Chapter 21: Dermatologic Disorders

63. A nursing student is taking care of a 2-year-old girl and notices her oxygen saturation has decreased. The patient has stridor when breathing and her hairline appears singed. The nurse should anticipate: 1. Possible intubation because of the airway being compromised. 2. This is normal for a patient after 36 hours. 3. To reposition the patient for better airway clearance. 4. This is furthering infection and may require antibiotics.

1 (1. A possible inhalation injury has occurred due to the oxygen saturations, stridor, and hairline being singed. This may not manifest until between the 24 to 48 hours after the initial injury. 2. This is not normal, and a doctor should be notified. 3. Repositioning may help with initially increasing oxygen saturations, but due to the stridor, the saturation level will not remain stable. 4. Infection could be developing, but this is not the priority at this point.)

44. Chloe, a 13-year-old girl, has herpes simplex 1 on her lip. She asks the school nurse if the virus is contagious. The best answer from the school nurse is: 1. "Yes, it is contagious for at least one week." 2. "No, the virus is dormant in your body and is not contagious." 3. "Yes, but it is past the incubation period once you see it on your skin, so it is no longer contagious." 4. "No, the virus occurs because of poor hygiene."

1 (1. Herpes simplex 1 is contagious for at least one week after the outbreak occurs. 2. The virus may be dormant, but it is contagious. 3. It remains contagious after eruption. 4. The virus is not linked to poor hygiene.)

18. A 10-year-old child presents to the ER with a large circular rash on the leg, along with a fever, headache, and achiness. What is your assessment? 1. Lyme disease 2. Eczema 3. MRSA infection 4. Spider bite

1 (1. Lyme disease has a characteristic rash that is circular, along with a fever, headache, and aching present. 2. Several dry areas would be present. 3. Oozing from the wound and fever would be present. 4. A streak of several small bites would be noted for a spider bite.)

12. Home care education for children with eczema includes: 1. Applying moisturizers 2 to 3 times a day. 2. Wearing wool and cotton clothing. 3. Keeping the environment warm and humidified. 4. None of the above

1 (1. Moisturizing 2 to 3 times a day is correct. 2. Wool may irritate the area. 3. This may cause the body may sweat more and cause more breakouts. 4. One answer is correct.)

61. Pain management is required for children throughout the healing process with burns. In the emergent phase, the child may require medication during the debridement and dressing changes. What type of pain management would be appropriate at this time? 1. Opiates 2. Narcotics 3. Acetaminophen 4. Ibuprofen

1 (1. Opiates prior to the debridement process will aid in pain management. 2. Narcotics are not recommended for children because of the side effects. 3. Acetaminophen will not be enough for pain management during this process. 4. Ibuprofen will not be enough for pain management during this process.)

48. A child with who has __________ should not use pediculicide shampoos. 1. Asthma 2. Cystic fibrosis 3. Latex allergies 3. Neurological disorders

1 (1. Pediculicide shampoos can cause an asthma exacerbation. 2. Pediculicide shampoos do not affect children with cystic fibrosis. 3. Pediculicide shampoos are not linked to latex allergies. 4. A child with neurological disorders can use pediculicide shampoos.)

50. A camp nurse has been notified that one of the campers, who has an allergy to bee stings, has been stung. The nurse gets to the child and begins her assessment. The child is noted to have stridor and has broken out in hives over her entire body. The nurse knows that this is a medical emergency and has brought the child's medication with her to the site. What is the anticipated medication the nurse should administer at this time? 1. EpiPen 2. Benadryl 3. Tylenol 4. An antihistamine

1 (1. The EpiPen will help decrease the respiratory tract swelling because this is an anaphylactic episode. 2. Benadryl can be used, but in this case, the child is in respiratory danger and needs a fast-acting medication. 3. Tylenol is not used in this anaphylactic event. 4. An antihistamine can be used, but it works too slowly for this situation due to the respiratory involvement.)

32. The most common areas for infantile eczema to appear are the: 1. Face, hands, and scalp. 2. Face, feet, and abdomen. 3. Extremities only. 4. Abdomen only.

1 (1. The face, hands, and scalp are the most common areas for infantile eczema. 2. The feet and abdomen usually do not exhibit infantile eczema. 3. The extremities may have infantile eczema, but they are not the only area. 4. The abdomen may have infantile eczema, but it is not the only area.)

49. A common area for scabies to occur on children under the age of 2 is/are the: 1. Head and neck. 2. Extremities. 3. Abdomen. 4. Buttocks.

1 (1. This is the most common area for scabies in young children. 2. Scabies usually does not occur on the extremities. 3. Scabies usually does not occur on the abdomen in young children. 4. Scabies usually does not occur on the buttocks of young children.)

62. When treating chemical burns, the initial treatment should include: 1. Washing the area with large amounts of water. 2. Soaking the body part in cool water. 3. Using ice on the burn. 4. Applying antibiotic cream.

1 (1. You need to rinse as much of the chemical off as possible as soon as possible. 2. Soak for partial thickness burns with blistering, not for chemical burns. 3. Applying ice can cause additional injuries. 4. This can be done after the injury has been treated.)

