A school nurse is examining a third-grade student complaining of a small lump on her head. After parting the hair, it is evident that a tick has embedded into the scalp. Which nursing intervention should the school nurse take?
Use tweezers or forceps to remove the tick, pulling up with a steady pressure.
Squeeze the tick and pull it off with bare fingers.
Spray DEET directly on to the child's skin where the tick is embedded.
Apply mineral oil to the site of attachment and wait for the tick to back out.
The Correct Answer is A
A. The appropriate method for tick removal involves using fine-tipped tweezers to grasp the tick as close to the skin's surface as possible and pulling upward with steady, even pressure. This minimizes the risk of the tick's mouthparts breaking off and remaining in the skin.
B. Using bare fingers can be unsanitary and may cause the tick to release more saliva, potentially increasing the risk of disease transmission. Squeezing the tick can also lead to the release of harmful pathogens into the bloodstream.
C. DEET is an insect repellent that is used to prevent tick bites but should not be applied to a tick that is already embedded. Applying repellent will not assist in tick removal and may cause irritation to the skin.
D. While some people believe that applying mineral oil can cause a tick to detach, this method is not recommended. It may irritate the tick and could increase the likelihood of the tick regurgitating pathogens into the skin, raising the risk of infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Cycloplegic drugs are used to paralyze the ciliary muscle and dilate the pupil, typically in specific situations such as during examinations or for certain conditions, but they do not facilitate the administration of antibiotic drops.
B. While alternating medications is sometimes done, in this case, both medications are to be given every 4 hours, not every 2 hours. Alternating them every 2 hours would not allow for the correct administration schedule and could lead to unnecessary confusion or overdose.
C. When administering multiple eye drops, it is generally recommended to wait about 5 to 10 minutes between the different drops to allow for proper absorption and prevent the first drop from being washed out by the second.
D. While both medications can be prescribed for a patient, they cannot be administered simultaneously. Using both drops at the same time would result in one medication washing out the other, which would reduce their effectiveness. They need to be given sequentially with appropriate timing in between.
Correct Answer is C
Explanation
A. This finding is generally not associated with peritonitis. Instead, hyperactive bowel sounds may indicate early gastrointestinal irritation or obstruction. In the case of peritonitis, bowel sounds are often diminished or absent due to the inflammation and irritation of the peritoneum.
B. Profuse diarrhea is not a typical sign of peritonitis. While gastrointestinal disturbances can occur, diarrhea is more commonly associated with infections or irritations of the intestines rather than with peritonitis itself. Peritonitis typically presents with symptoms related to abdominal rigidity and pain.
C. A hard, rigid abdomen is a classic sign of peritonitis. It indicates involuntary guarding, which occurs as a response to inflammation and irritation of the peritoneum. The rigidity reflects the body's protective mechanism against pain and is a significant assessment finding.
D. While abdominal cramping can occur in various gastrointestinal conditions, it is not a specific indicator of peritonitis. In cases of peritonitis, the pain is often more severe and localized rather than cramping. The patient may experience sharp, steady pain that worsens with movement.
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