BADNAP NP4 Final Exam
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Free BADNAP NP4 Final Exam Questions
1. Which observation of the patient made by the nurse is most indicative of Parkinson's disease?
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Large, embellished handwriting
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Weakness of one leg resulting in a limping walk
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Difficulty in rising from a chair and beginning to walk
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Onset of muscle spasms occurring with involuntary movement
Explanation
Explanation
Correct Answer: (C) Difficulty in rising from a chair and beginning to walk.
Difficulty rising from a chair and initiating walking is a hallmark manifestation of Parkinson's disease known as akinesia, or the difficulty initiating voluntary movement. This is directly related to the dopamine deficiency affecting the basal ganglia, which impairs the ability to start and smoothly execute voluntary motor movements. Freezing of gait and postural instability are classic features of Parkinson's disease.
Why Other Options are Incorrect:
A. Large, embellished handwriting is the opposite of what is seen in Parkinson's disease. Parkinson's produces micrographia, which is abnormally small and cramped handwriting, as a result of the rigidity and bradykinesia affecting fine motor control.
B. Weakness of one leg causing a limping gait is more characteristic of an upper motor neuron lesion such as a stroke or multiple sclerosis. Parkinson's disease primarily causes rigidity, bradykinesia, and tremor rather than unilateral leg weakness causing a limp.
D. Muscle spasms with involuntary movement describe conditions such as dystonia or chorea seen in Huntington's disease. Parkinson's disease is characterized by a resting tremor that decreases with intentional movement, not spasms with involuntary movement.
Correct Answer: (C) Difficulty in rising from a chair and beginning to walk.
Difficulty rising from a chair and initiating walking is a hallmark manifestation of Parkinson's disease known as akinesia, or the difficulty initiating voluntary movement. This is directly related to the dopamine deficiency affecting the basal ganglia, which impairs the ability to start and smoothly execute voluntary motor movements. Freezing of gait and postural instability are classic features of Parkinson's disease.
Why Other Options are Incorrect:
A. Large, embellished handwriting is the opposite of what is seen in Parkinson's disease. Parkinson's produces micrographia, which is abnormally small and cramped handwriting, as a result of the rigidity and bradykinesia affecting fine motor control.
B. Weakness of one leg causing a limping gait is more characteristic of an upper motor neuron lesion such as a stroke or multiple sclerosis. Parkinson's disease primarily causes rigidity, bradykinesia, and tremor rather than unilateral leg weakness causing a limp.
D. Muscle spasms with involuntary movement describe conditions such as dystonia or chorea seen in Huntington's disease. Parkinson's disease is characterized by a resting tremor that decreases with intentional movement, not spasms with involuntary movement.
2. The nurse is providing care for the client who sustained burns over 30% of the body in a fire. On assessment, the nurse notes the client is edematous in both burned and unburned body areas. The client's wife asks the nurse why her husband "looks so swollen." What is the nurse's best response?
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Increased capillary permeability has led to increased protein amounts in the blood
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Decreased capillary permeability has led to decreased protein amounts in the blood
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Increased capillary permeability has led to decreased protein amounts in the blood
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Decreased capillary permeability has led to increased protein amounts in the blood
Explanation
Explanation
Correct Answer: (C) Increased capillary permeability has led to decreased protein amounts in the blood.
Major burns cause a massive systemic inflammatory response that dramatically increases capillary permeability throughout the body, not just at the burn site. This increased permeability allows plasma proteins, particularly albumin, to leak out of the vascular space into the interstitial tissues. As protein levels in the blood decrease, the oncotic pressure that normally holds fluid within the vessels is lost, causing fluid to shift into the interstitial spaces throughout the body and resulting in generalized edema in both burned and unburned areas.
Why Other Options are Incorrect:
A. Increased capillary permeability causes proteins to leak out of the blood into the tissues, resulting in decreased blood protein levels, not increased. Increased protein in the blood would hold fluid in the vessels and prevent edema.
