PEDS Chapter 23: Nursing Care of the Child With an Alteration in Tissue Integrity/Integumentary Disorder

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." "Baby powder may be used if sprinkled on your hand away from the baby to prevent aspiration." "Baby powder should not be used because so many people are allergic to the ingredients in it." "Baby powder can be used anytime with no concerns."

"Baby powder should not be used on newborns because of the risk of aspiration upon application." The use of baby powders containing talc or 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 considered to contribute to the pathogenesis of diaper dermatitis.

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? "Has she been exposed to poison ivy?" "Does she wear sleepers with metal snaps?" "Do you change her diapers regularly?" "Tell me about your family history of allergies."

"Does she wear sleepers with metal snaps?" 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.

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?" "Do you have any concerns about filling the prescriptions?" "How long has the child had the infection?" "Is there anything else you think we should know about your family?"

"Does your child have any allergies to medications?" Since the child is hospitalized with a severe case of impetigo, the child will likely need intravenous antibiotics, so asking about medication allergies is the question that will have the greatest impact on care. Asking how long the child has had the infection, if the parent has concerns about filling prescriptions, or if there is anything the health care team should know about the family are all appropriate questions that should be asked during an admission interview. However, due to the severity of the infection, asking about medication allergies will impact care the most.

The nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding? "Atopic dermatitis turns to asthma later in life." "Hydrocortisone cream may lead to kidney disease." "Flare-ups of lesions are not uncommon following therapy." "Atopic dermatitis follows a streptococcal infection."

"Flare-ups of lesions are not uncommon following therapy." 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 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?" "Is your child allergic to peanuts or other foods?" "Does anyone in your family have any food allergies?" "Have you ever given your child antihistamines?"

"Has the child ever eaten shellfish before now?" 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 13-year-old girl with acne vulgaris and is teaching the girl about skin care. Which response by the girl indicates a need for further teaching? "I should avoid eating any kind of chocolate." "I must use my medicine daily so that it will work." "I should use a humectant moisturizer." "It is best to avoid hats and headbands."

"I should avoid eating any kind of chocolate." Ingestion of chocolate has not been proven to contribute to the incidence or severity of acne. Adhering to the medication regimen, using a humectant moisturizer, and avoiding hats and headbands would be appropriate.

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."

"I should be certain to use fabric softener in the care of the infant's clothes." 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.

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." "I should use the highest-potency steroid cream I can find." "I need to shake the preparation before using it." "I should apply the medicine at bedtime and rinse it off in the morning."

"I should not cover the area with plastic wrap after applying the cream." An occlusive dressing such as plastic wrap over the area should not be used with topical corticosteroids. High-potency preparations should not be used. There is no need to shake topical corticosteroids. Benzoyl peroxide requires shaking before use. Applying the medication at night and rinsing off in the morning is used for coal tar preparations.

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. "The formula she drinks sometimes causes her to have a diaper rash." "My child gets diaper rash if I wash her clothes in the same detergent we use for the family." "Sometimes if I leave the diaper off and let him be in the sunshine he gets diaper rash." "They told me to use baby powder every time I change her so she won't get diaper rash."

"My child gets diaper rash if I wash her clothes in the same detergent we use for the family." Infants may have a sensitivity to some soaps or disposable diaper perfumes, and the use of strong laundry detergents without thorough rinsing can cause diaper rash. Diarrheal stools, prolonged exposure to wet or soiled diapers, use of plastic or rubber pants, infrequently changed disposable diapers, inadequate cleansing of the diaper area (especially after bowel movements), and yeast infections are also causative factors. Exposing the diaper area to the air helps clear up the dermatitis. The use of baby powder when diapering is discouraged because caked powder helps create an environment in which organisms thrive.

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." "My child plays in our woods a lot so I need to be sure protective clothing and shoes are worn." "I cleaned the wound with soap and water right away. I hope that's okay." "I put ice on the bite to try to keep the swelling down."

