According to the rule of nine, a 40-year-old patient who has burns over the front of the chest and abdomen has about

Appeared in: GMCH - 2015

Explanation

The 'Rule of Nines' is a quick method to estimate the Total Body Surface Area (TBSA) of a burn in adults.
It divides the body into sections, each representing 9% or a multiple of 9% of the TBSA.
For an adult, the anterior trunk (front of the body) is considered 18% of the TBSA.
This is further broken down into the anterior chest (9%) and the anterior abdomen (9%).
Therefore, burns covering the front of the chest and abdomen equal 9% + 9% = 18%.

Option A: This percentage is too low. It represents only the anterior chest OR the anterior abdomen, but not both combined.
Option C: This value does not correspond to a standard anatomical division or a common combination of divisions in the adult Rule of Nines.
Option D: This percentage is too high. It represents the entire trunk (both front and back) or the total for both legs.

Clinical Relevance

Nursing practice connection: Use the key finding related to Calculation of Total Body Surface Area (TBSA) using the Rule of Nines in adults to guide bedside assessment, documentation, and the next nursing action.
Accurate TBSA calculation is a critical first step in burn management as it guides the volume of intravenous fluid resuscitation, most commonly calculated using the Parkland formula (4 mL of Lactated Ringer's × body weight in kg × %TBSA).
The estimated TBSA helps determine the severity of the burn, the need for transfer to a specialized burn unit, and informs the overall treatment plan, nutritional support, and prognosis.
What if the patient was a 2-year-old child? The 'Rule of Nines' would be inaccurate. The Lund-Browder chart would be the preferred method, as it accounts for the different body proportions of children (e.g., a larger head and smaller legs relative to TBSA).

How to Approach the Question

First, identify the patient's age from the question. The patient is 40 years old, which confirms that the adult 'Rule of Nines' is the correct tool to use.
Next, identify the specific body areas mentioned in the question: 'front of the chest and abdomen'.
Recall the percentages assigned by the Rule of Nines for an adult. The anterior chest is 9% and the anterior abdomen is 9%.
Sum the percentages for the affected areas: 9% (chest) + 9% (abdomen) = 18%.
Finally, compare your calculated total with the given options to select the correct answer.

Concept Tested & Keywords

Concept Tested: Calculation of Total Body Surface Area (TBSA) using the Rule of Nines in adults.
Stem keywords: Rule of nine, 40-year-old, burns, front of the chest, abdomen
Lead-in keywords: about
Clinical cues: Patient is a 40-year-old, which indicates the adult 'Rule of Nines' should be applied.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 693-695

Practise the full GMCH - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.