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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "When patches are present, it indicates that your infant has a systemic infection." Seborrheic dermatitis is a benign, non-infectious condition and does not indicate systemic infection.
B. "You can use petrolatum to help soften and remove patches from your infant's scalp. Petrolatum can help soften and loosen scales in seborrheic dermatitis, making them easier to remove gently. This can help manage the condition effectively.
C. "You should avoid washing your infant's hair while patches are present on the scalp." Gentle washing with a mild shampoo can help manage seborrheic dermatitis. Avoiding washing altogether is not necessary unless advised by a healthcare provider.
D. "When patches are present, you should keep your infant away from others." Seborrheic dermatitis is not contagious, so there is no need to keep the infant away from others.
Correct Answer is D
Explanation
A. Sun exposure: Sun exposure typically causes sunburn rather than tiny pinhead-sized papules.
B. Allergic reaction: Allergic reactions often present with different types of lesions or hives, not typically tiny papules.
C. Infection: Infections might cause different types of lesions or pustules rather than the described tiny papules.
D. Heat and moisture: Heat rash (miliaria) results from blocked sweat ducts, leading to tiny red papules due to overheating and trapped sweat, commonly occurring in areas like the neck and axilla.
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