36. Before starting Megan, a 15 year old, on Accutane, it is important to assess for: 1. Signs and symptoms of infection. 2. Urinary tract infections. 3. Pregnancy. 4. Sexually transmitted diseases.

3 (1. Accutane will not treat infection. 2. Accutane will not treat infection. 3. Accutane can be detrimental to a fetus. 4. Accutane will not treat sexually transmitted diseases.)

60. The rule of nines contains all of the following except: 1. Head 9 percent. 2. Anterior trunk 18 percent. 3. Posterior trunk 9 percent. 4. Each lower extremity 18 percent.

3 (1. Contained in the rule of nines 2. Contained in the rule of nines 3. The posterior and anterior trunk consists of 18% in the rule of nines. 4. Contained in the rule of nines)

73. The nurse in the PICU is caring for a 4-year-old child who was in a motor vehicle accident three days ago. The child is sedated with many IV lines, a catheter, and a ventilator. The plan of care requires new positioning every three hours and indicates for the child to have a skin check done every hour. Indicate an area of concern for skin breakdown. (Select all that apply.) 1. The area around the child's mouth where the endotracheal tube is taped 2. The peri-area because of the immobility and dampness to the area 3. The IV site because of the possibility of infiltrations 4. The scapula because the child rests more comfortably on her back 5. All of the above are areas of concern for skin breakdown.

1, 2, 3 (1. The tape and the endotracheal tube can irritate the skin, cause chaffing and increased skin breakdown. 2. Since the child is sedated, incontinence can be present, increasing the risk for skin breakdown. 3. IV sites should be checked every hour with the assessment to find possibilities of infiltrations. 4. This area is not at a high risk because the child is repositioned every three hours. 5. Not all of the above are areas are concerns for skin breakdown.)

70. Keshia, a 10-year-old girl, was removed from a burning apartment complex and brought to the ER via the ambulance. The EMTs have reported that Keshia is struggling to breathe. The nurse knows that: (Select all that apply.) 1. There could be an inhalation injury due to the smoke. 2. She will need to be monitored on the pulse oximeter. 3. The child will need emotional support while in the ER. 4. The child should be placed on a cardiac monitor. 5. The parents should not be allowed in the room until the child is stable.

1, 2, 3, 4 (1. Breathing struggles indicate inhalation injuries in this situation. 2. Monitoring the pulse oximeter will give aid in knowing if the patient needs oxygen support. 3. The child may need emotional assistance because of the situation. 4. The child should be placed on a cardiac monitor because of the respiratory compromise. 5. The parents should be allowed into the room to help calm the patient.)

72. A community health nurse is giving information to parents at the child health clinic about the prevention of sunburns. In planning the care session, it will be important for the nurse to include: (Select all that apply.) 1. The time of day when the sun is the brightest. 2. The length of time a child should be in the sun. 3. Applying sunscreen one time after the child goes out in the sun. 4. The fact that children with dark skin do not burn. 5. Applying sunscreen an hour before going in the sun.

1, 2, 5 (1. Important information for sunburn prevention 2. Important information for sunburn prevention 3. Sunscreen should be applied more than one time. 4. Children with dark skin can burn. 5. Important information for sunburn prevention)

29. A 3 month old is in the pediatric clinic for her well-child checkup. The mother states that the child's diaper area is very red and tender with some raised bumps. The doctor diagnoses the child with candida albicans and prescribes hydrocortisone for the area. The nurse is supposed to teach the mother about the signs and symptoms of possible infection and care to the area. The teaching should include all except: 1. Reporting if the sores increase in size. 2. Reporting if the sores decrease in size. 3. Reporting if the sores have purulent drainage 4. The use of a mild soap to cleanse the area at each diaper change.

2 (1. A spread for infection occurs if the area expands. 2. An area decreasing in size indicates healing. 3. Drainage from the site indicates possible infection. 4. This is the proper technique for cleansing the area.)

45. The nurse is instructing a 13 year old and her mother on alternative therapies for cold sores. The alternative therapies consist of: 1. Warm compresses to the lips. 2. Mouthwash with 1 teaspoon of sodium bicarbonate in slightly warm water. 3. Using lip gloss to create a barrier so that the drainage decreases. 4. None of the above is an alternative therapy for cold sores.

2 (1. A warm compress may irritate the cold sore. 2. The mixture provides comfort and can dry out the cold sore. 3. The gloss does not decrease the drainage. 4. One answer is correct.)

57. Katie is caring for a pediatric patient with extensive burns due to a house fire. She anticipates that pain medication will be administered via which route? 1. Oral 2. Intravenous 3. Intramuscular 4. Subcutaneous

2 (1. Decreased perfusion occurs to the GI tract to break down the medication due to the extensive burns. 2. Can be absorbed in the blood stream 3. Medication cannot be absorbed due to the injury. 4. Medication cannot be absorbed due to the injury.)

59. A child has burns on the face and hands. These are classified as: 1. Partial burns. 2. Major burns. 3. Minor burns. 4. First degree burns.

2 (1. The face and hands are considered major areas for burns because of the surface area. 2. The face and hands are considered major areas for burns because of the surface area. 3. The face and hands are considered major areas for burns because of the surface area. 4. The face and hands are considered major areas for burns because of the surface area.)

55. The wound nurse has prescribed the use of a hydrocolloid dressing for an abdominal wound that is not healing. The child's primary nurse knows that this type of dressing is effective because: 1. The dressing allows the child to be mobile. 2. The dressing aids in the regeneration of skin and helps the wound heal. 3. The dressing is soothing and reduces pain for the child. 4. The dressing absorbs a large amount of fluid, so the wound will heal.

2 (1. The mobility is not part of the healing for this situation. 2. The regeneration of skin is important for wound healing. 3. The dressing may not help reduce pain. 4. The dressing does not absorb fluid.)

58. Myoglobinuria is occurring with a child with extensive partial thickness burns. The nurse knows that this is occurring because: 1. The child's stomach has a large amount of acid and is causing the stomach to bleed. 2. It is a byproduct of the muscle damage due to the extensive burns. 3. The kidneys are failing. 4. The child has consumed a large amount of red oral fluids

2 (1. The myoglobinuria is related to the muscle, not a stomach bleed. 2. The extensive damage causes the myoglobinuria. 3. The kidneys are working harder at this point, but it is not the cause for myoglobinuria. 4. The child taking in red oral fluids would not be noted at this time.)

38. An outbreak of impetigo has occurred in a first grade classroom. The school nurse instructs the teachers to: 1. Not work because this is not a common occurrence. 2. Disinfect surfaces. 3. Have a change of clothes for the children with the infection. 4. Have the children with the infection sit in one particular area of the room.

2 (1. This is not a feasible option for a classroom teacher. 2. Disinfecting all areas will help reduce the chance of spreading the bacteria. 3. A change of clothes will not help decrease the spread of the disease. 4. Isolating the children to one area of the room does not stop the spread of the bacteria.)

74. The skin care nurse is working with the pediatric staff on ways to help reduce the number of pressure ulcers in the chronically ill child population on the floor. One nurse states that the children are coming onto the floor from home with diaper rashes. The skin care nurse knows that this can result from: (Select all that apply.) 1. Lack of communication skills from the child. 2. High acidity in the child's urine due to medications. 3. Relation to the preventative antibiotics the child takes on a daily basis. 4. The caregivers not responding to the needs of the child.

2, 3, 4 (1. Communication skills should not influence the perineal care of the child. 2. Medication of children with chronic illnesses can increase the acidity of the urine, increasing the risk of skin breakdown. 3. Antibiotics can increase the number of stools, causing skin breakdown in the perineal area. 4. A child that is not attended to can have an increased risk of skin breakdown.)

51. Karen is a camp nurse and is preparing information about Lyme's disease to give to the campers. Karen knows that a child could be initially infected without her knowing because: 1. The bite is so small that it is hard to with the human eye. 2. Children do not usually react to a tick bite immediately after it occurs. 3. Signs and symptoms may appear up to 32 days after the initial bite. 4. Mosquito bites and tick bites look similar, so children do not notice.

3 (1. A bite has a distinct target shape, but may take days to develop. 2. Children may not show signs for a long period of time. 3. Signs and symptoms can take 32 days to appear. 4. The bites are not similar.)

2. The nurse asks a nursing student if any systemic signs and symptoms were present when assessing a 5-year-old client. Which answer would demonstrate that the nursing student understood? 1. Itchy, red rash 2. Vesicles present 3. Fever and headache 4. Blistering

3 (1. A rash is not a systemic sign. 2. Vesicles are not a systemic sign. 3. Systemic signs and symptoms include fever, headache, decreased responsiveness, and pain. 4. Blistering is not a systemic reaction.)

19. The nursing instructor asks the student nurse to teach the parents tick bite prevention strategies. In evaluating the session, the instructor asks the parents what they have learning about this topic. Which statement would demonstrate what they have learned? 1. "I don't know. I am not an outdoor person." 2. "Avoid going outside if possible." 3. "Use DEET spray on the skin." 4. All of the above

3 (1. Even if not an outdoor person, the parent should have learned the information for his/her child. 2. Preventing a child from going outside is not a feasible task. 3. DEET and Permethrin can be used to prevent tick bites. 4. DEET and Permethrin can be used to prevent tick bites.)

30. Seborrheic dermatitis differs from contact dermatitis because: 1. Seborrheic dermatitis is caused by fungus. 2. Seborrheic dermatitis is caused by latex. 3. The general appearance of seborrheic dermatitis is greasy with scales. 4. The general appearance of seborrheic dermatitis is raised bumps with white centers.

3 (1. Seborrheic dermatitis is not caused by fungus. 2. Seborrheic dermatitis is not a reaction to latex. 3. Seborrheic dermatitis usually has scales and is predominately seen on the head of a child. 4. Seborrheic dermatitis is not raised, nor does it have white centers.)

26. While doing a skin assessment, the nurse assesses for the color of a child with dark skin. The nurse knows that the best place to assess for pallor is/are the: 1. Chest. 2. Extremities. 3. Inside of cheek. 4. Fingernails.

3 (1. The chest is used to test capillary refill in children, not pallor. 2. Because of the differing temperatures of the extremities, pallor should not be assessed in this area. 3. Appropriate assessment of pallor is done inside the cheek. 4. The fingernail beds can be used to test capillary refill, but are not appropriate to test skin color.)

3. The nurse in the PICU is checking for areas of skin breakdown on her 4-year-old patient. The most common areas for skin breakdown in the pediatric client include all of the following except the: 1. Ears. 2. Occiput. 3. Heels. 4. Scapula.

3 (1. The most common areas for pressure ulcers in children are the ears, occiput, sacrum, and scapula because of the pressure points. 2. The most common areas for pressure ulcers in children are the ears, occiput, sacrum, and scapula because of the pressure points. 3. The heels do not have as much pressure placed upon them when the child is in bed. 4. The most common areas for pressure ulcers in children are the ears, occiput, sacrum, and scapula.)

56. The clinic nurse has a patient arrive in the triage room with a dog bite that occurred three days ago. Which patient complaint would alert the nurse to the presence of a possible infection? 1. Puncture wounds 2. Blanching and swelling 3. Pain and purulent drainage 4. Bruising to the area

3 (1. The puncture wound can be present, but not indicate infection. 2. Blanching and swelling can be present because of the tissue damage, but they are not a direct link to infection. 3. Pain and drainage indicate infection. 4. Bruising is common and does not indicate infection.)

47. An outbreak of head lice has occurred on the high school softball team. The school nurse has given handouts about therapy to kill the nits. One mother asks what the best way of going through her child's hair would be. The best response from the nurse would be: 1. "Wash her hair with pediculicide shampoo and towel dry. This is a one-time treatment." 2. "Use a fine-toothed comb to remove the nits when the hair is dry." 3. "Make sure to wash all bedding with hot, soapy water and dry on the hot cycle after each night. This reduces the nits in her bedding." 4. "Wash her hair and towel dry, then apply the RID and rinse after 10 minutes. Repeat this several times throughout the day. "

3 (1. The treatment may need to occur more than one time. 2. Even after removal, the nits may be present on other objects that the teen possesses. 3. Washing everything in hot water will help kill the nits. 4. The RID will help kill the nits, but the parent needs to clean all of the bedding because nits can live on bedding and re-infest the teen.)

31. A mother calls the pediatric triage nurse and states, "I don't know what is on her hand. It is red with clear drainage coming out of small bumps. She got into the poison ivy patch yesterday." The nurse instructs the mother to: 1. Apply warm compresses to help reduce the pain. 2. Use a body wash, such as Dove, to help with the itching. 3. Use Calamine lotion to help with the itching. 4. Apply a thin coat of Cetaphil to help with itching.

3 (1. The warm compresses my increase pain and itching. 2. Dove will moisturize the area and not decrease the itching sensation. 3. Calamine lotion will help dry the drainage and decrease the itching. 4. Cetaphil will not decrease the drainage and will not help with the itching.)

40. A 9 year old is in the ER. His mother has brought him because of a leg injury. The child has been diagnosed with cellulitis. The nursing plan of care would include all of the following except: 1. Vital signs, including a heart rate, should be taken every 2 to 4 hours to monitor for furthering infection. 2. Assessing perfusion to the extremity. 3. Keeping the leg in a dependent position. 4. Encouraging oral fluids.

3 (1. Vital sign changes can indicate furthering infection 2. Perfusion indicates if the tissue is receiving the adequate nutrition it needs to heal. 3. Keeping the leg in a dependent position allows for blood pooling and does not help the healing process. 4. Oral fluids help the patient stay hydrated during this time.)

66. Identify the correct order for wound healing for a child. _1_ Saturation phase __2 Inflammation phase _3_ Proliferation phase

3, 1, 2

71. A pediatric intensive care nurse is caring for a boy with superficial partial thickness burns on his lower legs and chest. Which of the following would the nurse expect to note during the emergent phase of the burn injury? (Select all that apply.) 1. A decrease in the baseline heart rate 2. An increase in blood pressure 3. Decreased body temperature 4. An elevated hematocrit 5. Decreased hemoglobin

3, 4 (1. The baseline heart rate may be elevated at this time. 2. The blood pressure will be decreased because of the fluid loss. 3. The body temperature will be low because of the lack of subcutaneous tissue and capillary permeability. 4. The hematocrit will be elevated due to the increased capillary permeability and water loss. 5. The hemoglobin will be increased due to the increased capillary permeability and water loss.)

25. A community health nurse is participating in a health fair. What prevention strategies can the nurse teach to prevent house fires? 1. Have a functional indoor smoke alarm. 2. Keep a fire extinguisher in the home. 3. Educate the children on fire safety. 4. All of the above

4 (1. An adequate prevention strategy 2. An adequate prevention strategy 3. Education should be provided for prevention 4. All of the above are fire prevention strategies.)

34. Identify the possible nursing diagnosis for a teenager with severe acne. 1. Knowledge deficit related to hygiene 2. Self-esteem issues related to personal appearance 3. Insufficient nutrition related to skin breakouts 4. All of the above would be appropriate nursing diagnoses for the teenager.

