Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - ML5

A health care provider has prescribed cephalexin 30 mg/kg PO daily in 4 divided doses for a child diagnosed with impetigo. The child weighs 30 lb (14 kg). How many milligrams should the child receive each day?

Correct response: 420 Explanation: The nurse will use the client's weight in kilograms and multiply it by the prescribed dosage. 14 kg × 30 mg/kg = 420 mg Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, INTEGUMENTARY DISORDERS, p. 875. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 875

The nurse is providing teaching to the parents of a child with varicella. Which statement by the parents indicates the teaching was successful? "We should apply alcohol to the lesions every 4 hours." "If our child has a fever, we can give them some aspirin." "The lesions should eventually form soft crusts that drain." "We need to make sure that our child washes their hands frequently."

Correct response: "We need to make sure that our child washes their hands frequently." Explanation: The child with varicella needs to wash their hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may aid the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, COMMUNICABLE DISEASES OF CHILDHOOD, p. 901. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 901

An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants? Staphylococcus aureus Group A beta hemolytic strep Methicillin-resistant Staphylococcus aureus (MRSA) Escherichia coli

Correct response: Staphylococcus aureus Explanation: Staphylococcus aureus is the most common cause of impetigo in infants. MRSA is a hospital-associated infection (HAI), group A beta hemolytic strep is seen in older children, and Escherichia coli is not frequently associated with impetigo. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, INTEGUMENTARY DISORDERS, Impetigo, p. 875. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 875

The nurse is presenting a program on HIV and children for nursing students. The nurse determines that more teaching is needed when the students identify which of the following as a mode of transmission? skin contact sexual contact mother-to-infant transmission blood

Correct response: skin contact Explanation: Modes of transmission for HIV include sexual contact, mother-to-infant transmission before or around the time of birth, and contamination by blood or body fluids. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, SEXUALLY TRANSMITTED INFECTIONS, p. 893. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 893

After teaching the parents of a child with chickenpox (varicella zoster), the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time? After day 5 of the rash When the rash is completely healed Once the rash appears After the lesions have crusted

Correct response: After the lesions have crusted Explanation: Children with chickenpox (varicella zoster) can return to school once the lesions have crusted. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, COMMUNICABLE DISEASES OF CHILDHOOD, p. 901. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 901

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? First-degree or superficial burn Second-degree or partial-thickness burn Third-degree or full-thickness burn Fourth-degree or fat-layer burn

Correct response: Second-degree or partial-thickness burn Explanation: A burn that encompasses the epidermis and the underlying dermis is a second-degree burn. A first-degree burn would only involve the epidermis, and a third-degree burn would involve nerve endings as well as destruction of the epidermis and dermis. A fourth-degree burn would extend even deeper into the fat layer. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, BURNS, Types of Burns, p. 884. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 884

A nurse is teaching a group of parents about burn safety. Which statement made by a parent requires intervention by the nurse? "We installed smoke detectors on every floor in our home." "I always make sure the little ones stay out of the kitchen when I am cooking." "I had our plumber lower our water heater temperature to 130°F (53°C). "We made a song out of 'stop, drop and roll' to teach our children fire safety."

Correct response: "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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, BURNS, p. 889. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 889

A nurse is implementing interventions to prevent a negative nitrogen balance from occurring in a child with a burn injury. Which intervention would be most effective? establishing an adequate nutritional intake balance providing IV fluids providing adequate pain relief providing emotional support

Correct response: establishing an adequate nutritional intake balance Explanation: Establishing and maintaining adequate nutritional intake is essential to survival when caring for children with burns. This will help prevent the negative nitrogen balance that clients with burns are at high risk for developing. IV fluids, pain relief, and emotional support do not affect the nitrogen balance. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, BURNS, p. 886. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 886

An adolescent is to receive topical retinoid therapy for his moderately severe acne. The nurse would instruct the adolescent about which adverse effects? Select all that apply. burning photosensitivity dryness flu-like symptoms headache

Correct response: burning photosensitivity dryness Explanation: Adverse effects associated with topical retinoid therapy include burning, dryness, and photosensitivity. Flu-like symptoms and headache are associated with topical immune modulators. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, Acne Vulgaris, p. 876. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 876

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? Commend the parent on addressing the infant's diaper rash. Explain that frequent diaper changes will prevent diaper rash. Tell the parent that he or she has used too much ointment. Provide instruction on how to care for a diaper rash.

Correct response: Provide instruction on how to care for a diaper rash. Explanation: The best action for the nurse to take is to provide instruction on how to care for a diaper rash. This would include changing diapers frequently to prevent a rash, how to apply rash ointment, and how using too much ointment can cause the infant's skin to absorb the ointment. It is important to praise parents on taking good care of their child, but the best action is to provide instruction on the correct way to do so. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, Diaper Dermatitis, p. 874. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 874

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." "I'm going to have to have a blood count done every couple of months." "This drug can affect my lungs so I need a chest radiograph done first." "The drug might cause staining of my clothing."

Correct response: "I have to make sure that I do not become pregnant while taking this drug." Explanation: Adolescent girls taking this drug who are sexually active must be on a pregnancy prevention program because the drug causes defects in fetal development. Monthly complete blood counts are required when taking isotretinoin. Isotretinoin is not associated with lung problems, so a chest radiograph is not necessary. Coal tar preparations are associated with staining of the clothing or fabrics. Isotretinoin does not stain clothes or fabrics. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, Acne Vulgaris, p. 876. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 876

A nurse is providing care to a hospitalized child who has burns over 40% of the body. The child is receiving intravenous fluid replacement with a 24 hour total of 3,216 ml. The nurse is administering the second half of the fluid between 0100 and 1700 hours. What rate should the nurse set the infusion pump? Record your answer using one decimal place.

Correct response: 100.5 Explanation: First, the nurse divides the total amount of fluid by 2, because there are two doses. 3216 mL ÷ 2 = 1608 ml Next, the nurse divides the single dose amount by the total number of hours, which is 16. 1608 mL ÷ 16 hours = 100.5 ml/hour Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, BURNS, p. 886. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 886

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 assessing temperature every 4 hours urging adequate nutritional intake obtaining a culture of the impaired skin area

Correct response: using appropriate hand hygiene Explanation: Hand hygiene would be the priority because the child's risk for infection is increased and hand hygiene is crucial to preventing the transmission of infectious organisms. Monitoring the child's temperature is important to evaluate for possible fever and infection, but this would not be the most important action. Although nutritional status can influence wound healing, urging adequate nutritional intake would not be the most important action. Although obtaining a culture provides information about the cause of an infection, the child is at risk for infection, so a culture would not provide any information about the risk. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, ALLERGIC DISORDERS, p. 881. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 881

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 need to wash and rinse clothes thoroughly to be sure all of the detergent is washed out." "I should not overdress the infant." "I should only use ointments and creams as instructed by the health care provider." "I should be certain to use fabric softener in the care of the infant's clothes."

Correct response: "I should be certain to use fabric softener in the care of the infant's clothes." Explanation: Fabric softeners should be avoided because their use can result in skin irritation in the infant. Clothing and other baby items should be washed and rinsed thoroughly. Overdressing should be avoided as sweating irritates the rash, and only ointments and creams that are recommended by health care personnel should be used on the infant. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, INTEGUMENTARY DISORDERS, T I P S F O R R E I N F O R C I N G FAMILY TEACHING, p. 874. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 874

In the child diagnosed with miliaria rubra, a rash that appears as pinhead-sized reddened papules usually is most noticed in which areas of the body? folds of the skin and around the neck genital and anal areas scalp and top of the feet arms and lower legs

Correct response: folds of the skin and around the neck Explanation: The rash appears as pinhead-sized erythematous (reddened) papules. It is most noticeable in areas where sweat glands are concentrated, such as folds of the skin, the chest, and around the neck. It usually causes itching, making the child uncomfortable and fretful. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, INTEGUMENTARY DISORDERS, p. 873. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 873

A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of: pneumonia. impetigo. scarlet fever. osteomyelitis.

Correct response: scarlet fever. Explanation: Group A streptococcal pharyngitis can progress to scarlet fever with the rash appearing in about 12 hours after the onset of the disease. Group A streptococcal pharyngitis is not associated with pneumonia. Impetigo is a group A strep infection involving the skin. Osteomyelitis can occur with an infection by group B streptococcus. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, COMMUNICABLE DISEASES OF CHILDHOOD, p. 902. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 902

The school nurse has diagnosed a case of head lice in a first grader at school. After receiving a phone call from the nurse, the parent arrives in the clinic to take the student home. The school nurse hands the parent a document about lice and verbally reinforces the treatment for lice. Which of the following parental statements demonstrates proper learning has occurred? "I will wash our dogs right away in order to rid them of possible lice." "I will keep my child away from other children for the next two weeks." "I will treat my child with a pediculicidal shampoo, remove the nits, and then clean my house." "I will maintain better hygiene with my children in the future."

