The nurse is providing care to a client who sustained burns to 70% of the body 6 hours ago. Which of the following new assessment data requires the nurse to notify the healthcare provider?

Heart rate of 90 bpm.

Blood pressure of 96/50 mm Hg.

Urine output of 2 mL/kg per hour

Pain rating of 7 on a 1 to 10 point scale.

Answer and Explanation

The Correct Answer is B

A. Heart rate of 90 bpm: While an elevated heart rate may be expected in response to burn injury and the body's stress response, a heart rate of 90 bpm alone may not be concerning without additional context.

B. Blood pressure of 96/50 mm Hg: This blood pressure reading indicates hypotension, which can be a sign of inadequate tissue perfusion, fluid loss, or shock. It requires prompt notification of the healthcare provider for further assessment and intervention.

C. Urine output of 2 mL/kg per hour: Adequate urine output is important for renal function and fluid balance, and a urine output of 2 mL/kg per hour is within the normal range. While changes in urine output should be monitored, this finding alone does not require immediate notification of the healthcare provider.

D. Pain rating of 7 on a 1 to 10 point scale: Pain management is important in burn care, but a pain rating of 7 on a 1 to 10 scale is not unusual in clients with burns and may not require immediate notification of the healthcare provider unless accompanied by other concerning symptoms.

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Correct Answer is C

Explanation

A. Chemotherapy is only used for palliation: While chemotherapy can be used for palliative care to relieve symptoms and improve quality of life in advanced cancer, it is also used with curative intent in some cases, especially when cancer is diagnosed early or is responsive to chemotherapy.

B. Chemotherapy cures prostate cancer that has metastasized to the bone: Chemotherapy alone is generally not curative for prostate cancer that has metastasized to the bone. It may help slow disease progression, relieve symptoms, or prolong survival, but it is not typically curative on its own.

C. Chemotherapy is used in conjunction with other treatment modalities in this type of cancer: Chemotherapy is often used in combination with other treatment modalities such as hormone therapy, radiation therapy, or surgery in the management of prostate cancer with bone metastasis. The goal is to target cancer cells using multiple approaches to achieve the best possible outcome for the patient.

D. Chemotherapy makes the body fluid a biohazard: Chemotherapy drugs can be excreted in body fluids such as urine, saliva, and sweat, making them potentially hazardous. However, this statement does not specifically address the role of chemotherapy in the treatment of prostate cancer with bone metastasis.

A. Confusion and restlessness. B. Increased appetite and thirst. C. Increase in urinary and bowel output. D. Increased fatigue and sleep. E. Excess secretions in the throat and decrease swallow reflex.

Correct Answer is ["A","D","E"]

Explanation

A. Confusion and restlessness: Confusion and restlessness can indicate changes in cerebral perfusion as the body begins to shut down. These signs may occur as death approaches.

B. Increased appetite and thirst: Increased appetite and thirst are less likely as death approaches.

In fact, clients often have decreased appetite and thirst as the body's systems slow down.

C. Increase in urinary and bowel output: As death approaches, urinary and bowel output typically decrease as the body's metabolic processes slow down.

D. Increased fatigue and sleep: Increased fatigue and sleepiness are common as death approaches. The body's energy levels decrease, leading to increased periods of sleep and rest.

E. Excess secretions in the throat and decrease swallow reflex: Excess secretions in the throat and a decrease in the swallow reflex can occur as the body's ability to manage secretions diminishes. This can lead to a gurgling sound in the throat known as the death rattle.

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The nurse is providing care to a client who sustained burns to 70% of the body 6 hours ago. Which of the following new assessment data requires the nurse to notify the healthcare provider?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is scheduled for chemotherapy due to bone metastasis of prostate cancer. Which of the following statements about chemotherapy made by the nurse is correct?

Correct Answer is C

Explanation

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Correct Answer is ["A","D","E"]

Explanation

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