A nurse in the emergency department is caring for a client who has a 30% burn injury to her lower extremities.
Which of the following interventions should the nurse perform first?
Administer pain medication.
Administer a tetanus booster.
Clean and dress the wound.
Administer IV fluids.
The Correct Answer is D
Choice A rationale:
Administering pain medication is important, but it’s not the first priority. The first priority is to stabilize the client’s condition.
Choice B rationale:
Administering a tetanus booster is necessary for burn patients, but it’s not the first intervention. The first intervention should be to stabilize the client’s condition.
Choice C rationale:
Cleaning and dressing the wound is important, but it’s not the first intervention. The first intervention should be to stabilize the client’s condition.
Choice D rationale:
Administering IV fluids is the first intervention for a burn patient. This is because burns can cause significant fluid loss, leading to dehydration and shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Aphasia, or difficulty with language, is typically associated with left hemisphere strokes.
Choice B rationale:
Right hemisphere strokes often result in difficulty recognizing familiar people and objects.
Choice C rationale:
Right hemiparesis, or weakness on the right side of the body, is typically associated with left hemisphere strokes.
Choice D rationale:
Difficulty reading is typically associated with left hemisphere strokes.
Correct Answer is A
Explanation
Choice A rationale:
Potassium 2.3 mEq/L is below the normal range of 3.5 to 5.0 mEq/L1. Hydrochlorothiazide, a diuretic, can cause hypokalemia, which is a low level of potassium.
Choice B rationale:
Chloride 99 mEq/L is within the normal range of 96 to 106 mEq/L2, so it’s not a concern.
Choice C rationale:
Sodium 136 mEq/L is within the normal range of 135 to 145 mEq/L3, so it’s not a concern.
Choice D rationale:
Calcium 10 mg/dL is within the normal range of 8.6 to 10.2 mg/dL4, so it’s not a concern.
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