A 78 kg client has a 60% total body surface area (TBSA) thermal burn. Using the American Burn Association formula for fluid resuscitation the client should receive a fluid replacement of per hour during the first 8 hours after a major burn injury.
1170 mL
585 mL
4680 mL
9360 mL
The Correct Answer is A
A. 1170 mL: Using the Parkland formula (4 mL × body weight in kg × % TBSA burned), the total fluid for the first 24 hours is calculated: 4 × 78 × 60 = 18,720 mL. Half of this (9,360 mL) is administered in the first 8 hours. To determine the hourly rate: 9,360 ÷ 8 = 1,170 mL/hour. This is the correct rate for the initial 8-hour resuscitation period.
B. 585 mL: This is half of the correct hourly rate. Administering only 585 mL/hour would under-resuscitate the client, risking hypoperfusion and shock.
C. 4680 mL: This number may represent half of the total 24-hour fluid requirement, but it is not the per-hour rate. Administering all 4,680 mL at once would be unsafe and could cause fluid overload.
D. 9360 mL: This is the total volume for the first 8 hours, not the hourly rate. Delivering the entire 9,360 mL at once would be extremely dangerous and could result in cardiovascular compromise and pulmonary edema.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Administration of a calcium channel blocker: Calcium channel blockers are primarily used to manage hypertension, angina, or certain arrhythmias. They do not prevent sudden cardiac death in clients with severe left ventricular dysfunction and have not been shown to improve survival in this population.
B. Insertion of an implantable cardioverter defibrillator (ICD): An ICD continuously monitors the heart rhythm and delivers an electrical shock to terminate life-threatening ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation. This intervention significantly reduces the risk of sudden cardiac death and improve long-term survival in clients with severe left ventricular dysfunction.
C. Administration of a beta-blocker: Beta-blockers improve survival in heart failure and reduce the incidence of arrhythmias, but they do not provide immediate protection against sudden cardiac death in high-risk patients as effectively as an ICD.
D. Insertion of an implantable pacemaker: A pacemaker regulates bradyarrhythmias and maintains adequate heart rate but does not terminate life-threatening ventricular tachyarrhythmias. It does not have the same protective effect against sudden cardiac death as an ICD.
Correct Answer is B
Explanation
A. Sinus bradycardia, B/P 108/60: Sinus bradycardia with stable blood pressure and no signs of poor perfusion is usually not an emergency. While it may require monitoring and possible medication adjustments, immediate pacing is not indicated unless the client becomes symptomatic with hypotension, syncope, or chest pain.
B. Complete heart block at a rate of 30 beats per minute B/P 60/40: Complete heart block with severe bradycardia and hypotension represents a life-threatening condition. The heart is unable to maintain adequate cardiac output, leading to shock and potential cardiac arrest. Emergency pacing is indicated to restore effective heart rate and perfusion, making this the highest priority.
C. Ventricular tachycardia, B/P 50/30: Ventricular tachycardia with hypotension is a medical emergency that may require immediate defibrillation or antiarrhythmic therapy, but it is not treated primarily with a pacemaker. Pacemakers are ineffective in terminating ventricular tachyarrhythmias, so other interventions take precedence.
D. Paroxysmal atrial tachycardia B/P 70/40: While this rhythm can cause hypotension, it is usually less immediately life-threatening than complete heart block with severe bradycardia. Treatment focuses on rate control, antiarrhythmic medications, or vagal maneuvers rather than emergency pacing unless bradycardia develops after treatment.
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