B. Capillary permeability is increased in major burns due to inflammatory mediators, not decreased. Decreased permeability would actually prevent fluid and protein leakage and would not cause edema.
D. Decreased capillary permeability would restrict fluid and protein movement out of vessels, preventing edema rather than causing it, making this response physiologically inaccurate.
Correct Answer: (C) Increased capillary permeability has led to decreased protein amounts in the blood.
Major burns cause a massive systemic inflammatory response that dramatically increases capillary permeability throughout the body, not just at the burn site. This increased permeability allows plasma proteins, particularly albumin, to leak out of the vascular space into the interstitial tissues. As protein levels in the blood decrease, the oncotic pressure that normally holds fluid within the vessels is lost, causing fluid to shift into the interstitial spaces throughout the body and resulting in generalized edema in both burned and unburned areas.
Why Other Options are Incorrect:
A. Increased capillary permeability causes proteins to leak out of the blood into the tissues, resulting in decreased blood protein levels, not increased. Increased protein in the blood would hold fluid in the vessels and prevent edema.
B. Capillary permeability is increased in major burns due to inflammatory mediators, not decreased. Decreased permeability would actually prevent fluid and protein leakage and would not cause edema.
D. Decreased capillary permeability would restrict fluid and protein movement out of vessels, preventing edema rather than causing it, making this response physiologically inaccurate.
3. The nurse is caring for a client with mitral regurgitation. Referring to the figure, where should the nurse listen to best hear any murmur that the client has?
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2
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1
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4
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3
Explanation
Explanation:
Correct Answer: (C) 4
The mitral valve is best auscultated at the apex of the heart, which corresponds to the fifth intercostal space at the midclavicular line, referred to as the mitral or apical area. On standard cardiac auscultation diagrams, this location is typically labeled as point 4 or the apex. Mitral regurgitation produces a holosystolic blowing murmur that is loudest at this location and may radiate to the left axilla.
Why Other Options are Incorrect:
A. Point 2 corresponds to the aortic area located at the second intercostal space to the right of the sternum, where aortic valve murmurs are best heard.
B. Point 1 also corresponds to an aortic or pulmonic auscultation area at the base of the heart, not the mitral valve area.
D. Point 3 corresponds to the tricuspid area located at the left lower sternal border, where tricuspid valve murmurs are best auscultated, not mitral valve murmurs.
Correct Answer: (C) 4
The mitral valve is best auscultated at the apex of the heart, which corresponds to the fifth intercostal space at the midclavicular line, referred to as the mitral or apical area. On standard cardiac auscultation diagrams, this location is typically labeled as point 4 or the apex. Mitral regurgitation produces a holosystolic blowing murmur that is loudest at this location and may radiate to the left axilla.
Why Other Options are Incorrect:
A. Point 2 corresponds to the aortic area located at the second intercostal space to the right of the sternum, where aortic valve murmurs are best heard.
B. Point 1 also corresponds to an aortic or pulmonic auscultation area at the base of the heart, not the mitral valve area.
D. Point 3 corresponds to the tricuspid area located at the left lower sternal border, where tricuspid valve murmurs are best auscultated, not mitral valve murmurs.
4. A patient with DKA is receiving insulin therapy. Which electrolyte imbalance is the nurse most concerned about during treatment?
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Hypercalcemia
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Hypokalemia
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Hypernatremia
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Hypomagnesemia
Explanation
Explanation
Correct Answer: (B) Hypokalemia.
During insulin therapy for DKA, insulin drives potassium from the extracellular space into the cells, causing a rapid drop in serum potassium levels. This can lead to life-threatening hypokalemia, resulting in cardiac dysrhythmias and muscle weakness. Potassium levels must be closely monitored and replaced as needed throughout DKA treatment.
Why Other Options are Incorrect:
A. Hypercalcemia is not a primary concern during insulin therapy for DKA as insulin does not significantly affect calcium levels.
C. Hypernatremia may occur in DKA due to fluid shifts, but it is not the most critical electrolyte concern during insulin therapy compared to the immediate danger of hypokalemia.
