Derm Test

While in a skilled nursing facility, a client contracts scabies, which is diagnosed the day after discharge. The client is living at an adult child's home with six other people. During the client's visit to the clinic, the client asks a staff nurse, "What should my family do?" The most accurate response from the nurse is

all family members need to be treather

Which factor is most important for the nurse to consider when determining the angle at which to insert the needle for a subcutaneous injection?

amount of subcutaneous tissue

A client seeks medical care for severe sunburn. Which teaching should the nurse provide to reduce the client's risk of skin damage from sun exposure?

apply sunscreen even on overcast days

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

A nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp?

behind the ears

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?

cellutitis

Four clients are assigned to a nurse. Which client should the nurse identify who would benefit the most from hyperbaric oxygen therapy?

client with a compromised skin graft

A child is hospitalized with a diagnosis of severe cellulitis. The nurse is preparing the family for discharge. Which instruction is most important for the nurse to convey to the family?

complete the scheduled antibiotics

While repositioning an immobile client, a nurse notes that the client's sacral region is warm and red. Further assessment confirms that the skin is intact. Based on these findings, it's most appropriate for the nurse to do which actions? Select all that apply.

document the condition of the client's skin turn the client when in bed

The nurse is caring for a child with a suspected fungal infection. Which test would the nurse anticipate as being ordered?

potassium hydroxide (KOH) prep

An older adult has several ecchymotic areas on the left arm. What should the nurse further assess? Select all that apply.

elder abuse self-inflicted injury increased capillary fragility and permeability

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 physical findings?

erythema multiforme with inflammatory bullae of at least two types of mucosa

When assessing a client who is incontinent for risk for developing a pressure ulcer, the nurse should note which factor that can most alter tissue tolerance and lead to the development of a pressure ulcer?

exposure to moisture

At an outpatient clinic, a medical assistant interviews a client and documents the findings. The staff nurse reads the progress note and begins planning client care based on which nursing diagnosis?

fear related to potential diagnosis of malignant melanoma

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 or third-degree

When assessing a client with partial-thickness burns over 60% of the body, which finding should the nurse report immediately?

hoarseness of the voice

The nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding?

"Flare-ups of lesions are not uncommon following therapy."

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?

"I should avoid eating any kind of chocolate."

When teaching 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."

A nurse provides preoperative education to a client scheduled to undergo elective surgery. The nurse includes instructions about proper skin care. Which client statement indicates the need for further education?

"On the morning of the surgery, I can shave my surgical area at home to save time."

An autograft is taken from the client's left leg. The nurse should care for the donor site by:

keeping the site clean and dry.

In a client who has been burned, which medication should the nurse expect to use to prevent infection?

mafenide

A nurse is developing a care plan for a client recovering from a serious thermal burn. What does the nurse determine is the priority goal of therapy?

maintaining the client's fluid and electrolyte balance

An 8-year-old child has had skin testing done for allergies. After a review of the results, it is decided that the child will undergo hyposensitization therapy. The parents are asking the nurse questions about the purpose of this therapy and what to expect. Which information will the nurse include when teaching the parents and child about this therapy?

"Your child will have to remain in the office for about one-half hour after each treatment."

A triage nurse in the emergency department admits a male client with second-degree burns on the anterior and posterior portions of both legs. Based on the Rule of Nines, what percentage of the body is burned? Record your answer using a whole number.

36

A client is brought to the emergency department with partial-thickness and full-thickness burns on the left arm, left anterior leg, and anterior trunk. Using the Rule of Nines, what is the total body surface area that has been burned?

36%

A client has suffered a deep partial-thickness burn to the right arm from a high-voltage source of energy that was not turned off while working on it. What is the priority nursing intervention in the acute phase of care?

A cardiac monitor should be used for at least 24 hours to anticipate the potential for cardiac dysrhythmias.

The nurse is developing the plan of care for a child who has suffered a major burn and has just been admitted to the acute care facility. Which nursing diagnosis would be most appropriate?

Acute pain related to thermal injuries and procedures

A nurse is reviewing a plan of care for a 5-year-old child hospitalized with severe burns. Due to systemic changes that occur secondary to the burn injuries, what intervention(s) related to nutrition should the nurse expect to implement? Select all that apply.

Administer a proton pump inhibitor. Offer the child's favorite foods. Initiate total parenteral nutrition. insert a NG tube

A nurse is caring for a child with a wasp sting. Which nursing intervention is a priority?

Administer diphenhydramine per protocol.

The nurse is developing a plan of care for a client with a stage 3 heel ulcer. Which intervention should the nurse include?

Apply a hydrocolloidal dressing.

A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which recommendation is appropriate?

Apply sunscreen with a sun protection factor (SPF) of 30 or more before sun exposure.

