Chapter 30: The Child with a Skin Condition

The nurse caring for a patient with severe frostbite observes a purple flush on the hands and feet. What is the most appropriate nursing action? a. Report this sign immediately. b. Place a warm towel over the extremities. c. Gently sponge with cool water. d. Medicate for pain.

ANS: D A purple flush indicates the return of sensation and causes extreme pain.

The nurse is documenting a description of a skin assessment. What term can be used for an elevated, fluid-filled blister? a. Pustule b. Papule c. Wheal d. Vesicle

ANS: D A vesicle is an elevated, fluid-filled blister (cold sore, chicken pox).

A group of football players is taking oral griseofulvin for tinea pedis. What should the school nurse caution them to avoid? a. Citrus fruit and juice b. Eating shellfish c. Alcohol consumption d. Taking corticosteroids

ANS: C Consumption of alcohol while taking griseofulvin will cause severe tachycardia.

The nurse observes a tarry stool from a 16-year-old burn victim who has been in the ICU for 2 weeks. Which complication does the nurse anticipate? a. Diverticulitis b. Stress diarrhea c. Curling's ulcer d. Perforated bowel

ANS: C Curling's ulcer is a complication of burn victims resulting from the stress of their trauma

The nurse assesses a major burn as a full-thickness burn involving _____% or more of the body surface.

ANS: 10 A full-thickness burn involving 10% or more of the body surface is considered a major burn.

A 5-year-old boy is brought to the emergency department with a second-degree burn of his entire right arm and hand, anterior trunk and genital area, and front of right thigh. The nurse assesses the body surface area (BSA) percentage burn as ______%.

ANS: 26 Using the Burn Size Estimation Table on page 695, the nurse can determine that for a 5-year-old child, the upper and lower arm = 5.5%, the hand = 2.5%, anterior trunk = 13%, genital area = 1%, and half of the thigh = 4%. Together this totals to 26% BSA burn.

A 2-day-old infant is noted to have small pustules on her skin. What is the best nursing action? a. Report it immediately because it may be a staphylococcus infection. b. Keep the affected area dry and clean. c. Teach the parents how to care for seborrheic dermatitis. d. Chart the finding because it may be the beginning of a strawberry nevus.

ANS: A A staphylococcal infection can spread readily from one infant to another. Small pustules on the newborn must be reported immediately.

Which statement made by a parent indicates an understanding of the topical application of medications for a skin condition? a. "I apply the medication after I give my child a bath." b. "I rub the ointment in a circular motion over the rash." c. "I increased the amount of cream because the rash was not improving." d. "I use powder and cornstarch to keep the skin dry."

ANS: A Absorption of topical medications is best when preparations are applied after a warm bath.

A child is brought to the emergency department with burns on the face and chest. What is the nurse's first priority? a. Assess respiratory status. b. Administer pain medication. c. Remove clothing. d. Insert a Foley catheter. .

ANS: A Airway assessment and establishing an airway are the initial priorities

Which statement made by a parent indicates the need for further teaching about strategies to control itching for the infant with eczema? a. "Wool is the best fabric for the infant's clothing." b. "I should avoid laundry detergents with fragrances." c. "I put cotton gloves on the infant's hands." d. "The infant's fingernails are kept short."

ANS: A Clothing should be made of cotton. Wool is avoided because of its allergy potential.

A child has sustained a second-degree deep thermal burn to the hand. What is the best first action to take? a. Immerse the burned area in cold water. b. Apply ice to the burned area. c. Break any blisters that are present. d. Apply petroleum jelly to the burned skin.

ANS: A First aid treatment of a second-degree deep thermal burn is immersion of the burned area in water to halt the burning process.

An adolescent is at the pediatrician's office because he has been experiencing intense itching, particularly in the axilla and between the fingers. The itching is worse during the night and he has not been sleeping well. With what is this symptom associated? a. Scabies b. Pediculosis capitis c. Tinea corporis d. Eczema

ANS: A Intense itching, especially at night, is characteristic of scabies.

What should the nurse suggest before a 17-year-old girl starts a protocol of isotretinoin (Accutane) for her acne? a. Get a prescription for oral contraceptives. b. Increase the dose of the present medication. c. Limit intake of chocolate, cola, and peanuts. d. Increase exposure to sunlight.

ANS: A Oral contraceptives are often prescribed for adolescents with acne. Accutane can cause birth defects, so pregnancy should be prevented.

