Wong Peds Ch 30: Integumentary

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. This is most likely caused by which of the following? a. Impetigo b. Candida albicans c. Urine and feces d. Infrequent diapering

ANS: B Candida albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds.

ati) A nurse is caring for an adolescent who has acne and a prescription for isotretinoin from the dermatologist. Which of the following laboratory findings should the nurse plan to monitor? A. Cholesterol and triglycerides B. BUN and creatinine C. Blood potassium D. Blood sodium

A. CORRECT: Adverse effects of isotretinoin include elevated cholesterol and triglycerides. Plan to monitor these laboratory values during treatment. B. Medications (cephalosporins and furosemide) can alter blood BUN and creatinine levels. However, they do not to be monitored in clients taking isotretinoin. C. Medications (diuretics and corticosteroids) can alter blood potassium levels. However, it does not need to be monitored in clients taking isotretinoin. D. Medications(IV fluids and corticosteroids) can alter the blood sodium level. However, it does not need to be monitored in clients taking isotretinoin.

A nurse is assessing an infant who has eczema. Which of the following findings should the nurse expect? (Select all that apply.) A. Generalized distribution of lesions B. Papules C. Ecchymosis in flexural areas D. Crusting lesions E. Keratosis pilaris

A. CORRECT: Generalized distribution of lesions is an expected finding in infants who have eczema. B. CORRECT: Papules are an expected finding in infants who have eczema. C. Lesions, rather than ecchymosis, in the flexural areas are an expected finding in children 2 years of age and older. D. CORRECT: Crusting lesions are an expected finding in infants who have eczema. E. Keratosis pilaris is an expected finding in children 2 years of age and older.

ati) A nurse is caring for a child who has cellulitis on the hand. Which of the following actions should the nurse take? A. Administer oral antibiotics. B. Cleanse area using Burrow solution. C. Prepare for cryotherapy. D. Apply a topical antifungal medication.

A. CORRECT: Oral antibiotics are often prescribed for the treatment of cellulitis. B. Cleansing with Burow's solution is recommended for staphylococcal scalded skin syndrome or herpes simplex virus. C. Cryotherapy is recommended for human papillomavirus. D. Topical antifungal medications are indicated for the treatment of candidiasis or tinea corporis.

ati) A nurse is teaching the guardian of an infant who has seborrheic dermatitis of the scalp. Which of the following instructions should the nurse include in the teaching? A. "You can use petrolatum to help soften and remove patches from your infant's scalp." B. "When patches are present, you should keep your infant away from others." C. "You should avoid washing your infant's hair while patches are present on the scalp." D. "When patches are present, it indicates that your infant has a systemic infection."

A. CORRECT: Recommend that the guardian use petrolatum, vegetable oil, or mineral oil to help soften and remove scales and crusted areas. B. Seborrheic dermatitis is not contagious, so it is not necessary to keep the infant away from others. C. Washing the infant's hair daily with an antiseborrheic shampoo can help remove scales and crusted areas and can help prevent recurrence. D. The cause of seborrheic dermatitis is unknown and is not associated with a systemic infection.

ati) A nurse is caring for a child who has contact dermatitis due to poison ivy. Which of the following actions should the nurse take? (Select all that apply.) A. Remove the clothing over the rash. B. Initiate contact isolation precautions while the rash is present. C. Expose the rash to a heat lamp for 15 min. D. Cleanse the affected skin with hydrogen peroxide solution. E. Apply calamine lotion to the skin.

A. CORRECT: Removing the irritant from the skin will decrease the child's exposure. Remove the clothing over the affected area. B. Poison ivy is not spread by contact with the rash. Once the plant oils are removed, it cannot be transmitted to others. C. Avoid using a heat lamp, which can cause skin burns. D. Cleanse the affected area with cold running water, followed by soap and water as soon as possible following exposure. E. CORRECT: Apply calamine lotion to assist in relieving discomfort.

ati) A nurse is planning care for a child who has tinea capitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Treat infected house pets. B. Use selenium sulfide shampoo. C. Cleanse area with Burrow solution. D. Administer antiviral medication. E. Use moist, warm compresses.

