Ricci 45 Nursing Care of the Child with an Integumentary Disorder

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. Which of the following would be the best action for the nurse to take? The nurse should 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) Have the caregiver sign a permission form acknowledging that the girl has been given the drug without pregnancy testing c) 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 d) Arrange for the daughter to have the pregnancy testing without the caregiver's knowledge

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 Isotretinoin is a pregnancy category X drug: It must not be used at all during pregnancy because of serious risk of fetal abnormalities. To rule out pregnancy, a urine test is done before beginning treatment. For the sexually active adolescent girl, an effective form of contraception must be used for a month before beginning and during isotretinoin therapy. The risk to the fetus, should pregnancy occur, should be discussed with the girl whether she is sexually active or not.

The nurse is caring for a female child in a pediatric intensive care unit who was struck by lightening while playing softball. The parents state to the nurse, "I don't understand why our child has to be here; the doctor said she was fine?" What is the best response by the nurse? - "It is standard protocol to admit a burn client for surveillance; especially if it is an electrical injury." -"You should speak with your doctor because that is who admitted your daughter to this unit." -"It's just a precautionary measure. It's better to be safe than sorry if she develops complications." -"A child who has suffered an electrical burn can develop cardiac arrhythmias up to 72 hours after a burn injury, so we need to monitor her."

"A child who has suffered an electrical burn can develop cardiac arrhythmias up to 72 hours after a burn injury, so we need to monitor her." Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury; therefore, informing the parents that this is why the child has been admitted effectively answers their question. "If she develops complications" is very elusive and may frighten the parents.

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? -"I will need to make sure the dog gets a bath if he goes in the woods." -"When he plays in the woods again, I will make sure he wears long pants and long sleeves." -"I can buy a medicine to put on him before he goes out to prevent him from getting this again." -"As long as he takes a shower as soon as he gets inside, he shouldn't get this again."

"As long as he takes a shower as soon as he gets inside, he shouldn't get this again." Prevention of contact dermatitis from poison ivy, oak or sumac, include wearing long pants and long sleeves on outings in the wood. If contact occurs, wash vigorously with soap and water within 10 minutes of contact. The plant's oil residue may be on clothes, pets, toys and other objects, so these must be washed well with soap and water. Ivy Block is the only preventative treatment approved by the US FDA. It is applied to the skin before exposure.

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 of the following nurse responses is correct? a) "Baby powder should not be used on newborns due to the risk of aspiration upon application." b) "Baby powder can be used anytime with no concerns." c) "Baby powder may be used if sprinkled on your hand away from the baby to prevent aspiration." d) "Baby powder should not be used since so many people are allergic to the ingredients in it."

"Baby powder should not be used on newborns due to 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.

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? -"If your child starts having respiratory difficulties be sure to let your physician know." -"I'm not sure why you think a skin disorder would lead to asthma?" -"I can understand your concern. We will closely monitor your child for asthma development." -"Most children aren't going to develop asthma so there is no need to worry."

"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). About 30% to 35% of children who have atopic dermatitis will also develop allergic rhinitis and/or asthma. Therefore, the child will be monitored for the development of asthma.

The parents of an 8-year-old boy diagnosed with frostbite are distraught and state to the nurse, "We can't believe we didn't make our child come inside when he complained about his fingers being numb and hurting." How should the nurse respond? -"I can't imagine how you are feeling right now, but I'm sure you had no idea frostbite could happen. We will take good care of your son." -"Let's just hope he doesn't have second or third-degree frostbite." -"Local damage occurs when the tissue temperature drops to 32°F (0°C). That was the temperature of your child's fingers." -"Did you briskly massage your son's fingers when he complained of pain and numbness?"

"I can't imagine how you are feeling right now, but I'm sure you had no idea frostbite could happen. We will take good care of your son." The unintentional injury has already occurred so the nurse must be compassionate and supportive of the parents. The other options are judgmental and do not serve a purpose. Instruction can be given with teaching to prevent future incidents when the parents are ready for teaching.

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 only use ointments and creams as instructed by the health care provider." -"I need to wash and rinse clothes thoroughly to be sure all of the detergent is washed out." -"I should be certain to use fabric softener in the care of the infant's clothes." -"I should not overdress the infant."