The nurse is caring for an immune-compromised client with a fungal infection of the scalp. What recommendation should the nurse make to prevent future problems?

Avoid sharing combs and brushes.

An adolescent experiencing contact dermatitis reports experiencing pruritis. What intervention will the nurse recommend to relieve the itching?

Bathe with a product that is oatmeal-based.

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

Blisters appear

A nurse is caring for an elderly bedridden adult in the long term care facility. To prevent pressure ulcers, which intervention should the nurse include in the care plan?

Develop a written, individual turning schedule.

The nurse is caring for a child with a second-degree (partial-thickness) burn. What assessment findings would the nurse expect to observe?

Edema with wet blistering skin

A parent is observing a nurse provide care for the parent's 2-year-old toddler who was burned in a house fire. When the nurse is finished, the parent tells the nurse "I cannot believe this has happened. I should have been able to prevent this from happening." What is the best action for the nurse to take?

Encourage the parent to talk more about feelings.

In the acute phase of burn injury, which pain medication would most likely be given to the client to decrease the perception of the pain?

IV opioid

Irrigate the wounds with water.

IV rate increase

A client presents with blistering wounds caused by an unknown chemical agent. How should the nurse intervene?

Irrigate the wounds with water.

The nurse is conducting a focused skin assessment on a child. After inspecting the skin and noting drainage, what will the nurse do next?

Palpate for regional lymphadenopathy.

An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants?

Staphylococcus aureus

Which statement would be appropriate for a nurse documenting a stage 1 pressure ulcer found on a client who is immobilized?

The client's skin is intact with non-blanchable redness of a localized area over a bony prominence.

The nurse is caring for a 13-year-old client who asks about acne prevention. Which would be most appropriate for the nurse to suggest?

Wash the face twice a day with a mild soap then pat dry.

A child with a burn injury is scheduled for skin grafting. Which intervention would be most appropriate for the nurse to include in the child's plan of care?

provide around the clock pain medication

A nurse is caring for a client with a pressure ulcer. The nurse understands that the purpose of a hydrocolloid dressing application is to:

remove necrotic tissue by using enzymes

What is the primary goal of nursing care during the emergent phase after a burn injury?

replace lost fluids

An intensive care nurse has received the above hand-off report from the emergency department nurse. Thirty minutes later, the nurse assesses the child again. Which assessment finding should the nurse investigate further?

temp 100.5

The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing action is priority?

the nurse follows contact precautions

The nurse is teaching a small community group regarding methods to decrease the risk of burns. What is the priority method to decrease burn risks in the home?

use of smoke detectors

The nurse is wrapping a burned client's hand with a dressing. What is an important consideration when applying a dressing to the client's hand?

The hand and finger surfaces do not touch.

A client is receiving fluid replacement with lactated Ringer's after 40% of the body was burned 10 hours ago. The assessment reveals temperature 97.1°F (36.2°C), heart rate 122 bpm, blood pressure 84/42 mm Hg, central venous pressure (CVP) 2 mm Hg, and urine output 25 mL for the last 2 hours. The IV rate is currently at 375 mL/h. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, what prescription should the nurse request from the health care provider?

iv rate increase

Which nutritional deficiency may delay wound healing?

lack of vitamin C

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

While assessing the skin of a 45-year-old, fair-skinned female client, the nurse notes a lesion on the medial aspect of her lower leg. It has irregular borders, with various shades of black and brown. The client states that the lesion itches occasionally and bled slightly a few weeks ago. She also reveals a history of sunburns. Based on these signs and symptoms, the nurse suspects

melanoma.

The nurse is caring for a client who has been admitted to the hospital with a leg ulcer that is infected with vancomycin-resistant s. aureus (VRSA). Which nursing actions can be delegated to a licensed practical/vocational nurse (LPN/VN)?

obtaining a wound culture during a dressing change

A client with a severe staphylococcal infection is receiving the aminoglycoside gentamicin sulfate by the I.V. route. The nurse should assess the client for which adverse reaction?

ototoxicity

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

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

stocking-glove pattern on hands or feet

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

The nurse is performing triage in the emergency department. Which client should be seen first?

the client with burns to the chest and neck with singed nasal hair

A 10-year-old child is brought to the clinic by the parent. Assessment reveals small circular patches of hair loss on the scalp. The nurse suspects which condition?

tinea capitis

A client has been admitted with severe burns. Lactated Ringer's has been ordered to infuse via a pump. Why is this solution being used?

to prevent signs of hypovolemic shock and restore circulation

During the first 48 to 72 hours of fluid resuscitation therapy after a major burn injury, the nurse should monitor hourly which information that will be used to determine the IV infusion rate?

