Chapter 45: Tissue Integrity/ Integumentary Disorder

The nurse is interviewing the mother of a 6-month-old being seen at a well-child visit. The mother reports she has used an over-the-counter topical ointment intended for adults on her child for a skin rash. What is the most appropriate response by the nurse?

"Children have thin skin and can absorb medications differently than adults." Rationale: Children have thinner skin than adults. They will absorb topical medications more rapidly than adults. Medications concentrated for adults should not be used on children. It is important to explain this to the parent. It is confrontational to tell her this is dangerous or to tell her to contact the physician. The frequency of use is information that should be obtained but the education is most important in this scenario.

Which assessment finding by the nurse would warrant immediate action?

A child with periorbital cellulitis reports changes in vision and pain with eye movement. Rationale: In a child with periorbital cellulitis, the nurse musty notify the health care provider immediately if signs of progression to orbital cellulitis occur, such as conjunctival redness, change in vision, pain with eye movement, eye muscle weakness or paralysis, or proptosis. This assessment finding warrants immediate action. In nonbullous impetigo, a honey-colored exudate when the vesicles or pustules rupture may be noted on the skin. This assessment finding would be expected. A localized cellulitis will present with erythema, pain, edema, and warmth at the site of the skin disruption (such as a cut or spider bite). This assessment finding warrants further follow-up but not immediate attention. Fever may occur with bullous impetigo or cellulitis and is common with scalded skin syndrome; therefore, this assessment finding also warrants further, but not immediate, follow-up.

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. Rationale: Pruritis is a common problem associated with contact dermatitis. By healing the lesions, the itching will subside. Bathing with oatmeal-based products will accomplish this healing. If the area is too involved, then products like a topical corticosteroid can be used. Calamine lotion is a product that can help with itching, but it is primarily used to dry out weeping lesions. Moisturizers can be applied to the irritated skin, but they must be free of fragrances and dyes. The area should not be covered but allowed to be exposed to air to aid in healing.

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 Rationale: Tinea versicolor is a superficial tan or hypopigmented oval scaly lesions, especially on upper back and chest and proximal arms. It may take several months for pigmentation to return to normal; therefore, disturbed body image is going to be a high priority for an adolescent client.

The nurse is caring for a child with suspected child abuse (child mistreatment)-induced burns. Which assessment findings would support this?

a burn to the entire right hand up to 2 cm above wrist with consistent edges Rationale: A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water) is one sign of child abuse (child mistreatment)-induced burns. Inconsistent history given by caregivers, delay in seeking treatment by caregivers, and a lack of splattering of water burns are all indicators of child abuse (child mistreatment)-induced burns.

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 Rationale: 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.

The nurse is caring for a 13-year-old client who asks about acne prevention. Which would be most appropriate for the nurse to suggest?

Wash the face twice a day with a mild soap then pat dry. Rationale: The face should be washed twice per day with a mild soap and lukewarm water then patted dry. Avoiding certain foods will not prevent acne. Popping pimples does not make acne go away and can cause scarring. Washing the face with abrasive soaps can aggravate the acne and cause more flare-ups.

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 Rationale: Urticaria is a type I hypersensitivity reaction. Therefore, the priority nursing assessment is to carefully assess airway and breathing, as hypersensitivity reactions may affect respiratory status. A detailed history, skin inspection, and evaluation of the hives are other appropriate assessments, but determining respiratory status is the priority.

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 Rationale: Infants who have atopic dermatitis (infantile eczema) tend to have allergic rhinitis or asthma later in life.

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 Rationale: All prescribed oral medication should be finished in order to prevent reinfection. Socks should be removed after athletic events to allow skin to dry. Application of oils and petroleum jelly can cause more fungal growth. The child with tinea corporis may return to school after treatment has started.

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 Rationale: 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 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 Rationale: The nurse would suspect an airway injury since stridor is present. This would most concern the nurse as this indicates potential loss of airway. Burns on the hands, a broken tibia, and an inability to state own's name are concerning and require intervention. However, these are not indicative of an airway injury and not priority.