"Since my child just has a rash around the area of the bite there is nothing to worry about." 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 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? "It is okay to use a children's sunscreen as long as you avoid the face." "You should not take your infant to Florida." "Put plenty of children's sunscreen on the infant at least 15 minutes before going outdoors, then reapply every three to four hours." "Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun."

"Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun." Do not use sunscreens on children younger than 6 months of age. Instead, use hats, bonnets, and light-colored clothes to shield the skin, and keep the infant away from direct exposure to the sun. Telling the mother not to take the infant to Florida is inappropriate.

An 8-month-old has been diagnosed with infantile eczema. At a follow-up appointment, the child's caregiver seems exhausted and angry. He explains that he has done all of the child's care because his wife is repulsed by the child's raw and uncomfortable appearance. What responses would be appropriate for the nurse to say to this caregiver? "He will be better soon and your family can get back to normal." "I understand her feelings. It is hard to see a child in pain sometimes." "That's not fair to you; she should get some counseling to learn how to cope with illness better." "That's not an uncommon reaction, although it's hard on you and on your child."

"That's not an uncommon reaction, although it's hard on you and on your child." The family caregivers of the child with eczema are often frustrated and exhausted. Family caregivers may feel apprehensive or repulsed by this unsightly child. Support them in expressing their feelings and help them view this as a distressing but temporary skin condition. Although the caregiver can be assured that most cases of eczema clear up by the age of 2, this does little to relieve the present situation.

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." "I will let your primary health care provider know you need prescription shampoo." "Wash your hair vigorously twice a day for one week." "Apply warm baby oil to your scalp once a day for a few days."

"Wash your hair with a gentle shampoo daily." 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 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." "We should wash or shampoo the scalp areas with mild soap." "We can massage his head with mineral oil first and then shampoo it." "We can safely use a selenium sulfide shampoo on his hair."

"We can scrape off the crusts on his scalp with a cotton swab." The crusts should not be forcibly removed with a cotton swab. The affected areas are washed or shampooed with a mild soap. In the infant, mineral oil is applied to the scalp, massaged in well with a washcloth, and then shampooed 10 to 15 minutes later using a brush to gently lift the crusts. Selenium shampoo can be used safely on an infant.

The nurse is teaching the parents of a 6-year-old who has sustained a large laceration about providing care to the wound at home. The nurse determines that the parents need additional teaching when they state: "We need to keep the wound tightly bandaged for at least 3 days." "We should call the doctor if the wound becomes red and hot looking." "If we notice some yellowish drainage, we need to call the doctor." "If our son starts telling us that the pain is increasing, we need to have it checked out."

"We need to keep the wound tightly bandaged for at least 3 days." If a wound is large, it can be covered by a loose dressing, which is changed in about 12 hours and redressed after the wound is cleaned. The wound is then left open to the air after 24 hours have passed from the time of the injury. A wound that is red and hot looking or one with yellowish drainage or increased pain suggests infection, which needs to be evaluated by the practitioner.

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 need to avoid any skin product containing perfumes, dyes, or fragrances." "We should use a mild soap for sensitive skin." "We should bathe our child in hot water, twice a day." "We should use soap to clean only dirty areas."

"We should bathe our child in hot water, twice a day." 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.

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 10 to 12 ml/kg/hr 15 to 25 ml/kg/hr 30 to 50 ml/hr

1 to 2 ml/kg/hr Following a burn injury, an output of 1 to 2 ml/kg/hr for children weighing 30 kg (66 lb) or less, or 30 to 50 ml/hr for those weighing more than 30 kg is desirable. This child weighs 20 kg (44 lb).

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.

100.5 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

Which assessment finding by the nurse would warrant immediate action? A child with impetigo has honey-colored drainage noted on the skin area. A child with periorbital cellulitis reports changes in vision and pain with eye movement. A child has a red, warm, edematous area over an old spider bite. A child with cellulitis has a temporal temperature of 101°F (38.3°C).

