You are admitting a 20-month-old female 3 hours post partial-thickness scald burns. The burns are on the anterior torso and neck, the right upper extremity, and the right face. There are large blisters on the torso and upper extremities. In addition, splash marks on the left lower and upper extremities without blisters and intact skin. Using the rule of nines, you estimate the patient has 20% of the body surface burned. A 22G peripheral intravenous line is in the left arm, and 0.9% normal saline is infusing at 70 ml per hour. The transport team placed wet saline dressings before transport. The patient weighs 13.5 kg. Calculate the rate at which the patient's burn fluid resuscitation should be infused in the first 8 hours.
99.5 ml per hour.
35.5 ml per hour.
33.8 ml per hour.
67.5 ml per hour.
The Correct Answer is D
Choice A reason: A 99.5 ml/hour rate overestimates fluid needs for a 13.5 kg child with 20% burns. The Parkland formula (4 ml/kg/% burn) yields 1080 ml over 8 hours (540 ml first 8 hours ÷ 8 = 67.5 ml/hour), making this rate too high, risking fluid overload.
Choice B reason: A 35.5 ml/hour rate underestimates fluid resuscitation for a 13.5 kg child with 20% burns. The Parkland formula calculates 540 ml for the first 8 hours (4 × 13.5 × 20 ÷ 2), or 67.5 ml/hour, insufficient fluid risks hypovolemia and shock.
Choice C reason: A 33.8 ml/hour rate is too low for burn resuscitation in a 13.5 kg child with 20% burns. The Parkland formula gives 67.5 ml/hour (4 × 13.5 × 20 ÷ 2 ÷ 8), and under-resuscitation risks inadequate tissue perfusion, leading to organ failure.
Choice D reason: For a 13.5 kg child with 20% burns, the Parkland formula (4 ml/kg/% burn) calculates 1080 ml total (4 × 13.5 × 20), with half (540 ml) in the first 8 hours, or 67.5 ml/hour. This rate ensures adequate hydration, preventing shock while avoiding fluid overload.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","E"]
Explanation
Choice A reason: Genetic disorders affecting muscles, like muscular dystrophy, are distinct from cerebral palsy, which results from brain injury. Cerebral palsy is caused by perinatal brain damage, not inherited muscle disorders, making this statement incorrect as a primary cause of the condition.
Choice B reason: Lack of oxygen to the fetus, or perinatal hypoxia, damages developing brain tissue, causing cerebral palsy. Hypoxic-ischemic encephalopathy disrupts motor control areas, leading to movement and posture impairments, a well-established cause of this neurological condition in infants.
Choice C reason: Poor diet during pregnancy is not a direct cause of cerebral palsy. While malnutrition may affect fetal development, cerebral palsy is primarily linked to brain injury from hypoxia, trauma, or infection, not dietary deficiencies, making this statement inaccurate.
Choice D reason: Birth trauma, such as prolonged labor or forceps use, can cause brain injury leading to cerebral palsy. Physical trauma disrupts motor control regions, resulting in permanent neurological deficits, making this a significant risk factor for the condition in newborns.
Choice E reason: Premature babies are at higher risk for cerebral palsy due to underdeveloped brains vulnerable to hypoxia, hemorrhage, or infection. Preterm birth increases the likelihood of periventricular leukomalacia, damaging motor pathways, a key contributor to cerebral palsy’s neurological impairments.
Correct Answer is ["C","E"]
Explanation
Choice A reason: Loss of vision is not a typical manifestation of osteogenesis imperfecta, a genetic disorder affecting collagen, leading to fragile bones. While rare ocular complications like blue sclera occur, vision loss is not characteristic, as the condition primarily impacts skeletal and connective tissue integrity.
Choice B reason: Bone tumors are not associated with osteogenesis imperfecta. The condition causes brittle bones due to defective collagen, increasing fracture risk, but does not involve neoplastic growth. Tumors are linked to other conditions like osteosarcoma, not this connective tissue disorder.
Choice C reason: Limited mobility is common in osteogenesis imperfecta due to frequent fractures and bone deformities from defective collagen. Weak bones impair physical activity, leading to restricted movement, joint contractures, and potential wheelchair dependency, significantly affecting quality of life and physical function.
Choice D reason: Muscular dystrophy is a separate condition involving progressive muscle weakness, not osteogenesis imperfecta, which affects bone collagen. While muscle weakness may occur secondary to immobility from fractures, muscular dystrophy is not a direct manifestation of this skeletal disorder.
Choice E reason: Hearing difficulty is a known manifestation of osteogenesis imperfecta, particularly in older children, due to abnormal collagen in the middle ear bones. This can cause conductive hearing loss, as malformed ossicles impair sound transmission, a recognized complication of the condition.
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