urine output

A client is admitted with a 45% partial and full thickness burn. Which finding would alert the nurse that the client has a deficiency in fluid volume during the first 24 hours?

urine output < 30 mL/hr

A client with a major burn injury is receiving fluid resuscitation. Which assessment finding indicates that this treatment has been effective?

urine output at 0.5 mL/kg/hour

Which factor would have the least influence on the survival and effectiveness of a burn victim's porcine grafts?

use of analgesics for pain relief

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

The nurse is applying a hand mitt restraint for a client with pruritus (see figure). What should the nurse do first?

verify the prescription to use the restraint

The nurse is assessing the skin of a 5-year-old child and notes several lesions on the arm. The lesions are circumscribed, elevated, and pinpoint size. They contain serous fluid. How would the nurse document these findings?

vesicle

A pediatric client was brought to the emergency department by the parents after experiencing extensive urticaria following consumption of a seafood dinner. Upon discharge from the facility the nurse provided client teaching. Which statement by the parents indicate learning occurred?

"We need to get our child a medical alert bracelet as soon as possible in case this happens again."

The client phones the outpatient surgery center following skin biopsy on the left shoulder. The client states that the site continues to drain pinkish drainage and is uncomfortable. Which triage questions are appropriate to evaluate the client's concern? Select all that apply.

"What is your pain level on a 0-10 pain scale?" "How are you cleaning the area?" "On which day did you have the biopsy completed?" "Can you describe the drainage that you see."

A school-aged child is brought to the office of the camp nurse with a small, superficial burn (first-degree burn). Which action by the nurse would be most appropriate to take first?

Apply cold compresses to the area.

An occupational nurse is called to treat an employee who experienced a finger injury on a piece of equipment. When the nurse arrives, it is discovered that the finger tip was cut off at the first digit and is bleeding profusely. What should be the nurse's first action?

Apply direct pressure to the finger with a clean, dry cloth.

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

A child is brought to the emergency department with a full-thickness burn involving the epidermis, dermis, and underlying subcutaneous tissue, but does not report pain at this time. Which statements by the nurse are correct about this type of burn? Select all that apply.

The child must be monitored for signs of fluid shift. Rehabilitation and skin grafting will be necessary. This is a severe burn and nerve endings have been destroyed.

The nurse is working as charge on a medical-surgical unit and is working with a graduate nurse who has been on orientation for the past 4 weeks. Which client should the charge nurse assign to the new nurse?

a client who requires a dressing change of a pressure ulcer

The nurse is caring for a client with a burn injury who is experiencing hypersecretion of gastric acid. The nurse should monitor for development of what complication?

gi ulceration

The nurse is discussing dietary intake with the parents of a 4-year-old child who has been diagnosed with atopic dermatitis. Later, the nurse notes the menu selection made by the parents for the child. Which selection indicates the need for further instruction?

peanut butter and jelly sandwhich

A client is admitted with full-thickness burns to 30% of the body, including both legs. After establishing a patent airway, which intervention is a priority?

replacing fluid and electrolytes

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."

A nurse is 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. What should the nurse ask the mother?

"Does she wear sleepers with metal snaps?"

A child has been hospitalized with a diagnosis of severe impetigo. The nurse is interviewing the family. Which question will have the greatest impact on the child's care?

"Does your child have any allergies to medications?"

The parents of a child diagnosed 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."

The nurse admits a 10-year-old who has just eaten lobster and has hives over much of the body. In collecting data regarding this child, which question should the nurse ask the caregiver first?

"Has the child ever eaten shellfish before now?"

The nurse is discussing skin disorders with a group of caregivers. Which caregiver statement indicates an understanding of tinea capitis?

"I always tell my daughter to use her own hairbrush."

The school nurse has completed an educational program on first aid practices in the home. Which statement about burn care by a participant would indicate a need for further education?

"I guess my mom was right; she always put ice on our burns when we were kids."

The nurse is teaching parents about the care of diaper rash. The nurse would be concerned about the parents' level of understanding if they made which statement?

"I should be certain to use fabric softener in the care of the infant's clothes."

A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful?

"I should not cover the area with plastic wrap after applying the cream."

When reviewing bathing habits for a child with dermatitis, which statements by the child's mother indicates the need for further instruction? Select all that apply.

"I should use the warmest water my child can tolerate during the bath." "Antibacterial soap will be helpful in preventing infections at the site of the rash."

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."

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 nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which statements indicate learning has occurred? Select all that apply.

"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." "If I am sexually active I need to let my doctor know."

A healthcare provider orders an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond?

"To prevent evaporation of water from the hydrated epidermis."

The clinic nurse is assessing a 12-year-old client. The client reports having dandruff and asks the nurse what can be done for it. Which response by the nurse is best?

