Chapter 24: Nursing Care of the Child with an Integumentary Disorder
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 respiratory rate is 32 breaths a minute. 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 temperature is 38.4°C.
a)The child's respiratory rate is 32 breaths a minute. Explanation: An increase in the respiratory rate after a severe burn may be an indication of possible serious respiratory complications and should be reported immediately in case an endotracheal tube needs to be inserted. A temperature of 38.4°C, hourly urine output of 150 cc, and pain rating of 7 need to be documented and reported but are not as urgent as reporting respiratory concerns.
The nurse is collecting data on a child with a diagnosis of atopic dermatitis. While interviewing the caregiver, the nurse will direct questions to the caregiver recognizing that which of the following are common allergens involved in eczema? Select all that apply. a) Eggs b) Animal dander c) Cotton d) Oatmeal e) Nylon f) Cow's milk
f)Cow's milk b)Animal dander e)Nylon Explanation: The most common allergens involved in eczema are eggs, cow's milk, wheat products, orange juice, tomato juice, house dust, pollens, animal dander, wool, nylon, and plastic.
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) Seborrheic dermatitis d) Candidiasis
a)Impetigo Explanation: Impetigo is a superficial bacterial skin infection.
The nurse is examining a child for indications of frostbite and notes blistering with erythema and edema. The nurse notes which of the following degrees of frostbite? a) Third degree frostbite b) Second degree frostbite c) Fourth degree frostbite d) First degree frostbite
b)Second degree frostbite Explanation: 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.
A nurse is caring for a child with tinea pedis. Which of the following assessment findings would the nurse expect to note? a) Inflamed boggy mass filled with pustules b) Erythema, scaling, maceration in the inguinal creases and inner thighs c) Patches of scaling in the scalp with central hair loss d) Red scaling rash on soles and between the toes
d)Red scaling rash on soles and between the toes Explanation: Tinea pedis presents with red scaling rash on soles, and between the toes. Tinea capitis presents with patches of scaling in the scalp with central hair loss and the risk of kerion development (inflamed boggy mass filled with pustules). Tinea cruris presents with erythema, scaling, maceration in the inguinal creases and inner thighs.
The nurse is providing home care instructions for the parents of an infant with cradle cap. Which response by the parents indicates a need for further teaching? a) "We can safely use a selenium sulfide shampoo on his hair." b) "We should wash or shampoo the scalp areas with mild soap." c) "We can scrape off the crusts on his scalp with a cotton swab." d) "We can massage his head with mineral oil first and then shampoo it."
"We can scrape off the crusts on his scalp with a cotton swab." Explanation: The crusts should not be forcibly removed with a cotton swab. The affected areas are washed or shampooed with a mild soap. In the infant, mineral oil is applied to the scalp, massaged in well with a washcloth, and then shampooed 10 to 15 minutes later using a brush to gently lift the crusts. Selenium shampoo can be used safely on an infant.
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) Asthma b) Rheumatoid arthritis c) Hemophilia d) Otitis media
a)Asthma Explanation: Infants who have eczema tend to have allergic rhinitis or asthma later in life.
The process of removing necrotic tissue in the treatment of burns is known as which of the following? a) Débridement b) Autograft c) Allograft d) Hydrotherapy
a)Débridement Explanation: Débridement (removal of necrotic tissue), usually preceded by hydrotherapy (use of water in treatment), is performed in the treatment of burns. Débridement is extremely painful, and the child must have an analgesic administered before the therapy.
The nurse is caring for a 10-month-old with a rash. The child's mother reports that the onset was abrupt. The nurse assesses diffuse erythema and skin tenderness with, ruptured bullae in the axillary area with red weeping surface. The nurse suspects which of the following bacterial infections? a) Scalded skin syndrome b) Folliculitis c) Impetigo d) Non-bullous impetigo
a)Scalded skin syndrome Explanation: Staphylococcal scalded skin syndrome results from infection with S. aureus that produces a toxin which then causes exfoliation. It is abrupt in onset and results in diffuse erythema and skin tenderness. It is most common in infancy and rare beyond 5 years of age. Bullous impetigo presents with red macules and bullous eruptions on an erythematous base. Nonbullous impetigo presents as papules progressing to vesicles then painless pustules with a narrow erythematous border. Folliculitis presents with red raised hair follicles.