4 (1. Appropriate for the situation, along with others 2. Appropriate for the situation, along with others 3. Appropriate for the situation, along with others 4. All of the diagnoses would be appropriate for the situation.)

17. As the camp nurse, you have three campers who are allergic to bee stings. What is the appropriate treatment for these campers if they get stung? 1. Keep Benadryl on hand with counselors. 2. Use baking soda paste for application on the bee sting. 3. Scrape the stinger off if a bee sting occurs. 4. Keep an EpiPen on hand at all times and be able to give IM.

4 (1. Benadryl can be a long-term treatment. 2. The concoction would be appropriate for pain relief, but not for the allergic reaction. 3. Removing the stinger is important, but will not stop an allergic reaction. 4. An EpiPen may be needed if child is known to be allergic to bee stings.)

23. A nurse in the PICU is caring for a 7-year-old child with burns on more than 30 percent of the body. Which statement made by the parents indicates an understanding of the severity of the burns? 1. "I'm glad that he doesn't have any burns on his face." 2. "I feel so bad that he got burned." 3. "When do you think he will be out of the ICU?" 4. "Nurse, is he going to make it?"

4 (1. Burns to the face can increase the risk of complications, but burns on any part of the body increase the risk for infections. 2. The feeling of guilt is common, but does not demonstrate an understanding of the situation. 3. The parent needs to deal with the severity of the injury and concentrate on the present. 4. The parents are able to verbalize that death may occur because of the extent of the burns.)

7. You are examining an infant under your care. While assessing the head, you note greasy and scaly areas on the scalp. What true statements can be said about this condition? 1. Called "cradle cap" 2. Caused by a yeast organism 3. Called "kiddy crud" 4. Choice 1 and 2

4 (1. Cradle cap is caused by yeast and looks like greasy, scaly patches on the scalp. 2. Cradle cap is caused by yeast and looks like greasy, scaly patches on the scalp. 3. Kiddy cap does not exist. 4. Cradle cap is caused by yeast and looks like greasy, scaly patches on the scalp.)

13. What principles of skin care can you teach your adolescent patient regarding acne? 1. Eliminate chocolate and soda from your diet. 2. Cleanse your face gently on a daily basis. 3. Avoid oil-based cosmetics, creams, and makeup. 4. Choices 2 and 3

4 (1. Dietary changes do not affect acne. 2. Cleansing helps prevent the clogging of pores and promotes good circulation. 3. Oil-based products and makeup clogs pores, increasing the risk for acne. 4. 2 and 3 are correct. Dietary changes do not affect acne.)

43. A school nurse is teaching high school student athletes about the prevention of MRSA. The teaching should include: 1. Disinfecting sports equipment. 2. Avoiding the sharing of towels. 3. Avoiding touching the nose. 4. All are important prevention methods for MRSA.

4 (1. Disinfecting decreases the spread of MRSA, but this is not the only correct answer. 2. Not sharing towels helps prevent the spread of MRSA, but this is not the only correct answer. 3. Avoiding touching the nose can decrease the spread of MRSA, but this is not the only correct answer. 4. All of the answers are correct.)

52. Common treatments for tick bites include all of the following except: 1. Doxycycline. 2. Citronella oil. 3. Lavender oil. 4. Calamine lotion.

4 (1. Doxycycline is a common treatment for tick bites. 2. Citronella oil is a common comfort measure for tick bites. 3. Lavender oil is a common comfort measure for tick bites. 4. Calamine lotion does not provide comfort for nor treats tick bites.)

9. Which of the following is characteristic of eczema? 1. Triggered by food allergies and topical irritants 2. A family history of asthma 3. No family history of asthma 4. Choices 1 and 2

4 (1. Eczema is triggered by food allergies, topical irritants, and is also linked to a family history of asthma. 2. Eczema is triggered by food allergies, topical irritants, and is also linked to a family history of asthma. 3. A family history is usually present with this disease process. 4. Eczema is triggered by food allergies, topical irritants, and is also linked to a family history of asthma.)

20. As the nurse at the pediatric call center, you give advice to parents regarding follow-up care of a laceration. The most important signs and symptoms to teach caregivers to look for are: 1. Erythema. 2. Tenderness and swelling. 3. Drainage. 4. All of the above

4 (1. Erythema is a sign of infection. 2. Tenderness and swelling are signs of infection. 3. Drainage is a sign of infection. 4. Erythema, tenderness, swelling, drainage, and fever are all signs of infection.)

10. The key to successful treatment of eczema is hydration of the skin. Examples of emollients are: 1. Eucerin. 2. Desitin. 3. Petroleum jelly. 4. Choices 1 and 3

4 (1. Eucerin and petroleum jelly are emollients. 2. Desitin is a barrier cream. 3. Eucerin and petroleum jelly are emollients. 4. Eucerin and petroleum jelly are emollients. Desitin is a barrier cream.)

11. Which of the following statements regarding atopic dermatitis is true? 1. Complementary Foods must have a delayed introduction beyond 4 to 6 months. 2. Fish in the diet before nine months reduces the risk of eczema in infants. 3. Exclusive breastfeeding for four months may delay or prevent eczema. 4. Choices 2 and 3

4 (1. Foods will not influence the atopic dermatitis. 2. Fish in the diet before nine months and exclusive breastfeeding for four months have been shown to be helpful. 3. Fish in the diet before nine months and exclusive breastfeeding for four months have been shown to be helpful. 4. Fish in the diet before nine months and exclusive breastfeeding for four months have been shown to be helpful.)

