A client with partial-thickness burns to the trunk and both lower extremities is admitted 2 hours after injury.
Which intravenous fluid should the nurse initiate?
Albumin 2.5 percent.
Lactated Ringer's solution.
5 percent dextrose in water.
0.9 percent normal saline with 20 mEq potassium.
The Correct Answer is B
This scenario focuses on acute fluid resuscitation following thermal injury. Knowledge of fluid shift dynamics during the emergent phase of burns is essential to prevent hypovolemic shock. Crystalloid selection must prioritize electrolyte balance and volume expansion to maintain organ perfusion.
Choice A rationale
Albumin is a colloid used for volume expansion but is generally avoided in the first 24 hours of burn care. Increased capillary permeability allows large molecules to leak into interstitium, worsening edema rather than maintaining intravascular volume.
Choice B rationale
This isotonic crystalloid is the gold standard for burn resuscitation. It closely mimics extracellular fluid and provides essential electrolytes. The lactate is metabolized into bicarbonate, which helps buffer the metabolic acidosis commonly seen in major thermal injuries.
Choice C rationale
Dextrose in water is a hypotonic solution once glucose is metabolized. It does not stay in the intravascular space and can lead to cellular edema. It is ineffective for volume resuscitation and may cause dangerous electrolyte imbalances.
Choice D rationale
While normal saline is isotonic, adding potassium is contraindicated in the emergent burn phase. Damaged cells release intracellular potassium into the bloodstream, making hyperkalemia a significant risk. Normal range for potassium is 3.5 to 5.0 mEq/L.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Electrical burns require understanding the path of current through the body. Because electricity follows the path of least resistance, it often travels through the heart. This necessitates applying knowledge of cardiac rhythm disturbances and immediate diagnostic prioritization.
Choice A rationale
Checking pulses is important to assess for compartment syndrome or vascular damage in the right hand and left foot. However, it is secondary to assessing the heart, as electrical current can cause immediate, fatal cardiac arrest.
Choice B rationale
Irrigating wounds is part of standard burn care but is not the priority for electrical injuries. The surface wounds often mask extensive internal tissue damage. Addressing potential cardiac conduction issues must occur before performing local wound cleansing.
Choice C rationale
Electrical current passing between hands and feet frequently crosses the heart. This can cause immediate dysrhythmias or delayed cardiac irritability. Continuous telemetry is vital to monitor for life-threatening changes in the heart's electrical activity and rhythm.
Choice D rationale
While the client may experience pain, the report of chest tightness and lightheadedness suggests a cardiac or hemodynamic event. Administering opioids before stabilizing the cardiac status could mask symptoms or further complicate the clinical assessment process..
Correct Answer is A
Explanation
Managing post-concussion syndrome involves supporting neurological recovery through environmental and lifestyle modifications. Knowledge of brain rest, neuroplasticity, and the importance of circadian rhythms must be applied to mitigate symptoms like headaches, irritability, and persistent sleep disturbances.
Choice A rationale
A structured routine minimizes cognitive load and sensory overload, which are triggers for post-concussion headaches. Consistent sleep hygiene promotes neurological healing by regulating neurotransmitters and allowing the glymphatic system to clear metabolic waste from brain tissues.
Choice B rationale
Education on neuroimaging focuses on diagnostic tools rather than symptom management. While understanding scans may reduce anxiety, it does not provide the practical behavioral interventions required to alleviate the physiological symptoms of headaches and irritability.
Choice C rationale
Premature increase in physical activity can exacerbate post-concussion symptoms by increasing intracranial pressure and metabolic demand. Recovery requires a gradual return to activity, as overexertion can lead to a significant setback in neurological stabilization.
Choice D rationale
While adequate nutrition is important for general health, a high-calorie diet is not a specific treatment for post-concussion syndrome. Management focuses on neuro-rest and avoiding stimulants or triggers rather than increasing caloric intake to treat irritability.
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