Chapter 45: Integumentary Disorders Flashcards
(31 cards)
- The nurse is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching?
A. “We will leave fireworks displays to the professionals.”
B. “I will set our water heater at 130 degrees.”
C. “All sleepwear should be flame retardant.”
D. “The handles of pots on the stove should face inward.”
Ans: B
Rationale: If the temperature of the water heater is set at 130°F, a child can be burned significantly in only 30 seconds. The recommended maximal home hot water heater temperature is 120°F. Leaving fireworks to the professionals, using flame-retardant sleepwear, and turning the handles of pots on the stove inward are correct.
- The nurse is providing parental teaching about home care for an 8-year-old boy with widespread sunburn on his back and shoulders. Which response indicates a need for further teaching?
A. “Cool compresses may help cool the burn.”
B. “He should manually peel off any flaking skin.”
C. “Nonsteroidal anti-inflammatory drugs like ibuprofen are helpful.”
D. “He should avoid hot showers or baths for a couple of days.
Ans: B
Rationale: If skin flaking occurs, the child should be discouraged from manually "peeling" the flaked skin as it can
cause further injury. Using cool compresses, taking nonsteroidal anti-inflammatory drugs, and avoiding
hot showers or baths are appropriate measures.
- The nurse is providing care for a 14-year-old girl with severe acne. The girl expresses sadness and distress about her appearance. Which response by the nurse would be most appropriate?
A. “Are you using your medicine every day?”
B. “Your condition will most likely improve in a year or two.”
C. “Many people feel this way; I know someone who can help.”
D. “If you have any scarring you can undergo dermabrasion.”
Ans: C
Rationale: Depression can occur as a result of body image disturbances with severe acne. The nurse should provide emotional support to adolescents undergoing acne therapy and refer teens for counseling if necessary. Telling the girl that her condition is likely to improve in a year or two is not helpful. Asking the girl whether she uses her medicine every day or reminding her that her scars can be addressed with dermabrasion does not address her feelings of sadness and distress.
- The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as a:
A. papule.
B. macule.
C. vesicle.
D. scale.
Ans: B
Rationale: A macule is a flat, discolored area on the skin. A papule is a small, raised bump on the skin. A vesicle is a fluid-filled bump on the skin. Scaling is flaking of the skin.
- A nurse is caring for a 5-year-old in Bucks traction. When conducting a skin examination for signs of pressure ulcers, the nurse pays particular attention to which area?
A. Sacral area
B. Hip area
C. Occiput
D. Upper arm
Ans: C
Rationale: Common sites of pressure ulcers in hospitalized children include the occiput and toes, while children who require wheelchairs for mobility demonstrate pressure ulcers in the sacral or hip areas more frequently. The upper arm is not a common site for pressure ulcers.
- A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. What action would be the priority?
A. Determining the burn depth
B. Eliciting a description of the burn
C. Estimating burn extent
D. Ensuring a patent airway
Ans: D
Rationale: Carbonaceous sputum is a sign of potential airway injury due to smoke inhalation. Therefore, the nurse should ensure a patent airway while obtaining a brief history and simultaneously evaluating the child and providing emergency care. If the burn does not pose an immediate, life-threatening risk, the nurse would obtain an in-depth history and elicit a description of the burn. Determining the burn depth and extent are part of the secondary survey.
- A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would anticipate preparing the girl for which diagnostic tests as ordered?
A. Pulse oximetry
B. Fiberoptic bronchoscopy
C. Xenon ventilation–perfusion scanning
D. Electrocardiographic monitoring
Ans: D
Rationale: Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify possible cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury. Fiberoptic bronchoscopy and xenon ventilation– perfusion scanning may be ordered to evaluate an inhalation injury, not an electrical burn. Pulse oximetry is used to evaluate pulmonary function and would not be indicated in the case of an electrical burn.
- The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the healthcare provider to order?
A. Corticosteroids
B. Antifungals
C. Antibiotics
D. Retinoids
Ans: B
Rationale: Candidal diaper rash would require a fungicide. The nurse would expect to administer topical antifungals as ordered. Corticosteroids are not typically recommended for young infants and are used for atopic dermatitis and certain types of contact dermatitis. Antibiotics would be ineffective against
fungal infections. Retinoids are indicated for moderate to severe acne.
- The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a purplish color with discharge and a foul odor. The nurse suspects which infection?