A child with periorbital cellulitis reports changes in vision and pain with eye movement. 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.

The nurse is caring for a child with burns in a pediatric hospital. What would be an appropriate nursing diagnosis for this client? Knowledge deficit related to daily care procedures in the acute care setting Risk for fluid volume overload related to thermal injuries Acute pain related to thermal injuries and procedures Risk for aspiration related to effects of medication

Acute pain related to thermal injuries and procedures Management of acute pain is crucial for the burn client. Knowledge of the daily procedures at the acute care setting is not a priority for this child. Risk for aspiration would not be an appropriate nursing diagnosis.

A nurse is providing care to a child diagnosed with varicella zoster. The child has many lesions in various stages of healing, is irritable, and has a temperature of 100°F (37.8°C). The nurse and the child's parent constantly remind the child not to scratch the lesions. Which intervention is most important for the nurse to implement? Suggest distraction activities. Administer acetaminophen. Administer an oatmeal bath. Encourage oral fluids.

Administer an oatmeal bath. It is most important for the nurse to administer an oatmeal bath, which will result in less itching. Continued scratching could result in secondary infection of the lesions. Acetaminophen administration would be indicated if the child were in pain or if the child's temperature was above 100.4°F (38°C). Providing activities to distract the child would be more helpful once the child was made more comfortable.

A nurse is caring for a child with a wasp sting. Which nursing intervention is a priority? Remove jewelry or restrictive clothing. Apply ice intermittently. Administer diphenhydramine per protocol. Cleanse wound with mild soap and water.

Administer diphenhydramine per protocol. The nurse should administer diphenhydramine as soon as possible after the sting in an attempt to minimize a reaction. The other actions are important for an insect sting, but the priority intervention is to administer diphenhydramine.

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. Turn the child every 2 hours. Soak the child in a colloidal bath. Provide diversional activities.

Administer diphenhydramine. 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.

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 a topical anesthetic ointment. Administer acetaminophen. Cover the area with a sterile bandage. Apply cold compresses to the area.

Apply cold compresses to the area. Cool water is an excellent emergency treatment for burns involving small areas. The immediate application of cool compresses or cool water to burn areas appears to inhibit capillary permeability and thus suppress edema, blister formation, and tissue destruction.

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? Keep follow-up appointments. Perform proper hand hygiene. Complete the prescribed antibiotics. Monitor for signs of worsening condition.

Complete the prescribed antibiotics. The instruction that is most important for the nurse to convey is to complete the prescribed course of antibiotics. Many times, once the child feels better, the parent stops the medication; this action, though, can cause a rebound infection. Instructing the family to keep follow-up appointments, perform good hand hygiene, and look out for signs of worsening condition are all appropriate, but the most important instruction is to make sure the child completes the course of antibiotics.

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? Risk for fluid volume deficit Disturbed body image Pain Altered nutrition

Disturbed body image 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 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

Edema with wet blistering skin 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).

A child arrives at the emergency department with moderate hypothermia and frostbite. Which action would be most appropriate for the nurse to perform? Place heating pads and warmed blankets on the client's extremities and trunk. Rub the frostbitten extremities to increase circulation to the affected area. Place heating pads and warmed blankets on the trunk of the body initially. Apply dry heat to the extremities.

Place heating pads and warmed blankets on the trunk of the body initially. With moderate hypothermia, the trunk of the client should be warmed first. Warming the extremities and trunk at the same time can cause a condition where the core body temperature drops due to the returning cold blood from the extremities. Dry heat should not be applied to a client with hypothermia and frostbite. Rubbing a frostbitten area may cause further damage and should be avoided.

