A nurse working in a burn unit cares for clients with complicated body system responses. Which response describes the body's initial reaction to a severe burn injury?
Anaphylactic.
Noncompensatory.
Inflammatory.
Cholinergic.
The Correct Answer is C
A. Anaphylactic. Anaphylactic reactions are caused by severe allergic responses, leading to histamine release, vasodilation, and bronchoconstriction. While burns trigger an immune response, it is an inflammatory reaction rather than an allergic one.
B. Noncompensatory. The body's response to burns is compensatory, not noncompensatory. The body immediately reacts by activating the inflammatory and stress responses to maintain perfusion and initiate healing.
C. Inflammatory. A severe burn triggers an immediate and massive inflammatory response, causing capillary leakage, fluid shifts (burn shock), and immune activation. This leads to edema, hypovolemia, and increased risk of infection. The inflammatory response also activates cytokines and white blood cells to begin tissue repair.
D. Cholinergic. The cholinergic response is related to the parasympathetic nervous system, which controls rest-and-digest functions. Severe burns primarily activate the sympathetic nervous system (fight-or-flight), leading to vasoconstriction, tachycardia, and increased metabolic demands.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B","dropdown-group-3":"C"}
Explanation
Based on the client's history, physical, and laboratory findings, the priority need will be to treat the infection (cellulitis). In addition, the client will need interventions to manage complications, especially deep tissue injury and impaired circulation.
Rationale:
The infection (cellulitis) is the primary concern, as indicated by redness, warmth, swelling, and systemic symptoms like muscle aches. Immediate antibiotic therapy is crucial.
Deep tissue injury is a potential complication due to prolonged inflammation, swelling, and impaired circulation, which can lead to tissue damage.
Impaired circulation is a significant risk in a client with diabetes and peripheral vascular disease, as it can slow healing and increase the likelihood of further complications such as ulcers or necrosis.
Correct Answer is A
Explanation
A. It is the main structural component of the dermis which provides strength and elasticity. Collagen is the primary protein in the dermis, responsible for maintaining skin strength, firmness, and elasticity. Sun exposure damages collagen fibers, leading to wrinkles, sagging skin, and premature aging.
B. It increases skin elasticity with the aging process. Collagen production decreases with age, leading to reduced skin elasticity and increased wrinkle formation. Sun damage accelerates this process by breaking down collagen fibers.
C. It forms the ridges and valleys which provide traction for grasping objects and surfaces. Friction ridges (fingerprints) are formed by the dermal papillae, not collagen. They provide grip and are genetically determined.
D. It is an extensive network of blood vessels that regulates body temperature. The dermis contains a network of blood vessels for temperature regulation, but this function is not related to collagen. Instead, collagen provides structural support to the skin.
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