What is the correct nursing response to a mother who asks, "How can I get rid of the baby's cradle cap?" a. "Rub baby oil on the infant's head at night and shampoo the hair the next morning." b. "Use a brush with firm bristles to loosen the scales on the baby's head several times a day." c. "Wash the baby's head every night with a dandruff-control shampoo." d. "Lubricate the baby's head every morning with a small amount of olive oil."

ANS: A Scales may be softened by applying baby oil to the head the evening before, and shampooing the hair in the morning.

The nurse speaking to a group of junior high school students informs them that acne can be exacerbated by which drug(s)? (Select all that apply.) a. Steroids b. Phenytoin c. Phenobarbital d. Aspirin e. Oral contraceptives

ANS: A, B, C Long-term use of steroids, phenytoin, phenobarbital, lithium, and vitamin B12 can cause acne.

Which factor(s) activate the herpes simplex virus type I? (Select all that apply.) a. Stress b. Sun c. Menses d. Fever e. Food allergies

ANS: A, B, C, D The herpes simplex virus type I can be activated to cause a cold sore by exposure to stress, sun, initiation of menses, and fever. Food allergies do not activate the virus as a rule.

What would the nurse teach parents to do in order to avoid diaper rash? (Select all that apply.) a. Use ointments. b. Keep perineum covered at all times. c. Use disposable diapers. d. Avoid plastic bloomers or pants. e. Change diaper frequently.

ANS: A, C, D, E Keeping the skin dry and protected with emollients, leaving the area exposed to light and air periodically, changing the diaper frequently, and avoiding plastic pants will prevent diaper rash.

A child had a burn, evidenced by pink skin and blistering. The child complains of pain and is crying. How does the nurse classify this burn when documenting? a. First-degree b. Second-degree superficial c. Second-degree deep dermal d. Third-degree

ANS: B A second-degree superficial burn appears blistered, moist, and pink or red. The pain associated with this burn indicates tissue viability.

What would help the child with a serious burn meet nutritional needs during the subacute phase of recovery? a. Decrease calories because the child will be on bed rest and will not need as many. b. Increase calories and protein to compensate for the healing process. c. Increase fat to replace the layer of fat next to the burned skin. d. Decrease carbohydrates and starches because the pancreas is strained by the healing process.

ANS: B Frequent meals and snacks high in calories, protein, and iron are needed to meet the increased metabolic needs of the child with burns.

What is the appropriate technique for the application of a topical treatment for a child with eczema? a. Apply skin lotions in a circular motion. b. Apply prescribed ointments with a gloved hand. c. Apply as much and as frequently as relieves the symptoms. d. Choose lanolin-based ointments.

ANS: B The prescribed amount of ointment is usually applied to the skin by a gloved hand in long, smooth strokes. Lanolin-based preparations should be avoided because of a possible allergy to wool.

At a 2-month well-child visit, parents ask the nurse about the red area on the infant's neck. They tell the nurse that the mark appeared a few weeks after birth. What does the nurse recognize this skin lesion as? a. A port wine nevus b. A strawberry nevus c. Exanthem d. Intertrigo

ANS: B The strawberry nevus is a common hemangioma consisting of dilated capillaries in the dermal space, which may not become apparent for a few weeks after birth.

On the first day following a severe burn, the body's fluid reserves have left the circulating volume and entered the interstitial space, causing massive edema. What should the nurse monitor for very closely in the burn victim? a. Increasing intracranial pressure b. Reduced urine output c. Eschar formation d. Fluid overload

ANS: B With the fluid shift associated with severe burns, the nurse must be observant for the reduction of urine, an indication of altered renal function.

What intervention(s) would the nurse preparing a teaching plan for the care of a child with infantile eczema include? (Select all that apply.) a. Bathe the child using products with a light fragrance. b. Use oatmeal and baking soda as bath additives. c. Add bath oil to bath water after the child has soaked. d. Apply lanolin-based lotions after the bath. e. Bathe child several times a day.

ANS: B, C Use of oatmeal, baking soda, and baking powder is soothing. Adding oil to the bath water after the child has soaked for a while makes the oil application more effective. Items with any fragrance should be avoided as well as lanolin-based products. Many dermatologists advise minimal bathing.

Parents of a child show the nurse that their child has a flat strawberry nevus. What information can the nurse provide in educating the parents regarding strawberry nevus? (Select all that apply.) a. It is a rare skin variation. b. It is harmless. c. It gradually becomes raised. d. Laser treatment is available. e. Sometimes it can disappear spontaneously.

