Chapter 25 The Child with an Alteration in Tissue Integrity

The nurse is speaking with the mother of a child diagnosed with contact dermatitis from poison ivy. Which statement by the mother indicates a need for further education?

"As long as he takes a shower as soon as he gets inside, he shouldn't get this again." Prevention of contact dermatitis from poison ivy, oak or sumac, include wearing long pants and long sleeves on outings in the wood. If contact occurs, wash vigorously with soap and water within 10 minutes of contact. The plant's oil residue may be on clothes, pets, toys and other objects, so these must be washed well with soap and water. Ivy Block is the only preventative treatment approved by the US FDA. It is applied to the skin before exposure.

The nurse is caring for a mom and her baby on a postpartum unit. The mom states she has received advice not to use baby powder on newborns. She asks the nurse if this is true, and if so, why. Which nurse response is correct?

"Baby powder should not be used on newborns due to the risk of aspiration upon application." The use of baby powder containing "talc" or known as "talcum powder" can cause accidental aspiration, pneumonia, and death. Aspiration is predominantly caused when the baby receives a "puff of smoke" when the powder is shaken from the container directly onto the baby's skin. In addition, the use of talcum powder is abrasive and is considered to contribute to the pathogenesis of diaper dermatitis

The parents of a child diagnoses with atopic dermatitis ask the nurse, "My child has a skin disorder. I don't understand why a complete blood count (CBC) was ordered?" What is the appropriate response by the nurse?

"Eosinophils are a type of white blood cell that are often elevated with atopic dermatitis. These are part of the CBC and helps in making the diagnosis." Atopic dermatitis is a type of allergic skin disorder, not a bacterial infection, in which the eosinophil count is often elevated. This is one test that will help in diagnosing the disorder.

The nurse is caring for a 13-year-old girl with acne vulgaris and is teaching the girl about skin care. Which response by the girl indicates a need for further teaching? a) "I should use a humectant moisturizer." b) "I should avoid eating any kind of chocolate." c) "I must use my medicine daily so that it will work." d) "It is best to avoid hats and headbands."

"I should avoid eating any kind of chocolate." Explanation: Ingestion of chocolate has not been proven to contribute to the incidence or severity of acne. Adhering to the medication regimen, using a humectant moisturizer, and avoiding hats and headbands would be appropriate.

A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful? a) "I should not cover the area with plastic wrap after applying the cream." b) "I need to shake the preparation before using it." c) "I should use the highest-potency steroid cream I can find." d) "I should apply the medicine at bedtime and rinse it off in the morning."

"I should not cover the area with plastic wrap after applying the cream." Correct Explanation: An occlusive dressing such as plastic wrap over the area should not be used with topical corticosteroids. High-potency preparations should not be used. There is no need to shake topical corticosteroids. Benzoyl peroxide requires shaking before use. Applying the medication at night and rinsing off in the morning is used for coal tar preparations.

The nurse is caring for a child with an order for PO prednisone. Which statement by the child's mother would indicate a need for further education?

"I will give it to her at least 1 hour before all of her meals." Systemic corticosteroids such as prednisone should be administered with food to decrease GI upset. These medications may mask signs of infection. This medication may increase blood sugar levels. Corticosteroid doses should be tapered and should not be stopped abruptly.

When doing teaching with a group of caregivers of infants, the nurse is discussing the topic of diaper rash. The caregivers in the group make the following statements. Which statement is the most accurate related to the child with diaper rash.

"My child gets diaper rash if I wash her clothes in the same detergent we use for the family." Infants may have a sensitivity to some soaps or disposable diaper perfumes, and the use of strong laundry detergents without thorough rinsing can cause diaper rash. Diarrheal stools, prolonged exposure to wet or soiled diapers, use of plastic or rubber pants, infrequently changed disposable diapers, inadequate cleansing of the diaper area (especially after bowel movements), and yeast infections are also causative factors. Exposing the diaper area to the air helps clear up the dermatitis. The use of baby powder when diapering is discouraged because caked powder helps create an environment in which organisms thrive.

A child has an order for an erythrocyte sedimentation rate (ESR). The child's mother asks what the purpose of the test is. What is the best response by the nurse?

"This test will tell if your child has an infection or inflammation somewhere in their body." Erythrocyte sedimentation rate (ESR) is a nonspecific test used to detect the presence of infection or inflammation.

A 6-year-old child is diagnosed with tinea capitis and treatment is initiated. The nurse instructs the parents to have the child return to school within which time frame? a) 24 hours b) 5 days c) 1 week d) 72 hours

1 week Explanation: Once treatment is initiated for tinea capitis, the child can return to school or day care after 1 week.

The dermatologist treating a 16-year-old girl with a history of severe acne has ordered a pregnancy test so she can be started on a course of isotretinoin. The teen's caregiver has said that her daughter is a virgin and she refuses to allow her to have the required pregnancy testing. Which of the following would be the best action for the nurse to take? The nurse should a) Acknowledge the caregiver's discomfort about the pregnancy testing but encourage her to allow the daughter to have the testing so that she can use the medication b) Have the caregiver sign a permission form acknowledging that the girl has been given the drug without pregnancy testing c) Speak with the teen alone to ask her if she is sexually active. If she says she is not sexually active, let the provider know that it is okay to write the prescription d) Arrange for the daughter to have the pregnancy testing without the caregiver's knowledge

Acknowledge the caregiver's discomfort about the pregnancy testing but encourage her to allow the daughter to have the testing so that she can use the medication Explanation: Isotretinoin is a pregnancy category X drug: It must not be used at all during pregnancy because of serious risk of fetal abnormalities. To rule out pregnancy, a urine test is done before beginning treatment. For the sexually active adolescent girl, an effective form of contraception must be used for a month before beginning and during isotretinoin therapy. The risk to the fetus, should pregnancy occur, should be discussed with the girl whether she is sexually active or not.

The nurse is caring for a 6-year-old patient brought into the emergency department for burns from a house fire. The nurse notes burn areas surrounding the patient's nose and mouth upon initial assessment. Which of the following priority complications should the nurse be alerted to? a) Airway obstruction related to upper respiratory swelling b) Nutritional requirements increased c) One third area of fluid leakage resulting in hypovolemic shock d) Presence of an ileus

Airway obstruction related to upper respiratory swelling Correct Explanation: Airway obstruction related to swelling is a priority complication to be alert for when signs of inhalation injury such as burns on the mouth and nose are present. Presence of an ileus, increased nutritional requirements, and hypovolemic shock are all complications of burns; however, airway obstruction is the priority.

A school-age child is brought to the office of the camp nurse with a small, superficial burn. Which of the following actions by the nurse would be the most appropriate action for the nurse to do first? a) Apply cold compresses to the area b) Apply a topical anesthetic ointment c) Cover the area with a sterile bandage d) Administer acetaminophen

Apply cold compresses to the area Explanation: Cool water is an excellent emergency treatment for burns involving small areas. The immediate application of cool compresses or cool water to burn areas appears to inhibit capillary permeability and thus suppress edema, blister formation, and tissue destruction.

In working with infants diagnosed with atopic dermatitis, the nurse anticipates that when these children are older they will likely have a tendency to have which disorder?

Asthma Infants who have eczema tend to have allergic rhinitis or asthma later in life.

The nurse is caring for a child admitted with partial thickness burns. What is most characteristic of this type of burn?

Blisters appear In partial-thickness or second-degree burns, blistering usually occurs with an escape of body plasma.

The nurse is caring for a child admitted with partial thickness burns. Which of the following is most characteristic of this type of burn? a) Pain is minimal b) Blisters appear c) Muscle damage occurs d) Skin is red and edematous

Blisters appear Correct Explanation: In partial-thickness or second-degree burns, blistering usually occurs with an escape of body plasma.

The nurse is caring for a patient brought to a pediatric clinic for swelling in the lower extremities with reddened skin that has undefined borders and pits slightly when pressed. Which of the following is the most likely diagnosis of the patient's skin alteration? a) Cat scratch disease b) Impetigo c) Cellulitis d) Staphylococcal scalded skin syndrome

Cellulitis Correct Explanation: Cellulitis is characterized by reddened or lilac-colored swollen skin that pits when pressed by the fingertips. Impetigo has superficial lesions that can be bulbous or nonbulbous. SSSS involves bullae that enlarge and rupture, leaving a red, scalded-looking lesion. Cat scratch disease involves a benign, subacute, chronic course of lymphadenopathy that usually resolves spontaneously in 2 to 3 months.

The nurse is taking a health history of a 6-year-old girl with suspected Stevens-Johnson syndrome. During the physical examination, the nurse would expect to note which of the following physical findings? a) Red, raised hair follicles b) Erythema multiforme with inflammatory bullae of at least two types of mucosa c) Fiery red lesions, scaling in the skin folds, and satellite lesions d) Red macules and bullous eruptions on an erythematous base

Erythema multiforme with inflammatory bullae of at least two types of mucosa Explanation: Stevens-Johnson syndrome rash involves erythema multiforme with the addition of inflammatory bullae of at least two types of mucosa. Fiery red lesions, scaling in the skin folds, and satellite lesions are associated with diaper candidiasis. Red macules and bullous eruptions on an erythematous base are common skin findings for bullous impetigo. Red, raised hair follicles are indicative of folliculitis.

The nurse is assessing a child who pulled a boiling pot of soup off of the stove top. The child reports pain at a 9 on a scale of 0 to 10. The burn is red and edematous, and also shows areas of charred skin. The nurse is aware that these signs and symptoms are indicative of what kind of burn?

Full-thickness Full-thickness burns may be very painful or numb or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin.

Tinea is also called ringworm. The nurse knows that tinea is which type of infection?

Fungal infections Fungi that live in the outer (dead) layers of the skin, hair, and nails can develop into superficial infections. Tinea (ringworm) is the term commonly applied to these infections.

The term tinea is also called ringworm and it is applied to which of the following? a) Bacterial infections b) Sexually transmitted infections c) Fungal infections d) Contagious infections

Fungal infections Correct Explanation: Fungi that live in the outer (dead) layers of the skin, hair, and nails can develop into superficial infections. Tinea (ringworm) is the term commonly applied to these infections.

Which of the following accurately depicts the hemodynamic changes that occur in the body within the first 24 to 48 hours after a burn? a) Hematocrit increases and WBC count decreases b) Hematocrit and WBC counts elevate c) Hemoglobin and WBC counts decrease d) Hematocrit and WBC counts decrease

Hematocrit and WBC counts elevate Explanation: In the first 24 to 48 hours after a burn, the hematocrit will often be elevated secondary to fluid loss and the WBC may also be elevated as an acute-phase reaction, which later could indicate infection.

The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children. Which of the following disorders is the nurse most likely referring to? a) Impetigo b) Miliaria rubra c) Candidiasis d) Seborrheic dermatitis

Impetigo Correct Explanation: Impetigo is a superficial bacterial skin infection.

An adolescent girl is going to be treated for a severe case of acne vulgaris. A pregnancy test should be done prior to the adolescent starting treatment with which of the following? a) Tretinoin (Retin-A) b) Isotretinoin (Accutane) c) Erythromycin d) Benzoyl peroxide (Clearasil)

Isotretinoin (Accutane) Explanation: Isotretinoin is a pregnancy category X drug: it must not be used at all during pregnancy because of serious risk of fetal abnormalities.

The nurse is conducting a physical examination of a boy with erythema multiforme. Which assessment finding should the nurse expect?

Lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk Erythema multiforme typically manifests in lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk. Thick or flaky/greasy yellow scales are signs of seborrhea. Silvery or yellow-white scale plaques and sharply demarcated borders define psoriasis. Superficial tan or hypopigmented oval-shaped scaly lesions specially on upper back and chest and proximal arms are indicative of tinea versicolor.

A nurse is caring for a burn patient with second and third degree burns on 15% of the body. The patient is complaining of severe itching in and around the burn sites. Which of the following is the best nursing intervention to relieve this symptom? a) Soaking in a colloidal bath b) Medication c) Diversional activities d) Turning the patient every two hours

Medication Explanation: As nerve endings heal they cause intense itching that can be relieved with the use of medications. Turning the patient every two hours will not relieve the itching. Soaking in a colloidal bath in contraindicated with burn patients. Diversional activities will not be effective when attempting to relieve itching.

The nurse is caring for a pediatric patient in the emergency department with moderate hypothermia and frostbite. Which of the following is the most beneficial nursing intervention for this patient? a) Apply dry heat to the extremities. b) Place heating pads and warmed blankets on the trunk of the body initially. c) Place heating pads and warmed blankets on the patient's extremities and trunk. d) Rub the frostbitten extremities to increase circulation to the affected area.

Place heating pads and warmed blankets on the trunk of the body initially. Correct Explanation: The trunk of a person should be warmed first with moderate hypothermia. Warming the extremities and trunk at the same time can cause a condition where the core body temperature drops due to the returning cold blood from the extremities. Dry heat should not be applied to a patient with hypothermia and frostbite. Rubbing a frostbitten area may cause further damage and should be avoided.

An 8-year-old child requires wet dressings four times a day as treatment for a skin disorder. What would be most important for the nurse to do?

Premedicate the child before changing the dressing. Premedicating the child before changing the dressing is crucial to providing atraumatic care

A nurse is caring for a child with tinea pedis. Which assessment finding should the nurse expect?

Red scaling rash on soles and between the toes Tinea pedis presents with red scaling rash on soles, and between the toes. Tinea capitis presents with patches of scaling in the scalp with central hair loss and the risk of kerion development (inflamed boggy mass filled with pustules). Tinea cruris presents with erythema, scaling, maceration in the inguinal creases and inner thighs

The nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at doing which of the following? a) Managing pain and discomfort b) Reducing swelling and relieving itching c) Controlling nausea and vomiting d) Regulating skin and body temperature

Reducing swelling and relieving itching Correct Explanation: Treatment for skin allergies is aimed at reducing the swelling and relieving the itching. With swelling in various parts of the body, the child may have pain, nausea and vomiting, but reducing the swelling would prevent those symptoms from occurring.

The nurse is examining a child for indications of frostbite and notes blistering with erythema and edema. The nurse notes which degree of frostbite?

Second degree frostbite Second degree frostbite demonstrates blistering with erythema and edema. First degree frostbite results in superficial white plaques with surrounding erythema. In third degree frostbite, the nurse would note hemorrhagic blisters that would progress to tissue necrosis and sloughing when the fourth degree is reached.

The client is scheduled to have potassium hydroxide testing performed. What will be needed to complete this test?

Skin scrapings Potassium hydroxide (KOH) testing is done to assess for the presence of a fungal infection. Skin scrapings are placed on a microscope slide and a drop of KOH 20% drop is added.

The nurse admits a child who has sustained a severe burn. The child's immunizations are up to date. Which immunization would the child most likely be given at this time?

Tetanus toxoid vaccine If inoculations are up to date, a booster dose of tetanus toxoid is required to protect the child from infection introduced into the burn.

The nurse is caring for a 2-year-old boy with a burn. Which of the following findings would warrant referral to a burn unit? a) The boy has a superficial burn on his hands. b) The boy has suffered a chemical burn. c) The boy has a first-degree burn on the upper arm. d) The boy has a superficial burn on his chest.

The boy has suffered a chemical burn. Correct Explanation: According to the Committee on Trauma of the American College of Surgeons, chemical burns warrant referral to a burn unit. A partial-thickness burn greater than 10% of the body surface area would warrant a referral to a burn unit. A superficial burn on the chest or hands does not warrant a referral to a burn unit. A first-degree burn would most likely be classified as a superficial burn, which would not warrant a referral to a burn unit.

The nurse is caring for a 10-year-old male patient in a pediatric clinic with presenting symptoms of small circular patches of hair loss on the scalp. Which of the following skin conditions does the patient most likely have? a) Tinea corporis b) Tinea capitis c) Tinea cruris d) Tinea faciei

Tinea capitis Explanation: Tinea capitis is a fungal infection of the scalp that causes circular patches of hair loss. Tinea faciei is a fungal infection of the face; tinea cruris is a fungal infection of the inner thighs and inguinal creases; and tinea corporis is a fungal infection located on the entire body.

When assessing an adolescent for acne, which of the following would lead the nurse to identify the acne as severe? Select all that apply. a) Presence of nodules b) Widespread inflammatory lesions c) Comedones d) Facial papules e) Evidence of cysts

• Widespread inflammatory lesions • Evidence of cysts • Presence of nodules Explanation: Severe acne is characterized by comedones plus inflammatory lesions such as papules or pustules that are widespread and/or the presence of cysts or nodules and possibly scarring. Comedones are associated with mild acne. Papules localized to the face or back are associated with moderate acne.

The nurse is caring for a mom and her baby on a postpartum unit. The mom states she has received advice not to use baby powder on newborns. She asks the nurse if this is true, and if so, why. Which of the following nurse responses is correct? a) "Baby powder should not be used on newborns due to the risk of aspiration upon application." b) "Baby powder can be used anytime with no concerns." c) "Baby powder may be used if sprinkled on your hand away from the baby to prevent aspiration." d) "Baby powder should not be used since so many people are allergic to the ingredients in it."

"Baby powder should not be used on newborns due to the risk of aspiration upon application." Correct Explanation: The use of baby powders containing "talc" or known as "talcum powder" can cause accidental aspiration, pneumonia, and death. Aspiration is predominantly caused when the baby receives a "puff of smoke" when the powder is shaken from the container directly onto the baby's skin. In addition, the use of talcum powder is abrasive and is considered to contribute to the pathogenesis of diaper dermatitis.

A nurse assessing a 6-month-old girl with an integumentary disorder. The nurse notes three virtually identically sized, round red circles with scaling that are symmetrically spaced on both of the girl's inner thighs. Which should the nurse ask the mother?

"Does she wear sleepers with metal snaps?" Small round red circles with scaling, symmetrically located on the girls' inner thighs point to nickel dermatitis that may occur from contact with jewelry, eyeglasses, belts, or clothing snaps. The nurse should inquire about any sleepers or clothing with metal snaps. The girl does not have a rash in her diaper area. It is unlikely that an infant this age would have her inner thighs exposed to a highly allergenic plant. Discussing family allergy history is important, but the nurse should first inquire about any clothing with metal that could have come into contact with the girl's skin when she displays a symmetrical rash.

The parents of an 8-year-old boy diagnosed with frostbite are distraught and state to the nurse, "We can't believe we didn't make our child come inside when he complained about his fingers being numb and hurting." How should the nurse respond?

"I can't imagine how you are feeling right now, but I'm sure you had no idea frostbite could happen. We will take good care of your son." The unintentional injury has already occurred so the nurse must be compassionate and supportive of the parents. The other options are judgmental and do not serve a purpose. Instruction can be given with teaching to prevent future incidents when the parents are ready for teaching.

An adolescent is prescribed isotretinoin. Which of the following indicates that the adolescent understands the necessary precautions associated with this drug? a) "This drug can affect my lungs so I need a chest radiograph done first." b) "The drug might cause staining of my clothing." c) "I have to make sure that I do not become pregnant while taking this drug." d) "I'm going to have to have a blood count done every couple of months."

"I have to make sure that I do not become pregnant while taking this drug." Correct Explanation: Adolescent girls taking this drug who are sexually active must be on a pregnancy prevention program because the drug causes defects in fetal development. Monthly complete blood counts are required when taking isotretinoin. Isotretinoin is not associated with lung problems, so a chest radiograph is not necessary. Coal tar preparations are associated with staining of the clothing or fabrics. Isotretinoin does not stain clothes or fabrics.

The nurse is caring for an infant with diaper dermatitis. Which statement by the child's parent would indicate a need for further education?

"I will use rubber pants over the cloth diapers in the future." Prevention and management of diaper dermatitis includes avoiding rubber pants, avoiding diaper wipes with fragrance or preservatives. Treatment of a rash includes allowing the child to go diaperless for a period of time each day and using a warm blow dryer on the area for 3 to 5 minutes.

When doing teaching with a group of caregivers of infants the nurse is discussing the topic of diaper rash. The caregivers in the group make the following statements. Which statement is the most accurate related to the child with diaper rash. a) "The formula she drinks sometimes causes her to have a diaper rash." b) "Sometimes if I leave the diaper off and let him be in the sunshine he gets diaper rash." c) "My child gets diaper rash if I wash her clothes in the same detergent we use for the family." d) "They told me to use baby powder every time I change her so she won't get diapter rash."

"My child gets diaper rash if I wash her clothes in the same detergent we use for the family." Explanation: Infants may have a sensitivity to some soaps or disposable diaper perfumes, and the use of strong laundry detergents without thorough rinsing can cause diaper rash. Diarrheal stools, prolonged exposure to wet or soiled diapers, use of plastic or rubber pants, infrequently changed disposable diapers, inadequate cleansing of the diaper area (especially after bowel movements), and yeast infections are also causative factors. Exposing the diaper area to the air helps clear up the dermatitis. The use of baby powder when diapering is discouraged because caked powder helps create an environment in which organisms thrive.

