Chapter 29. Integumentary Disorders

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?" "Does your child have any allergies to medications?" "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?" Explanation: 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 discussing fever with the parents of a child who is in the emergency department with a temperature of 101 degrees Fahrenheit. Which statement by a parent indicates an understanding about fevers and their management in the ill child?

"Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection."

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? "Your child must have been exposed to someone with herpes zoster." "Herpes zoster is a reactivation of a previous varicella zoster infection." "Handwashing is an effective way to prevent the spread of infectious disorders." "Children who are immunocompromised are more likely to contract shingles."

"Herpes zoster is a reactivation of a previous varicella zoster infection." Explanation: Herpes zoster (shingles) is reactivation of the latent varicella zoster (chickenpox) infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.

A 4-year-old is brought to the urgent care center for evaluation of a burn on the forearm. On inspection, the burn is minor. After teaching the parents about how to care for this minor burn. the nurse determines that the teaching was successful based on which statement by the parents?

"If blisters form, we should leave them alone and not break them."

Skin inspection reveals linear lesions on both legs, below the knees. Numerous reddened macules and pustules appear in a linear fashion across the anterior and lateral aspects of the lower legs. Child reports intense pruritus. Rash is limited to lower legs. The nurse is inspecting the skin of a child with a rash on the lower legs and documents the above findings. Based on the findings, which question would the nurse most likely ask next? "Was your child outside near some plants that could be poison ivy?" "Is there any metal in your child's clothing that is near the lower legs?" "Did you recently change your detergent for washing your clothes?" "What type of soap does your child use to wash the skin?"

"Was your child outside near some plants that could be poison ivy?" Explanation: The rash described in the documentation (linear patter with pustules and erythema) suggest allergic dermatitis associated with exposure to plants such as poison ivy. Therefore, the next question should focus on possible exposure to the plant oils. The questions about detergent or soaps would be appropriate if the rash suggested irritant dermatitis as demonstrated by a more diffuse pattern. Asking about metal in the child's clothing would be appropriate if the rash suggested nickel dermatitis, which would be typically found at the navel, belt line, or earlobes.

The nurse is teaching the parents of an 8-year-old child diagnosed with folliculitis on both arms about caring for their child. The nurse determines that additional teaching is needed based on which statement by the parents? "We can apply a steroid cream to the area to help with the itching." "We should apply warm compresses to the area several times a day." "We need to wash the area with warm soap and water to keep it clean." "We should call our health care provider if the lesions get bigger in size."

"We can apply a steroid cream to the area to help with the itching." Explanation: Folliculitis is self-limiting but is often treated with topical antibiotics. However, the lesions generally do not cause pain or pruritus. Therefore, there is no need to apply steroid creams. The parents should wash the affected area with soap and warm water and apply warm compresses several times a day. The parents should also notify their health care provider if the lesions get bigger rather than smaller, feel warm to the touch, or have drainage.

A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent?

"Your child may return to school when all of the lesions have crusted over." Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though the child is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.

A child is diagnosed with varicella zoster and has been prescribed acyclovir 15 mg/kg q 8 hours IV. The child weighs 61.7 lb (28 kg). How many milligrams should the nurse administer in each dose? Record your answer using a whole number.

420 Explanation: The nurse will use the client's weight in kilograms, multiplying it by the prescribed dosage. 28 kg x 15 mg/kg = 420 mg in each 8-hour dose

The nurse is caring for an immunocompromised child with a primary varicella zoster infection undergoing treatment with acyclovir. What is a nursing consideration(s) while administering this therapy? Select all that apply. Administer 10 to 15 mg/kg. Explain that itching may increase temporarily. Continue 48 hours after last new lesions appear. Give 4 times daily for 5 to 7 days. Infuse over 1 hour.

Administer 10 to 15 mg/kg. Infuse over 1 hour. Continue 48 hours after last new lesions appear. Explanation: The nurse will administer acyclovir 10 to 15 mg/kg every 8 hours, infusing the medication over 1 hour for an immunocompromised child. The medication will be continued until 48 hours after the last new lesions appear. The nurse should explain that itching will not increase with acyclovir therapy. When acyclovir is given by mouth, it should be administered 4 times daily for 5 to 7 days, but the drug is given every 8 hours for 5 to 10 days when administered by IV infusion.

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

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.

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. "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?"

Are your child's immunizations up to date? "Did your child provoke the dog?"

