CHAPTER 29: integumentary disorders

A parent phones the nurse stating their 5-year-old child has lesions similar to those of varicella. The parent states the child is itchy and uncomfortable. Which statement by the parent will the nurse clarify? "I will try an oatmeal bath or oatmeal cream with an antihistamine to soothe the child's lesions." "I am going to give my child a baby aspirin to decrease their itchiness and so they can rest better." "I will keep my child home from school until all of the lesions have completely crusted over." "I have placed gloves on both of my child's hands so they will not scratch and cause an infection."

"I am going to give my child a baby aspirin to decrease their itchiness and so they can rest better." Explanation: Varicella is caused by a virus that causes chickenpox. Because it is a virus, the nurse will clarify the parent's comment about administering aspirin and teach that administering aspirin could cause Reye syndrome. Offering options of acetaminophen or diphenhydramine are better options for the child. The parent may place gloves on the hands as a means to remind the child that they should not scratch. Oatmeal is soothing for the lesions, and the child should remain home until all of the lesions are crusted over.

A new parent brings the 3-month-old infant to the clinic for a well-baby check up. During the visit, the parent asks the nurse, "I know the rays from the sun can be harmful, so what should I do to protect my infant?" Which suggestion by the nurse would be most appropriate? "Invest in clothing that has sun protective factor (SPF) already in the material." "A wide-brimmed hat and an umbrella for shade should be enough for your infant." "The best thing to do is keep any infant under the age of 6 months out of the sun." "As long as you use a sunscreen, your infant will be protected from the sun."

"The best thing to do is keep any infant under the age of 6 months out of the sun." Explanation: For infants under the age of 6 months, it is best to keep them out of the sun to reduce their risk of exposure to the sun's damaging rays. Sunscreen should be applied sparingly in infants younger than 6 months. As the infant gets older, he or she should have sunscreen of at least 15 SPF applied to all exposed areas and have it reapplied every 2 hours or after swimming or sweating. Clothing with SPF built in, a wide-brimmed hat, and umbrellas for shade are appropriate once the infant is over the age of 6 months.

The nurse is caring for an 11-year-old child with a primary open skin lesion. What action(s) will the nurse include in the plan of care to prevent infection in the child? Select all that apply. Advise the child not to scratch the affected area. Teach hand hygiene to the child and parents. Teach the child and parents to keep the lesion uncovered. Assess for increased warmth around the wound. Assess for hypopigmentation.

-Assess for increased warmth around the wound. -Teach hand hygiene to the child and parents. -Advise the child not to scratch the affected area. Explanation: The nurse will assess for increased warmth around the wound, which is a sign of infection. Teaching hand hygiene to the child and parents is a preventative measure against secondary infection. The nurse will advise the child not to scratch the affected area. An open skin lesion should be kept covered, if possible. The nurse should assess for erythema, which is a sign of infection, not hypopigmentation.

A 6-year-old child is brought to the clinic for evaluation of a rash. The nurse completes an assessment of the child's skin and documents the findings above. Based on the findings, which information would the nurse include in the teaching plan for the child's parents? skin pale pink, moist and warm to touch, multiple areas of raised pinpoint erythmatous macules noted on upper arms and forearms. Macules are warm to touch with distict edges. No oozing or drainage noted and purituts present. "Dry the child's skin thoroughly before applying any topical medication." "Use a patting motion, not a rubbing motion, to dry the child's skin." "Give the child a bath in cold water with an oatmeal bath product." "Have the child wear clothing that is snug around the affected area.

"Use a patting motion, not a rubbing motion, to dry the child's skin."

The nurse is teaching the parents of a 7-year-old child on preventing integumentary disorders. What will the nurse include in the teaching? Select all that apply. Apply sunscreen to your child. Teach your child to recognize and avoid poison oak. Avoid using insect spray on your child. Learn to identify infestations such as lice, scabies, and bed bugs. Teach your child to not approach strange pets without permission.

-Apply sunscreen to your child.-Teach your child to recognize and avoid poison oak.-Teach your child to not approach strange pets without permission.-Learn to identify infestations such as lice, scabies, and bed bugs.

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

"Does your child have any allergies to medications?"

The nurse is teaching the parents of a 5-year-old child diagnosed with head lice about using permethrin. The nurse determines that the teaching was successful based on which statement by the parents? "We should apply the medication to our child's hair and scalp when it is dry." "If we use the medicine, we will not have to use the special comb for the nits." "One application of the medication should be enough to get rid of the lice." "We need to leave the medication on for about 10 minutes before rinsing it off."

