Chapter 45 Tissue Integrity/Imtegumentary Prep U
The nurse is caring for a 2-year-old child who experienced burns to the left upper arm, left thigh, left leg, head, and neck. The nurse calculates this to represent what percentage of total body surface area (BSA) burned? Record your answer using one decimal place.
34.5
The nurse is educating a parent about the treatment for a child's tinea cruris. What medication class would the nurse include in the teaching plan?
antifungal
The nurse admits a child who has sustained a severe burn. The child's immunizations are up to date. Which immunization would the child most likely be given at this time?
tetanus toxoid vaccine
An adolescent is diagnosed with psoriasis. After speaking with the nurse about treatment options suggested by the primary health care provider, the adolescent states, "Since ultraviolet rays help, I am going to buy a tanning package so I can tan year round." How will the nurse respond?
"Year round tanning is not what your health care provider intended. Tanning puts you at high risk for skin cancer and other problems."
The parents of a child recently diagnosed with atopic dermatitis voice concern to the nurse that their child may develop asthma at some point. How should the nurse respond?
"I can understand your concern. We will closely monitor your child for asthma development."
A child with a burn injury is scheduled for skin grafting. Which intervention would be mostappropriate for the nurse to include in the child's plan of care?
Provide around the clock pain medication.
Which intervention is the most beneficial for a burn client undergoing a skin graft?
Provide around-the-clock pain medication as soon as pain is reported.
A nurse completes an assessment on an 8-month-old infant seen in the pediatrician's office for a well-child visit. The nurse notes that the infant's buttocks, perineum and inner thighs are covered in a thick coating of white ointment. When questioned, the parent says the infant has a diaper rash and the ointment is to protect the infant's skin. What is the best action for the nurse to take?
Provide instruction on how to care for a diaper rash.
The nurse is speaking with the mother of a child diagnosed with contact dermatitis from poison ivy. Which statement by the mother indicates a need for further education?
"As long as he takes a shower as soon as he gets inside, he shouldn't get this again."
An adolescent is seen in the clinic with a first-degree (superficial) burn. Which instruction(s) will the nurse provide for initial care of the burn? Select all that apply.
"Cleanse the burn with cool water." "Apply a clean, non-adhering dressing." ""Take ibuprofen for pain every 4 to 6 hours."
A nurse is 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?
"Does she wear sleepers with metal snaps?"
The parents of a child diagnosed with atopic dermatitis ask the nurse, "My child has a skin disorder. I don't understand why a complete blood count (CBC) was ordered?" What is the appropriate response by the nurse?
"Eosinophils are a type of white blood cell that are often elevated with atopic dermatitis. These are part of the CBC and helps in making the diagnosis."
The nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding?
"Flare-ups of lesions are not uncommon following therapy."
The nurse is discussing skin disorders with a group of caregivers. Which caregiver statement indicates an understanding of tinea capitis?
"I always tell my daughter to use her own hairbrush."
The parents of an 8-year-old boy diagnosed with frostbite are distraught and state to the nurse, "We can't believe we didn't make our child come inside when he complained about his fingers being numb and hurting." How should the nurse respond?
"I can't imagine how you are feeling right now, but I'm sure you had no idea frostbite could happen. We will take good care of your son."
An adolescent is prescribed isotretinoin. Which statement indicates that the adolescent understands the necessary precautions associated with this drug?
"I have to make sure that I do not become pregnant while taking this drug."
An adolescent with acne vulgaris who last week was prescribed tretinoin cream reports to the nurse, "The medicine has not helped my acne at all." What is an appropriate response(s) by the nurse? Select all that apply.
"I know it must be hard waiting for improvement, but it may take 4 to 6 weeks for the medication to begin working." "Be sure to avoid oil-based cosmetics and hair products because their use may block pores and worsen your acne." "Tell me about your daily regimen. While it takes some time for the medicine to work, there may be something in your routine that needs adjusting."
The nurse is teaching parents about the care of diaper rash. The nurse would be concerned about the parents' level of understanding if they made which statement?
