The nurse is caring for a client with a burn that is severely edematous with a wound bed that is brown and yellow in appearance. The client expresses feeling no pain. Which classification of burn depth should the nurse document?

Deep partial-thickness.

Full-thickness.

Superficial partial-thickness.

Deep full-thickness.

Answer and Explanation

The Correct Answer is B

Choice A reason: Deep partial-thickness burns are characterized by blisters and significant pain.

Choice B reason:

The correct answer is b) because full-thickness burns involve all layers of the skin and can extend into underlying tissues. They often appear brown or yellow and are usually painless due to nerve damage.

Choice C reason: Superficial partial-thickness burns affect the epidermis and part of the dermis, causing pain and redness.

Choice D reason: Deep full-thickness burns are also a possible answer, but full-thickness better describes the extent and characteristics given.

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Correct Answer is ["2"]

Explanation

Calculation steps:

Step 1: Identify the dosage required. 20 mg

Step 2: Identify the concentration available. 10 mg/mL

Step 3: Calculate the volume to be administered. 20 mg ÷ 10 mg/mL

Result: 2 mL

A. Bounding pulse, hypertension, and distended neck veins. B. Thready pulse, hypotension, and chest or back pain. C. Urticaria, itching, and wheezing. D. Chills, fever, and tachycardia.

Correct Answer is A

Explanation

Choice A reason:

The correct answer is a) because a bounding pulse, hypertension, and distended neck veins are signs of fluid overload, which can occur during blood transfusions, especially in older adults.

Choice B reason: A thready pulse, hypotension, and chest or back pain are more indicative of shock or severe anemia rather than fluid overload.

Choice C reason: Urticaria, itching, and wheezing suggest an allergic reaction, not fluid overload.

Choice D reason: Chills, fever, and tachycardia can indicate a febrile or transfusion reaction but are not specific to fluid overload.

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The nurse is caring for a client with a burn that is severely edematous with a wound bed that is brown and yellow in appearance. The client expresses feeling no pain. Which classification of burn depth should the nurse document?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with edema receives a prescription for a one-time dose of furosemide 20 mg IV. The medication is available in a 10 mg/mL vial. How many mL should the nurse administer? (Enter numerical value only.)

Correct Answer is ["2"]

Explanation

The nurse is administering the second unit of whole blood to an older adult client who was admitted yesterday with gastrointestinal (GI) bleeding. Which parameters should the nurse monitor that indicate fluid overload?

Correct Answer is A

Explanation

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