A nurse is caring for a child who is brought to the urgent care clinic following exposure to poison ivy 1 hr ago. Which of the following actions should the nurse take first?
Administer an oral corticosteroid.
Apply calamine lotion to the affected area.
Instruct the parent to give the child an oatmeal bath twice daily.
Flush the area with cold, running water.
The Correct Answer is D
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Placing the infant in a supine position during naps might not be the best action for an infant with heart failure. In heart failure, infants often experience difficulty breathing due to fluid accumulation in the lungs. Placing the infant in a more upright position, such as semi-Fowler's, can help alleviate some of this respiratory distress.
Choice B rationale:
Feeding the infant a bottle every 4 hours is important, but it might not directly address the immediate concerns of an infant with heart failure. Infants with heart failure might have difficulty feeding due to fatigue and respiratory distress. Feeding smaller, more frequent meals and assessing the infant's feeding tolerance is crucial.
Choice C rationale:
Correct Answer. Documenting the infant's respiratory rate every 2 hours is an important action. Infants with heart failure often have respiratory distress and an increased respiratory rate, as the body tries to compensate for decreased cardiac output. Documenting the respiratory rate will help the healthcare team monitor the infant's condition and assess the effectiveness of interventions.
Choice D rationale:
Withholding digoxin if the infant's heart rate is greater than 100/min is not necessarily the correct action. Digoxin is a medication commonly used in heart failure to improve cardiac contractility. While it's important to monitor the infant's heart rate, a heart rate of greater than 100/min might be due to the body's compensatory mechanisms in response to heart failure. Withholding the medication without consulting a healthcare provider might not be appropriate.
Correct Answer is ["B","D"]
Explanation
Choice A rationale:
Allowing an adolescent driver to answer their phone while driving can lead to distraction, increasing the risk of accidents. Engaging in conversations on the phone diverts the driver's attention from the road, which is unsafe. It's crucial for drivers, especially new ones, to focus solely on driving to prevent accidents.
Choice B rationale:
This choice is correct. Not answering the phone while driving is a responsible behavior that indicates an understanding of the dangers of distracted driving. Parents should encourage their children to focus on the road and avoid distractions like phone calls, promoting safe driving practices.
Choice C rationale:
This statement is incorrect. Adolescents should continue wearing helmets when riding their bikes even after age 13. Wearing helmets helps prevent head injuries in case of accidents. While older adolescents might perceive themselves as less prone to accidents, they are still at risk, and helmets are essential for their safety.
Choice D rationale:
This choice is correct. Wearing appropriate protective clothing, like long pants, while driving an all-terrain vehicle (ATV) is crucial. Long pants can provide some degree of protection against scrapes, scratches, and minor injuries that can occur while operating an ATV. It's a safety measure that shows an understanding of the importance of protective gear.
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