Burns NCLEX-RN Practice Questions

Burns NCLEX-RN Practice Questions

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Burns NCLEX-RN Practice Questions help you master high-stakes, real-world decision-making across the Physiological Adaptation domain. This topic-wise set targets critical priorities in the care of burn patients, including airway management, fluid resuscitation, electrolyte shifts, wound care, infection control, pain management, and complications such as inhalation injury and compartment syndrome. You’ll also review topical agents, graft care, nutrition, pediatric considerations, and transfer criteria to burn centers. Each question reflects exam-level complexity with a focus on safety, prioritization, and evidence-based interventions. Work through these 30 MCQs to sharpen your clinical judgment and readiness for emergent, acute, and rehabilitative phases of burn care on the NCLEX-RN.

Q1. A client arrives after a house fire with facial burns, singed nasal hairs, hoarseness, and carbonaceous sputum. What is the priority action?

  • Apply 100% oxygen via nonrebreather mask and continue observation
  • Prepare for early endotracheal intubation
  • Start two large-bore IV lines for fluid resuscitation
  • Obtain a carboxyhemoglobin level

Correct Answer: Prepare for early endotracheal intubation

Q2. Using the Parkland formula, what is the total volume of lactated Ringer’s to infuse in the first 8 hours for a 70-kg adult with 40% TBSA partial-thickness burns?

  • 4,200 mL
  • 5,600 mL
  • 11,200 mL
  • 2,800 mL

Correct Answer: 5,600 mL

Q3. During the emergent phase after a major burn, which laboratory abnormality is most expected due to cellular destruction and fluid shifts?

  • Serum potassium of 6.0 mEq/L
  • Serum sodium of 148 mEq/L
  • Hematocrit of 30%
  • Serum albumin of 4.2 g/dL

Correct Answer: Serum potassium of 6.0 mEq/L

Q4. An adult client has burns to the anterior trunk and the anterior surfaces of both arms. Using the rule of nines, what is the estimated TBSA burned?

  • 18%
  • 22.5%
  • 27%
  • 36%

Correct Answer: 27%

Q5. A client from a garage fire is suspected of carbon monoxide poisoning. Which initial order best reflects evidence-based management?

  • Place the client on 100% oxygen via nonrebreather mask immediately
  • Use pulse oximetry to titrate oxygen to 94%–98%
  • Administer methylene blue IV
  • Keep the head of bed flat to improve cerebral perfusion

Correct Answer: Place the client on 100% oxygen via nonrebreather mask immediately

Q6. Which client is the best candidate to avoid treatment with silver sulfadiazine cream?

  • A client with a documented sulfonamide allergy
  • A client with a mild contact dermatitis history
  • A client with partial-thickness burns to the trunk
  • A client with a past penicillin allergy

Correct Answer: A client with a documented sulfonamide allergy

Q7. The nurse plans analgesia for a major dressing change on a burn client. Which approach is best?

  • Administer oral oxycodone 60 minutes before the procedure
  • Administer IM morphine 30 minutes before the procedure
  • Administer IV opioid analgesic 5–10 minutes before the dressing change
  • Use distraction techniques only to minimize medication needs

Correct Answer: Administer IV opioid analgesic 5–10 minutes before the dressing change

Q8. A client with a high-voltage electrical injury arrives at the ED. What is the priority monitoring?

  • Continuous cardiac monitoring for dysrhythmias
  • Hourly oral temperature checks
  • Urine output measurement every 8 hours
  • Encourage early ambulation to prevent DVT

Correct Answer: Continuous cardiac monitoring for dysrhythmias

Q9. Which finding in a limb with a circumferential full-thickness burn requires immediate provider notification for possible escharotomy?

  • Increasing edema and tight, leathery skin
  • Blistering at the edges of the burn
  • Absent distal pulses with increasing pain and paresthesias
  • Serous drainage from the wound

Correct Answer: Absent distal pulses with increasing pain and paresthesias

Q10. Which parameter best indicates adequate fluid resuscitation in the first 24 hours for a 70-kg adult burn client?

  • Urine output of 15 mL/hr
  • Urine output of 35 mL/hr
  • Blood pressure 100/60 mm Hg
  • Heart rate 110/min

Correct Answer: Urine output of 35 mL/hr

Q11. What is the single most effective intervention to reduce cross-contamination and infection in burn patients?

  • Prophylactic broad-spectrum IV antibiotics
  • Laminar airflow isolation rooms
  • Meticulous hand hygiene before and after all patient contact
  • Daily wound cultures

Correct Answer: Meticulous hand hygiene before and after all patient contact

Q12. To prevent Curling’s ulcer in a severely burned client, which medication is most appropriate?

  • Aluminum hydroxide suspension
  • IV pantoprazole
  • Aspirin 81 mg daily
  • Bismuth subsalicylate

Correct Answer: IV pantoprazole

Q13. Early nutrition is planned for a client with 35% TBSA burns. Which order best supports outcomes in the acute phase?

  • Initiate early high-protein, high-calorie enteral feedings
  • Delay feeds and begin TPN on day 3
  • NPO for 48 hours to prevent aspiration
  • Start clear liquid diet and advance as tolerated

Correct Answer: Initiate early high-protein, high-calorie enteral feedings

Q14. A client has an alkali burn from dry lime powder. What is the priority first aid action?

  • Brush off the dry chemical before irrigation
  • Irrigate immediately with copious water for 30 minutes
  • Neutralize with a weak acid solution
  • Apply an occlusive dressing to contain the chemical

Correct Answer: Brush off the dry chemical before irrigation

Q15. Which assessment finding most strongly suggests a burn wound infection?

  • Pale pink granulation tissue at the wound base
  • Decreasing pain at the wound site
  • New greenish drainage with a foul odor and fever
  • Decreasing edema around the margins

Correct Answer: New greenish drainage with a foul odor and fever

Q16. After a split-thickness skin autograft to the leg, which nursing action is the priority in the first 3–5 days?

  • Encourage active range-of-motion exercises of the grafted limb
  • Keep the grafted site immobilized and elevated as ordered
  • Remove the dressing daily to assess the graft
  • Place the graft site in a dependent position for perfusion

Correct Answer: Keep the grafted site immobilized and elevated as ordered

Q17. Which finding indicates adequate fluid resuscitation in a 20-kg child with major burns?

  • Urine output averages 10 mL/hr
  • Urine output averages 15 mL/hr
  • Urine output averages 25 mL/hr
  • Urine output averages 5 mL/hr

Correct Answer: Urine output averages 25 mL/hr

Q18. A ventilated client with circumferential full-thickness chest burns shows worsening hypoxemia and rising peak inspiratory pressures. Which action is anticipated?

  • Increase opioid infusion to reduce agitation
  • Remove the endotracheal tube and reintubate
  • Prepare for escharotomy of the chest wall
  • Administer diuretics to reduce edema

Correct Answer: Prepare for escharotomy of the chest wall

Q19. Which order should the nurse question during the first 8 hours of resuscitation for a 30% TBSA burn?

  • Start lactated Ringer’s using the Parkland formula
  • Insert a Foley catheter for hourly urine output
  • Begin 5% albumin infusion
  • Monitor vital signs and mental status frequently

Correct Answer: Begin 5% albumin infusion

Q20. After a warehouse fire, which assessment finding requires immediate intervention?

  • Partial-thickness burns with intact blisters on the forearm
  • Hoarseness with carbonaceous sputum
  • Pain rated 8/10 at the burn site
  • Erythema of the cheeks without blisters

Correct Answer: Hoarseness with carbonaceous sputum

Q21. The nurse educates a client about mafenide acetate (Sulfamylon) for an infected burn. Which statement shows correct understanding?

