Which diagnostic test is most appropriate to identify pathogenic microorganisms in a patient with cellulitis?

Choice A rationale

Shifting weight to the heels when moving an object to the side is an incorrect application of body mechanics. Proper technique involves pivoting the entire body as a single unit rather than twisting the lumbar spine. Putting weight on the heels can lead to instability and loss of balance during the transition. The client should instead focus on a broad base of support and smooth weight shifts to avoid straining the lower back muscles.

Choice B rationale

Standing with the feet close together during a lift significantly narrows the base of support. This reduces the stability of the center of gravity and increases the risk of falling or causing a musculoskeletal injury to the back. For safe lifting, the feet should be shoulder-width apart to provide a stable foundation. This positioning allows the larger leg muscles, such as the gluteals and quadriceps, to bear the load rather than the vulnerable spinal discs.

Choice C rationale

Facing the direction of movement when sliding or moving an object is a fundamental principle of proper body mechanics. This alignment prevents rotational or twisting forces on the spine, which are primary causes of acute and chronic back injuries. By keeping the shoulders and hips square to the object, the client maintains the natural curvature of the spine. This finding indicates the client successfully understands how to protect the back while performing activities of daily living.

Choice D rationale

Moving the front foot backward when pushing an object is counterproductive to generating force and maintaining balance. To push effectively, a person should move the rear foot forward or lean into the object using their body weight. This stance ensures that the force is generated by the legs and transferred through the core. Reversing the foot movement compromises the stability of the posture and places unnecessary stress on the lower back and shoulder joints.

Choice A rationale

While electrolyte imbalances occur in burn victims, hyperkalemia is actually more common in the acute phase due to massive cell lysis and the release of intracellular potassium into the extracellular space. Hypokalemia might occur later during the diuretic phase or due to gastrointestinal losses. The normal serum potassium range is 3.5 to 5.0 mEq/L. Monitoring potassium is vital, but the immediate threat to metabolic stability in a large surface area burn is the loss of thermoregulation rather than a decrease in potassium.

Choice B rationale

The skin is the primary organ for thermoregulation. With 40 percent full thickness burns, the client loses the ability to prevent evaporative heat loss and maintain a stable core temperature. Hypothermia can lead to coagulopathy, cardiac arrhythmias, and impaired wound healing. The nurse must anticipate this because the loss of the epidermal barrier and the administration of large volumes of room temperature fluids significantly increase the risk. Maintaining a warm environment and using warmed fluids are standard burn protocols.

Choice C rationale

Hypoglycemia is not a typical primary complication of acute burn injury. In fact, the stress response associated with major burns often leads to the release of catecholamines and cortisol, which cause hyperglycemia through increased gluconeogenesis and glycogenolysis. While metabolic demands are extremely high and nutritional support is eventually needed, the immediate physiological threat is not a drop in blood glucose. Normal fasting blood glucose ranges from 70 to 100 mg/dL, but burn patients often require insulin for stress induced elevations.

Choice D rationale

Hypertension is unlikely in the early stages of a 40 percent burn. The more significant risk is burn shock, which is characterized by hypotension due to massive fluid shifts from the intravascular space to the interstitial space. This capillary leak results in decreased cardiac output and low blood pressure. Monitoring for hypotension and signs of poor organ perfusion is a priority during fluid resuscitation. Hypertension would be an unusual finding unless the client had pre-existing cardiovascular disease.