The nurse is caring for a child brought to the emergency department by the parents. Upon assessment the physician suspects the child has been bitten by a spider. While obtaining the nursing history of the present condition, which statement by the parent will require clarification from the nurse?

"Since my child just has a rash around the area of the bite there is nothing to worry about." A rash does could be an indication of a systemic reaction and the child should be monitored closely for other signs of a systemic, or possible anaphylactic, reaction. Protective clothing for prevention of insect or spider bites, cleansing the wound to help with infection control, and ice for prevention of swelling are all effective actions.

The nurse is discussing acne vulgaris with a group of adolescents. The teenagers make the following statements regarding the topic. Which statement is the most accurate regarding acne vulgaris? a) "My mom says I have acne because I eat too much chocolate." b) "My next door neighbor told me that acne was caused by a fungus." c) "There is a new immunization that you can get to keep from having acne." d) "Sometimes I get acne when I use my sister's makeup."

"Sometimes I get acne when I use my sister's makeup." Correct Explanation: Irritation and irritating substances, such as vigorous scrubbing and cosmetics with a greasy base, can cause acne vulgaris. Increased hormone levels, hereditary factors, and anaerobic bacteria can cause acne vulgaris as well. Eating chocolate and fatty foods does not cause acne, but a well-balanced, nutritious diet does promote healing.

The nurse is caring for a 2-month-old in a pediatric clinic. The mom states she is going on vacation in Florida in a month and she is concerned about sunburn. She asks if it is okay to use a sunscreen lotion made for children. What is the correct nursing response?

"Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun." Do not use sunscreens on children younger than 6 months of age. Instead, use hats, bonnets, and light-colored clothes to shield the skin, and keep the infant away from direct exposure to the sun. Telling the mother not to take the infant to Florida is inappropriate.

The nurse is caring for a 2-month-old patient in a pediatric clinic. The mom states she is going on vacation in Florida in a month and she is concerned about sunburn. She asks if it is okay to use a sunscreen lotion made for children. Which of the following is the correct nursing response? a) "Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun." b) "You should not take your infant to Florida." c) "Put plenty of children's sunscreen on the infant at least 15 minutes before going outdoors, then reapply every three to four hours." d) "It is okay to use a children's sunscreen as long as you avoid the face."

"Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun." Explanation: Do not use sunscreens on children younger than 6 months of age. Instead, use hats, bonnets, and light-colored clothes to shield the skin, and keep the infant away from direct exposure to the sun. Telling the mother not to take the infant to Florida is inappropriate.

An 8-month-old has been diagnosed with infantile eczema. At a follow-up appointment, the child's caregiver seems exhausted and angry. He explains that he has done all of the child's care because his wife is repulsed by the child's raw and uncomfortable appearance. What responses would be appropriate for the nurse to say to this caregiver?

"That's not an uncommon reaction, although it's hard on you and on your child." The family caregivers of the child with eczema are often frustrated and exhausted. Family caregivers may feel apprehensive or repulsed by this unsightly child. Support them in expressing their feelings and help them view this as a distressing but temporary skin condition. Although the caregiver can be assured that most cases of eczema clear up by the age of 2, this does little to relieve the present situation

An 8-month-old has been diagnosed with infantile eczema. At a follow-up appointment, the child's caregiver seems exhausted and angry. He explains that he has done all of the child's care because his wife is repulsed by the child's raw and uncomfortable appearance. Which of the following responses would be appropriate for the nurse to say to this caregiver? a) "That's not an uncommon reaction, although it's hard on you and on your child." b) "He will be better soon and your family can get back to normal." c) "I understand her feelings. It is hard to see a child in pain sometimes." d) "That's not fair to you; she should get some counseling to learn how to cope with illness better."

"That's not an uncommon reaction, although it's hard on you and on your child." Correct Explanation: The family caregivers of the child with eczema are often frustrated and exhausted. Family caregivers may feel apprehensive or repulsed by this unsightly child. Support them in expressing their feelings and help them view this as a distressing but temporary skin condition. Although the caregiver can be assured that most cases of eczema clear up by the age of 2, this does little to relieve the present situation.

The nurse is reviewing the integumentary system during a presentation to a group of nurses. Which statements made by the nurse is the most accurate regarding the integumentary system?

"The largest organ of the body helps regulate body temperature." The skin is the largest organ of the body. The skin helps regulate the body temperature by heating and cooling. The sebaceous and sweat glands are not fully functional until middle childhood. The major role of the skin is to protect the organs and structures of the body against bacteria, chemicals, and injury. Excretion in the form of perspiration is also a function of the skin glands, called the sweat glands. Sebaceous glands in the skin secrete oils to lubricate the skin and hair. The integumentary system is in place at birth, but the system is immature. A function of the respiratory system is to distribute oxygen to body cells.

The nurse is reviewing the integumentary system during a presentation to a group of nurses. Which of the following statements made by the nurses is the most accurate regarding the integumentary system? a) "The accessory structures of the integumentary system include the sebaceous or sweat glands." b) "The integumentary system is not in place until after the child is born and then takes many years to mature." c) "The largest organ of the integumentary system helps regulate body temperature." d) "One role of the integumentary system is to distribute oxygen to the body cells."

"The largest organ of the integumentary system helps regulate body temperature." Explanation: The skin is the major organ of the integumentary system and is the largest organ of the body. The skin helps regulate the body temperature by heating and cooling. Accessory structures such as the hair and nails also make up the integumentary system. The major role of the skin is to protect the organs and structures of the body against bacteria, chemicals, and injury. Excretion in the form of perspiration is also a function of the skin glands, called the sweat glands. Sebaceous glands in the skin secrete oils to lubricate the skin and hair. The integumentary system is in place at birth, but the system is immature. A function of the respiratory system is to distribute oxygen to body cells.

The nurse is caring for a 12-year-old patient in a pediatric clinic at a wellness checkup. The patient complains of embarrassing dandruff and asks the nurse what can be done for it. Which of the following is the best nursing response after a quick scalp assessment confirms the presence of dandruff? a) "Apply a corticosteroid cream to your scalp at night." b) "Wash your hair with an antiseborrheic shampoo daily." c) "Wear light-colored clothing so the flakes aren't noticeable." d) "Wash your hair vigorously twice a day for one week."

"Wash your hair with an antiseborrheic shampoo daily." Correct Explanation: In the older child and adolescent, an antiseborrheic shampoo should be used daily to control scaling caused by dandruff. Common names for these shampoos include Sebulex, Selsun Blue, and Head and Shoulders. Corticosteriod creams can be applied two to four times a day for severe cases. Washing hair vigorously twice a day is not recommended. Light-colored clothing is a good suggestion; however, it is not an intervention to control the prevalence of dandruff.

The nurse is teaching the parents of a 6-year-old who has sustained a large laceration about providing care to the wound at home. The nurse determines that the parents need additional teaching when they state which of the following? a) "If our son starts telling us that the pain is increasing, we need to have it checked out." b) "We should call the doctor if the wound becomes red and hot looking." c) "We need to keep the wound tightly bandaged for at least 3 days." d) "If we notice some yellowish drainage, we need to call the doctor."

"We need to keep the wound tightly bandaged for at least 3 days." Correct Explanation: If a wound is large, it can be covered by a loose dressing, which is changed in about 12 hours and redressed after the wound is cleaned. The wound is then left open to the air after 24 hours have passed from the time of the injury. A wound that is red and hot looking or one with yellowish drainage or increased pain suggests infection, which needs to be evaluated by the practitioner.

The nurse is providing teaching on ways to maintain skin integrity and prevent infection for the parents of a boy with atopic dermatitis. Which response indicates a need for further teaching?

"We should avoid using petroleum jelly." It is important to apply moisture multiply times through the day. Petroleum jelly is a recommended moisturizer that is inexpensive and readily available.

A nurse providing teaching on ways to promote skin hydration for the parents of an infant with atopic dermatitis. Which response indicates a need for further teaching?

"We should bathe our child in hot water, twice a day." The nurse should emphasize that the parents should avoid hot water. The child should be bathed twice a day in warm water.

The nurse is caring for a 1-week-old child with a feeding intolerance. The mother expresses a concern with white scales that have began to flake off the infant's scalp and she asks the nurse what she can do to prevent this. What is the best nursing response?

"Your child most likely has infantile seborrheic dermatitis, or cradle cap. You can care for it by cleansing the hair and scalp daily with baby shampoo. You can also apply baby oil to the area for 10 to 15 minutes and then rinse away the flakes." Infantile seborrheic dermatitis usually responds well to cleansing the scalp with a mild shampoo. The thick, scaling lesions on the child's scalp can be treated by applying baby oil, salicylic acid in mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft toothbrush; then the scales can be rinsed away. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Accusing a parent of poor hygiene is inappropriate. Infantile seborrheic dermatitis is not a result of poor hygiene

The nurse is caring for a 1-week-old child with a feeding intolerance. The mother expresses a concern with white scales that have began to flake off the infant's scalp and she asks the nurse what she can do to prevent this. Which of the following is the best nursing response? a) "How often do you bathe your infant? The infant should have a thorough shampooing every day to prevent things like this." b) "Your child most likely has infantile seborrheic dermatitis, or cradle cap. You can care for it by cleansing the hair and scalp daily with baby shampoo. You can also apply baby oil to the area for 10 to 15 minutes and then rinse away the flakes." c) "Your child most likely has dandruff. You can treat it with daily with antiseborrheic shampoo." d) "Your child most likely has infantile seborrheic dermatitis, or cradle cap. There is no intervention needed and it should resolve in one week."

"Your child most likely has infantile seborrheic dermatitis, or cradle cap. You can care for it by cleansing the hair and scalp daily with baby shampoo. You can also apply baby oil to the area for 10 to 15 minutes and then rinse away the flakes." Correct Explanation: Infantile seborrheic dermatitis usually responds well to cleansing the scalp with a mild shampoo. The thick, scaling lesions on the child's scalp can be treated by applying baby oil, salicylic acid in mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft toothbrush; then the scales can be rinsed away. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Accusing a parent of poor hygiene is inappropriate. Infantile seborrheic dermatitis is not a result of poor hygiene.

The nurse is caring for a child with suspected child abuse-induced burns. Which assessment findings would support this?

A burn to the entire right hand up to 2 cm above wrist with consistent edges A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water) is one sign is one sign of child abuse-induced burns. Inconsistent history given by caregivers, delay in seeking treatment by caregivers and a lack of splattering of water burns are all indicators of child abuse-induced burns.

The nurse is caring for a 2-year-old boy with a burn. What finding would warrant referral to a burn unit?

A chemical burn According to the American Burn Association, chemical burns warrant referral to a burn unit. A partial-thickness burn greater than 10% of the body surface area would warrant a referral to a burn unit. A superficial burn on the chest or hands does not warrant a referral to a burn unit. A first-degree burn would most likely be classified as a superficial burn, which would not warrant a referral to a burn unit.

A group of teenage boys have just gotten on the basketball team and will be showering in the school's locker room after practice. What suggestions should the school nurse provide to these adolescents to decrease the chance of contracting athlete's foot (tinea pedis)? Select all that apply. A. Bring your own soap and towel, and don't share them with others. B. Dry your feet completely. C. Wear your practice shoes home. D. Change your socks every other day when not practicing. E. Use talcum powder or antifungal powder to keep your feet dry. F. Make sure your shoes are thoroughly dry before wearing them.

A, B, E, F Bringing their own soap and towel and not sharing them with others is necessary. They should dry their feet completely. Fungus likes moist, dark areas. Talcum powder or antifungal powder to keep feet dry as prevention of athlete's foot is appropriate. It is essential that their shoes be thoroughly dry before wearing them. They should not wear their practice shoes home because of the sweat moisture and the fact that their feet were just washed and dried. This would undo the positive actions the adolescents have taken. Changing socks every other day when not practicing is not often enough because of foot sweat and darkness. Socks should be changed at least daily.

The nurse is caring for a 12-year-old boy who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that boy is "very brave" and appears to accept pain with little or no response. Based on the nurse's knowledge of burns, pain, and age-specific development, what is the most appropriate nursing action? A. Talk with the health care provider about the possibility of requesting a psychological consultation. B. Spend time with the child to better understand why he doesn't seem to respond to pain. C. Praise the child frequently for his ability to deal with the pain. D. Encourage continued bravery as a coping strategy.

A. Talk with the health care provider about the possibility of requesting a psychological consultation. A psychological consultation will assist the child to verbalize fears. This age group is concerned with physical appearance. The psychologists can help integrate the issues that the child is facing. The nurse would talk with the health care provider and share the observations about this child, but ultimately the health care provider would be the one to decide if a consult is warranted. Further assessment is needed, but this child would probably benefit from the psychologist. It is likely that the child is having pain but not acknowledging it. If the child is feeling pain, the nurse should not praise him for hiding it. The nurse must act as an advocate and keep the child as comfortable as possible. Encouraging bravery may not be an effective coping strategy if the child is in severe pain.

A new mother calls the pediatrician's office concerned because her newborn has developed a salmon colored, irregularly shaped spot between the eyes. The lesion becomes darker when the baby is crying. This skin lesion is called a(n) ____________.

ANS: salmon patch The nurse can reassure the mother that salmon patches are commonly known as "stork bites" or "angel kisses." These lesions are benign and usually fade during the first year of life. The only treatment necessary is parental education.

The management of a child who has just been stung by a bee or wasp should include the application of a. Cool compresses b. Warm compresses c. Antibiotic cream d. Corticosteroid cream

ANS: A Feedback A Bee or wasp stings are initially treated by carefully removing the stinger, cleansing with soap and water, application of cool compresses, and the use of common household agents such as lemon juice or a paste made with aspirin and baking soda. B Warm compresses are avoided. C Antibiotic cream is unnecessary unless a secondary infection occurs. D Corticosteroid cream is not part of the initial therapy. If a severe reaction occurs, systemic corticosteroids may be indicated.

What nursing assessment and care holds the highest priority in the initial care of a child with a major burn injury? a. Establishing and maintaining the child's airway b. Establishing and maintaining intravenous access c. Inserting a catheter to monitor hourly urine output d. Inserting a nasogastric tube into the stomach to supply adequate nutrition

ANS: A Feedback A Establishing and maintaining the child's airway is always the priority focus for assessment and care. B Establishing intravenous access is the second priority in this situation, after the airway has been established. C Inserting a catheter and monitoring hourly urine output is the third most important nursing intervention. D Nasogastric feedings are not begun initially on a child with major or severe burns. The initial assessment and care focus for a child with major burn injuries is the ABCs.

Impetigo ordinarily results in a. No scarring b. Pigmented spots c. Slightly depressed scars d. Atrophic white scars

ANS: A Feedback A Impetigo tends to heal without scarring unless a secondary infection occurs. B Hyperpigmentation may occur; however, only in dark skinned children. C No scarring usually occurs. D No scarring usually occurs

When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of a. Asthma b. Nephrosis c. Lower respiratory tract infections d. Neurotoxicity

ANS: A Feedback A Most children with atopic dermatitis have a family history of asthma, hay fever, or atopic dermatitis, and up to 80% of children with atopic dermatitis have asthma or allergic rhinitis. B Complications of atopic dermatitis relate to the skin. The renal system is not affected by atopic dermatitis. C There is no link between lower respiratory tract infections and atopic dermatitis. D Atopic dermatitis does not have a relationship to neurotoxicity.

A child experiences frostbite of the fingers after prolonged exposure to the cold. Which intervention should the nurse implement first? a. Rapid rewarming of the fingers by placing in warm water b. Placing the hand in cool water c. Slow rewarming by wrapping in warm cloth d. Using an ice pack to keep cold until medical intervention is possible

ANS: A Feedback A Rapid rewarming is accomplished by immersing the part in well-agitated water at 37.8° C to 42.2° C (100° F to 108° F). B The frostbitten area should be rewarmed as soon as possible to avoid further tissue damage. C Rapid rewarming results in less tissue necrosis than slow thawing. D The frostbitten area should be rewarmed, as soon as possible, to avoid further tissue damage.

When changing an infant's diaper, the nurse notices small bright red papules with satellite lesions on the perineum, anterior thigh, and lower abdomen. This rash is characteristic of a. Primary candidiasis b. Irritant contact dermatitis c. Intertrigo d. Seborrheic dermatitis

ANS: A Feedback A Small red papules with peripheral scaling in a sharply demarcated area involving the anterior thighs, lower abdomen, and perineum are characteristic of primary candidiasis. B A shiny, parchment-like erythematous rash on the buttocks, medial thighs, mons pubis, and scrotum, but not in the folds, is suggestive of irritant contact dermatitis. C Intertrigo is identified by a red macerated area of sharp demarcation in the groin folds. It can also develop in the gluteal and neck folds. D Seborrheic dermatitis is recognized by salmon-colored, greasy lesions with a yellowish scale found primarily in skin-fold areas or on the scalp.

What should be included in teaching a parent about the management of small red macules and vesicles that become pustules around the child's mouth and cheek? a. Keep the child home from school for 24 hours after initiation of antibiotic treatment. b. Clean the rash vigorously with Betadine three times a day. c. Notify the physician for any itching. d. Keep the child home from school until the lesions are healed.

ANS: A Feedback A To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours after treatment is initiated. Good handwashing is imperative in preventing the spread of impetigo. B The lesions should be washed gently with a warm soapy washcloth three times a day. The washcloth should not be shared with other members of the family. C Itching is common and does not necessitate medical treatment. Rather, parents should be taught to clip the child's nails to prevent maceration of the lesions. D The child may return to school 24 hours after initiation of antibiotic treatment.

A nurse is teaching parents about prevention of diaper dermatitis. Which should the nurse include in the teaching plan? Select all that apply. a. Clean the diaper area gently after every diaper change with a mild soap. b. Use a protective ointment to clean dry intact skin. c. Use a steroid cream after each diaper change. d. Use rubber or plastic pants over the diaper. e. Wash cloth diapers in hot water with a mild soap and double rinse.

ANS: A, B, E Feedback Correct: Prompt, gentle cleaning with water and mild soap (e.g., Dove, Neutrogena Baby Soap) after each voiding or defecation rids the skin of ammonia and other irritants and decreases the chance of skin breakdown and infection. A bland, protective ointment (e.g., A&D, Balmex, Desitin, zinc oxide) can be applied to clean, dry, intact skin to help prevent diaper rash. If cloth diapers are laundered at home, the parents should wash them in hot water, using a mild soap and double rinsing. Incorrect: Occlusion increases the risk of systemic absorption of a steroid; thus steroid creams are rarely used for diaper dermatitis because the diaper functions as an occlusive dressing. Rubber or plastic pants increase skin breakdown by holding in moisture and should be used infrequently. A steroid cream is not recommended.

Where do the lesions of atopic dermatitis most commonly occur in the infant? Select all that apply. a. Cheeks b. Buttocks c. Extensor surfaces of arms and legs d. Back e. Trunk

ANS: A, C, E Feedback Correct: The lesions of atopic dermatitis are generalized in the infant. They are most commonly on the cheeks, scalp, trunk, and extensor surfaces of the extremities. Incorrect: These lesions are not typically on the back or the buttocks.

Which nursing assessment is applicable to the care of a child with herpetic gingivostomatitis? a. Comparison of range of motion for the upper and lower extremities b. Urine output, mucous membranes, and skin turgor c. Growth pattern since birth d. Bowel elimination pattern

ANS: B Feedback A An oral herpetic infection does not affect joint function. B The child with herpetic gingivostomatitis is at risk for deficient fluid volume. Painful lesions on the mouth make drinking unpleasant and undesirable, with subsequent dehydration becoming a real danger. C Herpetic gingivostomatitis is not a chronic disorder that would affect the child's long-term growth pattern. D Although constipation could be caused by dehydration, it is more important to assess urine output, skin turgor, and mucous membranes to identify dehydration before constipation is a problem.

Parents of a child with lice infestation should be instructed carefully in the use of antilice products because of which potential side effect? a. Nephrotoxicity b. Neurotoxicity c. Ototoxicity d. Bone marrow depression

ANS: B Feedback A Antilice products are not known to be nephrotoxic. B Because of the danger of absorption through the skin and potential for neurotoxicity, antilice treatment must be used with caution. A child with many open lesions can absorb enough to cause seizures. C Antilice products are not ototoxic. D Products that treat lice are not known to cause bone marrow depression.

Ringworm, frequently found in schoolchildren, is caused by a(n) a. Virus b. Fungus c. Allergic reaction d. Bacterial infection

ANS: B Feedback A These are not the causative organisms for ringworm. B Ringworm is caused by a group of closely related filamentous fungi, which invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin. C Ringworm is not an allergic response. D These are not the causative organisms for ringworm.

Rocky Mountain spotted fever is caused by the bite of a a. Flea b. Tick c. Mosquito d. Mouse or rat

ANS: B Feedback A These organisms do not transmit Rocky Mountain spotted fever. B Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas. C These organisms do not transmit Rocky Mountain spotted fever. D These organisms do not transmit Rocky Mountain spotted fever.

The depth of a burn injury may be classified as a. Localized or systemic b. Superficial, superficial partial thickness, deep partial thickness, or full thickness c. Electrical, chemical, or thermal d. Minor, moderate, or major

ANS: B Feedback A These terms refer to the effect of the burn injury. For example, is there a reaction in the area of the burn (localized) or throughout the body (systemic)? B The vocabulary to classify the depth of a burn is superficial, partial thickness, or full thickness. C These terms refer to the cause of the burn injury. D These terms refer to the severity of the burn injury.

What should the nurse teach an adolescent who is taking tretinoin (Retin-A) to treat acne? a. The medication should be taken with meals. b. Apply sunscreen before going outdoors. c. Wash with benzoyl peroxide before application. d. The effect of the medication should be evident within 1 week.

ANS: B Feedback A Tretinoin is a topical medication. Application is not affected by meals. B Tretinoin causes photosensitivity, and sunscreen should be applied before sun exposure. C If applied together, benzoyl peroxide and tretinoin have reduced effectiveness and a potentially irritant effect. D Optimal results from tretinoin are not achieved for 3 to 5 months.

The primary treatment for warts is a. Vaccination b. Local destruction c. Corticosteroids d. Specific antibiotic therapy

ANS: B Feedback A Vaccination is prophylaxis for warts and is not a treatment. B Topical treatments include chemical cautery, which is especially useful for the treatment of warts. Local destructive therapy individualized according to location, type, and number. Surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies are used. C These are not effective in the treatment of warts. D These are not effective in the treatment of warts.

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend a. Administering antihistamine b. Cleansing with soap and water c. Keeping child quiet and come to emergency department d. Removing stinger and apply cool compresses

ANS: C Feedback A Antihistamines are not effective against scorpion venom. B The wound will have intense local pain. Emergency treatment is indicated. C Venomous species of scorpions inject venom that contains hemolysins, endotheliolysins, and neurotoxins. The absorption of the venom is delayed by keeping the child quiet and the involved area in dependent position. D The wound will have intense local pain. Emergency treatment is indicated.

Treatment for herpes simplex virus (types 1 or 2) includes a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical and/or systemic antibiotic

ANS: C Feedback A Corticosteroids are not effective for viral infections. B Griseofulvin is an antifungal agent and not effective for viral infections. C Oral antiviral agents are effective for viral infections such as herpes simplex. D Antibiotics are not effective in viral diseases.

An important nursing consideration when caring for a child with impetigo contagiosa is to a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C Feedback A Corticosteroids are not indicated in bacterial infections. B Dressings are usually not indicated. The undermined skin, crusts, and debris are carefully removed after softening with moist compresses. C A major nursing consideration related to bacterial skin infections, such as impetigo contagiosa, is to prevent the spread of the infection and complications. This is done by thorough handwashing before and after contact with the affected child. D A Wood lamp is used to detect fluorescent materials in the skin and hair. It is used in certain disease states, such as tinea capitis.

To assess the child with severe burns for adequate perfusion, the nurse monitors a. Distal pulses b. Skin turgor c. Urine output d. Mucous membranes

ANS: C Feedback A Distal pulses may be affected by many variables. Urine output is the most reliable indicator of end-organ perfusion. B Skin turgor is often difficult to assess on burn patients because the skin is not intact. C Urine output reflects the adequacy of end-organ perfusion. D Mucous membranes do not reflect end-organ perfusion.

The primary clinical manifestation of scabies is a. Edema b. Redness c. Pruritus d. Maceration

ANS: C Feedback A Edema is not observed in scabies. B Redness is not observed in scabies. C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact. In the previously sensitized person, the response occurs within 48 hours. D Maceration is not observed in scabies.

What best describes a full-thickness (third-degree) burn? a. Erythema and pain b. Skin showing erythema followed by blister formation c. Destruction of all layers of skin evident with extension into subcutaneous tissue d. Destruction injury involving underlying structures such as muscle, fascia, and bone

ANS: C Feedback A Erythema and pain are characteristic of a first-degree burn or superficial burn. B Erythema with blister formation is characteristic of a second-degree or partial-thickness burn. C A third-degree or full-thickness burn is a serious injury that involves the entire epidermis and dermis and extends into the subcutaneous tissues. D A fourth-degree burn is a full-thickness burn that also involves underlying structures such as muscle, fascia, and bone.

With what beverage should the parents of a child with ringworm be taught to give griseofulvin? a. Water b. A carbonated drink c. Milk d. Fruit juice

ANS: C Feedback A Griseofulvin is insoluble in water. B Carbonated drinks do not contain fat, which aids in the absorption of griseofulvin. C Griseofulvin is insoluble in water. Giving the medication with a high-fat meal or milk increases absorption. D Fruit juice does not contain any fat; fat aids absorption of the medication.

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise the father to a. Apply warm compresses. b. Carefully scrape off stinger. c. Take child to emergency department. d. Apply a thin layer of corticosteroid cream.

ANS: C Feedback A Warm compresses increase the circulation to the area and facilitate the spread of the venom. B The black widow spider does not have a stinger. C The black widow spider has a venom that is toxic enough to be harmful. The father should take the child to the emergency department for immediate treatment. D Corticosteroid cream will have no effect on the venom.

A nurse is instructing parents on treatment of pediculosis (head lice). Which should the nurse include in the teaching plan? Select all that apply. a. Bedding should be washed in warm water and dried on a low setting. b. After treating the hair and scalp with a pediculicide, shampoo the hair with regular shampoo. c. Retreat the hair and scalp with a pediculicide in 7 to 10 days. d. Items that cannot be washed should be dry cleaned or sealed in plastic bags for 2 to 3 weeks. e. Combs and brushes should be boiled in water for at least 10 minutes.

ANS: C, D, E Feedback Correct: An over-the-counter pediculicide, permethrin 1% (Nix, Elimite, Acticin), kills head lice and eggs with one application and has residual activity (i.e., it stays in the hair after treatment) for 10 days. Nix crème rinse is applied to the hair after it is washed with a conditioner-free shampoo. The product should be rinsed out after 10 minutes. Incorrect: The hair should not be shampooed for 24 hours after the treatment. Even though the kill rate is high and there is residual action, retreatment should occur after 7 to 10 days. Combs and brushes should be boiled or soaked in antilice shampoo or hot water (greater than 60° C [140° F]) for at least 10 minutes. Advise parents to wash clothing (especially hats and jackets), bedding, and linens in hot water and dry at a hot dryer setting.

What procedure is contraindicated in the care of a child with a minor partial-thickness burn injury wound? a. Cleaning the affected area with mild soap and water b. Applying antimicrobial ointment to the burn wound c. Changing dressings daily d. Leaving all loose tissue or skin intact

ANS: D Feedback A Cleaning with mild soap and water are important to the healing process. B Antimicrobial ointment is used on the burn wound to fight infection. C Clean dressings are applied daily to prevent wound infection. When dressings are changed, the condition of the burn wound can be assessed. D All loose skin and tissue should be debrided, because it can become a breeding ground for infectious organisms.

The pediatric nurse understands that cellulitis is most often caused by a. Herpes zoster b. Candida albicans c. Human papillomavirus d. Streptococcus or Staphylococcus organisms

ANS: D Feedback A Herpes zoster is the virus associated with varicella and shingles. B Candida albicans is associated with candidiasis or thrush. C Human papillomavirus is associated with various types of human warts. D Streptococcus, Staphylococcus, and Haemophilus influenzae are the organisms usually responsible for cellulitis

The skin condition commonly known as "warts" is the result of an infection by which organism? a. Bacteria b. Fungus c. Parasite d. Virus

ANS: D Feedback A Infection with these organisms does not result in warts. B Infection with these organisms does not result in warts. C Infection with these organisms does not result in warts. D Human warts are caused by the human papillomavirus.

What should the parents of an infant with thrush (oral candidiasis) be taught about medication administration? a. Give nystatin suspension with a syringe without a needle. b. Apply nystatin cream to the affected area twice a day. c. Give nystatin before the infant is fed. d. Swab nystatin suspension onto the oral mucous membranes after feedings.

ANS: D Feedback A Medication may not reach the affected areas when it is squirted into the infant's mouth. Rubbing the suspension onto the gum ensures contact with the affected areas. B Nystatin cream is used for diaper rash caused by Candida. C To prolong contact with the affected areas, the medication should be administered after a feeding. D It is important to apply the nystatin suspension to the affected areas, which is best accomplished by rubbing it onto the gums and tongue, after feedings, every 6 hours, until 3 to 4 days after symptoms have disappeared.

When taking a history on a child with a possible diagnosis of cellulitis, what should be the priority nursing assessment to help establish a diagnosis? a. Any pain the child is experiencing b. Enlarged, mobile, and nontender lymph nodes c. Child's urinalysis results d. Recent infections or signs of infection

ANS: D Feedback A Pain is important, but the history of recent infections is more relevant to the diagnosis. B Lymph nodes may be enlarged (lymphadenitis), but they are not mobile and are nontender. Lymphangitis may be seen with red "streaking" of the surrounding area. C An abnormal urinalysis result is not usually associated with cellulitis. D Cellulitis may follow an upper respiratory infection, sinusitis, otitis media, or a tooth abscess. The affected area is red, hot, tender, and indurated.

The process of burn shock continues until what physiologic mechanism occurs? a. Heart rate returns to normal. b. Airway swelling decreases. c. Body temperature regulation returns to normal. d. Capillaries regain their seal.

ANS: D Feedback A The heart rate will be increased throughout the healing process because of increased metabolism. B Airway swelling subsides over a period of 2 to 5 days after injury. C Body temperature regulation will not be normal until healing is well under way. D Within minutes of the burn injury, the capillary seals are lost with a massive fluid leakage into the surrounding tissue, resulting in burn shock. The process of burn shock continues for approximately 24 to 48 hours, when capillary seals are restored.

Which statement made by a parent indicates an understanding about the management of a child with cellulitis? a. "I am supposed to continue the antibiotic until the redness and swelling disappear." b. "I have been putting ice on my son's arm to relieve the swelling." c. "I should call the doctor if the redness disappears." d. "I have been putting a warm soak on my son's arm every 4 hours."

ANS: D Feedback A The parent should not discontinue antibiotics when signs of infection disappear. To ensure complete healing, the parent should understand that the entire course of antibiotics should be given as prescribed. B A warm soak is indicated for the treatment of cellulitis. Ice will decrease circulation to the affected area and inhibit the healing process. C The disappearance of redness indicates healing and is not a reason to seek medical advice. D Warm soaks applied every 4 hours while the child is awake increase circulation to the infected area, relieve pain, and promote healing.

Electric injury to a child often results in instant death because the electric current disrupts the rhythm of the heart. Is this statement true or false?

ANS: T The child who does not die instantly after an electrical injury is at risk for cardiac arrest or dysrhythmia, tissue damage, myoglobinuria, and metabolic acidosis.

The dermatologist treating a 16-year-old girl with a history of severe acne has ordered a pregnancy test so she can be started on a course of isotretinoin. The teen's caregiver has said that her daughter is a virgin and she refuses to allow her to have the required pregnancy testing. What would be the best action for the nurse to take?

Acknowledge the caregiver's discomfort about the pregnancy testing but encourage her to allow the daughter to have the testing so that she can use the medication. Isotretinoin is a pregnancy category X drug: It must not be used at all during pregnancy because of serious risk of fetal abnormalities. To rule out pregnancy, a urine test is done before beginning treatment. For the sexually active adolescent girl, an effective form of contraception must be used for a month before beginning and during isotretinoin therapy. The risk to the fetus, should pregnancy occur, should be discussed with the girl whether she is sexually active or not.

The nurse is caring for a child with burns in a pediatric hospital. What would be an appropriate nursing diagnosis for this client?

Acute pain related to thermal injuries and procedures Management of acute pain is crucial for the burn client

The nurse is caring for a burn patient in a pediatric hospital. Which of the following would be an appropriate nursing diagnosis for this patient? a) Risk for fluid volume overload related to thermal injuries b) Risk for aspiration related to effects of medication c) Acute pain related to thermal injuries and procedures d) Knowledge deficit related to daily care procedures in the acute care setting

Acute pain related to thermal injuries and procedures Correct Explanation: Management of acute pain is crucial for the burn patient. Knowledge of the daily procedures at the acute care setting is not a priority for this patient. Risk for aspiration would not be an appropriate nursing diagnosis.

The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a care provider. What is the most appropriate action for the nurse to do with this child?

Apply ice to the affected area. Spider bites can cause serious illness if untreated. Bites of black widow spiders, brown recluse spiders, and scorpions demand medical attention. Applying ice to the affected area until medical care is obtained can slow absorption of the poison.

The nurse is caring for a child with urticaria. What is the priority action?

Assessing the child's airway and breathing and noting any wheezing or stridor Urticaria is a type I hypersensitivity reaction. Therefore, the priority nursing assessment is to carefully assess airway and breathing, as hypersensitivity reactions may affect respiratory status. A detailed history, skin inspection, and evaluation of the hives are other appropriate assessments, but determining respiratory status is the priority

The nurse is caring for a child with urticaria. Which of the following would be the priority? a) Noting whether hives are pruritic, blanch when pressed, or are migrating b) Inspecting the skin, noting evidence of raised, edematous hives anywhere on the body c) Obtaining a detailed history of new foods, medications, stress, or changes in environment d) Assessing the child's airway and breathing and noting any wheezing or stridor

Assessing the child's airway and breathing and noting any wheezing or stridor Correct Explanation: Urticaria is a type I hypersensitivity reaction. Therefore, the priority nursing assessment is to carefully assess airway and breathing, as hypersensitivity reactions may affect respiratory status. A detailed history, skin inspection, and evaluation of the hives are other appropriate assessments, but determining respiratory status is the priority.

In working with infants diagnosed with atopic dermatitis, the nurse anticipates that when these children are older they will likely have a tendency to have which of the following disorders? a) Hemophilia b) Asthma c) Rheumatoid arthritis d) Otitis media

Asthma Correct Explanation: Infants who have eczema tend to have allergic rhinitis or asthma later in life.

The parents of a young boy with burns covering 40% of the total body surface area (TBSA) ask why he is receiving enteral feedings at night while he is sleeping and is eating during the day. Which response by the nurse is best? A. "His appetite is really poor right now and he needs more fluid." B. "Your son needs more protein and calories than he can eat while awake." C. "Your child needs a large quantity of high carbohydrate and low protein." D. "His intestinal activity is slow right now, and this is easier on his system."

B. "Your son needs more protein and calories than he can eat while awake." Enteral feedings can supply the protein, carbohydrate, and calories that the child cannot ingest. The feedings are stopped during the day so the child is able to eat basically whatever he wants, and then the minimum amount of nutrition can be ensured by the enteral feedings at night. A diet high in protein, carbohydrate, and calories is recommended. The combination of eating and enteral feedings allows the child to eat "kid food" during the day and receive the nutrients he needs at night. The hourly amount of the enteral feeding will also depend on how the child tolerates the feeding. It is often true that appetites are diminished because of pain. Oral feedings are not contraindicated. This is encouraged; however, most children with burns are unable to consume sufficient calories by mouth.

The nurse is reviewing the orders for a child with cellulitis. What would the nurse expect to see ordered for this patient? A. Damp to dry compresses using Burow's solution B. Administration of oral or parenteral antibiotics for several days C. Topical application of an antibiotic cream to the involved area D. Incision and drainage of cellulitis lesions covering a wide area

B. Administration of oral or parenteral antibiotics for several days Oral or parenteral antibiotics are indicated because of the need to have the antibiotic infused systemically. The antibiotic needs to be administered systemically. Incision and drainage of severe cellulitis lesions is done only if it is determined that the cellulitis is localized enough. If this is done, there is a risk of spreading infection or making the lesion worse. Warmed sterile water or sterile saline dressings may be indicated for limited cellulitis.

The pediatric office nurse is giving instructions to a parent whose child has scabies. What information should the school nurse include? A. Treat all of the family members if symptoms develop. B. Be prepared for symptoms to last 2 to 3 weeks. C. Notify your health care practitioner so an antibiotic can be prescribed. D. Carefully treat only those areas where there is a rash.

B. Be prepared for symptoms to last 2 to 3 weeks. The mite responsible for the scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate. A scabicide is used. Permethrin (Nix) and Lindane (Kwell) are currently used for topical administration. Permethrin (Nix) is applied to all skin surfaces. Only the affected individuals need to be treated.

The nurse is teaching adolescents about the management of acne. What should the nurse include in the discussion? A. Clean the face with an antibacterial soap twice each day. B. Clean the face gently with a mild soap once or twice each day. C. Avoid foods with a high fat content, such as French fries and chocolate. D. Express comedones by gentle squeezing; then cleanse with alcohol.

B. Clean the face gently with a mild soap once or twice each day. Cleansing the face with mild soap and water will remove surface dirt and oil. No relationship has been established between food intake and acne. Squeezing comedones and then cleansing with alcohol can break down the ductal walls of the lesions and cause the acne to worsen. Antibacterial soaps may be too drying when used in combination with topical medications.

During the rehabilitative phase of care, the nurse applies pressure dressings to the patient's severely burned areas. This activity is used to accomplish which goal? A. To relieve as much pain as possible B. To decrease the development of scar tissue C. To promote motion during the healing process D. To protect underlying tissue by encouraging scar formation

B. To decrease the development of scar tissue Uniform pressure to the scar decreases blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures. Motion is encouraged because it prevents contractures, but this has nothing to do with the pressure dressing application. The goal of the pressure dressing is to minimize the development of scar tissue. The goal of the pressure dressing is to improve the appearance of scars.

The school nurse is seeing a child who brought poison ivy to school in his leaf collection. The child says, "It only touched my hands." What is the initial nursing action? A. Apply compresses using Burow's solution. B. Soak the child's hands in warm water. C. Rinse the child's hands in cold, running water. D. Scrub the child's hands thoroughly with antibacterial soap.

C. Rinse the child's hands in cold, running water. Rinsing the child's hands in cold, running water is the recommended first action. Once contact has been made, it is desirable to flush the skin with cold, running water within 15 minutes of exposure. This will neutralize the urushiol not yet bonded to the skin. The antibacterial soap removes protective skin oils and dilutes the urushiol, allowing it to spread. Application of Burow's solution compresses is effective for soothing the skin lesions once the dermatitis has begun. Cold, running water, not warm, is effective in removing the oil.

The nurse is caring for an infant with recurrent atopic dermatitis (eczema). What information would the nurse expect to see in the infant's history? A. It last happened in the summer. B. The infant recently traveled to a humid climate. C. The infant has several allergies similar to her mother. D. The infant had an upper respiratory infection a week ago.

C. The infant has several allergies similar to her mother. The majority of children with atopic dermatitis have a family history of eczema, asthma, food allergies, or allergic rhinitis. This suggests a genetic predisposition. It is associated with allergies and not upper respiratory infections. Atopic dermatitis worsens in fall and winter. It improves in humid climates.

The nurse is caring for a client brought to a pediatric clinic for swelling in the lower extremities with reddened skin that has undefined borders and pits slightly when pressed. What is the most likely diagnosis of the client's skin alteration?

Cellulitis Cellulitis is characterized by reddened or lilac-colored swollen skin that pits when pressed by the fingertips. Impetigo has superficial lesions that can be bulbous or nonbulbous. SSSS involves bullae that enlarge and rupture, leaving a red, scalded-looking lesion. Cat scratch disease involves a benign, subacute, chronic course of lymphadenopathy that usually resolves spontaneously in 2 to 3 months

The nurse is assessing a child who has had an open wound for the last 2 weeks with no signs of healing. The parents report they have been using over-the-counter antibiotic ointment with no signs of improvement. The child is active in football in the fall and the swim team in the winter. What disorder does the nurse suspect?

