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Mr. Paul is a 39-year-old man who sustained a 30% partial burn. The affected areas include his right arm and hand and sections of his anterior and posterior trunk and neck. Mr. Paul was injured at 2:00 p.m. and rushed to the emergency room where intravenous therapy was begun at 3:00 p.m. If he is to receive 5,000 ml of lactated Ringer's in 24 hours, according to the Parkland formula how much solution should he receive by 10:00 p.m.

3,000 ml

2,500 ml

2,000 ml

3,500 ml

Answer and Explanation

The Correct Answer is B

Rationale:

A. 3,000 ml – This overestimates the volume for the first 8 hours.

B. 2,500 ml – This represents half of the 24-hour fluid requirement, appropriate for the first 8 hours.

The Parkland formula is used to calculate fluid resuscitation in the first 24 hours after a burn:

Total fluid requirement (ml) = 4 × body weight (kg) × % TBSA burned

Once the total 24-hour fluid requirement is calculated:

Half of the total fluid is given in the first 8 hours post-injury.
The remaining half is given over the next 16 hours.

In this scenario:

Mr. Paul’s total 24-hour fluid requirement is 5,000 ml.
Half of 5,000 ml = 2,500 ml, which should be administered in the first 8 hours after the burn occurred.

Timing calculation:

Burn occurred at 2:00 p.m.
First 8 hours after the burn: 2:00 p.m. → 10:00 p.m.
Therefore, by 10:00 p.m., Mr. Paul should have received 2,500 ml of lactated Ringer’s.

C. 2,000 ml – This underestimates the volume required in the first 8 hours.

D. 3,500 ml – This exceeds the volume for the first 8 hours and could lead to fluid overload.

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Correct Answer is D

Explanation

Rationale:
A. Dobutamine is an inotropic agent used to increase cardiac output in cases of cardiogenic shock or heart failure. It is not the first-line treatment for anaphylactic shock, where the primary problem is severe vasodilation and bronchoconstriction.

B. Methylprednisolone is a corticosteroid that can reduce inflammation and prevent delayed or prolonged allergic responses. While helpful, it acts slowly and does not address the immediate life-threatening cardiovascular and respiratory compromise in anaphylaxis.

C. Furosemide is a loop diuretic used to manage fluid overload and pulmonary edema. It has no role in treating anaphylactic shock and could worsen hypotension by reducing circulating volume.

D. Epinephrine is the first-line treatment for anaphylactic shock. It rapidly reverses severe hypotension and airway compromise by causing vasoconstriction, increasing cardiac output, and relaxing bronchial smooth muscle to relieve bronchospasm. Immediate administration is critical to prevent respiratory failure and death.

A. Age of the client B. Associated medical history C. Location of the burn D. Cause of the burn

Correct Answer is C

Explanation

Rationale:
A. Age of the client is an important consideration in overall prognosis and healing potential, as older adults and very young clients have higher morbidity and mortality from burns. However, age does not take priority over factors that immediately affect airway, breathing, and functional outcomes when determining burn severity.
B. Associated medical history, such as diabetes or cardiovascular disease, can influence healing and risk for complications, but it is a secondary consideration compared with the immediate threat posed by burns in critical areas.
C. Location of the burn is the priority factor when assessing burn severity. Burns involving the face and neck place the client at high risk for airway edema and obstruction, while burns to the upper extremities can significantly affect function. Burns in these critical areas are considered more severe regardless of total body surface area or cause, making location the most important priority.
D. Cause of the burn (thermal, chemical, electrical, or radiation) influences treatment decisions and potential complications, but it is not the primary factor when initially determining severity compared with burn location.

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A nurse is caring for a client who is experiencing anaphylactic shock in response to the administration of penicillin. Which of the following medications should the nurse administer first?

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