A nurse is reviewing the medical record of a client who has sustained a full-thickness burn and is in the emergent phase of the burn. Which of the following findings should the nurse expect?

Hypernatremia

Hypercalcemia

Hypermagnesemia

Hyperkalemia

Answer and Explanation

The Correct Answer is D

A.   Hypernatremia: Hypernatremia (elevated sodium levels) is not typically associated with the emergent phase of burn injuries.
B.   Hypercalcemia: Hypercalcemia (elevated calcium levels) is not typically associated with the emergent phase of burn injuries.
C.   Hypermagnesemia: Hypermagnesemia (elevated magnesium levels) is not typically associated with the emergent phase of burn injuries.
D.   Hyperkalemia: Hyperkalemia (elevated potassium levels) is a common electrolyte imbalance seen in the emergent phase of burn injuries due to the release of potassium from damaged cells.
It can lead to cardiac dysrhythmias and other complications if not promptly addressed.

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Correct Answer is B

Explanation

A. The client's foot feels cooler than in the previous assessment: While decreased temperature can indicate decreased perfusion, the absence of a palpable pedal pulse is a more concerning finding.
B. The client's pedal pulse in the right foot is not palpable: This finding suggests compromised blood flow distal to the site of the bypass graft, which could indicate graft occlusion or impaired circulation.
C. The client's capillary refill time is 5 seconds in the toes: While prolonged capillary refill time can indicate impaired circulation, the absence of a palpable pedal pulse is a more concerning finding.
D. The client reports a pain level of 8 on a scale from 3 to 10: Pain is subjective and can be managed with analgesics, but the absence of a palpable pedal pulse indicates a more serious issue related to perfusion.

A. Accountability B. Autonomy C. Veracity D. Justice

Correct Answer is C

Explanation

A. Accountability refers to the nurse's responsibility to provide safe and competent care, including administering medications accurately and documenting appropriately.
B. Autonomy refers to the client's right to make decisions about their own care, including whether or not to take prescribed medications.
C. Veracity refers to truthfulness and honesty in communication. By providing the client with accurate information about the purpose of the medication, the nurse is demonstrating veracity. D. Justice refers to fairness and equity in the distribution of resources and treatment. While ensuring access to necessary medications is important for justice, it is not directly related to the nurse's communication about the purpose of the medication.

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A nurse is reviewing the medical record of a client who has sustained a full-thickness burn and is in the emergent phase of the burn. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is establishing a baseline postoperative assessment for a client who is recovering from a right femoropopliteal bypass graft. Which of the following findings in the assessment of the client's right leg should be of the most concern to the nurse?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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