The nurse is caring for a child with urticaria. Which of the following would be the priority? a) Inspecting the skin, noting evidence of raised, edematous hives anywhere on the body b) Assessing the child's airway and breathing and noting any wheezing or stridor c) Noting whether hives are pruritic, blanch when pressed, or are migrating d) Obtaining a detailed history of new foods, medications, stress, or changes in environment
b)Assessing the child's airway and breathing and noting any wheezing or stridor 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.
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) Diversional activities b) Medication c) Soaking in a colloidal bath d) Turning the patient every two hours
b)Medication Explanation: As nerve endings heal they cause intense itching that can be relieved with the use of medications. Turning the patient every two hours will not relieve the itching. Soaking in a colloidal bath in contraindicated with burn patients. Diversional activities will not be effective when attempting to relieve itching.
The nurse is conducting a primary survey of a child with burns. Which of the following assessment findings points to airway injury from burn or smoke inhalation? a) Internal injuries b) Stridor c) Cervical spine injury d) Burns on hands
b)Stridor Explanation: Airway injury from burn or smoke inhalation should be suspected if stridor is present. Cervical spine or internal injures would not point to airway injury. Burns on hands would not be indicative of airway injury.
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) Candidiasis b) Seborrheic dermatitis c) Impetigo d) Miliaria rubra
c)Impetigo Explanation: Impetigo is a superficial bacterial skin infection.
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 child will have minimal pain. c) The child will likely have blisters. d) The nerve ending are destroyed.
c)The child will likely have blisters. 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 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 briskly scrub the site. b) The nurse should splint the leg. c) The nurse should apply ice to the affected area. d) The nurse should administer pain medication.
c)The nurse should apply ice to the affected area. 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.
A nurse is caring for a child with a wasp sting. What is the priority nursing intervention? a) Apply ice intermittently b) Cleanse wound with mild soap and water c) Remove jewelry or restrictive clothing d) Administer the diphenhydramine per protocol
d)Administer the diphenhydramine per protocol Explanation: The nurse should administer diphenhydramine as soon as possible after the sting in an attempt to minimize a reaction. The other actions are important for an insect sting, but the priority intervention is to administer diphenhydramine.
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.
d)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.
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. What should the nurse ask the mother? a) "Does she wear sleepers with metal snaps?" b) "Do you change her diapers regularly?" c) "Tell me about your family history of allergies." d) "Has she been exposed to poison ivy?"
a)"Does she wear sleepers with metal snaps?" Explanation: 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 is working as part of a response team caring for children who have been involved in an elementary school fire. Which children would the nurse identify as needing a referral to a burn unit? Select all that apply. a) 9-year-old with asthma and burns to the face b) 8-year-old with an inhalation injury c) 10-year-old with partial-thickness burns and rib fractures d) 7-year-old with superficial burns over 5% of the body e) 6-year-old with burns involving the knees and hips
b) 8-year-old with an inhalation injury e) 6-year-old with burns involving the knees and hips c)10-year-old with partial-thickness burns and rib fractures a)9-year-old with asthma and burns to the face Explanation: Referral to a burn unit should occur for children with inhalation injuries, burns involving the major joints, burns and preexisting conditions that might affect the care (such as asthma), or burns and traumatic injuries such as rib fractures. Superficial burns over 5% of the body are not a criterion for referring a child to a burn unit.
