The nurse is caring for a client who presents with a chemical burn to the right hand, what should the nurse do first?

Elevate the extremity and apply an ice pack to the injured area

Contact poison control to determine the best neutralizing agent

Apply a sterile dressing, wrapping the fingers separately

Irrigate the affected area with room temperature water

Answer and Explanation

The Correct Answer is D

A. Elevate the extremity and apply an ice pack to the injured area

Elevating the extremity can help reduce swelling, but applying ice is not recommended for chemical burns as it can cause further tissue damage.

B. Contact poison control to determine the best neutralizing agent

While contacting poison control is important, it should not be the immediate first action in an emergency setting.

C. Apply a sterile dressing, wrapping the fingers separately

This is important for protecting the wound, but it is not the immediate first action needed for chemical burns.

D. Irrigate the affected area with room temperature water

Immediate irrigation with room temperature water helps to remove the chemical from the skin and dilute its effect, which is the first critical step in managing a chemical burn.

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Correct Answer is C

Explanation

A. 63% TBSA
This value is too high based on the Rule of Nines calculation.

B. 45% TBSA
This overestimates the burn area.

C. 36% TBSA
Using the Rule of Nines, the TBSA is calculated as follows:

Entire right arm (anterior + posterior): 9%
Posterior trunk: 18%
Posterior right leg: 9%
Total TBSA = 9% + 18% + 9% = 36%

D. 27% TBSA
This underestimates the affected areas.

A. Fluid resuscitation B. Transfer to a burn center C. Application of sterile dressings D. Administer morphine 8mg IV.

Correct Answer is A

Explanation

A. Fluid resuscitation

Burns covering a large TBSA result in massive fluid loss due to increased capillary permeability, leading to hypovolemic shock. Fluid resuscitation with lactated Ringer’s solution using the Parkland formula is the priority to restore intravascular volume and prevent organ failure.

B. Transfer to a burn center

While this patient requires specialized burn care, the immediate priority is fluid resuscitation. After initial stabilization, transfer to a burn center can be arranged.

C. Application of sterile dressings

Wound care is important, but it is not the priority in the emergent phase. Restoring circulation and preventing shock take precedence.

D. Administer morphine 8 mg IV

Pain management is crucial, but it is secondary to restoring intravascular volume and preventing hypovolemic shock.

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The nurse is caring for a client who presents with a chemical burn to the right hand, what should the nurse do first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for an adult with a burn injury. The following parts of the patient's body were burned: anterior and posterior right arm, posterior trunk. and posterior right leg. Using the Rule of Nines, calculate the Total Body Surface Area (TBSA) percentage that is involved.

Correct Answer is C

Explanation

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Explanation

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