A nurse in the emergency department is caring for a client who has a 30% burn injury to her lower extremities. Which of the following interventions should the nurse perform first?

Choice A reason: Pain medication is important for burn patients due to severe pain from exposed nerve endings. However, in the ABCDE approach, circulation (fluid status) takes precedence over pain management. A 30% burn causes significant fluid loss, risking hypovolemic shock, making IV fluids the priority to stabilize the patient before addressing pain. Choice B reason: A 30% burn injury to the lower extremities causes significant plasma leakage, leading to hypovolemia and potential shock. Administering IV fluids, typically via the Parkland formula, restores intravascular volume, maintains blood pressure, and ensures organ perfusion. In the ABCDE approach, circulation is prioritized, making fluid resuscitation the first intervention. Choice C reason: Cleaning and dressing burn wounds prevent infection, a major complication due to loss of the skin barrier. However, this is not the immediate priority in the acute phase. Fluid resuscitation addresses life-threatening hypovolemia first, as per the ABCDE approach, ensuring circulatory stability before wound care is initiated. Choice D reason: A tetanus booster prevents infection from Clostridium tetani, especially in contaminated burns. While important, it is not the first priority in the acute management of a 30% burn. Fluid resuscitation addresses immediate life-threatening hypovolemia, which takes precedence over prophylactic measures like tetanus vaccination in the ABCDE framework.