Nursing Care of the Child With an Alteration in Immunity/Immunologic Disorder, Nursing Care of the Child With an Integumentary Disorder (and alteration in tissue integrity)

• 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.

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.

"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.

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?

-Altered family coping related to new presentation of significant illness -Altered comfort related to severity of new illness -Inadequate adherence to medication regimen related to side effects -Inadequate nutrition related to side effects of medication -Delayed growth and development related to frequent infections Because Susie has been relatively healthy since she was diagnosed with HIV, the change in her status is likely to cause changes in family coping mechanisms and dynamics that will have implications for the entire family. Next, the nurse needs to address the specific symptoms of the child. With the increased degree of illness and altered coping strategies, the child may have more difficulty with medication adherence, as well as other complications of AIDS-related illness and treatment, such as poor nutritional intake and delayed growth and development

Susie is a 3-year-old with a history of neonatal transmission of HIV and recent diagnosis of AIDS, as manifested by M. tuberculosis infection. To date, Susie has been relatively healthy with few illnesses associated with high fever; she has been developing appropriately and is at the 5th percentile for height and weight. Susie is at risk for all of the following diagnoses. Prioritize the order of urgency of these diagnoses based on the scenario provided.

• "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.

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?

• "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 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?

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 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?

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 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?

"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 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."

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.

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

"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 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."

"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.

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."

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 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.

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.

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

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 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

"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 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?

• 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

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?

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.

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)

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 child with suspected child abuse-induced burns. Which assessment findings would support this?

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.

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

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 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?

"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.

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."

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 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

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.

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.

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 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.

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 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 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.

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.

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.

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

"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 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."

1300/mm3 The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level?

-Grasps Epipen with black tip pointing downward -Forms a fist around the Epipen -Pulls off the gray safety release -Jabs the Epipen firmly into the outer thigh at a 90-degree angle -Holds Epipen in place for 10 seconds -Massages site for 10 seconds after removing Epipen The steps to using an Epipen are as follows: Grasp the Epipen or Epipen Jr. with the black tip pointing downward, forming a fist; with the other hand, pull off the gray safety release; swing and jab the Epipen firmly into the outer thigh at a 90-degree angle and hold firmly there for 10 seconds; remove the Epipen and massage the thigh for 10 seconds.

The nurse is observing a child demonstrate the use of an Epipen. The nurse determines that the child has performed the procedure correctly. Place the steps in the proper sequence that was demonstrated by the child.

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

Diphenhydramine Premedication with diphenhydramine or acetaminophen may be indicated in children who have never received IVIG, have not had an infusion in more than 8 weeks, have had a recent bacterial infection, have a history of serious infusion-related adverse reactions, or are diagnosed with agammaglobulinemia or hypogammaglobulinemia. Aspirin, ibuprofen and prednisone would not routinely be administered prior to IVIG

The nurse is preparing to administer IVIG to a child who has not received the medication before. What medication should the nurse expect to administer prior to the infusion?

Gently roll the vial to mix the medication. The nurse knows not to shake the intravenous immunoglobulin, as this may lead to foaming and may cause the immunoglobulin protein to degrade. Reconstituted intravenous immunoglobulin can be refrigerated overnight but should be brought to room temperature prior to administration. The nurse does not need to reconstitute the medication 2 hours prior to administration

The nurse is preparing to administer an intravenous immunoglobulin infusion. While reconstituting the product according the manufacturer's instructions, the nurse knows to take which step for proper preparation?

"The ELISA method detects antibodies so a person may have a false negative test for up to six months after exposure. ELISA method detects only antibodies, so the test may remain negative for several weeks up to 6 months (false-negative) after exposure. A false-positive may result with autoimmune disease. The ELISA test requires serial testing. HIV test results are confidential

The nurse is speaking with a teenager who has requested HIV testing. Which is the best statement by the nurse regarding HIV testing?

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 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

Epinephrine Epinephrine is the drug of choice to treat anaphylaxis.

A child is in the emergency department after a bee sting and experiencing bouts of nausea and vomiting. The client's blood pressure is 68/40; pulse is 48. The child is hypoxic and dyspneic. Which medication should the nurse prepare to give this client?