Correct response: "I will treat my child with a pediculicidal shampoo, remove the nits, and then clean my house." Explanation: Treatment of head lice involves use of a pediculicidal shampoo, removal of nits, and a thorough cleansing or delousing of the environment. Children can return to school when they are nit free, not in two weeks. The condition of head lice is not related to poor hygiene. Head lice do not live on pets. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, PARASITIC INFECTIONS, p. 877. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 877

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." "As long as I use two forms of birth control I don't need to have monthly pregnancy testing." "I am young so I won't need to have the liver tests the pamphlet suggests." "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."

Correct response: "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." Explanation: 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 by the physician, such as the CBC, to monitor the medication's side effects should be obtained. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, Acne Vulgaris, p. 876. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 876

An emergency department nurse is caring for a 5-year-old child who was just brought in by ambulance with partial-thickness (second-degree) and full-thickness (third-degree) burns to their face, neck, and chest. The client is awake and alert. Vital signs: temperature, 97.2°F (36.2°C); heart rate, 148 beats/min; blood pressure, 68/39 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 90% on 2 liters by nasal cannula. The nurse receives prescriptions for the client. Click to highlight the prescription(s) that requires immediate implementation. Prescriptions: Apply oxygen to maintain oxygen saturations 95% or greater. Administer 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hour. Initiate fluid resuscitation per Lund and Browder chart using Parkland formula with 0.9% saline. Administer acetaminophen by mouth (PO) 325 mg q6h prn for fever. Initiate a regular diet as tolerated.

Correct response: - Apply oxygen to maintain oxygen saturations 95% or greater. - Administer 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hour. - Initiate fluid resuscitation per Lund and Browder chart using Parkland formula with 0.9% saline. Explanation: The nurse applies oxygen to maintain an oxygen saturation of 95% or greater. The nurse will need to monitor the child's airway closely because the burns are on the chest and neck.Partial-thickness (second-degree) burns are very painful. The nurse administers 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hours.Fluid resuscitation is implemented promptly to prevent shock. Fluid resuscitation for children is determined using the Lund and Browder chart and Parkland formula. Because the child sustained burns to the neck and chest, the nurse would not administer anything by mouth including medications such as acetaminophen PO 325 mg q6h prn for fever or a regular diet as tolerated. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, Burns, p. 883. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 883

The rash in roseola is pruritic. Which measure would you teach the parent to provide comfort? Dress the child warmly to bring out the rash so that it fades quickly. Apply cool compresses to the skin to stop local itching. Discuss with the child the importance of not scratching lesions. Administer infant aspirin every 4 hours as necessary for comfort.

Correct response: 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. Antipruritics may be necessary 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 increased body temperature and intensify the itching. Aspirin should not be used in children as an antipyretic. There is an increased risk of developing Reye syndrome. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, BURNS, p. 885. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 885

The mother of a 5-year-old child with eczema is getting a checkup for her child before school starts. What will the nurse do during the visit? Change the bandage on a cut on the child's hand. Assess the compliance with treatment regimens. Discuss systemic corticosteroid therapy. Assess the child's fluid volume.

Correct response: Assess the compliance with treatment regimens. Explanation: Maintaining proper therapy for eczema can be exhausting both physically and mentally. Therefore, it is essential that the nurse assess compliance and support the parents' ability to cope if necessary. Changing a bandage is not part of a health maintenance visit. Hydration is important for a child with eczema; however, fluid volume is not the focus at this visit. Systemic corticosteroid therapy is very rarely used and the success of the current therapy needs to be assessed first. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, Atopic Dermatitis (Eczema), pp. 879-881. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 879-881 Add a Note

The school nurse is educating the faculty at an area elementary school. One of the teachers asks how to tell the difference between lice and scabies in children. Which of the following is the best response from the nurse? Children with lice are often inattentive at school. Children with scabies have whitish-beige nits in their scalp. Children with lice have burrows located on the wrists, hands, axilla, feet, and head. Children with lice tend to be itchy all day, whereas children with scabies itch more at nighttime.

Correct response: Children with lice tend to be itchy all day, whereas children with scabies itch more at nighttime. Explanation: Children with lice tend to be itchy all day, whereas children with scabies tend to be more itchy at nighttime. Children with lice, not scabies, have nits on their scalp. Children with scabies, not lice, have burrows. Children with lice and scabies can both be inattentive at school. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, PARASITIC INFECTIONS, pp. 877-879. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 877-879

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? Make an appointment for the parent to bring the child to the clinic for evaluation. Explain that children who have had a serious injury sometimes exhibit regressive behavior. Tell the parent to allow the child to nurse as much as the child wants. Encourage the parent to explain to the child that he or she must drink from the cup.