"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.

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

"My child gets diaper rash if I wash her clothes in 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 1-week-old child with a feeding intolerance. The mother expresses a concern with white scales that have began to flake off the infant's scalp and she asks the nurse what she can do to prevent this. Which of the following is the best nursing response? a) "How often do you bathe your infant? The infant should have a thorough shampooing every day to prevent things like this." b) "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." c) "Your child most likely has dandruff. You can treat it with daily with antiseborrheic shampoo." d) "Your child most likely has infantile seborrheic dermatitis, or cradle cap. There is no intervention needed and it should resolve in one week."

"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." Infantile seborrheic dermatitis usually responds well to cleansing the scalp with a mild shampoo. The thick, scaling lesions on the child's scalp can be treated by applying baby oil, salicylic acid in mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft toothbrush; then the scales can be rinsed away. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Accusing a parent of poor hygiene is inappropriate. Infantile seborrheic dermatitis is not a result of poor hygiene.

The nurse is caring for a child with a partial-thickness burn. Which of the following assessment findings would the nurse expect to observe? a) Edema with wet blistering skin b) Reddened and leathery skin c) Edema with dry or waxy-looking skin d) Peeling skin with eschar

Edema with wet blistering skin Partial-thickness burns are very painful and edematous and have a wet appearance or the presence of blisters. Full-thickness burns appear red, edematous, leathery, dry, or waxy and may display red or charred skin (eschar).

Which of the following accurately depicts the hemodynamic changes that occur in the body within the first 24 to 48 hours after a burn? a) Hematocrit increases and WBC count decreases b) Hematocrit and WBC counts elevate c) Hemoglobin and WBC counts decrease d) Hematocrit and WBC counts decrease

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

The nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at doing which of the following? a) Managing pain and discomfort b) Reducing swelling and relieving itching c) Controlling nausea and vomiting d) Regulating skin and body temperature

Reducing swelling and relieving itching Treatment for skin allergies is aimed at reducing the swelling and relieving the itching. With swelling in various parts of the body, the child may have pain, nausea and vomiting, but reducing the swelling would prevent those symptoms from occurring.

A 14-year-old child is diagnosed with tinea versicolor. Which of the following would the nurse expect the nurse practitioner to order? a) Topical nystatin b) Diphenhydramine c) Oral griseofulvin d) Selenium sulfide

Selenium sulfide Selenium sulfide is used to treat tinea versicolor. Topical nystatin is used to treat monilial diaper rash. Griseofulvin is used to treat tinea capitis. Diphenhydramine is an antihistamine used to treat hypersensitivity reactions, atopic dermatitis, or contact dermatitis that is highly pruritic.

The nurse is caring for a 2-year-old boy with a burn. Which of the following findings would warrant referral to a burn unit? a) The boy has a superficial burn on his hands. b) The boy has suffered a chemical burn. c) The boy has a first-degree burn on the upper arm. d) The boy has a superficial burn on his chest.

The boy has suffered a chemical burn. : According to the Committee on Trauma of the American College of Surgeons, chemical burns warrant referral to a burn unit. A partial-thickness burn greater than 10% of the body surface area would warrant a referral to a burn unit. A superficial burn on the chest or hands does not warrant a referral to a burn unit. A first-degree burn would most likely be classified as a superficial burn, which would not warrant a referral to a burn unit.

A group of nursing students are reviewing information about atopic dermatitis. Which of the following indicate that the students understand the information? Select all that apply. a) Changes in temperature can contribute to flare-ups. b) The reaction occurs in response to specific allergens. c) Scratching initiates the reaction, which then becomes pruritic. d) Excessively humid environments often lessen the severity of the reaction. e) The disorder is chronic with periods of remissions.

• The disorder is chronic with periods of remissions. • The reaction occurs in response to specific allergens. • Changes in temperature can contribute to flare-ups. Atopic dermatitis is a chronic disorder with a relapsing and remitting nature. The skin reaction occurs in response to specific allergens, usually foods, or environmental triggers. Changes in ambient temperature can contribute to flare-ups. Excessively humid or dry environments can cause the condition to worsen. When a trigger occurs, antigen-presenting cells stimulate interleukins to begin the inflammatory process. The skin begins to feel pruritic and then the child starts to scratch. Itchiness occurs first and then the rash appears.