The nurse is caring for a child brought to the emergency department after an animal bite. Which action will the nurse perform first? Question the child about malaise, pain, and hydrophobia. Assess the child's height, weight, and temperature. Ask if the animal was provoked prior to the bite. Administer rabies vaccine and rabies immune globulin.

Ask if the animal was provoked prior to the bite. Explanation: When a child presents with an animal bite, the nurse will ask the child if the animal was provoked prior to the bite. Animals with rabies will bite unprovoked. If the child states the animal bit without being provoked, and the animal is at risk for rabies, the nurse will administer the rabies vaccine and rabies immune globulin as prescribed by the health care provider and recommended by the local health department. Signs and symptoms of rabies, including fever, malaise, anorexia, pain, and hydrophobia, will occur on average 1 to 3 months after the bite. The nurse's priority is to gather history to help determine if the child needs treatment for rabies to avoid progression to the disease, which is almost always fatal.

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. Assess for hypopigmentation. Teach the child and parents to keep the lesion uncovered. Assess for increased warmth around the wound. Advise the child not to scratch the affected area. Teach hand hygiene to the child and parents.

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 child injured in a house fire is brought to the emergency department. What assessment(s) is a priority for the nurse to perform? Select all that apply. Provide psychosocial support to the family. Determine the total body surface area covered in burns. Examine the face for signs of soot. Remove the clothing to inspect burned areas. Assess the child's respiratory effort.

Assess the child's respiratory effort. Examine the face for signs of soot. Remove the clothing to inspect burned areas. Explanation: The most important initial assessments for the nurse to make are the child's airway, breathing, and circulation. These include the breathing efforts, changes in the child's color, and examining the face for signs of soot. Soot could indicate smoke inhalation and burns of the respiratory passages. Circulation will be assessed by heart rate and blood pressure. This is important because the child may be in shock. The clothing should be removed to assess the areas of burns. The clothing also holds in heat and needs to be removed to stop the burning process. Once assured that the child is stable in these areas, then the body surface area can be measured and the amount of fluids to be infused started. Psychological support for the family should be provided, but it is best done by a social worker or chaplain while the health care team works with the child.

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. Children should avoid sharing personal items such as combs and hats. Head lice infestation is the result of poor personal hygiene. A second treatment one week after the first is recommended. 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. Parents should inspect their child's head for nits with a fine tooth comb. A second treatment one week after the first is recommended. Explanation: To prevent head lice infestation children should avoid sharing personal items such as barrettes, combs, and hats. Parents should also wash and dry clothes, bedding, and hats using high temperatures. Vacuuming soft surfaces that cannot be laundered (sofas and chairs) is also helpful. Parents should inspect their child's head daily with a fine tooth comb for nits (lice eggs) after treatment. A second treatment is often necessary 1 week to 10 days after the first. A head lice infestation can happen to any child and is not a reflection of poor hygiene or socioeconomic status. Shampoos with specific medications are necessary to treat head lice (permethrin).

One difference between erythema multiforme and urticaria is that the lesions in erythema multiforme disappear after 24 hours but urticarial lesions do not. FALSE TRUE

False

The nurse is providing care to a 6-year-old child who was stung by a honey bee. Inspection reveals that the stinger is still present. Which action by the nurse would be appropriate? Apply a cold compress over the stinger to loosen it. Pinch the skin to cause the stinger to fall out. Use a paste of baking soda to soften the stinger. Remove the stinger by scraping the skin.

Remove the stinger by scraping the skin. Explanation: If the stinger is still present, the nurse should remove it by scraping the skin. Pinching the skin should be avoided because it may release more venom from the stinger. Cold compresses are used for pain relief, not to loosen the stinger. Meat tenderizer or a baking soda paste may also be applied to promote comfort, not to soften the stinger for removal.

A young girl arrives at the emergency room after being bitten by a neighbor's dog. The mother is concerned her daughter will get rabies. The nurse carefully examines and treats the bite and questions the mother and daughter about the details surrounding the dog biting her. What information would most strongly indicate a risk for rabies infection in this client? The dog belonged to a neighbor The dog was properly immunized for rabies The dog was unprovoked when he bit the girl There have been no other reported instances in the area

b. The dog was unprovoked when he bit the girl

A child is seen in the clinic because of a rash over the face and trunk area for the past 4 days. The nurse completes an assessment and suspects the child has rubeola. Which assessment finding best supports the nurse's suspicion?a. pruritusb. feverc. Koplik spotsd. malaise