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 use the highest-potency steroid cream I can find." b) "I should not cover the area with plastic wrap after applying the cream." c) "I should apply the medicine at bedtime and rinse it off in the morning." d) "I need to shake the preparation before using it."
b)"I should not cover the area with plastic wrap after applying the cream." 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 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) "It is okay to use a children's sunscreen as long as you avoid the face." b) "You should not take your infant to Florida." c) "Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun." d) "Put plenty of children's sunscreen on the infant at least 15 minutes before going outdoors, then reapply every three to four hours."
c)"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 burn patient in a pediatric hospital. Which of the following would be an appropriate nursing diagnosis for this patient? a) Knowledge deficit related to daily care procedures in the acute care setting b) Risk for fluid volume overload related to thermal injuries c) Acute pain related to thermal injuries and procedures d) Risk for aspiration related to effects of medication
c)Acute pain related to thermal injuries and procedures 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 child with a partial-thickness burn. Which of the following assessment findings would the nurse expect to observe? a) Peeling skin with eschar b) Edema with dry or waxy-looking skin c) Edema with wet blistering skin d) Reddened and leathery skin
c)Edema with wet blistering skin 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 burn patient in a pediatric hospital. The patient is scheduled to be discharged the following day and the nurse is going over discharge teaching with the parents. Which of the following is the best intervention for the parents when removing an old dressing? a) Soak the old dressing in tepid water before attempting to remove. b) Soak the old dressing in cold normal saline before attempting to remove. c) Remove the old dressing as quickly as possible. d) Take your time and be thorough when changing the burn dressing.
Soak the old dressing in tepid water before attempting to remove. Explanation: Instruct the parents to soak the dressing in tepid water before removing it, to loosen the dressing and to decrease the child's discomfort. Removing the old dressing too quickly could cause stripping of new skin and tissue that is attached to the dressing. Dressing changes are done as quickly as possible once the old dressing has been removed since exposure to air and water causes 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 we notice some yellowish drainage, we need to call the doctor." b) "We need to keep the wound tightly bandaged for at least 3 days." c) "If our son starts telling us that the pain is increasing, we need to have it checked out." d) "We should call the doctor if the wound becomes red and hot looking."
b)"We need to keep the wound tightly bandaged for at least 3 days." 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 conducting a physical examination of a child with severe burns. Which of the following internal physiologic manifestations would the nurse expect to occur first? a) Increased protein catabolism b) Decrease in cardiac output c) Hypermetabolic response with increased cardiac output d) Insulin resistance
b)Decrease in cardiac output Explanation: Initially, the severely burned child first experiences a decrease in cardiac output with a subsequent hypermetabolic response during which cardiac output increases dramatically. During this heightened metabolic state, the child is a risk for insulin resistance and increased protein catabolism.
When a child enters the acute care setting or clinic following a burn injury, for which of the following immunizations is it important to check for the last booster? a) Pertussis b) Tetanus c) Meningitis d) Diphtheria
b)Tetanus Explanation: For any burn, check the child's tetanus immunization status on admission and ensure that tetanus toxoid is given if the child's immunizations are not up to date, because anaerobic and aerobic bacteria can grow at the interface between burned and healthy tissue. Pertussis, diphtheria and meningitis are not important immunizations to check for with a burn patient.
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 a topical anesthetic ointment b) Administer acetaminophen c) Apply cold compresses to the area d) Cover the area with a sterile bandage
c)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 14-year-old child is diagnosed with tinea versicolor. Which of the following would the nurse expect the nurse practitioner to order? a) Diphenhydramine b) Topical nystatin c) Selenium sulfide d) Oral griseofulvin
c)Selenium sulfide 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 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) "Sometimes I get acne when I use my sister's makeup." b) "There is a new immunization that you can get to keep from having acne." c) "My mom says I have acne because I eat too much chocolate." d) "My next door neighbor told me that acne was caused by a fungus."
a)"Sometimes I get acne when I use my sister's makeup." 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 dietary intake with the parents of a 4-year-old child who has been diagnosed with atopic dermatitis. Later nurse notes the menu selection made by the parents for the child. Which selection indicates the need for further instruction? a) Peanut butter and jelly sandwich b) Carrot and celery sticks c) Tomato soup d) Chicken nuggets
a)Peanut butter and jelly sandwich Explanation: Atopic dermatitis is commonly associated allergies to food. Common culprits may include peanuts, eggs, orange juice, and wheat-containing products.
