Wong Peds Ch 30: Integumentary

Impetigo ordinarily results in which of the following? a. No scarring b. Pigmented spots c. Slightly depressed scars d. Atrophic white scars

ANS: A Impetigo tends to heal without scarring unless a secondary infection occurs.

A child steps on a nail and sustains a puncture wound of the foot. Which of the following is the most appropriate method for cleansing this wound? a. Wash wound thoroughly with chlorhexidine. b. Wash wound thoroughly with povidone-iodine. c. Soak foot in warm water and soap. d. Soak foot in solution of 50% hydrogen peroxide and 50% water.

ANS: C Puncture wounds should be cleansed by soaking the foot in warm water and soap.

The management of a child who has just been stung by a bee or wasp should include the application of which of the following? a. Cool compresses b. Warm compresses c. Antibiotic cream d. Corticosteroid cream

ANS: A Bee or wasp stings are initially treated by carefully removing stinger, cleansing with soap and water, applying cool compresses, and using common household agents such as lemon juice or a paste made with aspirin and baking soda.

The nurse should know that Lyme disease is which of the following? a. Difficult to prevent b. Easily treated with oral antibiotics in stages 1, 2, and 3 c. Caused by a spirochete that enters the skin through a tick bite d. Common in geographic areas where the soil contains the mycotic spores that cause the disease

ANS: C Lyme disease is caused by Borrelia burgdorferi, a spirochete spread by ticks. The early characteristic rash is erythema migrans.

Treatment for herpes simplex virus (types 1 or 2) includes which of the following? a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical and/or systemic antibiotic

ANS: C Oral antiviral agents are effective for viral infections such as herpes simplex.

Which of the following is the primary clinical manifestation of scabies? a. Edema b. Redness c. Pruritus d. Maceration

ANS: C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact.

Warts are caused by which of the following? a. Bacteria b. Fungus c. Parasite d. Virus

ANS: D Human warts are caused by the human papillomavirus.

A child falls on the playground and has a small laceration on the forearm. The school nurse should do which of the following to cleanse the wound? a. Slowly pour hydrogen peroxide over wound. b. Soak arm in warm water and soap for at least 30 minutes. c. Gently cleanse with sterile pad and a nonstinging povidone-iodine solution. d. Wash wound gently with mild soap and water for several minutes.

ANS: D Lacerations should be washed gently with mild soap and water or normal saline.

The nurse is talking to the parents of a child with pediculosis capitis. Which of the following should the nurse include when explaining how to manage pediculosis capitis? a. "You will need to cut the hair shorter if infestation and nits are severe." b. "You can distinguish viable from nonviable nits, and remove all viable ones." c. "You can wash all nits out of hair with a regular shampoo." d. "You will need to remove nits with an extra-fine tooth comb or tweezers."

ANS: D Treatment consists of the application of pediculicide and manual removal of nit cases. An extra-fine tooth comb facilitates manual removal.

ati) A nurse is caring for an adolescent who has acne and a prescription for isotretinoin from the dermatologist. Which of the following laboratory findings should the nurse plan to monitor? A. Cholesterol and triglycerides B. BUN and creatinine C. Blood potassium D. Blood sodium

A. CORRECT: Adverse effects of isotretinoin include elevated cholesterol and triglycerides. Plan to monitor these laboratory values during treatment. B. Medications (cephalosporins and furosemide) can alter blood BUN and creatinine levels. However, they do not to be monitored in clients taking isotretinoin. C. Medications (diuretics and corticosteroids) can alter blood potassium levels. However, it does not need to be monitored in clients taking isotretinoin. D. Medications(IV fluids and corticosteroids) can alter the blood sodium level. However, it does not need to be monitored in clients taking isotretinoin.

A nurse is assessing an infant who has eczema. Which of the following findings should the nurse expect? (Select all that apply.) A. Generalized distribution of lesions B. Papules C. Ecchymosis in flexural areas D. Crusting lesions E. Keratosis pilaris

A. CORRECT: Generalized distribution of lesions is an expected finding in infants who have eczema. B. CORRECT: Papules are an expected finding in infants who have eczema. C. Lesions, rather than ecchymosis, in the flexural areas are an expected finding in children 2 years of age and older. D. CORRECT: Crusting lesions are an expected finding in infants who have eczema. E. Keratosis pilaris is an expected finding in children 2 years of age and older.

ati) A nurse is caring for a child who has cellulitis on the hand. Which of the following actions should the nurse take? A. Administer oral antibiotics. B. Cleanse area using Burrow solution. C. Prepare for cryotherapy. D. Apply a topical antifungal medication.

A. CORRECT: Oral antibiotics are often prescribed for the treatment of cellulitis. B. Cleansing with Burow's solution is recommended for staphylococcal scalded skin syndrome or herpes simplex virus. C. Cryotherapy is recommended for human papillomavirus. D. Topical antifungal medications are indicated for the treatment of candidiasis or tinea corporis.

ati) A nurse is teaching the guardian of an infant who has seborrheic dermatitis of the scalp. Which of the following instructions should the nurse include in the teaching? A. "You can use petrolatum to help soften and remove patches from your infant's scalp." B. "When patches are present, you should keep your infant away from others." C. "You should avoid washing your infant's hair while patches are present on the scalp." D. "When patches are present, it indicates that your infant has a systemic infection."

A. CORRECT: Recommend that the guardian use petrolatum, vegetable oil, or mineral oil to help soften and remove scales and crusted areas. B. Seborrheic dermatitis is not contagious, so it is not necessary to keep the infant away from others. C. Washing the infant's hair daily with an antiseborrheic shampoo can help remove scales and crusted areas and can help prevent recurrence. D. The cause of seborrheic dermatitis is unknown and is not associated with a systemic infection.

ati) A nurse is caring for a child who has contact dermatitis due to poison ivy. Which of the following actions should the nurse take? (Select all that apply.) A. Remove the clothing over the rash. B. Initiate contact isolation precautions while the rash is present. C. Expose the rash to a heat lamp for 15 min. D. Cleanse the affected skin with hydrogen peroxide solution. E. Apply calamine lotion to the skin.

A. CORRECT: Removing the irritant from the skin will decrease the child's exposure. Remove the clothing over the affected area. B. Poison ivy is not spread by contact with the rash. Once the plant oils are removed, it cannot be transmitted to others. C. Avoid using a heat lamp, which can cause skin burns. D. Cleanse the affected area with cold running water, followed by soap and water as soon as possible following exposure. E. CORRECT: Apply calamine lotion to assist in relieving discomfort.

ati) A nurse is planning care for a child who has tinea capitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Treat infected house pets. B. Use selenium sulfide shampoo. C. Cleanse area with Burrow solution. D. Administer antiviral medication. E. Use moist, warm compresses.

A. CORRECT: Tinea capitis can be transmitted from household pets, especially cats, to persons. Pets should be treated, if infected. B. CORRECT: Selenium sulfide shampoo is recommended for use for children who have tinea capitis. C. A topical antifungal medication is recommended for children who have tinea capitis. D. Tinea capitis is a fungal infection. Antifungal medications are administered. E. Moist, warm compresses are applied for bacterial skin infections and not recommended for children who have tinea capitis.

ati) A nurse is teaching a parent of a child who has pediculosis capitis. Which of the following instructions should the nurse include in the teaching? A. Apply mayonnaise to the affected area at night. B. Treat all household pets. C. Use an over-the-counter medication containing 1% permethrin. D. Discard the child's stuffed animals.

A. Home remedies (mayonnaise) increase the risk of infection and should be avoided. B. Pediculosis capitis is transmitted person-to-person; house holdpets are not hosts. C. CORRECT: Pediculosis capitis is treated with 1% permethrin, which can be purchased over the counter. D. Items that cannot be placed in the laundry can be placed in a sealed bag for 14 days to kill the lice.

ati) A nurse is teaching a group of parents about preventing insect bites. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Wear perfumes when outside. B. Avoid areas of tall grass. C. Wear bright-colored clothing. D. Wear insect repellent. E. Check house pets frequently.

A. Perfumes attract insects and should be avoided. B. CORRECT: Insects live in tall grasses; these areas should be avoided. C. Bright-colored clothing attracts insects and should be avoided. D. CORRECT: Insect repellent should be applied to prevent insect bites. E. CORRECT: House pets should be inspected and treated for insects to prevent exposing familymembers.

ati) A nurse is assessing an infant who has scabies. Which of the following findings should the nurse expect? (Select all that apply.) A. Presence of nits on the hair shaft B. Pencil-like marks on hands C. Blisters on the soles of the feet D. Small, red bumps on the scalp E. Pimples on the trunk

A. Presence of nits on the hair shaft is a manifestation of pediculosis capitis. B. CORRECT: Pencil-like marks on hands is a manifestation of scabies. C. CORRECT: Blisters on the soles of the feet is a manifestation of scabies. D. Small, red bumps on the scalp are a manifestation of pediculosis capitis. E. CORRECT: Pimples on the trunk is a manifestation of scabies.

ati) A nurse is planning care for an infant who has diaper dermatitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Apply talcum powder with every diaper change. B. Allow the buttocks to air dry. C. Use commercial baby wipes to cleanse the area. D. Use cloth diapers until the rash is gone. E. Apply zinc oxide ointment to the affected area.

A. Talcum powder can cake and cause inhalation injury. It should not be used for infants who have diaper dermatitis. B. CORRECT: Allowing the buttocks to air dry facilitates thorough drying of the skin and should be included in the plan of care. C. Commercial baby wipes contain chemicals that can irritate the skin. They should not be used for infants who have diaper dermatitis. D. Superabsorbent diapers should be used for infants who have diaper dermatitis to assist in keeping the skin dry. E. CORRECT: Zinc oxide ointment protects the skin from moisture and irritation and should be included in the plan of care.

Therapeutic management of the child with ringworm infection would include which of the following? a. Administer oral griseofulvin. b. Administer topical or oral antibiotics. c. Apply topical sulfonamides. d. Apply Burow solution compresses to affected area.

ANS: A Treatment with the antifungal agent griseofulvin is part of the treatment for the fungal disease, ringworm. Oral griseofulvin therapy frequently continues for weeks or months.

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. This is most likely caused by which of the following? a. Impetigo b. Candida albicans c. Urine and feces d. Infrequent diapering

ANS: B Candida albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds.

11. The primary treatment for warts is which of the following? a. Vaccination b. Local destruction c. Corticosteroids d. Specific antibiotic therapy

ANS: B Local destructive therapy individualized according to location, type, and number—including surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies—is used.

Ringworm, frequently found in schoolchildren, is caused by which of the following? a. Virus b. Fungus c. Allergic reaction d. Bacterial infection

ANS: B Ringworm is caused by a group of closely related filamentous fungi that invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin.

Rocky Mountain spotted fever is caused by the bite of which of the following? a. Flea b. Tick c. Mosquito d. Mouse or rat

ANS: B Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas.

Which of the following is an important nursing consideration when caring for a child with impetigo contagiosa? a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C A major nursing consideration related to bacterial skin infections, such as impetigo contagiosa, is to prevent the spread of the infection and complications. This is done by thorough hand washing before and after contact with the affected child.

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend which of the following? a. Administer antihistamine. b. Cleanse with soap and water. c. Keep child quiet and come to emergency department. d. Remove stinger and apply cool compresses.

ANS: C Venomous species of scorpions inject venom that contains hemolysins, endotheliolysins, and neurotoxins. The absorption of the venom is delayed by keeping the child quiet and the involved area in a dependent position.

Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse's response should be based on which of the following? a. Poison ivy does not itch and needs further investigation. b. Scratching the lesions will not cause a problem. c. Scratching the lesions will cause the poison ivy to spread. d. Scratching the lesions may cause them to become secondarily infected.

ANS: D Poison ivy is a contact dermatitis that results from exposure to the oil urushiol in the plant. Every effort is made to prevent the child from scratching, since the lesions can become secondarily infected.

Cellulitis is often caused by: a. herpes zoster. b. Candida albicans. c. human papillomavirus. d. Streptococcus or Staphylococcus organisms.

ANS: D Streptococci, staphylococci, and Haemophilus influenzae are the organisms usually responsible for cellulitis.

1. When determining the etiology of a skin problem, what is essential to the diagnosis of the lesions? a. Careful inspection b. Skin products used c. Type of laundry detergent d. Whether the siblings have similar lesions

a. Careful inspection One of the more advantageous aspects of skin lesions is that the diagnosis is usually readily established by simple, careful inspection. Types of skin products and laundry detergents are important if the lesions appear to be a result of contact dermatitis. If a contagious origin is suspected after inspection, siblings having similar lesions would be part of the history.

Which of the following is usually the only symptom of pediculosis capitis (head lice)? a. Itching b. Vesicles c. Scalp rash d. Localized inflammatory response

a. Itching ANS: A Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft

2. What is the appropriate term to describe an abnormal sensation such as burning or prickling? a. Paresthesia b. Hyperesthesia c. Hypesthesia d. Anesthesia

a. Paresthesia An abnormal sensation such as burning or prickling describes paresthesia. Hyperesthesia is excessive sensitiveness, hypesthesia is diminished sensation, and anesthesia is absence of sensation.

