Nursing Care of the Child With an Alteration in Tissue Integrity/Integumentary Disorder
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."
The nurse is providing home care instructions for the parents of an infant with cradle cap (seborrhea). Which response by the parents indicates a need for further teaching?
"We can scrape off the crusts on his scalp with a cotton swab."
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."
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."
The nurse is caring for a child with a severe burn. The treatment for this child during the first 48 hours will be most likely be related to: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."
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
A 1-year-old child was brought to the clinic for evaluation of dry, itchy red patches of skin on the arms and legs. A diagnosis of atopic dermatitis (eczema) is made. Which would be an essential element to include in the plan of care for this child?
Frequently rehydrating the skin.
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.
The nurse is caring for a pediatric client in the emergency department with moderate frostbite of an extremity. Which nursing intervention is appropriate for this client?
Immerse the affected part in 104°F (40°C) water for 15 to 30 minutes.
The nurse is caring for a pediatric client with multiple wounds from a bike accident. What is the best method for cleansing or washing out the wound?
Use normal saline solution to wash the wound.
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
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."
The nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding?
"Flare-ups of lesions are not uncommon following therapy."
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."
A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful?
"I should not cover the area with plastic wrap after applying the cream."
When teaching a group of caregivers of infants, the nurse is discussing the topic of diaper rash. The caregivers in the group make the following statements. Which statement is the most accurate related to the child with diaper rash.
"My child gets diaper rash if I wash her clothes in the same detergent we use for the family."
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."
The nurse is caring for a 2-month-old in a pediatric clinic. The mom states she is going on vacation in Florida in a month and she is concerned about sunburn. She asks if it is okay to use a sunscreen lotion made for children. What is the correct nursing response?
"Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun."
A child has an order for an erythrocyte sedimentation rate (ESR). The child's mother asks what the purpose of the test is. What is the best response by the nurse?
"This test will tell if your child has an infection or inflammation somewhere in their body."
The nurse is caring for a 12-year-old child who comes to the pediatric clinic for a well-child checkup. The child reports embarrassing dandruff and asks the nurse what can be done for it. A quick scalp assessment confirms the presence of dandruff. Which response by the nurse would be most appropriate when addressing the child's concern?
"Wash your hair with an antiseborrheic shampoo daily."
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."
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."
The nurse is monitoring the urinary output of 3-year-old child admitted with a severe burn. The child weighs 44 lb (20 kg). Which would be a desirable and adequate urinary output for this child?
1 to 2 mL/kg/hr
The dermatologist treating a 16-year-old girl with a history of severe acne has ordered a pregnancy test so she can be started on a course of isotretinoin. The teen's caregiver has said that her daughter is a virgin and she refuses to allow her to have the required pregnancy testing. What would be the best action for the nurse to take?
Acknowledge the caregiver's discomfort about the pregnancy testing but encourage her to allow the daughter to have the testing so that she can use the medication
A nurse is caring for a child with a wasp sting. Which nursing intervention is a priority?
Administer diphenhydramine per protocol.
A nurse is providing care to an infant who is admitted with burns over the face, neck and chest. The nurse identifies which goal as priority for planning the infant's care?
Airway remains patent.
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?
Antifungal
A school-aged child is brought to the office of the camp nurse with a small, superficial burn (first-degree burn). Which action by the nurse would be most appropriate to take first?
Apply cold compresses to the area.
The nurse is caring for a child admitted with second-degree (partial-thickness) burns. What is most characteristic of this type of burn?
Blisters appear.
The nurse is caring for a child brought to a pediatric clinic for swelling in the lower extremities. The skin is reddened with undefined borders and pits slightly when pressed. Based on the assessment findings, which of the following would the nurse suspect?
Cellulitis
A child is hospitalized with a diagnosis of severe cellulitis. The nurse is preparing the family for discharge. Which instruction is most important for the nurse to convey to the family?