c. Koplik spots

The nurse is conducting a presentation for a group of parents at the local pediatric community health center. The nurse is describing the importance of immunizations to prevent common viral infections such as rubeola and rubella. As part of the presentation, the nurse describes the development of rubeola and explains the progression of signs and symptoms. Place the signs and symptoms listed below in the order that the nurse would describe them. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Koplik spots 2rash 3desquamation 4fever

fever rash Koplik spots desquamation Explanation: Children initially present in the prodromal, or early symptom, phase. During this phase, children experience mild fever, conjunctivitis, coryza, and cough. Koplik spots, which are clustered white lesions, may or may not be apparent on the oral mucosa at the time of presentation. However, Koplik spots appear within 4 days of the rash onset. Fever is highest 1 to 2 days before the appearance of the rash. The rash is maculopapular, beginning at the head and progressing down the trunk and upper extremities. After 5 days, the rash begins to fade, leading to desquamation.

A 7-year-old child is brought to the emergency department after suffering a burn injury. The nurse would expect the child to be transferred and admitted to the burn center based on which finding(s)? Select all that apply. evidence of smoke inhalation injury demonstration of full-thickness (third-degree) burns on trunk history of type 1 diabetes since age 3 partial-thickness (second-degree) burn affecting 5% of child's body surface area burns affecting the child's face and hands

history of type 1 diabetes since age 3 burns affecting the child's face and hands evidence of smoke inhalation injury demonstration of full-thickness (third-degree) burns on trunk Explanation: The American Burn Association has established criteria for when children should be admitted to a burn center. These include: partial-thickness (second-degree) burns affecting over 10% of the body surface area; burns involving the face, hands, feet, joints, or genitalia; full-thickness (third-degree) burns in a child of any age; inhalation injury, regardless of the type of burn; preexisting medical conditions that could complicate recovery (such as type 1 diabetes); chemical or electrical burns; suspected child abuse (child maltreatment); poor social situation; concomitant injuries; and burns that will require extensive rehabilitation and emotional support.

5-year-old child presents with fever (100.2°F [37.9°C]) and cough. Parents report temperature rose to 101°F (38.3°C) about 24 hours before rash was seen. Nasal mucosa inflamed with clear discharge. Conjunctiva reddened with nonpurulent drainage. Maculopapular rash noted on head and extending to trunk and upper extremities. Clusters of white lesions with erythematous base apparent on buccal mucosa 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? cellulitis rubella varicella measles

measles Explanation: The assessment findings suggest measles (rubeola). Children initially present in the prodromal, or early symptom, phase. During this phase, children experience mild fever, conjunctivitis, coryza, and cough. Conjunctival drainage is nonpurulent. Koplik spots, which are clustered white lesions, may or may not be apparent on the oral mucosa at the time of presentation. However, Koplik spots appear within 4 days of the rash onset. Fever is highest 1 to 2 days before the appearance of the rash. The rash is maculopapular, beginning at the head and progressing down the trunk and upper extremities. Rubella is characterized by a prodromal period consisting of fever, malaise, headache, sore throat, and red eyes. The rash begins on the face and neck as irregular macules. The rash on the face disappears as it spreads to the trunk and lasts no longer than 3 days. Varicella is characterized by prodromal symptoms including fever, malaise, and headache for 24 to 48 hours before the eruption of lesions. Skin lesions appear in various stages. New lesions appear as old ones scab over. The lesion begins as an erythematous macule and progresses to a pustule and finally a clear fluid-filled vesicle. The rash is severely pruritic. Children with cellulitis often have fever, chills, and lymphadenopathy. Infected areas are erythematous and warm to the touch and may be edematous and painful. There is no rash with cellulitis.

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? "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 should apply the medication to our child's hair and scalp when it is dry." "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."

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? until the rash disappears, which is about 3 days until there are no more new lesions and lesions have crusted over for up to 8 days more after the rash initially appears for 4 days more now that the rash is present

. Until there are no more new lesions and lesions have crusted over

A 10-year-old child brought to the emergency department after being outside in the frigid weather for several hours is diagnosed with second-degree frostbite of the hands. Treatment includes rewarming the hands. When preparing the water for the rewarming process, which water temperature would be appropriate for the nurse to use? 97.5°F (36.4°C) 100°F (37.8°C) 95°F (35°C) 102.8°F (39.3°C)

100°F (37.8°C) Explanation: Rewarming is accomplished by placing the affected areas in warm water at a temperature of 37°C (98.6°F) to 39°C (102.2°F) for at least 30 minutes.

