Peds 38

During the assessment of a child, the nurse notices the presence of vesicles that are oozing yellow fluid. Which term does the nurse use when documenting this finding in the medical record? 1) Bulla 2) Pustule 3) Wheal 4) Nodule

2 1 A bulla is a vesicle that oozes clear fluid. 2 A pustule is a raised, superficial-like vesicle, but the fluid is purulent. 3 A wheal is a raised, irregular, solid-shaped, cutaneous swelling on the skin. 4 A nodule is raised, firm, and circumscribed.

Which is the priority nursing intervention for a 4-year-old patient brought to the emergency department (ED) for treatment of frostbite? 1) Administering analgesics 2) Immersing the hands in extremely warm water (48.9°C [120°F]) 3) Not removing clothing 4) Placing the extremity in a dependent position

1 1 Administering analgesics to decrease the pain of the rewarming process is the priority nursing action in this situation. 2 The nurse should use mildly warm water (at 37.8°C to 40°C [100°F to 104°F) to warm the extremity. 3 Nursing interventions for frostbite include removing wet clothing. 4 Nursing interventions for frostbite include raising the affected extremity to improve venous return.

Which parental statement regarding preventive strategies for insect bites and stings indicates the need for further education? 1) "If my child wears bright colors and floral prints when outdoors, she will blend in with the surroundings, and the stinging insects will not sting her." 2) "We should remove any items with standing water from our yard and surrounding area to prevent mosquito reproduction." 3) "My child can use insect repellent containing DEET of 10% or less." 4) "My child should avoid heavy colognes, perfumes, and soaps so that insects are not attracted to them."

1 1 Bright-colored clothing and floral prints attract insects. White and light-colored clothing should be worn. This statement requires clarification. 2 Standing water is a breeding ground for mosquitoes. Rid yards of all birdbaths, stagnant pools, and any standing water that mosquitoes can use for breeding. No clarification is needed. 3 DEET is an appropriate insect repellent and can be used in children. A concentration of 10% or less is recommended because of neurotoxic effects at greater concentrations. No clarification is needed. 4 Heavy colognes, perfumes, soaps, and detergents resemble flowers and plants and attract stinging insects. This statement is correct.

Which is the most likely cause for a bright red perianal inflammation with scaly plaques and small papules noted by the nurse during the assessment of a 12-month-old infant? 1) Candida albicans (yeast) 2) Impetigo (Staphylococcus) 3) Infrequent diapering 4) Urine and feces

1 1 C albicans is frequently the underlying cause of severe diaper rash. When a primary or secondary infection with C albicans occurs, the rash has bright red, scaly plaques with sharp margins. Small papules and pustules might be seen along with satellite lesions. 2 Although diaper dermatitis can be caused by impetigo, urine, feces, and infrequent diapering, the lesions and persistent characteristics are common for Candida infection. 3 Infrequent diapering, along with urine and feces, can cause diaper dermatitis, but the persistence and characteristics of the lesions are common for Candida infection. 4 Urine and feces can cause diaper dermatitis, but the persistence and characteristics of the lesions are common for Candida infection.

The nurse is providing care to a child diagnosed with impetigo. The child's parents ask what caused this to occur. Which organism does the nurse include when educating the parents about impetigo? 1) Staphylococcus aureus 2) Human papillomavirus (HPV) 3) Pseudomonas aeruginosa 4) Escherichia coli

1 1 Impetigo may be caused by S aureus or Streptococcus pyogenes (S pyogenes) or both. On rare occasions, another bacterium may be responsible for the skin infection. 2 Viral infections can be caused by any number of viruses, but those encountered most often include a member of the poxvirus group, herpes simplex 1 or 2 and HPV. 3 P aeruginosa is an aerobic bacterium containing gram-negative rods that occur singly. Some species are plant pathogens, and others are involved in human infections. 4 E coli is a species that occurs normally in the intestines of humans and is a frequent cause of urinary tract infections and diarrhea in infants.

Which parental statement indicates to the nurse an accurate understanding regarding the care of a child with tinea capitis (ringworm of the scalp)? 1) "We will give the griseofulvin with milk or peanut butter." 2) "We're glad ringworm isn't transmitted from person to person." 3) "Once the lesion is gone, we can stop the griseofulvin." 4) "Well, at least we don't have to worry about the family cat getting ringworm."