A parent is observing a nurse provide care for the parent's 2-year-old toddler who was burned in a house fire. When the nurse is finished, the parent tells the nurse "I cannot believe this has happened. I should have been able to prevent this from happening." What is the best action for the nurse to take? Give the parent a hug. Tell the parent to be thankful that the child is alive. Encourage the parent to talk more about feelings. Tell the parent he or she could not have prevented the fire

Encourage the parent to talk more about feelings. The best action for the nurse to take is to encourage the parent to talk about his or her feelings. This gives the parent the opportunity to share feelings and concerns. Giving the parent a spontaneous hug may not be welcomed. Telling the parent he or she could not have prevented the fire or to be thankful that the child is alive is not therapeutic and negates the parent's feelings.

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? Teaching the child not to scratch the "itchy" skin. Frequently rehydrating the skin. Applying topical antibiotics routinely. Administering daily oral corticosteroid therapy.

Frequently rehydrating the skin. Frequently rehydrating the skin is a key element of the treatment regimen. To maintain healthy skin in the child with atopic dermatitis, hydration practices should be implemented to replace moisture in the stratum corneum and prevent transdermal water losses. Scratching itchy skin is a reflex that is very difficult to stop; preventing the itch is more effective. Topical antibiotics and oral corticosteroids are not treatments for atopic dermatitis.

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. Hemoglobin and white blood cell (WBC) counts decrease. Hematocrit and white blood cell (WBC) counts decrease. Hematocrit increases and white blood cell (WBC) count decreases.

Hematocrit and white blood cell (WBC) counts increase. 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.

A 2-year-old child is brought to the urgent care center for treatment of burns on both hands. The parent reports that the child pulled the coffee pot over and the hot liquid splashed on to the child's hands. The nurse examines the child and notes that the backs of the hands are reddened with a well-defined line of demarcation at the wrists. Several medium to large blisters are also present. What initial action should the nurse take? Make arrangements to transfer the child to the hospital. Contact the authorities to report suspected child abuse (child mistreatment). Determine the depth of the burn injuries. Place ice packs on the hands to stop the burning.

Make arrangements to transfer the child to the hospital. The nurse's initial action to make arrangements for the child to be transferred to the hospital. Burns on the hands or feet of a child are criteria for admission to a burn center. In addition, the nurse should suspect child abuse (child mistreatment) because of the defined lines of demarcation on the burns (glove pattern) which indicates that the child's hands were placed in scalding liquid versus a splash pattern if the pot had been knocked over. Although the nurse may suspect child abuse (child mistreatment), the initial action should be to get the child to the hospital. The depth of the burns can be determined at the hospital. Applying an ice pack could cause additional damage, most notably by breaking the blisters and increasing the risk of infection. Blisters should be left intact. Cool water can be applied to stop the burning and provide some comfort.

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. Examine the lips and oral mucosa for cyanosis. Question the parent about methods of punishment. Determine whether the child is breastfed or formula fed.

Observe the infant's respiratory effort. The raised red welts are likely urticaria or hives, an allergic response to a substance (food, drugs, plants, etc.). As such, it is most important to observe the infant's respiratory effort since that reaction can involve the lips, tongue, and airway. Cyanosis would not be visible unless the airway was blocked and then it would be central cyanosis, not just circumoral. Questioning the parent about methods of punishment is unnecessary as the welts are not a sign of trauma. It is appropriate to determine if the infant is breastfed or formula fed because it might be related to the hives, especially if the infant was switched from breast milk to formula. This, however, is not the most important assessment.

The nurse is completing the care plan for a pediatric client with deep partial-thickness or second-degree burns on the back and legs. Debridement of the burns is performed 2 to 3 times per week. What nursing diagnosis has the highest priority in regard to this treatment modality? Impaired skin integrity Pain Disturbed body image Risk for fluid volume deficit

Pain Debridement involves the removal of loose skin and eschar (dead, charred skin). This procedure is usually performed with sterile scissors and a pair of forceps or with a gauze sponge. Debridement is a necessary, but often excruciatingly painful, procedure. Thus, pain management needs of the child are of utmost importance. All of the nursing diagnoses would be applicable to a burn client, but pain is the highest priority in regards to debridement.