The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents. Which of the following statements made by a parent indicates a correct understanding of the teaching? a. "I should wash my infant's buttocks with soap and water every time I change the diaper." b. "I will wash with a mild soap and water and dry thoroughly whenever my infant has a bowel movement." c. "I should wash my infant's buttocks with soap before applying a thin layer of oil." d. "I will apply baby oil and powder to the creases in my infant's buttocks."

b. "I will wash with a mild soap and water and dry thoroughly whenever my infant has a bowel movement." Overwashing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating.

5. What is the cause of ringworm, a skin disorder frequently found in schoolchildren? a. Virus b. Fungus c. Allergic reaction d. Bacterial infection

b. Fungus Ringworm is a dermatophytosis, which is an infection caused by closely related fungi. They cause superficial infections that invade the stratum corneum, hair, and nails. Viruses, allergic reactions, and bacterial infections do not cause ringworm.

Nursing care of the infant with atopic dermatitis focuses on which of the following? a. Feeding a variety of foods b. Keeping lesions dry c. Preventing infection d. Using fabric softener to avoid rough cloth

c. Preventing infection ANS: C The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection. The infant's nails should be kept short and clean and have no sharp edges.

6. What would the nurse include when explaining how to manage pediculosis capitis? a. Cut hair shorter if infestation and nits are severe. b. Wash all nits out of hair with a regular shampoo. c. Remove nits with a fine-tooth comb or tweezers. d. Distinguish viable from nonviable nits and remove all viable ones.

c. Remove nits with a fine-tooth comb or tweezers. Daily removal of nits from a child's hair with a metal nit or flea comb is an essential control measure after treatment with a pediculicide. Cutting the child's hair short does not prevent infestation. Lice will infest short hair as readily as long hair. Regular shampoo will not remove nits. Using a fine-tooth comb or tweezers is necessary to remove the nits. It is not possible to tell viable and nonviable nits apart.

4. What is an important nursing consideration when caring for a child with impetigo contagiosa? a. Apply topical corticosteroids to decrease inflammation. b. Examine the child under a Wood lamp for possible spread of lesions. c. Thoroughly wash hands and maintain cleanliness when caring for an infected child. d. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris.

c. Thoroughly wash hands and maintain cleanliness when caring for an infected child. Preventing the spread of inspection is a prime consideration when caring for children with bacterial skin infections. Thorough hand washing and cleanliness will help achieve this goal. Topical corticosteroids are contraindicated in bacterial infections. A Wood lamp is used for diagnosis of some fungal and bacterial skin infections. Dressings are not used in impetigo.

Atopic dermatitis (eczema) in the infant is which of the following? a. Easily cured b. Worse in humid climates c. Associated with upper respiratory tract infections d. Associated with allergy with a hereditary tendency

d. Associated with allergy with a hereditary tendency ANS: D Atopic dermatitis is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency.

3. What factors promote(s) wound healing? a. Antiseptics b. Eschar formation c. Dry wound environment d. Moist, crust-free wound environment

d. Moist, crust-free wound environment A moist, crust-free wound environment enhances the migration of epithelial cells across the wound and facilitates healing. Antiseptics, such as hydrogen peroxide and povidone-iodine, have a cytotoxic effect on healthy cells and little effect on controlling infections.

7. Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. What is the basis of knowledge for the response by the nurse? a. Disturbing the lesions will cause the poison ivy to spread. b. After the lesions have formed, no further damage can be done. c. Poison ivy does not itch, so this needs further investigation. d. Scratching the lesions may cause them to become secondarily infected.

d. Scratching the lesions may cause them to become secondarily infected. Comfort measures should be used to minimize scratching. Irritating the lesions can result in secondary infection. The contact dermatitis is in response to the oil urushiol present in the poison ivy plant. The oozing from the skin irritation does not result in the development of further lesions. Poison ivy can be extremely itchy, and comfort measures should be used.

Treatment of psoriasis often involves which of the following? a. Antihistamines b. Oral antibiotics c. Topical application of calamine lotion d. Tar and exposure to sunlight and ultraviolet light

d. Tar and exposure to sunlight and ultraviolet light ANS: D Psoriasis is treated with tar preparations and exposure to ultraviolet B light or natural sunlight.