The nurse is caring for a 2-month-old child who suffered burns on his face due to abuse. What is the nurse’s immediate priority concern when caring for this patient?

Managing the airway.

Monitoring renal function.

Restoring fluid volume.

Assessing for shock.

Answer and Explanation

The Correct Answer is A

Choice A rationale

The immediate priority when caring for a patient with facial burns, especially a 2-month-old child, is managing the airway. Burns can cause swelling and compromise the airway, leading to respiratory distress. Therefore, ensuring a patent airway is crucial in these cases.

Choice B rationale

While monitoring renal function is important in burn patients due to the risk of acute kidney injury from decreased perfusion, it is not the immediate priority.

Choice C rationale

Restoring fluid volume is a critical part of burn management. However, it is not the immediate concern when the airway could be compromised.

Choice D rationale

Assessing for shock is important in burn patients due to the risk of hypovolemic shock from fluid loss. However, airway management takes precedence.

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Correct Answer is ["69"]

Explanation

Step 1 is: To calculate the total body surface area (TBSA) involved in burns, we use the rule of nines or a modified version for children. For a 7-year-old child, the head accounts for 8.5% (front) + 8.5% (back), and each leg accounts for 6.5% (front) + 6.5% (back)3.

Step 2 is: Therefore, the total percentage of TBSA involved is (8.5% + 8.5%) + 2 * (6.5% + 6.5%) = 17% (head) + 26% (each leg) * 2 = 17% + 52% = 69%. So, the calculated percentage of total body surface area involved is 69%.

A. Dehydration B. Infection C. Hemorrhage D. Aspiration

Correct Answer is A

Explanation

Choice A rationale

Given the patient’s history of tonsillectomy, elevated temperature, high pulse rate, and the fact that they were admitted due to dehydration, the patient is most at risk for dehydration.

Choice B rationale

While infection is a possible risk due to the recent surgery and elevated temperature, the provided information about the patient’s vital signs and history points more towards dehydration.

Choice C rationale

Hemorrhage could be a concern post-tonsillectomy, but the patient’s symptoms and history of dehydration make dehydration a more immediate risk.

Choice D rationale

Aspiration could be a risk in patients post-surgery, but given the patient’s vital signs and history, dehydration is the most immediate risk.

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The nurse is caring for a 2-month-old child who suffered burns on his face due to abuse. What is the nurse’s immediate priority concern when caring for this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a 7-year-old child with burns covering the entire head and both legs. Using the provided chart, what is the calculated percentage of total body surface area involved?

Correct Answer is ["69"]

Explanation

Correct Answer is A

Explanation

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