Chapter 29 Integumentary Disorders

The parent of a child with deep partial-thickness (second-degree) burns on the legs asks the nurse, "One of the staff told me that the dressings being used have silver in them. Why is that?" Which response by the nurse would be most appropriate?

"Dressings containing silver help prevent infection."

When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate?

"Herpes zoster is a reactivation of a previous varicella zoster infection."

The nurse is assessing the skin of a 6-year-old child with urticaria. When interviewing the child and parents, which question would be most important for the nurse to ask?

"Is the child having any trouble breathing?"

A nursing instructor is teaching about infectious diseases in childhood. The teacher identifies a need for clarification when a student makes which of the following statements?

"Lesions in chickenpox progress at the same rate."

The nurse is caring for a 6-year-old boy with mumps. Which of the following statements by the child would cause the nurse to suspect the boy is experiencing a complication of mumps?

"Please talk a little louder."

The nurse is teaching the parents of a child diagnosed with erythema multiforme about the condition. The nurse determines that the teaching was successful based on which statement by the parents?

"The rash should go away in about 2 weeks."

A 6-year-old child is brought to the clinic for evaluation of a rash. The nurse completes an assessment of the child's skin and documents the findings above. Based on the findings, which information would the nurse include in the teaching plan for the child's parents?

"Use a patting motion, not a rubbing motion, to dry the child's skin."

The nurse is inspecting the skin of a child with a rash on the lower legs and documents the above findings. Based on the findings, which question would the nurse most likely ask next?

"Was your child outside near some plants that could be poison ivy?"

The nurse is teaching the parents of a 5-year-old child diagnosed with head lice about using permethrin. The nurse determines that the teaching was successful based on which statement by the parents?

"We need to leave the medication on for about 10 minutes before rinsing it off."

A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent?

"Your child may return to school when all of the lesions have crusted over.

A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.

1. Low-grade fever 2. Macular rash 3. Papular rash 4. Vesicle formation 5. Crusting

A child is diagnosed with varicella zoster and has been prescribed acyclovir 15 mg/kg q 8 hours IV. The child weighs 61.7 lb (28 kg). How many milligrams should the nurse administer in each dose? Record your answer using a whole number.

420

A child weighing 66 lb (30 kg) with deep partial thickness burns is receiving fluid resuscitation. The nurse is monitoring the child's urine output via Foley catheter every hour and documenting the findings on the flowsheet above. The nurse would notify the health care provider about which urine output?

56 ml

The nurse is preparing to administer acyclovir intravenously to a child with varicella infection who is immunocompromised. The nurse correctly administers the medication over which time frame?

60 minutes

The nurse is caring for an immunocompromised child with a primary varicella zoster infection undergoing treatment with acyclovir. What is a nursing consideration(s) while administering this therapy? Select all that apply.

Administer 10 to 15 mg/kg. Infuse over 1 hour. Continue 48 hours after last new lesions appear.

A nurse is providing care to a 3-year-old child hospitalized with second-degree (partial-thickness) and deep partial-thickness burns to the dorsal portion of both legs. The nurse is preparing to change the child's dressings. Which action(s) should the nurse take to elicit the child's cooperation in the dressing change? Select all that apply.

Allow the child to decide which leg's dressing to change first. Permit the child to choose a method of distraction. Encourage the parent to hold the child's hand during the dressing change.

the nurse is teaching the parents of a 7-year-old child on preventing integumentary disorders. What will the nurse include in the teaching? Select all that apply.

Apply sunscreen to your child. Teach your child to recognize and avoid poison oak. Teach your child to not approach strange pets without permission. Learn to identify infestations such as lice, scabies, and bed bugs.

The nurse is caring for an 11-year-old child with a primary open skin lesion. What action(s) will the nurse include in the plan of care to prevent infection in the child? Select all that apply.

Assess for increased warmth around the wound. Teach hand hygiene to the child and parents. Advise the child not to scratch the affected area.

A school nurse has discovered that one of the children has acquired a case of head lice. The school principal asks the nurse to write a letter that will be sent to parents explaining about head lice and measures to prevent infestation. What information is important for the nurse to include in the letter? Select all that apply.

Children should avoid sharing personal items such as combs and hats. Parents should inspect their child's head for nits with a fine tooth comb. A second treatment one week after the first is recommended

A child is hospitalized with a diagnosis of severe cellulitis. The nurse is preparing the family for discharge. Which instruction is most important for the nurse to convey to the family?

Complete the prescribed antibiotics.

A parent is observing a nurse provide care for the parent's 2-year-old toddler who was burned in a house fire. When the nurse is finished, the parent tells the nurse "I cannot believe this has happened. I should have been able to prevent this from happening." What is the best action for the nurse to take?

Encourage the parent to talk more about feelings.

A 30-month-old child has been discharged from the hospital after receiving treatment for second-degree (partial-thickness) burns over 6% of the body. One week later, the parent calls the nurse to say that the child has been drinking from a cup for one year, but is now constantly pulling at the mother's breast trying to nurse and refuses to drink from a cup. What is the best way for the nurse respond?