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?" Rationale: Small round red circles with scaling, symmetrically located on the girl's inner thighs, point to nickel dermatitis that may occur from contact with jewelry, eyeglasses, belts, or clothing snaps. The nurse should inquire about any sleepers or clothing with metal snaps. The girl does not have a rash in her diaper area. It is unlikely that an infant this age would have her inner thighs exposed to a highly allergenic plant. Discussing family allergy history is important, but the nurse should first inquire about any clothing with metal that could have come into contact with the girl's skin when she displays a symmetrical rash.

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." Rationale: Atopic dermatitis is a type of allergic skin disorder, not a bacterial infection, in which the eosinophil count is often elevated. This is one test that will help in diagnosing the disorder. This explanation addresses the parents' question.

The nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding?

"Flare-ups of lesions are not uncommon following therapy." Rationale: Atopic dermatitis is relapsing and remitting. It may recur when the child is re-exposed to the substance to which he or she is allergic, even following treatment. Approximately 30% of children with atopic dermatitis develop allergic rhinitis and asthma. It does not occur as a result of a strep infection. It is caused by an inflammatory process. The use of periodic hydrocortisone cream will not lead to kidney disease.

The school nurse has completed an educational program on first aid practices in the home. Which statement about burn care by a participant would indicate a need for further education?

"I guess my mom was right; she always put ice on our burns when we were kids." Rationale: Steps for providing burn care at home to a first-degree (superficial) burn include running cool water, not ice, over the burn and covering it with a nonadherent bandage after cleaning with a fragrance-free mild soap. Other care includes not applying butter, ointments or creams; and administering acetaminophen or ibuprofen for pain.

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." Rationale: 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.

The nurse is caring for a child with a prescription for PO prednisone. Which statement by the child's mother would indicate a need for further education?

"I will give it to ny child at least 1 hour before all meals." Rationale: Systemic corticosteroids such as prednisone should be administered with food to decrease gastrointestinal upset. These medications may mask signs of infection. This medication may increase blood sugar levels. Corticosteroid doses should be tapered and should not be stopped abruptly.

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." Rationale: Prevention and management of diaper dermatitis include avoiding rubber pants, avoiding diaper wipes with fragrance or preservatives. Treatment of a rash includes allowing the child to go diaperless for a period of time each day and using a warm blow dryer on the area for 3 to 5 minutes.

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." Rationale: Irritation and irritating substances, such as vigorous scrubbing and cosmetics with a greasy base, can cause acne vulgaris. Increased hormone levels, hereditary factors, and anaerobic bacteria can cause acne vulgaris as well. Eating chocolate and fatty foods does not cause acne, but a well-balanced, nutritious diet does promote healing.

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." Rationale: In the older child and adolescent, a gentle shampoo should be used daily to control scaling caused by dandruff. A medicated shampoo may be indicated if shampooing with a gentle formula shampoo does not provide relief. Washing hair vigorously twice a day is not recommended. Warm baby oil is recommended for infants with cradle cap (seborrhea).

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." Rationale: It is important to apply moisture multiple times throughout the day. Petroleum jelly is a recommended moisturizer that is inexpensive and readily available. The other statements are correct.

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." Rationale: The nurse should emphasize that the parents should avoid hot water. The child should be bathed twice a day in warm water. The other statements are correct.

A nurse is caring for a child with second- and third-degree (partial- and full-thickness) burns over 15% of the body. The child reports severe itching in and around the burn sites. Which action would be most appropriate for the nurse to perform?

Administer diphenhydramine. Rationale: As nerve endings heal they cause intense itching that can be relieved with the use of medications (e.g., diphenhydramine hydrochloride, loratadine) and by applying soothing lotions such as Nivea or Eucerin. Turning the child every two hours will not relieve the itching. Soaking in a colloidal bath is contraindicated with burn clients. Although diversional activities can help somewhat, they will not relieve the child's itching.

