Following an explosion at a local chemical lab, several people have sustained burns and are now in the triage area.

Which patient should be attended to first?

A 33-year-old with burns to the back and shoulders.

A 32-year-old with burns on the hands and face.

A 42-year-old with burns on both legs.

A 25-year-old with a burn on the left arm.

Answer and Explanation

The Correct Answer is B

Choice A rationale
A 33-year-old with burns to the back and shoulders. While this patient’s injuries are serious, they are not immediately life-threatening. The back and shoulders are not vital areas, and while pain management and wound care will be necessary, this patient’s situation is not as urgent as others.
Choice B rationale
A 32-year-old with burns on the hands and face. This patient should be attended to first. Burns on the hands and face are more serious due to the high risk of infection and the potential for complications such as impaired breathing if the airway swells or becomes blocked due to the burns. Immediate treatment can help to prevent these complications.
Choice C rationale
A 42-year-old with burns on both legs. While these burns are serious, they are not immediately life-threatening. The patient will need pain management and wound care, and may have mobility issues, but their vital organs are not directly impacted by the burns.
Choice D rationale
A 25-year-old with a burn on the left arm. This patient, while in need of treatment, is not the highest priority. A burn on the arm, while painful and requiring treatment, is not as potentially serious or life-threatening as burns to the face, hands, or major portions of the body.

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Correct Answer is D

Explanation

Choice A rationale
Informing the charge nurse is an important step, but it is not the immediate action. The nurse should first assess the situation before escalating it.
Choice B rationale
Applying a dressing under the client’s nose might help manage the drainage, but it does not address the underlying issue. The drainage could be cerebrospinal fluid (CSF), which is a serious condition that needs immediate attention.
Choice C rationale
Checking the client’s temperature is a general assessment and does not directly relate to the symptom of clear nasal drainage.
Choice D rationale
Testing the drainage for glucose is the correct action. Clear nasal drainage after a basal skull fracture could be a sign of a cerebrospinal fluid (CSF) leak. CSF contains glucose, so testing the drainage for glucose can help confirm if it’s CSF34.

A. Handling the cast with the palms of the hands. B. Drying the cast with a hair dryer. C. Keeping the left leg in a dependent position. D. Covering the patient’s legs with a blanket.

Correct Answer is A

Explanation

Choice A rationale
Handling the cast with the palms of the hands is recommended, especially when the cast is still wet and not fully hardened. This helps to avoid indentations and pressure points that could lead to discomfort or skin complications.
Choice B rationale
Drying the cast with a hair dryer is not typically recommended. Excessive heat can cause the cast material to weaken and can also burn the skin.
Choice C rationale
Keeping the casted leg in a dependent position is not recommended. This can lead to increased swelling and discomfort.
Choice D rationale
Covering the patient’s legs with a blanket is not specifically related to the care of a fresh cast. While it may provide comfort, it does not have a direct impact on the care or outcome of the cast.

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Following an explosion at a local chemical lab, several people have sustained burns and are now in the triage area. Which patient should be attended to first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is attending to a client who has suffered a basal skull fracture. During the morning hygiene care, the nurse observes a thin clear drainage coming from the client’s right nostril. What should be the nurse’s immediate action?

Correct Answer is D

Explanation

A patient has recently had a cast applied to their left lower extremity. Which of the following is included in the nursing care of this fresh cast?

Correct Answer is A

Explanation

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A client has suffered a partial thickness second-degree burn injury of the chest, abdomen, and upper legs and is scheduled for hydrotherapy and debridement. Which of these actions should the nurse take to effectively assist the patient?

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Following an explosion at a local chemical lab, several people have sustained burns and are now in the triage area.

Which patient should be attended to first?