A nurse is assessing the depth and extent of injury on a client who has severe burns to the face, neck, and upper extremities. Which of the following factors is the nurse's priority when assessing the severity of the client's burns?

Age of the client

Associated medical history

Cause of the burn

Location of the burn

Answer and Explanation

The Correct Answer is D

This is because burns to the face, neck, and upper extremities can compromise the airway, circulation, and mobility of the client. The nurse should monitor for signs of respiratory distress, infection, and contractures in these areas.

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Correct Answer is A

Explanation

This is because fluticasone is an inhaled corticosteroid that suppresses the immune system and increases the risk of fungal infections in the mouth and throat. The nurse should instruct the client to rinse their mouth with water after each use of fluticasone and to report any signs of oral thrush, such as white patches, soreness, or difficulty swallowing. Polyuria, hypertension, and hypoglycemia are not associated with fluticasone.

A. "This procedure involves placing the client into a shower and removing the dead tissue." B. "Dead tissue will be non-surgically removed." C. "Large incisions will be made in the eschar to improve circulation." D. "A piece of healthy skin will be removed from an unburned area and grafted over the burned area."

Correct Answer is C

Explanation

An escharotomy is a surgical procedure that involves making incisions in the eschar, which is the hard, blackened tissue that forms over a severe burn wound. The eschar can restrict blood flow and cause compartment syndrome, which can lead to tissue necrosis and nerve damage. By cutting through the eschar, the pressure is relieved and circulation is restored. This procedure does not involve removing the dead tissue, which is done by debridement or hydrotherapy. A skin graft is a different procedure that involves transplanting healthy skin from another site to cover a burn wound.

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A nurse is assessing the depth and extent of injury on a client who has severe burns to the face, neck, and upper extremities. Which of the following factors is the nurse's priority when assessing the severity of the client's burns?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has asthma and is taking fluticasone. The nurse should monitor the client for which of the following adverse effects?

Correct Answer is A

Explanation

A nurse in a burn treatment center is caring for a client who is admitted with severe burns to both lower extremities and is scheduled for an escharotomy. The client's spouse asks the nurse what the procedure entails. Which of the following nursing statements is appropriate?

Correct Answer is C

Explanation

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