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? a) "I should use a humectant moisturizer." b) "I should avoid eating any kind of chocolate." c) "I must use my medicine daily so that it will work." d) "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.

A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful? a) "I should not cover the area with plastic wrap after applying the cream." b) "I need to shake the preparation before using it." c) "I should use the highest-potency steroid cream I can find." d) "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.

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? a) "We should avoid using petroleum jelly." b) "We should avoid tight clothing and heat." c) "We need to develop ways to prevent him from scratching." d) "We should keep his fingernails short and clean."

"We should avoid using petroleum jelly." It is important to apply moisture multiply times through the day. Petroleum jelly is a recommended moisturizer that is inexpensive and readily available. The other statements are correct.

A 6-year-old child is diagnosed with tinea capitis and treatment is initiated. The nurse instructs the parents to have the child return to school within which time frame? a) 24 hours b) 5 days c) 1 week d) 72 hours

1 week Once treatment is initiated for tinea capitis, the child can return to school or day care after 1 week.

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 -Risk for aspiration related to effects of medication -Acute pain related to thermal injuries and procedures

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.

The nurse is caring for a burn patient in a pediatric hospital. Which of the following would be an appropriate nursing diagnosis for this patient? a) Risk for fluid volume overload related to thermal injuries b) Risk for aspiration related to effects of medication c) Acute pain related to thermal injuries and procedures d) Knowledge deficit related to daily care procedures in the acute care setting

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

A school-age child is brought to the office of the camp nurse with a small, superficial burn. Which of the following actions by the nurse would be the most appropriate action for the nurse to do first? a) Apply cold compresses to the area b) Apply a topical anesthetic ointment c) Cover the area with a sterile bandage d) Administer acetaminophen

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.

The term tinea is also called ringworm and it is applied to which of the following? a) Bacterial infections b) Sexually transmitted infections c) Fungal infections d) Contagious infections

Fungal infections Fungi that live in the outer (dead) layers of the skin, hair, and nails can develop into superficial infections. Tinea (ringworm) is the term commonly applied to these infections.

A nurse is caring for a burn patient with second and third degree burns on 15% of the body. The patient is complaining of severe itching in and around the burn sites. Which of the following is the best nursing intervention to relieve this symptom? a) Soaking in a colloidal bath b) Medication c) Diversional activities d) Turning the patient every two hours

Medication As nerve endings heal they cause intense itching that can be relieved with the use of medications. Turning the patient every two hours will not relieve the itching. Soaking in a colloidal bath in contraindicated with burn patients. Diversional activities will not be effective when attempting to relieve itching.

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? -Carrot and celery sticks -Tomato soup -Chicken nuggets -Peanut butter and jelly sandwich

Peanut butter and jelly sandwich Atopic dermatitis is commonly associated allergies to food. Common culprits may include peanuts, eggs, orange juice, and wheat-containing products.

A nurse is caring for a child with tinea pedis. Which of the following assessment findings would the nurse expect to note? a) Inflamed boggy mass filled with pustules b) Erythema, scaling, maceration in the inguinal creases and inner thighs c) Patches of scaling in the scalp with central hair loss d) Red scaling rash on soles and between the toes

Red scaling rash on soles and between the toes Tinea pedis presents with red scaling rash on soles, and between the toes. Tinea capitis presents with patches of scaling in the scalp with central hair loss and the risk of kerion development (inflamed boggy mass filled with pustules). Tinea cruris presents with erythema, scaling, maceration in the inguinal creases and inner thighs.

The nurse is examining a child for indications of frostbite and notes blistering with erythema and edema. The nurse notes which degree of frostbite? -Third degree frostbite -Fourth degree frostbite -Second degree frostbite -First degree frostbite

Second degree frostbite Second degree frostbite demonstrates blistering with erythema and edema. First degree frostbite results in superficial white plaques with surrounding erythema. In third degree frostbite, the nurse would note hemorrhagic blisters that would progress to tissue necrosis and sloughing when the fourth degree is reached.