Correct response: Explain that children who have had a serious injury sometimes exhibit regressive behavior. Explanation: The best response is for the nurse to explain that children recovering from serious injuries such as burns will often regress in their behaviors. There is no indication for the parent to bring the child to the clinic for evaluation. It is inappropriate to tell the parent to allow the child to nurse as much as he or she wants. If the child has been weaned for one year, the mother likely has no breast milk. At 30 months, the child may not understand fully that he or she cannot nurse any longer. The parent can be supportive to the child, comforting the child with hugs and cuddling, and reinforcing the desired behavior. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, BURNS, p. 888. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 888

The home care nurse is observing a mother prepare mupirocin to treat a preschool-age child's skin rash. At which point should the nurse stop the mother during the preparation of the medication? Mother washes the lesions before using the medication. Mother washes own hands after touching the child's rash. Mother is still using the medication on day 9 of the infection. Mother measures out a teaspoon of the medication for the child to take orally.

Correct response: Mother measures out a teaspoon of the medication for the child to take orally. Explanation: Mupirocin is a topical antibiotic and should not be taken orally. The mother should wash the lesions before applying the medication. The mother should wash the hands before and after applying the medication or touching the rash. The mother should use the medication for the full course even though the rash and lesions might appear healed. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, Staphylococcal Infection, p. 875. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 875

A 3-year-old child is admitted after being severely burned. The nurse collects the following data. What finding would be most important for the nurse to report immediately? The child's respiratory rate is 42 breaths/min. The child's temperature is 101.2°F (38.4°C). The child's hourly urinary output is 150 ml. The child's pain level is a 7 on a 10-point pain scale.

Correct response: The child's respiratory rate is 42 breaths/min. Explanation: An increase in the respiratory rate after a severe burn may be an indication of possible serious respiratory complications and should be reported immediately in case an endotracheal tube needs to be inserted. A temperature of 101.2°F (38.4°C) would be expected with a burn. A child who has just been severely burned would be expected to have a lower urine output not higher. An hourly urine output of 150 ml exceeds the expected output of a 3-year-old child. That child should be producing 1 to 2 ml/kg/hr. A normal 3-year-old child would weigh approximately 30 lb (13.6 kg), which means the output should be around 27 ml/hr. Fluid replacement for the burned child aims to have a urine output of 1 to 2ml/kg/hr. The pain rating of 7 would be expected in severe burns. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, BURNS, Treatment of Moderate-to-Severe Burns: First Phase—48 to 72 Hours, p. 886. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 886

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first? a child diagnosed with chicken pox reporting nausea and malaise a child with herpes simplex who is reporting mouth pain and pruritis a child diagnosed with measles experiencing photophobia and coryza a child with erythema infectiosum experiencing fatigue and confusion

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, COMMUNICABLE DISEASES OF CHILDHOOD, p. 901. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 901

A chief danger of scarlet fever is that children may develop: acute glomerulonephritis. liver destruction. local areas of skin necrosis. respiratory obstruction.

Correct response: acute glomerulonephritis. Explanation: Scarlet fever infection is the result of group A streptococci. It generally starts with a throat infection (strep throat). The bacteria produce a toxin that causes the rash over the body. Because this is a streptococci-based infection, the child will need to be monitored for the development of rheumatic fever or glomerulonephritis following the illness. Scarlet fever does not cause respiratory symptoms, attack the liver, or have open lesions. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, COMMUNICABLE DISEASES OF CHILDHOOD, p. 902. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 902

Which child will the nurse identify as at greatest risk for developing a urinary tract infection? a 6-month-old breastfed female an 8-month-old bottle-fed female with HIV a 1-year-old formula-fed male a 2-year-old male with otitis media

Correct response: an 8-month-old bottle-fed female with HIV Explanation: Factors that make an individual more prone to a urinary tract infection include young age, female gender, and immunosuppression. Infants who are formula-fed are at greater risk than infants who are breastfed. To determine the child at greatest risk, the nurse should count risk factors and determine which child has the most risk factors. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, SEXUALLY TRANSMITTED INFECTIONS, p. 892. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 892

A school-age child with a rash over the abdomen now has a bright red tongue. The health care provider is going to begin treatment for scarlet fever. On which medication should the nurse instruct the mother for the child's care? aspirin steroids antibiotics antifungal medication

Correct response: antibiotics Explanation: Because the underlying reason for scarlet fever is a streptococcal infection, a course of antibiotics will be prescribed. Aspirin is not usually provided to children for fever control. Steroids are not used to treat scarlet fever. The child's red tongue is not because of an oral fungal infection. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, COMMUNICABLE DISEASES OF CHILDHOOD, p. 902. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 902

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. benzoyl peroxide. tretinoin. erythromycin.

