RN Nursing · Burns · Practice question
A client presents with a partial-thickness burn covering 20% of their total body surface area (TBSA) after an industrial accident. What is the most appropriate initial action by the nurse to manage fluid resuscitation for this client?
-
Provide oral fluids until the client is stable.
-
Wait for 24 hours before starting any fluid resuscitation.
-
✓
Administer 4 mL of lactated Ringer's solution IV per kg of body weight per TBSA.
-
Start administering 1000 mg of vancomycin IV immediately to prevent infection.
Answer & explanation
Correct: Administer 4 mL of lactated Ringer's solution IV per kg of body weight per TBSA.
For a burn injury covering 20% or more of total body surface area (TBSA), the Parkland formula is the standard approach to fluid resuscitation. The formula calls for 4 mL of lactated Ringer's solution per kilogram of body weight per percentage of TBSA burned over the first 24 hours, with half given in the first 8 hours and the remaining half over the next 16 hours. Lactated Ringer's is preferred because its electrolyte composition closely resembles plasma, helping to correct the electrolyte shifts that occur with major burns. Oral fluids alone are inadequate for a 20% TBSA burn because the gastrointestinal tract is often hypoperfused in the acute phase, and absorption is unreliable. Waiting 24 hours before starting fluid resuscitation would be dangerous — delayed resuscitation increases the risk of hypovolemic shock, organ failure, and death, as these clients lose massive amounts of fluid through the burn wound within the first hours. Administering vancomycin immediately is not indicated as an initial action; prophylactic antibiotics are not recommended in burn care and do not address the immediate priority of hemodynamic stabilization. Fluid resuscitation is the cornerstone of early burn management.
Practise Burns questions
Work through full question sets with instant rationales, timed exams, and progress tracking.
Start practising freeRelated practice questions
- An emergency department nurse learns from the paramedics that the team is transporting a client who has suffered injury from a scald from a hot kettle. What variables will the nurse consider when determining the depth of burn?
- A nurse is caring for a client who has major burns resulting from a house fire. Which of the following actions should the nurse take first?
- While John was working on his boat motor, a fire and explosion occurred due to fuel ignition. He received 2nd and 3rd degree burns on the anterior and posterior of both arms and hands. What was his evaluation by 9's percentages recorded in his assessment of BSA with burns?
- A first degree burn is described as: