Integumentary Disorders (Exam 4)
A 14-year-old child is diagnosed with tinea versicolor. What would the nurse expect the nurse practitioner to order? a) Selenium sulfide b) Diphenhydramine c) Oral griseofulvin d) Topical nystatin
a) Selenium sulfide 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
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) 1 week c) 72 hours d) 24 hours
b) 1 week Once treatment is initiated for tinea capitis, the child can return to school or day care after 1 week.
A group of students are preparing for a class exam on skin disorders. As part of their preparation, they are reviewing information about acne vulgaris and its association with increased sebum production. The students demonstrate understanding of the information when they identify which areas as having the highest sebaceous gland activity? Select all that apply. a) Shoulders b) Back c) Neck d) Face e) Upper chest
b) Back d) Face e) Upper chest The face, upper chest, and back are the areas of highest sebaceous activity and thus the most common areas for acne lesions to occur. The neck and shoulders are not typical areas involved with acne.
The nurse is providing education to a teenaged boy diagnosed with impetigo. Which statement by the boy indicates the need for further education? a) "This condition is contagious." b) "I can continue to attend school while taking the prescribed antibiotics." c) "I will need to cover my son's skin lesions with bandages until it has healed." d) "It is important to remove the crusts before applying any topical medications."
c) "I will need to cover my son's skin lesions with bandages until it has healed." 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.
Tinea is also called ringworm. The nurse knows that tinea is which type of infection? a) Bacterial infections b) Sexually transmitted infections c) Contagious infections d) Fungal infections
d) Fungal infections Fungi that live in the outer (dead) layers of the skin, hair, and nails can develop into superficial infections. Tinea (ringworm) is the term commonly applied to these infections.
A 3-year-old child has sustained severe burns and is ordered to receive 100% oxygen. What would the nurse use to administer the oxygen? a) Venturi mask b) Oxygen hood c) Nasal cannula d) Nonrebreather mask
d) Nonrebreather mask All children with severe burns should receive 100% oxygen via a nonrebreather mask or bag-valve-mask ventilation. A nasal cannula provides only low oxygen concentrations (22% to 44%); a Venturi mask provides only 24% to 50% oxygen concentrations. An oxygen hood is used for infants only.
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? a) Hepatitis A vaccine b) Haemophilus influenzae type B vaccine c) Tetanus toxoid vaccine d) Hepatitis B vaccine
c) Tetanus toxoid vaccine If inoculations are up to date, a booster dose of tetanus toxoid is required to protect the child from infection introduced into the burn.
The nurse is discussing skin disorders with a group of caregivers. The caregivers make the following statements. Which statement indicates an understanding of tinea capitis? a) "I always tell my daughter to use her own hairbrush." b) "My husband had that once and his groin itched so much." c) "That is an infection that you get under your fingernails." d) "My son got that infection when he was at the swimming pool."
a) "I always tell my daughter to use her own hairbrush." Ringworm of the scalp is called tinea capitis or tinea tonsurans. The most common cause is infection with Microsporum audouinii, which is transmitted from person to person through combs, towels, hats, barber scissors, or direct contact. A less common type, Microsporum canis, is transmitted from animal to child.
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) "My child gets diaper rash if I wash her clothes in the same detergent we use for the family." b) "Sometimes if I leave the diaper off and let him be in the sunshine he gets diaper rash." c) "The formula she drinks sometimes causes her to have a diaper rash." d) "They told me to use baby powder every time I change her so she won't get diapter rash."
a) "My child gets diaper rash if I wash her clothes in the same detergent we use for the family." 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
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 can scrape off the crusts on his scalp with a cotton swab." c) "We can massage his head with mineral oil first and then shampoo it." d) "We should wash or shampoo the scalp areas with mild soap."
b) "We can scrape off the crusts on his scalp with a cotton swab." 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.
The nurse is caring for a child with a partial-thickness burn. What assessment findings would the nurse expect to observe? a) Edema with dry or waxy-looking skin b) Peeling skin with eschar c) Edema with wet blistering skin d) Reddened and leathery skin
c) Edema with wet blistering skin 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).
An instructor is developing a plan for a class of nursing students on various skin disorders. When describing urticaria, what would the instructor include? a) The nonpruritic rash blanches with pressure. b) Wheals appear first followed by erythema. c) Histamine release leads to vasodilation. d) It is a type IV hypersensitivity reaction.
c) Histamine release leads to vasodilation. Urticaria is a type I hypersensitivity reaction caused by an immunologically mediated antigen-antibody response of histamine release from the mast cells. Vasodilation and increased vascular permeability result, leading to erythema and then wheals. The rash is pruritic and blanches with pressure
A nurse is caring for a child with tinea pedis. Which assessment finding should the nurse expect? a) Patches of scaling in the scalp with central hair loss b) Erythema, scaling, maceration in the inguinal creases and inner thighs c) Red scaling rash on soles and between the toes d) Inflamed boggy mass filled with pustules
c) Red scaling rash on soles and between the toes 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 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? a) 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. b) Have the caregiver sign a permission form acknowledging that the girl has been given the drug without pregnancy testing. c) Arrange for the daughter to have the pregnancy testing without the caregiver's knowledge. 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. 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.
The nurse has completed client teaching with a 16-year-old female who has been prescribed Accutane (isotretinoin) for cystic acne. Which statements indicate learning has occurred? Select all that apply. a) "If I am sexually active I need to let my doctor know." b) "It's important I get my CBC blood test when my doctor orders it." c) "I am young so I won't need to have the liver tests the pamphlet suggests." d) "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." e) "As long as I use two forms of birth control I don't need to have monthly pregnancy testing."
a) "If I am sexually active I need to let my doctor know." b) "It's important I get my CBC blood test when my doctor orders it." d) "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." Accutane (isotretinoin) is a powerful medication used for severe forms of acne and cystic acne when other treatment methods are not effective. Sexual activity should be reported to the physician. Some physicians may order monthly pregnancy tests even if the client says she is not sexually active because of the risk of birth defects to a fetus. No matter what form of birth control is used, pregnancy is possible, so monthly pregnancy tests are still necessary. Liver function tests are important regardless of age because of the side effects of the medication. Any labs ordered, such as the CBC, by the physician to monitor the medication's side effects should be obtained.
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. What is the best nursing response? a) "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." b) "Your child most likely has infantile seborrheic dermatitis, or cradle cap. There is no intervention needed and it should resolve in one week." c) "How often do you bathe your infant? The infant should have a thorough shampooing every day to prevent things like this." d) "Your child most likely has dandruff. You can treat it with daily with antiseborrheic shampoo."
a) "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." 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 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. The nurse most likely is referring to: a) impetigo. b) seborrheic dermatitis. c) candidiasis. d) miliaria rubra.
a) impetigo. Impetigo is a superficial bacterial skin infection.
The nurse is caring for a 1-year-old in a pediatric clinic. The child 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. What is a key element in the treatment regimen for this diagnosis? a) Applying topical antibiotics routinely b) Teaching the child not to scratch the "itchy" skin c) Daily oral cortisone d) Frequently rehydrating the skin
d) Frequently rehydrating the skin 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.