A young child has just been admitted to the emergency department with a burn that encompasses the dermis and the underlying dermis. From which type of burn does this child suffer?

Second-degree or partial-thickness burn A burn that encompasses the dermis 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.

Which of the following is the best technique to perform an assessment of the skin? a) Skin assessment involves inspection and palpation in a room with white walls and bright fluorescent light. b) Skin assessment involves inspection and palpation using latex gloves. c) Skin assessment involves inspection and palpation in a room with yellow walls and bright white light. d) Skin assessment involves inspection and palpation using vinyl gloves.

Skin assessment involves inspection and palpation in a room with white walls and bright fluorescent light. Physical assessment of the skin involves two basic techniques: inspection and palpation. The ideal environment for the physical assessment is a well-lit room with white walls, not yellow. Bright white fluorescent ceiling lighting is optimal, because it does not cast a yellow hue on the skin. Skin assessment does not require the use of gloves unless there are body fluids or open lesions on the skin. If gloves are required, they should be vinyl to prevent an allergic reaction.

The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a child abuse-induced burn? a) Stocking-glove pattern on hands or feet b) Nonuniform pattern c) Splash patterns d) 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.

The nurse admits a child who has sustained a severe burn. The child's immunizations are up to date. Which of the following immunizations would the child most likely be given at this time? a) Tetanus toxoid vaccine b) Hepatitis B vaccine c) Hepatitis A vaccine d) Haemophilus influenzae type B vaccine

Tetanus toxoid vaccine If inoculations are up to date, a booster dose of tetanus toxoid is required to protect the child from infection introduced into the burn.

The nurse is collecting data on a child admitted to the burn unit with a partial-thickness burn. Which of the following is most accurate regarding this type of burn? a) There is no destruction of tissue. b) The nerve ending are destroyed. c) The child will have minimal pain. d) The child will likely have blisters.

The child will likely have blisters. In a partial-thickness or second-degree burn, the epidermis and underlying dermis are both injured and devitalized or destroyed. Blistering usually occurs with an escape of body plasma, but regeneration of the skin occurs from the remaining viable epithelial cells in the dermis.

In caring for a 3 ½-year-old child admitted after being severely burned, the nurse collects the following data. Which of the following would be most important for the nurse to report immediately? a) The child's temperature is 38.4°C. b) The child's pain level is a 7 on the pain scale. c) The child's hourly urinary output is 150 cc. d) The child's respiratory rate is 32 breaths a minute.

The child's respiratory rate is 32 breaths a minute. An increase in the respiratory rate after a severe burn may be an indication of possible serious respiratory complications and should be reported immediately in case an endotracheal tube needs to be inserted. A temperature of 38.4°C, hourly urine output of 150 cc, and pain rating of 7 need to be documented and reported but are not as urgent as reporting respiratory concerns.

The nurse is caring for an infant who has impetigo and is hospitalized. Which of the following nursing interventions is the highest priority for this child? a) The nurse applies topical antibiotics to the lesions. b) The nurse follows contact precautions. c) The nurse applies elbow restraints to the infant. d) The nurse soaks the skin with warm water.

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 10-year-old male patient in a pediatric clinic with presenting symptoms of small circular patches of hair loss on the scalp. Which of the following skin conditions does the patient most likely have? a) Tinea corporis b) Tinea capitis c) Tinea cruris d) Tinea faciei

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

The nurse is caring for a pediatric patient with multiple wounds from a bike accident. Which of the following is the best method for cleansing or washing out the wound? a) Use sterile water to wash out the wound. b) Use iodine solution to wash the wound. c) Use an antibiotic wash to cleanse the wound. d) Use normal saline solution to wash 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.

The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a care provider. Which of the following is the most appropriate action for the nurse to do with this child? a) The nurse should administer pain medication. b) The nurse should briskly scrub the site. c) The nurse should apply ice to the affected area. d) The nurse should splint the leg.

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

The nurse is providing education to the parents of a teenaged boy diagnosed with impetigo. Which of the following statements by the boy indicates the need for further education? a) "This condition is contagious." b) "I will need to cover my son's skin lesions with bandages until it has healed." c) "It is important to remove the crusts before applying any topical medications." d) "My son can continue to attend school while he is taking the prescribed antibiotics."

