcare providers prevent chemical burns from occurring in the workplace?
A: Healthcare providers can prevent chemical burns by properly storing and labeling chemicals, wearing appropriate personal protective equipment, and following recommended safety procedures when handling and using chemicals.
What are the symptoms of a chemical burn, and when should a healthcare provider seek medical attention for a patient with a chemical burn?
A: Symptoms of chemical burns include pain, redness, blistering, and swelling. Healthcare providers and the general public should seek medical attention for a chemical burn. Chemical burns may be deeper than they initially appear. Chemical burns that are deep, cover a large area of the body, or involve the eyes, face, hands, or feet can result in serious injury and permanent impairment.
What are the best first-aid measures for a healthcare provider to take when treating a chemical burn?
A: The best first-aid measures for a healthcare provider to take when treating a chemical burn include removing the chemical from the affected area, flushing the affected area with water for at least 20 minutes, and covering the burn with a clean, dry bandage.
What are the long-term effects of chemical burns, and how can they be managed by healthcare providers?
A: Long-term effects of chemical burns can include scarring, skin discoloration, blindness and nerve damage. Healthcare providers can manage these effects by providing proper wound care, prescribing medications to manage pain or prevent infection, and referring patients to specialists as needed.
How should healthcare providers properly document and report chemical burns in their patients?
A: Healthcare providers should properly document and report chemical burns. It is important to report the type and amount of chemical involved, the extent and severity of the burn, and the steps taken to treat the burn. This information should be documented in the patient’s medical record and reported to the appropriate regulatory agencies.
What are the best practices for preventing the spread of infection in patients with chemical burns?
A: The best practices for preventing the spread of infection in patients with chemical burns include properly cleaning and dressing the burn, monitoring the burn for signs of infection, and administering antibiotics as prescribed by a healthcare provider.
How can healthcare providers effectively communicate with patients and their families about the treatment and prognosis of chemical burns?
A: Healthcare providers can effectively communicate with patients and their families about the treatment and prognosis of chemical burns by providing clear explanations of the treatment options, and answering any questions or concerns they may have.
What are the latest advancements in the treatment of chemical burns, and how are they being implemented by healthcare providers?
A: The latest advancements in the treatment of chemical burns include new wound-healing products, innovative surgical techniques, and advances in pain management. Healthcare providers at burn centers are implementing these advancements and best practices, and incorporating them into their patient care protocols.
