Question 1

Nursing care of the infant with atopic dermatitis focuses on:
A)feeding a variety of foods.
B)keeping lesions dry.
C)preventing infection.
D)using fabric softener to avoid rough cloth.

Accepted Answer

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.In periods of irritability,these children tend to have a decreased appetite.The restriction of hyperallergenic foods,such as milk,dairy products,peanuts,and eggs,may make adequate nutrition a challenge with these children.Wet soaks and compresses are used to keep the lesions moist and minimize the pruritus.Fabric softener should be avoided because of the irritant effects of some of its components.

Question 2

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider.The nurse should advise which to the father?
A)Apply warm compresses.
B)Carefully scrape off stinger.
C)Take child to emergency department.
D)Apply a thin layer of corticosteroid cream.

Accepted Answer

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.Warm compresses increase the circulation to the area and facilitate the spread of the venom.The black widow spider does not have a stinger.Corticosteroid cream will have no effect on the venom.

Question 3

The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents.Which statement made by a parent indicates a correct understanding of the teaching?
A)"I should cleanse my infant's skin with a commercial diaper wipe every time I change the diaper."
B)"If my infant's buttocks become slightly red, I will expose the skin to air."
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."

Accepted Answer

Slightly irritated skin can be exposed to air,not heat,to dry completely.Overwashing or cleansing the skin every diaper change with commercial wipes should be avoided.The skin should be thoroughly dried after washing.Application of oil does not create an effective barrier.Baby powder should not be used because of the danger of aspiration.

Question 4

A mother calls the emergency department nurse because her child was stung by a scorpion.The nurse should recommend:
A)administering an antihistamine.
B)cleansing area with soap and water.
C)keeping the child quiet and coming to the emergency department.
D)removing the stinger and applying cool compresses.

Accepted Answer

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.Antihistamines are not effective against scorpion venom.The wound will have intense local pain.Transport to the emergency department is indicated.

Question 5

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(n):
A)chemical burn.
B)inhalation injury.
C)electrical burn.
D)hot-water scald.

Accepted Answer

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.Chemical burns,electrical burns,and those associated with hot-water scalds would not cause singed nasal hair.

Question 6

Rocky Mountain spotted fever is caused by the bite of a:
A)flea.
B)tick.
C)mosquito.
D)mouse or rat.

Accepted Answer

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.Fleas,mosquitoes,and mice or rats do not transmit Rocky Mountain spotted fever.

Question 7

Which prescribed treatment should the nurse plan to implement for a child with psoriasis?
A)Antihistamines
B)Oral antibiotics
C)Topical application of calamine lotion
D)Tar and exposure to sunlight and ultraviolet light

Accepted Answer

Psoriasis is treated with tar preparations and exposure to ultraviolet B light or natural sunlight.Antihistamines,oral antibiotics,and topical application of calamine lotion are not effective in psoriasis.

Question 8

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 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.

Accepted Answer

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.The burns should be covered,not wrapped with a clean cloth.A blanket can be used initially to stop the burning process.Fluids should not be given by mouth to avoid aspiration and water intoxication.The child should be kept warm.Placing her in a tub of cool water will exacerbate heat loss.

Question 9

A young child has sustained a minor burn to the foot.Which is recommended for treatment of a minor burn?
A)Apply ice to foot.
B)Apply cortisone ointment.
C)Apply an occlusive dressing.
D)Cleanse the wound with a mild soap and tepid water.

Accepted Answer

In minor burns,the best method of treatment is to cleanse the wound with a mild soap and tepid water.Ice is not recommended.Most practitioners favor covering the wound with an antimicrobial ointment (not cortisone)to reduce the risk of infection and to provide some form of pain relief.The dressing is not occlusive but consists of nonadherent fine-mesh gauze placed over the ointment and a light wrap of gauze dressing that avoids interference with movement.This helps keep the wound clean and protects it from trauma.

Question 10

After the acute stage and during the healing process,the primary complication from burn injury is:
A)asphyxia.
B)shock.
C)renal shutdown.
D)infection.

Accepted Answer

During the healing phase,local infection and sepsis are the primary complications.Renal shutdown is not a complication of the burn injury,but may be a result of the profound shock.

Question 11

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:
A)impetigo.
B)Candida albicans.
C)urine and feces.
D)infrequent diapering.

Accepted Answer

C.albicans infection produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal folds.Impetigo is a bacterial infection that spreads peripherally in sharply marginated,irregular outlines.Eruptions involving the skin in contact with the diaper,but sparing the folds,are likely to be caused by chemical irritation,especially urine and feces.

Question 12

Which 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

Accepted Answer

A third-degree,or full-thickness,burn is a serious injury that involves the entire epidermis and dermis and extends into the subcutaneous tissues.Erythema and pain are characteristic of a first-degree,or superficial,burn.Erythema with blister formation is characteristic of a second-degree,or partial-thickness,burn.A fourth-degree burn is a full-thickness burn that also involves underlying structures such as muscle,fascia,and bone.

