A client has been admitted to a burn intensive care unit with extensive full thickness burns over 36% of the body. After ensuring cardiopulmonary stability, which should be the nurse's highest priority when planning the client's care in the early acute phase of the injury?

Assessing psychosocial coping

Adequate fluid resuscitation

Provide nutritional support

Mitigating risk of infection

Answer and Explanation

The Correct Answer is B

A. Assessing psychosocial coping:
Important, but not a priority in the early acute phase, when survival is the focus.

B. Adequate fluid resuscitation:
Major burns lead to capillary leakage and hypovolemia. Fluid resuscitation prevents shock and organ failure.

C. Provide nutritional support:
Necessary but becomes more relevant in the later stages after fluid and hemodynamic stability are achieved.

D. Mitigating risk of infection:
Infection control is vital but comes after fluid volume replacement in prioritization.

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Correct Answer is ["A","C","D","E"]

Explanation

A. Ensure NPO status: The client is kept NPO before the biopsy to reduce the risk of aspiration if sedation is used.

B. Administer diphenhydramine (Benadryl) prior to procedure: This is not routine for kidney biopsy unless the client has allergies or specific indications.

C. Obtain coagulation studies: Important to assess for bleeding risk because kidney biopsies have a high bleeding potential.

D. Verify informed consent: This is essential before any invasive procedure.

E. Collect a urine specimen prior to procedure: A pre-procedure urine sample is collected for baseline comparison.

A. pH 7.49, HCO3 24, PaCO2 30 B. pH 7.26, HCO3 14, PaCO2 30 C. pH 7.49, HCO, 30, PaCO2 40 D. pH 7.26, HCO, 24, PaCO2 46

Correct Answer is B

Explanation

A. pH 7.49, HCO₃ 24, PaCO₂ 30: Indicates respiratory alkalosis. Not consistent with AKI, which typically causes metabolic acidosis.

B. pH 7.26, HCO₃ 14, PaCO₂ 30: Reflects metabolic acidosis, expected in AKI due to accumulation of acidic waste (low pH, low bicarb), and partial respiratory compensation (low PaCO₂).

C. pH 7.49, HCO₃ 30, PaCO₂ 40: Reflects metabolic alkalosis; not expected in AKI.

D. pH 7.26, HCO₃ 24, PaCO₂ 46: Reflects respiratory acidosis (low pH, elevated CO₂), but bicarb is normal, which does not align with AKI-induced acidosis.

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A client has been admitted to a burn intensive care unit with extensive full thickness burns over 36% of the body. After ensuring cardiopulmonary stability, which should be the nurse's highest priority when planning the client's care in the early acute phase of the injury?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing a client for the operating room Exhibits A nurse is planning care for a client who is scheduled to have a kidney biopsy. Which of the following interventions should the nurse include in the plan? (Select all that apply)

Correct Answer is ["A","C","D","E"]

Explanation

A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have?

Correct Answer is B

Explanation

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A nurse is assessing a client with burns to the face, ears, and eyelids. The nurse should identify which of the following as the priority finding to report to the provider?

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A nurse is reviewing laboratory values of a client with chronic renal failure and discovers the client has a serum potassium of 6.2 mEq/L. Which of the following interventions should the nurse anticipate?

A nurse is teaching a client diagnosed with chronic kidney disease (CKD) about limiting foods that are high in potassium. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.)