ANS: B, C, D The strawberry nevus is a common hemangioma (consists of dilated capillaries in the dermal space) that may not become apparent for a few weeks after birth. Although it is harmless and usually disappears without treatment, it is disturbing to parents, especially when it appears on the head or face. At first it is flat, but it gradually becomes raised. The lesions gradually blanch, with 60% disappearing spontaneously by 5 years of age and 90% disappearing by 9 years of age. Laser treatment or excision may be considered if the area becomes ulcerated.

What should the nurse keep in mind when providing care to the school-age child hospitalized with a burn injury? a. Hospitalization will be brief. b. Analgesics should be given immediately after dressing changes. c. Contact with peers should be maintained. d. Parents usually handle injury worse than the child.

ANS: C A burn injury is taxing to the child and parents. It requires long periods of hospitalization and frequent readmissions. The accident itself is terrifying for the child but is made even worse if caused by disobedience. Nurses encourage children to express their feelings. Analgesics are administered before painful procedures. The long-term patient requires diversions of various types. School tutors are requested, and contact is maintained with peers through cards or e-mail.

The home health nurse discovers a family infected with pediculosis. What information can the nurse provide to the mother to start eradication of the lice? a. Cover the hair with Vaseline. b. Apply a soda-vinegar solution to the hair. c. Comb through the hair with a vinegar-water solution. d. Shampoo the hair with dish detergent.

ANS: C Combing a vinegar-water solution through the hair with a fine-tooth comb and then shampooing is an initial step toward eradication.

An adolescent girl with acne is being treated with an antibiotic in addition to topical applications. What side effect does the nurse caution the girl to expect? a. Lessened effectiveness of oral contraceptives b. Urinary burning and frequency c. Breast engorgement d. Vaginitis

ANS: D Antibiotic therapy can cause a monilial vaginitis.

An adolescent patient at a pediatric clinic presents with a butterfly rash. What diagnosis does the nurse suspect? a. Tuberous sclerosis b. Eczema c. Psoriasis d. Systemic lupus erythematosus

ANS: D Butterfly rash over the nose and cheeks can be associated with photosensitivity and may be associated with systemic lupus erythematosus (SLE).

What will the nurse include when teaching about general skin care measures that could help prevent acne? a. Eliminating chocolate, peanuts, and cola from the diet b. Washing the face with a cleansing product frequently c. Planning indoor activities to avoid sun exposure d. Eating a balanced diet and getting sufficient rest

ANS: D General hygienic measures of cleanliness, rest, and avoidance of emotional stress may help prevent exacerbations.

A child is brought to the emergency department with severe frostbite. Which body parts should be warmed first? a. Hands and arms b. Feet and legs c. Fingers and toes d. Head and torso

ANS: D In extreme cases of exposure to freezing temperatures, the head and torso should be warmed before the extremities.

A mother is concerned about what might have caused a heat rash on her infant. The nurse observes tiny pinhead-sized reddened papules on the infant's neck and axilla. What does the nurse explain as the most likely cause of this rash? a. Sun exposure b. Allergic reaction c. Infection d. Heat and moisture

ANS: D Miliaria, or prickly heat rash, is caused by excess body heat and moisture.

What should the nurse stress to the mother of a child with impetigo? a. The condition is caused by the herpes simplex virus type I. b. The crusts on the lesions should be left in place. c. The lesions may spread, but the disease is not contagious. d. Small cuts and bites should be treated promptly.

ANS: D Small cuts and bites should be treated promptly to prevent the invasions of the bacteria that cause impetigo. The crusts from the lesions should be gently removed. The disease is contagious.

What risk is increased with children who have been diagnosed with infantile eczema? a. Pneumonia b. Acne c. Sun sensitivity d. Asthma

ANS: D Some children with eczema also develop asthma and hay fever-type allergies.

The nurse is careful to apply only the prescribed amount of ointment to the skin of a 2-month-old infant. How is infant skin different from adult skin? a. Less perfusion b. Greater moisture c. More perspiration d. Greater absorption

ANS: D The child's skin has a dramatically greater ability to absorb than does that of the adult.

The nurse is caring for a 3-year-old child with severe burns. What is the nurse aware is the minimum adequate hourly urine output? a. 5 mL/hr b. 10 mL/hr c. 15 mL/hr d. 20 mL/hr

ANS: D The minimum acceptable hourly urine output for children over the age of 2 years is 20 to 30 mL/hr.

Which allergy would contraindicate the use of silver sulfadiazine (Silvadene) as a topical agent for burns? a. Penicillin b. Iodine c. Tetanus immunizations d. Sulfa

ANS: D The use of Silvadene cream on burns is contraindicated if the patient has a sulfa allergy