A nurse in an emergency room is caring a the client who sustained partial-thickness burns to both lower legs, chest, face, and both forearms. Which of the following is the priority action the nurse should take?
Insert an indwelling urinary catheter.
Draw blood for a complete blood cell (CBC) count.
Inspect the mouth for signs of inhalation injuries.
Administer intravenous pain medication.
The Correct Answer is C
This is because inhalation injuries can compromise the airway and cause respiratory distress or failure, which can be life-threatening. The nurse should assess for signs such as soot, burns, hoarseness, or stridor.
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Correct Answer is C
Explanation
This is because HSV-1 typically causes oral herpes, which manifests as cold sores or fever blisters around the mouth or lips.
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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