The nurse is providing education to the parents of a teenaged boy diagnosed with impetigo. Which of the following statements by the boy indicates the need for further education? a) "This condition is contagious." b) "I will need to cover my son's skin lesions with bandages until it has healed." c) "It is important to remove the crusts before applying any topical medications." d) "My son can continue to attend school while he is taking the prescribed antibiotics."
b)"I will need to cover my son's skin lesions with bandages until it has healed." Explanation: Impetigo is an infectious bacterial infection. The crusts should be removed after soaking prior to applying topical medications. Leaving the lesions open to air is not contraindicated. Children diagnosed with impetigo may attend school during treatment.
The nurse is discussing the use of over-the-counter ointments to manage a mild case of diaper rash. What ingredients should the nurse instruct the parents to look for in a compound? Select all that apply. a) Vitamin D b) Vitamin A c) Vitamin B12 d) Vitamin B6 e) Zinc
b)Vitamin A e)Zinc a)Vitamin D Explanation: The treatment of diaper rash may include topical ointments containing vitamins A and D as well as zinc.
An adolescent is prescribed isotretinoin. Which of the following indicates that the adolescent understands the necessary precautions associated with this drug? a) "I'm going to have to have a blood count done every couple of months." b) "This drug can affect my lungs so I need a chest radiograph done first." c) "I have to make sure that I do not become pregnant while taking this drug." d) "The drug might cause staining of my clothing."
c)"I have to make sure that I do not become pregnant while taking this drug." Explanation: Adolescent girls taking this drug who are sexually active must be on a pregnancy prevention program because the drug causes defects in fetal development. Monthly complete blood counts are required when taking isotretinoin. Isotretinoin is not associated with lung problems, so a chest radiograph is not necessary. Coal tar preparations are associated with staining of the clothing or fabrics. Isotretinoin does not stain clothes or fabrics.
The nurse is caring for a child admitted with partial thickness burns. Which of the following is most characteristic of this type of burn? a) Skin is red and edematous b) Muscle damage occurs c) Blisters appear d) Pain is minimal
c)Blisters appear Explanation: In partial-thickness or second-degree burns, blistering usually occurs with an escape of body plasma.
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
a)Tetanus toxoid vaccine 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.
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) Benzoyl peroxide (Clearasil) b) Isotretinoin (Accutane) c) Erythromycin d) Tretinoin (Retin-A)
b)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 developing the plan of care for a 3-year-old child diagnosed with atopic dermatitis. When reviewing the desired patient outcomes which of the following are common focuses for a child with this diagnosis? Select all that apply. a) Maintenance of skin integrity b) Prevention of infection c) Promotion of skin hydration d) Pain management e) Reduction in anxiety
c)Promotion of skin hydration a)Maintenance of skin integrity b)Prevention of infection Explanation: When caring for the child with atopic dermatitis the focus of care will be on the prevention of infection, maintenance of skin integrity, and promotion of skin hydration.
A nurse providing teaching on ways to promote skin hydration for the parents of an infant with atopic dermatitis. Which of the following responses indicates a need for further teaching? a) "We need to avoid any skin product containing perfumes, dyes, or fragrances." b) "We should use soap to clean only dirty areas." c) "We should use a mild soap for sensitive skin." d) "We should bathe our child in hot water, twice a day."
d)"We should bathe our child in hot water, twice a day." Explanation: The nurse should emphasize that the parents should avoid hot water. The child should be bathed twice a day in warm water. The other statements are correct.
