You are providing care for a client with an acute hemorrhagic stroke. The client's husband has been reading a lot about strokes and asks why his wife did not receive tissue plasminogen activator. What is your best response?

A. “Cardioversion is always attempted before defibrillation because it has fewer risks.”: Cardioversion is not always attempted first; the choice depends on the client’s rhythm and pulse status. Defibrillation is required immediately for pulseless shockable rhythms, and cardioversion is used only when a pulse is present.

B. “The difference is the timing of the delivery of the electric current.”: Cardioversion delivers a synchronized shock on the R wave to avoid inducing ventricular fibrillation, while defibrillation delivers an unsynchronized shock at any point in the cardiac cycle. This timing difference is the key distinguishing feature between the two.

C. “Cardioversion is done on fast rhythms with a pulse; defibrillation is done on all rhythms without a pulse.”: While cardioversion is used for tachyarrhythmias with a pulse, defibrillation is only for specific pulseless rhythms such as ventricular fibrillation and pulseless ventricular tachycardia, not all pulseless rhythms.

D. “Defibrillation is synchronized with the electrical activity of the heart but cardioversion is not.”: Cardioversion is synchronized to avoid shocking during the vulnerable T wave, while defibrillation is unsynchronized because pulseless rhythms lack organized activity to time the shock to.

A. Assessing mucous membranes: Moisture and color of mucous membranes can provide some indication of hydration status, but this assessment is subjective and may not reflect rapid changes in intravascular volume during the emergent phase of burn care. It is supportive but not the most reliable measure of fluid adequacy.

B. Monitoring the blood pressure: Blood pressure can indicate overall circulatory status, but it may remain stable until significant fluid loss occurs. Relying solely on BP can delay recognition of inadequate perfusion, making it less sensitive for immediate fluid assessment in burn patients.

C. Measuring hourly urine output: Hourly urine output is the most accurate and direct indicator of kidney perfusion and fluid adequacy. Maintaining a target output (typically 0.5–1 mL/kg/hr in adults) confirms that the client is receiving sufficient fluids to support organ perfusion during the critical emergent phase of burn management.

D. Checking daily weight: Daily weight is useful for tracking overall fluid balance over time but is not practical for assessing real-time fluid adequacy in the emergent phase. Acute fluid shifts in burn patients require more immediate and continuous measures, such as hourly urine output.