A. Burn wound cellulitis
B. Invasive burn cellulitis
C. Burn impetigo
D. Staphylococcal scalded skin syndrome
Ans: B
Rationale: Invasive burn cellulitis results in the burn developing a dark brown, black, or purplish color with a discharge and foul odor. In burn wound cellulitis, the area around the burn becomes increasingly red, swollen, and painful early in the course of burn management. Burn impetigo is characterized by multifocal, small, superficial abscesses. Staphylococcal scalded skin syndrome is not a burn infection; however, it is managed similarly to burns.
- The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction?
A. “After bathing, I need to rub his skin everywhere to make sure he is completely dry.”
B. “I must make sure I use lukewarm water instead of hot water.”
C. “Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment.”
D. “We should leave his skin moist before applying medication or moisturizer.”
Ans: A
Rationale: The nurse needs to emphasize to the mother that she must only pat the child dry and not rub his skin. Rubbing can cause further itching. Additionally, the skin should be left moist prior to applying medication or moisturizer. Lukewarm water and oatmeal baths are appropriate.
- After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states:
A. “An infant’s skin is thinner than an adult’s, so substances placed on the skin are absorbed more readily.”
B. “The infant’s epidermis is loosely connected to the dermis, increasing the risk for breakdown.”
C. “The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented.”
D. “An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss.”
Ans: C
Rationale: Infants have less pigmentation in their skin, placing at increased risk for skin damage from ultraviolet radiation. The infant’s skin is thinner, the epidermis is loosely connected, and there is less subcutaneous fat.
- The nurse is preparing a class for a group of adolescents about reducing the risk of skin cancer. What information would the nurse include?
A. Using a sunscreen with para-aminobenzoic acid (PABA) with an SPF of at least 10
B. Applying sunscreen at least 1 hour before going outside in the sun
C. Avoiding sun exposure between the hours of 10 AM and 2 PM
D. Using artificial ultraviolet (UV) tanning bed instead of sun exposure
Ans: C
Rationale: Avoiding sun exposure between the hours of 10 AM and 2 PM is one method of reducing the risk for skin cancer. Sunscreens with an SPF of 15 or greater that are fragrance- and PABA-free should be used. Sunscreen should be applied at least 30 minutes before exposure and then reapplied at least every 2 hours while exposed. Artificial UV light, including tanning beds, should be avoided.
- A nurse is assessing the skin of a child with cellulitis. What would the nurse expect to find?
A. Red, raised hair follicles
B. Warmth at skin disruption site
C. Papules progressing to vesicles
D. Honey-colored exudate
Ans: B
Rationale: Cellulitis is manifested by erythema, pain, edema, and warmth at the site of skin disruption. Red and raised hair follicles would indicate folliculitis. Papules progressing to vesicles and a honey-colored exudate would suggest nonbullous impetigo.
- When developing the plan of care for a child with burns requiring fluid replacement therapy, what information would the nurse expect to include?
A. Administration of colloid initially followed by a crystalloid
B. Determination of fluid replacement based on the type of burn
C. Administration of most of the volume during the first 8 hours
D. Monitoring of hourly urine output to achieve less than 1 mL/kg/hr
Ans: C
Rationale: With fluid replacement therapy, most of the volume is administered during the first 8 hours. Crystalloids (such as Ringer lactate) are administered for the first 24 hours, and then colloids are used once capillary permeability is less of a concern. Fluid replacement is determined by the amount of body surface area burned. Hourly urine output is expected to be at least 1 mL/kg/hr.
- What would the nurse include when teaching an adolescent about tinea pedis?
A. “Keep your feet moist and open to the air as much as possible.”
B. “Dry the area between your toes really well.”
C. “Wear nylon or synthetic socks every day.”
D. “Go barefoot when you are in the locker room at school.”
Ans: B
Rationale: Keeping the feet clean and dry is key for the child with tinea pedis. This includes rinsing the feet with water or a water/vinegar mixture and drying them well, especially between the toes. The adolescent should wear cotton socks and shoes that allow the feet to breathe. Going barefoot at home is allowed, but the adolescent should wear flip-flops around swimming pools and locker rooms.
- A child is diagnosed with atopic dermatitis. Which laboratory test would the nurse expect the child
to undergo to provide additional evidence for this condition?
A. Erythrocyte sedimentation rate
B. Potassium hydroxide prep
C. Wound culture
D. Serum immunoglobulin E (IgE) level
Ans: D
Rationale: IgE levels are often used to evaluate for atopic dermatitis. IgE levels are elevated in this condition. Erythrocyte sedimentation rate may be used but this test is nonspecific and only indicates infection or inflammation. Potassium hydroxide prep is used to identify fungal infections. Wound culture would be done to identify a specific organism if an infection occurs with atopic dermatitis.
- The nurse is providing care to a child with folliculitis. What would the nurse expect to administer?
