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Practice Question

A nurse in the emergency department is caring for a client who has extensive partial and full-thickness bums of the head, neck, and chest. While planning the clients care, the nurse should identify which of the following risks as the priority for assessment and intervention?

Answer Choices:

Correct Answer:

Airway obstruction

Rationale:

Facial, neck, and chest burns pose a severe threat to the airway due to rapid edema formation, inhalation injury, and thermal damage to the upper airway.

➤ These injuries can cause laryngeal edema, mucosal blistering, or obstruction — even when the airway initially appears clear.

➤ Early airway management (e.g., prophylactic intubation) is crucial within the first few hours, especially when voice hoarseness, stridor, or soot is present.

➤ Infection, ileus, and fluid shifts are concerns but do not override the immediacy of airway compromise in this region of injury.

Want to practice more questions like this?

This question is from RN ATI Custom Nurs 235 Summer~2023(Final) which contains 65 questions.

More Questions from This Exam
The nurse is caring for a postoperative client who has a chest tube connected to suction and a water seal drainage system. Which of the following indicates to the nurse that the chest tube is functioning properly?

Answer Choices:

A. Equal amount of fluid drainage in each collection chamber
B. Fluctuation of the fluid level within the water seal chamber
C. Continuous bubbling within the water seal chamber
D. Absence of fluid in the drainage tubing
A nurse is caring for a client who had an evacuation of a subdural hematoma. Which of the following actions should the nurse take first?

Answer Choices:

A. Observe for cerebrospinal fluid (CSF) leaks from the evacuation site.
B. Check the oximeter.
C. Assess for an increase in temperature.
D. Monitor for manifestations of increased intracranial pressure.
From Exam
RN ATI Custom Nurs 235 Summer~2023(Final)

65 Questions

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Question Details
  • Category: RN Nursing Exam(s)
  • Subcategory: ATI Exam(s)
  • Domain: RN ATI MedSurg
  • Answer Choices: 4
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