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A nurse is caring for a client who sustained burns in an enclosed space and is exhibiting singed nasal hair, black sputum and smoky smelling breath. What is the nurse’s priority intervention?

A.

Administering pain medication

B.

Applying a cool, wet cloth to burned areas.

C.

Administering high flow oxygen via a non-rebreather mask

D.

Initiating intravenous fluid resuscitation

Answer and Explanation

The Correct Answer is C

A. Administering pain medication: Pain management is essential, but in this case, the primary concern is potential airway compromise due to inhalation injury, which should be addressed first.

 

B. Applying a cool, wet cloth to burned areas: Cooling burned areas can help with pain and reduce burn severity but is not the priority in a case of suspected inhalation injury with airway compromise.

 

C. Administering high-flow oxygen via a non-rebreather mask: This client is at high risk for respiratory compromise due to inhalation injury; administering high-flow oxygen is the priority to ensure adequate oxygenation.

 

D. Initiating intravenous fluid resuscitation: Fluid resuscitation is essential for burn patients but is not the immediate priority over addressing potential airway and oxygenation issues.


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View Related questions

Correct Answer is A

Explanation

A. Reduction of inflammation and suppression of immune responses. Methylprednisolone is a corticosteroid that reduces inflammation and suppresses immune responses, which can help manage the acute exacerbations of MS.

B. Stimulation of nerve regeneration. Methylprednisolone does not stimulate nerve regeneration; it focuses on reducing inflammation.

C. Improvement in cognitive function. Cognitive improvement is not a primary goal of methylprednisolone in MS management, though reducing inflammation may indirectly benefit cognition.

D. Increase in muscle strength and coordination. While reducing inflammation can improve symptoms, methylprednisolone itself does not directly increase muscle strength or coordination.

Correct Answer is C

Explanation

A. "I should monitor my temperature regularly and report any fevers to my healthcare provider." This statement shows correct understanding. Fever may indicate worsening infection or complications, so it’s important to monitor and report any fevers.

B. "I need to inform my healthcare provider about any new symptoms, such as shortness of breath or chest pain." This statement shows understanding. New symptoms, especially respiratory or cardiac, could signify complications, and should be reported.

C. "I can stop taking my antibiotics once I feel better." This indicates a need for further teaching. Completing the full course of antibiotics is crucial to ensure the infection is completely eradicated, even if symptoms improve.

D. "I will need to take antibiotics before dental procedures." Patients with infective endocarditis often require prophylactic antibiotics before dental procedures to prevent bacterial entry into the bloodstream.

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