Chapter 45: Integumentary Disorders

Question 1

1. 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.”

Answer 1

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.

Question 2

2. 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.

Answer 2

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.

Question 3

3. 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.”

Answer 3

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.

Question 4

4. 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.

Answer 4

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.

Question 5

5. 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

Answer 5

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.

Question 6

6. 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

Answer 6

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.

Question 7

7. 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

Answer 7

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.

Question 8

8. 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

Answer 8

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.

Question 9

9. 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

Answer 9

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.

Question 10

10. 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.”

Answer 10

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.

Question 11

11. 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.”

Answer 11

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.

Question 12

12. 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

Answer 12

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.

Question 13

13. 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

Answer 13

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.

Question 14

14. 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

Answer 14

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.

Question 15

15. 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.”

Answer 15

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.

Question 16

16. 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

Answer 16

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.

Question 17

17. 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

Answer 17

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.

Question 18

18. 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

Answer 18

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.

Question 19

19. 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

Answer 19

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.

Question 20

20. 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.

Answer 20

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.

Question 21

21. 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

Answer 21

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.

Question 22

22. 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.

Answer 22

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.

Question 23

23. 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

Answer 23

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.

Question 24

24. 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

Answer 24

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.

Question 25

25. A 4-year-old is brought to the emergency department with a burn. What would alert the nurse to the possibility of child abuse?
    A. Burn assessment correlates with mother’s report of contact with a portable heater.
    B. Parents state that the injury occurred approximately 15 to 20 minutes ago.
    C. Clear delineations are noted between burned and nonburned skin areas.
    D. The burn area appears asymmetric and nonuniform.

Answer 25

Ans: C
Rationale: Suggested signs of a burn resulting from possible child abuse include a uniform appearance of the burn with clear delineations of burned and nonburned areas. Abuse would also be suspected if the report of the injury was inconsistent with burn injury or there was a delay in seeking treatment. An asymmetric nonuniform burn often correlates with a splatter-type burn resulting from the child pulling a source of hot fluid onto himself or herself.

Question 26

26. A nurse is preparing a presentation for a local parent group about burn prevention and care in children. What would the nurse be least likely to include in the presentation when describing how to care for a superficial burn?
    A. Using cool water over the burned area until the pain lessens
    B. Applying ice directly to the burned skin area
    C. Covering the burn with a clean, nonadhesive bandage
    D. Giving the child acetaminophen for pain relief

Answer 26

Ans: B
Rationale: With a superficial burn, ice should not be applied to the skin. Using cool water over the burn area; covering with a clean, nonadhesive bandage; and using acetaminophen for pain relief are appropriate to include in the presentation.

Question 27

27. The nurse is interviewing the mother of a 6-month-old being seen at a well- child visit. The mother reports she has used an over-the-counter topical ointment intended for adults on her child for a skin rash. What is most appropriate response by the nurse?
    A. “This is dangerous so please do not do this again.”
    B. “Why did you do that instead of contacting your healthcare provider?”
    C. “Children have thin skin and can absorb medications differently than adults.”
    D. “How often do you use this medication?”

Answer 27

Ans: C
Rationale: Children have thinner skin than adults. They will absorb topical medications more rapidly than adults. Medications concentrated for adults should not be used on children. It is important to explain this to the parent. It is confrontational to tell her this is dangerous or to tell her to contact the healthcare provider. The frequency of use is information that should be obtained but the education is most important in this scenario.

Question 28

28. The mother of a 15-year-old girl has contacted the clinic to report that her daughter has burned the back of her hand with a curling iron. The child’s mother reports the burn is mild but states her daughter is complaining of pain. After consulting with the healthcare provider, what instructions can the nurse anticipate will be recommended? Select all that apply.
    A. Apply a thin film of protective cocoa butter.
    B. Run cool water over the injured area.
    C. Apply ice for 15 to 20 minutes each hour until the pain subsides.
    D. Take acetaminophen using the manufacturer’s guidelines.
    E. Apply a thin layer of petroleum jelly to the burned area.

Answer 28

Ans: B, D
Rationale: Mild burns may be cared for at home. Cool water may be run over the injured tissue. Acetaminophen or ibuprofen may be administered for pain. Ointments and creams including butter, margarine, cocoa butter, and petroleum jelly should not be applied.

Question 29

29. The nurse is caring for a school-age child with tinea capitis. The child has open lesions from the disease and has lost hair in the areas affected. Which nursing diagnoses would be a part of this client’s care plan? Select all that apply.
    A. Impaired skin integrity
    B. Risk for infection
    C. Disturbed body image
    D. Bathing, self-care deficit
    E. Altered nutrition

Answer 29

Ans: A, B, C
Rationale: Tinea is a fungal disease of the skin occurring on any part of the body, in this case the head (scalp, eyebrows, or eyelashes). Since this child has open lesions and hair loss from affected areas, there is impairment of skin integrity (which makes the areas at risk for infection). Body image is disturbed since the hair loss is visible. There is no indication of bathing deficit or altered nutrition.

Question 30

30. A teenage girl with psoriasis tells the nurse that she is embarrassed by the plaque on her skin that she doesn’t want to go to school. What is the best response by the nurse?
    A. “Have you been applying your medication and emollients to your skin as directed by your healthcare provider?”
    B. “It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis.”
    C. “Sunlight really helps the plaque areas heal. Maybe going to a tanning bed routinely will help.”
    D. “You can’t miss school because of your skin. Can you wear clothes that will cover the areas?”

Answer 30

Ans: B
Rationale: “It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis” shows empathy and allows the nurse to determine how the girl is taking care of the psoriasis and if any suggestions to the treatment plan can be helpful. Questioning the client if she is doing what the healthcare provider has prescribed may make her defensive and does not show empathy. Suggesting tanning can cause too much exposure to unwanted UV rays; telling the girl that she can’t miss school and to cover the areas does not elicit open discussion and does not promote self-esteem.

Question 31

31. The mother of a 5-year-old child with eczema is getting a check-up for her child before school starts. What will the nurse do during the visit?
    A. Change the bandage on a cut on the child’s hand.
    B. Assess the compliance with treatment regimens.
    C. Discuss systemic corticosteroid therapy.
    D. Assess the child’s fluid volume.

Answer 31

Ans: B
Rationale: Maintaining proper therapy for eczema can be exhausting both physically and mentally. Therefore, it is essential that the nurse assess compliance and support the parents’ ability to cope if necessary. Changing a bandage is not part of a health maintenance visit. Hydration is important for a child with eczema, however, fluid volume is not the focus at this visit. Systemic corticosteroid therapy is very rarely used, and the success of the current therapy needs to be assessed.