Chapter 44: Injuries and Toxic Exposures Garzon Maaks: Burns' Pediatric Primary Care, 7th Edition

Chapter 44: Injuries and Toxic Exposures
Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition
MULTIPLE CHOICE
1. A child is brought to the clinic after falling from a swing and scraping both knees and hands.
An examination reveals abraded skin with oozing serous fluid and blood, along with dirt and
grime from the playground surface. What will the primary care pediatric nurse practitioner do
to minimize the risk of infection?
a. Apply povidone-iodine to all areas.
b. Irrigate gently with normal saline.
c. Rinse with hydrogen peroxide.
d. Scrub the abraded areas with alcohol.
ANS: B
Gentle irrigation with water or normal saline is the preferred method for cleaning a wound.
Povidone-iodine, alcohol, and hydrogen peroxide should not be used on open wounds.
2. A school-age child steps on a nail while wearing tennis shoes and develops cellulitis in that
foot. The child’s immunizations are up-to-date. What antibiotic will the pediatric nurse
practitioner empirically prescribe?
a. Amoxicillin-clavulanate
b. Ciprofloxacin
c. Clindamycin
d. Trimethoprim-sulfamethoxazole
ANS: B
Plantar puncture wounds, particularly those wounds that occur following puncture of
sneakers/shoes, require ciprofloxacin to cover potential Pseudomonas infection and to protect
against an osteomyelitis. Amoxicillin-clavulanate is used in other puncture wounds with signs
of infection. Clindamycin is used for similarly wounded children allergic to penicillins. TMP-
SMX is used if MRSA is cultured.
3. A child has a 1-cm laceration on the forehead proximal to the hairline after running into a pole
while playing sports. To minimize the risk of infection, the primary care pediatric nurse
practitioner will irrigate the wound and
a. allow the wound to heal by secondary intention.
b. delay closure of the wound for several days.
c. refer the child to a plastic surgeon for wound closure.
d. suture the wound within 6 hours.
ANS: D
Children are less likely than adults to get wound infections, with an infection rate from
sutured lacerations at 2%. The PNP should clean and suture the wound. Wounds from animal
bites are often left to heal by secondary intention to prevent infection. Referral to a plastic
surgeon is necessary for cosmetic reasons. Delaying closure for several days is recommended
for heavily contaminated wounds and those caused by high-velocity missile injuries, crush
injuries, and explosion injuries.
4. The primary care pediatric nurse practitioner is preparing to close a laceration on a child’s
forehead using topical skin adhesive. What is the correct way to apply this product?
a. Apply the adhesive between the wound margins and then hold the edges together.
b. Apply the adhesive to the wound and then secure the edges with surgical tape.
c. Have the child remain still for 15 to 20 minutes after the adhesive is applied.
d. Hold the wound edges together and apply the adhesive on top of the skin.
ANS: D
Topical adhesive is applied by holding the wound edges together (approximating the wound
edges) and then applying the adhesive on top, often requiring two or three applications of the
adhesive but allowing skin cooling between applications. The adhesive should not be applied
between the wound margins or in the wound. Surgical tape and bandages are not used with
topical adhesive. It is not necessary for the child to remain still after the adhesive is applied,
since it dries quickly.
5. A toddler is brought to the clinic after grabbing the hot end of his mother’s curling iron. An
examination reveals a pale, yellow burned area to the palm of one hand. What is true about
this burn?
a. It may take up to 3 weeks to heal with scarring likely.
b. Scarring is unlikely, with healing expected in 3 to 7 days.
c. Surgical intervention and skin grafting are usually required.
d. This type of burn usually heals without scarring in 7 to 14 days.
ANS: A
A deep partial-thickness burn appears pale and yellow and scarring is more likely to occur,
with complete healing taking up to 3 weeks. A superficial burn is erythematous without
blisters and heals in 3 to 7 days without scarring. A full-thickness burn involves extensive
destruction of underlying tissues and requires surgical intervention and skin grafts. A
superficial partial-thickness burn is red, mottled, moist, and painful and may scar, with healing
in 7 to 14 days.
6. A school-age child sustained a contusion on the front of one thigh while playing football and
reports some difficulty flexing the foot on the affected side. What will the primary care
pediatric nurse practitioner do to treat this injury?
a. Place the child on crutches and limit weight-bearing until symptoms subside.
b. Prescribe acetaminophen with hydrocodone along with NSAIDs.
c. Recommend rest, ice packs, compression, and elevation of the extremity.
d. Refer the child to an orthopedic specialist for immediate evaluation and treatment.
ANS: D
Children with contusions that restrict movement or sensation and those affecting the
quadriceps muscle may include compartment syndrome. These children should be referred to
orthopedic specialists immediately so that the compartment pressure does not result in
irreplaceable damage. The other options may be performed in consultation with a specialist.
7. A child is bitten on one arm by a neighbor’s dog. The dog is immunized against rabies and the
child’s last tetanus immunization was 4 years prior. The wound edges are gaping and avulsed.
What is an important initial intervention when treating this injury?
a. Administration of rabies prophylaxis and a tetanus booster
b. Debriding and suturing the wound to prevent infection
c. Irrigation of the wounds with high-pressure normal saline
d. Reporting the animal bite to the local animal control authority
ANS: C
Animal and human bites need to be irrigated with normal saline using >5 psi of pressure. The
animal has been vaccinated for rabies and the child’s tetanus is current, so prophylaxis for
both of these is not indicated. There is controversy about whether primary closure is
appropriate. Reporting the animal is not a primary action.
8. A child is brought to the clinic immediately after being stung by a wasp while playing in the
yard. The physical examination reveals localized redness and edema at the site, along with
abdominal tenderness, watery eyes, and generalized hives. What is the initial treatment?
a. Administer intramuscular epinephrine.
b. Apply a topical glucocorticoid cream.
c. Give oral diphenhydramine.
d. Order a bronchodilator treatment.
ANS: A
This child has signs of a severe reaction to the sting and should receive epinephrine first,
followed by oral diphenhydramine and bronchodilators if wheezing. Topical glucocorticoids
are used for mild, localized reactions.
9. A child is bitten by a snake near a swimming pool in an area where copperhead snakes are
known to inhabit, although the parents cannot describe the snake. An examination of the bite
reveals a severe local reaction at the site with edema and intense pain. What will the primary
care pediatric nurse practitioner do first?
a. Administer narcotic analgesics to provide comfort.
b. Begin treatment with oral amoxicillin-clavulanate for 5 days.
c. Clean the wound and administer tetanus prophylaxis.
d. Transport the child by ambulance to a medical center.
ANS: D
If a venomous snakebite is suspected, rapid transportation to a medical center with referral to
appropriate specialists and antivenin therapy is indicated. Narcotics may impair clinical
evaluation. Non-venomous snakebites are treated with oral antibiotics if signs of infection are
present after the wound is cleaned and tetanus prophylaxis is given.

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