A nurse is caring for a pediatric client receiving radiation therapy to the abdominal area. Which of the following statements by the nurse promotes proper skin integrity for the client?
"You should get an abdominal binder and try to keep the area covered"
"You need to keep the area exposed to air and direct sunshine."
"Do not wash the area with strong soaps and do not rub the area dry, just pat it dry."
"Apply some triple antibiotic ointment to help the dryness and itching"
The Correct Answer is C
A. "You should get an abdominal binder and try to keep the area covered": Covering the radiation site with binders or tight dressings can cause friction, moisture buildup, and irritation. The skin should be kept clean and protected without unnecessary pressure.
B. "You need to keep the area exposed to air and direct sunshine.": Direct sun exposure can worsen radiation-induced skin damage and increase the risk of burns. The area should be protected from sunlight throughout treatment.
C. "Do not wash the area with strong soaps and do not rub the area dry, just pat it dry.": Gentle skin care helps reduce irritation and maintain skin integrity. Using mild soap and patting the skin dry prevents breakdown, which is the recommended approach during radiation therapy.
D. "Apply some triple antibiotic ointment to help the dryness and itching": Topical ointments should only be used if specifically prescribed, as many products can further irritate radiation-exposed skin. Moisturizers may be recommended, but antibiotic ointments are not routine.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Respiratory rate: A respiratory rate of 22/min is within the normal range for a school-age child (18–30/min). This does not suggest acute distress or worsening dehydration, so it does not require reporting.
B. Heart rate: A heart rate of 96/min is normal for a school-age child (75–118/min). It does not indicate tachycardia or hypovolemic compromise and therefore is not concerning.
C. Capillary refill: A prolonged capillary refill time is a key indicator of poor peripheral perfusion, which can be a sign of moderate to severe dehydration and hypovolemia. This finding suggests that the child is not adequately compensating for their fluid loss.
D. Urine output: A urine output of 100 mL in 4 hours is within the expected range for a child of this weight. The normal urine output for a child is approximately 1 mL/kg/hr. For this child (22.7 kg), the expected output would be 22.7 mL/hr. Over 4 hours, this would be 90.8 mL.
Correct Answer is A
Explanation
A. "Share a bedroom with your infant for the first 6 months.": Room-sharing without bed-sharing is recommended to reduce the risk of SUID. Having the infant sleep in the same room as the parents allows for closer monitoring and easier access for feeding and comforting.
B. "Cover your infant with a nonflammable blanket at bedtime.": Loose bedding, including blankets, increases the risk of suffocation and SUID. Instead, sleep sacks or wearable blankets are safer options to keep the infant warm without creating hazards.
C. "Use bumper pads around the interior of your infant's crib.": Bumper pads are not recommended because they can lead to suffocation, strangulation, or entrapment. A firm mattress with a fitted sheet and no additional items in the crib is safest.
D. "Place your infant on a soft crib mattress after they are 4 months old.": Infants should always sleep on a firm, flat surface, regardless of age. Soft mattresses increase the risk of airway obstruction and SUID, making them unsafe for infant sleep.
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