A nurse is caring for a 32-year-old male client in an outpatient rehabilitation setting.

A client has been recovering for 16 months from burns that affected 40% total body surface area. Which of the following complications should the nurse expect? (Select all that apply.)

Body image disorder

Post Traumatic Stress Disorder (PTSD)

Suicidal thoughts or depression

Electrolyte imbalance

Fluid volume deficit

Answer and Explanation

Correct Answer : A,B,C

Choice A rationale:
Clients recovering from extensive burn injuries often experience body image disturbances due to visible scarring, contractures, and physical disfigurement. The emotional trauma associated with altered appearance affects self-esteem and social interactions. This client avoids looking at his scars and reports anxiety about his appearance, consistent with body image disorder. Burn survivors frequently need long-term psychological support and counseling to adjust to changes in physical identity and self-perception.

Choice B rationale:
The client shows clear signs of Post Traumatic Stress Disorder (PTSD)—such as nightmares, flashbacks, and emotional distress related to the fire. PTSD is common in burn survivors due to the traumatic nature of injury and hospitalization. The presence of hyperarousal symptoms and avoidance behaviors also aligns with PTSD diagnostic criteria in the DSM-5. Early identification and referral to mental health professionals are essential for managing PTSD in burn recovery.

Choice C rationale:
Suicidal ideation and depression are common psychological complications after severe burns, particularly with long rehabilitation periods, chronic pain, disfigurement, and loss of independence. This client expresses a low mood and occasional thoughts of self-harm, requiring immediate psychological intervention. Depression in burn clients can be linked to loss of function, changes in appearance, and feelings of hopelessness.

Choice D rationale:
Incorrect. Electrolyte imbalances are most critical during the acute phase (first 24–72 hours post-injury), especially in cases involving significant fluid shifts and tissue destruction. At 16 months post-injury, electrolyte levels usually stabilize unless other medical conditions exist. The client’s vitals and nutritional status are stable, with no signs of acute imbalance.

Choice E rationale:
Incorrect. Fluid volume deficit is an acute concern during the initial burn phase due to capillary leak and evaporative losses. At the rehabilitation stage, clients typically have normal fluid balance unless complications like infection or gastrointestinal issues arise. There is no clinical evidence of dehydration or hypotension in this client.

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Correct Answer is B

Explanation

Choice A rationale

Furosemide, a loop diuretic, primarily affects the ascending limb of the loop of Henle, inhibiting sodium, potassium, and chloride reabsorption. While it can cause some calcium excretion, hypocalcemia is not its most prominent or common electrolyte imbalance compared to potassium. Normal serum calcium is 8.5-10.2 mg/dL.

Choice B rationale

Furosemide works by inhibiting the Na-K-2Cl cotransporter in the thick ascending limb of the loop of Henle, leading to increased excretion of sodium, potassium, and chloride. This significant loss of potassium in the urine frequently results in hypokalemia, a common and critical adverse effect. Normal serum potassium is 3.5-5.0 mEq/L.

Choice C rationale

Furosemide promotes potassium excretion, making hyperkalemia an unlikely and rare occurrence. In fact, it is sometimes used to treat hyperkalemia in specific clinical situations due to its kaliuretic effect. Normal serum potassium is 3.5-5.0 mEq/L.

Choice D rationale

Furosemide causes increased excretion of sodium, leading to a risk of hyponatremia, not hypernatremia. The diuretic effect reduces total body water and sodium, potentially causing a dilutional or depletional hyponatremic state. Normal serum sodium is 135-145 mEq/L. .

A. Grilled chicken, white rice, sliced peaches. B. Fried shrimp, cauliflower, yogurt with granola. C. Grilled salmon, brown rice, broccoli. D. Spaghetti with tomato sauce, meatballs, and garlic bread.

Correct Answer is A

Explanation

Choice A rationale

Grilled chicken and white rice are low in fat and fiber, making them easily digestible and less likely to exacerbate diarrhea in an immunocompromised client with AIDS. Peaches, when peeled, offer easily digestible carbohydrates and some electrolytes, aiding in rehydration without increasing gastrointestinal motility, which is crucial for nutrient absorption in clients with compromised gut integrity.

Choice B rationale

Fried shrimp is high in fat, which can stimulate gastrointestinal motility and worsen diarrhea, leading to malabsorption. Cauliflower is a cruciferous vegetable high in insoluble fiber, which can irritate the bowel. Granola contains nuts and seeds, which are high in fiber and can be difficult to digest, potentially aggravating diarrhea.

Choice C rationale

Grilled salmon, while a healthy protein, is higher in fat than chicken, potentially contributing to gastrointestinal upset. Brown rice is a whole grain high in fiber, which can increase stool bulk and frequency. Broccoli is a high-fiber vegetable that can cause gas and bloating, worsening diarrheal symptoms.

Choice D rationale

Spaghetti with tomato sauce can be acidic and may irritate a sensitive bowel. Meatballs can be high in fat, which may worsen diarrhea. Garlic bread often contains fats and spices that can further irritate the gastrointestinal tract, leading to increased fluid loss.

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A nurse is caring for a 32-year-old male client in an outpatient rehabilitation setting. A client has been recovering for 16 months from burns that affected 40% total body surface area. Which of the following complications should the nurse expect? (Select all that apply.)

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A nurse is caring for a 32-year-old male client in an outpatient rehabilitation setting.

A client has been recovering for 16 months from burns that affected 40% total body surface area. Which of the following complications should the nurse expect? (Select all that apply.)