A nurse is assessing a client who has sustained burns on the entire left arm and the anterior chest. Using the rule of nines, the nurse calculates what percentage of total body surface area is affected by the burns?
36%
18%
27%
9%
The Correct Answer is C
Left arm (entire): 9%
Anterior chest: 18%
Total: 9% + 18% = 27%
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is []
Explanation
Potential Condition: Urinary Tract Infection (UTI)
The client is reporting frequency, burning, and urgency, classic symptoms of a lower UTI (cystitis). The recent removal of the urinary catheter (which increases infection risk) further supports this.
Actions to take:
- Check a urine culture and sensitivity: A urine culture will confirm the presence of infection and identify the specific organism, allowing for appropriate antibiotic selection.
- Request a prescription for an antispasmodic agent: Bladder spasms can contribute to frequency and urgency, especially post-catheter removal. An antispasmodic (e.g., oxybutynin) may help relieve discomfort.
Parameters to monitor:
- Temperature: Fever can indicate progression of the UTI to pyelonephritis or worsening infection. The current low-grade fever of 100.4°F may be an early sign.
- Fluid intake: Adequate hydration helps flush bacteria from the urinary tract and is essential in promoting recovery from a UTI.
Incorrect diagnoses:
The post-void residual is only 22 mL, which rules out urinary retention. No evidence points to STIs like gonorrhea, nor to incontinence.
Correct Answer is ["A","B","E"]
Explanation
A. Raisins: Dried fruits like raisins are concentrated sources of potassium and should be avoided in CKD.
B. Bananas: Bananas are high in potassium and commonly restricted in CKD to prevent hyperkalemia.
C. Green beans: Green beans are relatively low in potassium and generally safe for a renal diet.
D. Asparagus: Asparagus has moderate potassium levels but can be included in moderation depending on the client's labs.
E. Tomatoes: Tomatoes, especially in processed forms like sauce or juice, are high in potassium.
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