"We need to leave the medication on for about 10 minutes before rinsing it off." Explanation: Treatment of head lice begins with pediculicidal agents. Permethrin is the treatment of choice and is an over-the-counter drug. The parents should wash the child's hair before applying the medication, apply the medication to wet hair, leaving it on for 10 minutes before rinsing. One treatment is often not sufficient, and the treatment should be repeated in 7 days. Permethrin kills the live adult head lice but is not ovicidal, meaning that it does not kill the nits. Nits should be removed from wet hair with a specialized nit comb. Malathion is used for head lice infestations that do not respond to permethrin. This medication is applied to dry hair and scalp and left on overnight. Nit removal is still needed when this medication is used.

A child weighing 66 lb (30 kg) with deep partial thickness burns is receiving fluid resuscitation. The nurse is monitoring the child's urine output via Foley catheter every hour and documenting the findings on the flowsheet above. The nurse would notify the health care provider about which urine output? 80 ml 72 ml 60 ml 56 ml

56 ml Explanation: It is important to maintain adequate fluid volume in a child with burns. The nurse would monitor urine output via a Foley catheter, and notify the health care provider if output is less than 2 ml/kg/h. The child weighs 66 lb (30 kg). So an adequate hourly urine output for this child would be 60 ml/hr. Therefore, the nurse would notify the health care provider about a urine output of 56 ml.

The nurse is preparing to administer acyclovir intravenously to a child with varicella infection who is immunocompromised. The nurse correctly administers the medication over which time frame? 30 minutes 60 minutes 45 minutes 15 minutes

60 minutes

A school nurse has discovered that one of the children has acquired a case of head lice. The school principal asks the nurse to write a letter that will be sent to parents explaining about head lice and measures to prevent infestation. What information is important for the nurse to include in the letter? Select all that apply. A second treatment one week after the first is recommended. Head lice infestation is the result of poor personal hygiene. Parents should inspect their child's head for nits with a fine tooth comb. Any medicated shampoo may be used to treat head lice. Children should avoid sharing personal items such as combs and hats.

A second treatment one week after the first is recommended. Parents should inspect their child's head for nits with a fine tooth comb. Children should avoid sharing personal items such as combs and hats.

A parent brings a child to the emergency department and states "Our neighbor's dog just bit my child!" The nurse interviews the parent as the child receives treatment. Which question(s) should the nurse ask to assist with the child's care? Select all that apply. "Do you know if the dog has had its shots?" "Did your child provoke the dog?" "What kind of dog bit your child?" "Are your child's immunizations up to date? "Were the authorities notified of the incident?"

What kind of dog bit your child?" "Are your child's immunizations up to date?" Did your child provoke the dog?"" Do you know if the dog has had its shots?" To provide the child the best care, it is important to know the type of dog and whether the dog is up to dates on its immunizations particularly rabies. It is also important to determine if the dog was provoked or if the attack was unprovoked. If unprovoked, this may indicate the dog was ill. It is also important to know whether the child's immunizations are up to date. This will inform whether the child needs a tetanus shot. Lastly, it is appropriate to determine if the authorities were notified, but this is not most important as related to the child's care.

A nurse is preparing a presentation for a group of parents of toddlers at the local community center. The topic of the presentation is burn prevention. When describing burns in toddlers, which situation would the nurse likely identify as the most common cause of thermal burns? playing unsupervised with matches playing with a household cleaning agent container scalding from pulling a hot pan off the stove touching an open, hot oven door

scalding from pulling a hot pan off the stove

The most common complication of varicella is: scarring. pneumonia. encephalitis. secondary bacterial infections.

secondary bacterial infections. Explanation: Varicella starts with lesions that appear first on the scalp, face, trunk, and then extremities. The lesions begin as macules then develop into papules and finally clear, fluid-filled vesicles. These lesions are intensely pruritic. The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.

As part of a spring health fair at a local school, the nurse is presenting information for parents about treating insect stings. The nurse determines that more teaching is needed when the parents state that they would apply which substance to provide comfort? topical antibiotic ointment baking soda paste cold compresses meat tenderizer

topical antibiotic ointment Explanation: The nurse would instruct the parents to use cold compresses for pain relief. According to the Academy of Pediatrics, meat tenderizer or a baking soda paste may also be applied to promote comfort. Antihistamines and topical corticosteroids may be used if pain and itching are not relieved by other methods. Topical antibiotics would not be necessary at this time.

