# A 35-year-old male is on hospital day 2 following a 30% total body surface area mixed second- and third-degree burn. Parkland resuscitation was completed at 24 hours. Laboratory findings include potassium 5.4 mEq/L (normal 3.5-5.0). Review the chart and determine which provider order requires clarification before administration.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391798&lang=en  
> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

A 35-year-old male is on hospital day 2 following a 30% total body surface area mixed second- and third-degree burn. Parkland resuscitation was completed at 24 hours. Laboratory findings include potassium 5.4 mEq/L (normal 3.5-5.0). Review the chart and determine which provider order requires clarification before administration.

History

Vitals

Labs

Orders

Notes

35yo male, kitchen grease fire, mixed second/third-degree burns 30% TBSA (anterior chest, both arms, partial face). PMH: none. NKDA. Hospital day 2 (48h post-burn).

BP 110/68, HR 118, RR 22, T 38.1C, SpO2 96% on 2L NC. UO 0.7 mL/kg/h. Pain 7/10.

K+ 5.4 (ref 3.5-5.0), Na 138, Cr 1.3, Hgb 14.5, Hct 47, WBC 16, Glucose 168, Lactate 2.8, Albumin 2.4.

Parkland resuscitation completed at 24h. Maintenance: D5LR @ 125 mL/h. Morphine 4 mg IV q2h PRN. Cefazolin 1 g IV q8h. KCl 20 mEq IV in NS over 2h. Famotidine 20 mg IV BID. Daily wound care with silver sulfadiazine. Strict I/O.

Day 2 post-burn. Diuretic phase beginning; UO adequate. Hyperkalemia noted on AM labs (K+ 5.4). Continue stress ulcer and infection prophylaxis. Pain control adequate.

1

Morphine 4 mg IV q2h PRN for burn pain

✕

2

Enoxaparin 40 mg SC daily for DVT prophylaxis

✕

3

Potassium chloride 20 mEq IV in NS over 2 hours

✕

4

Famotidine 20 mg IV BID for stress ulcer (Curling) prophylaxis

✕

## Explanation

Burn injury causes massive tissue destruction and cell membrane disruption, releasing intracellular potassium into the bloodstream during the first 48-72 hours. This patient already has hyperkalemia (K+ 5.4 mEq/L, normal 3.5-5.0); administering additional potassium 20 mEq IV would worsen hyperkalemia and risk lethal cardiac arrhythmias. Therefore, the potassium chloride order must be clarified before administration. The other orders are appropriate: morphine for burn pain is standard and needed given a pain score of 7/10. Enoxaparin for DVT prophylaxis is recommended due to immobility and hypercoagulability in burn patients. Famotidine for stress ulcer (Curling ulcer) prophylaxis is standard post-burn care.

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