nursing 335 baton rouge college
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A patient is admitted with electrical burns. What is the nurse's immediate priority assessment?
- Pain level
- Cardiac monitoring
- Capillary refill
- 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.
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.
A patient with facial burns suddenly becomes restless with stridor. What is the nurse's priority action?
- Administer IV morphine
- Call for stat airway support
- Elevate the HOB
- 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.
A patient who has had a craniotomy is admitted to the ICU. The nurse notes that the patient is having difficulty speaking, and the right pupil is dilated and nonreactive. The nurse suspects increased intracranial pressure (ICP) and plans to assess the patient's neurological status. Which of the following should the nurse assess first?
- Determine a Glasgow Coma Scale score.
- Obtain heart rate and blood pressure.
- Assess reflexes and push pulls of feet.
- Assess for nuchal rigidity.
Explanation
Correct Answer: A) Determine a Glasgow Coma Scale score.
The Glasgow Coma Scale (GCS) is the standardized, priority neurological assessment tool used to evaluate level of consciousness in patients with suspected increased ICP. It assesses eye opening, verbal response, and motor response — providing a rapid, objective baseline of neurological status. In a patient with a dilated nonreactive pupil and speech difficulty following craniotomy, establishing a GCS score is the first priority as it guides all subsequent interventions. While vital signs and reflexes are also important, the GCS directly quantifies neurological deterioration and is the first step in ICP assessment.
A patient is diagnosed with a brain abscess and is being prepared for treatment. The nurse is reviewing the patient's medical history. Which of the following factors is most likely to contribute to the development of a brain abscess in this patient?
- History of chronic hypertension.
- History of migraines.
- Recent tick removal.
- Recent head trauma with a skull fracture.
Explanation
Correct Answer: D) Recent head trauma with a skull fracture.
A skull fracture creates a direct pathway for bacteria to enter the brain, making it the most likely contributing factor to brain abscess formation. Brain abscesses typically arise from contiguous spread of infection, hematogenous spread, or direct inoculation — skull fractures represent direct inoculation. Chronic hypertension and migraines are not associated with brain abscess development. While tick bites can transmit certain infections, a recent tick removal without confirmed disease is not as directly causative as a skull fracture.
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?
- "CRRT causes less electrolyte changes."
- "CRRT is faster than hemodialysis."
- "CRRT is used for hemodynamically unstable patients."
- "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 patient with suspected inhalation injury has hoarseness and singed nasal hair. What is the nurse's first action?
- Apply antibiotic ointment to nares
- Prepare for early intubation
- Administer antibiotics
- Initiate inhalation treatments
Explanation
Correct Answer: B) Prepare for early intubation.
Hoarseness and singed nasal hair are critical warning signs of upper airway inhalation injury. Hoarseness indicates that heat and toxic gases have already begun causing edema of the larynx and upper airway. Airway edema in inhalation injuries can progress with alarming speed, leading to complete obstruction within hours. Early intubation is the priority action to secure the airway before swelling makes intubation impossible. Antibiotic ointment and systemic antibiotics do not address the immediate airway emergency. Inhalation treatments may be appropriate later but are not the first priority when the airway is at imminent risk.
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?
- Instill normal saline into the nose to clear any possible obstructions.
- Use a sterile dressing to collect the nasal drainage and send it for testing.
- Apply ice packs to the nose to reduce swelling and drainage.
- 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 patient who is suspected of having an epidural hematoma is admitted to the emergency department. Which action will the nurse plan to take?
- Initiate high-dose barbiturate therapy.
- Prepare patient for immediate craniotomy.
- Type and cross-match for blood transfusion.
- Administer IV furosemide.
Explanation
Correct Answer: B) Prepare patient for immediate craniotomy.
An epidural hematoma is a neurosurgical emergency. It typically results from arterial bleeding (often from the middle meningeal artery) causing rapid accumulation of blood between the skull and dura mater. The classic presentation is a lucid interval followed by rapid neurological deterioration. Immediate surgical evacuation via craniotomy is required to relieve pressure and prevent brain herniation and death. High-dose barbiturates are used for refractory intracranial hypertension, not as a primary intervention. Blood transfusion and furosemide do not address the underlying hematoma.
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?
- Rehabilitation needs
- Type of intravenous fluids required
- Respiratory needs
- 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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