The nurse receives a phone call from a frantic father who has observed his 4-year-old child tip a pot of boiling water onto her chest. The father has called an ambulance and the pediatrician's office while he waits
The nurse instructs the father to:
A) Cover the burn with ice and secure with a towel.
B) Apply butter to the area that is burned.
C) Immerse the child in a cool bath.
D) Avoid touching the burned area and seek medical attention.
Ans: C
Feedback: After the flame or heat source has been removed or extinguished, the burned area and adherent clothing are soaked with cool water briefly to cool the wound and halt the burning process. This is the best first-aid measure while Options A and B would be harmful.
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A preschool-age child is going to have a potentially painful procedure. What action by the nurse is best to prepare the child for this event?
A. Allow the child to decide if the parents stay or not. B. Let the child touch and explore the equipment first. C. Talk about it briefly for several days beforehand. D. Use play to demonstrate the procedure to the child.
What wave on an ECG strip indicates to the nurse that the client is having a current MI and has an old MI?
a. inverted T wave c. prolonged QRS b. abnormal Q wave d. shortened ST seg-ment
The nurse suspects that patient who received intramuscular penicillin for treatment of secondary syphilis is developing the Jarisch-Herxheimer reaction. What information did the nurse use to make this clinical determination?
Select all that apply. 1. new onset of fever 2. heart rate 112 beats per minute 3. sudden severe abdominal cramping 4. complaints of musculoskeletal pain 5. administration of medication 16 hours ago
A type I hypersensitivity to latex is evident if the nurse assesses:
A. Localized swelling B. Skin redness and itching C. Runny eyes and nose and cough D. Tachycardia, hypotension, and wheezing