A male client who weighs 90 kg is admitted to the emergency department with full thickness burns to 45% of his total body surface area (TBSA). The burns occurred at 1000. At 1200, the nurse uses the prescribed protocol for burns fluid resuscitation to calculate the total fluid volume for the first 24 hours. The infusion pump should be set to deliver how many mL/hour during the first 8 hours? (Enter numeric value only. If rounding is required, round to the nearest whole number.)
The Correct Answer is ["1350"]
Rationale:
Fluid resuscitation rate using the Parkland formula:
- Calculate the total fluid volume needed for the first 24 hours.
The Parkland formula: 4 mL × client weight (kg) × % TBSA burned.
Client weight = 90 kg
TBSA burned = 45%
Total fluid volume = 4 mL × 90 kg × 45 = 16,200 mL
- Determine the amount of fluid to be given in the first 8 hours.
According to the Parkland formula, half of the total fluid volume is administered in the first 8 hours from the time of the burn injury.
Fluid for first 8 hours = 16,200 mL / 2
= 8,100 mL
- Calculate the infusion rate for the first 8 hours.
The burn occurred at 1000. The nurse arrives at 1200. This means 2 hours have already passed since the burn occurred within the initial 8-hour period.
Remaining time in the first 8 hours = 8 hours - 2 hours
= 6 hours.
Infusion rate (mL/hour) = Fluid for remaining first 8 hours / Remaining time in first 8 hours
= 8,100 mL / 6 hours
= 1350 mL/hour.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
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Correct Answer is B
Explanation
A. Recommend substituting opioids with other pain medication: Simply switching to another pain medication without addressing underlying misuse behaviors may reinforce dependency. This overlooks the denial and psychological aspects of addiction.
B. Explore other coping strategies aside from using medications: This client-centered approach gently addresses the issue without direct confrontation. It encourages self-reflection, promotes healthy alternatives, and meets the client where they are in terms of readiness for change, which is essential in early recovery.
C. Provide a list of local Narcotics Anonymous meetings: Although this is useful, offering it during the first interaction with a client in denial may lead to resistance. Engagement and trust-building through conversation about alternatives are more effective initially.
D. Explain that opioid abuse poses a great risk to life: Providing factual information about risk can be helpful, but directly labeling it as abuse when the client is in denial may trigger defensiveness. It is more therapeutic to explore behaviors and build insight before confrontation.
Correct Answer is D
Explanation
A. Squeeze the nipple base to introduce milk into the mouth: This may increase the risk of aspiration if milk flows too rapidly, especially in infants with cleft lips who have difficulty forming a tight seal and managing suck-swallow coordination effectively.
B. Position the baby in the left lateral position after feeding: Although side-lying may aid digestion in some cases, it’s not the priority after feeding a newborn with cleft lip. Upright positioning is safer and helps reduce aspiration risk.
C. Alternate milk with water during the feeding: Offering water during feedings is not recommended for newborns, as it can displace nutritional intake and may disrupt electrolyte balance. It also offers no benefit for cleft lip management.
D. Hold the newborn in an upright position: This reduces the risk of aspiration by improving control of milk flow and promoting effective swallowing. It is the safest and most effective position for feeding an infant with cleft lip.
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