NSG 420 Test 3 (Complete And Verified Study material) (50pages) LEARNEXAMS

1. When assessing a patient who spilled hot oil on the right leg and foot, the nurse notes dry, pale, and hard skin.The patient states that the burn is not painful.What term would the nurse use to document the burn depth?: Answer Full-thickness skin destruction 2. On admission to the burn unit, a patient with an approximate 25% total body surface area (TBSA) burn has the following initial laboratory results: Hct 58%, Hgb 18.2 mg/dL (172 g/L), serum K + 4.9 mEq/L (4.8 mmol/L), and serum Na + 135 mEq/L (135 mmol/L). Which of the following prescribed actions should be the nurse's priority? a. Monitoring urine output every 4 hours.: Answer Increasing the rate of the ordered IV solution. 3. A patient is admitted to the burn unit with burnsto the head,face, and hands. Initially, wheezes are heard, but an hour later, the lung sounds are decreased and no wheezes are audible. What is the best action for the nurse to take?: Answer Notify the health care provider and prepare for endotracheal intubation. 4. A patient with severe burns has crystalloid fluid replacement ordered using the Parkland formula.The initial volume of fluid to be administered in the first 24 hours is 30,000 mL. The initial rate of administration is 1875 mL/hr. After the first 8 hours, what rate should the nurse infuse the IV fluids?: Answer c. 938 mL/hr 5. During the emergent phase of burn care, which assessment will be most useful in determining whether the patient isreceiving adequate fluid infusion?: Answer Measure hourly urine output. 6. A patient has just been admitted with a 40% total body surface area (TBSA) burn injury. To maintain adequate nutrition, the nurse should plan to take which action?: