# A nurse is caring for a client who was stung by a bee on the back and shoulders. The client reports pain, redness, and blistering. Which nursing action should the nurse implement first? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540932 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a client who was stung by a bee on the back and shoulders. The client reports pain, redness, and blistering. Which nursing action should the nurse implement first? A 35-year-old client presents to the emergency department after being stung by a bee while gardening. The client reports immediate sharp pain at the sting site on the left forearm, followed by localized swelling and redness. ## 보기 1. Apply a warm compress to the sting site to promote circulation 2. Remove the stinger by scraping it out with a credit card or fingernail **✔ 정답** 3. Administer oral antihistamine medication as prescribed 4. Apply topical corticosteroid cream to reduce inflammation **정답: 2** ## 해설 Priority is removing the stinger by scraping to prevent continued venom injection. Other actions like warm compresses or antihistamines are secondary after stinger removal. ## 심화 해설 Clinical Priority & First Action The immediate priority after a honey bee sting is to remove the stinger as quickly as possible. The correct technique is to scrape it out using a dull edge, such as a credit card or fingernail, rather than pinching and pulling it out with tweezers or fingers. The rationale is rooted in the unique anatomy of the honey bee's venom apparatus. The stinger is bifurcated and attached to a venom sac that contains a piston-like mechanism. When the stinger embeds in human skin, the venom sac remains attached and continues to pulsate, actively injecting venom for up to 60 seconds after the initial sting [1]. Pinching or squeezing the venom sac with forceps or fingers compresses the sac, which can forcefully expel additional venom into the wound, worsening the local tissue injury and increasing the total venom dose [1]. A scraping motion with a straight edge, such as a credit card, effectively dislodges the stinger without applying pressure to the venom sac. This minimizes the volume of venom injected. The speed of removal is the most critical factor; even a delay of a few seconds can result in a significantly greater venom load. Therefore, removing the stinger by scraping is the first and most time-sensitive nursing action to limit the extent of the envenomation [1]. Other interventions, such as applying a cold compress for pain and swelling, administering an oral antihistamine for pruritus, or applying a topical corticosteroid for inflammation, are appropriate secondary measures. However, they do not address the ongoing mechanical injection of venom, which is the primary driver of the client's escalating pain, redness, and blistering. A warm compress is contraindicated as it would promote vasodilation and potentially enhance venom absorption. References (research sources) - [1]Methods of Honey Bee Stinger Removal: A Systematic Review of the Literature.Meta-analysis/systematic reviewLee JA, Singletary E, Charlton N. (2020) · DOI: 10.7759/cureus.8078 ## 임상 시나리오 Honey Bee Stinger RemovalImmediate First Aid to Limit Envenomation The priority action is immediate removal of the stinger. Use a dull edge (e.g., credit card, fingernail) to scrape it out. Speed is the most critical factor; even a delay of a few seconds increases the venom load. The honey bee's venom sac remains attached to the barbed stinger and pulsates, actively injecting venom for up to 60 seconds. Scraping avoids compressing the sac, which would inject more venom. CautionNever use tweezers or fingers to pinch and pull the stinger. This squeezes the venom sac, forcing additional venom into the wound and worsening tissue injury. ## 핵심 개념 - **Envenomation** — The process by which venom is injected into a victim; in bee stings, this continues as long as the stinger and attached venom sac remain in the skin. - **Stinger scraping** — A first aid technique using a dull, straight edge (e.g., credit card) to remove a bee stinger without squeezing the venom sac, minimizing additional venom injection. - **Venom sac** — A bulbous structure attached to the bee stinger that contains venom and continues to pulsate and inject venom for up to 60 seconds after detachment from the bee. ## 같은 주제 문제 - [A nurse is assessing a 16-year-old client who was stung by a bee 30 minutes ago. Which ass…](https://mymerci.kr/pages/nclex_q.php?qn_id=540927) - [A nurse is assessing a client who was stung by a bee 30 minutes ago. 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