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. Rationale: Spider bites can cause serious illness if untreated. Bites of black widow spiders, brown recluse spiders, and scorpions demand medical attention. Applying ice to the affected area until medical care is obtained can slow absorption of the poison.

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. Rationale: 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 child with a burn injury is scheduled for skin grafting. Which intervention would be most appropriate for the nurse to include in the child's plan of care?

Provide around the clock pain medication. Rationale: When the child undergoes a procedure, such as skin grafting, that is known to produce prolonged pain, administer pain medication on a scheduled basis—rather than as needed—once pain is reported. Around the clock pain medication will serve to diminish peaks and valleys in pain relief. Diversional activities and an egg crate mattress are not effective treatments for severe pain.

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. Rationale: When the child undergoes a procedure, such as skin grafting, that is known to produce prolonged pain, administer pain medication on a scheduled basis, rather than as needed once pain is reported. Around-the-clock pain medication will serve to diminish peaks and valleys in pain relief. Diversional activities and an egg-crate mattress are not effective treatments for severe pain.

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. Rationale: 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.

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." Rationale: Prevention of contact dermatitis from poison ivy, poison oak, or poison sumac includes wearing long pants and long sleeves on outings in the wood. If contact occurs, wash vigorously with soap and water within 10 minutes of contact. The plant's oil residue may be on clothes, pets, toys, and other objects, so these must be washed well with soap and water. Ivy Block is the only preventive treatment approved by the US FDA. It is applied to the skin before exposure.

The nurse admits a 10-year-old who has just eaten lobster and has hives over much of the body. In collecting data regarding this child, which question should the nurse ask the caregiver first?

"Has the child ever eaten shellfish before now?" Rationale: The first time the child comes in contact with an allergen, no reaction may be evident, but an immune response is stimulated—helper lymphocytes stimulate B lymphocytes to make the immunoglobulin E (IgE) antibody. The IgE antibody attaches to mast cells and macrophages. When contacted again, the allergen attaches to the IgE receptor sites, and a response occurs in which certain substances, such as histamine, are released; these substances produce the symptoms known as allergy. Asking the other questions is important, but the first question the nurse should ask is related to this child and this situation.

The nurse is caring for a child brought to the emergency department by the parents. Upon assessment the physician suspects the child has been bitten by a spider. While obtaining the nursing history of the present condition, which statement by the parent will require clarification from the nurse?

"Since my child just has a rash around the area of the bite there is nothing to worry about." Rationale: A rash could be an indication of a systemic reaction and the child should be monitored closely for other signs of a systemic, or possible anaphylactic, reaction. Protective clothing for the prevention of insect or spider bites, cleansing the wound to help with infection control, and ice for prevention of swelling are all effective actions.

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." Rationale: The skin is the largest organ of the body. The skin helps regulate the body temperature by heating and cooling. The sebaceous and sweat glands are not fully functional until middle childhood. The major role of the skin is to protect the organs and structures of the body against bacteria, chemicals, and injury. Excretion in the form of perspiration is also a function of the skin glands, called the sweat glands. Sebaceous glands in the skin secrete oils to lubricate the skin and hair. The integumentary system is in place at birth, but the system is immature. A function of the respiratory system is to distribute oxygen to body cells.

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." Rationale: Acknowledging that ultraviolet therapy is an option while clarifying what is meant by ultraviolet therapy and the risks of tanning year round addresses all concerns. Asking if that is what the doctor said may lead the adolescent to think year-round tanning is a viable option. Advising the adolescent to not get burned is giving approval for tanning. Simply telling the adolescent it is not a good option will be ineffective.

A 16-year-old male who is diagnosed with tinea pedis questions the nurse about how he may have contracted the condition. How should the nurse respond?

"You may have gotten the condition from a community shower or gym area." Rationale: Tinea pedis is commonly known as athlete's foot. It is a fungal infection. The fungi are able to readily grow in warm, moist conditions such as shower areas.