"Wash your hair with a gentle shampoo daily."

The nurse is providing home care instructions for the parents of an infant with cradle cap (seborrhea). Which response by the parents indicates a need for further teaching?

"We can scrape off the crusts on his scalp with a cotton swab."

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."

A nurse is 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."

A client in a wheelchair comes to the clinic for a follow-up evaluation of pressure ulcers on the buttocks. The client reports that the family has been changing the hydrocolloid dressings every 3 to 5 days. Over the past few weeks, the client has been spending less time in the wheelchair. During the appointment, the nurse notes that the client is not using a cushion and that the wound is covered with a dry sterile dressing. How should the nurse initially approach the client about the treatment regimen?

Ask the client to explain the treatment regimen.

A client with partial thickness burns to the chest and shoulders 6 hours after a fire has become restless and confused. Which action should the nurse take?

Assess oxygen saturation using pulse oximetry.

The nurse is using home telehealth monitoring to manage care for an 80-year-old who is home bound. The client spends most of the day in bed. Two months ago, the nurse detected sacral redness from friction and shearing force of being in bed. Last month, the client had increased sacral redness, and the area was classified as a stage I pressure ulcer. On this visit, the nurse is assessing the sacral area using a video camera. The nurse compares the site from a visit made 1 month ago (see figure part A) to the assessment made at this visit (see figure part B). Upon comparing the change of the pressure ulcer from this visit to the previous visit, what should the nurse do next?

Contact the health care practitioner (HCP) to request a hydrocolloid dressing.

A teenager is admitted to the burn unit with third-degree burn injuries over more than 40% of the body. When administering I.V. fluids to the client within the first 48 hours of injury, what is the most important responsibility of the nurse?

Ensure a fluid volume sufficient to prevent shock.

A parent brings an infant to the clinic for a well child visit. During the assessment, the parent asks the nurse why the infant never seems to sweat. What action should the nurse take?

Explain that this normal mechanism keeps the infant from losing too much water through the skin.

A 29-year-old woman is concerned about her personal risk factors for malignant melanoma. She is upset because her 49-year-old sister was recently diagnosed with the disease. After gathering information about the client's history of sun exposure, what should the nurse tell the client?

Some melanomas have a familial component and she should seek medical advice.

A client with a partial thickness burn injury has had Biobrane applied 2 weeks ago. The Biobrane is now separating from the wound. What nursing intervention is appropriate?

Trim away the Biobrane that has separated from the wound.

The nurse is caring for a child on the burn unit weighing 100 lb (45.5 kg) who has second-degree (partial-thickness) burns 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

The nurse is caring for a pediatric client with multiple wounds from a bike accident. What is the best method for cleansing or washing out the wound?

Use normal saline solution to wash the wound.

A nurse is changing a dressing and providing wound care. Place the following activities in the correct order. All options must be used.

Wash hands thoroughly. Put on latex gloves. Slowly remove the soiled dressing. Assess the drainage in the dressing.

The nurse is working as charge nurse on a medical-surgical unit. The nurse is providing orientation for a newly hired RN. Which action by the new RN requires immediate attention?

administering oral tetracycline with milk to a client with cellulitis

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 health care provider. What is the most appropriate action for the nurse to do with this child?

apply ice to the affected area

An adolescent is to receive topical retinoid therapy for his moderately severe acne. The nurse would instruct the adolescent about which adverse effects? Select all that apply.

burning photosensitivity dryness

The nurse is caring for a child brought to a pediatric clinic for swelling in the lower extremities. The skin is reddened with undefined borders and pits slightly when pressed. Based on the assessment findings, which of the following would the nurse suspect?

cellulitis

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

A client who was bitten by a wild animal is admitted to an acute care facility for treatment of rabies. Which type of isolation does this client require?

contact

A nurse assesses a client who was admitted to the emergency department with a thermal burn to the right arm and upper chest. Which assessment requires immediate action?

hoarse voice

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

During the emergent (resuscitative) phase of burn injury, which finding indicates that the client requires additional volume with fluid resuscitation?

serum creatinine level of 2.5 mg/dL (221 µmol/L)

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

skin scrapings

A client has a wound on the ankle that is not healing. The nurse should assess the client for which risk factors for delayed wound healing? Select all that apply.

smoking DM advancing age

The nurse is assessing a hospitalized older client for the presence of pressure ulcers. The nurse notes that the client has a 1 inch × 1 inch (3 cm x 3 cm) area on the sacrum in which there is skin breakdown as far as the dermis. What should the nurse note on the medical record?

stage 2

The nurse is bathing a client and discovers a pressure ulcer on the buttocks (see photo). Which nursing intervention, following completion of the bath, is completed first?

Position the client off of the ulcer.