A child is brought to the emergency department with burns on the face and chest. What is the nurse's first priority?

Remove clothing.

Administer pain medication.

Assess respiratory status.

Insert a Foley catheter.

Answer and Explanation

The Correct Answer is C

A. Remove clothing. Removing clothing is important to prevent further injury from retained heat or chemicals, but it is not the first priority compared to ensuring a patent airway and adequate breathing.
B. Administer pain medication. Pain management is important but comes after ensuring the child's airway and respiratory status are stable.
C. Assess respiratory status. Burns on the face and chest can compromise the airway and breathing. Assessing respiratory status is the first priority to ensure the child’s airway is not obstructed and that they are receiving adequate oxygen.
D. Insert a Foley catheter. Inserting a Foley catheter may be necessary to monitor urine output and assess kidney function in severe burns, but it is not the first priority compared to assessing respiratory status.

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Correct Answer is C

Explanation

A. Constipation: Vaso-occlusive crisis in sickle-cell disease is characterized by severe pain due to ischemia from blocked blood flow, rather than gastrointestinal symptoms like constipation.
B. Vomiting: Vomiting is not typically associated with vaso-occlusive crisis but may occur due to pain or other causes.
C. Pain: Pain is the hallmark symptom of vaso-occlusive crisis in sickle-cell disease, caused by ischemia and tissue damage.
D. Bradycardia: Bradycardia is not a typical finding in vaso-occlusive crisis; instead, tachycardia might be present due to pain or stress.

Correct Answer is "{\"xRanges\":[83.109375,104.109375],\"yRanges\":[119.5,140.5]}"

Explanation

Draw an imaginary line connecting the ASIS to the umbilicus.

McBurney's point is located one-third of the distance along this line, starting from the ASIS and moving towards the umbilicus.

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A child is brought to the emergency department with burns on the face and chest. What is the nurse's first priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a child who has sickle-cell disease and is experiencing a vaso-occlusive crisis. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

A nurse collecting data from a client who has manifestations of appendicitis. Where should the nurse palpate to monitor for pain at McBurney's point? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)

Correct Answer is "{\"xRanges\":[83.109375,104.109375],\"yRanges\":[119.5,140.5]}"

Explanation

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