A nurse in a well-child clinic is collecting data from four clients. Which of the following findings should the nurse report to the provider as a potential indication of child maltreatment?

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:
Encouraging active range of motion of the extremity is not recommended during the first 12 to 24 hours after a sprained wrist. Early movement can potentially worsen the swelling and delay the healing process.
Choice B rationale:
Applying warm compresses to the extremity is not the best choice to minimize swelling in the initial 12 to 24 hours after a sprained wrist. Heat can actually increase blood flow and promote more swelling in the injured area.
Choice C rationale:
Elevating the extremity above the level of the heart is the correct choice for minimizing swelling in the first 12 to 24 hours after a sprained wrist. Elevating the injured area helps to reduce blood flow to the area, which in turn decreases swelling and promotes healing.

Choice D rationale:
Wrapping the extremity loosely with an elastic bandage might be beneficial for providing support, but it's not the primary intervention for minimizing swelling in the first 12 to 24 hours after a sprained wrist. Elevation is more effective for reducing swelling during this initial period.