Question 13

Tretinoin (Retin-A)is a topical agent commonly used to treat acne.Nursing considerations with this drug should include:
A)teaching to avoid use of sunscreen agents.
B)applying generously to the skin.
C)explaining that medication should not be applied until at least 20 to 30 minutes after washing.
D)explaining that erythema and peeling are indications of toxicity.

Accepted Answer

The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning sensation.The avoidance of sun and the use of sunscreen agents must be emphasized because sun exposure can result in severe sunburn.The agent should be applied sparingly to the skin.Erythema and peeling are common local manifestations.

Question 14

Atopic dermatitis (eczema)in the infant is:
A)easily cured.
B)worse in humid climates.
C)associated with upper respiratory tract infections.
D)associated with allergy with a hereditary tendency.

Accepted Answer

Atopic dermatitis is a type of pruritic eczema that usually begins during infancy and is associated with allergy with a hereditary tendency.Atopic dermatitis can be controlled but not cured.Manifestations of the disease are worse when environmental humidity is lower.Atopic dermatitis is not associated with respiratory tract infections.

Question 15

A child experiences frostbite of the fingers after prolonged exposure to the cold.Which intervention should 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

Accepted Answer

Rapid rewarming is accomplished by immersing the part in well-agitated water at 37.8° to 42.2° C (100° to 108° F).The frostbitten area should be rewarmed as soon as possible to avoid further tissue damage.Rapid rewarming results in less tissue necrosis than slow thawing.

Question 16

A toddler sustains a minor burn on the hand from hot coffee.Which is the first action the nurse should recommend in treating this burn?
A)Apply ice to burned area.
B)Hold burned area under cool running water.
C)Break any blisters with a sterile needle.
D)Cleanse wound with soap and warm water.

Accepted Answer

In minor burns,the best method to stop the burning process is to hold the burned area under cool running water.Ice is not recommended.Removal of blisters is not generally accepted therapy unless the injury is from a chemical substance.Cooling is necessary to stop the burning process.

Question 17

Which 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

Accepted Answer

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.Vasoconstriction,decreased capillary permeability,and decreased hydrostatic pressure within capillaries are not physiologic mechanisms for edema formation in burn patients.

Question 18

The most immediate threat to life in children with thermal injuries is:
A)shock.
B)anemia.
C)local infection.
D)systemic sepsis.

Accepted Answer

The immediate threat to life in children with thermal injuries is airway compromise and profound shock.Anemia is not of immediate concern.During the healing phase,local infection or sepsis are the primary complications.Respiratory problems,primarily airway compromise,are the primary complications during the acute stage of burn injury.

Question 19

The school nurse is conducting a class for school-age children on Lyme disease.Which is characteristic of Lyme disease?
A)Difficult to prevent
B)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

Accepted Answer

Lyme disease is caused by Borrelia burgdorferi,a spirochete spread by ticks.The early characteristic rash is erythema migrans.Tick bites should be avoided by entering tick-infested areas with caution.Light-colored clothing should be worn to identify ticks easily.Long-sleeved shirts and long pants tucked into socks should be the attire.Early treatment of the erythema migrans (stage 1)can prevent the development of Lyme disease.Lyme disease is caused by a spirochete,not mycotic spores.

Question 20

When is isotretinoin (Accutane)indicated for the treatment of acne during adolescence?
A)The 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.

Accepted Answer

Isotretinoin is reserved for severe cystic acne that has not responded to other treatments.Isotretinoin has teratogenic effects and should never be used when there is a possibility of pregnancy.No correlation exists between foods and acne.Antibacterial soaps are ineffective.Frequent washing with antibacterial soap is not a recommended therapy for acne.

Quiz 30: The Child with Integumentary Dysfunction

Nursing care of the infant with atopic dermatitis focuses on:

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider.The nurse should advise which to the father?

The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents.Which statement made by a parent indicates a correct understanding of the teaching?

A mother calls the emergency department nurse because her child was stung by a scorpion.The nurse should recommend:

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(n) :

Rocky Mountain spotted fever is caused by the bite of a:

Which prescribed treatment should the nurse plan to implement for a child with psoriasis?

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 is important in her immediate care?

A young child has sustained a minor burn to the foot.Which is recommended for treatment of a minor burn?

After the acute stage and during the healing process,the primary complication from burn injury is:

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 best describes a full-thickness (third-degree) burn?

Tretinoin (Retin-A) is a topical agent commonly used to treat acne.Nursing considerations with this drug should include:

Atopic dermatitis (eczema) in the infant is:

A child experiences frostbite of the fingers after prolonged exposure to the cold.Which intervention should the nurse implement first?

A toddler sustains a minor burn on the hand from hot coffee.Which is the first action the nurse should recommend in treating this burn?

Which explains physiologically the edema formation that occurs with burns?

The most immediate threat to life in children with thermal injuries is:

The school nurse is conducting a class for school-age children on Lyme disease.Which is characteristic of Lyme disease?

When is isotretinoin (Accutane) indicated for the treatment of acne during adolescence?