A nurse is assessing a patient who has sustained a burn injury. The affected area is dry, white, and charred, with no pain present. Based on the classification of burns, the nurse understands this burn is:
Full-Thickness (Third-Degree)
Superficial (First-Degree)
Deep Full-Thickness (Fourth-Degree)
Partial-Thickness (Second-Degree)
The Correct Answer is A
A. Full-Thickness (Third-Degree). A third-degree (full-thickness) burn destroys both the epidermis and dermis, leaving the skin dry, white, or charred. Due to nerve damage, the patient does not experience pain in the affected area.
B. Superficial (First-Degree). A first-degree burn affects only the epidermis and presents with redness, mild swelling, and pain. The skin remains intact, unlike the description provided.
C. Deep Full-Thickness (Fourth-Degree). A fourth-degree burn extends beyond the skin into muscle, bone, or fat. The description does not indicate such deep involvement.
D. Partial-Thickness (Second-Degree). A second-degree burn involves the epidermis and part of the dermis, causing blistering, redness, and pain. This is not consistent with the described dry, white, and painless presentation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Increased hip range of motion and absence of pain. A hip dislocation causes severe pain and reduced mobility, not increased range of motion. This option is incorrect.
B. Reports of hearing a "pop" at the time of pain onset. A "popping" sound often occurs when the prosthetic hip dislocates from the joint, making this a key symptom of hip dislocation.
C. Ability to bear weight on the affected leg without discomfort. A hip dislocation causes severe pain and functional impairment, making weight-bearing extremely difficult or impossible.
D. Symmetric leg length with normal alignment. A dislocated hip causes the affected leg to appear shortened and externally rotated, so symmetrical leg length would not be expected.
Correct Answer is D
Explanation
A. Nausea and vomiting after eating fatty foods: This symptom is more commonly associated with gallbladder disease (e.g., cholecystitis) rather than TB.
B. Sudden high fever and chills with a rash: TB typically causes a low-grade fever, night sweats, and progressive weight loss rather than sudden high fevers with a rash, which are more indicative of systemic infections like meningococcemia or viral exanthems.
C. Wheezing and shortness of breath that improves with bronchodilators: While TB can cause respiratory symptoms, it does not typically present with reversible airway constriction like asthma or chronic obstructive pulmonary disease (COPD), which respond to bronchodilators.
D. Productive cough with blood (hemoptysis): Hemoptysis (coughing up blood) is a hallmark symptom of active TB, resulting from lung tissue damage caused by the Mycobacterium tuberculosis infection.
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