D. Hypomagnesemia can occur in DKA but is not the primary electrolyte imbalance of concern during insulin therapy, as the risk of hypokalemia and its cardiac consequences is far more immediate and life-threatening.
Correct Answer: (B) Hypokalemia.
During insulin therapy for DKA, insulin drives potassium from the extracellular space into the cells, causing a rapid drop in serum potassium levels. This can lead to life-threatening hypokalemia, resulting in cardiac dysrhythmias and muscle weakness. Potassium levels must be closely monitored and replaced as needed throughout DKA treatment.
Why Other Options are Incorrect:
A. Hypercalcemia is not a primary concern during insulin therapy for DKA as insulin does not significantly affect calcium levels.
C. Hypernatremia may occur in DKA due to fluid shifts, but it is not the most critical electrolyte concern during insulin therapy compared to the immediate danger of hypokalemia.
D. Hypomagnesemia can occur in DKA but is not the primary electrolyte imbalance of concern during insulin therapy, as the risk of hypokalemia and its cardiac consequences is far more immediate and life-threatening.
5. The cardiac nurse understands that ventricular assist devices (VADs) depend on adequate preload. Which definition best describes preload?
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The resistance the heart must overcome to eject stroke volume
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The strength of the myocardial fiber contraction
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The stretch caused by volume in the ventricles at the end of diastole
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The percentage of blood ejected during systolic contraction
Explanation
Explanation
Correct Answer: (C) The stretch caused by volume in the ventricles at the end of diastole.
Preload refers to the degree of myocardial fiber stretch at the end of diastole, just before ventricular contraction. It is determined by the volume of blood filling the ventricles during diastole. According to the Frank-Starling law, the greater the stretch of the myocardial fibers, the stronger the subsequent contraction. VADs depend on adequate preload to function effectively as insufficient ventricular filling results in poor device output.
Why Other Options are Incorrect:
A. The resistance the heart must overcome to eject stroke volume describes afterload, which is the force opposing ventricular ejection, primarily determined by systemic vascular resistance.
B. The strength of myocardial fiber contraction describes contractility, which is the intrinsic ability of the cardiac muscle to contract independent of preload and afterload.
D. The percentage of blood ejected during systolic contraction describes ejection fraction, which is a measure of ventricular systolic function, not preload.
Correct Answer: (C) The stretch caused by volume in the ventricles at the end of diastole.
Preload refers to the degree of myocardial fiber stretch at the end of diastole, just before ventricular contraction. It is determined by the volume of blood filling the ventricles during diastole. According to the Frank-Starling law, the greater the stretch of the myocardial fibers, the stronger the subsequent contraction. VADs depend on adequate preload to function effectively as insufficient ventricular filling results in poor device output.
Why Other Options are Incorrect:
A. The resistance the heart must overcome to eject stroke volume describes afterload, which is the force opposing ventricular ejection, primarily determined by systemic vascular resistance.
B. The strength of myocardial fiber contraction describes contractility, which is the intrinsic ability of the cardiac muscle to contract independent of preload and afterload.
D. The percentage of blood ejected during systolic contraction describes ejection fraction, which is a measure of ventricular systolic function, not preload.
6. A client arrives via ambulance to the emergency department because of sudden inability to move the right side. Which question is most important for the nurse to ask at this time?
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What is your normal blood pressure?
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When is the last time you were able to use your right arm and leg?
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Do you have a family history of cerebrovascular disease or heart disease?
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Have you ever been diagnosed with a transient ischemic attack (TIA) before?
Explanation
Explanation
Correct Answer: (B) When is the last time you were able to use your right arm and leg?
Establishing the exact time of symptom onset is the most critical question in suspected acute stroke because it directly determines eligibility for thrombolytic therapy with tPA. The treatment window for tPA administration is within 3 to 4.5 hours of symptom onset. If the time of last known normal neurological function cannot be established, the client may be ineligible for time-sensitive treatments. This single piece of information guides all subsequent clinical decisions.