The parents of a child diagnosed with varicella are concerned about their other children getting it. The nurse instructs the parents that their child is contagious for how much longer now that the rash has appeared? for 4 days more now that the rash is present until the rash disappears, which is about 3 days for up to 8 days more after the rash initially appears until there are no more new lesions and lesions have crusted over

until there are no more new lesions and lesions have crusted over Explanation: With varicella, children are contagious 1 to 2 days before the rash appears and continue to be contagious until there are no more new lesions and all lesions are crusted over. Children with mumps are infectious for 7 days before parotid swelling and up to 8 days after the onset of swelling. A child with rubeola is contagious for 4 days before and 4 days after the appearance of the rash. The rash of rubella typically lasts no longer than 3 days.

During a routine assessment, the nurse determines that a school-age child has head lice. What did the nurse assess in this child? red raised rash on the neck white flecks on hair shafts macular rash on the arms pustule formation on the trunk

white flecks on hair shafts

The parent of a child with deep partial-thickness (second-degree) burns on the legs asks the nurse, "One of the staff told me that the dressings being used have silver in them. Why is that?" Which response by the nurse would be most appropriate? "Silver is used to help prevent any scarring." "Dressings containing silver help prevent infection." "Silver has been shown to speed up the healing process." "Silver helps repair nerve endings that were damaged."

"Dressings containing silver help prevent infection." Explanation: Dressings impregnated with silver have been shown to prevent infection. They are not associated with preventing scarring, speed up healing, or repair injured nerve endings.

A nurse is teaching a group of parents about burn safety. Which statement made by a parent requires intervention by the nurse? "I had our plumber lower our water heater temperature to 130°F (53°C). "I always make sure the little ones stay out of the kitchen when I am cooking." "We made a song out of 'stop, drop and roll' to teach our children fire safety." "We installed smoke detectors on every floor in our home."

"I had our plumber lower our water heater temperature to 130°F (53°C)

The nurse is teaching the parents of a child diagnosed with erythema multiforme about the condition. The nurse determines that the teaching was successful based on which statement by the parents? "The sulfa drug our child was taking caused this rash." "We need to have our child avoid exposure to nickel." "After this one episode, our child will not have it again." "The rash should go away in about 2 weeks."

"The rash should go away in about 2 weeks." Explanation: Parents need to know that the lesions should resolve within 2 weeks. However, some children do develop recurrent erythema multiforme. The most common cause of this condition is infection with the herpes simplex virus, with fewer than 10% of cases being drug related. Stevens-Johnson syndrome is often related to the use of sulfa drugs. Contact dermatitis, specifically nickel contact dermatitis, is caused by exposure to nickel.

A nurse is providing care to a 13-year-old client hospitalized with deep partial- and full-thickness (deep second-degree and third-degree) burns on the neck, torso and arms. The nurse attempts to begin a treatment, but the client refuses and angrily tells the nurse "What is the point in all this? I will never be the same again!" What action should the nurse take? Express disappointment in the client's behavior. Tell the client that this behavior will not be tolerated. Leave the room to give the client a chance to calm down. Acknowledge that the client is upset and offer to talk about feelings.

Acknowledge that the client is upset and offer to talk about feelings.

The mother of a child with pediculosis capitis infestation tells the nurse that she does not understand why her child still has the infestation. The mother states, "I used the prescribed treatment just like I was instructed." How should the nurse respond? "Have you been combing the hair for nits from the hair on a weekly basis?" "After finding the infestation did you wash items that your child's head came into contact with, like bed linen?" "Maybe you should use some of the home remedies like petroleum jelly or mayonnaise." "Do you wash your child's hair daily? Having clean hair will help get rid of the infestation."

After finding the infestation did you wash items that your child's head came into contact with, like bed linen?"

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

Complete the prescribed antibiotics.

When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate? "Children who are immunocompromised are more likely to contract shingles." "Herpes zoster is a reactivation of a previous varicella zoster infection." "Your child must have been exposed to someone with herpes zoster." "Handwashing is an effective way to prevent the spread of infectious disorders."

Herpes zoster is a reactivation of a previous varicella zoster infection."

A nurse is conducting a parenting class on infant skin care. What information should the nurse include when preparing materials on the characteristics of the skin of infants? Select all that apply. The epidermis is thicker than in adults. Substances are easily absorbed. It is thinner and more fragile than an adult's Skin is less susceptible to the sun. Sweat glands are fully functioning at birth.

It is thinner and more fragile than an adult'sSubstances are easily absorbed.An infant's skin is more fragile than that of adult's and is more susceptible to breakdown as well as the effects of the sun. The epidermis of an infant's skin is much thinner than an adult's and does not reach the thickness of adult skin until late adolescence. Sweat glands are immature at birth, contributing to the difficulty infants have in regulating temperature. Sweat glands do mature as the infant grows.