Correct response: isotretinoin. Explanation: Isotretinoin is a drug used to treat cystic acne after at least 3 months of antibiotic therapy has not been successful. Isotretinoin is a pregnancy category X drug. It must not be used at all during pregnancy because of serious risk of fetal abnormalities. Tretinoin is used to treat severe acne vulgaris. Instruction for the use of this medication include using sunscreen. Benzoyl peroxide can be used for mild acne and can be used with topical antibiotics. Erythromycin is an antibiotic that has no pregnancy contraindications. It is used for many skin infections. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, INTEGUMENTARY DISORDERS, Acne Vulgaris, p. 876. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 876

The nurse anticipates that a 16-year-old girl with infectious mononucleosis will be instructed to avoid strenuous activities and contact sports to: protect her from joint involvement. prevent irritation of her stiff neck. prevent splenic rupture. prevent liver involvement.

Correct response: prevent splenic rupture. Explanation: The spleen is greatly enlarged with this infection. Avoiding strenuous activities and contact sports for the child helps to protect against injury. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, INFECTIOUS MONONUCLEOSIS, p. 897. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 897

A child is diagnosed with atopic dermatitis. Which laboratory test would the nurse expect the child to undergo to provide additional evidence for this condition? erythrocyte sedimentation rate potassium hydroxide prep wound culture serum immunoglobulin E (IgE) level

Correct response: serum immunoglobulin E (IgE) level Explanation: IgE levels are often used to evaluate for atopic dermatitis. IgE levels are elevated in this condition. Erythrocyte sedimentation rate may be used, but this test is nonspecific and only indicates infection or inflammation. Potassium hydroxide prep is used to identify fungal infections. Wound culture would be done to identify a specific organism if an infection occurs with atopic dermatitis. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, ALLERGIC DISORDERS, p. 879. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 879

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 Reddened and leathery skin Edema with dry or waxy-looking skin Peeling skin with eschar

Correct response: Edema with wet blistering skin Explanation: Partial-thickness or second-degree burns are very painful and edematous and have a wet appearance or the presence of blisters. Third-degree (full-thickness) burns appear red, edematous, leathery, dry, or waxy and may display red or charred skin (eschar). Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, BURNS, pp. 884-885. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 884-885

The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? "Our child is contagious for 1 week after the rash appeared." "Acetaminophen or ibuprofen can be given to help with pain." "Antibiotics are needed to help our child recover from rubella." "Family members should wear a mask when coming to visit us."

Correct response: "Antibiotics are needed to help our child recover from rubella." Explanation: Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, COMMUNICABLE DISEASES OF CHILDHOOD, p. 901. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 901

The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as a: papule. macule. vesicle. scale.

Correct response: macule. Explanation: A macule is a flat, discolored area on the skin. A papule is a small, raised bump on the skin. A vesicle is a fluid-filled bump on the skin. Scaling is flaking of the skin. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, COMMUNICABLE DISEASES OF CHILDHOOD, p. 901. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 901

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? "Your child must have been exposed to someone with herpes zoster." "Herpes zoster is a reactivation of a previous varicella zoster infection." "Children who are immunocompromised are more likely to contract shingles." "Handwashing is an effective way to prevent the spread of infectious disorders."

Correct response: "Herpes zoster is a reactivation of a previous varicella zoster infection." Explanation: Herpes zoster (shingles) is reactivation of the latent varicella zoster (chickenpox) 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, COMMUNICABLE DISEASES OF CHILDHOOD, p. 901. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 901

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? corticosteroid antifungal antibiotic antihistamine

Correct response: antifungal Explanation: Tinea cruris is a fungal infection of the groin area. Treatment would include antifungals. Antihistamines are typically used for the treatment of hypersensitivity and allergy disorders. Corticosteroids are used in the treatment of allergies and dermatitis. Antibiotics would be used to treat bacterial infections of the skin. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 41: The Child with an Integumentary Disorder/Communicable Disease, FUNGAL INFECTIONS, p. 877. Chapter 41: The Child with an Integumentary Disorder/Communicable Disease - Page 877