• Peanuts • Eggs • Shrimp Foods that should be avoided in children younger than 1 year of age include cow's milk, eggs, peanuts, tree nuts, sesame seeds, and fish and shellfish (i.e., shrimp). Carrots, potatoes, and bananas are not considered problematic.

A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which foods would the nurse most likely include? Select all that apply.

• Milk • Peanuts • Eggs Allergies to eggs, peanuts, and milk are common in childhood. Cheerios are made of oats and are not known to be allergenic. Apples also are not allergenic, unlike bananas, which can cause problems for children who have latex allergies.

Food allergies have become more and more common in the last few decades. What are some common food allergies of childhood?

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

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.

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.

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.

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

IgE Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin?

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

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

Epinephrine Epinephrine (adrenaline) reverses the effects of histamine (severe bronchospasm and edema).

Which drug should be available for emergency treatment of a child who goes into anaphylactic shock?

• 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.

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?

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.

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

"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.

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."

"Humoral immunity is generally functional at birth." Normal immune function is a complex process involving phagocytosis (process by which phagocytes swallow up and break down microorganisms), humoral immunity (immunity mediated by antibodies secreted by B cells), cellular immunity (cell-mediated immunity controlled by T cells), and activation of the complement system. Cellular immunity is generally functional at birth, and as the infant is exposed to various substances over time, humoral immunity develops.

The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education?

Obtain a medical alert ID bracelet so the presence of the allergy can be identified easily. Stinging-insect allergy can lead to anaphylactic shock. Alerting health care personnel to the possibility of an insect sting is important.

What advice would be most appropriate for the child with a stinging-insect allergy?

Elimination diet Elimination diets involve adding foods slowly to a child's diet so foods to which the child is allergic can be identified.

What would best identify foods to which a child is allergic?

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.

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.

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.

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 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.

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.

PCR PCR tests directly for the HIV antigen. ELISA and the Western blot test detect the presence of HIV antibodies. The CD4 count is used as a measure of disease status and progression

The most accurate screening test for the presence of HIV antigen in young children is:

The nurse should encourage the child to talk with his parents about his medications Generally, children older than 6 years of age will eventually need to have their diagnosis disclosed to them in an age-appropriate manner. They begin to ask questions and often seem to sense that something is going on other than what they've been told so far. Encouraging discussion with the parents is the best first step

The parents of a 10-year-old with HIV have never told their child that he has the virus. The child asks the nurse why he is "on so many medications." What action should the nurse take?

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.

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

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

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

"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 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?

"He will likely outgrow this." Older children and adolescents with allergic reactions to fish, shellfish, and nuts usually continue to have that concern as a life-long problem

A nurse is providing dietary interventions for a 12-year-old with a shellfish allergy. Which response indicates a need for further teaching?

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.

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)

• 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.

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

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.

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?

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 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

• After mixing, roll the vial of medication. • Store the vial in the refrigerator until use. • Promote hydration prior to administration. • Medicate with acetaminophen prior to administration. IVIG must be reconstituted. After the diluent is added to the powder, gently roll the vial between your hands to mix. Shaking will damage the medication. Reconstituted IVIG may be refrigerated overnight but should be brought to room temperature prior to infusion. Premedication with acetaminophen may be indicated in children who have never received IVIG. The child should be well hydrated prior to the administration. Adverse reactions should be monitored for within 15 minutes of the initiation of the infusion

The nurse is planning to administer IVIG to a child for the first time. What actions related to this therapy are indicated?

Impetigo. Impetigo is a superficial bacterial skin 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. The nurse most likely referring to:

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.

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

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.

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

• "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

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?

"Have you noticed any hair loss or redness on your face?" Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE. Rhinorrhea, wheezing, and an enlarged spleen are not hallmark manifestations of SLE. Petechiae and purpura are more commonly associated with hematological disorders, not SLE

A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl?

• Perinatally from mother to fetus • Sharing contaminated needles • Transfusion of contaminated blood • Through breastfeeding • Exposure to blood and body fluids through sexual contact HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding

A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread?

Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse Anaphylaxis typically is a very rapid response to exposure to an allergen. Vasodilation leads to potential circulatory collapse. Bronchospasm occurs simultaneously with other system reactions, also contributing to the life-threatening possibility.

Place in correct order the steps in the anaphylactic response.

"Removal of this gland may not improve your child's symptoms." Myasthenia gravis is an autoimmune condition. It is characterized by progressive weakness and fatigue. There is not cure. Removal of the thymus gland is recommended by some professionals but the thymus gland and its relationship to this disease are not clear. Removal of the gland may not improve the child's condition

The mother of a child with myasthenia gravis inquires about thymus gland removal. She reports she has read that this is a possible cure for her child. What response by the nurse is indicated?"

Lymphocyte T cells The thymus is responsible producing lymphocyte T cells. The bone marrow produces stem cells that are capable of differentiating into various blood cells. White blood cells arise from the stem cells in the bone marrow. Antibodies are formed by the B cells

A group of nursing students are reviewing information about the immune system. The students demonstrate understanding of the information when they identify what as being produced by the thymus?

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.

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.

"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.

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."

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

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 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

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 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

"If we need to use the EpiPen® we will need to notify her physician's office the next business day." If an EpiPen® is used, the child still needs immediate medical attention. EpiPens should be carried with the patient at all times. When administering an EpiPen, the grey safety cap should not be removed until immediately prior to using. Medical alert bracelets or necklaces should be worn by all children with severe allergies

The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education?

Screening for HIV No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test. Prophylactic treatment would be initiated only once the woman has been screened. Screening for STIs and ensuring proper nutrition are also part of health promotion for women in this age group, but they are of lower priority than identifying HIV-positive individuals

The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting?

Erythrocyte sedimentation rate (ESR) The erythrocyte sedimentation rate (ESR) is an indicator of inflammation; it would likely be elevated during an exacerbation of arthritis. Immunoglobulin electrophoresis determines the level of individual immunoglobulins; it would not be elevated in an autoimmune disease. Lymphocyte immunophenotyping T-cell quantification measures T-cells; this would be used to monitor immunosuppressive disorders. The radioallergosorbent test measures minute quantities of IgE in the blood; it is used for asthma and food allergy testing.

The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated?

Bananas The nurse should instruct children and their families to avoid foods with a known cross-reactivity to latex, such as bananas

The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food?

• Acute otitis media, one episode every 3 to 4 weeks over the past year. • Recurrent deep abscess of the thigh • Oral thrush, persistent over the past 6 to 7 months Warning signs associated with primary immunodeficiency include four or more new episodes of acute otitis media in 1 year, recurrent deep skin or organ abscesses, persistent oral thrush or skin candidiasis after 1 year of age. A history of infections requiring IV antibiotics to heal and two or more episodes of pneumonia in 1 year are also warning signs.

The nurse is reviewing the medical history of a 4-year-old child. What would the nurse identify as potentially indicative of a primary immunodeficiency?

"Has your child ever been tested for a peanut allergy?" Explanation: Enchilada sauce is an unexpected food that may contain a form of peanuts (such as peanut oil) that may be causing an allergic reaction in the child.

The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant he gets a rash. It just doesn't make sense to me." How should the nurse respond?

"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 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?

"Has she ever had penicillin before?" Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug

To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant?

• 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.

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

Importance of yearly eye examinations When hydroxychloroquine is given, the child should have a fundoscopic eye exam and visual field testing every year. Corticosteroids need to be tapered gradually over time. Cyclosporine A should not be taken with grapefruit juice. Nonsteroidal anti-inflammatory agents should be given with food to decrease gastrointestinal upset

A child with systemic lupus erythematosus is receiving hydroxychloroquine sulfate. Which instruction would the nurse emphasize when teaching the child and parents about this drug?

Assessing patency of the airway The priority nursing intervention is to assess patency of the airway and breathing. If the child is stable, the next step would be to obtain a brief history of allergen exposure. If epinephrine is required, it would be administered prior to diphenhydramine. Corticosteroids would be used to prevent late-onset reactions.

The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority?

