A client has a large thermal burn injury and is receiving large amounts of intravenous crystalloid fluid as part of initial therapy. What is the best explanation of the purpose of this therapy?
Development of third spacing reduces renal perfusion.
It is part of the protocol for initial burn management.
Burn trauma cell damage causes external fluid loss.
Crystalloid intravenous fluids are less expensive.
The Correct Answer is A
A. Development of third spacing reduces renal perfusion: Large burn injuries cause massive fluid shifts into the interstitial and third spaces due to increased capillary permeability. This reduces circulating blood volume and decreases renal perfusion, creating a risk of shock and acute kidney injury. Large-volume crystalloid resuscitation restores intravascular volume and supports organ perfusion.
B. It is part of the protocol for initial burn management: While fluid resuscitation is indeed part of burn protocols, this option does not explain why fluids are required. The rationale must focus on the pathophysiology of fluid shifts and reduced perfusion.
C. Burn trauma cell damage causes external fluid loss: Although burns cause loss of the skin barrier and some evaporative fluid loss, the primary reason for large-volume replacement is internal fluid shifting (third spacing), not external loss.
D. Crystalloid intravenous fluids are less expensive: Cost is not a clinical reason for choosing the type of fluid for burn resuscitation. The choice is based on safety, evidence-based guidelines, and physiologic needs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Blood pressure, pulse and respirations: Vital signs are important for monitoring overall stability, but they can remain within normal limits in the early stages of shock due to compensatory mechanisms. Relying solely on vital signs may not provide the most accurate assessment of tissue perfusion.
B. Level of consciousness, urine output, skin color and temperature: These parameters directly reflect the adequacy of tissue perfusion. Altered mental status indicates cerebral hypoperfusion, decreased urine output signals renal hypoperfusion, and cool, pale skin reflects peripheral vasoconstriction. They provide an immediate assessment of organ and tissue oxygenation.
C. Breath sounds, blood pressure and body temperature: Breath sounds assess respiratory status, and temperature indicates thermoregulation, but neither provides a direct measure of tissue perfusion. Blood pressure alone may not reflect early perfusion deficits.
D. Pulse pressure, level of consciousness and pupillary response: While level of consciousness is relevant, pulse pressure and pupillary response are less sensitive indicators of tissue perfusion compared to urine output and skin characteristics. These parameters may change later in shock progression.
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.
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