A nurse is planning care for a client who sustained a major burn over 20% of the body. Which of the following interventions should the nurse include to support the client's nutritional requirements?
Schedule meals at 6-hr intervals.
Maintain calorie intake at 1,500 per day.
Keep a calorie count for foods and beverages.
Provide a low-protein, high-carbohydrate diet.
The Correct Answer is C
A. Scheduling meals at 6-hour intervals is inadequate as clients with major burns require frequent, high-calorie intake.
B. A calorie intake of 1,500 per day is insufficient for burn clients, who require significantly higher caloric intake to support healing.
C. Keeping a calorie count helps ensure the client is meeting their increased nutritional needs for wound healing and recovery.
D. A high-protein, high-carbohydrate diet is necessary, not a low-protein diet, to support tissue repair and metabolic demands.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Hypotension is a concern but may occur for various reasons and is not as immediately life-threatening as dyspnea.
B. Tachycardia can indicate a problem but is less urgent than respiratory distress.
C. Dyspnea is the priority as it may indicate a recurrence of pulmonary embolism or another life-threatening respiratory issue.
D. A dry cough is a less urgent symptom and does not require immediate reporting.
Correct Answer is D
Explanation
A. Ensure that the transfusion is completed within 6 hr: Incorrect. Blood transfusions should be completed within 4 hours to reduce the risk of bacterial contamination.
B. Obtain venous access using a 22-gauge needle: Incorrect. A larger gauge (18-20) is preferred to prevent hemolysis and allow for faster administration.
C. Store the unit of blood at room temperature for 1 hr prior to the infusion: Incorrect. Blood should remain refrigerated until it is ready to be transfused, and it should be started within 30 minutes of removal from refrigeration.
D. Use a solution of 0.9% sodium chloride to flush the transfusion tubing: 0.9% sodium chloride is the only compatible solution with blood products to prevent hemolysis.
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