A nurse is assessing an infant who has contact dermatitis. Which of the following findings should the nurse expect?

Mild, occasional itching

Oily skin

Warm hands

Scaly patches on the cheeks

Answer and Explanation

The Correct Answer is D

A. Mild, occasional itching: Contact dermatitis usually causes more persistent and sometimes severe itching rather than mild and occasional.
B. Oily skin: Contact dermatitis typically causes dryness and irritation rather than oily skin.
C. Warm hands: Warm hands are not a characteristic finding of contact dermatitis.
D. Scaly patches on the cheeks: This is correct. Contact dermatitis can cause scaly patches, redness, and irritation on the skin, including the cheeks.

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Correct Answer is C

Explanation

A. Offer to give the client a back massage using warm lotion. This is a non-pharmacological intervention but may not address the client's acute pain effectively.
B. Explain that the client might not receive another dose for a few hours. This does not address the client's immediate need for pain relief.
C. Ask the client about his previous pain relief measures. This allows the nurse to assess the effectiveness of previous interventions and understand the client's pain history.
D. Request that the provider prescribe another dose of opioid analgesia. This might be necessary, but assessment of the client's pain and relief measures should be conducted first.

A. Place the client in the prone position. B. Insert the lubricated tip 2.5 cm (1 in) into the anal canal. C. Hang the solution bag 7.5 cm (3 in) above the rectum. D. Raise the solution bag if the client exhibits pain during the procedure. E. Encourage the client to retain the enema solution for 10 min.

Correct Answer is ["E"]

Explanation

A. Place the client in the prone position. The client should be placed in the Sims' (left lateral) position for enema administration.
B. Insert the lubricated tip 2.5 cm (1 in) into the anal canal. The lubricated tip should be inserted 7.5-10 cm (3-4 inches) into the anal canal.
C. Hang the solution bag 7.5 cm (3 in) above the rectum. The solution bag should be hung approximately 30 cm (12 inches) above the rectum.
D. Raise the solution bag if the client exhibits pain during the procedure. The solution bag should be lowered or the flow rate slowed if the client experiences pain.
E. Encourage the client to retain the enema solution for 10 min. Retaining the enema solution for a period of time enhances its effectiveness.

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A nurse is assessing an infant who has contact dermatitis. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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