NCLEX-RNPhysiological AdaptationHard
An 80 kg client sustains a 40% total body surface area burn at 0800. The client arrives in the emergency department at 1000. Using the Parkland formula (4 mL/kg/%TBSA), the nurse calculates the total 24-hour fluid requirement and administers half of that volume in the first 8 hours from the time of injury. At what rate, in mL/hr, should the IV pump be set for the remainder of the first 8-hour period?
- A1,600 mL/hr
- B533 mL/hr
- C1,067 mL/hr
- D800 mL/hr
Show answer & explanationAnswer & explanation
Correct answer: C. 1,067 mL/hr
Total 24-hr fluid = 4 mL x 80 kg x 40% = 12,800 mL. Half of this (6,400 mL) is given in the first 8 hours from the time of injury (0800-1600). Since 2 hours have already elapsed before arrival, only 6 hours remain to infuse the 6,400 mL, giving a rate of 6,400 ÷ 6 = 1,066.7, rounded to 1,067 mL/hr.
Why the other options are wrong
- A. This would result from dividing the full 6,400 mL by 4 hours, an incorrect time frame.
- B. This divides the full 12,800 mL total dose by 24 hours, ignoring the required front-loaded first-8-hour dosing schedule.
- D. This is the rate if the full 8 hours were used without accounting for elapsed time, which underestimates the needed rate.
Parkland Burn Formula
A fluid resuscitation formula for burn clients: 4 mL/kg x %TBSA burned = total 24-hr fluid, with half given in the first 8 hours from the time of injury (not arrival) and the remaining half over the next 16 hours.
- Formula: 4 mL x weight (kg) x %TBSA burned
- Half of total volume given in first 8 hours from injury time
- Adjust infusion rate for any time already elapsed before treatment begins
Memory trick: Half by hour 8 from injury—not from arrival!