Question 1

A child is in the emergency department (ED)with a dog bite.After cleansing the wound and attending to the child's comfort,which action should the nurse perform next?
A)Give a dose of antibiotic.
B)Offer the child a toy to play with.
C)Provide discharge teaching.
D)Report the bite to authorities.

Accepted Answer

Animal bites are reportable injuries.The nurse has an obligation to report the bite as soon as he or she is able,as the animal control authorities may want to interview the child and parents quickly.Antibiotics are not warranted in all dog bites.Discharge teaching should be provided when the family is done in the ED.Offering the child a toy is a nice gesture that could be considered a comfort measure,but does not take priority over a legal requirement.

Question 2

A teen has been taking griseofulvin (Fulvicin)for a fungal skin and scalp condition and reports that it is not working.Which action by the nurse is the most important?
A)Assess for noncompliance with the regimen.
B)Discuss changing medications with the provider.
C)Prepare to administer the drug as an injection.
D)Tell the teen it takes nearly 6 months to work.

Accepted Answer

The nurse should assess the teen for compliance with the medication regimen,because it takes at least 6 weeks for this medication to work.Due to the lengthy treatment time and the fact that teens are often noncompliant,this would be the nurse's first step.If the medication has been used appropriately,discussing a change would be correct.This drug is not give via IM injection.

Question 3

A child in the emergency department has cellulitis on the forearm.A nursing student is preparing to administer benzathine penicillin (Bicillin LA).Which action by the nursing student warrants intervention by the staff nurse?
A)Instructs the family members that they must wait at least 15 minutes before leaving
B)Plans to use a 25-gauge, $3 / 4$ -inch needle to administer the medication
C)Reconstitutes the medication using sterile normal saline solution
D)Selects a large,well-defined muscle for a deep intramuscular injection

Accepted Answer

The correct answer is B because a 25-gauge, $3 / 4$ -inch needle is too short to administer benzathine penicillin, which requires a deep intramuscular injection.

Question 4

What important safety measure regarding the use of insect repellents does the nurse teach a parenting group?
A)Apply repellents to the child's clothing.
B)There are no substitutes for DEET.
C)Use oil of lemon eucalyptus on babies.
D)Wash repellent off after 2 hours.

Accepted Answer

Insect repellents are harsh chemicals and should be applied to the clothing of children.Spraying the product on the adult's hands and then spreading it on the face and head and exposed skin is an acceptable ways of applying insecticide to a limited amount of skin.The CDC has recently recognized some insecticides that do not contain DEET.Oil of lemon eucalyptus is safe on children over the age of 3.Although insecticides should not stay on for long periods of time,there is no strict 2-hour limit.

Question 5

A mother-baby nurse is demonstrating swaddling a neonate as a method of keeping the baby warm.The mother asks why she needs to be so careful about the baby's temperature.Which response by the nurse is the most appropriate?
A)"After being in your womb for 9 months,this is how the baby prefers to stay."
B)"Babies' immune systems are immature;any cold breeze will make them sick."
C)"Their skin is thin and they have little fat,so it's hard to control their temperature."
D)"You need to keep their temperature above what we call normal to keep them well."

Accepted Answer

Babies have thin skin,a large body surface area,scanty subcutaneous fat,and immature neurological systems.All these factors combined make it difficult for a baby to regulate his or her temperature.The other statements are not factual or informative.

Question 6

A student is learning about cutaneous skin reactions.Which description is correct?
A)Blistering: heat-related
B)Exanthema: an eruption
C)Pustular: contagious
D)Urticarial: round patches

Accepted Answer

An examthema is an eruption.Blistering is swelling.Pustular is raised and filled with white blood cells.Urticarial is itching.

Question 7

A child has been diagnosed with scabies and the parents are taught about the use of 5% permethrin lotion (Elimite).Which statement by the parents indicates the need for further instruction?
A)"Elimite goes from the nape of the neck to the toes,except on the genitals."
B)"The lotion is left on until the next day,when a bath is given."
C)"This treatment will have to be repeated 1 week after the first."
D)"We will give our child a warm soapy bath before applying the lotion."

Accepted Answer

Elimite is left on for 8 to 14 hours and then must be removed.The other statements show good understanding.

Question 8

A parent calls the pediatric clinic asking for advice on treating lice.The child has already been treated once with lindane (Qwell).Which advice from the nurse is the most appropriate?
A)"Be sure you are cleaning your house and linens well."
B)"Qwell is usually effective after two or three treatments."
C)"Switch to malathion (Ovide)and see if that works better."
D)"There are some oral medications your child can try."

Accepted Answer

Ovide is a safe,nontoxic lice shampoo that is very efficacious.The mother should not be told to use Qwell again;the FDA has a black box warning against using this as a first-line drug and the American Academy of Pediatrics no longer recommends it at all.There are oral medications that can be used on resistant lice,but the parent needs to try another shampoo first.Cleaning is important,but not as important as treating the lice.

Question 9

An adolescent is in the clinic with a few skin lesions on his thighs.The lesions have an open center with a thin crust.Which question by the nurse will aid the diagnosis of this patient's skin problem?
A)"Are you active in any athletics or sports?"
B)"Do you have siblings with respiratory infections?"
C)"Do you seem to scratch a lot at night?"
D)"Have you been in any wooded areas lately?"

Accepted Answer

This lesion sounds like MRSA (methicillin-resistant Staphylococcus aureus).MRSA is common in athletes.This question would elicit the most useful information.Respiratory infection is not related.Scratching,especially at night,is characteristic of scabies.Wooded areas have ticks,which can spread Lyme disease.

Question 10

A 20-lb (9-kg)child is having a severe allergic reaction.The school nurse has an EpiPen Jr.auto-injector containing 0.3 mg.Which action by the nurse is the most appropriate?
A)Administer the injection.
B)Begin CPR.
C)Call 911 immediately.
D)Give half the injection.

Accepted Answer

EpiPen Jr.auto-injectors are available in two strengths: 0.15 mg for children weighing up to 33 lb (15 kg)and one containing 0.3 mg for older children and adults.The nurse has the wrong-size injector.The most appropriate action is to call 911 to access the emergency medical system.The child does not need CPR.Because the injector is automated,you cannot change the amount that is given.

Question 11

An adolescent patient has acne characterized by pustules and scarring.Which teaching information is most appropriate for the nurse to give the patient and family?
A)"Scrub your face vigorously twice a day with soap and water."
B)"Tetracycline (Sumacin)will make you more sensitive to the sun."
C)"Use good moisturizer because treatment is very drying."
D)"You need a pregnancy test every 3 months on isotretinoin (Accutane)."

Accepted Answer

Tetracycline,minocyline,and doxycycline all cause photosensitivity,so the nurse should warn the teen about sun exposure and use of tanning beds.Skin cleansing should be gentle.Although acne treatments are very drying,makeup and moisturizers should not be applied on top of the dry skin.Pregnancy tests are done prior to starting treatment with Accutane,every month during treatment,and 1 month after treatment has stopped.

Question 12

A school-age child has been prescribed "magic mouthwash" for gingival herpes simplex type I (HSV-1)infection.The parent asks how this helps the child's condition.Which response by the nurse is the most appropriate?
A)Decreases the pain so the child can eat and drink
B)Kills the virus causing the infection by suffocation
C)Prevents secondary infection of the gingiva
D)Shortens the duration of the outbreak

Accepted Answer

"Magic mouthwash" has several recipes,but common ingredients include Benadryl,lidocaine,and Mylanta,which all help increase comfort so the child continues to eat and drink.It does not kill the virus,prevent secondary infection,or shorten the duration of the outbreak.

Question 13

A child presents to the emergency department with cutaneous manifestations of an allergic response.Which nursing diagnosis takes priority?
A)Altered comfort related to itching lesions
B)Impaired tissue integrity related to lesions
C)Knowledge deficit related to unknown condition
D)Risk for impaired airway secondary to edema

Accepted Answer

Usually,actual nursing diagnoses take priority over "risk for" diagnoses,but in this case,risk for impaired airway is the priority.The child's airway can quickly become compromised due to laryngeal edema.The nurse places priority on frequent assessments of the child's airway.The other diagnoses are relevant,but not as important as the potential for compromised airway.

Question 14

The pediatric nurse knows that which child is most likely to bite another?
A)Adolescent,due to increased anger
B)No specific group is at higher risk.
C)School-aged child,due to frustration
D)Toddler,due to lack of verbal ability

Accepted Answer

Toddlers are more prone to biting due to the frustration of not being able to verbalize their feelings.

Question 15

A toddler has a few vesicular lesions on his hands that rupture,producing a honey-colored,sticky exudate.Based on this assessment,which medication does the nurse teach the parents about?
A)Azithromycin (Zithromax)
B)Amoxicillin/clavulanate (Augmentin)
C)Doxycycline (Vibramycin)
D)Mupirocin (Bactroban)ointment

Accepted Answer

This child has impetigo,which is treated in one of two ways.For limited lesions (which this child has),topical Bactroban is appropriate.For widespread lesions,Augmentin is one of the antibiotics used.Azithromycin and doxycycline are not used.

Question 16

A child takes anti-inflammatory medications for a chronic condition.The mother asks the nurse why the child's cuts and scrapes seem to take so long to heal.Which response by the nurse is the most appropriate?
A)"Chronic diseases always affect the healing process."
B)"Inflammation is the first stage of healing wounds."
C)"Sick kids tend to be anemic,which often delays healing."
D)"Wound healing would not be affected in your child."

Accepted Answer

The first stage of healing consists of the inflammatory process,which is being hampered by this child's need to take chronic anti-inflammatory medications.Although chronic disease can affect healing,this answer is too vague to be useful.Not all sick children are anemic.Wound healing definitely would be affected in this child.

