A nurse is providing education to a community group about burn prevention. Which of the following is an example of a first-degree burn?

Excessive scarring

Blistering from flames

Blackened dead skin

A sunburn

Answer and Explanation

The Correct Answer is D

A. Excessive scarring:

Excessive scarring is not an example of a first-degree burn. It typically occurs in more severe burns that affect deeper layers of the skin, such as second-degree or third-degree burns. Second-degree burns extend into the dermis, while third-degree burns damage all layers of the skin and can lead to significant scarring. First-degree burns, on the other hand, only affect the outer layer of the skin (epidermis) and usually do not result in excessive scarring.

B. Blistering from flames:

Blistering from flames is more characteristic of a second-degree burn rather than a first-degree burn. Second-degree burns involve damage to both the epidermis and part of the dermis, which can result in blister formation. These burns are often caused by direct contact with flames, hot liquids, or steam.

C. Blackened dead skin:

Blackened dead skin is indicative of a third-degree burn, which is the most severe type of burn. Third-degree burns damage all layers of the skin, including the epidermis, dermis, and sometimes underlying tissues. The skin may appear charred or blackened, and these burns often require medical intervention, such as skin grafting, due to the extent of tissue damage.

D. A sunburn:

A sunburn is an example of a first-degree burn. It occurs due to overexposure to ultraviolet (UV) radiation from the sun, leading to redness, pain, and mild swelling of the skin. First-degree burns affect only the outer layer of the skin (epidermis) and typically heal within a few days without significant scarring or blistering. Applying soothing lotions, staying hydrated, and avoiding further sun exposure can help manage sunburns.

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Correct Answer is B

Explanation

A.Prone positioning and postural drainage are typically not appropriate interventions for a client 1 day postoperative following an open thoracotomy, as this could place stress on the incision site and cause discomfort or injury.

B.High-Fowler's position facilitates lung expansion, which can improve ventilation and oxygenation. Encouraging the use of an incentive spirometer and promoting coughing helps clear secretions and expand the lungs, addressing the mild respiratory acidosis indicated by the ABG results (pH 7.31 and PaCO2 50 mm Hg).

C.Increasing oxygen to 70% is not appropriate, as the PaO2 level is within normal limits (93 mm Hg). The client's issue appears to be related more to ventilation (indicated by the elevated PaCO2) rather than oxygenation, so additional oxygen would not address the underlying cause and could lead to oxygen toxicity if used long-term.

D.A nonrebreather mask delivers a high concentration of oxygen, which is not necessary in this case since the client’s PaO2 is already adequate. The primary issue is not a lack of oxygen but rather the retention of CO2, so promoting ventilation and lung expansion through positioning and respiratory exercises is more appropriate.

A. The transfusion will begin after the administration of 650 mg of acetaminophen {Tylenol). B. The blood will be held, and the health care provider will be notified C. The transfusion will begin after the administration of an antihistamine D. The transfusion will begin as prescribed

Correct Answer is A

Explanation

A. The transfusion will begin after the administration of 650 mg of acetaminophen (Tylenol).

This option suggests that the nurse would administer acetaminophen to lower the client's temperature and then proceed with the blood transfusion. While acetaminophen can be used to reduce fever, the decision to administer medication should be made by the healthcare provider after assessing the client's overall condition and determining the cause of the fever. Administering medication without proper evaluation and orders from the healthcare provider is not appropriate.

B. The blood will be held, and the health care provider will be notified.

This option is the correct choice. When a client has an elevated temperature before a blood transfusion, it is standard practice to hold the transfusion and notify the healthcare provider. An elevated temperature could indicate an underlying infection or another condition that needs to be evaluated before proceeding with the transfusion to ensure the client's safety.

C. The transfusion will begin after the administration of an antihistamine.

Administering an antihistamine would not be the appropriate action in response to an elevated temperature before a blood transfusion. Antihistamines are typically used to treat allergic reactions, not fevers. Holding the transfusion and notifying the healthcare provider to assess the situation would be the correct course of action.

D. The transfusion will begin as prescribed.

This option is not appropriate because starting the transfusion without addressing the elevated temperature could pose risks to the client's health. Elevated temperatures may indicate an underlying infection or other conditions that need to be evaluated before proceeding with the transfusion. Holding the transfusion and seeking further guidance from the healthcare provider is the recommended action in this scenario.

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A nurse is providing education to a community group about burn prevention. Which of the following is an example of a first-degree burn?

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Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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