nursing 335 baton rouge college
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A patient presents to the emergency department after a fall. The nurse notes raccoon eyes and rhinorrhea. The healthcare provider suspects a skull fracture. Which of the following nursing interventions is most appropriate?
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Instill normal saline into the nose to clear any possible obstructions.
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Use a sterile dressing to collect the nasal drainage and send it for testing.
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Apply ice packs to the nose to reduce swelling and drainage.
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Instruct the patient to cough to clear nasal passages.
Explanation
Correct Answer: B) Use a sterile dressing to collect the nasal drainage and send it for testing.
Raccoon eyes (periorbital ecchymosis) and rhinorrhea following head trauma are classic signs of a basilar skull fracture. The nasal drainage may contain cerebrospinal fluid (CSF), which can be confirmed by testing for glucose or the halo/ring sign on a sterile dressing. Collecting the drainage with a sterile dressing for testing is the appropriate nursing action. Instilling saline into the nose is contraindicated as it could introduce bacteria into the CSF and cause meningitis. Ice packs do not address the clinical concern. Instructing the patient to cough or blow the nose is dangerous as it can increase intracranial pressure and worsen a CSF leak.
A 37-year-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?
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Glomerular filtration rate (GFR)
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Potassium level
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Blood urea nitrogen (BUN) level
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Urine volume
Explanation
Correct Answer: A) Glomerular filtration rate (GFR)
The GFR is the most direct and comprehensive measure of kidney function, reflecting how efficiently the kidneys are filtering waste from the blood. An improving GFR indicates recovering renal function in AKI. While potassium level, BUN, and urine volume are all important parameters to monitor in AKI, they are indirect indicators of kidney function. Potassium and BUN can be affected by non-renal factors such as diet and catabolism. Urine volume alone does not confirm functional recovery, as a patient can have non-oliguric AKI with normal urine output but still have significantly impaired filtration. GFR remains the gold standard for evaluating true improvement in kidney function.
A burn patient is placed on enteral feeding. Which diet is most appropriate for promoting wound healing?
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Low protein, low carb
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High protein, high calorie
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High carb, low protein
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Low sodium, low protein
Explanation
Correct Answer: B) High protein, high calorie.
Burn injuries cause a hypermetabolic state with dramatically increased caloric and protein demands. Protein is essential for tissue repair, immune function, and wound healing, while high caloric intake is necessary to meet the energy demands of the hypermetabolic response and prevent catabolism of muscle mass. Burn patients may require 2–3 times their normal caloric needs. Low protein diets would delay wound healing and increase infection risk. High carb without adequate protein does not support tissue repair. Low sodium restrictions are not the priority in acute burn nutritional management.
During the emergent phase of burn care, which nursing action will be most useful in determining if a patient is receiving adequate fluid resuscitation?
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Measure hourly urine output.
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Monitor daily weight.
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Check skin turgor.
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Assess mucous membranes.
Explanation
Correct Answer: A) Measure hourly urine output.
Hourly urine output is the most reliable and sensitive indicator of adequate fluid resuscitation in burn patients during the emergent phase. The goal is to maintain urine output of 0.5–1 mL/kg/hour in adults, which reflects adequate renal perfusion and overall tissue perfusion. Daily weight, skin turgor, and mucous membrane assessment provide useful but less precise and less immediate information about fluid status compared to hourly urine monitoring.
A patient with facial burns suddenly becomes restless with stridor. What is the nurse's priority action?
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Administer IV morphine
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Call for stat airway support
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Elevate the HOB
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Obtain ABG
Explanation
Correct Answer: B) Call for stat airway support.
Stridor in a patient with facial burns is a medical emergency indicating impending upper airway obstruction due to inhalation injury and edema. The airway is the absolute priority — the nurse must immediately call for stat airway support, as the patient may require emergency intubation or surgical airway management before complete obstruction occurs. Airway edema from burns can progress extremely rapidly, making delayed action life-threatening. Morphine, HOB elevation, and ABG are all secondary interventions that must wait until the airway is secured.
Six hours after a thermal burn, the nurse obtains the following assessment data for a patient who weighs 70 kg and has a 50% total body surface area (TBSA) burn. Which information is most important to communicate to the health care provider?
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Serous exudate is leaking from the burns.
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Urine output is 20 mL per hour for the past 2 hours.
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Pulse rate of 104.
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Blood pressure is 94/46 per arterial line.
Explanation
Correct Answer: B) Urine output is 20 mL per hour for the past 2 hours.
For a 70 kg patient, the minimum acceptable urine output during burn resuscitation is 0.5 mL/kg/hour, which equals 35 mL/hour. A urine output of only 20 mL/hour for the past two hours indicates inadequate fluid resuscitation and compromised renal perfusion — a critical finding that must be reported immediately so the IV fluid rate can be adjusted. While a pulse of 104 and BP of 94/46 are also concerning, low urine output is the most specific and sensitive indicator of inadequate resuscitation in burn patients and directly guides fluid management. Serous exudate from burns is an expected finding and not an urgent concern.
The nurse is teaching about fire safety. Which prevention strategy will the nurse focus on?
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Encourage regular work and home fire exit drills.
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Never allow older adults to cook unsupervised.
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Hard wire all smoke detectors.
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Set hot water temp to 140 degrees F.
Explanation
Correct Answer: A) Encourage regular work and home fire exit drills.
Practicing regular fire exit drills at home and work is the most effective and universally applicable fire prevention and safety strategy, ensuring that people know how to evacuate quickly and safely in an emergency. Restricting older adults from unsupervised cooking is overly restrictive and not evidence-based as a primary safety strategy. Hard-wiring smoke detectors is beneficial but not always feasible; battery-operated detectors are equally effective when maintained. Hot water temperature should be set to 120°F or below — 140°F actually increases the risk of scald burns, particularly in children and older adults.
A nurse is caring for a postoperative patient following a total knee replacement. Which of the following medications should the nurse anticipate the provider to prescribe to prevent the formulation of a deep vein thrombosis (DVT)?
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Alteplase
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Clopidogrel
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Warfarin
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Enoxaparin
Explanation
Correct Answer: D) Enoxaparin
Enoxaparin (Lovenox), a low molecular weight heparin (LMWH), is the preferred anticoagulant for DVT prophylaxis following total knee replacement. It has a predictable dose response, does not require routine monitoring, and has a well-established safety profile in the postoperative orthopedic setting. Alteplase is a thrombolytic used to dissolve existing clots, not for prevention. Clopidogrel is an antiplatelet agent used primarily in cardiovascular conditions, not DVT prophylaxis. Warfarin, while sometimes used for DVT prevention, has a delayed onset, narrow therapeutic window, and requires frequent INR monitoring, making it less preferred over enoxaparin in the immediate postoperative period.
Due to the patient's worsening acute kidney injury (AKI), the nurse expects the provider to prescribe a . The nurse prepares for b .
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sodium polystyrene / arteriovenous fistula placement
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hemodialysis / continuous renal replacement therapy
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NPO status / peritoneal catheter placement
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lactated Ringer's bolus / arteriovenous graft placement
Explanation
Correct Answer: B) hemodialysis / continuous renal replacement therapy
Given the patient's severely elevated potassium (7.2 mEq/L), rising creatinine, elevated BUN, declining urine output, and worsening fluid overload, the provider would prescribe hemodialysis to urgently remove potassium and waste products the kidneys can no longer excrete. The nurse then prepares for continuous renal replacement therapy (CRRT), which is used in critically ill, hemodynamically unstable patients as a slower, gentler form of dialysis to manage fluid and solute balance continuously over time.
Sodium polystyrene can help reduce potassium but is not sufficient for a critically ill AKI patient. NPO status and lactated Ringer's bolus do not address the underlying renal failure or hyperkalemia. Fistula and graft placements are long-term access options for chronic dialysis patients, not immediate interventions for acute decompensation.
The nurse is assessing a patient with a burn injury using the "rule of nines." Which information will this assessment contribute to future care planning?
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Rehabilitation needs
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Type of intravenous fluids required
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Respiratory needs
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Amount of body surface area burned
Explanation
Correct Answer: D) Amount of body surface area burned.
The "rule of nines" is a standardized tool used to estimate the total body surface area (TBSA) affected by burns. It divides the body into sections each representing 9% (or multiples of 9%) of the body surface. This calculation is critical for care planning because the TBSA burned directly guides fluid resuscitation calculations (such as the Parkland formula), determines severity, and informs decisions about wound management and transfer to a burn center. While rehabilitation, IV fluid type, and respiratory needs are all important, they are determined by other assessments — the rule of nines specifically quantifies the extent of the burn.
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