A nurse in an emergency department is caring for a client who has deep partial- and full thickness burns to his chest, abdomen, and upper arms. What is the nurse's priority intervention for this client during the resuscitation of phase of injury?

Medicate for pain.

Maintain the airway.

Insert an indwelling urinary catheter.

Initiate fluid resuscitation.

Answer and Explanation

The Correct Answer is B

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.

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Correct Answer is ["A","B","D"]

Explanation

Correct answers: A, B ,D

A.Stress ulcer prophylaxis (e.g., a PPI) is indicated for critically ill, ventilated patients to prevent GI bleeding from stress-related mucosal damage.

B.Rotating the tube and tape from side to side prevents pressure necrosis of the lips and oral mucosa.

D.Semi-Fowler’s positioning (≥30°) reduces aspiration risk and helps prevent ventilator-associated pneumonia.

A. Rotate nursing staff so he can have varied interactions. B. Keep family members aware of his condition. C. Talk with the client during wound care. D. Assign assistive personnel to keep his room neat and clean.

Correct Answer is C

Explanation

This is because talking with the client can help reduce anxiety, pain, and isolation, as well as build trust and rapport between the nurse and the client. Talking with the client can also provide an opportunity for education, feedback, and encouragement.

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A nurse in an emergency department is caring for a client who has deep partial- and full thickness burns to his chest, abdomen, and upper arms. What is the nurse's priority intervention for this client during the resuscitation of phase of injury?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is receiving positive-pressure mechanical ventilation. Which of the following interventions should the nurse implement to prevent complications? (Select all that apply.)

Correct Answer is ["A","B","D"]

Explanation

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Correct Answer is C

Explanation

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