This page is not a content page — it is a trap page. Ten of the most-missed burn items, each with the right answer, the arithmetic written out, and a specific reason why each wrong option is wrong. The underlying content lives on the other four burn pages, linked from every question.
Cover the options with your hand. Answer out loud. Then uncover.
↔️ Front or back?The #1 calculation error. A posterior arm is 4.5%, not 9%. Halve every limb when only one surface is burned.
🚽 Low urine = MORE fluidNever a diuretic, never "slow the rate." Under-perfusion is fixed with Lactated Ringer's.
⏱️ 18–24 hInterstitial shifting peaks 18–24 h post-injury. Diuresis at 48–72 h.
🧪 Hct 60%Big burn, first day → hemoconcentration. High H&H is the expected answer, not low.
🎯
HOW TO ATTACK A BURN QUESTION
STEP 0 · THE SYSTEM
Four questions, asked in the same order every time. They eliminate most distractors before you even read them.
🧭 The four-question filter
🧠 “Phase · Airway · Number · Urine.” Four words. Run them in order on every burn stem before you look at the options.
🧾 The numbers you must have memorized cold
Head/neck 9% · each arm 9% · anterior trunk 18% · posterior trunk 18% · each leg 18% · perineum 1%
Patient's palm plus fingers ≈ 1% (the palm alone is often taught as ≈0.5%)
Parkland: 4 mL × kg × %TBSA, half in 8 h, half in 16 h, clock from injury
Targets: urine ≥30 mL/hr · systolic ≥90 · HR <120
Peak interstitial shift 18–24 h · diuresis 48–72 h
Emergent labs: K⁺ >5.0 · Na⁺ <135 · Hgb and Hct both elevated (typical adult reference bands ≈ Hgb 12–18 g/dL, Hct 36–54% — ranges vary by lab and by sex)
🧠 If a number in an option does not match one of these, it is probably the distractor.
⭐ Read the stem for these five words
ANTERIOR / POSTERIOR → halve the limb values
ENTIRE / CIRCUMFERENTIAL → use the whole-region value (and think escharotomy)
PERINEUM → they want the extra 1%
HOURS AFTER THE INJURY → the resuscitation clock, and which phase you are in
FULL-THICKNESS / PARTIAL-THICKNESS → both count in TBSA; a superficial (1°) area does not
🧠 Physically underline those words. On a real exam, mouth them. The stem is telling you the answer.
①
TBSA CALCULATION TRAPS
RULE OF NINES
Two classic items. Both are missed for the same reason: whole-limb values used for a single surface.
🎓 Question 1 — full-thickness burns to ALL posterior body surfaces
A client has full-thickness burns to all posterior body surfaces. Using the Rule of Nines, calculate the percentage of total body surface area affected.
❌ 36% — This counts only the back of the trunk (18%) plus the back of both legs (18%) and forgets the head and the arms entirely.
❌ 45% — A tempting "round number." It drops the posterior head and neck (4.5%).
✅ 49.5% — Correct. Back of head & neck 4.5 + entire back 18 + posterior arms 4.5 × 2 = 9 + posterior legs 9 × 2 = 18.
❌ 76.5% — The classic error: whole arms (9% each) and whole legs (18% each) were used instead of halving for the posterior surface only.
🧠 49.5% = "just under half." If your answer to an all-posterior burn is over 50%, you forgot to halve the limbs.
A client has partial-thickness burns to the anterior legs and the perineum. Using the Rule of Nines, calculate the percentage of total body surface area affected.
❌ 9% — Only one leg was counted. The stem says legs, plural.
❌ 18% — The two anterior legs are right, but the perineum's 1% was dropped. If the stem names the perineum, the 1% is the point of the question.
✅ 19% — Correct. Anterior right leg 9 + anterior left leg 9 + perineum 1 = 19% TBSA.
❌ 37% — Whole legs (18% each) were used instead of the anterior surfaces only, plus the 1%.
🧠 “Eighteen and the little one.” Both anterior legs plus the perineum = 19%.
②
PARKLAND CALCULATION TRAPS
4 × kg × %TBSA
The multiplication is easy. The marks are lost on the split, the units and the clock.
🎓 Question 3 — 100 kg client with 19% TBSA
The client above weighs 100 kg with 19% TBSA. Calculate the Lactated Ringer's fluid resuscitation needed in the first 24 hours.
❌ 1,900 mL — Someone used 1 mL instead of 4 mL. The constant is 4.
❌ 3,800 mL — That is only half the total, i.e. the volume for the first 8 hours. The question asked for the whole 24 hours.
✅ 7,600 mL — Correct. 4 mL × 100 kg × 19 = 7,600 mL of LR in the first 24 hours.
❌ 15,200 mL — The total was doubled instead of halved. Halving applies to the timing, not to the total.
4 mL × 100 kg × 19 %TBSA= 7,600 mL Lactated Ringer's in the first 24 hours½ = 3,800 mL in the first 8 h → 475 mL/hr½ = 3,800 mL over the next 16 h → 237.5 mL/hr
🧠 “Four, weight, burn — then halve the CLOCK, not the answer.”
🎓 Question 4 — the delayed-arrival variant
A 70 kg client sustained burns to 36% TBSA at 06:00 and arrives in the emergency department at 09:00. The Parkland formula is prescribed. How much LR should be infused by 14:00?
❌ 10,080 mL — That is the entire 24-hour total, not the first-8-hour portion.
✅ 5,040 mL — Correct. Total = 4 × 70 × 36 = 10,080 mL. Half = 5,040 mL must be in by 8 hours after the injury, i.e. by 14:00.
❌ 5,040 mL by 17:00 — This restarted the clock at arrival. The 8 hours run from 06:00, so the deadline is 14:00, not 17:00.
❌ 2,520 mL — The total was halved twice.
4 × 70 kg × 36 % = 10,080 mL totalhalf = 5,040 mL due by 8 h post-injury (14:00)3 h already gone → 5,040 ÷ 5 remaining hours≈ 1,008 mL/hr until 14:00, then 5,040 mL over 16 h = 315 mL/hr
🧠 “What time did it happen?” Ask it before you touch the calculator.
③
TITRATION, TIMING & LAB TRAPS
JUDGMENT ITEMS
These three are the most-missed non-calculation burn questions in the bank.
🎓 Question 5 — the client is not responding to the fluids
A client is undergoing fluid replacement after being burned on 20% of her body 12 hours ago. Assessment: BP 90/50, pulse 110, urine output 20 mL over the past hour. The nurse anticipates which prescription?
✅ Increasing the IV Lactated Ringer's — Correct. Urine under 30 mL/hr with a borderline BP and a rising pulse means the patient is under-resuscitated. The fix for hypovolemia is more isotonic fluid.
❌ Administering a diuretic (e.g. furosemide) — The most attractive wrong answer. It "treats" the low urine number while emptying a tank that is already empty, and will worsen shock and kidney injury. Low urine output in burn shock is never treated with a diuretic.
❌ Decreasing the IV rate — Backwards. Nothing in the data suggests overload; there are no crackles, no JVD, no dyspnea.
❌ Transfusing packed red blood cells — Blood is not first-line burn resuscitation. There is no bleeding and no hemoglobin value here; in the first 24 hours the H&H is usually falsely high from hemoconcentration.
🧠 “Low urine in a burn = more fluid, never a diuretic.” The kidney is not lazy; it is dry.
A client has an extensive burn injury involving 45% of total body surface area. When planning for fluid resuscitation, the nurse should consider that fluid shifting to the interstitial spaces is greatest during which time period?
❌ During the first 2 hours after the injury — Leaking has started, but it has not peaked. Most of the shift is still ahead of you.
❌ Between 6 and 12 hours after the injury — Still climbing. Tempting because this is when the first (faster) half of the fluid is running.
✅ Between 18 and 24 hours after the injury — Correct. Capillary permeability peaks here; this is when interstitial shifting — and the edema — is greatest.
❌ Between 48 and 72 hours after the injury — This is the opposite: capillaries are sealing and fluid is coming back into the vessels. This is the diuresis window, when you start watching for fluid overload instead.
🧠 “Out by 24, back by 72.” Peak leak 18–24 h; reabsorption/diuresis 48–72 h.
