PEDS Chapt 24 Nursing Care of the Child with an Integumentary Disorder

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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