NUR 213 Test 4 Questions Answered
b
a nurse is caring for a male client with extensive 2nd and 3rd degree burn injuries. which of the
following lab values should be reported immediately to the HCP?
a. glucose of 200
b. potassium 6.1
c. hemoglobin 19
d. hematocrit 55%
c, g
a client with major burns of the buttocks is scheduled for treatment with silver nitrate. which
statements about this drug are correct? select all that apply
a. it is effective for more then 72 hours
b. it causes hyperchloremia
c. it causes cellular toxicity
d. it does not stain dressing
e. it improves visual inspection
f. it causes hypertonicity
g. it interacts with chloride ions
b
a nurse is caring for an adolescent who has a superficial partial thickness burn to the thigh. which of the
following actions should the nurse take?
a. prepare the adolescent for transport to the burn center
b. cleanse the affected area with tepid water
c. scrub the affected area using a soft bristle brush
d. administer morphine
b
potassium is not given post burn because of the risk of hyperkalemia
a nurse is caring for a client who was just admitted to the ED with a severe burn injury. which of the
following orders would the nurse question?
a. water
b. potassium
c. LR
d. plasma expanders
b, c, d
,a nurse is administering mafenide acetate to a client with burns. which statement about this drug are
correct? select all that apply
a. effective for first degree burns
b. used to eradicate pseudomonas aeruginosa
c. causes pain
d. contains sulfonamide
e. the brand name is silvadene
f. causes ototoxocity
g. is diffused gradually and slowly in the skin
b
a nurse is caring for a client with 3rd degree burns over 15% of his body surface. which of the following
indicates adequate fluid replacement during the first 24 hours post burn?
a. hematocrit level rising from 50-55
b. slowing of a previously rapid heart rate
c. falling CVP readings
d. urinary output of 15-20 ml/hr
c
a nurse is caring for a client who has sustained full thickness burns on the arms, face, neck, and
shoulders and is in the resuscitation phase. the nurse notes that the clients voice has become hoarse
with brassy cough and drooling. the nurse should identify these findings as indications that the client has
which of the following?
a. pulmonary edema
b. bacterial pneumonia
c. inhalation injury
d. carbon monoxide poisoning
a
burns on both buttocks indicates abuse and needs to be reported to adult protective services
a nurse manager is reviewing the admission history of four adult clients. the nurse is required to report
which of the following situations to an outside agency?
a. an older adult client who is dependent on caregivers and was admitted for the treatment of burns on
the buttocks
b. a young adult client who was admitted for asthma and has track marks that might indicate IV
substance abuse
c. a young adult client who was admitted for acute glomerulonephritis following a viral infection
d. an emancipated minor who has acute appendicitis and wants to leave the facility without treatment
a
morphine IV via continuous infusion is recommended for anybody who has major burns regardless of
age
a nurse is caring for a school age child who has a major burn and is experiencing severe pain. which of
the following actions should the nurse implement to manage this clients pain?
, a. administer morphine sulfate IV via continuous infusion
b. administer meperidine IV around the clock as needed
c. administer acetaminophen PO q4h
d. administer hydrocodone PO q6h
b
an electrical burn can cause dysrhythmias by disrupting the electrical cycle.
a nurse in the ED is caring for a client who has experienced an electrical burn. which of the following
nursing interventions is most important in this situation?
a. brush off dirt particles and debris
b. monitor for cardiac arrhythmias
c. cool the client with water
d. lower the client's head
A, B, D
silver sulfadiazine is a bactericidal agent. you need to keep the client hydrated to prevent the crystals
from growing too large and observe for leukopenia. sulfamylon is the brand name of mafenide
acetate
the nurse is preparing silver sulfadiazine to an older client. which of the following is true about this
drug? select all that apply
a. it causes black stains on the skin
b. it causes leukopenia
c. it causes flushing and tingling sensation
d. it forms sulfa crystals in the urine
e. sulfamylon is the brand name
f. it interferes with liver function
c, d
a third degree burn is describes with eschar and edema and destroys nerve endings which makes it
painless.
a nurse is caring for a client who has a 3rd degree burn. which of the following would the nurse expect
to find when assessing the burn? select all that apply
a. pain
b. erythema
c. edema
d. eschar
e. fluid filled vesicles
c
IV is first choice because of the rapid absorption and pain relief
a nurse is preparing to administer fentanyl to a client who sustained deep partial thickness burns over
60% of his body 24 hours ago. which of the following routes should the nurse administer the
medication?