The appearance of which hallmark clinical manifestation occurs in measles? Conjunctivitis Koplik spots Cough Fever

Koplik spots Explanation: The hallmark symptom of measles is the appearance of Koplik spots. These occur a few days before the outbreak of the rash. They are classic in appearance, described as a red ring around white dots. They occur on the buccal mucosa generally around the first and second molars. Measles has fever, conjunctivitis, and a cough as prodromal symptoms, but these are not definitive for measles as they can occur with many other illnesses.

A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child? Mumps Mononucleosis Fifth disease Measles

Mumps

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? Question the parent about methods of punishment. Observe the infant's respiratory effort. Determine whether the child is breastfed or formula fed. Examine the lips and oral mucosa for cyanosis.

Observe the infant's respiratory effort.

An adolescent is brought to the urgent care clinic for evaluation of the hands. The adolescent had been out snowboarding for the past several hours in 20°F (-6.7°C) temperatures. The adolescent was wearing gloves but took them off because they were wet and causing problems with holding onto the snowboard. The nurse completes an assessment and documents the findings. Based on the assessment findings above, which action would be appropriate as part of the plan of care? Massage both hands vigorously for 5 minutes. Notify the health care provider if the hands become red. Contact a plastic surgeon to debride the skin. Place the hands in warm water for 30 minutes.

Place the hands in warm water for 30 minutes.

After teaching a group of nursing students about varicella zoster infection, the instructor determines that the teaching was successful when the students identify which of the following? The incubation period is 7 days. It tends to be more severe in children. Secondary bacterial infections of the skin can occur as a complication. It is transmitted by fecal-oral route.

Secondary bacterial infections of the skin can occur as a complication. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.

The nurse is evaluating the plan of care of a child with measles. Which outcome(s) indicates the plan of care has been effective for the child? Select all that apply. The child maintains adequate hydration. The child's comfort is maintained. Oxygen saturation remains at 95% or above. Testicular swelling decreases. Fever resolved at day 7.

The child maintains adequate hydration. Fever resolved at day 7. The child's comfort is maintained. Oxygen saturation remains at 95% or above.

he nurse is administering a chickenpox vaccination to a 12-month-old girl. Which concern is unique to varicella? This disease can reactivate years later and cause shingles. Dehydration is caused by mouth lesions. Vitamin A is indicated for children younger than 2 years. Children with this disease need to avoid pregnant women.

This disease can reactivate years later and cause shingles. Explanation: Varicella zoster results in a lifelong latent infection. It can reactivate later in life resulting in shingles. The American Academy of Pediatrics recommends consideration of vitamin A supplementation in children 6 months to 2 years hospitalized for measles. Dehydration caused by mouth lesions is a concern with foot and mouth disease. Avoiding exposure to pregnant women is a concern with rubella, rubeola, and erythema infectiosum.

The nurse is teaching the parents of a 9-year-old child about preventing contact dermatitis. What will the nurse include in the teaching? Select all that apply. Apply precontact solution to exposed areas of skin. Read product labels to ensure that products do not contain offending ingredients. Wash the clothes after exposure to a causative agent such as poison ivy. Use fragrance- and dye-free products. Avoid long-sleeved shirts and pants, which may collect causative agents.

Wash the clothes after exposure to a causative agent such as poison ivy. Apply precontact solution to exposed areas of skin. Read product labels to ensure that products do not contain offending ingredients. Use fragrance- and dye-free products. Explanation: The nurse will instruct the parents to wash the child's clothes after exposure to a causative agent such as poison ivy, apply precontact solution to exposed areas, read product labels to ensure that products do not contain offending ingredients, and to use fragrance- and dye-free products. The child should wear long-sleeved shirts and pants, which are protective against causative agents such as poison ivy.

A 5-year-old child is brought to the pediatric health clinic for evaluation. The nurse completes the assessment and documents the findings. Based on the assessment findings above, which condition would the nurse suspect? maculopapular rash noted on head and extending to trunk and upper extremities. Clusters of white lesions with erythematous base on buccal mucosa. Nasal mucosa inflamed with clear discharge. conjuctiva rededened with nonpurulent drinage. rubella cellulitis varicella measles

measles

The nurse is assessing the skin of a 6-year-old child with urticaria. When interviewing the child and parents, which question would be most important for the nurse to ask? "Did you do anything at home to treat the rash?" "Is there any itching with the rash?" "When did you first notice the rash?" "Is the child having any trouble breathing?"