"I will need to cover my son's skin lesions with bandages until it has healed." Impetigo is an infectious bacterial infection. The crusts should be removed after soaking prior to applying topical medications. Leaving the lesions open to air is not contraindicated. Children diagnosed with impetigo may attend school during treatment.

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 of the following disorders? a) Hemophilia b) Asthma c) Rheumatoid arthritis d) Otitis media

Asthma Infants who have eczema tend to have allergic rhinitis or asthma later in life.

The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children. Which of the following disorders is the nurse most likely referring to? a) Impetigo b) Miliaria rubra c) Candidiasis d) Seborrheic dermatitis

Impetigo Impetigo is a superficial bacterial skin infection.

The nurse is caring for a child with a suspected fungal infection. Which of the following tests would the nurse anticipate as being ordered? a) Potassium hydroxide (KOH) prep b) Patch or skin testing c) Culture of wound/drainage d) Erythrocyte sedimentation rate (ESR)

Potassium hydroxide (KOH) prep Potassium hydroxide (KOH) prep is indicated for identifying a fungal infection. Patch or skin testing is indicated for evaluation of atopic or contact dermatitis. ESR is a nonspecific test used to determine the presence of infection or inflammation. Culture of wound/drainage is used to identify the specific organism.

An 8-year-old child requires wet dressings four times a day as treatment for a skin disorder. Which of the following would be most important for the nurse to do? a) Elevate the area after performing the dressing change. b) Ensure that the temperature of the solution is 120°F. c) Premedicate the child before changing the dressing.

Premedicate the child before changing the dressing. Premedicating the child before changing the dressing is crucial to providing atraumatic care. Elevating the area may or may not be appropriate depending on the problem and its location. A temperature of 120°F is the recommended maximal hot water heater temperature. The solution for a wet dressing should not be this high.

Which of the following interventions is the most beneficial for a burn patient undergoing a skin graft? a) Provide pain medication on a PRN schedule as soon as pain is reported. b) Provide an egg-crate mattress or gel mattress for the patient to lie upon. c) Provide diversional activities for the patient. d) Provide around-the-clock pain medication as soon as pain is reported.

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.

Which of the following interventions is the most effective in treating burn wound infections? a) Systemic intravenous antibiotics b) Systemic oral antibiotics c) Proper hand washing d) Topical antibiotics applied to the wound site

Topical antibiotics applied to the wound site : Topical burn creams are used because the local blood supply to the area of burn injury is destroyed with the burn, and systemic antibiotics thus are not delivered to the burn wound. Proper hand washing is a preventive treatment.

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

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.

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: -Curling ulcer. -wound care. -graft placement. -hypovolemic shock.

hypovolemic shock. Hypovolemic shock is the major manifestation in the first 48 hours in massive burns. As extracellular fluid pours into the burned area, it collects in enormous quantities, which dehydrates the body.

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

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.

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

"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 developing the plan of care for a child who has suffered a major burn and has just been admitted to the acute care facility. Which nursing diagnosis would be most appropriate? - Acute pain related to thermal injuries and procedures - Knowledge deficit related to daily care procedures in the acute care setting - Risk for fluid volume overload related to thermal injuries - 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 patient. Knowledge of the daily procedures at the acute care setting is not a priority for this patient. A child with a burn would most likely experience fluid volume deficit due to the fluid loss associated with burns. Risk for aspiration would not be an appropriate nursing diagnosis.

The nurse is caring for a patient brought to a pediatric clinic for swelling in the lower extremities with reddened skin that has undefined borders and pits slightly when pressed. Which of the following is the most likely diagnosis of the patient's skin alteration? a) Cat scratch disease b) Impetigo c) Cellulitis d) Staphylococcal scalded skin syndrome

Cellulitis Cellulitis is characterized by reddened or lilac-colored swollen skin that pits when pressed by the fingertips. Impetigo has superficial lesions that can be bulbous or nonbulbous. SSSS involves bullae that enlarge and rupture, leaving a red, scalded-looking lesion. Cat scratch disease involves a benign, subacute, chronic course of lymphadenopathy that usually resolves spontaneously in 2 to 3 months.

