# A client is rescued from an enclosed-space fire with facial burns and suspected smoke inhalation. For each finding or intervention, select the best classification.

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client is rescued from an enclosed-space fire with facial burns and suspected smoke inhalation. For each finding or intervention, select the best classification.

|  | Threatened-airway or inhalation-injury cue | Appropriate stabilization or resuscitation | Unsafe or delays care |
| --- | --- | --- | --- |
| Progressive hoarseness, stridor, and increasing oral or facial edema |  |  |  |
| Carbonaceous sputum with tachypnea and worsening oxygenation after an enclosed-space fire |  |  |  |
| Administer humidified 100% oxygen and evaluate carbon monoxide exposure while the airway is assessed |  |  |  |
| Prepare early endotracheal intubation before progressive edema makes airway access difficult |  |  |  |
| Establish IV access and titrate prescribed crystalloid using urine output and hemodynamic response |  |  |  |
| Wait for the chest radiograph to become abnormal before escalating a progressively threatened airway |  |  |  |

## Explanation

Progressive hoarseness or stridor and carbonaceous sputum with respiratory distress suggest inhalation injury and impending airway compromise. Give humidified 100% oxygen, assess for carbon monoxide exposure, and prepare early definitive airway management before edema progresses. For a major burn, establish IV access and titrate prescribed crystalloid using physiologic response such as urine output; do not wait for a chest radiograph to become abnormal before protecting a threatened airway.

## In-depth explanation

Quick answer
Treat progressive voice change, stridor, soot with respiratory distress, and facial edema as an airway emergency. Give humidified 100% oxygen, mobilize early intubation support, and begin monitored burn resuscitation.

Why this is correct
Thermal injury and smoke exposure can produce rapidly progressive upper-airway edema. Carbon monoxide also impairs oxygen delivery even when conventional pulse oximetry appears reassuring. Airway protection is safer before swelling makes intubation difficult.

Easy analogy or mental picture
The airway is a tunnel that is swelling inward. Secure the passage before the opening becomes too narrow.

Memory hook
Enclosed fire plus worsening voice or stridor: oxygen now, airway early.

NCLEX decision rule
Prioritize airway and oxygenation over wound care. Use the complete cue pattern: isolated singed hair alone does not prove obstruction, but progressive hoarseness, stridor, oral edema, hypoxemia, or impaired mental status requires urgent escalation. Titrate burn fluids to response rather than giving an unmonitored fixed volume.

Why the other choices are wrong
A normal early chest radiograph does not exclude inhalation injury. Delaying airway management for imaging can allow edema to progress, and fluid administration without urine-output and hemodynamic reassessment risks both under- and over-resuscitation.

Source
1American Burn Association Clinical Practice Guidelines
2ABA Airway, Ventilator, and Fluid Resuscitation Guidance
32026 NCLEX-RN Test Plan

## Clinical scenario

The client has progressive hoarseness, soot in the mouth, carbonaceous sputum, tachypnea, and increasing facial edema. Humidified 100% oxygen, airway equipment, burn-center consultation, IV access, and prescribed fluid resuscitation are available.

## Key concepts

- **Inhalation injury** — Airway and lung injury caused by heat, smoke, or toxic combustion products, often with delayed respiratory deterioration.
- **Carbonaceous sputum** — Dark soot-containing respiratory secretions that support concern for smoke inhalation when interpreted with the full respiratory assessment.
- **Carboxyhemoglobin** — Hemoglobin bound to carbon monoxide, reducing oxygen transport and requiring co-oximetry rather than routine pulse oximetry for measurement.

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