The nurse is preparing to perform a dressing change for a 9-year-old child with a severe burn injury. What nonpharmacologic intervention(s) will the nurse perform to decrease pain and discomfort for the child? Select all that apply. Encourage the child to ignore the procedure. Allow the child to choose where on the body to start procedure. Avoid speaking during the dressing change. Allow the child to choose means of distraction. Provide positive feedback.

Allow the child to choose means of distraction. Provide positive feedback. Allow the child to choose where on the body to start procedure. Explanation: The nurse will allow the child to choose a means of distraction such as listening to music or watching television. Positive feedback during the procedure creates a therapeutic environment. The nurse will also allow the child to choose where on the body to start the procedure, because this encourages the child to be involved in the process. Avoiding speaking and encouraging the child to ignore the procedure do not encourage the child's involvement during the procedure.

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

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. Explanation: The nurse should teach the parents to have their child apply sunscreen, recognize and avoid poison oak, and avoid approaching strange pets without permission. The parents should learn to identify infestations such as lice, scabies, and bed bugs. The parents should use insect spray because of its importance for preventing insect stings.

A nursing instructor is teaching about infectious diseases in childhood. The teacher identifies a need for clarification when a student makes which of the following statements? "Lesions in chickenpox progress at the same rate." "Lesions of smallpox arise as one crop of lesions." "Lesions in smallpox progress at the same time." "Lesions of smallpox resemble those of chickenpox."

b. "Lesions in chickenpox progress at the same rate.

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?

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

The nurse is providing care to a 5-year-old child brought to the emergency department with a cat bite wound on the arm. While teaching the parents how to care for the wound, the child's mother asks the nurse, "Why isn't the bite being stitched closed?" Which response by the nurse would be appropriate?

"Bites from cats are likely to become infected, so it is better to leave the wound open and heal from the inside out."

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? "Dressings containing silver help prevent infection." "Silver has been shown to speed up the healing process." "Silver is used to help prevent any scarring." "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.

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? "When did you first notice the rash?" "Is the child having any trouble breathing?" "Is there any itching with the rash?" "Did you do anything at home to treat the rash?"

"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.

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." "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." "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." 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 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." "After this one episode, our child will not have it again." "The rash should go away in about 2 weeks." "We need to have our child avoid exposure to nickel."

"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.

The nurse is assessing a child with a varicella infection.The nurse would be alert for which possible complication(s) Select all that apply?

-Secondary Bacterial infection -Pneumonia -Scarring -Encephalitis

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? 72 ml 80 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? 60 minutes 45 minutes 30 minutes 15 minutes

60 minutes Explanation: When acyclovir is given intravenously to a immunocompromised child with varicella, the nurse would administer the medication over a period of 1 hour.

Following a head lice infestation, parents should be instructed to place stuffed animals in garbage bags and seal them tightly for at least hours to kill any live bugs.

72

The rash in roseola is pruritic. Which measure would you teach the parent to provide comfort?

Apply cool compresses to the skin to stop local itching.

The nurse is caring for a 2-month-old infant. What action(s) will the nurse take to help prevent skin breakdown? Select all that apply.

Assess the skin at regular intervals.Perform frequent diaper changes as appropriate.Note areas of redness on the skin.

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

Complete the prescribed antibiotics. Explanation: 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.

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."

Correct response: "Please talk a little louder." Explanation: 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.

What information should be included in the teaching plan for a child with varicella? Utilize salt solutions to assist in healing oral lesions. Place the child in a warm bath for skin discomfort. Remind the child not to scratch the lesions. Administer aspirin for fever.

Correct response: Remind the child not to scratch the lesions. Explanation: Varicella lesions appear first on the scalp. They spread to the face, the trunk, and to the extremities. There may be various stages of the lesions present at any one time. The lesions are intensely pruritic. The teaching plan for varicella should include that the child not scratch the lesions. Opening the lesions gives access for secondary infection to occur and causes scarring. Acetaminophen, not aspirin, should be administered for fever due to the link with Reye syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. Warm baths cause more itching and dry the skin.

A nurse is providing care to a child with partial and full thickness burns over 26% of the body. In monitoring the child's output the nurse expects an output of 1 to 2 mL/kg/hr. The nurse has emptied 46 mL from the foley catheter for the past hour. The child weighs 62 lb (28 kg). What action should the nurse take?

Document the output and continue to monitor.

A parent brings an infant to the clinic for a well child visit. During the assessment, the parent asks the nurse why the infant never seems to sweat. What action should the nurse take?

Explain that this normal mechanism keeps the infant from losing too much water through the skin.