A. CORRECT: Tinea capitis can be transmitted from household pets, especially cats, to persons. Pets should be treated, if infected. B. CORRECT: Selenium sulfide shampoo is recommended for use for children who have tinea capitis. C. A topical antifungal medication is recommended for children who have tinea capitis. D. Tinea capitis is a fungal infection. Antifungal medications are administered. E. Moist, warm compresses are applied for bacterial skin infections and not recommended for children who have tinea capitis.

ati) A nurse is teaching a parent of a child who has pediculosis capitis. Which of the following instructions should the nurse include in the teaching? A. Apply mayonnaise to the affected area at night. B. Treat all household pets. C. Use an over-the-counter medication containing 1% permethrin. D. Discard the child's stuffed animals.

A. Home remedies (mayonnaise) increase the risk of infection and should be avoided. B. Pediculosis capitis is transmitted person-to-person; house holdpets are not hosts. C. CORRECT: Pediculosis capitis is treated with 1% permethrin, which can be purchased over the counter. D. Items that cannot be placed in the laundry can be placed in a sealed bag for 14 days to kill the lice.

ati) A nurse is assessing an infant who has scabies. Which of the following findings should the nurse expect? (Select all that apply.) A. Presence of nits on the hair shaft B. Pencil-like marks on hands C. Blisters on the soles of the feet D. Small, red bumps on the scalp E. Pimples on the trunk

A. Presence of nits on the hair shaft is a manifestation of pediculosis capitis. B. CORRECT: Pencil-like marks on hands is a manifestation of scabies. C. CORRECT: Blisters on the soles of the feet is a manifestation of scabies. D. Small, red bumps on the scalp are a manifestation of pediculosis capitis. E. CORRECT: Pimples on the trunk is a manifestation of scabies.

ati) A nurse is planning care for an infant who has diaper dermatitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Apply talcum powder with every diaper change. B. Allow the buttocks to air dry. C. Use commercial baby wipes to cleanse the area. D. Use cloth diapers until the rash is gone. E. Apply zinc oxide ointment to the affected area.

A. Talcum powder can cake and cause inhalation injury. It should not be used for infants who have diaper dermatitis. B. CORRECT: Allowing the buttocks to air dry facilitates thorough drying of the skin and should be included in the plan of care. C. Commercial baby wipes contain chemicals that can irritate the skin. They should not be used for infants who have diaper dermatitis. D. Superabsorbent diapers should be used for infants who have diaper dermatitis to assist in keeping the skin dry. E. CORRECT: Zinc oxide ointment protects the skin from moisture and irritation and should be included in the plan of care.

Impetigo ordinarily results in which of the following? a. No scarring b. Pigmented spots c. Slightly depressed scars d. Atrophic white scars

ANS: A Impetigo tends to heal without scarring unless a secondary infection occurs.

Therapeutic management of the child with ringworm infection would include which of the following? a. Administer oral griseofulvin. b. Administer topical or oral antibiotics. c. Apply topical sulfonamides. d. Apply Burow solution compresses to affected area.

ANS: A Treatment with the antifungal agent griseofulvin is part of the treatment for the fungal disease, ringworm. Oral griseofulvin therapy frequently continues for weeks or months.

11. The primary treatment for warts is which of the following? a. Vaccination b. Local destruction c. Corticosteroids d. Specific antibiotic therapy

ANS: B Local destructive therapy individualized according to location, type, and number—including surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies—is used.

Ringworm, frequently found in schoolchildren, is caused by which of the following? a. Virus b. Fungus c. Allergic reaction d. Bacterial infection

ANS: B Ringworm is caused by a group of closely related filamentous fungi that invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin.

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

ANS: C Oral antiviral agents are effective for viral infections such as herpes simplex.

Which of the following is the primary clinical manifestation of scabies? a. Edema b. Redness c. Pruritus d. Maceration

ANS: 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.

Warts are caused by which of the following? a. Bacteria b. Fungus c. Parasite d. Virus

ANS: D Human warts are caused by the human papillomavirus.