1 1 Parents are advised to give oral griseofulvin with fatty foods such as milk or peanut butter to enhance absorption. 2 All members of the family and household pets should be assessed for fungal lesions because person-to-person transmission is common. 3 The medication must be used for the entire prescribed period, even if the lesions are gone. 4 Dogs and cats can develop the fungal lesions and can be sources of spread of the organism.

Which should the nurse include in the plan of care for a child with a minor burn to enhance nutrition and healing? 1) Protein 2) Minerals 3) Carbohydrates 4) Fats

1 1 Parents should be taught that management of a minor burn requires a high-calorie, high-protein diet. This is necessary to meet the increased nutritional requirements of healing. 2 A high-calorie, high-protein diet is required to meet the increased nutritional requirements for healing. 3 The family should be taught that a high-calorie, high-protein diet is best to meet the increased nutritional requirements for healing. 4 A high-calorie, high-protein diet is best to meet the increased nutritional requirements for healing.

The pediatric nurse is assessing a wound on a preschool-aged child's leg and notes that the site is pink with the formation of new epithelial cells. Based on these data, which term does the nurse use to describe the current stage of healing? 1) Proliferation 2) Inflammation 3) Restoration 4) Remodeling

1 1 Proliferation is the second phase of healing, in which blood flow is reestablished to the site and natural débridement occurs. This phase, lasting 2 days to 3 weeks, occurs when the wound contracts and a fine layer of epithelial cells cover the site of new collagen. 2 The first stage of healing, inflammation, reflects the skin's initial healing response and lasts about 2 to 5 days. This is a preparatory stage for repair. 3 Restoration is not a term used to describe a phase of wound healing. 4 During remodeling, the third phase, collagen production occurs and allows for scar production. This phase, lasting 3 weeks to 2 years, allows the collagen to increase the tensile strength of the newly mended tissue.

Which nursing action is accurate when applying a 5% permethrin lotion to a toddler with scabies? 1) Applying the lotion to the scalp, the forehead, and everywhere below the chin 2) Applying the lotion only to areas with evidence of activity 3) Applying the lotion only to the hands 4) Applying the lotion only to the scalp

1 1 Treatment of scabies involves application of a scabicide, such as 5% permethrin lotion, over the entire body from the chin down. The scabicide is also applied to the scalp and forehead of younger children, avoiding the rest of the face. 2 Treatment of scabies involves application of a scabicide, such as 5% permethrin lotion, over the entire body from the chin down, as well as the scalp and forehead. 3 Treatment of scabies involves application of a scabicide, such as 5% permethrin lotion, over the entire body from the chin down, including the scalp and forehead. 4 Treatment of scabies involves application of a scabicide, such as 5% permethrin lotion, over the entire body from the chin down, as well as the scalp and forehead.

Which topics should be included in a teaching session with parents of school-aged children to prevent sunburn? (Select all that apply.) 1) Playing in the shade 2) Wearing a hat while outdoors 3) Restricting outside activities between 10 a.m. and 2 p.m. 4) Using sunscreen with an SPF of 30 or higher 5) Avoiding sunglasses

1,2,4 1. This is correct. The nurse should recommend that school-aged children play in the shade while outdoors to decrease the risk for sunburn. 2. This is correct. The nurse should recommend that school-aged children wear a hat while outdoors to decrease the risk for sunburn. 3. This is incorrect. Outdoor activities should be restricted between 10 a.m. and 4 p.m. to decrease the risk for sunburn. 4. This is correct. The nurse should recommend that school-aged children use sunscreen with an SPF of 30 or higher to decrease the risk for sunburn. 5. This is incorrect. Sunglasses should be encouraged, not discouraged, to decrease the risk for sunburn around the eyes.

Which preventive strategies for tinea pedis, a fungal infection also known as athlete's foot, should the nurse include in a teaching session for an adolescent client? (Select all that apply.) 1) Wear white, 100%-cotton socks, changed twice a day. 2) Use talc on the feet daily. 3) Use an over-the-counter corticosteroid cream to treat the area. 4) Wear foot covers such as flip-flops in the locker room and shower. 5) Apply heat to the area twice a day.

1,2,4 1. This is correct. The socks will wick moisture away from the feet to promote healing. 2. This is correct. This process will help keep the feet dry. 3. This is incorrect. Corticosteroids will not destroy the organism. An antifungal medication is required. 4. This is correct. This will reduce the spread of the organism among team members. 5. This is incorrect. Heat will not treat the problem. Antifungal medications are required.

Which skin conditions should the nurse identify as having a genetic or inherited component during a presentation to the staff nurses who work in the integument clinic? (Select all that apply.) 1) Atopic dermatitis 2) Seborrheic dermatitis 3) Epidermolysis bullosa 4) Molluscum contagiosum 5) Psoriasis

1,3,5 1. This is correct. Atopic dermatitis is an allergic skin disorder. Allergies have an inherited component. 2. This is incorrect. Seborrheic dermatitis is thought to be an overgrowth of yeast and is influenced by hormones. It is not inherited. 3. This is correct. Epidermolysis bullosa is inherited either as autosomal dominant or autosomal recessive, depending on type. 4. This is incorrect. Molluscum contagiosum is caused by a poxvirus and is transmitted person-to-person. 5. This is correct. Psoriasis is usually seen in clients with a family history. A multifactorial inheritance is suspected.

The nurse is teaching the parents of an infant diagnosed with candidiasis in the diaper area how to treat this occurrence and decrease the risk for future occurrences. Which teaching point does the nurse include in the teaching session? 1) Finishing all of the antiviral medication as prescribed 2) Keeping the diaper area as dry as possible 3) Changing to a lactose-free formula 4) Administering an oral antifungal liquid for prevention of future occurrences

2 1 An antiviral medication is not appropriate to treat a fungal infection. 2 An infant diagnosed with a candidiasis skin infection in the diaper area is prescribed an antifungal cream to treat the current infection. The nurse educates the parents to keep the diaper area as dry and clean as possible and to use a moisture barrier cream. 3 There is no indication for the need to switch formulas. 4 An antifungal liquid medication to prevent future infection is not appropriate.

The nurse explains to the parents of a child with a severe burn that wearing an elastic pressure garment (Jobst stocking) during the rehabilitative stage can help prevent which complication? 1) Pain 2) Hypertrophic scarring 3) Poor circulation 4) Formation of a thrombus in the burn area

2 1 Jobst stockings, or pressure garments, do not prevent pain. They are used to prevent development of hypertrophic scarring and contractures. 2 During the rehabilitation stage, Jobst stockings, or pressure garments, are used to reduce development of hypertrophic scarring and contractures. 3 Jobst pressure garments are used to prevent or minimize the development of hypertrophic scarring and contractures. 4 The elastic pressure garments are used to prevent development of hypertrophic scarring and contractures. They do not prevent the formation of a thrombus in the burn area.

A 10-year-old child is admitted to the hospital following an accident at school that resulted in a puncture wound of the abdomen. Two days after the injury, the child continues in the inflammation phase of healing. What does the nurse expect to see while changing the child's dressing and assessing the wound? 1) The wound is contracting, and the edges are growing together. 2) A blood clot has formed, sealing the wound. 3) Epithelial cells are growing into the wound. 4) The wound is pale and weepy.

2 1 Wound contraction and inward movement of the wound edge occur during the reconstruction phase of wound healing. 2 Clot formation to seal the wound with fibrin and trapped cells and platelets occurs during the inflammation phase of wound healing, in the first 3 to 5 days. 3 Epithelial cells growing into the wound occurs in the reconstruction phase of wound healing. 4 During the initial phase of healing, there is increased blood flow, giving the area an "inflamed" appearance.

The pediatric nurse is providing a preschool-aged child's mother with information regarding impetigo. The mother is concerned about the possibility of passing the infection on to her other toddler-aged child. Which response by the nurse is most appropriate in this situation? 1) "I know that you are concerned about the health of both of your children. Your child has been prescribed 7 days of antibiotic therapy. After 24 hours of antibiotic therapy, you will not need to worry about any transmission of bacteria to your other child." 2) "Caring for both of your children right now will take more time than usual. Do you have anyone who can come and help you with their care?" 3) "To decrease the chance of exposing your younger child, both children must have all of their linens, towels, and toys washed to prevent the spread of disease. In addition, it is best to wash everyone's hands well." 4) "You need to concern yourself only with the child who has impetigo. It is important to ensure that all of the medication is taken and that all toys and linens are washed in the next 24 hours."

