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 ["A","B","C","D","E"]
Explanation
Easier to breathe and less short of breath: The client reports improvement in breathing, stating it is easier to breathe and they are less short of breath. This suggests that the respiratory status is improving, which is a key indicator of progress.
Lung sounds still diminished with crackles, but no wheezes detected: While lung sounds are still diminished and crackles remain, the absence of wheezes indicates that the client’s condition is stabilizing. Wheezing would be concerning for bronchospasm or worsening respiratory distress, so the absence of this finding is a positive development.
Oxygen saturation 92%: The client’s oxygen saturation has improved from 88% on room air (Day 1) to 92% on 1 L/min of oxygen. Although still slightly below the target of 94%–98%, this improvement is a sign that oxygenation is improving with the current treatment.
Pleuritic chest pain reduced to 3/10: The client's report of pleuritic chest pain has decreased from 6/10 to 3/10. This reduction in pain indicates a positive response to treatment and the improvement of the underlying infection.
Increased oral intake (drinking 2 L/day): The client is drinking 2 L of fluids per day, which indicates adequate hydration and may help with recovery, particularly in the context of respiratory and infection management.
Normal urine output (200 mL of clear yellow urine): The client’s urine output appears adequate, and the urine is clear and yellow, which suggests proper hydration and normal renal function, supporting overall recovery.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}
Explanation
- Seizures: The client's elevated blood pressure, severe headache, and hyperreflexia are indicative of preeclampsia, which can lead to eclampsia and seizures.
- Placental abruption: The client's history of preterm birth and current symptoms of severe headache, decreased fetal movement, and proteinuria increase the risk of placental abruption
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