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BCEN CBRNFree Certified Burn Registered Nurse practice test
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A 28-year-old patient with healed partial-thickness burns covering 18% TBSA is being fitted for custom pressure garments at a 6-week outpatient follow-up visit. The nurse explains the recommended wear schedule. Which instruction is MOST consistent with current burn rehabilitation guidelines?
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Q1. A 28-year-old patient with healed partial-thickness burns covering 18% TBSA is being fitted for custom pressure garments at a 6-week outpatient follow-up visit. The nurse explains the recommended wear schedule. Which instruction is MOST consistent with current burn rehabilitation guidelines?
Correct answer: B. Wear garments 23 hours per day, removing only for hygiene and wound care
Current burn rehabilitation guidelines recommend pressure garment use for 23 hours per day (allowing 1 hour for bathing/skin care) to achieve consistent pressure of 25–30 mmHg necessary to inhibit hypertrophic scar formation. Removing garments at night (option A) allows scar rebound and undermines therapeutic pressure. Gradual increase to only 12 hours (option C) is insufficient for effective scar remodeling. Discontinuing based on itch resolution alone (option D) is inappropriate, as garments are typically worn until scar maturation, which may take 12–24 months.
Q2. A nurse is preparing a patient for a contracture release and Z-plasty procedure on the right axilla following a flame burn sustained 14 months ago. Which preoperative nursing priority is MOST critical for this patient?
Correct answer: B. Documenting baseline range of motion measurements of the shoulder and elbow bilaterally
Documenting baseline range of motion (ROM) bilaterally before reconstructive surgery establishes the objective functional baseline against which postoperative outcomes will be measured; this is essential for perioperative nursing assessment and surgical planning in contracture release. Warm compresses (option A) are not standard preoperative preparation for this procedure and carry a burn risk in patients with impaired sensation. A routine 12-lead ECG (option C) may be part of anesthesia clearance but is not the most critical burn-specific nursing priority. Pressure garments should generally not be discontinued preoperatively without a surgeon's order; premature discontinuation can worsen scar before reconstruction (option D).
Q3. A 35-year-old patient presents to the outpatient burn clinic 8 months post-injury with complaints of intense pruritus over maturing hypertrophic scars on the trunk. Current medications include cetirizine 10 mg daily, but the patient reports only partial relief. Which intervention should the nurse anticipate adding to the pruritus management plan NEXT?
Correct answer: B. Initiate gabapentin at a low dose (e.g., 300 mg at bedtime) with titration as tolerated
Gabapentin targets neuropathic itch pathways (central sensitization) and is well-supported in burn scar literature as an effective add-on when non-sedating antihistamines alone provide inadequate relief; starting at a low dose (300 mg at bedtime) minimizes initial side effects. Switching to a sedating antihistamine such as diphenhydramine (option A) does not address neuropathic mechanisms and increases fall and cognitive risk without demonstrated superiority over non-sedating agents. Prolonged topical corticosteroids on large scar areas (option C) risk skin atrophy and are not a first-line escalation. Pulsed dye laser (option D) is a valid long-term modality for scar remodeling but is not the immediate next pharmacologic step when a patient still has partially responsive itch requiring medication adjustment.
Q4. During discharge education, the burn rehabilitation nurse is counseling a patient with extensive facial and neck scarring about long-term thermoregulation. Which statement by the patient indicates a CORRECT understanding of thermoregulation impairment after significant burn injury?
Correct answer: B. "Grafted areas cannot sweat effectively, so I must rely on other cooling strategies in hot weather."
Skin-grafted areas permanently lose eccrine sweat gland function because sweat glands are not transferred with split-thickness skin grafts; patients must compensate by seeking shade, using wet cloths, wearing light clothing, and increasing hydration in heat. Grafted skin does not produce excess sweating (option A) — the opposite is true, as sweat capacity is lost. Healed or grafted skin is not a functional insulating layer in the thermoregulatory sense (option C). Eccrine gland regeneration does not reliably occur in deeply burned or grafted tissue, and 12-month full recovery (option D) is not supported by burn physiology research.
