Chapter 30: The Child with Integumentary Dysfunction

Isotretinoin (Accutane) is indicated for the treatment of acne during adolescence when: a. acne has not responded to other treatments. b. the adolescent is or may become pregnant. c. the adolescent is unable to give up foods causing acne. d. frequent washing with antibacterial soap has been unsuccessful.

ANS: A Isotretinoin is reserved for severe cystic acne that has not responded to other treatments.

A child steps on a nail and sustains a puncture wound of the foot. Which of the following is the most appropriate method for cleansing this wound? a. Wash wound thoroughly with chlorhexidine. b. Wash wound thoroughly with povidone-iodine. c. Soak foot in warm water and soap. d. Soak foot in solution of 50% hydrogen peroxide and 50% water.

ANS: C Puncture wounds should be cleansed by soaking the foot in warm water and soap.

Lymphangitis ("streaking") is frequently seen in: a. cellulitis. b. folliculitis. c. impetigo contagiosa. d. staphylococcal scalded skin.

ANS: A Lymphangitis is frequently seen in cellulitis. If it is present, hospitalization is usually required for parenteral antibiotics.

The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents. Which of the following statements made by a parent indicates a correct understanding of the teaching? a. "I should wash my infant's buttocks with soap and water every time I change the diaper." b. "I will wash with a mild soap and water and dry thoroughly whenever my infant has a bowel movement." c. "I should wash my infant's buttocks with soap before applying a thin layer of oil." d. "I will apply baby oil and powder to the creases in my infant's buttocks."

ANS: A Overwashing the skin should be avoided, especially with perfumed soaps or commercial wipes, which may be irritating.

A child experiences frostbite of the fingers after prolonged exposure to the cold. Which of the interventions would the nurse implement first? a. Rapid rewarming of the fingers by placing in warm water b. Placing the hand in cool water c. Slow rewarming by wrapping in warm cloth d. Using an ice pack to keep cold until medical intervention is possible

ANS: A Rapid rewarming is accomplished by immersing the part in well-agitated water at 37.8° to 42.2° C (100° to 108° F).

Tretinoin (Retin-A) is a topical agent commonly used to treat acne. Nursing considerations with this drug include which of the following? a. Avoid use of sunscreen agents. b. Cosmetics with lanolin and petrolatum are preferred in acne. c. Explain that medication should not be applied until at least 20 to 30 minutes after washing. d. Explain that erythema and peeling are indications of toxicity.

ANS: C The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning sensation.

The most immediate threat to life in children with thermal injuries is: a. shock. b. anemia. c. local infection. d. systemic sepsis.

ANS: A The immediate threat to life in children with thermal injuries is airway compromise and profound shock.

Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. What is the primary purpose of hydrotherapy? a. Débride the wounds. b. Increase peripheral blood flow. c. Provide pain relief. d. Destroy bacteria on the skin.

ANS: A The water acts to loosen and remove sloughing tissue, exudate, and topical medications.

11. The primary treatment for warts is which of the following? a. Vaccination b. Local destruction c. Corticosteroids d. Specific antibiotic therapy

ANS: B Local destructive therapy individualized according to location, type, and number—including surgical removal, electrocautery, curettage, cryotherapy, caustic solutions, x-ray treatment, and laser therapies—is used.

A flat, brown mole less than 1 cm in diameter would be called a: a. patch. b. scale. c. macule. d. plaque.

ANS: C A macule is flat; nonpalpable; circumscribed; less than 1 cm in diameter; and brown, red, purple, white, or tan.

Which of the following is an important nursing consideration when caring for a child with impetigo contagiosa? a. Apply topical corticosteroids to decrease inflammation. b. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris. c. Carefully wash hands and maintain cleanliness when caring for an infected child. d. Examine child under a Wood lamp for possible spread of lesions.

ANS: C A major nursing consideration related to bacterial skin infections, such as impetigo contagiosa, is to prevent the spread of the infection and complications. This is done by thorough hand washing before and after contact with the affected child.

Nitrous oxide is being administered to a child with extensive burn injuries. The purpose of this drug is to: a. promote healing. b. prevent infection. c. provide anesthesia. d. improve urinary output.

ANS: C The use of short-acting anesthetic agents, such as propofol and nitrous oxide, has proven beneficial in eliminating procedural pain.

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise the father to: a. apply warm compresses. b. carefully scrape off stinger. c. take child to emergency department. d. apply a thin layer of corticosteroid cream.

ANS: C The venom of the black widow spider has a neurotoxic effect. The father should take the child to the emergency department for treatment with antivenin and muscle relaxants as needed.

Which of the following explains physiologically the edema formation that occurs with burns? a. Vasoconstriction b. Decreased capillary permeability c. Increased capillary permeability d. Decreased hydrostatic pressure within capillaries

ANS: C With a major burn, an increase in capillary permeability occurs, allowing plasma proteins, fluids, and electrolytes to be lost. Maximal edema in a small wound occurs about 8 to 12 hours after injury. In larger injuries, the maximal edema may not occur until 18 to 24 hours.

