A nurse in a burn treatment center is caring for a client who is admitted with severe burns to both lower extremities and is scheduled for an escharotomy. The client's spouse asks the nurse what the procedure entails. Which of the following nursing statements is appropriate?

"This procedure involves placing the client into a shower and removing the dead tissue."

"Dead tissue will be non-surgically removed."

"Large incisions will be made in the eschar to improve circulation."

"A piece of healthy skin will be removed from an unburned area and grafted over the burned area."

Answer and Explanation

The Correct Answer is C

An escharotomy is a surgical procedure that involves making incisions in the eschar, which is the hard, blackened tissue that forms over a severe burn wound. The eschar can restrict blood flow and cause compartment syndrome, which can lead to tissue necrosis and nerve damage. By cutting through the eschar, the pressure is relieved and circulation is restored. This procedure does not involve removing the dead tissue, which is done by debridement or hydrotherapy. A skin graft is a different procedure that involves transplanting healthy skin from another site to cover a burn wound.

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Correct Answer is B

Explanation

This is because inhalation injury can cause airway edema, obstruction, and respiratory failure, which can be life-threatening. The nurse should monitor the client's respiratory status, administer oxygen, and prepare for intubation if needed.

A. "I will inhale slowly through pursed lips to help me breathe better." B. "I will lie on my stomach to practice abdominal breathing every day." C. "I will follow a daily diet high in calories and protein." D. "I will avoid getting a flu shot."

Correct Answer is C

Explanation

The correct answer is choiceC. “I will follow a daily diet high in calories and protein.”

Choice A rationale:

Inhaling slowly through pursed lips is incorrect.The correct technique is toexhaleslowly through pursed lips, which helps to keep the airways open longer, allowing for better air exchange and reducing shortness of breath.

Choice B rationale:

Lying on the stomach to practice abdominal breathing is not a recommended strategy for managing emphysema.Abdominal or diaphragmatic breathing can be beneficial, but it is typically practiced in a comfortable, upright position.

Choice C rationale:

Clients with emphysema often have an increased caloric demand due to the effort required to breathe. A diet high in calories and protein can help maintain energy levels and prevent muscle wasting.

Choice D rationale:

Avoiding a flu shot is incorrect.Patients with emphysema are at higher risk for respiratory infections, and getting an annual flu shot is crucial to prevent complications.

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A nurse in a burn treatment center is caring for a client who is admitted with severe burns to both lower extremities and is scheduled for an escharotomy. The client's spouse asks the nurse what the procedure entails. Which of the following nursing statements is appropriate?

Nursing Test Bank

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Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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A nurse in a burn treatment center is caring for a client who is admitted with severe burns to both lower extremities and is scheduled for an escharotomy. The client's spouse asks the nurse what the procedure entails. Which of the following nursing statements is appropriate?

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