Q5. A nurse is caring for a patient in the postoperative period following placement of a tissue expander on the anterior chest wall as preparation for a future reconstructive flap procedure. On postoperative day 2, the nurse notes the overlying skin appears pale and feels cool to touch, and the patient reports increased tightness at the site. Which action is MOST appropriate?
Correct answer: B. Notify the surgeon immediately, as these findings suggest compromised tissue perfusion over the expander
Pallor, coolness, and increased tightness over a tissue expander on postoperative day 2 are early warning signs of compromised skin perfusion — a surgical emergency that can lead to skin necrosis and expander exposure if not addressed promptly. The surgeon must be notified immediately for possible expander deflation or intervention. Warm compresses (option A) are contraindicated over an expander with suspected vascular compromise and can mask deterioration. Tightness in early postoperative phase may be expected, but combined pallor and coolness are abnormal findings that cannot be attributed to routine swelling (option C). A 4-hour delay in reassessment (option D) is unsafe when perfusion signs suggest tissue ischemia, which can progress to full-thickness necrosis within hours.
Q6. A 38-year-old man with 45% TBSA flame burns is intubated on post-burn day 3. His current ventilator settings are: AC/VC, FiO₂ 0.60, PEEP 8 cmH₂O, tidal volume 420 mL (6 mL/kg IBW), rate 18/min. His plateau pressure is 32 cmH₂O and SpO₂ is 88%. Which intervention is the MOST appropriate next step?
Correct answer: B. Increase PEEP incrementally per the ARDSnet PEEP/FiO₂ table while monitoring plateau pressure, targeting SpO₂ 88–95%
This patient meets criteria for moderate ARDS (SpO₂ 88% on FiO₂ 0.60 with PEEP 8, yielding an estimated PaO₂/FiO₂ likely <200) and is already on lung-protective 6 mL/kg IBW tidal volumes. The ARDSnet protocol directs incremental PEEP increases paired with FiO₂ adjustment per the standardized PEEP/FiO₂ table to improve oxygenation. Because the plateau pressure is already 32 cmH₂O (just above the 30 cmH₂O ARDSnet target), PEEP should be titrated cautiously in small increments with close plateau pressure monitoring; nonetheless, optimizing PEEP remains the correct next step before escalating to rescue therapies. Increasing tidal volume (A) worsens ventilator-induced lung injury. Switching to pressure control (C) does not directly address hypoxemia and does not alter lung mechanics at the same pressures. High-frequency oscillatory ventilation (D) is a rescue strategy, not indicated as the immediate next step when standard PEEP optimization has not been maximized.
Q7. A burn patient develops acute agitation, disorientation to place and time, and visual hallucinations on post-burn day 5. She was lucid 6 hours ago. Her vital signs: HR 112, BP 138/84, SpO₂ 96%, Temp 37.8°C. She has no prior psychiatric history. Which assessment tool and intervention set is MOST appropriate?
Correct answer: B. Use the CAM-ICU to confirm delirium, treat reversible causes, and reorient using non-pharmacologic measures first
The Confusion Assessment Method for the ICU (CAM-ICU) is the validated instrument for diagnosing delirium in non-verbal or intubated ICU patients. Current ABCDEF Bundle and SCCM Pain, Agitation, and Delirium (PADIS) guidelines prioritize identification of reversible causes (pain, urinary retention, hypoxia, medication effects) and non-pharmacologic interventions (reorientation, sleep hygiene, early mobilization) before pharmacotherapy. Benzodiazepines (A) increase delirium risk and are not first-line for hyperactive delirium. A CT head (C) is premature without focal neurological deficits in a patient with a clear temporal onset and no lateralizing signs. High-dose haloperidol and restraints (D) are not first-line and physical restraints can worsen agitation, impair graft perfusion at pressure points, and violate evidence-based delirium management.