A. Topical mupirocin
B. Oral cephalosporin
C. Intravenous oxacillin
D. Topical Eucerin cream
Ans: A
Rationale: For folliculitis, topical mupirocin is indicated in conjunction with aggressive hygiene and warm compresses. Oral cephalosporins are used for nonbullous impetigo if there are numerous lesions. Intravenous oxacillin is used for severe cases of staphylococcal scalded skin syndrome. Topical Eucerin cream is used for atopic dermatitis.
- A nurse is preparing a class for parents of infants about managing diaper dermatitis. What advice would the nurse include in the presentation? Select all that apply.
A. Applying topical nystatin to the diaper area
B. Using a blow dryer on warm to dry the diaper area
C. Refraining from using rubber pants over diapers
D. Using scented diaper wipes to clean the area
E. Washing the diaper area with an antibacterial soap
Ans: B, C
Rationale: For diaper dermatitis, topical products such as ointment or creams containing vitamins A, D, and E; zinc oxide; or petrolatum help to provide a barrier. Nystatin is an antifungal agent used for diaper candidiasis. Using a blow dryer on warm to dry the area, avoiding the use of rubber pants, and using unscented diaper wipes or ones free of preservatives are appropriate. The area should be washed with a soft cloth, without harsh soaps.
- A group of students are preparing for a class exam on skin disorders. As part of their preparation, they are reviewing information about acne vulgaris and its association with increased sebum production. The students demonstrate understanding of the information when they identify which areas as having the highest sebaceous gland activity? Select all that apply.
A. Face
B. Upper chest
C. Neck
D. Back
E. Shoulders
Ans: A, B, D
Rationale: The face, upper chest, and back are the areas of highest sebaceous activity and thus the most common areas for acne lesions to occur. The neck and shoulders are not typical areas involved with acne.
- An instructor is developing a plan for a class of nursing students on various skin disorders. When describing urticaria, what would the instructor include?
A. It is a type IV hypersensitivity reaction.
B. Histamine release leads to vasodilation.
C. Wheals appear first followed by erythema.
D. The nonpruritic rash blanches with pressure.
Ans: B
Rationale: Urticaria is a type I hypersensitivity reaction caused by an immunologically mediated antigen–antibody response of histamine release from the mast cells. Vasodilation and increased vascular permeability result, leading to erythema and then wheals. The rash is pruritic and blanches with pressure.
- A nurse is inspecting the skin of a child with atopic dermatitis. What would the nurse expect to
observe?
A. Erythematous papulovesicular rash
B. Dry, red, scaly rash with lichenification
C. Pustular vesicles with honey-colored exudates
D. Hypopigmented oval scaly lesions
Ans: B
Rationale: Atopic dermatitis or eczema is characterized by a dry, red, scaly rash with lichenification and hypertrophy. An erythematous papulovesicular rash is associated with contact dermatitis. Pustules and vesicles with honey-colored exudates suggest nonbullous impetigo. Hypopigmented oval scaly lesions are associated with tinea versicolor.
- A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. What action should the nurse take first?
A. Inspect the child’s skin color.
B. Assess for a patent airway.
C. Observe for symmetric breathing.
D. Palpate the child’s pulse.
Ans: B
Rationale: When performing a primary survey, the nurse first assesses the child’s airway for patency and then intervenes accordingly to ensure that the airway is patent. Next the nurse would evaluate the child’s skin color, respiratory effort, and symmetry of breathing and breath sounds. Then the nurse would determine the pulse strength, perfusion status, and heart rate.
- A 3-year-old child has sustained severe burns and is ordered to receive 100% oxygen. What would the nurse use to administer the oxygen?
A. Nasal cannula
B. Venturi mask
C. Nonrebreather mask
D. Oxygen hood
Ans: C
Rationale: All children with severe burns should receive 100% oxygen via a nonrebreather mask or bag–valve– mask ventilation. A nasal cannula provides only low oxygen concentrations (22% to 44%); a Venturi mask provides only 24% to 50% oxygen concentrations. An oxygen hood is used for infants only.
- As part of a clinical conference with a group of nursing students, the instructor is describing the burn classification. The instructor determines that the teaching has been successful when the group identifies what as characteristic of full-thickness burns?
A. Skin that is reddened, dry, and slightly swollen
B. Skin appearing wet with significant pain
C. Skin with blistering and swelling
D. Skin that is leathery and dry with some numbness
Ans: D
Rationale: Full-thickness burns may be very painful, numb, or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin. Superficial burns are painful, red, dry, and possibly edematous. Partial- thickness and deep partial-thickness burns are very painful and edematous and have a wet appearance or blisters.