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. Administer analgesics when the child reports pain. Provide diversional activities for the client. Provide an egg crate mattress or gel mattress for the client to lie upon.

Provide around the clock pain medication.

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. Provide pain medication on a PRN schedule as soon as pain is reported. Provide diversional activities for the client. Provide an egg-crate mattress or gel mattress for the client to lie upon.

Provide around-the-clock pain medication as soon as pain is reported. 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? 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.

Provide instruction on how to care for a diaper rash. 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.

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

Second-degree or partial-thickness burn 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.

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 iodine solution to wash the wound. Use sterile water to wash out the wound. Use normal saline solution to wash the wound. Use an antibiotic wash to cleanse the wound.

Use normal saline solution to wash the wound. Normal saline is still considered the best solution to wash out wounds because of its relative isotonicity and minimal effect on tissue regeneration.

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

Staphylococcus aureus 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.

The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing action is priority? The nurse soaks the skin with warm water. The nurse applies topical antibiotics to the lesions. The nurse follows contact precautions. The nurse applies elbow restraints to the infant.

The nurse follows contact precautions. Impetigo is highly contagious and can spread quickly. The nurse should follow contact (skin and wound) precautions, including wearing a cover gown and gloves. The nurse will soak the crusts with warm water, apply topical antibiotics, and apply elbow restraints, but these are not as high a priority as trying to prevent the spread of the infection by following contact precautions.

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? Avoid chocolate and greasy foods. Wash the face with abrasive soaps three times a day. Pop the pimples to make them go away. Wash the face twice a day with a mild soap then pat dry.

Wash the face twice a day with a mild soap then pat dry. 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 2-year-old boy with a burn. What finding would warrant referral to a burn unit? a chemical burn a superficial or first-degree burn on the hand a superficial or first-degree burn on the chest a superficial or first-degree burn on the upper arm

a chemical burn According to the American Burn Association, chemical burns warrant referral to a burn unit. A partial-thickness or second-degree burn greater than 10% of the body surface area would warrant a referral to a burn unit. A superficial or first-degree burn on the chest or hands does not warrant a referral to a burn unit.

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. a. burning b. photosensitivity c. dryness d. flu-like symptoms e. headache

a, b, c Adverse effects associated with topical retinoid therapy include burning, dryness, and photosensitivity. Flu-like symptoms and headache are associated with topical immune modulators.

The nurse is discussing dermatitis with the parents of an affected child. When addressing nonpharmacologic options for managing the condition what information can be included? Select all that apply. a. "Avoid irritating fabrics such as wool." b. "Wearing breathable fabrics such as cotton is recommended." c. "Apply moisturizers throughout the day." d. "Vigorously towel dry to increase blood flow to affected areas." e. "Avoid use of perfumes."

a, b, c, e Skin affected with atopic dermatitis is sensitive. Care should be taken to avoid irritants and triggers. Fabrics such as wool and synthetics can be irritating. Cotton is recommended. Moisturizing the skin is beneficial. Using unscented lotion and petroleum jelly can be used. Limit exposure of the skin to perfumes and dyes in skin care and bathing products.

The parent of a 4-year-old child with atopic dermatitis reports having difficulty keeping the child from scratching. What information can be provided by the nurse? Select all that apply. a. "Keep your child's finger nails trimmed and filed." b. "Distract your child with activities when you notice scratching." c. "Consider flannel sheets for your child's bed." d. "Give your child a small stuffed animal or ball to squeeze when the child itches instead of scratching." "Keep a diary of triggers for a week to see what patterns your child has related to this problem."

a, b, d, e Itching is a chief concern with atopic dermatitis. Strategies should be employed to reduce scratching. Keeping the fingernails trimmed is helpful in preventing cuts to the skin and introducing bacteria to open wounds. Distracting the child with activities is helpful when the child is experiencing sensations of itching. A small ball or stuffed animal can be used to focus attention on something else when the urge to scratch is present. A diary can be useful when trying to identify patterns of behavior related to triggers of this condition. Flannel sheets may be irritating and should be avoided.

