A nurse receives new prescriptions for a client with severe burn ...

[mikaylakyoung]

A nurse receives new prescriptions for a client with severe burn injuries who is receiving fluid resuscitation per the Parkland formula. The client's urine output continues to range from 0.2 to 0.25 mL/kg/hr. Which prescription should the nurse question?
 
  a. Increase intravenous fluids by 100 mL/hr.
  b. Administer furosemide (Lasix) 40 mg IV push.
  c. Continue to monitor urine output hourly.
  d. Draw blood for serum electrolytes STAT.

Question 2

A nurse prepares to administer intravenous cimetidine (Tagamet) to a client who has a new burn injury. The client asks, Why am I taking this medication? How should the nurse respond?
 
  a. Tagamet stimulates intestinal movement so you can eat more.
  b. It improves fluid retention, which helps prevent hypovolemic shock.
  c. It helps prevent stomach ulcers, which are common after burns.
  d. Tagamet protects the kidney from damage caused by dehydration.

[macagnavarro]

Answer to Question 1

ANS: B
The plan of care for a client with a burn includes fluid and electrolyte resuscitation. Furosemide would be inappropriate to administer. Postburn fluid needs are calculated initially by using a standardized formula such as the Parkland formula. However, needs vary among clients, and the final fluid volume needed is adjusted to maintain hourly urine output at 0.5 mL/kg/hr. Based on this client's inadequate urine output, fluids need to be increased, urine output needs to be monitored hourly, and electrolytes should be evaluated to ensure appropriate fluids are being infused.

Answer to Question 2

ANS: C
Ulcerative gastrointestinal disease (Curling's ulcer) may develop within 24 hours after a severe burn as a result of increased hydrochloric acid production and a decreased mucosal barrier. This process occurs because of the sympathetic nervous system stress response. Cimetidine is a histamine2 blocker and inhibits the production and release of hydrochloric acid. Cimetidine does not affect intestinal movement and does not prevent hypovolemic shock or kidney damage.