A child is admitted to the acute care facility with a burn injury. The nurse would check the child's immunization status, specifically for which of the following? a)Diphtheria b)Pertussis c)Tetanus d)Meningitis

Tetanus For any burn, check the child's tetanus immunization status on admission and ensure that tetanus toxoid is given if the child's immunizations are not up to date, because anaerobic and aerobic bacteria can grow at the interface between burned and healthy tissue. Pertussis, diphtheria and meningitis are not important immunizations to check for with a burn patient.

The nurse is caring for a 2-month-old patient 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. Which of the following is the correct nursing response? a) "Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun." b) "You should not take your infant to Florida." c) "Put plenty of children's sunscreen on the infant at least 15 minutes before going outdoors, then reapply every three to four hours." d) "It is okay to use a children's sunscreen as long as you avoid the face."

"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.

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 which of the following? a) "If our son starts telling us that the pain is increasing, we need to have it checked out." b) "We should call the doctor if the wound becomes red and hot looking." c) "We need to keep the wound tightly bandaged for at least 3 days." d) "If we notice some yellowish drainage, we need to call the doctor."

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

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 the 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.

A newborn has a generalized rash on the skin, which the nurse identifies as erythema toxicum neonatorum. Which informaiton would the nurse include when explaining the condition to the newborn's parent? -"What you see on your newborn's skin is eythema 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." -"What you see on your newborn's skin is eythema toxicum neonatorum. It is a common newborn skin condition. You will need to apply a topical cream twice a day until it disappears." -"This is a normal newborn rash, do not be so worried." -"What you see on your newborn's skin is eythema toxicum neonatorum. It is an extensive skin condition that is rare in newborns. You will need to treat the infant as soon as possible to prevent its spread."

"What you see on your newborn's skin is eythema 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." Erythema toxicum neonatorum (ETN), or neonatal erythema, is one of the more well-known benign, self-limiting skin eruptions in the newborn period. Incidence estimates range from 50% to 70% of all healthy newborns. The rash usually remits within 1 week with no treatment. It is never appropriate to tell a mother not to be so worried.

The nurse is caring for a child with a skin disorder. The child presented with papules that progressed to vesicles with a honey-colored exudate. What treatment would the nurse expect to be ordered to treat this disorder? Select all that apply.

-Topical mupirocin ointment -Cool compresses to assist in removing crusts on vesicles -Regular hygiene measures Nonbullous impetigo symptoms include papules progressing to vesicles with honey-colored exudate when the vesicles rupture. Treatment includes topical mupirocin ointment with cool compresses BID to assist in removing honey-colored crust. Oral cephalexin and good hygiene are used to treat bullous impetigo. Warm compresses after washing with soap is used to treat folliculitis.

The nurse is working in a community setting and receives a call from a local day care center. One of the children in the center has been diagnosed with impetigo, and the director of the day care center wants to know whether she should be concerned. The nurse's response should reflect which of the following related to impetigo? a) Impetigo is a sexually transmitted infection and should be reported. b) Impetigo is usually caused because of sensitivity to pollens and molds. c) Impetigo is highly contagious and can spread quickly. d) Impetigo cannot be treated with medication and has to run its course.

Impetigo is highly contagious and can spread quickly. Impetigo is highly contagious and can spread quickly. Impetigo in the newborn nursery is cause for immediate concern.

The nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which statements indicate learning has occurred? Select all that apply. -"It's important I get my CBC blood test when my doctor orders it." -"If I am sexually active I need to let my doctor know." -"As long as I use two forms of birth control I don't need to have monthly pregnancy testing." -"I am young so I won't need to have the liver tests the pamphlet suggests." -"This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her."

-"It's important I get my CBC blood test when my doctor orders it." -"If I am sexually active I need to let my doctor know." -"This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her."

The nurse is caring for a child admitted with partial thickness burns. Which of the following is most characteristic of this type of burn? a) Pain is minimal b) Blisters appear c) Muscle damage occurs d) Skin is red and edematous

Blisters appear In partial-thickness or second-degree burns, blistering usually occurs with an escape of body plasma.

