Why are narcotics given intravenously to manage pain during initial management of the patient with burns?
Additional skin disruption is to be avoided at all costs.
Burn pain is so severe it requires relief by the fastest route available.
Thrombosis may occur at injection sites.
Tissue edema may interfere with drug absorption via other routes.
The Correct Answer is D
Rationale:
A. Additional skin disruption is incorrect because while avoiding further trauma to burn wounds is important, it is not the primary reason for choosing the intravenous route for narcotics.
B. Burn pain is so severe it requires relief by the fastest route available is partially correct in acknowledging the severity of pain, but the main limitation of other routes is not speed alone—it is absorption.
C. Thrombosis may occur at injection sites is incorrect because thrombosis is not a significant concern with routine pain management in burn patients; it does not dictate the choice of intravenous administration.
D. Tissue edema may interfere with drug absorption via other routes is correct because burn injuries cause massive tissue edema, which can reduce or delay absorption of orally or subcutaneously administered medications. Intravenous administration ensures reliable and rapid delivery of analgesics, providing effective pain control during the critical initial management phase.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Confusion is a common finding in the compensatory (early) stage of shock. During this stage, the body activates compensatory mechanisms such as increased sympathetic nervous system activity to maintain perfusion to vital organs. Reduced cerebral perfusion and increased catecholamine release can cause restlessness, anxiety, agitation, or mild confusion, making this finding consistent with compensatory shock.
B. A blood pressure of 84/50 mm Hg indicates hypotension, which is characteristic of the progressive (decompensatory) stage of shock. In the compensatory stage, blood pressure is usually maintained within normal limits due to vasoconstriction and increased heart rate.
C. Anuria reflects severe and prolonged renal hypoperfusion and is associated with the progressive or irreversible stages of shock. In the compensatory stage, urine output may be decreased but is not completely absent.
D. Petechiae are small pinpoint hemorrhages often associated with clotting abnormalities such as disseminated intravascular coagulation (DIC), which can occur in severe sepsis or late stages of shock. They are not a typical finding of the compensatory stage.
Correct Answer is B
Explanation
Rationale:
A. 3,000 ml – This overestimates the volume for the first 8 hours.
B. 2,500 ml – This represents half of the 24-hour fluid requirement, appropriate for the first 8 hours.
The Parkland formula is used to calculate fluid resuscitation in the first 24 hours after a burn:
Total fluid requirement (ml) = 4 × body weight (kg) × % TBSA burned
Once the total 24-hour fluid requirement is calculated:
- Half of the total fluid is given in the first 8 hours post-injury.
- The remaining half is given over the next 16 hours.
In this scenario:
- Mr. Paul’s total 24-hour fluid requirement is 5,000 ml.
- Half of 5,000 ml = 2,500 ml, which should be administered in the first 8 hours after the burn occurred.
Timing calculation:
- Burn occurred at 2:00 p.m.
- First 8 hours after the burn: 2:00 p.m. → 10:00 p.m.
- Therefore, by 10:00 p.m., Mr. Paul should have received 2,500 ml of lactated Ringer’s.
C. 2,000 ml – This underestimates the volume required in the first 8 hours.
D. 3,500 ml – This exceeds the volume for the first 8 hours and could lead to fluid overload.
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