nursing 335 baton rouge college
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A patient is admitted with electrical burns. What is the nurse's immediate priority assessment?
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Pain level
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Cardiac monitoring
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Capillary refill
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Skin color
Explanation
Correct Answer: B) Cardiac monitoring
Electrical burns carry a high risk of life-threatening cardiac dysrhythmias because electrical current travels through the body and can disrupt the heart's electrical conduction system, causing arrhythmias such as ventricular fibrillation or asystole — even if the patient appears stable on the surface.
Cardiac monitoring is therefore the immediate priority assessment upon admission. Pain level, capillary refill, and skin color are all important assessments but are secondary to the life-threatening cardiac complications that make electrical injuries uniquely dangerous compared to thermal burns.
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.
The nurse is explaining to a patient the difference between hemodialysis and continuous renal replacement therapy (CRRT). What statement by the patient leads the nurse to determine that additional education is needed?
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"CRRT causes less electrolyte changes."
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"CRRT is faster than hemodialysis."
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"CRRT is used for hemodynamically unstable patients."
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"CRRT is used to treat acute kidney injury."
Explanation
Correct Answer: B) "CRRT is faster than hemodialysis."
CRRT is actually slower and continuous — it runs 24 hours a day, delivering gradual, gentle fluid and solute removal. This makes it safer for hemodynamically unstable patients. Saying it is "faster" than hemodialysis is incorrect and indicates a need for further teaching. Options A, C, and D are all true statements about CRRT.
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 patient receiving heparin therapy develops a platelet count of 120,000/mm³ (normal: 150,000–450,000) and presents with red and swollen legs. The nurse suspects Heparin-Induced Thrombocytopenia. What is the nurse's priority action?
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Continue heparin therapy and monitor platelet counts.
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Discontinue heparin immediately and start an alternative anticoagulant.
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Administer platelet transfusion to manage thrombocytopenia.
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Administer intravenous fluids to prevent dehydration.
Explanation
Correct Answer: B) Discontinue heparin immediately and start an alternative anticoagulant.
Heparin-Induced Thrombocytopenia (HIT) is a life-threatening immune-mediated reaction to heparin that paradoxically causes thrombosis despite low platelet counts. The hallmark signs are a drop in platelets and evidence of clotting (red, swollen legs indicating deep vein thrombosis). The immediate priority is to stop all heparin products — including flushes — and transition to a non-heparin anticoagulant such as argatroban or bivalirudin. Continuing heparin would worsen clot formation. Platelet transfusions are contraindicated in HIT as they can fuel further thrombosis. IV fluids do not address the underlying coagulation emergency.
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.
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.
A patient is scheduled for an electromyography (EMG) test. The nurse is preparing the patient for the procedure. Which of the following actions should the nurse take to ensure the patient's safety and comfort during the EMG?
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Instruct the patient to wash their hair prior to the test.
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Tell the patient that the procedure will involve taking a small amount of tissue from the affected muscle.
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Explain that the procedure involves inserting a needle into the muscle to record electrical activity.
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Apply an ice pack to the muscles before the test to reduce discomfort.
Explanation
Correct Answer: C) Explain that the procedure involves inserting a needle into the muscle to record electrical activity.
An EMG measures electrical activity in muscles using needle electrodes inserted directly into the muscle tissue. Providing accurate pre-procedure education about what to expect — including needle insertion — is essential to ensure informed consent, reduce anxiety, and promote cooperation during the test. Washing hair is relevant for an EEG (electroencephalogram), not an EMG. Tissue biopsy is not part of an EMG. Applying ice before the test is not a standard preparation and could affect muscle activity readings.
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.
Prescribed: Begin Heparin IV infusion at 1,050 units/hr. Available: Heparin 25,000 units/500 mL NS. How many mL/hr will the nurse program the IV pump? Record your answer in whole number.
Explanation
Correct Answer: 21 mL/hr
Use the formula: (Desired dose ÷ Available dose) × Volume = mL/hr
(1,050 units/hr ÷ 25,000 units) × 500 mL = 0.042 × 500 = 21 mL/hr
First, determine the concentration: 25,000 units in 500 mL = 50 units/mL. Then divide the desired rate by the concentration: 1,050 ÷ 50 = 21 mL/hr. The nurse programs the IV pump to deliver 21 mL/hr.
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