TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
Chapter 21: Burns x x
Test Bank x
x MULTIPLE
x CHOICE
1. When xassessing xa xpatient xwho xspilled xhot xoil xon xthe xright xleg xand xfoot, xthe
nurse notes that the skin is dry, pale, hard skin. The patient states that the
x x x x x x x x x x x x x x x
burn is not painful. What term would the nurse use to document theburn
x x x x x x x x x x x x x x
x depth?
a. First-degree skin destruction x x
b. Full-thickness skin destruction x x
c. Deep partial-thickness skin destruction
x x x
d. Superficial partial-thickness x
x skin destructionANS: B
x x x
With full-thickness skin destruction, the appearance is pale and dry or
x x x x x x x x x x
leathery and the area is painless becauseof the associated nerve destruction.
x x x x x x x x x x x x
Erythema, swelling, and blisters point to a deep partial-thickness burn.
x x x x x x x x x x
With superficial partial-thickness burns, the area is red, but no blisters are
x x x x x x x x x x x
TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
,TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
present. First-degree burns exhibiterythema, blanching, and pain.
x x x x x x x x
DIF: Cognitive Level: Understand (comprehension)
x x x x
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
x x x x x x x
2. On xadmission xto xthe xburn xunit, xa xpatient xwith xan xapproximate x25% xtotal
body surface area (TBSA) burn hasthe following initial laboratory results:
x x x x x x x x x x x
x Hct 58%, Hgb 18.2 mg/dL (172 g/L), serum K+ 4.9 mEq/L (4.8 mmol/L),
x x x x x x x x
x
x x x
x and serum Na+ 135 mEq/L (135 mmol/L). Which action will the nurse
x x
x
x x x x x x x x
x anticipate taking now? x x
a. Monitor urine output every 4 hours.
x x x x x
b. Continue to monitor the laboratory results.
x x x x x
c. Increase the rate of the ordered IV solution.
x x x x x x x
d. Type and crossmatch for a blood transfusion.
x x x x x x
ANS: C x
The patients laboratory data show hemoconcentration, which may lead to
x x x x x x x x x
TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
,TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
x a decrease in blood flow to the microcirculation unless fluid intake is
x x x x x x x x x x x
x increased. Because the hematocrit and hemoglobin are elevated, a
x x x x x x x x
x transfusion is inappropriate, although transfusions may be needed after the
x x x x x x x x x
emergent phase once the patients fluid balance has been restored. On
x x x x x x x x x x x
admission to a burn unit, the urine output would be monitored more often
x x x x x x x x x x x x x
than every 4 hours; likely every1 hour.
x x x x x x x
DIF: Cognitive Level: Apply (application)
x x x x
TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
, TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
x x x x x x x
3. A xpatient xis xadmitted xto xthe xburn xunit xwith xburns xto xthe xhead, xface, xand
hands. Initially, wheezes are heard,but an hour later, the lung sounds are
x x x x x x x x x x x x x
decreased and no wheezes are audible. What is the best action for the
x x x x x x x x x x x x x
x nurse to take? x x
a. Encourage the patient to cough and auscultate the lungs again.
x x x x x x x x x
b. Notify the health care provider and prepare for endotracheal
x x x x x x x x
intubation.
x
c. Document the results and continue to monitor the patients respiratory
x x x x x x x x x
rate.
x
d. Reposition the patient in high-Fowlers position and reassess breath
x x x x x x x x
sounds.
x
ANS: B x
The patients history and clinical manifestations suggest airway edema and the
x x x x x x x x x x
TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
Chapter 21: Burns x x
Test Bank x
x MULTIPLE
x CHOICE
1. When xassessing xa xpatient xwho xspilled xhot xoil xon xthe xright xleg xand xfoot, xthe
nurse notes that the skin is dry, pale, hard skin. The patient states that the
x x x x x x x x x x x x x x x
burn is not painful. What term would the nurse use to document theburn
x x x x x x x x x x x x x x
x depth?
a. First-degree skin destruction x x
b. Full-thickness skin destruction x x
c. Deep partial-thickness skin destruction
x x x
d. Superficial partial-thickness x
x skin destructionANS: B
x x x
With full-thickness skin destruction, the appearance is pale and dry or
x x x x x x x x x x
leathery and the area is painless becauseof the associated nerve destruction.
x x x x x x x x x x x x
Erythema, swelling, and blisters point to a deep partial-thickness burn.
x x x x x x x x x x
With superficial partial-thickness burns, the area is red, but no blisters are
x x x x x x x x x x x
TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
,TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
present. First-degree burns exhibiterythema, blanching, and pain.
x x x x x x x x
DIF: Cognitive Level: Understand (comprehension)
x x x x
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
x x x x x x x
2. On xadmission xto xthe xburn xunit, xa xpatient xwith xan xapproximate x25% xtotal
body surface area (TBSA) burn hasthe following initial laboratory results:
x x x x x x x x x x x
x Hct 58%, Hgb 18.2 mg/dL (172 g/L), serum K+ 4.9 mEq/L (4.8 mmol/L),
x x x x x x x x
x
x x x
x and serum Na+ 135 mEq/L (135 mmol/L). Which action will the nurse
x x
x
x x x x x x x x
x anticipate taking now? x x
a. Monitor urine output every 4 hours.
x x x x x
b. Continue to monitor the laboratory results.
x x x x x
c. Increase the rate of the ordered IV solution.
x x x x x x x
d. Type and crossmatch for a blood transfusion.
x x x x x x
ANS: C x
The patients laboratory data show hemoconcentration, which may lead to
x x x x x x x x x
TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
,TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
x a decrease in blood flow to the microcirculation unless fluid intake is
x x x x x x x x x x x
x increased. Because the hematocrit and hemoglobin are elevated, a
x x x x x x x x
x transfusion is inappropriate, although transfusions may be needed after the
x x x x x x x x x
emergent phase once the patients fluid balance has been restored. On
x x x x x x x x x x x
admission to a burn unit, the urine output would be monitored more often
x x x x x x x x x x x x x
than every 4 hours; likely every1 hour.
x x x x x x x
DIF: Cognitive Level: Apply (application)
x x x x
TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
, TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
x x x x x x x
3. A xpatient xis xadmitted xto xthe xburn xunit xwith xburns xto xthe xhead, xface, xand
hands. Initially, wheezes are heard,but an hour later, the lung sounds are
x x x x x x x x x x x x x
decreased and no wheezes are audible. What is the best action for the
x x x x x x x x x x x x x
x nurse to take? x x
a. Encourage the patient to cough and auscultate the lungs again.
x x x x x x x x x
b. Notify the health care provider and prepare for endotracheal
x x x x x x x x
intubation.
x
c. Document the results and continue to monitor the patients respiratory
x x x x x x x x x
rate.
x
d. Reposition the patient in high-Fowlers position and reassess breath
x x x x x x x x
sounds.
x
ANS: B x
The patients history and clinical manifestations suggest airway edema and the
x x x x x x x x x x
TESTBANK FOR LEWIS MEDICAL SURGICAL NURSING x x x x x
11TH EDITION BYHARDING Questions & Answers
x x x x x x x x
satisfaction guaranteed success ( CHAPTERS 21-29)
x x x x x x x
latest update x x