The nurse is working with the caregiver of a neonate. The caregiver states, "My first baby had a disorder they called seborrheic dermatitis; what can I do to prevent this baby from having that?" Which response is the most appropriate?

"You should wash your neonate's hair every day to help prevent this disorder." Rationale: Seborrheic dermatitis is commonly known as cradle cap. Daily washing of the neonate's hair and scalp can help prevent it.

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 best respond?

"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." Rationale: Infantile seborrheic dermatitis, better known as cradle cap, 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, mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft brush to lift the scales then shampooed again. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Infantile seborrheic dermatitis is not a result of poor hygiene and will not resolve without intervention.

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." Rationale: 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.

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. Rationale: In the first 24 to 48 hours after a burn, the hematocrit will often be elevated secondary to fluid loss and the WBC count may also be elevated as an acute-phase reaction, which later could indicate infection.

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 Rationale: Erythema multiforme typically manifests in lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk. Thick or flaky/greasy yellow scales are signs of seborrhea. Silvery or yellow-white scale plaques and sharply demarcated borders define psoriasis. Superficial tan or hypopigmented oval-shaped scaly lesions, especially on the upper back and chest and proximal arms, are indicative of tinea versicolor.

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 Rationale: Tinea capitis is a fungal infection of the scalp that causes circular patches of hair loss. Tinea faciei is a fungal infection of the face; tinea cruris is a fungal infection of the inner thighs and inguinal creases; and tinea corporis is a fungal infection located on the entire body.

The nurse is caring for a mom and her baby on a postpartum unit. The mom states she has received advice not to use baby powder on newborns. She asks the nurse if this is true, and if so, why. Which nurse response is correct?

"Baby powder should not be used on newborns due to the risk of aspiration upon application." Rationale: The use of baby powder containing "talc" (also known as "talcum powder") can cause accidental aspiration, pneumonia, and death. Aspiration is predominantly caused when the baby receives a "puff of smoke" when the powder is shaken from the container directly onto the baby's skin. In addition, the use of talcum powder is abrasive and is can contribute to the pathogenesis of diaper dermatitis.

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." Rationale: First-degree (superficial) burns affect the epidermis. These burns will heal without scarring but are painful and red. For initial care, the burned area should be first rinsed with cool water until the pain improves. A non-adhering dressing can then be applied. Acetaminophen or ibuprofen can be taken as needed for pain. No ice should be used nor should any butter, ointments or creams be applied. For ongoing care after the initial injury, the site can be cleaned in the tub or shower with a mild soap. It should be patted dry. A thin layer of antibiotic ointment can be applied and covered with a non-adhering dressing and dry gauze.

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 Rationale: The wound was not a clean wound, such as a surgical wound, so risk for infection would be a top priority. The child has impaired skin integrity from the wound and from the IV. Since the wound is new and on the arm the nursing diagnosis disturbed body image would not be a top 2 priority at this time. It is unlikely that a great deal of fluid has been lost from this wound. Knowledge deficit of wound care would not be a top 2 priority at this time, but would be an important nursing diagnosis to address later.

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 Rationale: 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.

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. Rationale: Tinea pedis refers to a fungal infection that typically begins between the toes. The nurse would question the child being out of school for a week. While these infections are highly contagious, children can return to school once treatment is started. Tinea pedis can be treated with topical or oral antifungals or a combination of both. Topical agents, such as luliconazole, are used for 1 to 6 weeks, depending on the brand. Antibacterial soaps help reduce the risk of infection to the affected area. Warm soaks may help soothe painful muscles or joints and can help drain skin infections, if present.

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." Rationale: 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.

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." Rationale: 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.

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 Rationale: Impetigo is a superficial bacterial skin infection. Impetigo in the newborn is usually bullous (blister-like, fluid filled); in the older child, the lesions are nonbullous and have a honey-colored, crusted appearance.