39. A child on the pediatric floor has been diagnosed with MRSA. The nurse's discharge teaching should include all of the following except: 1. Good hand hygiene. 2. Completing the entire course of antibiotics. 3. Disinfecting the shower/bathtub and other surfaces. 4. Leaving the wound open so that it airs out twice a day.

4 (1. Hand hygiene helps prevent the spread of MRSA. 2. Antibiotic therapy can help reduce the chance of spreading the disease. 3. Disinfecting the area helps prevent the spread of the MRSA. 4. Leaving the wound open can increase the spread of the bacteria.)

64. A mother and father have come to a baby education class at the local hospital. The nurse is teaching families about the prevention of burns. This teaching would include all the following except: 1. Not holding infants while cooking. 2. Not holding infants while heating bottles. 3. Not placing a bottle in the microwave to be heated. 4. All should be include in the teaching.

4 (1. Holding the infant when cooking increases the chance of the child obtaining a burn. 2. Heating bottles can cause steam burns, so an infant should not be held while performing this task. 3. Heating bottles in the microwave can cause hot spots within the milk and burn the child. 4. All of the teachings should be taught to the parents for the safety of their infant.)

6. A mother brings her child in for a 4-week visit to the pediatrician. You observe that the child has a diaper rash. What caregiver education would you, the nurse, provide for this mother? 1. Keep diaper areas dry and change diapers frequently. 2. Air dry the diaper area as much as possible. 3. Use baby wipes to cleanse the diaper area. 4. Choices 1 and 2

4 (1. Home care of diaper rash includes frequent diaper changes and air drying. 2. Home care of diaper rash includes frequent diaper changes and air drying. 3. Warm water and mild soaps should be used, not wipes. 4. Home care of diaper rash includes frequent diaper changes and air drying. Warm water and mild soaps should be used, not wipes.)

16. As the school nurse, you receive a call from a mother who says her daughter has head lice. What information should you tell her? 1. Distinguish nits from dandruff. Nits are firmly attached to the hair shaft. 2. Treat with pediculicide shampoo and repeat in seven days. 3. Toys and clothes can be tied up in a bag for two weeks. 4. All of the above

4 (1. Identification of nits needs to be made. 2. The shampoo will help treat and kill the nits and eggs. 3. All things the child has been exposed too should be wrapped up to prevent the spread of lice. 4. All of the above statements are caregiver education that you would share.)

37. Allen is sent to the school nurse because the teacher notices a lesion on his face. The school nurse examines around his month and notes that the area has a yellow crust over the top. The nurse calls Allen's mother. His mother states that he was diagnosed with impetigo two days ago and has been on antibiotics since then. The nurse knows the cause for impetigo is usually: 1. A bacterial infection. 2. Staphylococcus aureus. 3. Group A beta-hemolytic streptococcus. 4. All of the above.

4 (1. It is a bacterial infection, but this is not the only correct answer. 2. It is usually caused by Staphylococcus aureus, but this is not the only correct answer. 3. It can be caused by A B-hemolytic streptococcus, but this is not the only answer. 4. All the answers are correct.)

35. A 14-year-old boy is asking the nurse about how to decrease his atopic dermatitis. Which of the following statements is an appropriate teaching? 1. Wear loose cotton clothing. 2. Apply moisturizers 2 to 3 times a day. 3. Use mild soap for cleansing. 4. Keep warm and be in a moist environment while asleep.

4 (1. Loose clothing may increase the dermatitis. 2. Moisturizers may irritate the area and increase the dermatitis. 3. Soap may irritate the area and increase the dermatitis. 4. Keeping warm and moist overnight will increase the healing rate.)

41. CA-MRSA colonization occurs most commonly in the ______ of health-care employees. 1. Eyes 2. Hands 3. Nares 4. Mouths

4 (1. Not common in the eye 2. Can be spread by poor hand hygiene, but not the most common spot for colonization 3. The nares can carry MRSA, but they are not the most common spot for colonization. 4. The most common spot for colonization)

22. A lifeguard needs education regarding sunburn prevention in the future. What education needs to be provided by the nurse? 1. Apply sunscreen SPF 30 and reapply every hour. 2. A shirt should be worn while outdoors. 3. Ask the boss if you can avoid the sun from 10 to 2 p.m. 4. Choices 1 and 2

4 (1. Prevention is the best way to avoid serious sunburns. Applying the sunscreen will help reduce burns. 2. A shirt will help prevent burning to sensitive areas of the body. 3. Not a realistic request for a lifeguard 4. Prevention is the best way to avoid serious sunburns.)

