Which client will the nurse recognize as having the greatest risk for development of hypocalcemia?

Choice A reason: Restricting fluids is contraindicated in burns, as hypovolemia requires aggressive fluid resuscitation. Administering lactated Ringer’s is correct, making this incorrect, as it’s unsafe compared to the nurse’s priority to restore volume in a burn-injured client.

Choice B reason: Dextrose 5% is not used for burn resuscitation, as it lacks electrolytes needed for fluid shifts. Lactated Ringer’s is standard, making this incorrect, as it’s inappropriate compared to the nurse’s focus on proper fluid therapy for burn management.

Choice C reason: Administering oxygen addresses potential airway compromise and hypoxia from facial and chest burns. This aligns with burn care priorities, making it a correct action the nurse would implement to ensure respiratory stability in the emergency department.

Choice D reason: A cooling blanket is not standard for partial-thickness burns; cooling is brief and initial. Elevating extremities reduces edema, making this incorrect, as it’s not a priority action compared to the nurse’s focus on burn injury management.

Choice E reason: Elevating extremities without fractures reduces edema in burned arms, improving circulation. This aligns with burn care protocols, making it a correct action the nurse would implement to manage swelling in the client with partial-thickness burns.

Choice F reason: Oral pain medication is contraindicated with facial burns due to airway risks and absorption issues. IV lactated Ringer’s is appropriate, making this incorrect, as it’s unsafe compared to the nurse’s priority for pain management in burns.

Choice G reason: Administering lactated Ringer’s 1 L bolus restores fluid volume in burn-induced hypovolemia, per resuscitation protocols. This is a correct action the nurse would implement to stabilize the client with partial-thickness burns in the emergency department.

Choice A reason: Nausea and vomiting may occur with nitroglycerin, but depression, fatigue, and impotence are unrelated. Headache and hypotension are primary effects, making this incorrect, as it includes irrelevant symptoms compared to the nurse’s teaching on nitroglycerin’s expected side effects.

Choice B reason: Sedation, constipation, and respiratory depression are opioid effects, not nitroglycerin, which causes vasodilation. Dizziness and flushing are correct, making this incorrect, as it misattributes opioid side effects to nitroglycerin in the nurse’s education for angina management.

Choice C reason: Nitroglycerin causes headache, hypotension, dizziness, and flushing due to vasodilation, common side effects. This aligns with pharmacological education for angina, making it the correct set of symptoms the nurse would teach the client to expect after taking sublingual nitroglycerin.

Choice D reason: Pedal edema is not a nitroglycerin side effect, though flushing, dizziness, and headache are. Hypotension is more precise than edema, making this incorrect, as it includes an unrelated symptom compared to the accurate side effects in nitroglycerin teaching.

Choice E reason: Decreased cardiac output and peripheral edema are not nitroglycerin effects; it improves coronary flow. Flushing is correct, but hypotension is key, making this incorrect, as it misrepresents nitroglycerin’s pharmacological effects in the nurse’s teaching for angina relief.