"Is the child having any trouble breathing?" Explanation: Although all the questions are important to obtain information about the urticaria, asking about any difficulty breathing is the priority question. Urticaria is caused by an allergic trigger and anaphylaxis is always a concern. If the child experiences breathing difficulties, the nurse would need to intervene immediately to ensure airway and breathing. Once airway and breathing are ensured, the nurse can gather additional information.

The nurse is teaching the parents of a 7-year-old child who was exposed to an adolescent infected with measles about 2 weeks ago. The child has not been immunized. Which statement by the parents requires further follow up by the nurse? "The best treatment for measles is prevention with the MMR vaccine." "My child is contagious for 4 days prior to the appearance of a rash." "It has been 14 days since the exposure, so my child is not infected." "It is not recommended for my child to receive Ig or the MMR vaccine at this time."

"It has been 14 days since the exposure, so my child is not infected." Explanation: The statement, "It has been 14 days since the exposure, so my child is not infected," requires further follow up by the nurse, because the incubation period of measles is up to 21 days. The statements, "My child is contagious for 4 days prior to the appearance of a rash," "The best treatment for measles is prevention with the MMR vaccine," and, "It is not recommended for my child to receive Ig or the MMR vaccine at this time," are all accurate with regard to measles and do not require further follow up by the nurse.

The nurse is caring for a 6-year-old boy with mumps. Which of the following statements by the child would cause the nurse to suspect the boy is experiencing a complication of mumps? "My knees are sore and stiff." "I feel wobbly when I walk." "I keep coughing up mucus." "Please talk a little louder."

"Please talk a little louder." Rationale:Complications of mumps include meningoencephalitis with seizures and auditory neuritis, which can result in deafness. Joint complaints, which might suggest arthritis, are a complication of erythema infectiosum. Difficulty walking, which might suggest cerebellar ataxia, is a complication of chickenpox. Coughing, which might suggest bronchopneumonia, is a complication of rubeola.

A new parent brings the 3-month-old infant to the clinic for a well-baby check up. During the visit, the parent asks the nurse, "I know the rays from the sun can be harmful, so what should I do to protect my infant?" Which suggestion by the nurse would be most appropriate? "As long as you use a sunscreen, your infant will be protected from the sun." "A wide-brimmed hat and an umbrella for shade should be enough for your infant." "Invest in clothing that has sun protective factor (SPF) already in the material." "The best thing to do is keep any infant under the age of 6 months out of the sun."

"The best thing to do is keep any infant under the age of 6 months out of the sun." Explanation: For infants under the age of 6 months, it is best to keep them out of the sun to reduce their risk of exposure to the sun's damaging rays. Sunscreen should be applied sparingly in infants younger than 6 months. As the infant gets older, he or she should have sunscreen of at least 15 SPF applied to all exposed areas and have it reapplied every 2 hours or after swimming or sweating. Clothing with SPF built in, a wide-brimmed hat, and umbrellas for shade are appropriate once the infant is over the age of 6 months.

The nursing is caring for a hospitalized child diagnosed with varicella-zoster virus. The child's parents ask how to prevent the child's siblings from contracting the virus. Which response by the nurse is best? "We will place your child on contact and airborne precautions. It is best for the other children not to visit." "As long as your other children wash their hands, they should not contract the virus." "Since this is a virus, there is nothing you can do to prevent your other children from getting it." "Vaccinating your other children is the only way to prevent them from contracting the virus."

"We will place your child on contact and airborne precautions. It is best for the other children not to visit." Explanation:The causative agent for chickenpox is the varicella-zoster virus, which is spread through contact and airborne methods. The client should be placed on precautions and limit visitors who are at risk.

A nurse is providing care to an infant who is admitted with burns over the face, neck and chest. The nurse identifies which goal as priority for planning the infant's care? Pain is at a tolerable level. Fluid balance is maintained. Airway remains patent. Wounds remain infection-free.

Airway remains patent. Explanation: The priority goal is to maintain a patent airway especially because the burns affect the face and neck. Adequate output, maintaining pain at a tolerable level, and keeping the burns free from infection are all appropriate goals for this infant, but maintaining a patent airway is the priority.

The nurse is caring for a child presenting with plaques around the nose and mouth that have a honey-crusted appearance. What treatment does the nurse anticipate for the child? acyclovir for 5 to 7 days one application of malathion left on overnight topical mupirocin for 10 to 14 days one application of permethrin, then repeat application in 7 days

topical mupirocin for 10 to 14 days Explanation: The nurse will anticipate topical mupirocin therapy for 10 to 14 days in the child presenting with plaques around the nose and mouth that have a honey-crusted appearance. These findings are consistent with nonbullous impetigo. Acyclovir is indicated for children with herpes zoster, and permethrin and malathion are indicated for children with head lice.