Question 17

The pediatric clinic nurse assesses small,pink "pearl-like" lesions on the trunk of a school-aged child.Which treatment regimen does the nurse plan to teach the family about based on the assessment findings?
A)Antibiotics twice a day for 7-10 days
B)Cleaning the bathtub after the child bathes
C)Intramuscular injection of an antibiotic
D)Topical use of tretinoin (RetinA)on lesions

Accepted Answer

This child has manifestations of molluscum contagiosum,a viral infection that generally resolves on its own.Because this is contagious,the bathtub should be disinfected after the child bathes and his or her towels should not be shared.More aggressive treatment is only used for cases that do not resolve or when the lesions become infected.

Question 18

A child has blood testing for possible atopic dermatitis.The parent asks why testing for IgE is done.Which response by the nurse is the most appropriate?
A)"High levels of IgE from an overactive immune system are treated with steroids."
B)"If we can control the levels of IgE,we can control your child's skin condition."
C)"IgE is raised in allergies and asthma,which are often seen with atopic dermatitis."
D)"These results will help us determine how your child's immune system is functioning."

Accepted Answer

Atopic dermatitis is often seen in children with allergies and asthma.In those conditions,levels of IgE are elevated,so this correlation helps confirm the diagnosis if it is in question.The other answers are inaccurate.

Question 19

A nurse is working with a child who has a chronic skin disorder consisting of many vesicles and pustules.Which nursing assessment indicates that a priority long-term goal has been met?
A)Child states that he no longer gets teased at school because of his appearance.
B)Parents and child verbalize acceptance of disease process and need for medication.
C)Patient participates in sporting events and other after school-activities regularly.
D)Skin around primary lesions remains free of redness,warmth,swelling,and pain.

Accepted Answer

All options show evidence of positive outcomes.However,physical needs take priority over psychosocial needs,so absence of infection is evidence that a priority goal has been met.Secondary infection can occur due to scratching,picking,and the presence of the lesions themselves.

Question 20

A child who was visiting a wooded area on vacation presents to the doctor's office with a localized bull's-eye rash.Which action by the nurse is the most appropriate?
A)Advise parents that treatment depends on laboratory results.
B)Assess for cardiac and neurological involvement.
C)Facilitate admission to a nearby hospital.
D)Teach the parents about cefuroxime (Ceftin).

Accepted Answer

This child may have early Lyme disease,which is treated presumptively with Ceftin prior to obtaining laboratory results.By the time carditis and neurological involvement occur,the rash has generalized.Admission is not warranted.

Quiz 30: Caring for the Child With a Integumentary Condition

A child is in the emergency department (ED) with a dog bite.After cleansing the wound and attending to the child's comfort,which action should the nurse perform next?

A teen has been taking griseofulvin (Fulvicin) for a fungal skin and scalp condition and reports that it is not working.Which action by the nurse is the most important?

A child in the emergency department has cellulitis on the forearm.A nursing student is preparing to administer benzathine penicillin (Bicillin LA) .Which action by the nursing student warrants intervention by the staff nurse?

What important safety measure regarding the use of insect repellents does the nurse teach a parenting group?

A mother-baby nurse is demonstrating swaddling a neonate as a method of keeping the baby warm.The mother asks why she needs to be so careful about the baby's temperature.Which response by the nurse is the most appropriate?

A student is learning about cutaneous skin reactions.Which description is correct?

A child has been diagnosed with scabies and the parents are taught about the use of 5% permethrin lotion (Elimite) .Which statement by the parents indicates the need for further instruction?

A parent calls the pediatric clinic asking for advice on treating lice.The child has already been treated once with lindane (Qwell) .Which advice from the nurse is the most appropriate?

An adolescent is in the clinic with a few skin lesions on his thighs.The lesions have an open center with a thin crust.Which question by the nurse will aid the diagnosis of this patient's skin problem?

A 20-lb (9-kg) child is having a severe allergic reaction.The school nurse has an EpiPen Jr.auto-injector containing 0.3 mg.Which action by the nurse is the most appropriate?

An adolescent patient has acne characterized by pustules and scarring.Which teaching information is most appropriate for the nurse to give the patient and family?

A school-age child has been prescribed "magic mouthwash" for gingival herpes simplex type I (HSV-1) infection.The parent asks how this helps the child's condition.Which response by the nurse is the most appropriate?

A child presents to the emergency department with cutaneous manifestations of an allergic response.Which nursing diagnosis takes priority?

The pediatric nurse knows that which child is most likely to bite another?

A toddler has a few vesicular lesions on his hands that rupture,producing a honey-colored,sticky exudate.Based on this assessment,which medication does the nurse teach the parents about?

A child takes anti-inflammatory medications for a chronic condition.The mother asks the nurse why the child's cuts and scrapes seem to take so long to heal.Which response by the nurse is the most appropriate?

The pediatric clinic nurse assesses small,pink "pearl-like" lesions on the trunk of a school-aged child.Which treatment regimen does the nurse plan to teach the family about based on the assessment findings?

A child has blood testing for possible atopic dermatitis.The parent asks why testing for IgE is done.Which response by the nurse is the most appropriate?

A nurse is working with a child who has a chronic skin disorder consisting of many vesicles and pustules.Which nursing assessment indicates that a priority long-term goal has been met?

A child who was visiting a wooded area on vacation presents to the doctor's office with a localized bull's-eye rash.Which action by the nurse is the most appropriate?