The nurse is caring for a 1-year-old patient in a pediatric clinic. The patient was brought to the clinic with symptoms of dry, itchy red patches of skin on the arms and legs. A diagnosis of atopic dermatitis (eczema) is made. Which of the following is a key element in the treatment regimen for this diagnosis? a) Frequently rehydrating the skin b) Applying topical antibiotics routinely c) Teaching the child not to scratch the "itchy" skin d) Daily oral cortisone
a)Frequently rehydrating the skin Explanation: Frequently rehydrating the skin is a key element of the treatment regimen. To maintain healthy skin in the child with AD, hydration practices should be implemented to replace moisture in the stratum corneum and prevent transdermal water losses. Scratching the itchy skin is a reflex that is very difficult to stop; preventing the itch is more effective. Topical antibiotics and oral cortisone are not treatments for atopic dermatitis.
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 elbow restraints to the infant. b) The nurse applies topical antibiotics to the lesions. c) The nurse follows contact precautions. d) The nurse soaks the skin with warm water.
c)The nurse follows contact precautions. 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 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) "One role of the integumentary system is to distribute oxygen to the body cells." b) "The integumentary system is not in place until after the child is born and then takes many years to mature." c) "The accessory structures of the integumentary system include the sebaceous or sweat glands." d) "The largest organ of the integumentary system helps regulate body temperature."
d)"The largest organ of the integumentary system helps regulate body temperature." Explanation: The skin is the major organ of the integumentary system and is the largest organ of the body. The skin helps regulate the body temperature by heating and cooling. Accessory structures such as the hair and nails also make up the integumentary system. The major role of the skin is to protect the organs and structures of the body against bacteria, chemicals, and injury. Excretion in the form of perspiration is also a function of the skin glands, called the sweat glands. Sebaceous glands in the skin secrete oils to lubricate the skin and hair. The integumentary system is in place at birth, but the system is immature. A function of the respiratory system is to distribute oxygen to body cells.
The nurse is caring for a 15-year-old boy with psoriasis. In addition to the plaques, which of the following would the nurse expect to note? a) Lichenification b) Fissures and scaling on palms and soles c) Hyperpigmentation d) Fever and malaise
b)Fissures and scaling on palms and soles Explanation: Fissures and scaling on the palms and soles are common findings with psoriasis. Fever and malaise, lichenification, and hyperpigmentation are noted with other integumentary disorders but are not typical physical findings with psoriasis.
The nurse is providing teaching on ways to maintaining skin integrity and preventing infection for the parents of a boy with atopic dermatitis. Which of the following responses indicates a need for further teaching? a) "We should avoid using petroleum jelly." b) "We should avoid tight clothing and heat." c) "We need to develop ways to prevent him from scratching." d) "We should keep his fingernails short and clean."
a)"We should avoid using petroleum jelly." Explanation: It is important to apply moisture multiply times through the day. Petroleum jelly is a recommended moisturizer that is inexpensive and readily available. The other statements are correct.
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) 5 days b) 72 hours c) 1 week d) 24 hours
c)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 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) Presence of an ileus d) One third area of fluid leakage resulting in hypovolemic shock
a)Airway obstruction related to upper respiratory swelling 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 with a suspected fungal infection. Which of the following tests would the nurse anticipate as being ordered? a) Potassium hydroxide (KOH) prep b) Erythrocyte sedimentation rate (ESR) c) Patch or skin testing d) Culture of wound/drainage
a)Potassium hydroxide (KOH) prep 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.
A 16-year-old male who has diagnosed with tinea pedis questions the nurse about how he may have contracted the condition. What information may be provided to the boy by the nurse? a) "This condition is common in individuals with lowered immunity." b) "You may have gotten the condition from a community shower or gym area." c) "It is unlikely you will be able to determine the cause of the infection." d) "You likely had an infection in another area of your body and it has spread"
b)"You may have gotten the condition from a community shower or gym area." Explanation: Tinea pedis is commonly known as athlete's foot. It is a fungal infection. The fungi are able to readily grow in warm, moist conditions such as shower areas.
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) Photosensitivity b) Dryness c) Flu-like symptoms d) Burning e) Headache
b)Dryness d)Burning a)Photosensitivity 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.