Children with varicella are contagious from as soon as the rash appears until all the lesions have crusted over. FALSE TRUE

False

Contact dermatitis is contagious and can spread from one part of the body to another part by scratching. FALSE TRUE

False

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. Skin is less susceptible to the sun. Substances are easily absorbed. It is thinner and more fragile than an adult's Sweat glands are fully functioning at birth.

It is thinner and more fragile than an adult's Substances are easily absorbed. Explanation: 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.

Children with measles usually have clustered white lesions on the oral mucosa known as spots.

Koplik Spots

A child who developed parotid gland swelling on March 5 was diagnosed with mumps. The nurse determines that the child will no longer be contagious at which time?

March 14

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? Notify the health care provider if the hands become red. Place the hands in warm water for 30 minutes. Massage both hands vigorously for 5 minutes. Contact a plastic surgeon to debride the skin.

Place the hands in warm water for 30 minutes. Explanation: The key to treating second-degree frostbite is to rewarm the affected area. Rewarming is accomplished by placing the affected areas in warm water at a temperature of 98.6°F (37°C) to 102.2°F (39°C) for at least 30 minutes. Wound care specialists and plastic surgeons would be involved with more severe (third-degree) frostbite. Massaging should be avoided because it can cause tissue damage. As the area is rewarmed, the color of the skin typically appears red to purple.

A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease?

Playing in the woods about a week ago

A nurse completes an assessment on an 8-month-old infant seen in the pediatrician's office for a well-child visit. The nurse notes that the infant's buttocks, perineum and inner thighs are covered in a thick coating of white ointment. When questioned, the parent says the infant has a diaper rash and the ointment is to protect the infant's skin. What is the best action for the nurse to take?

Provide instruction on how to care for a diaper rash.

What is a true statement regarding varicella zoster virus infection? The incubation period is 7 days. Secondary bacterial infections of the skin can occur. It tends to be more severe in children. It is transmitted by fecal-oral route.

Secondary bacterial infections of the skin can occur. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The lesions are intensely pruritic, making the child want to scratch the lesions and opening them to a variety of organisms to invade. 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 caring for multiple clients on the pediatric unit. Which child will the nurse see first?

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first?

To help prevent the spread of impetigo, nurses should teach parents how to clean the lesions, proper hand washing techniques, and the signs and symptoms of secondary infection.

True

When the injury does not match the mechanism of injury reported by the parents, child abuse should be suspected. FALSE TRUE

True

The nurse is caring for a 4-year-old child with a full-thickness (third-degree) burn injury who was trapped in a bedroom during a house fire. What diagnostic testing will the nurse anticipate in the child's plan of care? Select all that apply.a. arterial blood gasesb. carboxyhemoglobin levelc. electrolyte paneld. complete blood count with differentiale. electrocardiogram

a,b,c,d

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? a. Mumps b. Fifth disease c. Measles d. Mononucleosis

a.mumps

An 11-year-old child is brought to the health center for evaluation of a rash. The child's parents report that the rash, located on both arms and trunk, suddenly appeared yesterday. After further assessment, the nurse suspects erythema multiforme based on which finding? reddened, painful swollen subcutaneous tissue small pustules at the base of hair follicles honey-crusted plaques with small vesicles bull's-eye appearance of the lesions

bull's-eye appearance of the lesions Explanation: Erythema multiforme appears as an abrupt onset of lesions symmetrically distributed across the upper extremities, trunk, and, possibly, the oral mucosa. The lesions are characteristically doughnut-shaped. Papules have an erythematous border with a central clearing, giving the appearance of a target or a bull's-eye. Impetigo is characterized by small vesicles that develop into plaques with a honey-crusted appearance. Folliculitis is characterized by small pustules located at the base of hair follicles. Cellulitis is characterized by inflammation and infection of the subcutaneous tissue that is warm to the touch, edematous, and painful.

A 10-year-old child is brought to the health care provider's office by the child's parent. The parent voices concern over the appearance of the child's arms. The nurse documents the assessment above. The nurse suspects folliculitis. Which question would the nurse ask to help confirm the suspicion? a. "Did the child have any recent cuts or trauma to the skin?" b. "Has your child ever been vaccinated against rubeola?" c. "Has the child been swimming in a lake or hot tub recently." d. "Has the child been in the woods near any poison ivy or oak?"

c

A 10-year-old child is brought to the clinic by the parents for evaluation of swelling of the foot. The child tells the nurse, "I wore new soccer shoes and got a blister. The blister broke and is red." Further inspection reveals an edematous third toe on the right foot. The area is reddened and warm and tender to the touch. A diagnosis of cellulitis is made and medication is prescribed for the child. The nurse would most likely educate the child and parents about which medication? permethrin mupirocin cephalexin ampicillin

cephalexin Explanation: The drug of choice for treating cellulitis in children is cephalexin. Ampicillin is not typically used. Mupirocin is used to treat impetigo. Permethrin is used to treat head lice.