42. An in-service for MRSA is being held for the pediatric nurses. The nurses know that which of the following is a common practice for resistant bacteria? 1. Saving leftover antibiotics for self-medication 2. Taking antibiotics for viral infections 3. Failing to take the entire prescribed regime of antibiotics 4. Taking prophylactic antibiotics

4 (1. Self-medication is dangerous and should be discouraged. 2. Antibiotics for a viral infection increase the chances for resistant bacteria. 3. Not taking the prescribed antibiotic regime increases the chances for resistant bacteria. 4. Taking the prophylactic antibiotics can help reduce the chance of MRSA.)

46. A child has been diagnosed with tinea pedis. The teaching by the nurse for home care includes: 1. Not sharing shoes. 2. Changing socks daily. 3. Air the feet as much as possible. 4. All the above should be included in the teaching.

4 (1. Sharing of shoes and other answers are correct. 2. Changing socks and other answers are correct. 3. Airing feet and other answers are correct. 4. All of the answers are the proper ways to care for tinea pedia.)

14. The mother of a 4 year old brings her child into the clinic. Impetigo is present on the face around the mouth and nose. What information should the nurse share with the mother? 1. This is caused by staphylococcus aureus. 2. After caring for child, carefully wash your hands. 3. Administer topical antibiotics. 4. All of the above

4 (1. Staphylococcus aureus is the bacteria responsible for impetigo. 2. Hand washing should occur to help prevent the spread of the disease. 3. Topical antibiotics will help reduce the spread of the disease. 4. All of the above statements regarding impetigo are true.)

4. Which of the categories are parts of the Braden Q scale? 1. Mobility and activity 2. Sensory perception 3. Nutrition, tissue perfusion, and oxygenation 4. All of the above

4 (1. The Braden Q scale includes assessment of mobility and activity. 2. The Braden Q scale includes assessment of sensory perception. 3. The Braden Q scale includes assessment of nutrition, tissue perfusion, and oxygenation. 4. The Braden Q scale includes assessment of mobility, activity, sensory perception, moisture, friction shear, nutrition, tissue perfusion, and oxygenation.)

54. The mother of an 8 year old with steri-strips to the right temporal area has been receiving teaching about caring for the wound. The nurse knows that the mother understands the teaching when she states: 1. "I will need to remove the stitches in two days, and then bring my child back for more steri-strips." 2. "I will clean the area with peroxide and keep the steri-strips dry." 3. "I will keep the sterile dressing over the wound for the next 12 hours." 4. "I will leave the steri-strips alone, and they will fall off in 7 to 10 days."

4 (1. The child does not have stitches. 2. Cleansing the area with peroxide will not keep the area dry. 3. A sterile dressing is not needed at this time because the steri strips are in place. 4. The steri strips should be left alone to fall off when the wound heals.)

27. Amber, a 10 year old, has been in fixed traction for a femur fracture for the past two weeks. Her parents are currently getting breakfast in the cafeteria. The nursing plan of care indicates that she should be moved every two hours and assess for skin breakdown. Today, Amber is refusing to move and tells the nurse "I am not going to do it." The best way for the nurse to handle this situation is: 1. "I will speak with the doctor to see if we can change your orders so you do not need to be moved so often." 2. "We will call your mother to come back and move you." 3. "I will give you 10 minutes to think about how you want to be positioned. After that, you can ring your call light, and we will move you to the position of your choosing." 4. "I understand that you do not want to move today, but we have to make sure you do not get any sores on your back or leg. I will let you be for 10 minutes, and then when you ring the call light, I will come in and move you to the position of your choosing."

4 (1. The child needs to be moved to prevent pressure sores. 2. Waiting for the parent to return may not be acceptable at this time, and the parent needs a break. 3. The nurse is not addressing what the child needs and allows for the child to have the control of the situation. 4. The nurse acknowledges the child's needs and has control of when the repositioning will occur.)

1. The mother brings a 10-month-old child into the clinic due to an unusual rash that she has noted. In completing the history, the nurse should ask about: 1. The general health of the child. 2. Allergies. 3. Recent immunizations or medications. 4. All of the above.

4 (1. The general health history is needed at this time. 2. Allergies will help identify the cause of the rash. 3. Immunizations and medications can cause rashes, thus should be assessed. 4. All of the above should be included in assessing the child for dermatologic conditions.)

5. Which of the following interventions will assist the acute care patient in the PICU with the prevention of skin breakdown? 1. Using water-based skin moisturizers for dry skin 2. Keeping the child well oxygenated and well nourished 3. Changing positions at least every two hours 4. All of the above

4 (1. The intervention will help prevent skin breakdown. 2. Oxygenation and nutrition are important factors in prevention of skin breakdown. 3. Changing positions helps prevent the pressure points from developing breakdown. 4. The interventions listed all help to prevent skin breakdown of the hospitalized child.)

28. An in-service day for the pediatric nurses is focusing on the use of the Braden Q Scale. The nurses are given scenarios of when to use the scale. Which of the following situations would be an appropriate time to use the scale? 1. A child with a lack of mobility due to conscious sedation. 2. A child with a femur fracture who is refusing to eat anything but fast food. 3. A child who is physically handicapped and needs a two-person transfer from bed to wheelchair. 4. All would be appropriate times to use the Braden Q Scale.

4 (1. The patient is at risk due to immobility. 2. The patient is at risk due to poor nutrition. 3. The patient is at risk due to physical needs. 4. Correct. All are appropriate times to use the Braden Q Scale.)

