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On the first day following a severe burn, the body’s fluid reserves have left the circulating volume and entered the interstitial space, causing massive edema. The nurse monitors the burn victim very closely for:
a. increasing intracranial pressure.
b. reduced urine output.
c. eschar formation.
d. fluid overload.
What is ANS: B
With the fluid shift associated with severe burns, the nurse must be observant for the reduction of urine, an indication of altered renal function.