Q8. On post-burn day 2, a patient with 30% TBSA burns and an inhalation injury develops audible wheezing and rising peak inspiratory pressures. Suctioning yields carbonaceous secretions. Which medication regimen should be added to this patient's nebulizer protocol to specifically address bronchospasm and mucociliary dysfunction from inhalation injury?
Correct answer: B. Nebulized albuterol every 4 hours combined with alternating nebulized heparin sodium and nebulized N-acetylcysteine every 2–4 hours
The Galveston inhalation injury protocol uses a three-component nebulizer regimen: (1) albuterol to treat bronchospasm, (2) nebulized heparin sodium (5,000 units in 3 mL normal saline) to prevent fibrin cast formation by its anticoagulant effect on endobronchial secretions, and (3) nebulized N-acetylcysteine to act as a mucolytic and free-radical scavenger — with heparin and N-acetylcysteine alternating every 2–4 hours and albuterol given concurrently. N-acetylcysteine alone (A) addresses mucolysis but not bronchospasm or fibrin cast formation. Racemic epinephrine (C) is used for upper airway edema (e.g., post-extubation stridor), not subglottic inhalation injury. Hypertonic saline (D) is used primarily in cystic fibrosis airway clearance and is not part of standard burn inhalation injury protocols.
Q9. A burn patient's urinalysis reveals reddish-brown discoloration with a urine dipstick positive for blood but no red blood cells on microscopy. Urine output is 0.8 mL/kg/hr. Serum CK is 28,000 U/L. Which intervention is MOST important to prevent acute kidney injury in this patient?
Correct answer: B. Increase IV fluid resuscitation to target urine output of 1–2 mL/kg/hr and consider sodium bicarbonate infusion to alkalinize the urine
The clinical picture is myoglobinuria from rhabdomyolysis — hemoglobin-positive dipstick without RBCs on microscopy, markedly elevated CK (>10,000 U/L), and pigmented urine. The priority intervention is aggressive fluid resuscitation targeting urine output of 1–2 mL/kg/hr to flush myoglobin through the tubules before it precipitates and causes obstructive acute kidney injury. Urine alkalinization with sodium bicarbonate (target urine pH >6.5) reduces myoglobin precipitation in the tubular lumen and is recommended adjunctively in severe cases. Furosemide (A) can worsen dehydration and concentrate myoglobin in tubular fluid, increasing AKI risk. Continuous renal replacement therapy (C) and hemodialysis (D) are indicated for established AKI with refractory fluid overload or severe electrolyte derangements, not as prophylaxis when aggressive fluid therapy may still prevent injury.
Q10. A 52-year-old woman with 55% TBSA burns on post-burn day 7 meets three of the American Burn Association burn sepsis criteria: temperature 39.6°C, HR 132 bpm, and blood glucose 185 mg/dL despite no enteral dextrose. She has a central venous catheter placed on admission. Which action is MOST consistent with evidence-based practice for burn sepsis and central line–associated bloodstream infection (CLABSI) prevention?
Correct answer: B. Obtain blood cultures from the existing line and two peripheral sites, begin broad-spectrum antibiotics, and remove and replace the central line at a new site
ABA burn sepsis criteria (≥3 of: temp >39°C or <36.5°C, HR >110, RR >25, thrombocytopenia, hyperglycemia, feed intolerance) direct early antibiotic initiation within the first hour after cultures are drawn. Blood cultures should be obtained both from the existing central line and from two peripheral venipuncture sites to evaluate for CLABSI and bacteremia. Because burn patients are profoundly immunocompromised and intravascular catheters are a primary infection source, suspected CLABSI mandates removal and replacement at a new anatomic site — not over-a-guidewire exchange (A), which perpetuates a potentially infected tract and is contraindicated per CDC CLABSI guidelines. Delaying antibiotics for wound culture sensitivities (C) or for repeat assessment (D) risks progression to septic shock in a physiologically stressed burn patient.
Exam facts and objectives sourced from the official BCEN (Board of Certification for Emergency Nursing) certification page. Last reviewed June 2026.
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