Which of the following interventions is the most effective in treating burn wound infections? a) Systemic intravenous antibiotics b) Proper hand washing c) Topical antibiotics applied to the wound site d) Systemic oral antibiotics
c)Topical antibiotics applied to the wound site 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) Assessing temperature every 4 hours b) Obtaining a culture of the impaired skin area c) Using appropriate hand hygiene d) Urging adequate nutritional intake
c)Using appropriate hand hygiene 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.
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) Facial papules b) Comedones c) Widespread inflammatory lesions d) Presence of nodules e) Evidence of cysts
c)Widespread inflammatory lesions e)Evidence of cysts d)Presence of nodules Explanation: Severe acne is characterized by comedones plus inflammatory lesions such as papules or pustules that are widespread and/or the presence of cysts or nodules and possibly scarring. Comedones are associated with mild acne. Papules localized to the face or back are associated with moderate acne.
The nurse is conducting a physical examination of a boy with erythema multiforme. Which of the following assessment findings would the nurse expect to note? a) Superficial tan or hypopigmented oval shaped scaly lesions especially on upper back and chest and proximal arms b) Thick or flaky/greasy yellow scales c) Silvery or yellow-white scale plaques and sharply demarcated borders d) Lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk
d)Lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk Explanation: 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 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) Regulating skin and body temperature b) Managing pain and discomfort c) Controlling nausea and vomiting d) Reducing swelling and relieving itching
d)Reducing swelling and relieving itching 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.
A nursing instructor is preparing a class discussion about pediatric skin variations, specifically related to differences in dark-skinned children. Which of the following would the nurse most likely include? Select all that apply. a) Papules often appear more prominent on the skin. b) Vesicles appear less visible in most dark-skinned children. c) Keloid formation occurs less often in dark-skinned children. d) Hypertrophic scarring is a common occurrence in dark-skinned children. e) Hypopigmentation often occurs after a skin condition heals.
e)Hypopigmentation often occurs after a skin condition heals. a)Papules often appear more prominent on the skin. d)Hypertrophic scarring is a common occurrence in dark-skinned children. Explanation: Dark-skinned children often experience hypo- or hyperpigmentation of an affected area following healing of a dermatologic condition. Papules, follicular responses, lichenification, and vesicular or bullous reactions are more prominent and keloid formation occurs more often.
The nurse is presenting an in-service to a group of nursing students discussing atopic dermatitis. The following statements were made by the students. Which statement is most accurate related to atopic dermatitis? a) "When children are diagnosed, if they aren't up to date with all of their immunizations they need to get them right away." b) "My sister never gives her 6-month-old eggs because her other kids have all had this disorder." c) "Children with this disorder sleep a lot; sometimes you even have to wake them to feed them." d) "This disorder is usually first recognized by red skin on the child's back."
b)"My sister never gives her 6-month-old eggs because her other kids have all had this disorder." Explanation: The protein of egg white is such a common offender that most pediatricians advise against feeding whole eggs to infants until late in the first year of life. Infantile eczema usually starts on the cheeks and spreads to the extensor surfaces of the arms and legs. Smallpox vaccination is definitely contraindicated for the child with eczema. In fact, such a child must be kept away from anyone who has recently been vaccinated. A serious condition called eczema vaccinatum results when a child with eczema is vaccinated or is exposed to the vaccination of another person.
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 decrease c) Hematocrit and WBC counts elevate d) Hemoglobin and WBC counts decrease
c)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.
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) The reaction occurs in response to specific allergens. b) Scratching initiates the reaction, which then becomes pruritic. c) Changes in temperature can contribute to flare-ups. d) Excessively humid environments often lessen the severity of the reaction. e) The disorder is chronic with periods of remissions.
e)The disorder is chronic with periods of remissions. a)The reaction occurs in response to specific allergens. c)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.
