Chapter 24: Bites and Stings Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A child experiences a snake bite while camping and is seen in the emergency department. The child’s parents are not able to identify the type of snake. An inspection of the site reveals two puncture wounds on the child’s arm with no swelling or erythema at the site. The child has normal vital signs. Which treatment is indicated?

a. Administering antivenom and observing the child for 24 to 48 hours b. Cleaning the wound, giving tetanus prophylaxis, and observing for 12 hours c. Performing a type and cross match of the child’s blood d. Referral to a surgeon for incision and suction of the wound

ANS: B

The child does not have immediate symptoms of envenomation, since there is no swelling or erythema. Because symptoms may be delayed, and the type of snake is unknown, the child should be observed in an ED or hospital for 12 hours after providing wound care and tetanus prophylaxis. Antivenom is not indicated unless envenomation occurs. Type and cross match is done if envenomation is severe. Incision and suction of the sound is not recommended.

Multiple Response

1. A patient is seen in the emergency department after experiencing a spider bite. The spider is in a jar and is less than one inch in size, yellow-brown, and has a violin-shaped marking on its back. Depending on the patient’s symptoms, which treatments and diagnostic evaluations may be ordered? (Select all that apply.)

a. Airway management b. An acute abdominal series c. Antivenom therapy

NURSINGTB.COM d. CBC, BUN, electrolytes, and creatinine e. Coagulation studies f. Tetanus prophylaxis

ANS: D, E, F

The spider is a brown recluse. If the patient exhibits systemic symptoms, laboratory workup, including CBC, BUN, creatinine, electrolytes, and coagulation studies should be performed. Tetanus prophylaxis is given. Airway management, an acute abdominal series, and antivenom therapy are used for black widow spider bites.