The nurse is caring for an unconscious child. Skin care should ...

[dejastew]

The nurse is caring for an unconscious child. Skin care should include:
 
  a. Avoiding use of pressure reduction on the bed.
  b. Massaging reddened bony prominences to prevent deep tissue damage.
  c. Using draw sheet to move child in bed to reduce friction and shearing injuries.
  d. Avoiding rinsing skin after cleansing with mild antibacterial soap to provide a protective barrier.

Question 2

Kimberly, age 3 years, has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102 F even though Kimberly had acetaminophen 2 hours ago. The nurse's action should be based on knowing that:
 
  a. Fevers such as this are common with viral illnesses.
  b. Seizures are common in children when antipyretics are ineffective.
  c. Fever over 102 F indicates greater severity of illness.
  d. Fever over 102 F indicates a probable bacterial infection.

[ttt030911]

Answer to Question 1

ANS: C
A draw sheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms. Bony prominences should not be massaged if reddened. Deep tissue damage can occur. Pressure-reduction devices should be used to redistribute weight instead. The skin should be cleansed with mild nonalkaline soap or soap-free cleaning agents for routine bathing.

Answer to Question 2

ANS: A
Most fevers are of brief duration, have limited consequences, and are viral. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection.

[dejastew]

Excellent

[gcook]

TYSM