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) Place heating pads and warmed blankets on the trunk of the body initially. b) Place heating pads and warmed blankets on the patient's extremities and trunk. c) Rub the frostbitten extremities to increase circulation to the affected area. d) Apply dry heat to the extremities.
a)Place heating pads and warmed blankets on the trunk of the body initially. 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 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 since so many people are allergic to the ingredients in it." b) "Baby powder should not be used on newborns due to the risk of aspiration upon application." c) "Baby powder can be used anytime with no concerns." d) "Baby powder may be used if sprinkled on your hand away from the baby to prevent aspiration."
b)"Baby powder should not be used on newborns due to the risk of aspiration upon application." 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 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."
b)"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.
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) "They told me to use baby powder every time I change her so she won't get diaper rash." b) "My child gets diaper rash if I wash her clothes in the same detergent we use for the family." c) "Sometimes if I leave the diaper off and let him be in the sunshine he gets diaper rash." d) "The formula she drinks sometimes causes her to have a diaper rash."
b)"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.
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 fair to you; she should get some counseling to learn how to cope with illness better." b) "That's not an uncommon reaction, although it's hard on you and on your child." c) "He will be better soon and your family can get back to normal." d) "I understand her feelings. It is hard to see a child in pain sometimes."
b)"That's not an uncommon reaction, although it's hard on you and on your child." Explanation: The family caregivers of the child with eczema are often frustrated and exhausted. Family caregivers may feel apprehensive or repulsed by this unsightly child. Support them in expressing their feelings and help them view this as a distressing but temporary skin condition. Although the caregiver can be assured that most cases of eczema clear up by the age of 2, this does little to relieve the present situation.
The nurse is 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) Cellulitis c) Impetigo d) Staphylococcal scalded skin syndrome
b)Cellulitis 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 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) "Your child most likely has infantile seborrheic dermatitis, or cradle cap. There is no intervention needed and it should resolve in one week." b) "How often do you bathe your infant? The infant should have a thorough shampooing every day to prevent things like this." c) "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." d) "Your child most likely has dandruff. You can treat it with daily with antiseborrheic shampoo."
c)"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." 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 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 macules and bullous eruptions on an erythematous base b) Red, raised hair follicles c) Erythema multiforme with inflammatory bullae of at least two types of mucosa d) Fiery red lesions, scaling in the skin folds, and satellite lesions
c)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.
Which of the following interventions is the most beneficial for a burn patient undergoing a skin graft? a) Provide an egg-crate mattress or gel mattress for the patient to lie upon. b) Provide diversional activities for the patient. c) Provide around-the-clock pain medication as soon as pain is reported. d) Provide pain medication on a PRN schedule as soon as pain is reported.
c)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 is the best technique to perform an assessment of the skin? a) Skin assessment involves inspection and palpation in a room with yellow walls and bright white light. b) Skin assessment involves inspection and palpation using latex gloves. c) Skin assessment involves inspection and palpation in a room with white walls and bright fluorescent light. d) Skin assessment involves inspection and palpation using vinyl gloves.
c)Skin assessment involves inspection and palpation in a room with white walls and bright fluorescent light. Explanation: Physical assessment of the skin involves two basic techniques: inspection and palpation. The ideal environment for the physical assessment is a well-lit room with white walls, not yellow. Bright white fluorescent ceiling lighting is optimal, because it does not cast a yellow hue on the skin. Skin assessment does not require the use of gloves unless there are body fluids or open lesions on the skin. If gloves are required, they should be vinyl to prevent an allergic reaction.
The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a child abuse-induced burn? a) Spattering pattern b) Splash patterns c) Stocking-glove pattern on hands or feet d) Nonuniform pattern
c)Stocking-glove pattern on hands or feet 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 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 chest. b) The boy has a superficial burn on his hands. c) The boy has suffered a chemical burn. d) The boy has a first-degree burn on the upper arm.
c)The boy has suffered a chemical burn. 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 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) Arrange for the daughter to have the pregnancy testing without the caregiver's knowledge 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) 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
d)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.