  • “This medicine is painless and may cause low white blood cells.”
  • “This agent penetrates eschar and can cause metabolic acidosis; ABGs may be monitored.”
  • “It is unrelated to sulfa medicines and safe with sulfa allergy.”
  • “It primarily protects against fungal infections only.”

Correct Answer: “This agent penetrates eschar and can cause metabolic acidosis; ABGs may be monitored.”

Q22. A client with an electrical burn has tea-colored urine and myoglobinuria. What is the most appropriate fluid goal?

  • Titrate IV fluids to maintain urine output at least 75–100 mL/hr
  • Restrict fluids to prevent pulmonary edema
  • Use hypotonic saline to enhance diuresis
  • Target urine output at 20 mL/hr to protect kidneys

Correct Answer: Titrate IV fluids to maintain urine output at least 75–100 mL/hr

Q23. Which statement about split-thickness skin graft donor sites is accurate?

  • “The donor site is usually less painful than the graft site.”
  • “The donor site is left open to air immediately after surgery.”
  • “The donor site often hurts more than the grafted site.”
  • “The donor site cannot bleed because it is full-thickness.”

Correct Answer: “The donor site often hurts more than the grafted site.”

Q24. What is the most appropriate prehospital care for a small partial-thickness burn with intact blisters?

  • Debride blisters and apply topical antibiotic
  • Cover with a clean, dry dressing without breaking blisters
  • Apply ice directly to the burned area
  • Apply butter or oil to reduce pain

Correct Answer: Cover with a clean, dry dressing without breaking blisters

Q25. Which intervention best reduces the risk of hypothermia during the emergent phase of burn management?

  • Keep the room cool and use cooling blankets
  • Warm the ambient room and use warmed IV fluids and blankets
  • Expose the patient fully to allow wound drying
  • Use fans to promote airflow over moist dressings

Correct Answer: Warm the ambient room and use warmed IV fluids and blankets

Q26. A client with deep lower leg and foot burns is at risk for plantar flexion contractures. What is the best preventive plan?

  • Place pillows under the ankles continuously
  • Apply posterior splints to maintain dorsiflexion and perform scheduled ROM
  • Keep the foot dependent to promote circulation
  • Restrict movement until grafting is complete

Correct Answer: Apply posterior splints to maintain dorsiflexion and perform scheduled ROM

Q27. On day 2 after a 40% TBSA burn, which lab value is most concerning and requires intervention?

  • Serum potassium 3.0 mEq/L
  • Serum sodium 138 mEq/L
  • Hematocrit 45%
  • Serum calcium 9.0 mg/dL

Correct Answer: Serum potassium 3.0 mEq/L

Q28. A burn client requires frequent IV opioids. Which nursing action best minimizes the risk of respiratory depression?

  • Use large single doses to reduce dosing frequency
  • Administer oral benzodiazepines instead of opioids
  • Titrate small IV doses with close respiratory monitoring and have naloxone available
  • Switch to IM dosing to avoid oversedation

Correct Answer: Titrate small IV doses with close respiratory monitoring and have naloxone available

Q29. Which hydrotherapy practice is most appropriate for a client with extensive partial-thickness burns?

  • Prolong sessions beyond 60 minutes for thorough debridement
  • Limit sessions to about 20 minutes in warm water to reduce heat loss and fatigue
  • Use cold water to reduce pain and edema
  • Add antiseptic bleach routinely to the water

Correct Answer: Limit sessions to about 20 minutes in warm water to reduce heat loss and fatigue

Q30. Which patient meets American Burn Association criteria for transfer to a burn center?

  • 12% TBSA superficial sunburn in a healthy adult
  • 8% TBSA partial-thickness burn to the back in a healthy adult
  • Electrical injury with entry and exit wounds and minimal surface burns
  • 4% TBSA partial-thickness scald to the thigh in a healthy adult

Correct Answer: Electrical injury with entry and exit wounds and minimal surface burns

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