🎓 Question 7 — which lab would you expect?
A client has a severe burn injury covering 35% of the total body surface area. The nurse is most likely to note which finding on the laboratory report?
✅ Hematocrit 60% (0.60) — Correct. Plasma has leaked out of the vessels while red cells stayed behind, so the Hct is falsely elevated — hemoconcentration. A typical adult reference band is about 36–54% (varies by lab and sex).
❌ Hematocrit 28% — A low Hct fits the acute phase (hemodilution once fluid returns, plus red-cell destruction) — not the first 24 hours.
❌ Potassium 3.0 mEq/L — Backwards for the emergent phase. Burned cells rupture and dump potassium, so early K⁺ is high (>5.0). Low potassium belongs to the acute/diuretic phase.
❌ Sodium 148 mEq/L — Also backwards. Sodium follows water into the interstitium and is lost through the wound, so serum Na⁺ tends to be low (<135).
🧠 “Fluids flow — electrolytes go.” Water leaving the vessels concentrates the blood and floods it with potassium.
These feel like "common sense" questions, which is exactly why they are missed.
🎓 Question 8 — the immunocompromised burn client
A client with burns is immunocompromised. What precaution should be taken to prevent infection?
✅ Avoid placing fresh flowers or plants in or near the client's room — Correct. Standing vase water harbors Pseudomonas and potting soil harbors Aspergillus and other fungi. Both are dangerous to a patient with no skin barrier and a suppressed immune system.
❌ Place the client in a semi-private room — The opposite. A private room with protective isolation is indicated; a roommate is an infection source.
❌ Restrict all fluids to reduce wound drainage — Dangerous and unrelated. Burn patients need more fluid, not less, and drainage is not controlled by dehydration.
❌ Administer prophylactic systemic antibiotics to all burn clients — Not routine. Broad prophylaxis selects for resistant organisms; antibiotics treat documented infection. Topical antimicrobials are used on the wound as prescribed.
A client is entering the rehabilitation phase after a major burn. Which statement indicates that teaching has been effective?
✅ "I'll use a water-based lotion several times a day, wear my pressure garment as prescribed, and do my exercises every day." — Correct. That is the whole W-W-E teaching plan: Water-based lotion · Wear pressure garments · Exercise daily (range of motion).
❌ "I'll take the pressure garment off whenever it feels tight or hot." — Wrong. It is supposed to be snug; it is commonly worn up to 23 hours a day for many months. Report numbness, tingling or color change — but do not simply stop wearing it.
❌ "Now that the wounds are closed, infection is my biggest risk." — Wrong phase. Infection was the danger in the acute phase. Once wounds are healed, the risks are contractures, hypertrophic scarring, loss of function and psychosocial problems.
❌ "I can go back to sunbathing now that the skin has healed." — Wrong. Healed skin has less melanin, burns quickly and pigments permanently. Avoid direct sun to healed areas for at least a year; cover up and use high-SPF sunscreen.
🧠 “W-W-E — like the wrestling. You have to wrestle the scar every day.”
A client is brought to the emergency department after being rescued from a house fire. There are burns to the face and neck, the voice is hoarse, and there is soot around the nose and mouth. Which action does the nurse take FIRST?
✅ Assess the airway and apply 100% oxygen by non-rebreather, anticipating early intubation — Correct. Enclosed-space fire + facial/neck burns + hoarseness + soot = inhalation injury. Airway swelling worsens over hours; intubate before it closes. Airway always outranks the burn.
❌ Calculate the TBSA using the Rule of Nines — Necessary, but not first. Nobody dies in the first five minutes from an un-calculated percentage.
❌ Start two large-bore IVs and begin Lactated Ringer's — This is second, not first. Circulation follows airway and breathing.
❌ Administer IV morphine for pain — Pain control matters, and it must be IV — but sedating a patient with a threatened airway before it is secured is unsafe.
1
AIRWAY — the four signs: facial/neck burn · singed nasal hair · sooty (carbonaceous) sputum · hoarseness or stridor
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2
BREATHING — 100% O₂; remember carbon monoxide makes SpO₂ read falsely normal