After being exposed to smoke and flames from a house fire, which assessment finding is most important in determining care of the client?
A) Presence of soot around nasal passages
B) Fracture of the fibula with displacement
C) Elevation of blood pressure and heart rate
D) Partial-thickness burns to hands and wrists
A
Feedback:
If the client has soot or evidence of carbon about the nasal passages, the nurse should anticipate respiratory difficulties. Edema and swelling of the internal airways may not be present initially but can progress quickly. Elevation of heart rate without hypotension is not as significant. Fracture to any bone as well as care of burns should be managed once the airway, breathing, and circulation are assessed and managed.
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