Why Other Options are Incorrect:
A. Knowing the client's normal blood pressure is useful background information but is not the most immediately critical question in determining stroke treatment eligibility.
C. Family history of cerebrovascular or cardiac disease is relevant for long-term risk assessment but does not influence immediate acute stroke management decisions.
D. A previous TIA history is relevant to understanding stroke risk but does not change the immediate priority of establishing time of symptom onset for tPA eligibility determination.
Correct Answer: (B) When is the last time you were able to use your right arm and leg?
Establishing the exact time of symptom onset is the most critical question in suspected acute stroke because it directly determines eligibility for thrombolytic therapy with tPA. The treatment window for tPA administration is within 3 to 4.5 hours of symptom onset. If the time of last known normal neurological function cannot be established, the client may be ineligible for time-sensitive treatments. This single piece of information guides all subsequent clinical decisions.
Why Other Options are Incorrect:
A. Knowing the client's normal blood pressure is useful background information but is not the most immediately critical question in determining stroke treatment eligibility.
C. Family history of cerebrovascular or cardiac disease is relevant for long-term risk assessment but does not influence immediate acute stroke management decisions.
D. A previous TIA history is relevant to understanding stroke risk but does not change the immediate priority of establishing time of symptom onset for tPA eligibility determination.
7. A client presents to the emergency department with chest pain, severe bronchospasm, cough, and hemoptysis. Plague is suspected. The first action the RN should take is to
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Place client in isolation.
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Initiate antibiotic treatment
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Obtain a sputum culture.
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Order diagnostic testing.
Explanation
Explanation
Correct Answer: (A) Place client in isolation.
When plague, particularly pneumonic plague, is suspected, the absolute first priority is placing the client in strict respiratory isolation to prevent person-to-person transmission of this highly contagious and potentially fatal bioterrorism agent. Infection control and containment must be established before any diagnostic or treatment interventions to protect other patients, staff, and the public.
Why the other options are incorrect:
B. Initiating antibiotic treatment is an important and urgent intervention for plague but cannot take priority over isolation, as the risk of spreading a highly infectious and potentially weaponized pathogen to others must be contained first.
C. Obtaining a sputum culture is necessary for diagnosis and confirmation but is a secondary action that follows the establishment of isolation precautions to prevent transmission during specimen collection.
D. Ordering diagnostic testing is important but is not the first action, as containing the spread of a suspected highly contagious and life-threatening infection through immediate isolation must come before any diagnostic workup.
Correct Answer: (A) Place client in isolation.
When plague, particularly pneumonic plague, is suspected, the absolute first priority is placing the client in strict respiratory isolation to prevent person-to-person transmission of this highly contagious and potentially fatal bioterrorism agent. Infection control and containment must be established before any diagnostic or treatment interventions to protect other patients, staff, and the public.
Why the other options are incorrect:
B. Initiating antibiotic treatment is an important and urgent intervention for plague but cannot take priority over isolation, as the risk of spreading a highly infectious and potentially weaponized pathogen to others must be contained first.
C. Obtaining a sputum culture is necessary for diagnosis and confirmation but is a secondary action that follows the establishment of isolation precautions to prevent transmission during specimen collection.
D. Ordering diagnostic testing is important but is not the first action, as containing the spread of a suspected highly contagious and life-threatening infection through immediate isolation must come before any diagnostic workup.
8. A client presents to the emergency department (ED) with moderate chest pain (7/10), bloody sputum, and a persistent cough over the last six months. Right lung fields have diminished breath sounds. Over the past 6 months, the client has been taking OTC cough medications, has continued to feel fatigued, and has experienced a 10-pound weight loss. Health history includes a 20-pack year smoking history and current cannabis use. The client states they are current on Covid, flu, and pneumonia vaccines. Current vital signs are BP 128/72, HR 98, Temp 97.9 F, RR 14 and SaO2 92% on room air. Complete the diagram to specify what condition the client is most likely experiencing, 2 actions to take, and 2 parameters to monitor.
