The nurse is caring for a patient with a burn that is severely swollen, and the wound bed appears brown and yellow. The patient reports no pain. How should the nurse classify the depth of this burn?

Superficial partial-thickness.

Full-thickness.

Deep partial-thickness.

Deep full-thickness.

Answer and Explanation

The Correct Answer is B

Choice A rationale
A superficial partial-thickness burn involves the destruction of the epidermis and possibly a portion of the dermis. The description provided does not match this type of burn.
Choice B rationale
A full-thickness burn involves total destruction of the epidermis and dermis, and in some cases, the underlying tissue, muscle, and bone. The description of the burn as severely swollen, with a wound bed that appears brown and yellow, and the patient reporting no pain, is consistent with a full-thickness burn.
Choice C rationale
A deep partial-thickness burn involves the destruction of the epidermis and upper layers of the dermis and injury to the deeper portions of the dermis. The description provided does not match this type of burn.
Choice D rationale
Deep full-thickness burns are a more severe form of full-thickness burns that extend beyond the dermis into deeper tissues. The description provided does not match this type of burn.

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Correct Answer is C

Explanation

Choice A rationale
Exclusively consuming lactose-free dairy products is not a specific characteristic of the DASH diet. While the DASH diet recommends low-fat or fat-free dairy products, it does not specifically require them to be lactose-free.
Choice B rationale
Meticulously cleaning and peeling all fresh fruits and vegetables is a good practice for food safety, but it is not specific to the DASH diet.
Choice C rationale
Enjoying fat-free yogurt as an occasional snack aligns with the DASH diet’s emphasis on low-fat dairy products.
Choice D rationale
Eliminating grains from the diet is not recommended in the DASH diet. On the contrary, the DASH diet encourages the consumption of whole grains.

A. Urinary output. B. Skin elasticity. C. Pain scale. D. Lung sounds. E. Oxygen saturation.

Correct Answer is ["A","D","E"]

Explanation

Furosemide is a loop diuretic used to treat fluid retention and high blood pressure by increasing the amount of urine the body makes. Therefore, assessing urinary output is crucial to determine the patient’s response to treatment. Lung sounds and oxygen saturation should also be assessed as furosemide is often used to treat edema caused by heart failure. Improved lung sounds and oxygen saturation can indicate a reduction in fluid buildup in the lungs.

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The nurse is caring for a patient with a burn that is severely swollen, and the wound bed appears brown and yellow. The patient reports no pain. How should the nurse classify the depth of this burn?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing a patient’s understanding of the DASH (Dietary Approaches to Stop Hypertension) diet. Which patient behavior suggests adherence to this diet?

Correct Answer is C

Explanation

An hour after administering 60 mg of furosemide intravenously (IV), which assessments should the nurse perform to determine the patient’s response to treatment? (Select all that apply.)

Correct Answer is ["A","D","E"]

Explanation

A nurse is assessing a client who has an arteriovenous (AV) graft in the right forearm for hemodialysis access. The nurse auscultates a bruit over the graft area. Which intervention should the nurse implement?

The nurse assesses a client with cirrhosis and finds 4+ pitting edema of the feet and legs, and massive ascites. Which mechanism contributes to edema and ascites in clients with cirrhosis?

The nurse is caring for a client diagnosed with psoriasis vulgaris who is receiving a psoralen and ultraviolet A light (PUVA) treatment. Which assessment finding indicates that the client has been overexposed to the treatment?

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