------frostbite results in skin that appears waxy, has a blue or white tint, and is hard to the touch.

second-degree

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

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.

A parent calls the pediatric clinic and tells the nurse that the child has developed a large rash. Which question is most important for the nurse to ask the parent? "How long has the child had the rash?" "Is the child up to date on immunizations?" "What more can you tell me about the rash?" "Has there been a change in your child's behavior?"

"What more can you tell me about the rash?" Explanation: It is most important for the nurse to find out more about the child's rash (the color, the location, is there any itching). This will help the nurse determine if this is a contact dermatitis or a bacterial or viral infection. Asking how long the child has had the rash, whether the child has had a change in behavior, and whether the child is current with immunizations are also appropriate. However, gathering more information about the rash itself is most important.

When describing measles to a local parent group, the nurse explains that which of the following is the hallmark clinical manifestation? conjunctivitis fever cough Koplik spots

Koplik spots Explanation: The hallmark of measles is the appearance of Koplik spots. Other typical symptoms include fever, conjunctivitis, and a cough.

A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Crusting 2Macular rash 3Vesicle formation 4Low-grade fever 5Papular rash

Low-grade fever Macular rash Papular rash Vesicle formation Crusting Explanation: The disease is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a rash. The lesion begins as a macula, then progresses rapidly within 6 to 8 hours to a papule, then to a vesicle that first becomes umbilicated and then forms a crust.

A young client in the clinic has a rash, cough, and fever that the parent says spiked on day 5 of the rash. The client also had conjunctivitis. What illness would the nurse expect the health care provider to diagnose?

Measles

A child, injured in a house fire, is brought to the emergency department. The nurse performs a primary assessment on the child. What assessment(s) is important for the nurse make initially? Select all that apply.

Observe the child's breathing effortsExamine the face for signs of sootObserve for changes in the child's color

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes pustule?

Small elevation of epidermis filled with a viscous fluid

Swelling of the dermis and subcutaneous tissue known as may be present in children with urticaria.

angioedema

Parotid gland swelling is the hallmark presentation of

mumps

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 one application of permethrin, then repeat application in 7 days topical mupirocin for 10 to 14 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.

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 am going to give my child a baby aspirin to decrease their itchiness and so they can rest better." "I have placed gloves on both of my child's hands so they will not scratch and cause an infection." "I will try an oatmeal bath or oatmeal cream with an antihistamine to soothe the child's lesions." "I will keep my child home from school until all of the lesions have completely crusted over."

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

"I had our plumber lower our water heater temperature to 130°F (53°C). Explanation: Water heater temperature should be 120°F (49°C) or lower to prevent significant burns. Installing smoke detectors on every floor of a home is recommended. Keeping young children out of the kitchen during food preparation is important. Teaching children to stop, drop, and roll is important for fire safety.

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." "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." "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." 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 parent of a child diagnosed with nonbullous impetigo brings the child back to the clinic. The parent states, "I am doing what I am supposed to for my child, but the lesions have not gone away yet." The child began treatment with a topical antibiotic ointment 7 days ago. Which response by the nurse is most appropriate? "It takes 10 to 14 days for the lesions to decrease." "It looks like a secondary infection has started." "Your child most likely developed another type of skin infection." "The medicine is taking longer to treat the infection than usual."

"It takes 10 to 14 days for the lesions to decrease." Explanation: Typically, treatment for nonbullous impetigo with a topical antibiotic ointment lasts for 10 to 14 days with the expected outcome that the presence of the lesions will decrease over this time. Since it has only been 7 days since treatment started, the lesions would not be expected to be gone in this period of time. There is no evidence to support a secondary infection or another type of skin infection. The medicine is given for 10 to 14 days, so it would be inappropriate to tell the parent that the medication is taking longer to treat the infection.