Atopic dermatitis (eczema) in the infant is which of the following? a. Easily cured b. Worse in humid climates c. Associated with upper respiratory tract infections d. Associated with allergy with a hereditary tendency

ANS: D Atopic dermatitis is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency.

A young child has sustained a minor burn to the foot. Which of the following is the best method to stop the burning process? a. Apply ice to foot. b. Apply burn ointment. c. Cover foot with gauze dressing. d. Hold foot under cool running water.

ANS: D In minor burns, the best method to stop the burning process is to hold the burned area under cool running water.

A child falls on the playground and has a small laceration on the forearm. The school nurse should do which of the following to cleanse the wound? a. Slowly pour hydrogen peroxide over wound. b. Soak arm in warm water and soap for at least 30 minutes. c. Gently cleanse with sterile pad and a nonstinging povidone-iodine solution. d. Wash wound gently with mild soap and water for several minutes.

ANS: D Lacerations should be washed gently with mild soap and water or normal saline.

Treatment of psoriasis often involves which of the following? a. Antihistamines b. Oral antibiotics c. Topical application of calamine lotion d. Tar and exposure to sunlight and ultraviolet light

ANS: D Psoriasis is treated with tar preparations and exposure to ultraviolet B light or natural sunlight.

Which of the following is a firm, palpable, circumscribed elevation of the skin less than 1 cm in diameter? a. Papule b. Plaque c. Nodule d. Vesicle

ANS: A A papule is elevated; palpable; firm; circumscribed; less than 1 cm in diameter; and brown, red, pink, tan, or bluish red.

The management of a child who has just been stung by a bee or wasp should include the application of which of the following? a. Cool compresses b. Warm compresses c. Antibiotic cream d. Corticosteroid cream

ANS: A Bee or wasp stings are initially treated by carefully removing stinger, cleansing with soap and water, applying cool compresses, and using common household agents such as lemon juice or a paste made with aspirin and baking soda.

Impetigo ordinarily results in which of the following? a. No scarring b. Pigmented spots c. Slightly depressed scars d. Atrophic white scars

ANS: A Impetigo tends to heal without scarring unless a secondary infection occurs.

Which of the following is usually the only symptom of pediculosis capitis (head lice)? a. Itching b. Vesicles c. Scalp rash d. Localized inflammatory response

ANS: A Itching is generally the only manifestation of pediculosis capitis (head lice). Diagnosis is made by observation of the white eggs (nits) on the hair shaft

Therapeutic management of the child with ringworm infection would include which of the following? a. Administer oral griseofulvin. b. Administer topical or oral antibiotics. c. Apply topical sulfonamides. d. Apply Burow solution compresses to affected area.

ANS: A Treatment with the antifungal agent griseofulvin is part of the treatment for the fungal disease, ringworm. Oral griseofulvin therapy frequently continues for weeks or months.

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. This is most likely caused by which of the following? a. Impetigo b. Candida albicans c. Urine and feces d. Infrequent diapering

ANS: B C. albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds.

A child is admitted with extensive burns. The nurse notes that there are burns on the child's lips and singed nasal hairs. The nurse should suspect that the child has: a. a chemical burn. b. an inhalation injury. c. an electrical burn. d. a hot-water scald.

ANS: B Evidence of an inhalation injury is burns of the face and lips, singed nasal hairs, and laryngeal edema. Clinical manifestation may be delayed for up to 24 hours.

A toddler sustains a minor burn on the hand from hot coffee. The first action in treating this burn is to: a. apply ice to burned area. b. hold burned area under cool running water. c. break any blisters with a sterile needle. d. clean wound with soap and warm water.

ANS: B In minor burns, the best method to stop the burning process is to hold the burned area under cool running water.

Ringworm, frequently found in schoolchildren, is caused by which of the following? a. Virus b. Fungus c. Allergic reaction d. Bacterial infection

ANS: B Ringworm is caused by a group of closely related filamentous fungi that invade primarily the stratum corneum, hair, and nails. They are superficial infections that live on, not in, the skin.

Rocky Mountain spotted fever is caused by the bite of which of the following? a. Flea b. Tick c. Mosquito d. Mouse or rat

ANS: B Rocky Mountain spotted fever is caused by a tick. The tick must attach and feed for at least 1 to 2 hours to transmit the disease. The usual habitat of the tick is in heavily wooded areas.

Which of the following best describes a full-thickness (third-degree) burn? a. Erythema and pain b. Skin showing erythema followed by blister formation c. Destruction of all layers of skin evident with extension into subcutaneous tissue d. Destruction injury involving underlying structures such as muscle, fascia, and bone

ANS: C A third-degree, or full-thickness, burn is a serious injury that involves the entire epidermis and dermis and extends into the subcutaneous tissues.

