A nurse in an emergency department is caring for a 118.8-lb client who sustained burn injuries in a grease fire. The nurse documents the burnt surface areas in the accompanying diagram and starts an infusion of lactated Ringers at 2300 hours. Using the Rule of Nines, what is the rate of infusion of lactated Ringers at 0600 hrs?
213 mL/hr
152 mL/hr
425 mL/hr
284 mL/hr
The Correct Answer is C
- Calculation of the TBSA according to the rule of 9s:
Anterior Trunk: 18%
Right Arm: 9% (full arm on both posterior and anterior aspects)
Left Arm: 4.5% (only one half, from the elbow to the fingers in both anterior and posterior sides).
Then TBSA = 18 + 9 + 4.5
= 31.5%.
- Calculate the rate of infusion of lactated Ringer's, using the Parkland formula:
Parkland Formula:
Total fluid volume (mL) = 4 mL × client weight (kg) × % TBSA burned
Given:
- Client weight = 118.8 lb
- Burnt surface area = 31.5%
- Infusion starts at 2300 hours (11 PM)
- We need to find the rate at 0600 hours (6 AM)
Calculation:
- Convert client's weight from pounds (lb) to kilograms (kg):
Weight in kg = 118.8 lb / 2.2 lb/kg
= 54 kg
- Calculate the total fluid volume needed for the first 24 hours:
Total fluid volume (mL) = 4 mL × client weight (kg) × % TBSA burned
= 4 mL × 54 kg × 31.5%
= 4 × 54 × 31.5
= 6804 mL
- Determine the amount of fluid to be administered in the first 8 hours:
According to the Parkland formula, half of the total fluid volume is administered in the first 8 hours from the time of the burn injury. The problem states the burn occurred, and the nurse starts the infusion at 2300. This implies 2300 is the "time of the burn"
Fluid for first 8 hours = 6804 mL / 2
= 3402 mL
- Calculate the time elapsed since the start of the infusion until 0600 hrs:
From 2300 (11 PM) to 0600 (6 AM) = 7 hours
This means 0600 is within the first 8 hours of resuscitation.
- Calculate the infusion rate for the first 8 hours.
Rate for first 8 hours (mL/hr) = Fluid for first 8 hours / 8 hours
= 3402 mL / 8 hours
= 425.25 mL/hr
- Round the answer to the nearest whole number.
= 425 mL/hr.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["125"]
Explanation
Total volume to be infused = 250 mL.
Infusion time = 2 hr.
- Calculate the infusion rate in milliliters per hour (mL/hr).
Infusion rate (mL/hr) = Total volume (mL) / Infusion time (hr)
= 250 mL / 2 hr
= 125 mL/hr.
Correct Answer is C
Explanation
A. Pronation of the hands: Pronation of the hands is not specifically associated with decorticate posturing. This type of posturing is characterized by flexion of the arms, with the hands in a clenched position, rather than pronation.
B. External rotation of the lower extremities: External rotation of the lower extremities is more commonly seen in other types of posturing, such as decerebrate posturing, and is not a key feature of decorticate posturing.
C. Stiff arms bent on chest, clenched fists: Decorticate posturing is characterized by flexion of the arms, with the arms bent at the elbows, hands clenched into fists, and legs extended with feet turned inward. This indicates severe damage to the brain’s motor pathways.
D. Extension of the arms: Extension of the arms is characteristic of decerebrate posturing. In decerebrate posturing, the arms are extended and pronated, and the legs are rigidly extended with plantarflexion. This is distinct from the flexor response seen in decorticate posturing.
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