Resuscitation Phase and Fluid Replacement Practice Questions
20 free Resuscitation Phase and Fluid Replacement practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
In the acute resuscitation phase of a major burn (>20% TBSA), which formula is commonly used to estimate initial fluid needs?
- A 1 mL × kg × %TBSA burn
- B 2–4 mL × kg × %TBSA burn of lactated Ringer’s in first 24 hours
- C 5–6 mL × kg × %TBSA burn of normal saline in first 8 hours
- D 10 mL × kg × %TBSA burn of dextrose solution in first 24 hours
Correct answer: 2–4 mL × kg × %TBSA burn of lactated Ringer’s in first 24 hours
The consensus is to start with ~2–4 mL × kg × %TBSA burn of crystalloid (usually lactated Ringer’s) in the first 24 hours for adult burn resuscitation.
According to standard resuscitation protocols, how much of the calculated 24-hour fluid volume should be administered during the first 8 hours post-burn?
- A One quarter
- B One half
- C Two-thirds
- D The full amount
Correct answer: One half
Protocols instruct that half of the 24-hour fluid total be given in the first 8 hours from time of burn.
What is the primary end-point used to titrate fluid replacement in burn resuscitation in adults?
- A Heart rate measurement alone
- B Serum creatinine concentration
- C Urine output of 0.5–1.0 mL/kg/hour
- D Serum sodium level
Correct answer: Urine output of 0.5–1.0 mL/kg/hour
Urine output is a key practical target to assess adequacy of fluid resuscitation in adult burn patients.
Which type of crystalloid is preferred during initial burn resuscitation?
- A 0.9% normal saline
- B Dextrose 5% in water
- C Lactated Ringer’s solution
- D Hypertonic saline (3%)
Correct answer: Lactated Ringer’s solution
Lactated Ringer’s is recommended as first‐line crystalloid for initial burn fluid resuscitation due to more physiological electrolyte balance.
Which factor increases the fluid requirement during the resuscitation phase?
- A Superficial partial-thickness burn <10% TBSA
- B Delay in initiation of fluid resuscitation (late transfer)
- C Young age with no inhalation injury
- D Small‐area burn in otherwise healthy adult
Correct answer: Delay in initiation of fluid resuscitation (late transfer)
Late initiation of fluid resuscitation, full-thickness burns, inhalation injury, and large TBSA increase fluid needs.
In children with burns, how does urine output goal differ from adults?
- A The target is the same as adults (0.5 mL/kg/h)
- B Children aim for 1.0–1.5 mL/kg/hour
- C Children aim for less than 0.3 mL/kg/h
- D Children aim for a fixed 30 mL/hour regardless of weight
Correct answer: Children aim for 1.0–1.5 mL/kg/hour
Pediatric burn resuscitation protocols often target urine output of ~1.0–1.5 mL/kg/h, higher than adult targets.
For a 70 kg adult with 30% TBSA burn, using the 4 mL/kg/%TBSA formula, the total first 24-hour fluid volume would be:
- A 1200 mL
- B 5600 mL
- C 8400 mL
- D 14,000 mL
Correct answer: 8400 mL
4 mL × 70 kg × 30% = 4 × 70 × 30 = 8400mL; the target is ~8400 mL in the first 24 hours.
Why is fluid administration 'just a starting point' and must be titrated in burn resuscitation?
- A Because one fixed protocol fits every burn patient
- B Because the type of fluid matters more than the volume
- C Because individual response varies and over-resuscitation is harmful
- D Because fluids are needed only within the first hour
Correct answer: Because individual response varies and over-resuscitation is harmful
Initial formula estimates are a guide; fluids must be adjusted based on actual parameters to avoid under- or over-resuscitation.
Which statement is true regarding the use of albumin or colloids in the initial 24 hours of burn resuscitation?
- A Colloids should always replace crystalloids from the start
- B Routine colloid use in the first 24 h is standard for all burns
- C Albumin may be considered when crystalloid volumes exceed 6 mL/kg/%TBSA
- D Colloids raise mortality and must always be avoided
Correct answer: Albumin may be considered when crystalloid volumes exceed 6 mL/kg/%TBSA
Some burn CPGs suggest considering albumin after 12 h if fluid volumes become excessive; but it’s not routine in all cases.
A nurse notices a patient’s urine output is 20 mL/hour despite resuscitation. What should the nurse anticipate?
- A Halve the current fluid infusion rate
- B Maintain the same rate with no change
- C Increase the infusion rate or reassess the cause of oliguria
- D Switch immediately to hypertonic saline
Correct answer: Increase the infusion rate or reassess the cause of oliguria
Low urine output indicates inadequate perfusion/resuscitation; fluid infusion rate may need increasing or other causes of low output evaluated.
What is a potential complication of 'fluid creep' (excessive fluid administration) during burn resuscitation?
