A nurse in a family practice clinic is collecting data from a school-age child. Which of the following behavioral findings should the nurse identify as a possible indication of sexual abuse?

The correct answer is Choice D.

Choice A rationale: Administering an oral corticosteroid is not the first action the nurse should take. Corticosteroids are used to reduce inflammation and itching caused by poison ivy. However, they are usually prescribed if the symptoms are severe or if the rash covers a large area of the body. It’s important to note that corticosteroids can have side effects, especially when used for a long time, so they should be used under the supervision of a healthcare provider.

Choice B rationale: Applying calamine lotion to the affected area can help soothe the skin and relieve itching caused by poison ivy. However, this is not the first action the nurse should take. The first step is to remove the oil from the skin that causes the allergic reaction. Calamine lotion can be applied after the area has been thoroughly washed.

Choice C rationale: Instructing the parent to give the child an oatmeal bath twice daily can help soothe the skin and relieve itching. However, this is not the first action the nurse should take. Similar to calamine lotion, an oatmeal bath can be beneficial after the area has been thoroughly washed to remove the oil from the skin.

Choice D rationale: The first action the nurse should take when caring for a child exposed to poison ivy is to flush the area with cold, running water. This helps to remove the oil (urushiol) from the skin that causes the allergic reaction. It’s important to do this as soon as possible after exposure to help prevent the spread of the oil to other areas of the body or to other people. After flushing the area, the nurse can then apply calamine lotion or recommend an oatmeal bath to help soothe the skin and relieve itching.

Choice A rationale:
Occupational therapy is the appropriate referral for an adolescent with rheumatoid arthritis who is having difficulty feeding themselves. Rheumatoid arthritis is a chronic autoimmune disorder that can lead to joint inflammation and deformities. Occupational therapy focuses on helping individuals improve their ability to perform daily activities, which includes activities like feeding, dressing, and grooming. Occupational therapists work with patients to develop strategies and use adaptive equipment to make these tasks more manageable. In the case of an adolescent with rheumatoid arthritis, occupational therapy can provide techniques and tools to facilitate feeding independently despite joint limitations.
Choice B rationale:
Physical therapy primarily focuses on improving mobility, strength, and function in individuals with musculoskeletal issues. While physical therapy could be beneficial for an adolescent with rheumatoid arthritis to address joint mobility and muscle strength, it might not directly address the difficulty in feeding. Therefore, although physical therapy can be a helpful component of care for patients with rheumatoid arthritis, it might not be the first choice for addressing feeding difficulties.
Choice C rationale:
Speech therapy is not the most appropriate referral for an adolescent with rheumatoid arthritis experiencing feeding difficulties. Speech therapy primarily addresses communication and swallowing disorders. While swallowing difficulties might be relevant in some cases of rheumatoid arthritis due to potential joint involvement in the jaw, the primary focus should be on addressing joint limitations and adaptive techniques for feeding, making occupational therapy a more suitable referral.
Choice D rationale:
A case manager is not the recommended referral for an adolescent with rheumatoid arthritis and feeding difficulties. Case managers typically coordinate and facilitate various aspects of a patient's care, such as arranging appointments and services. While case managers play a valuable role in healthcare, the immediate concern of feeding difficulties in an adolescent with rheumatoid arthritis is best addressed through specialized interventions like occupational therapy.