Explanation
Explanation
Correct Answer: Potential Condition: Lung Cancer. Actions to Take: Obtain a chest x-ray and Arterial blood gases. Parameters to Monitor: Airway patency and oxygenation status, and Pain/discomfort level.
The clinical presentation strongly points to lung cancer. The combination of a 20-pack year smoking history, persistent cough with hemoptysis lasting six months, unilateral diminished breath sounds, significant unintentional weight loss, fatigue, and an SaO2 of 92% are classic warning signs of lung malignancy. Obtaining a chest x-ray is the priority diagnostic action to visualize the lung fields and identify masses, while arterial blood gases assess the degree of respiratory compromise. Airway patency and oxygenation must be monitored given the low oxygen saturation, and pain and discomfort level must be monitored given the significant chest pain reported.
Why Other Options are Incorrect:
Pneumonia is less likely because the client is vaccinated against pneumonia, the symptoms have persisted for six months rather than presenting acutely, and the combination of hemoptysis with significant weight loss and smoking history is more consistent with malignancy.
Tuberculosis is possible given hemoptysis and weight loss, but the six-month gradual progression combined with a heavy smoking history and unilateral findings makes lung cancer more probable.
Cardiac tamponade presents with the classic Beck's triad of hypotension, muffled heart sounds, and jugular venous distension, none of which are present in this scenario.
Chest tube insertion is not an appropriate action at this stage as there is no evidence of pneumothorax or pleural effusion requiring immediate drainage.
Correct Answer: Potential Condition: Lung Cancer. Actions to Take: Obtain a chest x-ray and Arterial blood gases. Parameters to Monitor: Airway patency and oxygenation status, and Pain/discomfort level.
The clinical presentation strongly points to lung cancer. The combination of a 20-pack year smoking history, persistent cough with hemoptysis lasting six months, unilateral diminished breath sounds, significant unintentional weight loss, fatigue, and an SaO2 of 92% are classic warning signs of lung malignancy. Obtaining a chest x-ray is the priority diagnostic action to visualize the lung fields and identify masses, while arterial blood gases assess the degree of respiratory compromise. Airway patency and oxygenation must be monitored given the low oxygen saturation, and pain and discomfort level must be monitored given the significant chest pain reported.
Why Other Options are Incorrect:
Pneumonia is less likely because the client is vaccinated against pneumonia, the symptoms have persisted for six months rather than presenting acutely, and the combination of hemoptysis with significant weight loss and smoking history is more consistent with malignancy.
Tuberculosis is possible given hemoptysis and weight loss, but the six-month gradual progression combined with a heavy smoking history and unilateral findings makes lung cancer more probable.
Cardiac tamponade presents with the classic Beck's triad of hypotension, muffled heart sounds, and jugular venous distension, none of which are present in this scenario.
Chest tube insertion is not an appropriate action at this stage as there is no evidence of pneumothorax or pleural effusion requiring immediate drainage.
9. The nurse in the emergency department is taking care of a client who is reported to have sustained a head injury. The client briefly lost consciousness following the injury, regained consciousness temporarily, and then became unresponsive. Which action will the nurse plan to take?
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Initiate high-dose barbiturate therapy.
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Prepare for a craniotomy.
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Prepare for ventricular drainage and ICP monitoring.
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Prepare the client for a cerebral angiogram.
Explanation
Explanation
Correct Answer: (B) Prepare for a craniotomy.
The clinical presentation described, losing consciousness, regaining it briefly (lucid interval), and then becoming unresponsive again, is classic for an epidural hematoma caused by arterial bleeding. This is a neurosurgical emergency requiring immediate craniotomy to evacuate the hematoma and relieve pressure on the brain.
Why Other Options are Incorrect:
A. Initiating high-dose barbiturate therapy is used to reduce refractory intracranial pressure but is not the priority intervention for an epidural hematoma requiring surgical evacuation.
