The nurse is explaining to a family the benefit of a patient-controlled analgesia pump. Which of the following is an appropriate use of Dilaudid PCA for burn patients?

To prevent infection in burn wounds

To promote wound healing in burn patients

To decrease the risk of hypothermia in burn patients

To provide controlled and individualized pain relief in burn patients

Answer and Explanation

The Correct Answer is D

A. To prevent infection in burn wounds:
Analgesics like Dilaudid do not prevent infection; antibiotics and wound care do.

B. To promote wound healing in burn patients:
Pain control may aid indirectly, but opioids do not promote wound healing directly.

C. To decrease the risk of hypothermia in burn patients:
Hypothermia prevention involves warm blankets, warming devices, and fluid management-not PCA.

D. To provide controlled and individualized pain relief in burn patients:
PCA pumps allow patients to self-administer opioid analgesia, offering consistent, effective pain control with less risk of overdose when properly programmed.

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Correct Answer is A

Explanation

A. It divides the body into eight equal regions, with each region representing 12.5% of the total body surface area:
The Rule of Nines assigns percentages to major body parts (e.g., each leg = 18%, each arm = 9%, anterior torso = 18%) totaling 100%.

B. It divides the body into twelve equal regions, with each region representing 59% of the total body surface area:
Incorrect math and region count; total exceeds 100% and is not part of the rule of nines.

C. It divides the body into six equal regions, with each region representing 15% of the total body surface area:
Also incorrect; not consistent with the actual anatomic distribution used in the rule of nines.

D. It divides the body into nine equal regions, with each region representing 100% of the total body surface area:
Nonsensical; if each is 100%, total would be 900%, which is not accurate.

A. Adequate Tissue Perfusion B. Risk for infection C. Impaired Gas Exchange D. Acute Pain E. Fluid Volume Deficit

Correct Answer is ["B","C","D","E"]

Explanation

A. Adequate Tissue Perfusion
While this important in burn management, it is not typically classified as a priority nursing diagnosis in the early stages of treatment.

B. Risk for infection
Burned skin is a lost barrier to pathogens, increasing infection risk.

C. Impaired Gas Exchange
Especially in cases of inhalation injury, airway swelling or carbon monoxide exposure can impair gas exchange.

D. Acute Pain
Burns cause significant pain that requires management for comfort and healing.

E. Fluid Volume Deficit
Burns result in fluid shifts and capillary leakage, leading to hypovolemia.

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The nurse is explaining to a family the benefit of a patient-controlled analgesia pump. Which of the following is an appropriate use of Dilaudid PCA for burn patients?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is admitting a client with severe burns. The nurse uses the rule of nines to estimate the percentage of total body surface area affected by burns. Which of the following statements accurately describes the rule of nines?

Correct Answer is A

Explanation

Priority nursing diagnoses for burns include: (Select All That Apply)

Correct Answer is ["B","C","D","E"]

Explanation

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