A nurse is planning care for a client who sustained a major burn over 20% of the body. Which of the following interventions should the nurse include to support the client's nutritional requirements?

Schedule meals at 6-hr intervals.

Maintain calorie intake at 1,500 per day.

Keep a calorie count for foods and beverages.

Provide a low-protein, high-carbohydrate diet.

Answer and Explanation

The Correct Answer is C

A. Scheduling meals at 6-hour intervals is inadequate as clients with major burns require frequent, high-calorie intake.

B. A calorie intake of 1,500 per day is insufficient for burn clients, who require significantly higher caloric intake to support healing.

C. Keeping a calorie count helps ensure the client is meeting their increased nutritional needs for wound healing and recovery.

D. A high-protein, high-carbohydrate diet is necessary, not a low-protein diet, to support tissue repair and metabolic demands.

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Correct Answer is D

Explanation

A. Pain level of 6: Important but not life-threatening.

B. Excoriation: Requires treatment but is not the priority.

C. Xerostomia: Manageable with supportive care.

D. Dysphagia: Can lead to aspiration, malnutrition, or airway compromise and requires immediate attention.

A. Assign the AP to ask the client if she has taken her antidiabetic medication today. B. Determine if the AP has the skills to perform the test. C. Help the AP perform the blood glucose test. D. Have the AP check the medical record for prior blood glucose test results.

Correct Answer is B

Explanation

A. Assign the AP to ask the client if she has taken her antidiabetic medication today: Incorrect. Assessing medication use is a nursing responsibility and cannot be delegated to an AP.

B. Determine if the AP has the skills to perform the test: The nurse must ensure that the AP is competent to perform the task safely and accurately before delegation, as part of the nurse's responsibility in delegation.

C. Help the AP perform the blood glucose test: Incorrect. The task should be performed independently by the AP if delegated.

D. Have the AP check the medical record for prior blood glucose test results: Incorrect. Reviewing the medical record is a nursing responsibility and not typically delegated to an AP.

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