"I should be certain to use fabric softener in the care of the infant's clothes."
The nurse is caring for an infant with diaper dermatitis. Which statement by the child's parent would indicate a need for further education?
"I will use rubber pants over the cloth diapers in the future."
The nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which statements indicate learning has occurred? Select all that apply.
"If I am sexually active I need to let my doctor know." - "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her." "It's important I get my CBC blood test when my doctor orders it."
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?
"Sometimes I get acne when I use my sister's makeup."
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. What responses would be appropriate for the nurse to say to this caregiver?
"That's not an uncommon reaction, although it's hard on you and on your child."
The nurse instructor is reviewing the integumentary system during a presentation to a group of student nurses. Which statement made by the instructor is the most accurate regarding the integumentary system?
"The largest organ of the body helps regulate body temperature."
A child has an order for an erythrocyte sedimentation rate (ESR). The child's mother asks what the purpose of the test is. What is the best response by the nurse?
"This test will tell if your child has an infection or inflammation somewhere in their body."
The clinic nurse is assessing a 12-year-old client. The client reports having dandruff and asks the nurse what can be done for it. Which response by the nurse is best?
"Wash your hair with a gentle shampoo daily."
The nurse is providing teaching on ways to maintain skin integrity and prevent infection for the parents of a boy with atopic dermatitis. Which response indicates a need for further teaching?
"We should avoid using petroleum jelly."
A nurse is providing teaching on ways to promote skin hydration for the parents of an infant with atopic dermatitis. Which response indicates a need for further teaching?
"We should bathe our child in hot water, twice a day."
A newborn has a generalized rash on the skin, which the nurse identifies as erythema toxicum neonatorum. Which information would the nurse include when explaining the condition to the newborn's parent?
"What you see on your newborn's skin is erythema toxicum neonatorum. It is a common newborn skin condition that typically resolves on its own in about 1 week. There is nothing special you will need to do for this."
The parent of a 1-week-old infant is concerned with white scales that have begun to flake off the infant's scalp. The parent asks the nurse what to do to treat this. How should the nurse bestrespond?
"Your child most likely has cradle cap (seborrhea). You can care for it by cleansing the hair and scalp daily with baby shampoo and applying baby oil."
A parent expresses a concern about white scales that have begun to flake off the 1-week-old infant's scalp. The parent asks, "What can I do to prevent this?" Which response by the nurse would be most appropriate?
"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."
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?
1 week
Which assessment finding by the nurse would warrant immediate action?
A child with periorbital cellulitis reports changes in vision and pain with eye movement.
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. What would be the best action for the nurse to take?
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.
The nurse is caring for a child with burns in a pediatric hospital. What would be an appropriate nursing diagnosis for this client?
Acute pain related to thermal injuries and procedures
The nurse is developing the plan of care for a child who has suffered a major burn and has just been admitted to the acute care facility. Which nursing diagnosis would be most appropriate?
Acute pain related to thermal injuries and procedures
A nurse is providing care to an infant who is admitted with burns over the face, neck and chest. The nurse identifies which goal as priority for planning the infant's care?
Airway remains patent.
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 health care provider. What is the most appropriate action for the nurse to do with this child?
Apply ice to the affected area.
An adolescent experiencing contact dermatitis reports experiencing pruritis. What intervention will the nurse recommend to relieve the itching?
Bathe with a product that is oatmeal-based.
The nurse is caring for a child admitted with second-degree (partial-thickness) burns. What is mostcharacteristic of this type of burn?
Blisters appear.
An adolescent with tinea versicolor is admitted for treatment of the disorder. Which nursing diagnosis will the nurse identify as having the highest priority for this client?
Disturbed body image
The nurse is caring for a child with a second-degree (partial-thickness) burn. What assessment findings would the nurse expect to observe?
Edema with wet blistering skin
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.
What accurately depicts the hemodynamic changes that occur in the body within the first 24 to 48 hours after a burn?
Hematocrit and white blood cell (WBC) counts increase.