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? a. "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." b. "Your child most likely has dandruff. You can treat it with daily with antiseborrheic shampoo." c. "The infant should have a thorough shampooing every day to prevent things like this." d. "Cradle cap (seborrhea) will resolve by itself. There is no intervention needed."

a. "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." 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.

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? a. 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. b. Speak with the teen alone to ask her if she is sexually active. If she says she is not sexually active, let the provider know that it is okay to write the prescription. c. Arrange for the daughter to have the pregnancy testing without the caregiver's knowledge. d. Have the caregiver sign a permission form acknowledging that the girl has been given the drug without pregnancy testing.

a. 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.

The nurse is caring for a child with urticaria. What is the priority action? a. assessing the child's airway and breathing and noting any wheezing or stridor b. obtaining a detailed history of new foods, medications, stress, or changes in environment c. inspecting the skin and noting evidence of raised, edematous hives anywhere on the body d. Noting whether hives are pruritic, blanch when pressed, or are migrating

a. assessing the child's airway and breathing and noting any wheezing or stridor 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.

The nurse is conducting a physical examination of a boy with erythema multiforme. Which assessment finding should the nurse expect? a. lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk b. thick or flaky/greasy yellow scales c. silvery or yellow-white scale plaques and sharply demarcated borders d. superficial tan or hypopigmented oval-shaped scaly lesions especially on upper back and chest and proximal arms

a. lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk 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 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

antifungal 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.

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? hemophilia asthma rheumatoid arthritis otitis media

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

The nurse is developing the plan of care for a 3-year-old child diagnosed with atopic dermatitis. Which client outcomes are common focuses for a child with this diagnosis? Select all that apply. a. pain management b. promotion of skin hydration c. maintenance of skin integrity d. reduction in anxiety e. prevention of infection

b, c, e When caring for the child with atopic dermatitis the focus of care will be on the prevention of infection, maintenance of skin integrity, and promotion of skin hydration.

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? a. "I am not sure why you think a skin disorder would lead to asthma?" b. "I can understand your concern. We will closely monitor your child for asthma development." c. "If your child starts having respiratory difficulties, be sure to let your health care provider know." d. "All children with atopic dermatitis develop both asthma and hay fever, so we will monitor your child for both conditions."

b. "I can understand your concern. We will closely monitor your child for asthma development." Atopic dermatitis (eczema) is one of the disorders in the atopy family (along with asthma and allergic rhinitis [hay fever]). About 30% to 35% of children who have atopic dermatitis will also develop allergic rhinitis (hay fever) and/or asthma. Therefore, the child will be monitored for the development of asthma.

The student nurse gives a presentation on the dangers of sun exposure to clients at a community health center. Which statement(s) by the attendees demonstrate that knowledge was gained from the presentation? Select all that apply. a. The parents of a 3-month-old infant report they have been using sunscreen on their infant since attending the presentation. b. A 16-year-old adolescent reports avoiding the sun until after 12:00 noon. c. A 17-year-old adolescent states no longer using the tanning bed after attending the presentation. d. A 15-year-old adolescent states always using sunscreen because "she does not want to get skin cancer like my mother did." e. A 16-year-old adolescent states that it "scares me to think that my cells are changing when I get a sunburn."

c, d, e Sunburn occurs as a result of overexposure to the ultraviolet (UV) rays of the sun. The erythema and eventual blisters occur as a result of the skin's blood flow changes as well as alterations in cell kinetics and pigment products in response to UV exposures. Healthy People 2030 encourages use of sunscreen in all children older than 6 months of age, to form a lifelong habit, and to avoid sun exposure between the hours of 10:00 am and 2:00 pm. Exposure to sun without sunscreen and the use of tanning beds leads to skin damage and potentially skin cancer.

