A nurse is assessing a client immediately after the provider removed the client's endotracheal tube. Which of the following findings should the nurse report to the provider?

Copious oral secretions

Stridor

Hoarseness

Sore throat

Answer and Explanation

The Correct Answer is B

A. Copious oral secretions can be common after extubation and can be managed with suctioning.
B. It indicates possible airway obstruction or swelling and requires immediate evaluation and intervention.
C. Hoarseness is a common, usually temporary, side effect after extubation.
D. Sore throat is also common and typically resolves without intervention.

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Correct Answer is B

Explanation

A. Paralytic ileus can occur due to stress or injury, but it is not the most immediate threat to life in a burn victim.
B. Burns to the head, neck, and chest can cause rapid swelling and potential airway compromise. Ensuring a patent airway is always the top priority in emergency care, especially in cases involving inhalation injuries or facial burns.
C. Infection is a serious concern in burn clients, particularly as the healing process progresses, but it is not the most immediate life-threatening issue at the time of admission.
D. Fluid imbalance is a critical concern in burn patients due to fluid shifts, but it follows airway management in terms of emergency prioritization according to the ABCs (Airway, Breathing, Circulation) of trauma care.

A. Administer pain medication. B. Clean and dress the wound. C. Administer IV fluids. D. Administer a tetanus booster.

Correct Answer is C

Explanation

A. Pain medication is important but secondary to stabilizing the client’s circulation.
B. Cleaning and dressing the wound is essential but should follow fluid resuscitation in major burns.
C. Administering IV fluids is the priority to prevent hypovolemic shock due to fluid loss from burn injuries.
D. A tetanus booster is important but not the immediate priority in emergency care.

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A nurse is assessing a client immediately after the provider removed the client's endotracheal tube. Which of the following findings should the nurse report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the emergency department is caring for a client who has extensive partial and full-thickness burns of the head, neck, and chest. While planning the client's care, the nurse should identify which of the following risks as the priority for assessment and Intervention?

Correct Answer is B

Explanation

A nurse in the emergency department is caring for a client who has a 30% burn injury to her lower extremities. Which of the following interventions should the nurse perform first?

Correct Answer is C

Explanation

client who suffered burn injuries to their face and entire left arm is to receive lactated ringers. The client weighs 73 kg. How much fluid will be infused for the first 8 hours? (Round to the nearest whole number).

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