To help prevent transmission of the disease to the fetus A goal of therapy during pregnancy is to maintain the CD4 cell count at greater than 500 cells/mm3 by administering oral zidovudine which helps halt maternal/fetal transmission dramatically along with one or more protease inhibitors, such as ritonavir (Norvir) or indinavir (Crixivan), in conjunction with an NRTI. If P. carinii pneumonia develops, a woman is treated with trimethoprim with sulfamethoxazole. Kaposi's sarcoma is normally treated with chemotherapy. Women may need a platelet transfusion close to birth to restore coagulation ability.

The nurse is working with a pregnant client with HIV who is receiving oral zidovudine. What is the primary rationale for this intervention?

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

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

Administer epinephrine immediately. Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing.

school-aged child has a bee-sting allergy. When the child is stung by a bee during a school recess, assuming that all of the following interventions are covered by school protocol, which initial intervention by the school nurse would be most appropriate?

The client will remain free from infection. While all of these are goals for the client, the highest priority for the immunocompromised client is to remain free from infection since she is at a high risk for development of an infection. In the immunocompromised client any infection can be life threatening

The nurse is preparing a care plan for a 3-year-old client diagnosed with severe combined immune deficiency. What is the primary goal for this client?

Epinephrine The child is demonstrating an anaphylactic reaction. While all of the medications may be necessary, the first medication to be administer is epinephrine to counteract the analphylaxis.

The nurse on a pediatric unit finds a child having extreme shortness of breath, a swollen tongue, and urticaria on her face and neck. The nurse notices her lunch tray to have a half-eaten peanut butter and jelly sandwich. The client is allergic to peanuts. What is the first medication the nurse should be prepared to administer?

"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.

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 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.

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."

Discontinue the infusion. Clients receiving intravenous immunoglobulin are at risk for anaphylaxis. Vomiting can signal an allergic response. The first action would be to stop the infusion. The remaining activities are appropriate for inclusion in the plan of care but are not of the highest priority

The nurse is caring for a child who is receiving an intravenous immunoglobulin treatment. The client calls the nurse and reports she vomited. What action should be completed first?

"Does your child get a whipped cream or foam topping on their favorite drink?" Albumin, globulin, ovalbumin should be avoided if allergic to eggs. Some foam toppings for drinks contain these substances and would cause an allergic reaction to the person allergic to eggs. This would be important information to ascertain from the family as they would likely not be aware of this.

The parents of an adolescent tell the nurse, "Our child seems to have allergy symptoms every time we visit our favorite cafe. I don't understand since the only allergy indicated in the testing was to eggs?" How should the nurse respond?

"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.

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."

Elevated blood pressure Renal complications may result from lupus. This may be accompanied by hypertension making monitoring of blood pressure of the highest importance.

The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of the greatest concern?

"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.

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?

"The best way is to eliminate the food from the diet and then look for improvement." Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies.

The mother of a child with a possible food allergy asks the nurse for information about how to test for it. Which response by the nurse would be most appropriate?

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.

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

"I can use the egg white when baking, but not the yolk." The parents must understand that their child cannot consume any part of an egg in any form. The other statements are accurate.

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching?

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.

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

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 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

Autoimmunity Autoimmunity results from an inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells and tissue. Delayed hypersensitivity is when T-lymphocyte activity occurs without an accompanying humoral response. Immunity is the ability to destroy like antigens. An allergen is any mediating substance that when released causes tissue injury and allergic symptoms.

A nursing student correctly identifies the inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells:

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.

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?

"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.

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

Humoral; bacterial B cells are also called humoral cells and typically attack bacterial organisms. Another term for T cells is killer cells, and they most commonly attack viral organisms.

The nurse is explaining to a parent some of the basic aspects of the immune system and its functions. She informs them that B cells, also known as _________ cells, will attack __________ antigens.

Human immunodeficiency virus (HIV) Of the immunologic disorders, HIV infection is the most serious, not only because it is still fatal but also because its spread has been difficult to contain

A nursing student correctly identifies what to be the most serious of all of the immunologic disorders?