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 of the following physical findings? a) Red, raised hair follicles b) Erythema multiforme with inflammatory bullae of at least two types of mucosa c) Fiery red lesions, scaling in the skin folds, and satellite lesions d) Red macules and bullous eruptions on an erythematous base

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.

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. Which of the following responses would be appropriate for the nurse to say to this caregiver? a) "That's not an uncommon reaction, although it's hard on you and on your child." b) "He will be better soon and your family can get back to normal." c) "I understand her feelings. It is hard to see a child in pain sometimes." d) "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." 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 nurse is caring for a child with a tinea corporis infection involving several sites. Which information would be the most important for the nurse to include in the teaching plan for the parents? a) Allowing the child to return to school after 3 days of treatment b) Keeping socks on before, during, and after athletic events c) Finishing all prescribed oral medication, even after lesions fade d) Applying oils and petroleum jelly to the affected areas

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

The nurse 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? a) "My mom says I have acne because I eat too much chocolate." b) "My next door neighbor told me that acne was caused by a fungus." c) "There is a new immunization that you can get to keep from having acne." d) "Sometimes I get acne when I use my sister's makeup."

"Sometimes I get acne when I use my sister's makeup." Irritation and irritating substances, such as vigorous scrubbing and cosmetics with a greasy base, can cause acne vulgaris. Increased hormone levels, hereditary factors, and anaerobic bacteria can cause acne vulgaris as well. Eating chocolate and fatty foods does not cause acne, but a well-balanced, nutritious diet does promote healing.

The nurse is caring for a 12-year-old patient in a pediatric clinic at a wellness checkup. The patient complains of embarrassing dandruff and asks the nurse what can be done for it. Which of the following is the best nursing response after a quick scalp assessment confirms the presence of dandruff? a) "Apply a corticosteroid cream to your scalp at night." b) "Wash your hair with an antiseborrheic shampoo daily." c) "Wear light-colored clothing so the flakes aren't noticeable." d) "Wash your hair vigorously twice a day for one week."

"Wash your hair with an antiseborrheic shampoo daily." In the older child and adolescent, an antiseborrheic shampoo should be used daily to control scaling caused by dandruff. Common names for these shampoos include Sebulex, Selsun Blue, and Head and Shoulders. Corticosteriod creams can be applied two to four times a day for severe cases. Washing hair vigorously twice a day is not recommended. Light-colored clothing is a good suggestion; however, it is not an intervention to control the prevalence of dandruff.

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

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.

An adolescent is to receive topical retinoid therapy for his moderately severe acne. The nurse would instruct the adolescent about which adverse effect? Select all that apply. a) Burning b) Photosensitivity c) Dryness d) Flu-like symptoms e) Headache

• Burning • Photosensitivity • Dryness Adverse effects associated with topical retinoid therapy include burning, dryness, and photosensitivity. Flu-like symptoms and headache are associated with topical immune modulators.

When assessing an adolescent for acne, which of the following would lead the nurse to identify the acne as severe? Select all that apply. a) Presence of nodules b) Widespread inflammatory lesions c) Comedones d) Facial papules e) Evidence of cysts

• Widespread inflammatory lesions • Evidence of cysts • Presence of nodules Severe acne is characterized by comedones plus inflammatory lesions such as papules or pustules that are widespread and/or the presence of cysts or nodules and possibly scarring. Comedones are associated with mild acne. Papules localized to the face or back are associated with moderate acne.

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? a) Obtaining a culture of the impaired skin area b) Using appropriate hand hygiene c) Urging adequate nutritional intake d) Assessing temperature every 4 hours

Using appropriate hand hygiene Hand hygiene would be the priority because the child's risk for infection is increased and hand hygiene is crucial to preventing the transmission of infectious organisms. Monitoring the child's temperature is important to evaluate for possible fever and infection, but this would not be the most important action. Although nutritional status can influence wound healing, urging adequate nutritional intake would not be the most important action. Although obtaining a culture provides information about the cause of an infection, the child is at risk for infection, so a culture would not provide any information about the risk.

The nurse is reviewing the integumentary system during a presentation to a group of nurses. Which of the following statements made by the nurses is the most accurate regarding the integumentary system? a) "The accessory structures of the integumentary system include the sebaceous or sweat glands." b) "The integumentary system is not in place until after the child is born and then takes many years to mature." c) "The largest organ of the integumentary system helps regulate body temperature." d) "One role of the integumentary system is to distribute oxygen to the body cells."

