A nurse is creating a plan of care for a school-age child who has moderate partial-thickness burns on both lower extremities. Which of the following interventions should the nurse include in the plan?
Maintain aseptic technique during the child's dressing changes.
Provide low-calorie snacks for the child several times each day.
Apply continuous passive motion devices to the child's lower extremities during periods of rest.
Administer pain medication to the child 30 min following physical therapy.
The Correct Answer is A
A. "Maintain aseptic technique during the child's dressing changes." Aseptic technique reduces the risk of infection, which is critical for children with burns as their immune response may be compromised.
B. "Provide low-calorie snacks for the child several times each day." Children with burns require a high-calorie, high-protein diet to promote healing and compensate for increased metabolic demands.
C. "Apply continuous passive motion devices to the child's lower extremities during periods of rest." Passive motion devices are not typically indicated for burn injuries unless there is joint involvement requiring physical therapy for mobility restoration.
D. "Administer pain medication to the child 30 min following physical therapy." Pain medication should be administered before physical therapy to improve tolerance and participation.
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Related Questions
Correct Answer is D
Explanation
A. "Flat anterior fontanel." A sunken anterior fontanel, not flat, is a sign of severe dehydration in infants.
B. "Dry, hot skin." Dry skin is a symptom of dehydration, but "hot" skin may indicate fever rather than severe dehydration.
C. "Loss of 5% of weight." A 5% weight loss indicates mild dehydration; severe dehydration is characterized by a weight loss of 10% or more.
D. "Absence of tears when crying." Absence of tears is a reliable indicator of severe dehydration in infants.
Correct Answer is A
Explanation
A. Face, legs, activity, cry, consolability (FLACC) scale: The FLACC scale is appropriate for children aged 2 months to 7 years and assesses pain based on non-verbal cues such as facial expression, leg movement, activity, crying, and consolability.
B. Oucher scale and C. FACES scale are more appropriate for children aged 3 years and older who can self-report their pain.
D. Visual analog scale (VAS) is suitable for older children (typically 8 years and older) who can understand the concept of a continuum of pain.
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