during the acute phase of burn the priority nursing intervention in caring for this client is
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Nursing Elites

ATI RN

ATI RN Nutrition Online Practice 2019

1. During the acute phase of a burn, the priority nursing intervention in caring for this client is:

Correct answer: D

Rationale: During the acute phase of a burn, fluid resuscitation is the priority nursing intervention. This phase is characterized by fluid loss and the risk of hypovolemic shock. Administering fluids is crucial to maintain perfusion and prevent complications such as organ failure. While prevention of infection, pain management, and prevention of bleeding are important aspects of burn care, fluid resuscitation takes precedence in the acute phase to stabilize the client's condition and prevent further damage.

2. A nurse is planning care for a toddler who has burns over 50% total body surface area. Which of the following actions should the nurse include in the plan of care?

Correct answer: A

Rationale: Administering enteral feedings is crucial for ensuring adequate nutrition and supporting healing in toddlers with extensive burns. Burns over 50% total body surface area can lead to increased metabolic demands, making it essential to provide nutrition through enteral feedings to meet the child's needs for healing and recovery. Limiting intake of vitamin C or dietary protein would be detrimental in this scenario as the child requires increased amounts of nutrients to support healing. Administering insulin prior to meals is not indicated in this case as the priority is to provide adequate nutrition to promote healing.

3. Name 4 of the 12 discussed groups at risk for nutritional deficiencies.

Correct answer: A

Rationale: The correct answer is A: Elderly. The other choices provided, low income, vegans, and chronic disease, alcoholics, are also at risk for nutritional deficiencies but the question specifically asks for 4 groups out of the 12 discussed. The 12 groups at risk for nutritional deficiencies include the elderly, low income individuals, vegans, chronic disease, alcoholics, smokers, periods of growth, individuals with medical conditions, physical stress, physiological stress, those on polypharmacy, and those with inadequate intake. The question focuses on identifying 4 out of these 12 groups, making 'Elderly' the correct choice.

4. The past history of Camila would most probably reveal that her premorbid personality is:

Correct answer: D

Rationale: Understanding the underlying pathology and therapeutic techniques ensures that nursing care is not only reactive but also preventative, reducing the risk of complications.

5. What would a diet manual most likely contain?

Correct answer: D

Rationale: A diet manual typically contains guidance on specific food preparation methods to ensure proper nutrition and health for individuals following the diet. Therefore, choice D is correct. Choices A and B refer to sanitation procedures and staff hygiene issues, which are important but not typically the focus of a diet manual. Choice C, regarding specific patients' resting metabolic rates, is too individualized and detailed for a general diet manual, as it would be part of a personalized dietary plan developed with a healthcare professional.

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