- A Automatically faster wound healing
- B Reduced extremity and tissue swelling
- C Compartment syndrome, pulmonary edema, and abdominal hypertension
- D Lower infection rates from increased perfusion
Correct answer: Compartment syndrome, pulmonary edema, and abdominal hypertension
Over-resuscitation leads to tissue edema, increased compartment pressures, risk of abdominal hypertension, and organ dysfunction.
During fluid resuscitation, what adjunctive monitoring besides urine output is often used to assess adequacy?
- A Daily body weight measurements only
- B Hourly axillary temperature checks
- C Titration to mean arterial pressure and heart rate goals
- D Serum lactate measured only after 24 hours
Correct answer: Titration to mean arterial pressure and heart rate goals
Hemodynamic targets along with urine output help assess whether perfusion is adequate and guide fluid adjustments.
What is the main fluid challenge in resuscitating a patient with inhalation injury plus cutaneous burns?
- A Immediately at the time of admission
- B When fluid shifts, urine output, and hemodynamics stabilize (24–48 h)
- C Only after roughly 10 days of care
- D At the time the patient is discharged home
Correct answer: When fluid shifts, urine output, and hemodynamics stabilize (24–48 h)
Inhalation injury increases systemic inflammation, capillary leak, and fluid shifts, thus increasing resuscitation fluid needs.
When should the 'resuscitation phase' of fluid management generally transition to the 'early wound closure / fluid‐balance stabilization' phase?
- A Immediately at admission
- B When the patient’s fluid shifts stabilise, urine output and hemodynamics are stable, often after first 24-48 hours
- C Only after 10 days
- D When the patient is discharged
Correct answer: When the patient’s fluid shifts stabilise, urine output and hemodynamics are stable, often after first 24-48 hours
The resuscitation phase is in the first 24-48h; once perfusion stabilizes and capillary leak moderates, fluid requirements diminish and focus shifts to wound management.
Which patients may require less fluid than the traditional 4 mL/kg/%TBSA formula suggests?
- A Patients with delayed resuscitation
- B Those with smaller TBSA burns (<20%)
- C Those with inhalation injury
- D Very large TBSA burns (>50%)
Correct answer: Those with smaller TBSA burns (<20%)
Patients with smaller burns may only need maintenance or less aggressive fluid volumes; formulas apply primarily to major burns.
Why is warmed intravenous fluid recommended during burn resuscitation?
- A Warmed fluid is simply cheaper to administer
- B Cold fluids speed up the patient's metabolic rate
- C Cold fluids worsen hypothermia, raising metabolic demand
- D Warmed and cold fluids have no clinical difference
Correct answer: Cold fluids worsen hypothermia, raising metabolic demand
Burn patients are at high risk of hypothermia; cold fluids can worsen this, increase vasoconstriction and metabolic demand—so warmed fluids are recommended.
In addition to crystalloid infusion, what is a key nursing intervention during the resuscitation phase?
- A Restricting all oral and IV intake until 72 hours post-burn injury
- B Monitoring extremities for compartment syndrome, especially in circumferential burns
- C Avoiding urinary catheter placement to prevent ascending infection risk
- D Delaying all central line insertion until at least 24 hours after admission
Correct answer: Monitoring extremities for compartment syndrome, especially in circumferential burns
Frequent neurovascular checks and fasciotomy monitoring are critical due to the risk of compartment syndrome, especially with circumferential burns.
According to the updated consensus, what is the evolving trend in burn resuscitation fluid volume?
- A Steadily increasing total fluid volumes given for resuscitation each year
- B Applying one fixed resuscitation volume regardless of patient or burn size
- C Lower crystalloid volumes plus colloids or plasma to limit edema and complications
- D Eliminating fluid resuscitation altogether in favor of oral rehydration only
Correct answer: Lower crystalloid volumes plus colloids or plasma to limit edema and complications
Recent evidence suggests lower crystalloid volumes supplemented reduce complications of over-resuscitation.
A patient weighs 60 kg with 25% TBSA full-thickness burn. According to a 3 mL/kg/%TBSA formula, how much fluid in the first 24 h?
- A 4500 mL
- B 3000 mL
- C 7500 mL
- D 15,000 mL
Correct answer: 4500 mL
3 mL × 60 kg × 25 = 4500 mL; this is an estimate, and half should be given in the first ~8 h then adjusted.
What is one reason fluid resuscitation may fail (i.e., the patient remains hypotensive or oliguric despite fluids)?
- A Over-administration of fluids reliably resolves persistent hypotension and oliguria
- B Concomitant cardiac or renal dysfunction, delayed transport, or ongoing bleeding
- C Choosing lactated Ringer's solution instead of normal saline for resuscitation
- D Withholding fluids until full enteral feeding has been successfully established
Correct answer: Concomitant cardiac or renal dysfunction, delayed transport, or ongoing bleeding
If resuscitation fails, reasons may include delayed initiation, inhalation injury, cardiac/renal issues, ongoing hemorrhage or under-estimated burn size—all requiring reassessment beyond simply increasing fluids.