In planning the care for a patient with a burn in the emergency room, the nurse recognizes that the patient is likely to experience a local and systemic response to the burn when the burn exceeds a total body surface area (TBSA) of:
A) 10%
B) 15%
C) 20%
D) 25%
Ans: D
Feedback: Burns that exceed 25% TBSA may produce both local and systemic responses and are considered major burn injuries.
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A young adult patient whose family history contains many first- and second-degree relatives who have had colon cancer wants to know if yearly colonoscopies would be a good idea. The best response by the nurse would be to encourage the patient to
a. ask the physician about the colonoscopies. b. not worry because risks are low at his or her age. c. search for a company to provide screening. d. talk to the doctor about genetic screening.
A nurse may use a topical antiseptic or germicide for which of the following reasons? Select all that apply
A) To reduce the number of bacteria on skin surfaces B) As a surgical scrub C) As a preoperative skin cleanser D) For washing the hands before and after caring for clients E) On minor cuts and abrasions to prevent infection
Identify the most appropriate nursing diagnosis for promoting the safety of a frail, elderly patient after hip replacement surgery, who also has a history of emphysema
1) Impaired Mobility related to weakness 2) Ineffective Breathing Pattern related to disease process 3) Activity Intolerance related to injury 4) Risk for Injury related to medical condition
Car safety seats should be used:
a. Because it is mandated by law b. Only if the parent cannot control the child c. Only when driving on the highway d. Until 1 year of age