Integumentary Disorders (Saunders NCLEX-PN® Flashcards
A nurse is providing instructions to a mother of a child with atopic dermatitis (eczema) regarding the application of topical cortisone cream to the affected skin sites. Which of the following statements, if made by the mother, indicates an understanding of the use of this medication?
- “I need to wash the sites gently before I apply the medication.”
- “The medication is applied everywhere except the face.”
- “I need to apply the medication generously and allow it to absorb.”
- “I shouldn’t rub the medication into the skin.”
“I need to wash the sites gently before I apply the medication.”
Rationale: Topical corticosteroids should be applied sparingly and rubbed into the area thoroughly. The affected area should be cleansed gently prior to application. The cream should not be applied over extensive areas. Systemic absorption is more likely to occur with extensive application.
A mother brings her child to the health care clinic because the child has developed lesions located around the mouth and nose, and mild impetigo is diagnosed. The nurse provides instructions to the mother regarding care of the child. Which statement by the mother indicates the need for further instructions?
- “The impetigo is extremely contagious.”
- “The lesions should be washed gently three times a day with a warm, soapy washcloth.”
- “The crusts on the lesions need to be soaked and carefully removed.”
- “My child will need to be treated with oral antibiotics.”
“My child will need to be treated with oral antibiotics.”
Rationale: Impetigo is extremely contagious and may spread to other parts of the child’s skin or to others who touch the child, use the same towel, or drink from the same glass. Lesions should be gently washed three times a day with a warm, soapy facecloth and crusts soaked and carefully removed. Mild cases are treated with topical antibiotic ointment. The topical antibiotic ointment is applied to the lesions after they are washed. Severe cases are treated with oral antibiotics.
A child is diagnosed with tinea capitis of the scalp. Oral griseofulvin (Gris-PEG) has been prescribed for the child, and the nurse provides instructions regarding the administration of the medication. Which of the following instructions would the nurse provide to the mother?
- Administer the medication with water.
- Administer the medication on an empty stomach.
- Administer the medication at bedtime.
- Administer the medication with milk.
Administer the medication with milk.
Rationale: Griseofulvin (topical and oral) is the treatment of choice for tinea capitis. For topical treatment to be effective, topical medication must penetrate the hair follicles. Topical therapy alone is not effective, and oral medication is prescribed. Because the medication is insoluble in water, absorption of the medication is improved it is taken with a high-fat meal or with milk.
A nurse is caring for a child who was burned in a house fire. The nurse assists in developing a plan of care for monitoring the child during the treatment for burn shock. The nurse identifies which of the following assessments as providing the most accurate guide to determine the adequacy of fluid resuscitation?
- Level of consciousness
- Amount of edema at the site of the burn injury
- Heart rate
- Lung sounds
Level of consciousness
Rationale: The sensorium, or level of consciousness, is an important guide to the adequacy of fluid resuscitation. The burn injury itself does not affect the sensorium, so the child should be alert and oriented. Any alteration in sensorium should be evaluated further. A neurological assessment would determine the level of consciousness in the child. Options 2, 3, and 4, although important in the assessment of the child with a burn injury, would not provide an accurate assessment of the adequacy of fluid resuscitation.
A 4-year-old child is being transported to the trauma center from a local community hospital for treatment of a burn injury that is estimated as covering over 40% of the body. The burns are both partial- and full-thickness burns. The nurse is asked to prepare for the arrival of the child and gathers supplies anticipating that which of the following will be prescribed initially?
- Insertion of a nasogastric tube
- Insertion of a Foley catheter
- Administration of an anesthetic agent for sedation
- Application of an antimicrobial agent to the burns
Insertion of a Foley catheter
Rationale: A Foley catheter is inserted into the child’s bladder so that urine output can be accurately measured on an hourly basis. Although pain medication may be required, the child would not receive an anesthetic agent and should not be sedated. The burn wounds would be cleansed and treated after assessment, but this would not be the initial action. Intravenous fluids are administered at a rate sufficient to keep the child’s urine output at 1 mL/kg of body weight per hour, thus reflecting adequate tissue perfusion. A nasogastric tube may or may not be required but would not be the priority intervention.
A nurse provides instructions to the mother of a child diagnosed with pediculosis (head lice). Permethrin (Nix) has been prescribed. Which statement by the mother regarding the use of the medication indicates a need for further instructions?
- “After rinsing out the medication, I need to avoid washing my child’s hair for 24 hours.”
- “I need to shampoo my child’s hair, apply the medication, leave it on for 10 minutes, and then rinse it out.”
- “I need to shampoo my child’s hair, apply the medication, and leave the medication on for 24 hours.”
- “I need to purchase the medication from the pharmacy.”
“I need to shampoo my child’s hair, apply the medication, and leave the medication on for 24 hours.”
Rationale: Permethrin is an over-the-counter antilice product that kills both lice and eggs with one application and has residual activity for 10 days. It is applied to the hair after shampooing and left for 10 minutes before rinsing out. The hair should not be shampooed for 24 hours after the rinsing treatment.
