Question 1

A child who is intubated and on a mechanical ventilator is being transferred from the emergency department to the burn unit.Which action by the nurse takes priority?
A)Ensure an Ambu bag is at the bedside.
B)Have sedation available if needed.
C)Orient the family to the burn unit.
D)Place the patient on protective isolation.

Accepted Answer

Maintaining a patent airway is the priority in this child.The nurse should make sure an Ambu bag is at the bedside and that other emergency equipment is available.Sedation may be needed.Orienting the family is important but is not the priority.There is no indication that the child needs protective isolation.

Question 2

A nurse wishes to prevent radiant heat loss from an infant.What action is the most appropriate?
A)Apply warm blankets to the baby.
B)Cover the baby's head with a cap.
C)Place a space heater near the baby.
D)Warm and humidify the oxygen.

Accepted Answer

Radiant heat loss occurs as warmth dissipates into the environment,often occurring rapidly and accounting for over 50% of infant heat loss.The nurse covers the baby's head with a cap.Warm blankets would warm the baby through conduction.A space heater provides convection.Breathing warmed oxygen is preventing heat loss through respiration.

Question 3

A nurse is teaching a community parent group about signs and symptoms of Lyme disease.Which statements does the nurse include? (Select all that apply.)
A)Bull's-eye rash is seen in the early stage of the disease.
B)Fatigue and headache frequently occur in the early stage.
C)Inability to bear weight is often seen in the late disease phase.
D)Lyme disease manifests 3-30 days after a tick bite.
E)Signs of meningitis are seen in the early disseminated phase.

Accepted Answer

The early localized stage includes a rash (often classified as a bull's-eye rash)and vague systemic symptoms such as fatigue,headache,arthralgia,neck pain,fever,and myalgia.In the early disseminated phase,the rash expands;fatigue,headache,and arthralgia become more common;and the child may develop cranial nerve palsy,meningitis,and carditis.In the late disease phase,arthritis occurs that migrates from joint to joint,making walking uncomfortable,but the child is still able to bear weight.

Question 4

A nurse has assessed the skin of a newborn with the AWHONN Neonatal Skin Condition Score Tool and determines that her patient has a score of 3.What action by the nurse is most appropriate?
A)Document the findings and continue to monitor.
B)Elevate the child's lower extremities on pillows.
C)Implement pressure ulcer prevention measures.
D)Request a consultation by the wound care nurse.

Accepted Answer

This is a perfect score using this tool.The nurse should document the findings and continue to monitor per agency protocol.None of the other actions is required.

Question 5

The faculty member explains fungal skin diseases to a group of students.Which are the common types of this disorder? (Select all that apply.)
A)Tinea capitis
B)Tinea corporis
C)Tinea cruris
D)Tinea manus
E)Tinea pedis

Accepted Answer

The common integumentary fungal infections include tinea capitis (scalp),tinea corporis ("ringworm"),tinea cruris ("jock itch"),and tinea pedis (athlete's foot).Tinea manus is not a type of fungal infection.

Question 6

When teaching a parenting group how to prevent the most common cause of childhood burns,what action does the nurse advise?
A)Cover electrical outlets.
B)Keep children out of the kitchen.
C)Install smoke detectors.
D)Lock up household chemicals.

Accepted Answer

The most common type of childhood burn is a thermal burn.Installing smoke detectors provides early warning and the chance to escape a fire.

Question 7

A nurse is preparing to administer a prn medication to a 6-year-old child for pruritus.Which order should the nurse question?
A)Chlorpheniramine (Chlor-Trimeton)2 mg every 6 hours with food
B)Cyproheptadine (Periactin)2-4 mg every 8-12 hours
C)Diphenhydramine (Benadryl)50 mg PO every 4-6 hours
D)Hydroxyzine (Atarax)2 mg/kg/day in divided doses every 6-8 hours

Accepted Answer

For a child 6 to 12 years of age,the dose of Benadryl is 12.5-25 mg every 4-6 hours,not to exceed 150 mg/day.The other doses are appropriate.

Question 8

A child is brought to the emergency department from a house fire.She has singed eyebrows and sounds hoarse.After applying oxygen,which action by the nurse takes priority?
A)Assemble intubation equipment.
B)Gently cleanse any burn wounds.
C)Place child on a cardiac monitor.
D)Prepare to give pain medication.

Accepted Answer

All actions are appropriate for this child;however,airway patency is always the priority.This child has manifestations that cause the nurse to consider an inhalation injury.Swelling can occur rapidly,cutting off the airway.The nurse applies oxygen and ensures intubation supplies are nearby.If needed,the nurse delegates this activity.The child should be placed on a cardiac monitor,but because this is not related to airway,this is not the priority.Pain medication will be an important intervention,as is burn care,but,again,they are not the priority over airway.

Question 9

The nurse working in a community pediatric clinic knows that which are examples of secondary skin lesions? (Select all that apply.)
A)Crusts
B)Scales
C)Scars
D)Ulcers
E)Wheals

Accepted Answer

Secondary lesions are the result of changes from primary lesions and include crusts,scales,scars,ulcers,lichenification,keloids,fissures,and erosions.A wheal is a primary lesion.

Question 10

A nurse is providing anticipatory guidance to a community parent group about burn prevention.When discussing school-age and older children,which cause of burn occurs most often in this age group?
A)Cooking and kitchen activities
B)Exposure to hot water
C)Household electrical wires
D)Touching hot appliances

Accepted Answer

School-age and adolescent children are more independent than younger children and often cook food on the stove,in the oven,or in the microwave.This activity is associated with a risk for burns not seen in younger children.The other activities usually cause burns in infants and toddlers.

Question 11

A student is caring for a burned child on the burn unit.The student is performing burn care.Which action by the student requires intervention by the registered nurse? A)Applies silver nitrate (0.5% AgNO₃)to the child's face B)Applies silver sulfadiazine (AgSD)to the child's face C)Checks electrolyte levels before applying silver nitrate D)Uses Sulfamylon (mafenide acetate)on child's ear burns

Accepted Answer

Silver nitrate cannot be used on the face.The other actions are appropriate.

Question 12

The student studying pediatric integumentary problems learns that which are functions of the skin? (Select all that apply.)
A)Assists in water retention
B)Initiates tactile sensations
C)Provides physical barrier
D)Regulates temperature set point
E)Synthesizes vitamin D

Accepted Answer

The skin serves many functions,including forming a physical barrier to protect the body;initiating the sensations of touch,pain,heat,and cold;helping to regulate temperature;synthesizing vitamin D;and aiding in water retention.The temperature set point is regulated by the hypothalamus.

Question 13

The clinic nurse is assessing a child who had a tick bite for tick-borne disease.What assessment finding indicates to the nurse the child may have Rocky Mountain Spotted Fever and not Lyme disease?
A)Abdominal pain
B)Clear skin
C)Fever
D)Headache

Accepted Answer

Rocky Mountain Spotted Fever produces severe abdominal pain.Fever and headache are seen in both diseases,as is a rash.

Question 14

A nurse assesses a pressure ulcer on a child and finds full-thickness loss of the dermal layer and visible subcutaneous fat.At which stage does the nurse document this pressure ulcer to be?
A)Stage I
B)Stage II
C)Stage III
D)Stage IV

Accepted Answer

A stage III pressure ulcer involves the full thickness of the dermis,possible visible subcutaneous fat,possible sloughing,and possible tunneling.This is a stage III ulcer.

Question 15

A burned patient had an escharotomy on the right anterior thigh.Which assessment finding indicates that this procedure has been effective?
A)Absence of infection in the burn
B)Compartment pressure of 42 mm Hg
C)Decreased pain in the right leg
D)Pedal pulses 3+/4+ bilaterally

Accepted Answer

An escharotomy is performed when eschar impedes circulation.Strong and equal pedal pulses indicate return of circulation.Escharotomies are not related to preventing infection.A compartment pressure greater than 30 mm Hg requires emergency surgery.Decreased pain is usually the finding when eschar is present and intact.

Question 16

The nurse working in a pediatric burn unit explains to new registered nurses that which is the most common cause of death in burned children?
A)Hypovolemic shock
B)Infection
C)Sepsis
D)Thrombotic events

Accepted Answer

About 75% of burn mortality is related to infection.

Question 17

Paramedics bring a child to the emergency department with possible hypothermia.He walked to school without a coat and upon arrival he is noted to be shivering,nauseated,and uncoordinated.After removing the child's clothing,what nursing intervention does the nurse plan to implement?
A)Administer rapid IV boluses.
B)Apply a Bair Hugger.
C)Cover the child with warm blankets.
D)Start dialysis with warmed solution.

Accepted Answer

These are manifestations of mild hypothermia in which the child's temperature will be 35-37°C (95-98.6°F).After removing the cold and/or wet clothing,the nurse covers the child with warm blankets and administers warmed O₂ and warmed IV solutions.Rapid IV boluses are not indicated.The Bair Hugger would be used in more severe hypothermia,as would dialysis.