The nurse is caring for a 15-year-old boy with psoriasis. In addition to the plaques, what would the nurse expect to note? fissures and scaling on palms and soles fever and malaise lichenification hyperpigmentation

fissures and scaling on palms and soles Fissures and scaling on the palms and soles are common findings with psoriasis. Fever and malaise, lichenification, and hyperpigmentation are noted with other integumentary disorders but are not typical physical findings with psoriasis.

A pediatric client was brought to the emergency department by the parents after experiencing extensive urticaria following consumption of a seafood dinner. Upon discharge from the facility the nurse provided client teaching. Which statement by the parents indicate learning occurred? a. "Since our child only had hives, we could allow our child to try seafood again to see if there is a true allergy present." b. "We will give our child an antihistamine and corticosteroid next time we eat seafood." c. "The hives should not last over a couple of days. If they last longer it means we need to contact our physician immediately." d. "We need to get our child a medical alert bracelet as soon as possible in case this happens again."

d. "We need to get our child a medical alert bracelet as soon as possible in case this happens again." A medical alert bracelet would identify the child's allergies in case the parents were not with the child or if the child was incapacitated following a reaction. Urticaria, commonly called hives, is a type I hypersensitivity reaction, which indicates a serious reaction. The child should not try to eat seafood again. Urticaria usually begins rapidly and may disappear in a few days or may take up to 6 to 8 weeks to resolve.

The nurse is taking a health history of a 6-year-old girl with suspected Stevens-Johnson syndrome. During the physical examination, the nurse would expect to note which physical findings? erythema multiforme with inflammatory bullae of at least two types of mucosa fiery red lesions, scaling in the skin folds, and satellite lesions red macules and bullous eruptions on an erythematous base red, raised hair follicles

erythema multiforme with inflammatory bullae of at least two types of mucosa Stevens-Johnson syndrome rash involves erythema multiforme with the addition of inflammatory bullae of at least two types of mucosa. Fiery red lesions, scaling in the skin folds, and satellite lesions are associated with diaper candidiasis. Red macules and bullous eruptions on an erythematous base are common skin findings for bullous impetigo. Red, raised hair follicles are indicative of folliculitis.

The nurse is assessing a child who pulled a boiling pot of soup off of the stove top. The child reports pain at a 9 on a scale of 0 to 10. The burn is red and edematous, and also shows areas of charred skin. The nurse is aware that these signs and symptoms are indicative of what kind of burn? superficial or first-degree partial-thickness or second-degree deep partial-thickness or second-degree full-thickness or third-degree

full-thickness or third-degree Full-thickness or third-degree burns may be very painful or numb or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin.

The client is scheduled to have potassium hydroxide testing performed. What will be needed to complete this test? a blood specimen a urine specimen skin scrapings a strand of hair with the root attached

skin scrapings Potassium hydroxide (KOH) testing is done to assess for the presence of a fungal infection. Skin scrapings are placed on a microscope slide and a drop of KOH 20% drop is added.

The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a burn induced by child abuse (child maltreatment)? stocking-glove pattern on hands or feet splash patterns nonuniform pattern spattering pattern

stocking-glove pattern on hands or feet A stocking-glove pattern on the hands or feet or a circumferential ring appearing around the extremity points to the caregiver forcefully holding the child under extremely hot water. A nonuniform pattern and splash or spattering patterns are not typical indicators of child abuse (child maltreatment).

The nurse is assessing the skin of a 5-year-old child and notes several lesions on the arm. The lesions are circumscribed, elevated, and pinpoint size. They contain serous fluid. How would the nurse document these findings? nodule papule vesicle bulla

vesicle Vesicles are circumscribed elevated lesions, less than 1 cm, that contain serous fluid. Nodules are solid, elevated, hard or soft lesions in the dermal or subcutaneous tissue and are larger than 1 cm. Papules are solid, elevated, circumscribed areas less than 1 cm. Bullae are circumscribed elevated lesions containing serous fluid that are larger than 1 cm.