Which approaches would be best for a nurse to use when attempting to do a physical assessment on a 2-year-old child? (Select all that apply)

Choice A reason: A blood lead level of 48 µg/dL in a 24-month-old is significantly elevated, requiring immediate chelation therapy to remove lead from the body. Even asymptomatic children are at risk for neurological damage, developmental delays, and organ toxicity, necessitating urgent hospitalization for chelating agents like EDTA or succimer to prevent long-term harm.

Choice B reason: Monitoring lead levels and providing nutritional counseling (e.g., calcium, iron) are appropriate for lower lead levels (10-20 µg/dL). A level of 48 µg/dL indicates acute toxicity, requiring immediate chelation therapy rather than monitoring alone, as untreated high levels can cause irreversible neurological and developmental damage in young children.

Choice C reason: No treatment is incorrect for a blood lead level of 48 µg/dL, even if asymptomatic. Lead is neurotoxic, causing subtle cognitive and developmental impairments without immediate symptoms. Levels above 45 µg/dL require urgent chelation therapy to prevent long-term brain damage, making this statement inappropriate for management.

Choice D reason: Environmental changes, such as removing lead sources (e.g., paint, water), are critical for preventing further exposure but are insufficient alone for a blood lead level of 48 µg/dL. This level indicates significant toxicity requiring immediate medical intervention like chelation therapy to reduce lead burden and prevent neurological damage.

Choice A reason: Partial thickness burns affect the epidermis and part of the dermis, preserving some nerve endings and dermal structures like hair follicles, resulting in pain, redness, and blisters. The described burn, with no sensation, dry eschar, and absent dermal elements, indicates deeper tissue damage beyond the dermis, making partial thickness incorrect.

Choice B reason: Subcutaneous burn is not a standard term in burn classification systems. Burns are categorized by depth as superficial, partial thickness, or full thickness. Subcutaneous refers to tissues beneath the dermis, but the described burn’s features—dry eschar and no sensation—align with full thickness burns, making this choice inappropriate.

Choice C reason: Scalding burn refers to the cause of injury, specifically hot liquids or steam, not the depth of tissue damage. Scalds can result in superficial, partial, or full thickness burns. The clinical findings of dry eschar and no sensation indicate a full thickness burn, not the mechanism, rendering scalding burn incorrect.

Choice D reason: Full thickness burns extend through the entire dermis into subcutaneous tissue, destroying nerve endings and dermal elements, leading to dry, leathery eschar and no pain sensation. The described burn’s characteristics—dry appearance, eschar, and lack of sensation—match this classification, requiring debridement to remove necrotic tissue for healing.