Skin pale pink, moist, and warm to touch. Multiple areas of raised pinpoint erythematous macules noted on upper arms and forearms. Macules are warm to touch with distinct edges. No oozing or drainage noted. Child observed scratching areas, stating, "I'm so itchy." 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? "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." Explanation: For skin disorders that cause itching, the nurse would instruct the parents to pat the skin dry and not to rub it. The nurse would also teach the parents to place the child in a lukewarm bath, using a commercial oatmeal bath product, if desired, and to apply antibiotic ointment, hydrocortisone cream, or moisturizers while the skin is still damp. The child should wear loose clothing to promote air circulation and avoid sweating, which could exacerbate pain and itching.

Two siblings, a 5-year-old and 3-year-old, brought to the clinic for evaluation of rash. Reddened papules noted on the arms and neck of the 5-year-old; reddened papules noted on the arms, neck, and trunk of the 3-year-old. Papules on both children arranged in a linear fashion in groups of three. Both children report feeling "very itchy." Children share a bedroom in the house. Parents deny any similar lesions or complaints. Two siblings, a 5-year-old child and a 3-year-old child are brought to the clinic by their parents. The parents are concerned because each child has developed a rash. The nurse documents the assessment findings. Which information would the nurse include when teaching the parents about caring for their children? Select all that apply. "Check your children's bedroom first thing in the morning for bedbugs." "Wipe down all the surfaces in your home with a disinfectant." "Wash all of your sheets and clothes in hot water." "Schedule a professional exterminator to come in to get rid of the bugs." "Put items that cannot be washed into a closed trash bag for at least 3 days."

"Wash all of your sheets and clothes in hot water." "Put items that cannot be washed into a closed trash bag for at least 3 days." "Schedule a professional exterminator to come in to get rid of the bugs." Explanation: The nurse suspects bedbug infestation. The parents should be taught to wash all sheets and clothing in hot water or place items in the dryer on high heat for at least 30 minutes to kill any live bugs. Items that cannot be washed should be placed in a closed trash bag for at least 72 hours. The parents should look for bedbugs at night with a flashlight under mattresses and box springs, around headboards, and in crevices in the children's bedroom. A professional exterminator is needed to rid the house of bedbugs. Wiping down surfaces with a disinfectant will not be effective.

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? "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." "Since this is a virus, there is nothing you can do to prevent your other children from getting it." "As long as your other children wash their hands, they should not contract 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. Vaccinating is the best way to prevent the spread of varicella; however, it is not the only way. Preventing exposure will work as well. Stating there is nothing that can be done is incorrect. Handwashing is not effective against varicella.

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 Explanation: 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

The nurse working in a pediatrician's office is caring for a 5-year-old child whose parent brings the child to the office for a possible skin infection. A focused assessment reveals warm, swollen, and painful area on the child's lower leg. The child states that they feel cold. The nurse assesses palpable cervical lymph nodes. Vital signs: temperature, 100.4°F (38°C); heart rate, 110 beats/min; respiratory rate, 24 breaths/min; oxygen saturation, 98% on room air. For each assessment finding, click to specify if the finding indicates impetigo, cellulitis, or folliculitis. Each finding may support more than 1 disease process. Folliculitis Cellulitis Impetigo lymphedema erythema swelling pain fever

Impetigo: Erythema, Lymphedema Cellulitis:Erythema,pain,swelling,lymphedema,fever Folliculitis: erythema Explanation: Signs and symptoms of impetigo include erythema, regional lymphedema, and small vesicles that develop into plaques with a honey-crusted appearance usually found around the nose and mouth.Cellulitis is an infection of the skin. Signs and symptoms include erythema, pain, swelling, regional lymphedema, and fever.Folliculitis is an infection of a hair follicle. Signs and symptoms include erythema around the follicle. Swelling, pain, and fever are not associated with impetigo.Pain, swelling, lymphedema, and fever are not associated with folliculitis.

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 Fifth disease Measles Mononucleosis

Mumps Explanation: Mumps begins with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe. Mumps is contagious 1 to 7 days prior to the onset of symptoms and 4 to 9 days after the parotid swelling begins. Fifth disease is also known as the "slapping disease," as the rash on the cheeks look like someone slapped the child's face. Measles does not involve parotid swelling or earaches. Mononucleosis does involve swollen lymph nodes but they are in the neck and the axillary area.

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

Observe the infant's respiratory effort. Explanation: 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.

When the health care provider looks in a child's mouth during a sick-visit examinaiton, the parent exclaims: "The tongue is bright red! It was not like that yesterday." The health care provider would most likely prescribe which medication based on the probable diagnosis?

Penicillin to prevent acute glomerulonephritis

When reviewing infectious diseases in the pediatric population, nursing students identify which disease as a common childhood exanthema?