Fentanyl and midazolam (Versed) are given before débridement of a child's burn wounds. These drugs are important to: a. promote healing. b. prevent infection. c. provide pain relief. d. limit amount of débridement that will be necessary.

ANS: C Fentanyl and midazolam provide excellent intravenous sedation and analgesia to control procedural pain in children with burns.

The nurse should know that Lyme disease is which of the following? a. Difficult to prevent b. Easily treated with oral antibiotics in stages 1, 2, and 3 c. Caused by a spirochete that enters the skin through a tick bite d. Common in geographic areas where the soil contains the mycotic spores that cause the disease

ANS: C Lyme disease is caused by Borrelia burgdorferi, a spirochete spread by ticks. The early characteristic rash is erythema migrans.

Treatment for herpes simplex virus (types 1 or 2) includes which of the following? a. Corticosteroids b. Oral griseofulvin c. Oral antiviral agent d. Topical and/or systemic antibiotic

ANS: C Oral antiviral agents are effective for viral infections such as herpes simplex.

Which of the following is the primary clinical manifestation of scabies? a. Edema b. Redness c. Pruritus d. Maceration

ANS: C Scabies is caused by the scabies mite. The inflammatory response and intense itching occur after the host has become sensitized to the mite. This occurs approximately 30 to 60 days after initial contact.

Nursing care of the infant with atopic dermatitis focuses on which of the following? a. Feeding a variety of foods b. Keeping lesions dry c. Preventing infection d. Using fabric softener to avoid rough cloth

ANS: C The eczematous lesions of atopic dermatitis are intensely pruritic. Scratching can lead to new lesions and secondary infection. The infant's nails should be kept short and clean and have no sharp edges.

Herpes zoster is caused by the varicella virus and has an affinity for which of the following? a. Sympathetic nerve fibers b. Parasympathetic nerve fibers c. Posterior root ganglia and posterior horn of the spinal cord d. Lateral and dorsal columns of the spinal cord

ANS: C The herpes zoster virus has affinity for posterior root ganglia, the posterior horn of the spinal cord, and skin.

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend which of the following? a. Administer antihistamine. b. Cleanse with soap and water. c. Keep child quiet and come to emergency department. d. Remove stinger and apply cool compresses.

ANS: C Venomous species of scorpions inject venom that contains hemolysins, endotheliolysins, and neurotoxins. The absorption of the venom is delayed by keeping the child quiet and the involved area in a dependent position.

Which of the following is an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous fluid? a. Cyst b. Papule c. Pustule d. Vesicle

ANS: D A vesicle is elevated, circumscribed, superficial, less than 1 cm in diameter, and filled with serous fluid.

After the acute stage and during the healing process, the primary complication from burn injury is which of the following? a. Asphyxia b. Shock c. Renal shutdown d. Infection

ANS: D During the healing phase, local infection and sepsis are the primary complications.

Warts are caused by which of the following? a. Bacteria b. Fungus c. Parasite d. Virus

ANS: D Human warts are caused by the human papillomavirus.

An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. Which of the following is important in her immediate care? a. Wrap her in a blanket until help arrives. b. Encourage her to drink clear liquids. c. Place her in a tub of cool water. d. Remove her burned clothing and jewelry.

ANS: D In major burns, burned clothing should be removed to avoid further damage from smoldering fabric and hot beads of melted synthetic materials. Jewelry is also removed to eliminate the transfer of heat from the metal and constriction resulting from edema formation.

Matt's mother tells the nurse that he keeps scratching the areas where he has poison ivy. The nurse's response should be based on which of the following? a. Poison ivy does not itch and needs further investigation. b. Scratching the lesions will not cause a problem. c. Scratching the lesions will cause the poison ivy to spread. d. Scratching the lesions may cause them to become secondarily infected.

ANS: D Poison ivy is a contact dermatitis that results from exposure to the oil urushiol in the plant. Every effort is made to prevent the child from scratching, since the lesions can become secondarily infected.

Cellulitis is often caused by: a. herpes zoster. b. Candida albicans. c. human papillomavirus. d. Streptococcus or Staphylococcus organisms.

ANS: D Streptococci, staphylococci, and Haemophilus influenzae are the organisms usually responsible for cellulitis.

A high-protein diet for the child with major burns is ordered to: a. promote growth. b. improve appetite. c. diminish risks of stress-induced hyperglycemia. d. avoid protein breakdown.

ANS: D The diet must provide sufficient calories to meet the increased metabolic needs and enough protein to avoid protein breakdown.

The nurse is talking to the parents of a child with pediculosis capitis. Which of the following should the nurse include when explaining how to manage pediculosis capitis? a. "You will need to cut the hair shorter if infestation and nits are severe." b. "You can distinguish viable from nonviable nits, and remove all viable ones." c. "You can wash all nits out of hair with a regular shampoo." d. "You will need to remove nits with an extra-fine tooth comb or tweezers."

ANS: D Treatment consists of the application of pediculicide and manual removal of nit cases. An extra-fine tooth comb facilitates manual removal.