A 10-year-old has been bitten on the lower posterior arm by a dog, requiring several stitches. The child was just admitted to the hospital for 3 days of antibiotic therapy. When developing the care plan, the nurse identifies which nursing diagnoses as being the top 2 priorities?
Impaired skin integrity Risk for infection
The community nurse receives a call from a local day care center. One of the children in the center has been diagnosed with impetigo. Which information related to impetigo will the nurse provide to the day care center?
Impetigo is highly contagious and can spread quickly.
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.
A child arrives at the emergency department with moderate hypothermia and frostbite. Which action would be most appropriate for the nurse to perform?
Place heating pads and warmed blankets on the trunk of the body initially.
A young child has just been admitted to the emergency department with a burn that encompasses the epidermis and the underlying dermis. From which type of burn does this child suffer?
Second-degree or partial-thickness burn
An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants?
Staphylococcus aureus
A 6-year-old child is diagnosed with tinea pedis. Which prescription will the nurse question?
The child may return to school in 1 week.
The nurse is caring for a child on the burn unit weighing 100 lb (45.5 kg) who has second-degree (partial-thickness) burns over 30% of the body. During the beginning shift assessment, which assessment finding is of most concern to the nurse?
Urine output of 15 ml per hour over the last 4 hours
A 2-month-old infant has been diagnosed with seborrheic dermatitis (cradle cap). The nurse is educating the parent about care of the child. Which instructions would the nurse include? Select all that apply.
Wash the child's hair every day. Carefully but vigorously wash the area of the "soft spot." Use a fine-tooth baby comb after washing the hair. Apply mineral oil to loosen the crusts.
The nurse is caring for a 13-year-old client who asks about acne prevention. Which would be mostappropriate for the nurse to suggest?
Wash the face twice a day with a mild soap then pat dry.
The nurse is caring for a child with urticaria. What is the priority action?
assessing the child's airway and breathing and noting any wheezing or stridor
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 disorder?
asthma
The nurse is caring for a child brought to a pediatric clinic for swelling in the lower extremities. The skin is reddened with undefined borders and pits slightly when pressed. Based on the assessment findings, which of the following would the nurse suspect?
cellulitis
The nurse is assessing a child who has had an open wound for the last 2 weeks with no signs of healing. The parents report they have been using over-the-counter antibiotic ointment with no signs of improvement. The child is active in football in the fall and the swim team in the winter. What disorder does the nurse suspect?
community acquired MRSA
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 physical findings?
erythema multiforme with inflammatory bullae of at least two types of mucosa
The nurse is caring for a child with a tinea corporis infection involving several sites. Which information would be the most important for the nurse to include in the teaching plan for the parents?
finishing all prescribed oral medication, even after lesions fade
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 that involves honey-colored crusted lesions. The nurse most likely is referring to:
impetigo.
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:
isotretinoin.
The nurse is conducting a physical examination of a boy with erythema multiforme. Which assessment finding should the nurse expect?
lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk
The nurse is discussing dietary intake with the parents of a 4-year-old child who has been diagnosed with atopic dermatitis. Later, the nurse notes the menu selection made by the parents for the child. Which selection indicates the need for further instruction?
peanut butter and jelly sandwich
The nurse is examining a child for indications of frostbite and notes blistering with erythema and edema. The nurse notes which degree of frostbite?
second-degree frostbite
The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a burn induced by child abuse (child maltreatment)?
stocking-glove pattern on hands or feet
The nurse is conducting a primary survey of a 12-year-old child involved in a motor vehicle accident. Which assessment finding most concerns the nurse?
the presence of stridor
The nurse is caring for a 10-year-old male in a pediatric clinic with presenting symptoms of small circular patches of hair loss on the scalp. Which skin condition does the child most likely have?
tinea capitis
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?
using appropriate hand hygiene
The nurse is caring for a 6-year-old child brought into the emergency department for burns from a house fire. The nurse notes burn areas surrounding the client's nose and mouth upon initial assessment. Which priority complication should the nurse be alert for?
airway obstruction related to 889 swelling
