When providing information to a client in the rehabilitative phase of a burn injury, which of the following will the nurse identify as the goal?
Resume a functional role in society
Pain management
Provide continued full support to the client
Prevent infection
The Correct Answer is A
Choice A reason: This is correct because resuming a functional role in society is the ultimate goal for a client in the rehabilitative phase of a burn injury. The rehabilitative phase begins when wound healing is complete and lasts until physical and psychosocial recovery is achieved. The nurse should help the client regain independence, self-esteem, and quality of life by providing education, counseling, referrals, and resources.
Choice B reason: This is incorrect because pain management is not a goal, but an intervention for a client in the rehabilitative phase of a burn injury. Pain management is important throughout all phases of burn care, but especially during wound healing and scar formation, which can cause itching, tightness, or hypersensitivity. The nurse should assess the client's pain level and administer analgesics, antipruritics, or moisturizers as ordered.
Choice C reason: This is incorrect because providing continued full support to the client is not a goal, but an intervention for a client in the rehabilitative phase of a burn injury. Providing continued full support to the client can help them cope with physical and emotional challenges, such as scarring, disfigurement, disability, or depression. The nurse should provide emotional support, active listening, positive feedback, and encouragement to the client.
Choice D reason: This is incorrect because preventing infection is not a goal, but an intervention for a client in the rehabilitative phase of a burn injury. Preventing infection is crucial during wound healing and grafting, which can be compromised by bacterial colonization or contamination. The nurse should monitor the client's vital signs, wound appearance, and laboratory results, and administer antibiotics or antiseptics as ordered.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","E","F"]
Explanation
Choice A reason: This is incorrect because the nurse should not include this in the postoperative education to the client. The client should not drive home after glaucoma surgery, as they will have reduced vision and increased sensitivity to light in the operated eye. The nurse should advise the client to arrange for someone else to drive them home.
Choice B reason: This is incorrect because the nurse should not include this in the postoperative education to the client. The client should not lay on the right side when going to bed, as this can put pressure on the operated eye and increase the risk of bleeding or infection. The nurse should advise the client to sleep on their back or on their left side.
Choice C reason: This is correct because the nurse should include this in the postoperative education to the client. The client should report flashing lights, as this can indicate a complication such as retinal detachment or vitreous hemorrhage. The nurse should instruct the client to call the provider immediately if they see flashing lights.
Choice D reason: This is incorrect because the nurse should not include this in the postoperative education to the client. The client should not nap on their left side when they get home, as this can cause fluid accumulation and increased intraocular pressure in the operated eye. The nurse should advise the client to elevate their head at least 30 degrees when resting.
Choice E reason: This is correct because the nurse should include this in the postoperative education to
the client. The client should avoid housework like vacuuming, as this can cause bending, lifting, or straining that can increase intraocular pressure and affect wound healing. The nurse should advise the client to limit physical activity and follow the provider's instructions on when to resume normal activities.
Choice F reason: This is correct because the nurse should include this in the postoperative education to
the client. The client may see flashes of light in the operated eye, as this is a normal phenomenon caused by stimulation of the retina by gas bubbles or fluid shifts. The nurse should reassure the client that flashes of light are normal and will subside over time.
Correct Answer is ["A","B","E"]
Explanation
Choice A Reason: This is a correct choice. Trying to avoid scratching is an advice that the nurse will provide to the client, as it prevents further damage and infection of the skin. Scratching can break the skin barrier and introduce bacteria or fungi into the wound, leading to inflammation and complications.
Choice B Reason: This is a correct choice. Applying a moist cool compress is an advice that the nurse will provide to the client, as it soothes and relieves itching and swelling. A moist cool compress can reduce inflammation and histamine release, which are responsible for allergic symptoms.
Choice C Reason: This is an incorrect choice. Using alcohol to cleanse the area is not an advice that the nurse will provide to the client, as it irritates and dries out the skin. Alcohol can strip away the natural oils and moisture from the skin, making it more prone to cracking and itching.
Choice D Reason: This is an incorrect choice. Using a wooden stick to scratch lesions is not an advice that the nurse will provide to the client, as it causes more harm than good. A wooden stick can injure or infect the skin, as well as spread the allergen or irritant to other areas.
Choice E Reason: This is a correct choice. Avoiding hot air is an advice that the nurse will provide to the client, as it aggravates itching and inflammation. Hot air can increase blood flow and histamine release, which are responsible for allergic symptoms. The client should also avoid hot water or showers, as they can have the same effect.
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