Complete the prescribed antibiotics
The nurse is collecting data from a 14-year-old female and her mother who have come to the clinic for a check-up. The child's mother reports the teen has had hives intermittently for the past two months. What is the priority action for this client?
Determine the underlying cause.
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
A child has been hospitalized with a diagnosis of severe impetigo. The nurse is interviewing the family. Which question will have the greatest impact on the child's care?
Does your child have any allergies to medications?
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.
The nurse is planning an educational program on burn prevention at home. Which information should be included? Select all that apply.
Keep pot handles turned in on a stove. Test bath water temperature before bathing children. Teach children to "stop, drop and roll" if their clothes catch on fire.
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
An infant is seen in the emergency department with several raised red welts over the abdomen and lower extremities. The parent states that the symptoms developed suddenly over the past few hours. The infant is fussy and has a low grade temperature. What assessment is most important for the nurse to perform?
Observe the infant's respiratory effort.
The nurse is conducting a focused skin assessment on a child. After inspecting the skin and noting drainage, what will the nurse do next?
Palpate for regional lymphadenopathy.
The nurse is discussing dietary intake with the parents of a 4-year-old child who has been diagnosed with atopic dermatitis. Later, the nurse notes the menu selection made by the parents for the child. Which selection indicates the need for further instruction?
Peanut butter and jelly sandwich
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
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.
What is the best technique to perform an assessment of the skin?
Skin assessment involves inspection and palpation in a room with natural daylight.
An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants?
Staphylococcus aureus
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
The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing action is priority?
The nurse follows contact precautions.
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
The nurse is discussing the use of over-the-counter ointments to manage a mild case of diaper rash. What ingredients should the nurse instruct the parents to look for in a compound? Select all that apply.
Vitamin D Zinc Vitamin A
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.
The nurse is caring for a 2-year-old boy with a burn. What finding would warrant referral to a burn unit?
a chemical burn
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
A child is admitted to the burn unit with a full-thickness or third-degree burn over 35% of the body. Which infection prevention measures would the health care team use with this child? Select all that apply.
head cover mask gown frequent handwashing
The nurse is caring for a child with a severe burn. The treatment for this child during the first 48 hours will be most likely be related to:
hypovolemic shock.
The client is scheduled to have potassium hydroxide testing performed. What will be needed to complete this test?
skin scrapings
An intensive care nurse has received the above hand-off report from the emergency department nurse. Thirty minutes later, the nurse assesses the child again. Which assessment finding should the nurse investigate further?
temperature 100.5°F (38.1°C)
When reviewing bathing habits for a child with dermatitis, which statements by the child's mother indicates the need for further instruction? Select all that apply.
"Antibacterial soap will be helpful in preventing infections at the site of the rash." "I should use the warmest water my child can tolerate during the bath.
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."
The nurse is caring for a mother and newborn on a postpartum unit. The mother asks if it OK to use baby powder on newborns. Which response by the nurse would be most appropriate?
"Baby powder should not be used on newborns because of the risk of aspiration upon application."
The nurse is collecting data on a child admitted to the burn unit with a partial-thickness or second-degree burn. What is most accurate regarding this type of burn?
The child will likely have blisters.
A newborn has a generalized rash on the skin, which the nurse identifies as erythema toxicum neonatorum. Which information would the nurse include when explaining the condition to the newborn's parent?
"What you see on your newborn's skin is erythema toxicum neonatorum. It is a common newborn skin condition that typically resolves on its own in about 1 week. There is nothing special you will need to do for this."
A teen has experienced a minor burn from a hair styling appliance. What interventions will be of benefit? Select all that apply.
Cover with a clean nonadhesive bandage. Rinse the burned area in cool water.
The parents of a child recently diagnosed with atopic dermatitis voice concern to the nurse that their child may develop asthma at some point. How should the nurse respond?
"I can understand your concern. We will closely monitor your child for asthma development."
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?
Explain that children who have had a serious injury sometimes exhibit regressive behavior
