A nurse arrives at an accident scene where the victim has just received an electrical burn. Which is the nurse's primary concern?
The sites of entry and exit
Control of bleeding
The likelihood of cardiac arrest
The extent and depth of the burn
The Correct Answer is C
A. The sites of entry and exit: While important for assessing burn severity, immediate concern is not the primary issue.
B. Control of bleeding: Electrical burns do not typically cause significant external bleeding.
C. The likelihood of cardiac arrest: Electrical burns can cause cardiac arrhythmias or arrest, making this the primary concern.
D. The extent and depth of the burn While important for treatment, the immediate concern is cardiac arrest.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "What we say can be secret. What I write in the chart is available to the health team." This response lacks clarity about legal and ethical obligations.
B. "I am required to report any intent to hurt yourself or others." This response clearly communicates the legal and ethical obligation to protect the patient and others from harm, while also acknowledging the importance of patient confidentiality in other situations.
C. "Conversations between patient and nurse are confidential." This is true, but it does not address exceptions such as harm to self or others.
D. "I can't help you unless you trust me." This does not address the patient's concerns about confidentiality directly.
Correct Answer is D
Explanation
A. Increase activity to promote mobility. While moderate activity is beneficial, excessive activity can exacerbate symptoms of SLE.
B. Increase exposure to the sun to increase vitamin D absorption. Sun exposure can trigger lupus flares, so it should be minimized.
C. Increase sodium consumption. Increased sodium intake is not recommended as it can lead to hypertension, a common concern in SLE patients.
D. Maintain a balance between rest and activity. Balancing rest and activity helps manage fatigue and prevent symptom exacerbation in SLE.
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