Chapter 29: Alterations in Integumentary Function

A child comes to the clinic for evaluation of skin lesions and is diagnosed with impetigo. Which medications are potentially ordered with instructions placed on the discharge summary? Select all that apply. A. Penicillin B. Erythromycin C. Mupirocin D. Tetracycline E. Lindane

ANS: A, B, C Rationale: Treatment of impetigo includes oral administration of penicillin or erythromycin or the application of mupirocin. Tetracycline is not used. Lindane is used to treat tinea infections.

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? A. "We should apply alcohol to the lesions every four hours." B. "If he has a fever, we can give him some aspirin." C. "The lesions should eventually form soft crusts that drain." D. "We need to make sure that he washes his hands frequently."

ANS: D Rationale: The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes erythema? A. Redness of the skin produced by congestion of the capillaries B. Small, circumscribed, solid elevation of the skin C. Discolored skin spot not elevated at the surface D. Small elevation of epidermis filled with a viscous fluid

ANS: A Rationale: Erythema is redness of the skin produced by congestion of the capillaries.

A nurse is teaching parents about erythema infectiosum and describing the progression of the disease from earliest to latest. Place the following manifestations in the order in which the nurse would describe them. A. Intense red rash on the face B. Rash on the flexor surfaces of extremities and trunk C. Rash on extremity extensor surfaces D. Fever and headache E. Lace-like lesion appearance

ANS: D, A, C, B, E Rationale: The first phase of the infection includes fever, headache, and malaise. A week later, a rash, which erupts in three stages, appears. The rash is intensely red and appears first on the face. The lesions are maculopapular and coalesce on the cheeks to form a "slapped face" appearance. The facial lesions fade in 1 to 120 days. A day after the facial lesions appear, a rash appears on the extensor surfaces of the extremities. One day later, the rash appears on the flexor surfaces and the trunk. These lesions last for 1 week or more. When they fade, they fade from the center outward, giving the lesions a lace-like appearance.

A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug? A. That the infant's skin has greater permeability than that of an adult B. That there is less body surface area to be concerned about. C. That there is decreased absorption rates of topical drugs in infants. D. That there is a lower concentration of water in an infant's body compared with an adult.

ANS: A Rationale: Compared to adult skin, infants' skin exhibits greater permeability. This can result in increased absorption, which may result in adverse effects that usually do not occur in the adult patient. The nurse must consider this fact before administering skin ointment. Infants have greater, not lesser, body surface area. Greater body surface area plus increased permeability results in increased absorption of topical agents. Infants tend to have a higher concentration of water in their bodies than do adults.

The nurse is teaching a group of parents about head lice. Which statement is essential to include during the presentation? A. Head lice are becoming very resistant to treatment. B. Send your child to school even if you suspect head lice, but have the school nurse check the child. C. Discourage the children from going to sleepovers. D. Wash the bed linens in hot water to kill the lice.

ANS: A Rationale: The accurate advice is that head lice are becoming resistant to treatment. Children with head lice do not need to stay home, but parents should follow school policies regarding whether children are allowed in school until they are nit-free. Children should be allowed to participate in sleepovers, preferably bringing their own pillows. Head lice do not survive long once they have fallen off. Most children can be treated effectively without treating their bedding and clothing.

The nurse is teaching the parents of a child with varicella about the disorder. The nurse determines that the teaching was successful when the parents state which of the following? A. "We will make sure to remind him not to scratch the lesions." B. "We can give him aspirin for fever." C. "We should put him in a warm bath if he is itchy." D. "We can use salt solutions to help heal his oral lesions."

ANS: A Rationale: The parents understand the teaching when they state that they will help make sure to remind him not to scratch the lesions. Acetaminophen should be administered for fever, not aspirin, due to the link with Reye's syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. The child should avoid citrus, spicy, or salty foods.

The nurse is caring for a child admitted to the pediatric medical unit with chickenpox who has infected vesicles. What personal protective equipment should the nurse use when measuring the child's vital signs? A. Gloves B. Gown C. N95 respirator D. Face mask E. Eye wear

ANS: A, B, C Rationale: Transmission of chickenpox (Varicella zoster) occurs through direct contact with infected persons' nasopharyngeal secretions or via air-borne spread, to a lesser degree by contact with unscabbed lesions. Airborne and contact precautions (gloves, gown, N95 respirator) should be used with the hospitalized child for a minimum of 5 days after onset of rash and as long as vesicular lesions are present. A simple face mask is used for droplet precautions. Eye wear would only be necessary if splashing was likely.

A nurse is teaching parents of a child with a nursing diagnosis of pain related to pruritus from skin lesions. Which of the following would the nurse include in the instructions? Select all that apply. A. "Keep the child's fingernails short." B. "Wrap your child up snugly with blankets." C. "Bathe the child in lukewarm water and baking soda." D. "Have the child press on the itching area instead of scratching it." E. "Avoid having your child wear cotton clothing."