Community acquired MRSA Risk factors for community acquired MRSA (CA-MRSA) are turf burns, towel sharing, participation in team sports, or attendance at day care or outdoor camps. The condition usually presents with a moderate to severe skin infection or with an infection that is not responding as expected to therapy. Impetigo is a readily recognizable skin rash infection. Staphylococcal scalded skin syndrome results from infection with S. aureus that produces a toxin, which then causes exfoliation, and it has abrupt onset. Folliculitis is an infection of a hair follicle

The school nurse is educating a group of elementary school teachers about ringworm (tinea capitis). Which explanation of the condition by the nurse is best? A. It is self-limiting and not contagious. B. It is a sign of uncleanliness. C. The patient should recover spontaneously without interventions. D. It is spread by direct and indirect contact.

D. It is spread by direct and indirect contact. Ringworm is spread by both direct and indirect contact. Children should wear protective caps at night to avoid transfer of ringworm to bedding. Ringworm is infectious and not self-limiting. Because ringworm is easily transmitted, it is not a sign of uncleanliness. It can be transmitted by theater seats, gym mats, and animal-to-human transmission. Treatment is required with the drug griseofulvin (Grisactin), which is indicated for a prolonged course, possibly several months.

An occlusive dressing, Acu-Derm, is applied to a large abrasion. What is the reason the nurse would use this type of dressing? A. It delivers vitamin C to the wound. B. It provides an antiseptic for the wound. C. It promotes mechanical friction for healing. D. It maintains a moist environment for healing.

D. It maintains a moist environment for healing. Occlusive dressings, such as Acu-Derm, provide a dressing that is non-adherent to the wound site. It provides a moist wound surface and insulates the wound. The dressing does not have vitamin C, does not have antiseptic capabilities, and protects

The nurse is applying wet dressings on the skin. What procedure would be correct for the nurse to use? A. Apply the dressing when it is saturated and dripping. B. Apply the dressing so that the area is totally immobilized. C. Pour new solution over a dressing that has become dry, or apply solution with a syringe. D. Pour the desired solution on soft gauze and then squeeze the gauze to remove excess liquid prior to putting it on the skin.

D. Pour the desired solution on soft gauze and then squeeze the gauze to remove excess liquid prior to putting it on the skin. The desired solution should be applied to soft gauze or soft cotton cloths, but the excess fluid must be removed, or the desired effects will not occur. After immersion in the solution, the dressings are wrung out to avoid dripping. The moist dressing should be laid flat on the area with an attempt to avoid restriction of movement. As the evaporation begins to dry them, the dressings are removed, immersed in the solution again, and reapplied by using aseptic technique. When the solution dries, concentrated residue is left in the dressing. The addition of fluid may result in a more concentrated soak being placed on the sensitive tissue.

An adolescent with tinea versicolor is admitted for treatment of the disorder. Which nursing diagnosis will the nurse identify as having the highest priority for this client?

Disturbed body image Tinea versicolor is a superficial tan or hypopigmented oval scaly lesions, especially on upper back and chest and proximal arms. It may take several months for pigmentation to return to normal; therefore, disturbed body image is going to be a high priority for an adolescent client.

The nurse is caring for a child with a partial-thickness burn. Which of the following assessment findings would the nurse expect to observe? a) Edema with wet blistering skin b) Reddened and leathery skin c) Edema with dry or waxy-looking skin d) Peeling skin with eschar

Edema with wet blistering skin Correct Explanation: Partial-thickness burns are very painful and edematous and have a wet appearance or the presence of blisters. Full-thickness burns appear red, edematous, leathery, dry, or waxy and may display red or charred skin (eschar).

The nurse is assessing a child who was brought into the clinic. The nurse notes honey-colored crusting on the toddler's face, as seen in the figure. The nurse recognizes this to be what type of infection?

Impetigo Impetigo is a readily recognizable skin rash that is characterized with honey-colored crusting. Nonbullous impetigo generally follows some type of skin trauma or may arise as a secondary bacterial infection of another skin disorder, such as atopic dermatitis. Bullous impetigo demonstrates a sporadic occurrence pattern and develops on intact skin, resulting from toxin production by S. aureus.

The nurse is working in a community setting and receives a call from a local day care center. One of the children in the center has been diagnosed with impetigo, and the director of the day care center wants to know whether she should be concerned. The nurse's response should reflect which of the following related to impetigo? a) Impetigo is a sexually transmitted infection and should be reported. b) Impetigo is usually caused because of sensitivity to pollens and molds. c) Impetigo is highly contagious and can spread quickly. d) Impetigo cannot be treated with medication and has to run its course.

Impetigo is highly contagious and can spread quickly. Correct Explanation: Impetigo is highly contagious and can spread quickly. Impetigo in the newborn nursery is cause for immediate concern.

The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children. The nurse most likely referring to:

Impetigo. Impetigo is a superficial bacterial skin infection.

The nurse is caring for a child with a suspected fungal infection. Which of the following tests would the nurse anticipate as being ordered? a) Potassium hydroxide (KOH) prep b) Patch or skin testing c) Culture of wound/drainage d) Erythrocyte sedimentation rate (ESR)

Potassium hydroxide (KOH) prep Correct Explanation: Potassium hydroxide (KOH) prep is indicated for identifying a fungal infection. Patch or skin testing is indicated for evaluation of atopic or contact dermatitis. ESR is a nonspecific test used to determine the presence of infection or inflammation. Culture of wound/drainage is used to identify the specific organism.

An 8-year-old child requires wet dressings four times a day as treatment for a skin disorder. Which of the following would be most important for the nurse to do? a) Elevate the area after performing the dressing change. b) Ensure that the temperature of the solution is 120°F. c) Premedicate the child before changing the dressing.

Premedicate the child before changing the dressing. Correct Explanation: Premedicating the child before changing the dressing is crucial to providing atraumatic care. Elevating the area may or may not be appropriate depending on the problem and its location. A temperature of 120°F is the recommended maximal hot water heater temperature. The solution for a wet dressing should not be this high.

Which intervention is the most beneficial for a burn client undergoing a skin graft?

Provide around-the-clock pain medication as soon as pain is reported. When the child undergoes a procedure, such as skin grafting, that is known to produce prolonged pain, administer pain medication on a scheduled basis, rather than as needed once pain is reported. Around-the-clock pain medication will serve to diminish peaks and valleys in pain relief. Diversional activities and an egg-crate mattress are not effective treatments for severe pain

Which of the following interventions is the most beneficial for a burn patient undergoing a skin graft? a) Provide pain medication on a PRN schedule as soon as pain is reported. b) Provide an egg-crate mattress or gel mattress for the patient to lie upon. c) Provide diversional activities for the patient. d) Provide around-the-clock pain medication as soon as pain is reported.

Provide around-the-clock pain medication as soon as pain is reported. Explanation: When the child undergoes a procedure, such as skin grafting, that is known to produce prolonged pain, administer pain medication on a scheduled basis, rather than as needed once pain is reported. Around-the-clock pain medication will serve to diminish peaks and valleys in pain relief. Diversional activities and an egg-crate mattress are not effective treatments for severe pain.

The nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at:

Reducing swelling and relieving itching Treatment for skin allergies is aimed at reducing the swelling and relieving the itching. With swelling in various parts of the body, the child may have pain, nausea and vomiting, but reducing the swelling would prevent those symptoms from occurring

A 14-year-old child is diagnosed with tinea versicolor. Which of the following would the nurse expect the nurse practitioner to order? a) Topical nystatin b) Diphenhydramine c) Oral griseofulvin d) Selenium sulfide

Selenium sulfide Correct Explanation: Selenium sulfide is used to treat tinea versicolor. Topical nystatin is used to treat monilial diaper rash. Griseofulvin is used to treat tinea capitis. Diphenhydramine is an antihistamine used to treat hypersensitivity reactions, atopic dermatitis, or contact dermatitis that is highly pruritic.

Which of the following is the best technique to perform an assessment of the skin? a) Skin assessment involves inspection and palpation in a room with white walls and bright fluorescent light. b) Skin assessment involves inspection and palpation using latex gloves. c) Skin assessment involves inspection and palpation in a room with yellow walls and bright white light. d) Skin assessment involves inspection and palpation using vinyl gloves.

Skin assessment involves inspection and palpation in a room with white walls and bright fluorescent light. Explanation: Physical assessment of the skin involves two basic techniques: inspection and palpation. The ideal environment for the physical assessment is a well-lit room with white walls, not yellow. Bright white fluorescent ceiling lighting is optimal, because it does not cast a yellow hue on the skin. Skin assessment does not require the use of gloves unless there are body fluids or open lesions on the skin. If gloves are required, they should be vinyl to prevent an allergic reaction.

The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a child abuse-induced burn?

Stocking-glove pattern on hands or feet A stocking-glove pattern on the hands or feet or a circumferential ring appearing around the extremity points to the caregiver forcefully holding the child under extremely hot water. A nonuniform pattern and splash or spattering patterns are not typical indicators of child abuse.

The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a child abuse-induced burn? a) Stocking-glove pattern on hands or feet b) Nonuniform pattern c) Splash patterns d) Spattering pattern

Stocking-glove pattern on hands or feet Correct Explanation: A stocking-glove pattern on the hands or feet or a circumferential ring appearing around the extremity points to the caregiver forcefully holding the child under extremely hot water. A nonuniform pattern and splash or spattering patterns are not typical indicators of child abuse.

The nurse admits a child who has sustained a severe burn. The child's immunizations are up to date. Which of the following immunizations would the child most likely be given at this time? a) Tetanus toxoid vaccine b) Hepatitis B vaccine c) Hepatitis A vaccine d) Haemophilus influenzae type B vaccine

Tetanus toxoid vaccine Correct Explanation: If inoculations are up to date, a booster dose of tetanus toxoid is required to protect the child from infection introduced into the burn.

The nurse is collecting data on a child admitted to the burn unit with a partial-thickness burn. Which of the following is most accurate regarding this type of burn? a) There is no destruction of tissue. b) The nerve ending are destroyed. c) The child will have minimal pain. d) The child will likely have blisters.

The child will likely have blisters. Correct Explanation: In a partial-thickness or second-degree burn, the epidermis and underlying dermis are both injured and devitalized or destroyed. Blistering usually occurs with an escape of body plasma, but regeneration of the skin occurs from the remaining viable epithelial cells in the dermis.

In caring for a 3 ½-year-old child admitted after being severely burned, the nurse collects the following data. Which of the following would be most important for the nurse to report immediately? a) The child's temperature is 38.4°C. b) The child's pain level is a 7 on the pain scale. c) The child's hourly urinary output is 150 cc. d) The child's respiratory rate is 32 breaths a minute.