C. Preparing for ventricular drainage and ICP monitoring may be used in other types of head injuries but is not the immediate priority when an epidural hematoma is suspected.
D. Preparing the client for a cerebral angiogram is used to assess vascular abnormalities but is not appropriate in this acute emergency situation requiring immediate surgical intervention.
Correct Answer: (B) Prepare for a craniotomy.
The clinical presentation described, losing consciousness, regaining it briefly (lucid interval), and then becoming unresponsive again, is classic for an epidural hematoma caused by arterial bleeding. This is a neurosurgical emergency requiring immediate craniotomy to evacuate the hematoma and relieve pressure on the brain.
Why Other Options are Incorrect:
A. Initiating high-dose barbiturate therapy is used to reduce refractory intracranial pressure but is not the priority intervention for an epidural hematoma requiring surgical evacuation.
C. Preparing for ventricular drainage and ICP monitoring may be used in other types of head injuries but is not the immediate priority when an epidural hematoma is suspected.
D. Preparing the client for a cerebral angiogram is used to assess vascular abnormalities but is not appropriate in this acute emergency situation requiring immediate surgical intervention.
10. A client with an approximate 30% total body surface area (TBSA) burn has the following initial laboratory results: Hct 56%, Hgb 19 mg/dL, potassium 4.7 mEq/L, and sodium 136 mEq/L. Which action will the nurse anticipate next?
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Monitor urine output every 8 hours
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Obtain a 12-Lead EKG
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Increase the rate of the IV infusion
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Type and crossmatch for a blood transfusion
Explanation
Explanation
Correct Answer: (C) Increase the rate of the IV infusion.
In a major burn injury covering 30% TBSA, massive fluid shifts occur from the intravascular to the interstitial space during the first 24-48 hours due to increased capillary permeability. The elevated hematocrit of 56% and hemoglobin of 19 mg/dL indicate hemoconcentration, confirming significant intravascular fluid loss. The priority intervention is aggressive IV fluid resuscitation using a protocol such as the Parkland formula to restore circulating volume and prevent hypovolemic shock and organ failure.
Why Other Options are Incorrect:
A. Monitoring urine output every 8 hours is insufficient in an acute major burn. Urine output should be monitored hourly as it is the primary indicator of adequate fluid resuscitation, with a target of 0.5-1 mL/kg/hour in adults.
B. Obtaining a 12-Lead EKG may be warranted if there are cardiac concerns such as electrical burns, but it is not the priority action based on the laboratory data showing hemoconcentration requiring immediate fluid resuscitation.
D. Type and crossmatch for blood transfusion is not indicated at this stage. The elevated hemoglobin and hematocrit reflect hemoconcentration from fluid loss, not anemia. IV fluid resuscitation is the appropriate intervention, not blood products.
Correct Answer: (C) Increase the rate of the IV infusion.
In a major burn injury covering 30% TBSA, massive fluid shifts occur from the intravascular to the interstitial space during the first 24-48 hours due to increased capillary permeability. The elevated hematocrit of 56% and hemoglobin of 19 mg/dL indicate hemoconcentration, confirming significant intravascular fluid loss. The priority intervention is aggressive IV fluid resuscitation using a protocol such as the Parkland formula to restore circulating volume and prevent hypovolemic shock and organ failure.
Why Other Options are Incorrect:
A. Monitoring urine output every 8 hours is insufficient in an acute major burn. Urine output should be monitored hourly as it is the primary indicator of adequate fluid resuscitation, with a target of 0.5-1 mL/kg/hour in adults.
B. Obtaining a 12-Lead EKG may be warranted if there are cardiac concerns such as electrical burns, but it is not the priority action based on the laboratory data showing hemoconcentration requiring immediate fluid resuscitation.
D. Type and crossmatch for blood transfusion is not indicated at this stage. The elevated hemoglobin and hematocrit reflect hemoconcentration from fluid loss, not anemia. IV fluid resuscitation is the appropriate intervention, not blood products.
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