Rubella

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? Secondary bacterial infections of the skin can occur as a complication. It is transmitted by fecal-oral route. 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. 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 mother of a 4-year-old boy has contacted the physician's office. She reports her son was exposed to someone with chickenpox. She has inquired about when her son may show if he has gotten the disease. What information should be provided?

The incubation period for the disease is between 10 and 21 days.

Which of the following is a true statement regarding measles?

The incubation period is 10 to 12 days.

The nurse is caring for a 6-month-old child with a rash. Which information from the parent strongly suggests that roseola is the diagnosis?

The infant's temperature fell when the rash appeared.

A nurse is assessing a child brought to the clinic because of swelling on one side of the face. The nurse assesses the swelling by placing a hand along the child's jawline. The nurse suspects that the child has parotitis because most of the swelling occurs at which location? in front toward the lips behind the nurse's hand toward the child's neck below the nurse's hand above the nurse's hand

above the nurse's hand Explanation: When placing the hand at the jawline, most swelling associated with parotitis is above the nurse's hand. If it is below the hand, the condition is most likely submaxillary adenitis.

A 30-month-old child has been discharged from the hospital after receiving treatment for second-degree (partial-thickness) burns over 6% of the body. One week later, the parent calls the nurse to say that the child has been drinking from a cup for one year, but is now constantly pulling at the mother's breast trying to nurse and refuses to drink from a cup. What is the best way for the nurse respond? Explain that children who have had a serious injury sometimes exhibit regressive behavior. Make an appointment for the parent to bring the child to the clinic for evaluation. Tell the parent to allow the child to nurse as much as the child wants. Encourage the parent to explain to the child that he or she must drink from the cup.

b. Explain that children who have had a serious injury sometimes exhibit regressive behavior.

The nurse is assessing a 10-year-old child with severe burn injuries for signs of sepsis. Which finding(s) will the nurse report to the health care provider immediately? Select all that apply. decreased level of consciousness capillary refill greater than 3 seconds bounding pulses lethargy increased bowel sounds

lethargy capillary refill greater than 3 seconds decreased level of consciousness Explanation: The nurse will report lethargy, capillary refill of greater than 3 seconds, and decreased level of consciousness to the health care provider immediately. Diminished pulses, not bounding pulses, are considered a sign of sepsis. Similarly, decreased bowel sounds, not increased bowel sounds, are a sign of sepsis.

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? touching an open, hot oven door scalding from pulling a hot pan off the stove playing unsupervised with matches playing with a household cleaning agent container

scalding from pulling a hot pan off the stove Explanation: The most common type of thermal burns during the toddler years is scalding burns, which typically result from a child pulling a hot pan off of a stove or being immersed in bathwater that is too hot. Although less common, hot objects, such as irons, flat irons, curling irons, stoves, and ovens can also cause burns. During the school-age years, thermal burns are often caused by playing with matches, fireworks, or gasoline. Ingesting a household cleaning agent would lead to a chemical burn.

10-year-old male with partial-thickness and full-thickness burns over 25% of the body. Vital signs: blood pressure, 102/50 mm Hg; heart rate, 108 beats/min; respirations, 26 breaths/min; temperature, 99.8°F (37.7°C); 02 saturation, 97% (0.97) on 2L via nasal cannula. Level of consciousness (LOC): sedated but arouses easily to verbal commands. Client has two peripheral intravenous lines: in the left antecubital space is 1L Ringers lactate infusing at 200 mL/hour; a saline lock is inserted in the right antecubital space. Client received morphine 30 minutes ago for pain level 10 out of 10. An intensive care nurse has received the above hand-off report from the emergency department nurse. Thirty minutes later, the nurse assesses the child again. Which assessment finding should the nurse investigate further?

temperature 100.5°F (38.1°C) Explanation: The nurse should investigate the increased temperature, because it could be a sign of infection or a response to injury. The child's blood pressure and oxygen saturation has changed minimally. The pain level has decreased slightly and will need to be monitored. However, the temperature is increasing and should be investigated.

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? cold compresses topical antibiotic ointment meat tenderizer baking soda paste

topical antibiotic ointment

Head lice infestations have occurred in several of the elementary schools in the surrounding area. The local school district has asked the nurse to conduct a presentation for parents at the community center about this condition. When preparing this presentation, which information is appropriate for the nurse to include? Select all that apply. It is easier to remove nits from wet hair. Head lice can happen in anyone. Head lice is most often occurs from a lack of hygiene. The child's bed linens should be washed in cold water. Head lice is mainly spread through play.

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.