The child's respiratory rate is 32 breaths a minute. Correct Explanation: An increase in the respiratory rate after a severe burn may be an indication of possible serious respiratory complications and should be reported immediately in case an endotracheal tube needs to be inserted. A temperature of 38.4°C, hourly urine output of 150 cc, and pain rating of 7 need to be documented and reported but are not as urgent as reporting respiratory concerns.

The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing intervention is the highest priority for this child?

The nurse follows contact precautions. Impetigo is highly contagious and can spread quickly. The nurse should follow contact (skin and wound) precautions, including wearing a cover gown and gloves. The nurse will soak the crusts with warm water, apply topical antibiotics, and apply elbow restraints, but these are not as high a priority as trying to prevent the spread of the infection by following contact precautions.

The nurse is caring for an infant who has impetigo and is hospitalized. Which of the following nursing interventions is the highest priority for this child? a) The nurse applies topical antibiotics to the lesions. b) The nurse follows contact precautions. c) The nurse applies elbow restraints to the infant. d) The nurse soaks the skin with warm water.

The nurse follows contact precautions. Correct Explanation: Impetigo is highly contagious and can spread quickly. The nurse should follow contact (skin and wound) precautions, including wearing a cover gown and gloves. The nurse will soak the crusts with warm water, apply topical antibiotics, and apply elbow restraints, but these are not as high a priority as trying to prevent the spread of the infection by following contact precautions.

The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a care provider. Which of the following is the most appropriate action for the nurse to do with this child? a) The nurse should administer pain medication. b) The nurse should briskly scrub the site. c) The nurse should apply ice to the affected area. d) The nurse should splint the leg.

The nurse should apply ice to the affected area. Correct Explanation: Spider bites can cause serious illness if untreated. Bites of black widow spiders, brown recluse spiders, and scorpions demand medical attention. Applying ice to the affected area until medical care is obtained can slow absorption of the poison.

Which of the following interventions is the most effective in treating burn wound infections? a) Systemic intravenous antibiotics b) Systemic oral antibiotics c) Proper hand washing d) Topical antibiotics applied to the wound site

Topical antibiotics applied to the wound site Correct Explanation: Topical burn creams are used because the local blood supply to the area of burn injury is destroyed with the burn, and systemic antibiotics thus are not delivered to the burn wound. Proper hand washing is a preventive treatment.

The nurse is caring for a child, weighing 100 pounds, on the burn unit who has partial-thickness burns on over 30% of the body. During the beginning shift assessment, which assessment finding is of most concern to the nurse?

Urine output of 15 mL per hour over the last 4 hours Fluid and electrolyte imbalance is a primary concern when caring for the client with burns. The urine output should be a minimum of 1 mL/kg/hour. The client weighs 45.5 kg, so output should equal approximately 45 mL/hour. Pain is a major concern, but the higher priority at this time is the decreased output. Refusal of one meal is not a higher priority. Weight gain of 0.9 kg over 2 days is not a concern at this time

The nurse is caring for a pediatric patient with multiple wounds from a bike accident. Which of the following is the best method for cleansing or washing out the wound? a) Use sterile water to wash out the wound. b) Use iodine solution to wash the wound. c) Use an antibiotic wash to cleanse the wound. d) Use normal saline solution to wash the wound.

Use normal saline solution to wash the wound. Explanation: Normal saline is still considered the best solution to "wash out" wounds because of its relative isotonicity and minimal effect on tissue regeneration.

The nursing diagnosis of risk for infection related to a disruption in the protective skin barrier is noted on a child's plan of care. Which action would be of greatest importance?

Using appropriate hand hygiene Hand hygiene would be the priority because the child's risk for infection is increased and hand hygiene is crucial to preventing the transmission of infectious organisms. Monitoring the child's temperature is important to evaluate for possible fever and infection, but this would not be the most important action. Although nutritional status can influence wound healing, urging adequate nutritional intake would not be the most important action. Although obtaining a culture provides information about the cause of an infection, the child is at risk for infection, so a culture would not provide any information about the risk.

The nursing diagnosis of risk for infection related to a disruption in the protective skin barrier is noted on a child's plan of care. Which action would be of greatest importance? a) Obtaining a culture of the impaired skin area b) Using appropriate hand hygiene c) Urging adequate nutritional intake d) Assessing temperature every 4 hours

Using appropriate hand hygiene Correct Explanation: Hand hygiene would be the priority because the child's risk for infection is increased and hand hygiene is crucial to preventing the transmission of infectious organisms. Monitoring the child's temperature is important to evaluate for possible fever and infection, but this would not be the most important action. Although nutritional status can influence wound healing, urging adequate nutritional intake would not be the most important action. Although obtaining a culture provides information about the cause of an infection, the child is at risk for infection, so a culture would not provide any information about the risk.

A child has been diagnosed with impetigo and the nurse is performing discharge teaching to the parents. Which statements by the parents indicate that additional teaching is necessary?

• "Even though the lesions have crusted, the infection is contagious and our child should stay home from school." • "Antifungal medications should be administered as ordered by our physician." • "We should soak impetiginous lesions with cool compresses to remove crusts before applying topical medication." Though impetigo is considered a contagious disorder among vulnerable populations, removal from school or day care is not necessary unless the condition is widespread or actively weeping. Impetigo is a bacterial not a fungal infection, therefore antibiotics will be ordered. Soaking and removing crusts is necessary for the medication to penetrate the infection. Antibiotics should be spread out evenly so a constant level remains in the blood. Hand hygiene helps prevent spread of the infection

The nurse has completed client teaching with a 16-year-old female who has been prescribed Accutane (isotretinoin) for cystic acne. Which statements indicate learning has occurred?

• "If I am sexually active I need to let my doctor know." • "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her." • "It's important I get my CBC blood test when my doctor orders it." Accutane (isotretinoin) is a powerful medication used for severe forms of acne and cystic acne when other treatment methods are not effective. Sexual activity should be reported to the physician. Some physicians may order monthly pregnancy tests even if the client says she is not sexually active because of the risk of birth defects to a fetus. No matter what form of birth control is used, pregnancy is possible, so monthly pregnancy tests are still necessary. Liver function tests are important regardless of age because of the side effects of the medication. Any labs ordered, such as the CBC, by the physician to monitor the medication's side effects should be obtained

The mother of a 4-year-old child with atopic dermatitis reports she is having difficulty keeping her child from scratching. What information can be provided by the nurse?

• "Keep your child's finger nails trimmed and filed." • "Distract your child with activities when you notice scratching." • "Keep a diary of triggers for a week to see what patterns your child has related to this problem." Itching is a chief concern with atopic dermatitis. Strategies should be employed to reduce scratching. Keeping the finger nails trimmed is helpful in preventing cuts to the skin and introducing bacteria to open wounds. Distracting the child with activities is helpful when they are experiencing sensations of itching. A small ball or stuffed animal can be used to focus attention to something else when the urge to scratch is present. A diary can be useful when trying to identify patterns of behavior related to triggers of this condition. Flannel sheets may be irritating and should be avoided.

An adolescent is to receive topical retinoid therapy for his moderately severe acne. The nurse would instruct the adolescent about which adverse effect? Select all that apply. a) Burning b) Photosensitivity c) Dryness d) Flu-like symptoms e) Headache

• Burning • Photosensitivity • Dryness Correct Explanation: Adverse effects associated with topical retinoid therapy include burning, dryness, and photosensitivity. Flu-like symptoms and headache are associated with topical immune modulators.

A 10-year-old has been bitten on the lower posterior arm by a dog, requiring several stitches. The child was just admitted to the hospital for 3 days of antibiotic therapy. When developing the care plan, the nurse identifies which nursing diagnoses as being the top 2 priorities?

• Impaired skin integrity • Risk for infection The wound was not a clean wound, such as a surgical wound, so risk for infection would be a top priority. The child has impaired skin integrity from the wound and from the IV. Since the wound is new and on the arm the nursing diagnosis disturbed body image would not be a top 2 priority at this time. It is unlikely that a great deal of fluid has been lost from this wound. Knowledge deficit of wound care would not be a top 2 priority at this time, but would be an important nursing diagnosis to address later.

The nurse is planning an educational program on burn prevention at home. Which information should be included?

• Keep pot handles turned in on a stove. • Test bath water temperature before bathing children. • Teach children to "stop, drop and roll" if their clothes catch on fire. Burn prevention techniques include keeping hot water heater temperature set at 120 degrees F or lower, not 130 degrees or lower. Do not drink hot beverages while holding children. Other techniques include keeping pots on the inside of the stove with the handles turned in, testing bath water before bathing a child and teaching them to 'stop, drop and roll' if their clothes catch on fire.

The nurse is caring for a child who has a severe case of contact dermatitis following exposure to Toxicodendron radicans (poison ivy). The nurse adds the nursing diagnosis, "Knowledge deficit regarding disease process and care of the client," to the care plan. What nursing interventions should the nurse add to the care plan for this nursing diagnosis?

• Teach the client and parents that even contact with dormant plants or plants perceived to be dead may cause an allergic response. • Inform the client that itching is very common for contact dermatitis. • Notify the client and parents that the rash may last for 2 to 4 weeks. • Encourage the client to not scratch the skin since this can cause a secondary infection. To help prevent future contact, the nurse should teach the client to avoid live and dead poison ivy plants. The rash is extremely pruritic and may last for 2 to 4 weeks. Contact dermatitis is not contagious and does not spread either to other parts of the affected child's skin or to other people. The complication of a bacterial skin infection can occur from scratching

A group of nursing students are reviewing information about atopic dermatitis. Which of the following indicate that the students understand the information? Select all that apply. a) Changes in temperature can contribute to flare-ups. b) The reaction occurs in response to specific allergens. c) Scratching initiates the reaction, which then becomes pruritic. d) Excessively humid environments often lessen the severity of the reaction. e) The disorder is chronic with periods of remissions.

• The disorder is chronic with periods of remissions. • The reaction occurs in response to specific allergens. • Changes in temperature can contribute to flare-ups. Explanation: Atopic dermatitis is a chronic disorder with a relapsing and remitting nature. The skin reaction occurs in response to specific allergens, usually foods, or environmental triggers. Changes in ambient temperature can contribute to flare-ups. Excessively humid or dry environments can cause the condition to worsen. When a trigger occurs, antigen-presenting cells stimulate interleukins to begin the inflammatory process. The skin begins to feel pruritic and then the child starts to scratch. Itchiness occurs first and then the rash appears.