ANS: A, C, D Rationale: Measures to reduce pruritus include keeping the child's fingernails short to prevent injury from scratching; bathing the child in lukewarm water with oatmeal or baking soda; dressing the child in loose, light cotton clothing to prevent overheating and perspiration, which can intensify the itching; having the child press on the itching area rather than scratching it; and avoiding wool, which can irritate the skin and worsen the itching.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease? A. Measles B. Mumps C. Whooping cough D. Scabies

ANS: B Rationale: Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder which causes severe paroxysmal coughing which produces a whooping sound. Measles is recognized by Koplick spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very puritic and is seen on the hands, feet, and folds of the skin.

The nurse is evaluating outcomes for teaching provided to the mother of a school-age child with an itchy rash. Which outcome indicates that teaching has been effective? A. Mother applies hot compresses to itchy skin areas every few hours B. Child drinks a glass of water every 1 to 2 hours throughout the day C. Child showers in hot water and uses soap on the rash every morning D. Child wearing long denim pants and a long-sleeve shirt while playing outside

ANS: B Rationale: To relieve the itchiness of a rash, the child should be encouraged to have an adequate fluid intake to maintain good hydration because dry skin increases discomfort. Cold cloths or compresses applied to itchy areas are appropriate. Heat makes the itch worse. Baking soda should be used when bathing in lukewarm water. Hot water and harsh soap will irritate the rash. The child should be dressed in light cotton clothing so overheating and perspiration does not occur. Perspiration makes the itch worse. Denim pants and long-sleeved shirt would make the child very uncomfortable.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which best describes a macule? A. Redness of the skin produced by congestion of the capillaries B. Small, circumscribed, solid elevation of the skin C. Discolored skin spot not elevated at the surface D. Small elevation of epidermis filled with a viscous fluid

ANS: C Rationale: A macule is a discolored skin spot not elevated above the surface.

The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? A. "Our child is contagious for 1 week after the rash appeared." B. "Acetaminophen or ibuprofen can be given to help with pain." C. "Antibiotics are needed to help our child recover from rubella." D. "Family members should wear a mask when coming to visit us."

ANS: C Rationale: Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.

19. The mother of a an 8-year-old boy with mumps tells the nurse that she does not understand how her son could have gotten mumps since he was immunized according to her physician's recommendations. What is the best response by the nurse? a. "I am sure it must be frustrating. Where did you have the immunizations performed?" b. "I am wondering if your physician followed the immunization schedule correctly?" c. "Are you sure your child received an immunization for mumps?" d. "While immunizations are highly effective they aren't 100% effective at preventing infectious diseases."

ANS: D Rationale: According to the CDC (2014d), one dose of MMR prevents 78% of cases and two doses prevent approximately 88% of cases. Questioning where the immunizations were given, if the immunization was given, and if the physician followed the guidelines correctly is accusatory and unlikely to be the cause of the child contracting the infection.

Parents usually ask when their child can return to school after having chickenpox. The correct answer would be: A. not until all lesions have completely faded. B. as soon as the temperature is normal. C. 10 days after the initial lesions appear. D. as soon as all lesions are crusted.

ANS: D Rationale: Chickenpox lesions are infectious until they crust.

The nurse is caring for a school-age child with varicella. What should the nurse observe about the rash that is associated with this infection? A.Dark red color B. Noticeable crusts but no pruritus C. Dark red, macular, very pruritic lesions D. Various stages of lesions present at the same time

ANS: D Rationale: Most of chickenpox lesions are found on the trunk, although the face, scalp, palate, and neck also may be involved. They appear in approximately three separate series or crops, with each new lesion moving through progressive stages. At some point, all four stages of lesions—macule, papule, vesicle, and crust—can be present. The lesions are not dark red in color. These lesions are very itchy.

The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge? A. "I can't believe it. We're not unclean, poor people." B. "We'll have to get that special shampoo." C. "Everybody in the house will need to be checked." D. "That explains his complaints of itching on his neck."

ANS: A Rationale: Head lice is not an indication of poor hygiene or poverty. It occurs in all socioeconomic groups. Thus, the parents' statement about being unclean and poor reflects a lack of knowledge about the infection. A pediculicide is used to wash the hair to treat the infestation. Household contacts need to be examined and treated if affected. Extreme pruritus is the most common symptom, with nits or lice especially behind the ears or at the nape of the neck.

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition? A. Mumps B. Infectious mononucleosis C. Poliomyelitis D. Herpes zoster

ANS: A Rationale: Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, he points to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? A. Encourage rest and relaxation. B. Antibiotic therapy may be initiated. C. Antiviral medications can be prescribed. D. Range of motion to prevent contractures.

ANS: A Rationale: Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.

The parent of a child with mumps on one side of the face is concerned that the disease can develop on the other side in the future. How should the nurse respond to the mother about this concern? A. The child is immune to further attacks of the disease. B. It does not matter because mumps in adulthood is not serious. C. The child should receive active immunization against mumps. D. There is nothing that can be done to prevent another attack of mumps in the future.

ANS: A Rationale: Some parents worry that because their child had swelling only on one side, the child will develop mumps on the opposite side in the future. One attack of mumps gives lasting immunity, and the child will not contract the disease again. Mumps is a potentially dangerous disease and should not be minimized. The child does not need immunization against mumps.