Placental spread during pregnancy Although it is decreasing in incidence, transmission of HIV from mother to child by placental spread is still the most common reason for childhood HIV infection in the United States. Children with hemophilia no longer have a high incidence of the disease because blood products are now screened for the virus. HIV is not transmitted by animals or through usual casual contact, such as shaking hands or kissing, or in households, day care centers, or schools. Infection via breast milk is possible but less likely that via placental spread

A mother, who is HIV positive, is distraught when she learns that her 6-month-old baby is also human immunodeficiency virus (HIV) positive. The child had undergone open heart surgery as a newborn and had received numerous blood transfusions. The nurse recognizes that the most likely means of transmission of the disease to this child was:

"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 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?

"The epinephrine auto-injector should be jabbed into the upper arm." An epinephrine auto-injector should be jabbed into the outer thigh, as this is a larger muscle, at a 90 degree angle, not into the upper arm. The other statements are correct

The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which statement by the parents indicates a need for further teaching about the use of an epinephrine auto-injector?

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 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

"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.

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?

Corticosteroid therapy This child's symptoms are consistent with systemic lupus erythematosus (SLE), which is usually treated with corticosteroids. Antiretrovirals, IVIG and phototherapy are of no benefit in the treatment of SLE

The nurse is assessing a child with a complex medical history that includes fatigue, Raynaud phenomenon, anemia and photosensitivity. The nurse should anticipate that this child may require which treatment?

Be certain that the child has not received an antihistamine in the past 8 hours. Skin testing is done to detect the presence of IgE in the skin, or to isolate an antigen (allergen) to which the IgE is responding or to which a child is sensitive. When an allergen is introduced into the child's skin and the child is sensitive to that allergen, a wheal or flare response will appear at the site of the test from the release of histamine, which leads to local vasodilation. Because this reaction appears quickly, the test should be read in 20 minutes, not 40 minutes. Systemic or aerosol administration of an antihistamine will inhibit the flare response, so be certain the child has not received these drugs for 8 hours before skin testing. Because intracutaneous injections are given just below the epidermal layer of skin (not in the muscle), they are almost painless; thus, no anesthetic is needed.

A nurse is assisting with skin testing for allergies in a 14-year-old girl. What should the nurse do to ensure an accurate test?

Enzyme-linked immunosorbant assay (ELISA) The ELISA test will be positive in infants of HIV-infected mothers because of trans-placentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate in detecting true HIV infection in infants and toddlers than the polymerase chain reaction (PCR). The PCR test is positive in infected infants over the age of 1 month. The erythrocyte sedimentation rate would be ordered for an immune disorder initial workup or ongoing monitoring of autoimmune disease. Immunoglobulin electrophoresis would be ordered to test for immune deficiency and autoimmune disorders

A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus?

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 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

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 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.

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.

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

"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.

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?

An upper respiratory viral infection GBS is a disorder in which an immune response within the body attacks the peripheral nervous system but does not usually affect the brain or spinal cord. GBS is believed to be an autoimmune condition that most commonly is triggered by a previous viral or bacterial infection, usually described as an upper respiratory tract infection or an acute gastroenteritis with fever, and is more commonly seen in adults rather than children

The nurse is reviewing the health records of an 18-year-old with Guillain-Barré syndrome (GBS). The nurse anticipates finding what information in the client's health history?

• Muscle weakness • Shortness of breath • Rash • Unusual bleeding Ziagen (abacavir) is a nucleoside analog reverse transcriptase inhibitor given as part of the drug treatment regimen for HIV. Muscle weakness, shortness of breath, headache, insomnia, rash, or unusual bleeding are side effects that must be reported to the physician.

The nurse is caring for a client with HIV who is receiving Ziagen (abacavir) for treatment. What signs and symptoms will require the nurse to notify the physician?

• Child diagnosed with six episodes of acute otitis media during the previous year • Child with oral thrush that is unresolved with treatment • Child admitted to the hospital three times within the last year with pneumonia • Child who has taken antibiotics for the last 3 months without evidence of clearing of the infection The following children may have a primary immunodeficiency: a child with a persistent case of oral candidiasis, a child who has been diagnosed with pneumonia at least twice during the previous year, and a child who has taken antibiotics for 2 months or longer with little effect

The nurse is assessing children in a physician's office. Which children may have a primary immunodeficiency?

"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 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."

"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 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."

"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.

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."