Difficulty: Medium
Average Score: 63%
Simulated
The nurse is applying mafenide acetate (Sulfamylon), a sulfa antibiotic cream, to a clientÔÇÖs lower extremity burn. Which assessment data would require immediate attention by the nurse?
Correct answer
C
Rationale
ABGs showing low HCO3 (20) and pH 7.34 suggest metabolic acidosis, a serious mafenide side effect requiring immediate attention. Pain is expected, electrolytes are normal, and ROM is positive.