A nurse is contributing to the plan of care for a client who has partial-thickness and full-thickness burns on their lower extremities. Which of the following interventions should the nurse recommend including in the plan of care?
Administer filgrastim
Monitor the effects of dantrolene.
Initiate protective isolation
Wear a dosimeter when providing client care.
The Correct Answer is C
A. Administer filgrastim: Filgrastim is used to stimulate white blood cell production in clients with neutropenia. It is not a standard intervention for burn patients unless they develop severe immunosuppression.
B. Monitor the effects of dantrolene: Dantrolene is indicated for malignant hyperthermia, not for burn management. Monitoring its effects is not relevant to the care of clients with partial- and full-thickness burns.
C. Initiate protective isolation: Clients with significant burns are at high risk for infection due to skin barrier loss. Protective isolation helps minimize exposure to pathogens, which is critical for preventing sepsis and promoting wound healing.
D. Wear a dosimeter when providing client care: Dosimeters are used to monitor exposure to ionizing radiation, which is not relevant in standard burn care. This intervention is unnecessary for routine burn management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The weights apply a pulling force continuously: Proper functioning of Buck’s traction requires that the weights hang freely and apply a constant, uninterrupted pulling force. Continuous traction maintains alignment, reduces muscle spasm, and prevents further injury.
B. The boot allows active leg movement: Active movement of the affected leg is restricted in Buck’s traction to maintain proper alignment and traction. Excessive movement can interfere with the traction force and compromise treatment effectiveness.
C. The weights are just touching the floor: Weights should hang freely without touching the floor. Contact with the floor reduces the effective traction force and prevents the system from functioning as intended.
D. The footplate rests against the foot of the bed: The footplate should not rest against the bed, as this can alter alignment and reduce traction effectiveness. Proper positioning requires clear space to allow the traction system to work correctly.
Correct Answer is D
Explanation
A. Explain medical terminology using basic, one-syllable words: While simplifying language is important, limiting explanations to only one-syllable words may overly restrict clarity and precision. Key terms can be explained in plain language without compromising accuracy.
B. Present information from complex to simple: Effective teaching typically progresses from simple concepts to more complex ones. Presenting information in reverse can confuse readers and reduce comprehension, especially for health education materials.
C. Write the information at an 8th-grade reading level: Health education materials are most effective when written at a 5th- to 6th-grade reading level to ensure accessibility to a broad audience, including those with limited health literacy. Writing at an 8th-grade level may be too advanced for some readers.
D. Use a 12-point font size: Using a 12-point font enhances readability, especially for older adults or individuals with visual impairments. Clear, legible text supports comprehension and encourages engagement with the educational material.
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