a. subcutaneous
b
a nurse is caring for a male client with extensive 2nd and 3rd degree burn injuries. which of the
following lab values should be reported immediately to the HCP?
a. glucose of 200
b. potassium 6.1
c. hemoglobin 19
d. hematocrit 55%
c, g
a client with major burns of the buttocks is scheduled for treatment with silver nitrate. which
statements about this drug are correct? select all that apply
a. it is effective for more then 72 hours
b. it causes hyperchloremia
c. it causes cellular toxicity
d. it does not stain dressing
e. it improves visual inspection
f. it causes hypertonicity
g. it interacts with chloride ions
b
a nurse is caring for an adolescent who has a superficial partial thickness burn to the thigh. which of the
following actions should the nurse take?
a. prepare the adolescent for transport to the burn center
b. cleanse the affected area with tepid water
c. scrub the affected area using a soft bristle brush
d. administer morphine
b
potassium is not given post burn because of the risk of hyperkalemia
a nurse is caring for a client who was just admitted to the ED with a severe burn injury. which of the
following orders would the nurse question?
a. water
b. potassium
c. LR
d. plasma expanders
b, c, d
,a nurse is administering mafenide acetate to a client with burns. which statement about this drug are
correct? select all that apply
a. effective for first degree burns
b. used to eradicate pseudomonas aeruginosa
c. causes pain
d. contains sulfonamide
e. the brand name is silvadene
f. causes ototoxocity
g. is diffused gradually and slowly in the skin
b
a nurse is caring for a client with 3rd degree burns over 15% of his body surface. which of the following
indicates adequate fluid replacement during the first 24 hours post burn?
a. hematocrit level rising from 50-55
b. slowing of a previously rapid heart rate
c. falling CVP readings
d. urinary output of 15-20 ml/hr
c
a nurse is caring for a client who has sustained full thickness burns on the arms, face, neck, and
shoulders and is in the resuscitation phase. the nurse notes that the clients voice has become hoarse
with brassy cough and drooling. the nurse should identify these findings as indications that the client has
which of the following?
a. pulmonary edema
b. bacterial pneumonia
c. inhalation injury
d. carbon monoxide poisoning
a
burns on both buttocks indicates abuse and needs to be reported to adult protective services
a nurse manager is reviewing the admission history of four adult clients. the nurse is required to report
which of the following situations to an outside agency?
a. an older adult client who is dependent on caregivers and was admitted for the treatment of burns on
the buttocks
b. a young adult client who was admitted for asthma and has track marks that might indicate IV
substance abuse
c. a young adult client who was admitted for acute glomerulonephritis following a viral infection
d. an emancipated minor who has acute appendicitis and wants to leave the facility without treatment
a
morphine IV via continuous infusion is recommended for anybody who has major burns regardless of
age
a nurse is caring for a school age child who has a major burn and is experiencing severe pain. which of
the following actions should the nurse implement to manage this clients pain?
, a. administer morphine sulfate IV via continuous infusion
b. administer meperidine IV around the clock as needed
c. administer acetaminophen PO q4h
d. administer hydrocodone PO q6h
b
an electrical burn can cause dysrhythmias by disrupting the electrical cycle.
a nurse in the ED is caring for a client who has experienced an electrical burn. which of the following
nursing interventions is most important in this situation?
a. brush off dirt particles and debris
b. monitor for cardiac arrhythmias
c. cool the client with water
d. lower the client's head
A, B, D
silver sulfadiazine is a bactericidal agent. you need to keep the client hydrated to prevent the crystals
from growing too large and observe for leukopenia. sulfamylon is the brand name of mafenide
acetate
the nurse is preparing silver sulfadiazine to an older client. which of the following is true about this
drug? select all that apply
a. it causes black stains on the skin
b. it causes leukopenia
c. it causes flushing and tingling sensation
d. it forms sulfa crystals in the urine
e. sulfamylon is the brand name
f. it interferes with liver function
c, d
a third degree burn is describes with eschar and edema and destroys nerve endings which makes it
painless.
a nurse is caring for a client who has a 3rd degree burn. which of the following would the nurse expect
to find when assessing the burn? select all that apply
a. pain
b. erythema
c. edema
d. eschar
e. fluid filled vesicles
c
IV is first choice because of the rapid absorption and pain relief
a nurse is preparing to administer fentanyl to a client who sustained deep partial thickness burns over
60% of his body 24 hours ago. which of the following routes should the nurse administer the
medication?
a. subcutaneous
