Free BCEN Certified Emergency Nurse (CEN) Practice Question

The correct answer is to administer rabies immune globulin (RIG) and initiate the rabies vaccine series. This case presents a high-risk scenario for potential rabies exposure. Bats are considered high-risk animals for rabies transmission, and the inability to test the animal necessitates treating this as a potential rabies exposure. The deep lacerations increase the risk of transmission if the bat was rabid. Despite the initial wound cleaning, which was appropriate, the 36-hour delay in seeking medical attention makes immediate rabies post-exposure prophylaxis (PEP) crucial.

Rabies PEP for previously unvaccinated individuals includes both passive immunization with RIG and active immunization with the rabies vaccine series. RIG provides immediate passive immunity while the vaccine series stimulates active immunity. This combination is more effective than either component alone.

While wound irrigation is important, it's not the primary concern at this point given the time elapsed and the patient's self-cleaning. Antibiotics may be indicated but are secondary to rabies prevention. Suturing is generally avoided in animal bites to prevent sealing in pathogens. Observation without treatment is inappropriate given the high-risk nature of the exposure and the potential fatality of rabies if it develops.