Pediatric - integumentary & infectious diseases PrepU

A parent brings an infant to the clinic for a well child visit. During the assessment, the parent asks the nurse why the infant never seems to sweat. What action should the nurse take?

Explain that this normal mechanism keeps the infant from losing too much water through the skin. Explanation: The sweat glands of an infant are immature and this normal mechanism keeps the infant from losing too much insensible water. Because this is a normal occurrence, there is no reason to make a note to inform the health care provider or to refer the infant to a specialist. An infant's temperature does not run lower than an adult's temperature.

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 Explanation: The most common type of thermal burns during the toddler years is scalding burns, which typically result from a child pulling a hot pan off of a stove or being immersed in bathwater that is too hot. Although less common, hot objects, such as irons, flat irons, curling irons, stoves, and ovens can also cause burns. During the school-age years, thermal burns are often caused by playing with matches, fireworks, or gasoline. Ingesting a household cleaning agent would lead to a chemical burn.

A nurse is teaching a group of parents about burn safety. Which statement made by a parent requires intervention by the nurse?

"I had our plumber lower our water heater temperature to 130°F (53°C)." Explanation: Water heater temperature should be 120°F (49°C) or lower to prevent significant burns. Installing smoke detectors on every floor of a home is recommended. Keeping young children out of the kitchen during food preparation is important. Teaching children to stop, drop, and roll is important for fire safety.

The rash in roseola is pruritic. Which measure would you teach the parent to provide comfort?

Apply cool compresses to the skin to stop local itching Explanation: Rashes can be uncomfortable and irritating. Parents need to be educated on ways to relieve discomfort and to protect and maintain skin integrity. Cool compresses or cool baths will help to relieve the itching associated with the rash. Antipuretics may be necessary also to help with itching. To protect the skin the child should be instructed not to scratch the skin to alleviate itching. The child's fingernails should be kept short. Keeping the child dressed warmly will not bring out the rash any sooner. Being warm will, however, cause an increased temperature and intensify the itching. Aspirin should not be used in children as an antipyretic. There is an increased risk of developing Reye's syndrome.

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. Explanation: Herpes zoster (shingles) is reactivation of the latent varicella zoster (chicken pox) infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.

The appearance of which hallmark clinical manifestation occurs in measles?

Koplik spots Explanation: The hallmark symptom of measles is the appearance of Koplik spots. These occur a few days before the outbreak of the rash. They are classic in appearance, described as a red ring around white dots. They occur on the buccal mucosa generally around the first and second molars. Measles has fever, conjunctivitis, and a cough as prodromal symptoms, but these are not definitive for measles as they can occur with many other illnesses.

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 Explanation: Mumps begin with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe.

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 Explanation: The raised red welts are likely urticaria or hives, an allergic response to a substance (food, drugs, plants, etc.). As such, it is most important to observe the infant's respiratory effort since that reaction can involve the lips, tongue and airway. Cyanosis would not be visible unless the airway was blocked and then it would be central cyanosis, not just circumoral. Questioning the parent about methods of punishment is unnecessary as the welts are not a sign of trauma. It is appropriate to determine if the infant is breastfed or formula fed because it might be related to the hives the especially if the infant was switched from breast milk to formula, but it is not the most important assessment.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes pustule?

Small elevation of epidermis filled with a viscous fluid Explanation: A pustule is a small elevation of epidermis filled with pus.

What is a true statement regarding measles?

The incubation period is 10 to 12 days Explanation: The typical incubation period is 10 to 12 days. Outbreaks peak in the winter and spring. It is highly contagious and is transmitted by airborne suspended droplets.

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. Explanation: Parents need to know that the lesions should resolve within 2 weeks. However, some children do develop recurrent erythema multiforme. The most common cause of this condition is infection with the herpes simplex virus, with fewer than 10% of cases being drug related. Stevens-Johnson syndrome is often related to the use of sulfa drugs. Contact dermatitis, specifically nickel contact dermatitis, is caused by exposure to nickel.

After teaching the parents of a 7-year-old how to apply the prescribed topical medication, the nurse determines that the teaching was successful when the parents state they will do which of the following?

Wash the area with warm water and dry completely before application Explanation: When applying a topical medication, the parents should cleanse the skin, as ordered using basin of warm water and a washcloth only and dry skin well before applying the topical medication. Soap should not be used to clean the area and skin should be dried before applying medication. An excessive amount of medication may result in irritation of the skin and adverse systemic effects. Gloves should be worn at all times when applying topical medication to prevent absorption. Washing hands after removing gloves is appropriate.

