Fluid
This compartment contains about two thirds of body water.
Intracellular fluid (ICF).
Rationale: ICF is fluid within cells and represents about two thirds of total body water
Normal potassium range?
3.5–5.0 mEq/L. Rationale: small potassium changes can significantly affect cardiac and neuromuscular function.
Normal arterial pH?
7.35–7.45.
Rationale: values below indicate acidemia and above indicate alkalemia.
A flat, circumscribed color change less than 0.5 cm is called what?
Macule.
Rationale: macules are flat color changes; freckles and petechiae are examples.
Adult anterior trunk TBSA by Rule of Nines?
18%.
Rationale: the adult anterior trunk accounts for 18% TBSA.
IV potassium is ordered. What administration method is never appropriate?
V bolus/push.
Rationale: rapid potassium administration can cause fatal dysrhythmias or cardiac arrest.
Name two classic findings of deficient fluid volume.
Examples: thirst/dry mucosa, poor skin turgor, weight loss, oliguria/concentrated urine, tachycardia, orthostatic hypotension.
Rationale: loss of circulating volume produces dehydration and compensatory cardiovascular changes.
Which ECG finding is specific to hypokalemia?
Elevated U wave.
Rationale: hypokalemia may also cause flat/inverted T waves and ST depression.
pH 7.30, PaCO2 52, HCO3 24.
Respiratory acidosis.
Rationale: pH is acidic and PaCO2 is elevated while bicarbonate is normal.
A small superficial collection of serous fluid is what lesion?
Vesicle.
Rationale: vesicles contain clear/serous fluid and occur with conditions such as shingles or partial-thickness burns.
Which burn depth has blisters, is pink/red and painful, and usually heals in 2–3 weeks?
Superficial partial-thickness.
Rationale: the epidermis and part of the dermis are injured while nerve endings remain intact.
A client with severe hyponatremia develops a seizure. What safety intervention is essential?
Maintain airway and seizure precautions.
Rationale: acute severe hyponatremia can cause cerebral edema, seizures, coma, and respiratory arrest.
A 1-kg weight change in 24 hours is approximately how much fluid?
1 liter.
Rationale: daily weight is a sensitive indicator of fluid gain/loss; 1 kg (2.2 lb) approximates 1 L.
Peaked T waves and a widened QRS suggest which imbalance?
Hyperkalemia.
Rationale: excess extracellular potassium alters cardiac conduction and can progress to arrest.
pH 7.49, PaCO2 30, HCO3 24.
Respiratory alkalosis.
Rationale: alkalemia with low PaCO2 indicates excessive CO2 loss from hyperventilation.
What does diascopy assess?
Blanchability.
Rationale: pressure with a glass slide helps distinguish inflammatory vascular lesions, which blanch, from hemorrhagic/nonvascular lesions, which do not.
What is the minimum adult urine output goal during emergent burn resuscitation?
30 mL/hr.
Rationale: urine output is used to evaluate adequacy of perfusion and fluid resuscitation.
A burn client has hoarseness, stridor, and soot in sputum. Priority concern?
Impending airway obstruction from inhalation injury.
Rationale: airway edema can progress rapidly; airway and oxygenation take priority.
Which severe complication can result from significant body-fluid loss?
Hypovolemic shock.
Rationale: major fluid loss decreases circulating volume, MAP, tissue perfusion, and oxygen delivery.
Positive Chvostek and Trousseau signs point to what imbalance?
Hypocalcemia.
Rationale: low calcium increases neuromuscular excitability and can produce tetany/seizures.
Severe diarrhea most directly predisposes to which imbalance?
Metabolic acidosis.
Rationale: diarrhea causes bicarbonate loss.
Silvery-white scales on reddened thickened skin suggest what disorder?
Psoriasis vulgaris.
Rationale: psoriasis is associated with accelerated keratinocyte turnover and recurrent scaly plaques.
What procedure relieves pressure from a circumferential eschar?
Escharotomy.
Rationale: cutting through constricting eschar relieves pressure and can restore circulation/ventilation.
A burn client has absent distal pulses below a circumferential extremity burn. What complication is suspected?
Compartment syndrome/constricting eschar.
Rationale: swelling under nonelastic eschar compromises blood flow and requires urgent decompression.
Pink frothy sputum, ascending crackles, dyspnea at rest, and JVD suggest what emergency?
Pulmonary edema from severe fluid overload.
Rationale: fluid accumulates in lung tissue and impairs gas exchange; high-Fowler’s and oxygen are priorities.
Which medication should be readily available while IV magnesium is administered for severe hypomagnesemia?
Calcium gluconate.
Rationale: it can reverse manifestations of excessive magnesium if hypermagnesemia develops.
Prolonged vomiting or NG suction commonly causes what imbalance?
Metabolic alkalosis.
Rationale: loss of gastric acid produces an acid deficit and relative base excess.
What test confirms a fungal skin lesion by identifying hyphae?
KOH test.
Rationale: scales are mixed with potassium hydroxide and examined microscopically for fungal hyphae.
State the Parkland formula.
4 mL × body weight in kg × %TBSA burned.
Rationale: half is given in the first 8 hours from time of injury and half over the next 16 hours.
A client with K 6.8 mEq/L and ECG changes requires which monitoring priority?
Continuous cardiac monitoring.
Rationale: severe hyperkalemia can cause lethal dysrhythmias and cardiac arrest.