3 1 This is not an appropriate response by the nurse. 2 This is not an appropriate response by the nurse. 3 Keeping the child's skin clean as well as keeping the child well hydrated will decrease cracks and lesions in the skin that open the area to bacterial invasion. Good hand-washing and rigorous cleansing of shared toys in the family will decrease the spread of the bacteria. It is important to teach family members that they must not share personal items including bathroom towels, clothing, and bedding in order to prevent the spread of the bacteria within the family. 4 This is not an appropriate response by the nurse.

Which adolescent statements indicate the need for further education related to the prevention and treatment of acne? (Select all that apply.) 1) "I should wash my face each day with an approved cleanser." 2) "I should wash my hands frequently and avoid touching my face." 3) "I should stay away from greasy foods such as pizza." 4) "I should shampoo my hair only once per week." 5) "I should use my topical medication only when acne is present."

3,4,5 1. This is incorrect. Washing the face with an approved cleanser each day indicates appropriate understanding of the prevention and treatment of acne. 2. This is incorrect. Performing frequent hand hygiene and not touching the face indicate appropriate understanding of the prevention and treatment of acne. 3. This is correct. There is no evidence to suggest that greasy foods such as pizza cause acne. This statement indicates the need for further education. 4. This is correct. Hair should be shampooed frequently because the oil in hair can cause acne. This statement indicates the need for further education. 5. This is correct. Prescribed topical medication should be used daily and spread over the entire face. This statement indicates the need for further education.

Which is the priority intervention when planning care for an infant who is diagnosed with eczema? 1) Applying antibiotics to lesions 2) Keeping the baby content 3) Maintaining adequate nutrition 4) Preventing infection of lesions

4 1 Antibiotics are not routinely applied to the lesions because the lesions are not related to infection. However, impaired skin barrier function and cutaneous immunity place the infant at greater risk for the development of skin infection. 2 Keeping the infant content is not as high a priority as is prevention of infection. An infant with eczema is at a greater risk for the development of skin infection. 3 Maintaining adequate nutrition is important, but it is not as high a priority. Because of impaired skin barrier function and cutaneous immunity, an infant with eczema is at greater risk for the development of skin infection. 4 Nursing care should focus on preventing infection of lesions. Because of impaired skin barrier function and cutaneous immunity, an infant with eczema is at greater risk for the development of skin infections by organisms.

A toddler pulled a pot of boiling water off the stove and suffered partial and full-thickness burns to the chest. The child is now in the recovery-management phase of burn treatment. Which common complication should the nurse assess this client for on the basis of the current data? 1) Asphyxia 2) Metabolic acidosis 3) Shock 4) Wound infection

4 1 Asphyxia is not a common complication during the recovery-management phase of burn treatment. Infection of the burned area is a frequent complication. 2 Metabolic acidosis is not common in the recovery-management phase of burn treatment. Infection of the burned area is a frequent complication. 3 Shock is not the most common complication during the recovery-management phase of burn treatment. Infection of the burned area is a frequent complication. 4 Infection of the burned area is a frequent complication in the recovery-management phase. A goal of burn-wound care is protection from infection.

Which finding noted by the school nurse while conducting pediculosis capitis (head lice) checks indicates the need for treatment? 1) White, flaky particles throughout the scalp region 2) Lesions on the scalp that extend to the hairline or neck 3) Maculopapular lesions behind the ears 4) Silver/white sacs attached to the hair shafts in the occipital area

4 1 Lice and nits must be distinguished from dandruff, which appears as white, flaky particles. 2 Lesions might be present from itching, but the positive sign of head lice is evidence of nits. 3 Lesions might be present from itching, but the positive sign of head lice is evidence of nits. 4 Evidence of pediculosis capitis includes silver/white sacs (nits) that are attached to the hair shafts, frequently in the occiput area.