24. When working in the ER, how does the nurse determine whether a burn was an intentional injury? 1. Consider that the incidence of unintentional burns is 5% to 25% as reported by the World Health Organization. 2. Consider if the history is compatible with the pattern of injury. 3. Consider the child's age and development. 4. All of the above

4 (1. The percentage of burn should be reviewed. 2. A history should be taken to identify if the pattern of injury is consistent. 3. The age of the child determines the size of the burn in proportion to the body. 4. All of the above considerations should be reviewed.)

21. A 17-year-old lifeguard presents to the health center with blistering of the skin on his back. What nursing interventions should you provide for him? 1. Cool baths and compresses 2. Additional fluids to prevent dehydration 3. Acetaminophen or Ibuprofen for pain 4. All of the above

4 (1. This will provide comfort to the area. 2. The teen is at risk for dehydration because of the amount of fluid being released from the burned skin. 3. The medication will help reduce inflammation to the area. 4. All of the above are appropriate for second-degree sunburns.)

33. Alternative therapies may be used to treat eczema in adolescents. Which of the following is considered an alternative therapy? 1. Vitamin A 2. Vitamin B 3. Zinc 4. Calcium

4 (1. Vitamin A does not demonstrate effectiveness with eczema in adolescents. 2. Vitamin B does not demonstrate effectiveness with eczema in adolescents. 3. Zinc does not demonstrate effectiveness with eczema in adolescents. 4. Calcium is known to help reduce eczema in adolescents.)

8. The mother of an infant tells you how she has been treating the infant's scalp. Which answer demonstrates that she needs education regarding care? 1. Washing the baby's hair once a week 2. Using an anti-seborrheic shampoo 3. Applying baby oil, and then gently brushing the scalp 4. Choices 2 and 3

4 (1. Washing of the hair needs to occur more often to reduce the dirt and oil. 2. Washing the baby's scalp daily with seborrheic shampoo would be appropriate. 3. Washing the baby's scalp daily would be appropriate. 4. Washing the baby's scalp daily with seborrheic shampoo would be appropriate. Washing the baby's scalp daily would be appropriate.)

53. The school nurse has a 6 year old enter the office with a laceration to the left leg. The area is bleeding profusely. The nurse's first reaction to the situation should be to: 1. Apply a sterile dressing and antibiotic ointment to the area. 2. Apply a band-aid. 3. Irrigate the wound with normal saline. 4. Use sterile gauze to apply pressure.

4 (1. Will be an important step, but is not the initial response needed 2. Depending on the size of the wound, a band-aid may not be appropriate. Also, it is not the initial response needed. 3. Cleansing the wound is important, but it is not the immediate need in this situation. 4. Stopping the bleeding is the priority nursing intervention.)

15. The mother of a 4-year-old with impetigo wants to know if she can still take the child to day care. The nurse's most appropriate response would be: 1. It is okay for her child to go to day care as long as there is no fever. 2. She can attend day care if you teach her hand washing. 3. She can attend day care as long as the lesions are covered. 4. She can attend day care as long as the lesions are crusted and removed, and she has been on antibiotics for 24 hours.

4 (Impetigo is contagious. Lesions should be crusted, removed, and treated with antibiotics for 24 hours. Impetigo is contagious when the lesions are open, so even hand washing will not prevent the spread of the germ.)

68. A nurse is teaching a mother and a 12-year-old boy how to apply topical steroid cream and emollients for eczema. Number the steps in the correct order. 1__ Leave on body for 10 minutes. 2__ Apply a thin layer of steroid cream. _3_ Wrap the area in plastic wrap or a damp towel. _4_ Apply emollient cream.

4, 1, 3, 2

65. A mother calls the pediatric triage nurse and states that her son has just burned his hand on a pot handle on the stove. The burn is superficial. The mother wants to know what she should do to help her son. The nurse is able to provide step-by-step instructions for the mother over the phone. Place these steps in order of occurrence. _1_ Watch for signs of infection. _2_ Apply Aloe Vera to the area. _3_ Perform hand hygiene. _4_ Soak the burn in cool water.

4, 3, 1, 2

67. The camp nurse is teaching the camp counselors how to give EpiPen Auto Injectors if they have a camper who has severe allergic reactions. The camp nurse knows that her teaching has been successful if the staff performs the procedure in the correct manner. Place the steps in the correct order. _1__ Count for 10 to 15 seconds when the epinephrine is being injected. __2_ Seek continued medical help. __3_ Remove the pen from its plastic carrying case. __4_ Press the black end of the pen at a 90 degree angle into the thigh. _5__ Press the black end harder for a pop to be heard and start counting. _6__ Grasp the pen in the fist. _7__ Remove the pen at a 90 degree angle. _8__ Massage the area. _9__ Dispose of the needle safely, and then put pen back in its plastic carrying case. 10__ Remove the gray cap.

6, 10, 1, 4, 5, 3, 7, 8, 9, 2

True/False 69. Dressing changes are no longer needed after epithelialization occurs.

T (Epithelization is the creation of skin, and thus does not need a dressing.)