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. Explanation: Treatment of head lice begins with pediculicidal agents. Permethrin is the treatment of choice and is an over-the-counter drug. The parents should wash the child's hair before applying the medication, apply the medication to wet hair, leaving it on for 10 minutes before rinsing. One treatment is often not sufficient, and the treatment should be repeated in 7 days. Permethrin kills the live adult head lice but is not ovicidal, meaning that it does not kill the nits. Nits should be removed from wet hair with a specialized nit comb. Malathion is used for head lice infestations that do not respond to permethrin. This medication is applied to dry hair and scalp and left on overnight. Nit removal is still needed when this medication is used.

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. Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by the direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.

The parent of a child diagnosed with nonbullous impetigo brings the child back to the clinic. The parent states, "I am doing what I am supposed to for my child, but the lesions have not gone away yet." The child began treatment with a topical antibiotic ointment 7 days ago. Which response by the nurse is most appropriate?

"It takes 10 to 14 days for the lesions to decrease." Explanation: Typically, treatment for nonbullous impetigo with a topical antibiotic ointment lasts for 10 to 14 days with the expected outcome that the presence of the lesions will decrease over this time. Since it is only been 7 days since treatment started, the lesions would not be expected to be gone in this period of time. There is no evidence to support a secondary infection or another type of skin infection. The medicine is given for 10 to 14 days, so it would be inappropriate to tell the parent that the medication is taking longer to treat the infection.

Two siblings, a 5-year-old child and a 3-year-old child are brought to the clinic by their parents. The parents are concerned because each child has developed a rash. The nurse documents the assessment findings. Which information would the nurse include when teaching the parents about caring for their children? Select all that apply.

- Wash all of your sheets and clothes in hot water - Put items that cannot be washed into a closed trash bag for at least 3 days - Schedule a professional exterminator to come in to get rid of the bugs Explanation: The nurse suspects bedbug infestation. The parents should be taught to wash all sheets and clothing in hot water or place items in the dryer on high heat for at least 30 minutes to kill any live bugs. Items that cannot be washed should be placed in a closed trash bag for at least 72 hours. The parents should look for bedbugs at night with a flashlight under mattresses and box springs, around headboards, and in crevices in the children's bedroom. A professional exterminator is needed to rid the house of bedbugs. Wiping down surfaces with a disinfectant will not be effective.

The nurse is caring for a child brought to the emergency department after an animal bite. Which action will the nurse perform first?

Ask if the animal was provoked prior to the bite Explanation: When a child presents with an animal bite, the nurse will ask the child if the animal was provoked prior to the bite. Animals with rabies will bite unprovoked. If the child states the animal bit without being provoked, and the animal is at risk for rabies, the nurse will administer the rabies vaccine and rabies immune globulin as prescribed by the health care provider and recommended by the local health department. Signs and symptoms of rabies, including fever, malaise, anorexia, pain, and hydrophobia, will occur on average 1 to 3 months after the bite. The nurse's priority is to gather history to help determine if the child needs treatment for rabies to avoid progression to the disease, which is almost always fatal.

A nurse is providing care to a child with partial and full thickness burns over 26% of the body. In monitoring the child's output the nurse expects an output of 1 to 2 mL/kg/hr. The nurse has emptied 46 mL from the foley catheter for the past hour. The child weighs 62 lb (28 kg). What action should the nurse take?

Document the output and continue to monitor Explanation: The nurse multiplies the client's weight in kilograms by the expected output.28 kg × 1mL = 28 mL/hrThe output of 28 mL/hr is within normal limits, so the nurse should document it and continue to monitor the output. There is no indication to notify the health care provider that the output is low. There is no indication to increase the IV fluid rate and doing so may not compensate for a low output. Maintaining proper fluid balance in a client with burns is a challenging and constantly changing process. There is no indication to check the catheter for kinks because the output is within normal limits.

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 20oF (-6.7oC) 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?

Placing the hands in warm water for 30 minutes Explanation: The key to treating second-degree frostbite is to rewarm the affected area. Rewarming is accomplished by placing the affected areas in warm water at a temperature of 98.6°F (37°C) to 102.2°F (39°C) for at least 30 minutes. Wound care specialists and plastic surgeons would be involved with more severe (third-degree) frostbite. Massaging should be avoided because it can cause tissue damage. As the area is rewarmed, the color of the skin typically appears red to purple.

The nurse is teaching the parents of an 8-year-old child diagnosed with folliculitis on both arms about caring for their child. The nurse determines that additional teaching is needed based on which statement by the parents?

We can apply a steroid cream to the area to help with the itching. Explanation: Folliculitis is self-limiting but is often treated with topical antibiotics. However, the lesions generally do not cause pain or pruritus. Therefore, there is no need to apply steroid creams. The parents should wash the affected area with soap and warm water and apply warm compresses several times a day. The parents should also notify their health care provider if the lesions get bigger rather than smaller, feel warm to the touch, or have drainage.

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 flow sheet above. The nurse would notify the health care provider about which urine output?