Question 18

A student nurse is caring for an adolescent with frostbite of the hand in the emergency department.Which action by the student would require the registered nurse to intervene?
A)Applies warm blankets to the child
B)Has the teen wear a warmed gown
C)Rubs patient's fingers to warm them
D)Takes teen's watch off of his wrist

Accepted Answer

A frostbitten area is never rubbed or massaged,as the ice crystals in the capillaries will damage the tissue when they break out of the vascular beds.Warm blankets and gown are appropriate for general re-warming measures.The watch (and any rings)should be removed in case of swelling.

Question 19

A nurse is caring for four patients on a general pediatric unit.The nurse identifies risk for impaired skin integrity as a nursing diagnosis for all four.Which patient's skin should the nurse assess first?
A)Adolescent 4 hours postoperative after appendectomy
B)School-age child just back from a tonsillectomy
C)Teen eating in a chair 1 week post-burn
D)Toddler with broken femur in skeletal traction

Accepted Answer

Immobility is a major risk factor for impaired skin integrity.The nurse should first assess the child in traction,as this child is the least mobile.A child sitting in a chair to eat is at least partially mobile.Children after routine surgery are expected to recover quickly and begin activity within a day.

Question 20

A child has been in the burn unit for 13 days.Which nursing assessment indicates that a priority goal has been met?
A)Decreased albumen over 5 days
B)Intake equals output for 24 hours
C)Participates in dressing changes
D)Weight gain of 0.5 kg in 1 week

Accepted Answer

Nutrition is an important problem for the child with burns,as the child is hypermetabolic and needs a high-calorie,high-protein diet.Children are generally weighed twice a week in the burn center.A weight gain shows that nutritional needs are being met.Albumen should increase with improved nutrition,but remember that this laboratory value lags behind other indicators of nutrition.Participating in dressing changes shows evidence of meeting a psychosocial goal,but that would not take priority over a physical problem.Intake should be more than output because of the insensible losses.

Quiz 30: Caring for the Child With a Integumentary Condition

A child who is intubated and on a mechanical ventilator is being transferred from the emergency department to the burn unit.Which action by the nurse takes priority?

A nurse wishes to prevent radiant heat loss from an infant.What action is the most appropriate?

A nurse is teaching a community parent group about signs and symptoms of Lyme disease.Which statements does the nurse include? (Select all that apply.)

A nurse has assessed the skin of a newborn with the AWHONN Neonatal Skin Condition Score Tool and determines that her patient has a score of 3.What action by the nurse is most appropriate?

The faculty member explains fungal skin diseases to a group of students.Which are the common types of this disorder? (Select all that apply.)

When teaching a parenting group how to prevent the most common cause of childhood burns,what action does the nurse advise?

A nurse is preparing to administer a prn medication to a 6-year-old child for pruritus.Which order should the nurse question?

A child is brought to the emergency department from a house fire.She has singed eyebrows and sounds hoarse.After applying oxygen,which action by the nurse takes priority?

The nurse working in a community pediatric clinic knows that which are examples of secondary skin lesions? (Select all that apply.)

A nurse is providing anticipatory guidance to a community parent group about burn prevention.When discussing school-age and older children,which cause of burn occurs most often in this age group?

A student is caring for a burned child on the burn unit.The student is performing burn care.Which action by the student requires intervention by the registered nurse?

The student studying pediatric integumentary problems learns that which are functions of the skin? (Select all that apply.)

The clinic nurse is assessing a child who had a tick bite for tick-borne disease.What assessment finding indicates to the nurse the child may have Rocky Mountain Spotted Fever and not Lyme disease?

A nurse assesses a pressure ulcer on a child and finds full-thickness loss of the dermal layer and visible subcutaneous fat.At which stage does the nurse document this pressure ulcer to be?

A burned patient had an escharotomy on the right anterior thigh.Which assessment finding indicates that this procedure has been effective?

The nurse working in a pediatric burn unit explains to new registered nurses that which is the most common cause of death in burned children?

Paramedics bring a child to the emergency department with possible hypothermia.He walked to school without a coat and upon arrival he is noted to be shivering,nauseated,and uncoordinated.After removing the child's clothing,what nursing intervention does the nurse plan to implement?

A student nurse is caring for an adolescent with frostbite of the hand in the emergency department.Which action by the student would require the registered nurse to intervene?

A nurse is caring for four patients on a general pediatric unit.The nurse identifies risk for impaired skin integrity as a nursing diagnosis for all four.Which patient's skin should the nurse assess first?

A child has been in the burn unit for 13 days.Which nursing assessment indicates that a priority goal has been met?