Explain that children who have had a serious injury sometimes exhibit regressive behavior.

A nurse is conducting a parenting class on infant skin care. What information should the nurse include when preparing materials on the characteristics of the skin of infants? Select all that apply.

It is thinner and more fragile than an adult's Substances are easily absorbed.

A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child?

Mumps

An infant is seen in the emergency department with several raised red welts over the abdomen and lower extremities. The parent states that the symptoms developed suddenly over the past few hours. The infant is fussy and has a low grade temperature. What assessment is most important for the nurse to perform?

Observe the infant's respiratory effort

An adolescent is brought to the urgent care clinic for evaluation of the hands. The adolescent had been out snowboarding for the past several hours in 20°F (-6.7°C) temperatures. The adolescent was wearing gloves but took them off because they were wet and causing problems with holding onto the snowboard. The nurse completes an assessment and documents the findings. Based on the assessment findings above, which action would be appropriate as part of the plan of care?

Place the hands in warm water for 30 minutes.

What is a true statement regarding varicella zoster virus infection?

Secondary bacterial infections of the skin can occur

The nurse is caring for a 6-year-old child with contact dermatitis. What action(s) will the nurse include in the plan of care? Select all that apply.

Teach the parents to have the child wear loose clothing. Administer oral antihistamines as prescribed. Provide the child with activities to distract from discomfort.

new parent brings the 3-month-old infant to the clinic for a well-baby check up. During the visit, the parent asks the nurse, "I know the rays from the sun can be harmful, so what should I do to protect my infant?" Which suggestion by the nurse would be most appropriate?

The best thing to do is keep any infant under the age of 6 months out of the sun

A young girl arrives at the emergency room after being bitten by a neighbor's dog. The mother is concerned her daughter will get rabies. The nurse carefully examines and treats the bite and questions the mother and daughter about the details surrounding the dog biting her. What information would most strongly indicate a risk for rabies infection in this client?

The dog was unprovoked when he bit the girl

The nurse is teaching the parents of a 7-year-old client with head lice about permethrin therapy. What will the nurse include in the teaching? Select all that apply

Wash hair before application. Apply enough cream to saturate hair and scalp. Itching may increase temporarily.

The nurse is teaching the parents of a 9-year-old child about preventing contact dermatitis. What will the nurse include in the teaching? Select all that apply.

Wash the clothes after exposure to a causative agent such as poison ivy. Apply precontact solution to exposed areas of skin. Read product labels to ensure that products do not contain offending ingredients. Use fragrance- and dye-free products.

The nursing is caring for a hospitalized child diagnosed with varicella-zoster virus. The child's parents ask how to prevent the child's siblings from contracting the virus. Which response by the nurse is best?

We will place your child on contact and airborne precautions. It is best for the other children not to visit."

A nurse is assessing a child brought to the clinic because of swelling on one side of the face. The nurse assesses the swelling by placing a hand along the child's jawline. The nurse suspects that the child has parotitis because most of the swelling occurs at which location?

above the nurse's hand

An 11-year-old child is brought to the health center for evaluation of a rash. The child's parents report that the rash, located on both arms and trunk, suddenly appeared yesterday. After further assessment, the nurse suspects erythema multiforme based on which finding?

bull's-eye appearance of the lesions

A child has been hospitalized with a diagnosis of severe impetigo. The nurse is interviewing the family. Which question will have the greatest impact on the child's care?

does your child have any allergies to medications?"

A 30-month-old child has been discharged from the hospital after receiving treatment for second-degree (partial-thickness) burns over 6% of the body. One week later, the parent calls the nurse to say that the child has been drinking from a cup for one year, but is now constantly pulling at the mother's breast trying to nurse and refuses to drink from a cup. What is the best way for the nurse respond?

explain that children who have had a serious injury sometimes exhibit regressive behavior.

A 5-year-old child is brought to the pediatric health clinic for evaluation. The nurse completes the assessment and documents the findings. Based on the assessment findings above, which condition would the nurse suspect?

measles

A nurse is preparing a presentation for a group of parents of toddlers at the local community center. The topic of the presentation is burn prevention. When describing burns in toddlers, which situation would the nurse likely identify as the most common cause of thermal burns?

scalding from pulling a hot pan off the stove

An 8-year-old child is brought to the emergency department after being lost in the woods for the past 10 hours. It has been snowing and the temperatures have been between 20°F and 25°F (-6.7°C to -3.9°C), with the windchill 0°F (-17.8°C). The nurse assesses the child and suspects fourth-degree frostbite of the hands and feet. Which finding(s) would support the nurse's suspicion? Select all that apply.

sloughing of skin on the soles of both feet and hands gangrene of the right index finger and left great toe

An intensive care nurse has received the above hand-off report from the emergency department nurse. Thirty minutes later, the nurse assesses the child again. Which assessment finding should the nurse investigate further?

temperature 100.5°F (38.1°C)

The nurse is caring for a child presenting with plaques around the nose and mouth that have a honey-crusted appearance. What treatment does the nurse anticipate for the child?

topical mupirocin for 10 to 14 days