56 mL Explanation: It is important to maintain adequate fluid volume in a child with burns. The nurse would monitor urine output via a Foley catheter, and notify the health care provider if output is less than 2 mL/kg/h. The child weighs 66 lb (30 kg). So an adequate hourly urine output for this child would be 60 mL/hr. Therefore the nurse would notify the health care provider for a urine output of 56 mL.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first?

A child with erythema infectiosum experiencing fatigue and confusion Explanation: A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

A young client in the clinic has a rash, cough, and fever that the parent says spiked on day 5 of the rash. The client also had conjunctivitis. What illness would the nurse expect the health care provider to diagnose?

Measles Explanation: Measles are diagnosed based on the symptoms of a rash, Koplik spots, conjunctivitis, coryza, cough, and a fever that usually spikes on day 5.

The nurse is caring for a 6-month-old child with a rash. Which information from the parent strongly suggests that roseola is the diagnosis?

The infant's temperature fell when the rash appeared. Explanation: The rash of roseola is distinctive. There are discrete, rose-pink macules approximately 2 to 3 mm in size and flat with the skin surface. With roseola, infants become irritable and anorexic although even with a high fever remain playful and alert. The condition is diagnosed based on the physical signs and symptoms with the hallmark being a rash that appears immediately after a sharp decline in fever.

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?" Explanation: The rash described in the documentation (linear patter with pustules and erythema) suggest allergic dermatitis associated with exposure to plants such as poison ivy. Therefore, the next question should focus on possible exposure to the plant oils. The questions about detergent or soaps would be appropriate if the rash suggested irritant dermatitis as demonstrated by a more diffuse pattern. Asking about metal in the child's clothing would be appropriate if the rash suggested nickel dermatitis, which would be typically found at the navel, belt line, or earlobes.

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 Explanation: The priority goal is maintain a patent airway especially because the burns affect the face and neck. Adequate output, maintaining pain at a tolerable level, and having the burns infection free are all appropriate goals for this infant, but maintaining a patent airway is the priority.

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 Explanation: The assessment findings suggest measles (rubeola). Children initially present in the prodromal, or early symptom, phase. During this phase, children experience mild fever, conjunctivitis, coryza, and cough. Conjunctival drainage is nonpurulent. Koplik spots, which are clustered white lesions, may or may not be apparent on the oral mucosa at the time of presentation. However, Koplik spots appear within 4 days of the rash onset. Fever is highest 1 to 2 days before the appearance of the rash. The rash is maculopapular, beginning at the head and progressing down the trunk and upper extremities. Rubella is characterized by a prodromal period consisting of fever, malaise, headache, sore throat, and red eyes. The rash begins on the face and neck as irregular macules. The rash on the face disappears as it spreads to the trunk and lasts no longer than 3 days.Varicella is characterized by prodromal symptoms including fever, malaise, and headache for 24 to 48 hours before the eruption of lesions. Skin lesions appear in various stages. New lesions appear as old ones scab over. The lesion begins as an erythematous macule and progresses to a pustule and finally a clear fluid-filled vesicle. The rash is severely pruritic. Children with cellulitis often have fever, chills, and lymphadenopathy. Infected areas are erythematous and warm to thetouch and may be edematous and painful. There is no rash with cellulitis.

When the health care provider looks in a child's mouth during a sick-visit examination, the parent exclaims: "The tongue is bright red! It was not like that yesterday." The health care provider would most likely prescribe which medication based on the probable diagnosis?

Penicillin to prevent acute glomerulonephritis Explanation: A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to treat the beta-hemolytic group A strococcal infection and to prevent the complication of developing acute glomerulonephritis and rheumatic fever. Erythromycin can be used to treat the disease if the child is allergic to penicillin. Antibiotics are not give prophylactally to siblings. The disease is spread via droplets, so keeping the siblings away from the infected child and handwashing are the best preventative measures. Acetaminophen can be administered for fever control. It works systemically and has very little, if any, affect locally. Antibiotics are the mainstay of treatment. Steroids are used infrequently.

The nurse is providing care to a 5-year-old child brought to the emergency department with a cat bite wound on the arm. While teaching the parents how to care for the wound, the child's mother asks the nurse, "Why isn't the bite being stitched closed?" Which response by the nurse would be appropriate?

"Bites from cats are likely to become infected, so it is better to leave the wound open and heal from the inside out." Explanation: Cat bite wounds are more likely to become infected because of the nature of the puncture wound. Cat bite wounds are left open to heal by secondary intention because of the high rate of infections associated with these types of bites. Saying that it is too early to close the wound or that the child needs to be seen by a plastic surgeon or have a tetanus vaccine is inappropriate.

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 Explanation: The best action for the nurse to take is to encourage the parent to talk about his or her feelings. This gives the parent the opportunity to share feelings and concerns. Giving the parent a spontaneous hug may not be welcomed. Telling the parent he or she could not have prevented the fire or to be thankful that the child is alive is not therapeutic and negates the parent's feelings.