"The largest organ of the integumentary system helps regulate body temperature." The skin is the major organ of the integumentary system and is the largest organ of the body. The skin helps regulate the body temperature by heating and cooling. Accessory structures such as the hair and nails also make up the integumentary system. The major role of the skin is to protect the organs and structures of the body against bacteria, chemicals, and injury. Excretion in the form of perspiration is also a function of the skin glands, called the sweat glands. Sebaceous glands in the skin secrete oils to lubricate the skin and hair. The integumentary system is in place at birth, but the system is immature. A function of the respiratory system is to distribute oxygen to body cells.

An adolescent girl is going to be treated for a severe case of acne vulgaris. A pregnancy test should be done prior to the adolescent starting treatment with which of the following? a) Tretinoin (Retin-A) b) Isotretinoin (Accutane) c) Erythromycin d) Benzoyl peroxide (Clearasil)

Isotretinoin (Accutane) Isotretinoin is a pregnancy category X drug: it must not be used at all during pregnancy because of serious risk of fetal abnormalities.

The nurse is caring for a pediatric patient in the emergency department with moderate hypothermia and frostbite. Which of the following is the most beneficial nursing intervention for this patient? a) Apply dry heat to the extremities. b) Place heating pads and warmed blankets on the trunk of the body initially. c) Place heating pads and warmed blankets on the patient's extremities and trunk. d) Rub the frostbitten extremities to increase circulation to the affected area.

Place heating pads and warmed blankets on the trunk of the body initially. The trunk of a person should be warmed first with moderate hypothermia. 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 patient with hypothermia and frostbite. Rubbing a frostbitten area may cause further damage and should be avoided.

The parents of a child diagnoses 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? -"The complete blood count is a routine test used anytime there is an abnormal condition in the body." -"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." -"This is just another tool to help rule out any other disorders that can be causing this skin disorder. There will be other lab tests ordered as well." -"This test will help in determining the type of bacteria that is causing this infection."

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

A 10-year-old has been bitten on the lower posterior arm by a dog, requiring several stitches. The child was just admitted to the hospital for 3 days of antibiotic therapy. When developing the care plan, the nurse identifies which nursing diagnoses as being the top 2 priorities? -Disturbed body image -Knowledge deficit regarding care of wound -Risk for fluid volume deficit -Impaired skin integrity -Risk for infection

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

An adolescent is prescribed isotretinoin. Which of the following indicates that the adolescent understands the necessary precautions associated with this drug? a) "This drug can affect my lungs so I need a chest radiograph done first." b) "The drug might cause staining of my clothing." c) "I have to make sure that I do not become pregnant while taking this drug." d) "I'm going to have to have a blood count done every couple of months."

"I have to make sure that I do not become pregnant while taking this drug." Adolescent girls taking this drug who are sexually active must be on a pregnancy prevention program because the drug causes defects in fetal development. Monthly complete blood counts are required when taking isotretinoin. Isotretinoin is not associated with lung problems, so a chest radiograph is not necessary. Coal tar preparations are associated with staining of the clothing or fabrics. Isotretinoin does not stain clothes or fabrics.

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? -"My child plays in our woods a lot so I need to be sure protective clothing and shoes are worn." -"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." -"I cleaned the wound with soap and water right away. I hope that's okay."

"Since my child just has a rash around the area of the bite there is nothing to worry about." A rash does 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 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 6-year-old patient brought into the emergency department for burns from a house fire. The nurse notes burn areas surrounding the patient's nose and mouth upon initial assessment. Which of the following priority complications should the nurse be alerted to? a) Airway obstruction related to upper respiratory swelling b) Nutritional requirements increased c) One third area of fluid leakage resulting in hypovolemic shock d) Presence of an ileus

Airway obstruction related to upper respiratory swelling Airway obstruction related to swelling is a priority complication to be alert for when signs of inhalation injury such as burns on the mouth and nose are present. Presence of an ileus, increased nutritional requirements, and hypovolemic shock are all complications of burns; however, airway obstruction is the priority.