Correct answer—C. Rationales: Rabies isn’t generally transmitted through the bites of rodents. Members of the rodent family include rats, mice, hamsters, gerbils, squirrels, and chipmunks. Rabies is primarily transmitted through the saliva of carnivorous animals. All wild carnivorous animals should be considered rabid unless proven otherwise by laboratory analysis. Domestic animals that don’t have veterinary documentation of immunization should be observed for 10 days for development of symptoms.

Nursing process step: Assessment

Correct answer—A. Rationales: Corticosteroids shouldn’t be given to a client who’s receiving rabies immunization. The anti-inflammatory properties of corticosteroids interfere with active immunity. Administering tetanus toxoid is an appropriate choice for a break in skin integrity from a potentially contaminated source. Rabies immune globulin and the HDCV should be administered as soon as possible after the bite.

Nursing process step: Intervention

Correct answer—A. Rationales: The coral snake is an elapid, and its venom is neurotoxic. The effects are primarily systemic; local wound signs or symptoms are few or absent. Hemotoxic and proteolytic venoms are associated with pit vipers. Coagulopathic venom isn’t a category of snake venom.

Nursing process step: Analysis

Correct answer—B. Rationales: Pit viper bites (copperheads, water moccasins, and rattlesnakes) are associated with proteolytic and hemotoxic reactions. Their bites are painful, and blood usually oozes from visible fang marks. Edema of the affected area can lead to compartment syndrome. Other signs and symptoms include erythema, ecchymosis, blisters, hypotension, shock, and coagulopathies. Slurred speech, respiratory paralysis, and muscle weakness are associated with the neurotoxic venom of elapids (coral snakes and cobras).

Nursing process step: Assessment

Correct answer—A. Rationales: Because venom is spread through the lymphatic system, immobilization of the extremity reduces lymph production. The affected extremity should be placed slightly lower than the heart to decrease the spread of the venom. Applying tight or constricting bands isn’t recommended. Instead, a moderately constricting band may be placed about 4” (10 cm) proximal to the bite. The purpose of the band is to slow lymphatic flow. Care should be taken to avoid impeding arterial or venous flow. Applying ice to the affected extremity won’t reduce the spread of the venom.

Nursing process step: Intervention

Correct answer—C. Rationales: Applying direct pressure to an injury is the initial step in controlling bleeding. For severe or arterial bleeding, pressure point control can be used. Pressure points are those areas where large blood vessels can be compressed against bone: femoral, brachial, facial, carotid, and temporal artery sites. Elevation reduces the force of flow, but direct pressure is the first step. A tourniquet may further damage the injured extremity and should be avoided unless all other measures have failed.

Nursing process step: Intervention

Correct answer—A. Rationales: Clients taking tetracycline are photosensitive and have exaggerated sunburn reaction. At the first sign of skin erythema, clients should stop taking the drug and notify their physicians; rash and itching are signs of a hypersensitivity reaction. Tetracycline should be taken with a full glass of water 1 hour before or 2 hours after meals because taking it with food or milk interferes with its absorption. Antacids that contain aluminum, calcium, or magnesium impair absorption of tetracycline.

Nursing process step: Evaluation

Correct answer—A. Rationales: Tetanus immune globulin should be administered I.M. (3,000 to 5,000 units) along with tetanus toxoid. Seizures aren’t associated with tetany. Sedatives and muscle relaxants can be used to reduce pain. Because of their effect against Clostridia, penicillin and tetracycline are the antibiotics of choice.

Nursing process step: Intervention

Correct answer—D. Rationales: Postexposure rabies prophylaxis includes administration of human diploid cell vaccine on days 0, 3, 7, 14, and 28. If human diploid cell vaccine is being administered as a preexposure immunization, only days 0 and 3 are necessary. Rabies immune globulin is administered in a dose of 20 IU/kg. The full dose is administered locally, around the wound; any remaining volume should be administered I.M. Option C is an incorrect schedule for administering this immunization.

Nursing process step: Intervention

Correct answer—B. Rationales: Found in every state, Rocky Mountain spotted fever has the highest incidence in North Carolina, South Carolina, Oklahoma, and Virginia. The disease is primarily seen in the warmer months of late spring, summer, and early fall. Symptoms of the fever appear 2 to 14 days after contact with infected ticks, and a rash develops over the soles, palms, hands, feet, wrists, and ankles on the 2nd to 5th day. The rash becomes petechial and eventually spreads to the rest of the body. The client may develop edema, hypotension, and delirium. Meningococcemia typically follows a mild upper respiratory tract infection. A petechial rash appears on the trunk and lower portion of the body. Poison ivy erupts in linear streaks that correspond to the areas that have come in contact with the vines or stems of the ivy. Additional lesions can spread to new locations and may have accompanying blisters and edema. Measles begin as a red maculopapular rash on the face that rapidly spreads over the trunk and arms.

Nursing process step: Assessment

Correct answer—A. Rationales: The best method for removing a tick is to grasp it gently with tweezers close to the skin. Slowly pull it away from the skin while applying gentle traction. Take care not to squeeze the tick because toxins or viruses could be injected into the client. The other options aren’t recommended because they may cause the tick to regurgitate or salivate into the wound.

Nursing process step: Intervention

Correct answer—B. Rationales: Doxycycline is the first-line treatment for adults and children and should be initiated immediately. Amoxicillin, co-trimoxazole, and erythromycin, although antimicrobials, aren’t effective for treating Rickettsia rickettsii (Rocky Mountain spotted fever).

Nursing process step: Intervention

Correct answer—B. Rationales: The early symptoms of Rocky Mountain spotted fever are nonspecific, such as fever (usually greater than 102° F [38.9° C]), nausea, vomiting, headache, muscle aches, and fatigue. These symptoms are commonly ignored or attributed to other causes. The rash, abdominal pain, joint pain, and diarrhea usually develop about 2 to 14 days after a bite by an infected tick. The rash usually begins on the wrists and ankles and spreads, but some individuals (about 10% to 15%) don’t develop it. Other symptoms that may occur are loss of appetite, hallucinations, photosensitivity, and excessive thirst.

Nursing process step: Evaluation

Correct answer—D. Rationales: Permethrin is supplied in a cream. It should be massaged into the skin from the head to the soles. Although permethrin is the treatment of choice for children younger than age 1, its safety hasn’t been established for those younger than age 2 months. Lindane, a treatment for scabies, isn’t recommended for children younger than age 1, and it shouldn’t be used on children older than age 1 if they won’t be supervised. The hands and feet of a child should be covered during treatment to prevent him from ingesting the cream or lotion. Young children may be more sensitive to central nervous system toxicity from the drug. Tolnaftate is used to treat ringworm. Thiabendazole is used to treat hookworm, roundworm, threadworm, and whipworm.

Nursing process step: Intervention

Correct answer—B. Rationales: Because scabies is transmitted through prolonged contact, it commonly affects all family members. Most clients are infested before obvious symptoms appear. The other options represent information that should be included in discharge instructions.