A nurse in a provider's office is assessing a client who has a severe sunburn. Which of the following classifications should the nurse use to document the burn?
A. Superficial thickness
B. Superficial partial thickness
C. Deep partial thickness
D. Full thickness - Answer-A. superficial thicknes...
Burn ATI Exam Questions and Answers
A nurse in a provider's office is assessing a client who has a severe sunburn. Which of
the following classifications should the nurse use to document the burn?
A. Superficial thickness
B. Superficial partial thickness
C. Deep partial thickness
D. Full thickness - Answer-A. superficial thickness
A sunburn is a superficial thickness burn. Superficial burns damage the top layer of the
skin.
A nurse is caring for a client who has sustained burns over 35% of his total body
surface area. Of this total, 20% are full-thickness burns on the arms, face, neck, and
shoulders. The client's voice has become hoarse. He has a brassy cough and is
drooling. The nurse should identify these findings as indications that the client has
which of the following?
A. Pulmonary edema
B. Bacterial pneumonia
C. Inhalation injury
D. Carbon monoxide poisoning - Answer-C. Inhalation injury
Wheezing and hoarseness indicate inhalation injury with impending loss of the airway.
These require immediate reporting to the provider.
A nurse is assessing a client who sustained deep partial-thickness and full-thickness
burns over 40% of his body 24 hr ago. Which of the following are findings should the
nurse expect? (Select all that apply)
A. Dyspnea
B. Bradycardia
C. Hyperkalemia
D. Hyponatremia
E. Decreased hematocrit - Answer-A, C, & D
A: Dyspnea can occur during the initial phase following a burn due to airway injury and
fluid shifts.
C: Hyperkalemia occurs during the initial phase following a burn as a result of leakage
of fluid from the intracellular space.
D. Hyponatremia occurs during the initial phase of a burn as a result in sodium retention
in the interstitial space.
A nurse is preparing to administer fentanyl to a client who sustained deep partial-
thickness and full-thickness burns over 60% of his body 24 hr ago. The nurse should
plan to use which of the following routes to administer the medication?
A. Subcutaneous
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