The nurse is talking to the parents of a child with pediculosis capitis. Which of the following should the nurse include when explaining how to manage pediculosis capitis? a. "You will need to cut the hair shorter if infestation and nits are severe." b. "You can distinguish viable from nonviable nits, and remove all viable ones." c. "You can wash all nits out of hair with a regular shampoo." d. "You will need to remove nits with an extra-fine tooth comb or tweezers."

ANS: D Treatment consists of the application of pediculicide and manual removal of nit cases. An extra-fine tooth comb facilitates manual removal.

Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse's response should be based on which of the following? a. Poison ivy does not itch and needs further investigation. b. Scratching the lesions will not cause a problem. c. Scratching the lesions will cause the poison ivy to spread. d. Scratching the lesions may cause them to become secondarily infected.

ANS: D Poison ivy is a contact dermatitis that results from exposure to the oil urushiol in the plant. Every effort is made to prevent the child from scratching, since the lesions can become secondarily infected.

Cellulitis is often caused by: a. herpes zoster. b. Candida albicans. c. human papillomavirus. d. Streptococcus or Staphylococcus organisms.

ANS: D Streptococci, staphylococci, and Haemophilus influenzae are the organisms usually responsible for cellulitis.

Which of the following is usually the only symptom of pediculosis capitis (head lice)? a. Itching b. Vesicles c. Scalp rash d. Localized inflammatory response

a. Itching ANS: A Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft

The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents. Which of the following statements made by a parent indicates a correct understanding of the teaching? a. "I should wash my infant's buttocks with soap and water every time I change the diaper." b. "I will wash with a mild soap and water and dry thoroughly whenever my infant has a bowel movement." c. "I should wash my infant's buttocks with soap before applying a thin layer of oil." d. "I will apply baby oil and powder to the creases in my infant's buttocks."

b. "I will wash with a mild soap and water and dry thoroughly whenever my infant has a bowel movement." Overwashing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating.

5. What is the cause of ringworm, a skin disorder frequently found in schoolchildren? a. Virus b. Fungus c. Allergic reaction d. Bacterial infection

b. Fungus Ringworm is a dermatophytosis, which is an infection caused by closely related fungi. They cause superficial infections that invade the stratum corneum, hair, and nails. Viruses, allergic reactions, and bacterial infections do not cause ringworm.

Nursing care of the infant with atopic dermatitis focuses on which of the following? a. Feeding a variety of foods b. Keeping lesions dry c. Preventing infection d. Using fabric softener to avoid rough cloth

c. Preventing infection ANS: C The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection. The infant's nails should be kept short and clean and have no sharp edges.

6. What would the nurse include when explaining how to manage pediculosis capitis? a. Cut hair shorter if infestation and nits are severe. b. Wash all nits out of hair with a regular shampoo. c. Remove nits with a fine-tooth comb or tweezers. d. Distinguish viable from nonviable nits and remove all viable ones.

c. Remove nits with a fine-tooth comb or tweezers. Daily removal of nits from a child's hair with a metal nit or flea comb is an essential control measure after treatment with a pediculicide. Cutting the child's hair short does not prevent infestation. Lice will infest short hair as readily as long hair. Regular shampoo will not remove nits. Using a fine-tooth comb or tweezers is necessary to remove the nits. It is not possible to tell viable and nonviable nits apart.

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

c. Thoroughly wash hands and maintain cleanliness when caring for an infected child. Preventing the spread of inspection is a prime consideration when caring for children with bacterial skin infections. Thorough hand washing and cleanliness will help achieve this goal. Topical corticosteroids are contraindicated in bacterial infections. A Wood lamp is used for diagnosis of some fungal and bacterial skin infections. Dressings are not used in impetigo.

Atopic dermatitis (eczema) in the infant is which of the following? a. Easily cured b. Worse in humid climates c. Associated with upper respiratory tract infections d. Associated with allergy with a hereditary tendency

d. Associated with allergy with a hereditary tendency ANS: D Atopic dermatitis is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency.