TEST 9: The Child with Dermatologic and Endocrine Health Problems Flashcards
The Client with Skin Disorders
1. A 17-year-old female with severe nodular acne is considering treatment with isotretinoin
(Accutane). Prior to beginning the medication, the nurse explains that the client will be required to:
1. Enroll in a risk management plan.
2. Have proof of a mental health evaluation.
3. Begin an effective form of birth control.
4. Temporarily give up sports.
The Client with Skin Disorders
1. 1. Because of the risk of birth defects with isotretinoin, risk management plans require all
clients to meet certain requirements to obtain the medication. Providers are advised to closely
monitor clients for signs of depression, but a mental health evaluation is not universally required.
Women of child-bearing age must use two forms of effective birth control for 2 months before, during,
and 1 month after taking the drug. Isotretinoin may cause muscle aches and extreme exercise should be
avoided, but general participation in sports should be considered on an individual basis.
CN: Safety and infection control; CL: Synthesize
- When teaching an adolescent with facial acne about skin care, the nurse should instruct the
adolescent to: - Wash the face twice a day with mild soap and water.
- Remove whiteheads and comedones after washing his face with antibacterial soap.
- Apply vitamin E ointment twice daily to the affected skin.
- Apply tretinoin (Retin-A) daily in the morning and expose the face to the sun.
- Washing the face once or twice a day with a mild soap removes fatty acids from the skin.
Acne is an inflammation of the sebaceous glands that produce sebum. Washing the face with mild
soap and water keeps the sebaceous glands from becoming plugged. Excessive washing or squeezing
the eruptions can cause rupture of these glands, spreading the sebum and causing further inflammation.
Applying vitamin E to the lesions does not reduce the inflammation and, due to the greasiness of the
preparation, may plug the ducts. Retin-A should be applied at night. Exposure to the sun can result in
sunburn and an increased risk of skin cancer and should be avoided. Sunscreen with a sun protection
factor of at least 15 must be applied before the client can be exposed to the sun.
CN: Physiological adaptation; CL: Synthesize
- Washing the face once or twice a day with a mild soap removes fatty acids from the skin.
- A 9-month-old infant with eczema has lesions that are secondarily infected. Which of the
following is most appropriate to help the parents best meet the needs of the child? - Preventing siblings from being in close contact.
- Sending the child to day care as usual.
- Playing video games for several hours each evening.
- Playing with the child every day.
- The parents can best meet the needs of their 9-month-old infant by playing with the child
every day. All infants need time with their parents to develop trust and thus attain optimal
development. The parents of a child with a chronic problem may need more guidance to meet the
child’s needs because of the focus on medical problems. The child’s lesions are secondarily infected
and therefore should not be contagious. Siblings do not need to stay away. Even with lesions that are
infected, the child can still attend day care, but the child needs attention from the parents as well.
Playing video games for several hours is not appropriate for a 9-month-old infant.
CN: Health promotion and maintenance; CL: Synthesize
- The parents can best meet the needs of their 9-month-old infant by playing with the child
- After the nurse teaches the mother of a child with atopic dermatitis how to bathe her child,
which of the following statements by the mother indicates effective teaching? - “I let my child play in the tub for 30 minutes every night.”
- “My child loves the bubble bath I put in the tub.”
- “When my child gets out of the tub I just pat the skin dry.”
- “I make sure my child has a bath every night.”
- Atopic dermatitis is a chronic pruritic dermatitis that usually begins in infancy. Many of the
children diagnosed with it have a family history of eczema, allergies, or asthma. Atopic dermatitis is
best treated with hydrating the skin, controlling the pruritus, and preventing secondary infection.
Patting the skin dry removes less natural skin moisturizer and thus maintains skin hydration. Water has
a drying effect on the skin. Playing in the tub for 30 minutes each night would deplete the skin of its
natural moisturizers, thereby leading to increased pruritus and dry skin. Bubble baths are to be
avoided in children with atopic dermatitis because they may act as an irritant, possibly exacerbatingthe condition. Also, bubble baths deplete the skin of its natural moisturizers. The issue is not whether
the child bathes every night. Rather, the goal is to decrease dryness and itching.
CN: Physiological adaptation; CL: Evaluate
- Atopic dermatitis is a chronic pruritic dermatitis that usually begins in infancy. Many of the
- A 5-year-old child brought to the clinic with several superficial sores on the front of the left
leg is diagnosed with impetigo. Which of the following instructions should the nurse give the parent? - Wash the child’s legs gently three times per day with a mild soap.
- Cover the sores with loose gauze.
- Allow the child to go back to school after 24 hours of treatment.
- Have the child return to the clinic the next week for a follow-up examination
- Impetigo involving several superficial lesions is usually treated topically, including washing
the affected areas, removing crusts, and applying antibiotic ointment several times a day. The child
can return to day care or school after being treated for 24 hours. The lesions do not need to be
covered, they can remain open to the air. There is no need for follow-up unless the lesions have not
resolved or have become more severe.
CN: Physiological adaptation; CL: Create
- Impetigo involving several superficial lesions is usually treated topically, including washing
- When developing the teaching plan for the mother of a 2-year-old child diagnosed with
scabies, which of the following points should the nurse expect to include? - The floors of the house should be cleaned with a damp mop.
- The child should be held frequently.
- Itching should cease in a few days.
- The entire family should be treated.
- Scabies is caused by the scabies mite, Sarcoptes scabiei. The mite burrows into the stratum
corneum of the epidermis, where the female deposits eggs and fecal material. These burrows are
linear. Scabies is highly contagious. The length of time from infestation to physical symptoms is 30 to
60 days, so everyone in close contact with the child will need to be treated. The bed linens and the
child’s clothing should be washed in hot water and dried on the hot setting. It is not necessary to damp
mop the floors to prevent the spread of scabies. The child should be held minimally until treatment is
completed. Family members should wash their hands after contact with the child. Itching lasts for 2 to
3 weeks until the stratum corneum is replaced.
CN: Safety and infection control; CL: Create
- Scabies is caused by the scabies mite, Sarcoptes scabiei. The mite burrows into the stratum
The Client with Burns
7. A 10-year-old has just spilled hot liquid on his arm, and a 4-inch (10.2-cm) area on his
forearm is severely burned. His mother calls the emergency department. What should the nurse advise
the mother to do?
1. Keep the child warm.
2. Cover the burned area with an antibiotic cream.
3. Apply cool water to the burned area.
4. Call 911 to transport the child to the hospital.
The Client with Burns
7. 3. To prevent further injury to the skin, the mother should apply cool water to the burn site.
Doing so causes vasoconstriction, retards further damage to tissues, and decreases fluid loss.
Keeping the child warm promotes vasodilation, increases fluid loss, and decreases blood pressure
and, thus, circulation to the area. Applying ointment to the burn is contraindicated because it does not
allow healing to occur and may need to be removed in the hospital. Only a clean cloth should be used
to cover the wound to prevent contamination or decrease pain or chilling. If only the arm is burned, a
call to 911 for emergency care is not necessary, but the mother should seek health care services
immediately.
CN: Health promotion and maintenance; CL: Synthesize
- A school-age child who has received burns over 60% of his body is to receive 2,000 mL of IV fluid
over the next 8 hours. At what rate (in milliliters per hour) should the nurse set the infusion pump?
_______________ mL/h.
- 250 mL/h
2000 ml / 8 hr = 250 ml / h
CN: Pharmacological and parenteral therapies; CL: Apply
- Which of the following would be most appropriate to institute when a school-age child with
burns becomes angry and combative when it is time to change the dressings and apply mafenide
acetate? - Ensure parental support during the dressing changes.
- Allow the child to assist in removing the dressings and applying the cream.
- Give the child permission to cry during the procedure.
- Allow the child to schedule the time for dressing changes.
- Expressions of anger and combativeness are often the result of loss of control and a feeling
of powerlessness. Some control over the situation is regained by allowing the child to participate in
care. Although having parental support during the dressing changes may be helpful, this action does
nothing to allow the child control. Giving the child permission to cry may help with verbalizing
feelings, but doing so does nothing to provide the child with control over the situation. Although
allowing the child to determine the time for dressing changes may provide a sense of control over the
situation, doing so is inappropriate because the dressing changes need to be performed as prescribed
to ensure effectiveness and healing.
CN: Physiological adaptation; CL: Synthesize
- Expressions of anger and combativeness are often the result of loss of control and a feeling
- A 5-year-old child with burns on the trunk and arms has no appetite. The nurse and the mother
develop a plan of care to stimulate the child’s appetite. Which of the following suggestions made by
the mother would indicate that she needs additional teaching? - Deciding that she will feed the child herself.
- Withholding dessert and treats unless meals are eaten.
- Offering the child finger foods that the child likes.
- Serving smaller and more frequent meals.
- Withholding certain foods until the child complies is punitive and rarely successful.Allowing the mother to feed the child, serving smaller and more frequent meals, and offering finger
foods are all acceptable interventions for a 5-year-old child. This is true whether the child is well or
ill.
CN: Basic care and comfort; CL: Evaluate
- Withholding certain foods until the child complies is punitive and rarely successful.Allowing the mother to feed the child, serving smaller and more frequent meals, and offering finger
- After teaching the mother of a child with severe burns about the importance of specific
nutritional support in burn management, which of the following, if chosen by the mother from the
child’s diet menu, indicates the need for further instruction? - Bacon, lettuce, and tomato sandwich; milk; and celery and carrot sticks.
- Cheeseburger, cottage cheese and pineapple salad, chocolate milk, and a brownie.
- Chicken nuggets, orange and grapefruit sections, and a vanilla milkshake.
- Beef, bean, and cheese burrito; a banana; fruit-flavored yogurt; and skim milk.
- Hypoproteinemia is common after severe burns. The child’s diet should be high in protein
to compensate for protein loss and to promote tissue healing. The child will also require a diet that is
high in calories and rich in iron. The menu of bacon, lettuce, and tomato sandwich; milk; and celery
sticks is lacking in sufficient protein and calories.
CN: Physiological adaptation; CL: Evaluate
- Hypoproteinemia is common after severe burns. The child’s diet should be high in protein
- When caring for a child with moderate burns from the waist down, which of the following
should the nurse do when positioning the child? - Place the child in a position of comfort.
- Allow the child to lie on the abdomen.
- Ensure the application of leg splints.
- Have the child flex the hips and knees.
- A child with moderate burns is at high risk for contractures. A position of comfort would
encourage contracture formation. Therefore, splints need to be applied to maintain proper positioning
and joint function, thereby preventing contractures and loss of function. Allowing the child to lie on
the abdomen or with the hips and knees flexed often encourages contracture formation.
CN: Reduction of risk potential; CL: Synthesize
- A child with moderate burns is at high risk for contractures. A position of comfort would
The Client with Hyperthyroidism
13. An adolescent is to receive radioactive iodine for Graves’ disease. Which statement by the
client reflects the need for more teaching?
1. “I plan to talk on Facebook since I have to keep several feet (kilometers) from my friends for 3
days.”
2. “Taking radioactive iodine will not affect my ability to have children in the future.”
3. “The advantage of radioactive iodine is that I will not need future medication for my disease.”
4. “I should try to use a separate bathroom from the rest of my family for several days.”
The Client with Hyperthyroidism
13. 3. Most clients will need lifelong thyroid replacement after treatments with radioactive
iodine. Most clients are treated as outpatients. To reduce the risk of exposure to radioactivity to
others, clients are advised to avoid public places for at least 1 day and maintain a prudent distance
from others for 2 to 3 days. Additionally, clients are advised to avoid close contact with pregnant
women and children for 5 to 11 days. The use of radioiodine to treat Graves’ disease has not been
found to affect long-term fertility. Clients are taught not to share food, utensils, and towels. Use of a
private bathroom is desirable. Clients are also instructed to flush the toilet more than one time after
each use.
CN: Safety and infection control; CL: Evaluate
- The nurse should instruct the family of a child with newly diagnosed hyperthyroidism to:
- Keep their home warmer than usual.
- Encourage plenty of outdoor activities.
- Promote interactions with one friend instead of groups.
- Limit bathing to prevent skin irritation.
- Children with hyperthyroidism experience emotional lability that may strain interpersonal
relationships. Focusing on one friend is easier than adapting to group dynamics until the child’s
condition improves. Because of their high metabolic rate, children with hyperthyroidism feel too
warm. Bright sunshine may be irritating because of disease-related ophthalmopathy. Sweating is
common and bathing should be encouraged.
CN: Physiological adaptation; CL: Synthesize
- Children with hyperthyroidism experience emotional lability that may strain interpersonal
- An 11-year-old child has been diagnosed with Graves’ disease and is to start drug therapy.
Which of the following instructions should the nurse include in the teaching plan for the child’s mother
and teacher? - Continue with the same amount of schoolwork and homework.
- Understand that mood swings are rare with this disorder.
- Limit the amount of food that is offered to the child.
- Provide the child with a calm, nonstimulating environment.
- Because it takes approximately 2 weeks before the response to drug treatment occurs, much
of the child’s care focuses on managing the child’s physical symptoms. Signs and symptoms of the
disorder include inability to sit still or concentrate, increased appetite with weight loss, emotional
lability, and fatigue. Nursing care is directed toward ensuring that the mother and teacher know how
to handle the child, suggesting a shortened school day, a nonstimulating environment, and decreased
stress and workload. The child should be encouraged to eat a well-balanced diet.
CN: Physiological adaptation; CL: Create
- Because it takes approximately 2 weeks before the response to drug treatment occurs, much
The Client with
Mellitus
Insulin-Dependent Diabetes
16. A student with type 1 diabetes tells the nurse she is feeling light-headed. The student’s blood
sugar is 60 mg/dL (3.3 mmol/L). Using the 15-15 rule, the nurse should give:
1. 15 mL of juice and give another 15 mL in 15 minutes.
2. 15 g of carbohydrate and retest the blood sugar in 15 minutes.
3. 15 g of carbohydrate and 15 g of protein.
4. 15 oz of juice and retest in 15 minutes
The Client with Insulin-Dependent Diabetes Mellitus
16. 2. The 15-15 rule is a general guideline for treating hypoglycemia where the client consumes15 g of carbohydrate and repeats testing the blood sugar in 15 minutes. Fifteen grams of carbohydrate
equals 60 cal and is roughly equal to 1⁄2 cup of juice or soda, six to eight lifesavers, or a tablespoon of
honey or sugar. The general recommendation is if the blood sugar is still low, the client may repeat
the sequence. Fifteen milliliters of juice would only provide 15 cal. This would not be sufficient
carbohydrates to treat the hypoglycemia. Protein does not treat insulin-related hypoglycemia;
however, a protein-starch snack may be offered after the blood glucose improves. Fifteen ounces of
juice would be 450 mL—almost four times the recommended 4 oz (120 mL) of juice.
CN: Physiological adaptation; CL: Synthesize
- An overweight adolescent has been diagnosed with type 2 diabetes. To increase the client’s
self-efficacy to manage their disease, the nurse should: - Provide the client with a written daily food and exercise plan.
- Discuss eliminating junk food in the home with the parents.
- Arrange for the school nurse to weigh the child weekly.
- Utilize a peer with type 2 diabetes to role model lifestyle changes.
- Self-efficacy, or the belief that one can act in a way to produce a desired outcome, can be
promoted through the observation of role models. Peers are particularly effective role models
because clients can more readily identify with them and believe they are capable of similar
behaviors. Providing a written plan alone does not promote self-efficacy. Having parents eliminate
junk food and having the school nurse weigh the adolescent can be part of the plan, but these actions
do not empower the client.
CN: Management of care; CL: Synthesize
- Self-efficacy, or the belief that one can act in a way to produce a desired outcome, can be
- After 6 months of treatment with diet and exercise, a 12-year-old with type 2 diabetes still
has a fasting blood glucose level of 140 mg/dL (7.8 mmol/L). The primary care provider has decided
to begin metformin (Glucophage). The adolescent asks how the medication works. The nurse should
tell the client that the medicine decreases the glucose production and: - Replaces natural insulin.
- Helps the body make more insulin.
- Increases insulin sensitivity.
- Decreases carbohydrate adsorption.
- Metformin is currently approved by the FDA and Health Canada to treat type 2 diabetes in
children. The medication decreases glucogenesis in the liver and increases insulin sensitivity in the
peripheral tissues. Only insulin can actually replace insulin. This treatment is reserved for clients
with type 1 diabetes or those with type 2 who do not respond to diet, exercise, and an oral diabetic
agent. Other oral medications used to treat diabetes augments insulin production or decreases
carbohydrate absorption, but those medications are primarily used in adults.
CN: Pharmacological and parenteral therapies; CL: Apply
- Metformin is currently approved by the FDA and Health Canada to treat type 2 diabetes in
- The nurse is evaluating a child’s skills in self-administering insulin (see figure). The nurse
should: (with picture - the child is holding the insulin syringe 90-degree with her left hand while administering insulin on her left upper thigh ) - Have the child use both hands on the syringe.
- Ask the child to place the needle at a 45-degree angle.
- Tell the child to use a site lower on her thigh.
- Remind the child to rotate sites.
- The child is using correct injection technique, and the nurse can remind the child to rotate
sites. The nurse should also reinforce that the child has used correct technique and praise the child for
doing so. If the child can manipulate the plunger of the syringe with one hand, this is appropriate.
Insulin is administered at a 90-degree angle as shown. The child should identify appropriate sites on
the thighs as one handbreadth below the hip and above the knee; the child is using appropriate sites.
CN: Health promotion and maintenance; CL: Apply
- The child is using correct injection technique, and the nurse can remind the child to rotate
20.A 14-year-old is using glargine and lispro to manage type I diabetes. The prescription for sliding
scale lispro reads:
Lispro subcutaneous give units according to sliding scale:
Blood glucose: 70–150 mg/dL (3.9–8.3 mmol/L) = 0 units
151–200 mg/dL (8.4–11.1 mmol/L) = 1 unit
201–250 mg/dL (11.2–13.9 mmol/L) = 2 units
251–300 mg/dL (13.93–16.65 mmol/L) = 3 units
301–350 mg/dL (17–19.4 mmol/L) = 4 units
Call for Blood glucose > 350 (19.4 mmol/L)
In addition give 1 unit for every 15 g of carbohydrate.
The morning blood glucose is 202 mg/dL (11.2 mmol/L) and the client is going to eat two
carbohydrate exchanges. The nurse has the client administer how many units of lispro?
____________________ units.
- 4 Units. Each carbohydrate food exchange has 15 g of carbohydrate. Two units are needed to
cover the current blood glucose and 2 units are needed to cover the anticipated carbohydrate intake.
CN: Pharmacological and parenteral therapies; CL: Apply
- An 8-year-old with diabetes is placed on neutral protamine Hagedorn (NPH) and regular
insulin before breakfast and before dinner. She will receive a snack of milk and cereal at bedtime.
The snack will: - Help her regain lost weight.
- Provide carbohydrates for immediate use.3. Prevent late night hypoglycemia.
- Help her stay on her diet.
- NPH insulin peaks in 6 to 8 hours, which would occur during sleep. A bedtime snack is
needed to prevent late night hypoglycemia. The snack is not given to help regain weight. Milk
contains fat and protein, which cause delayed absorption into the blood stream and maintains the
blood glucose level at night when the NPH insulin will peak. The snack is not used to provide
carbohydrates for immediate use because NPH insulin, unlike regular insulin, does not peak
immediately. The snack has nothing to do with a diet.
CN: Psychosocial integrity; CL: Apply
- NPH insulin peaks in 6 to 8 hours, which would occur during sleep. A bedtime snack is
- A nurse is teaching an 8-year-old with diabetes and her parents about managing diabetes
during illness. The nurse determines the parents understand the instruction when they indicate that,
when the child is ill, they will provide: - More calories.
- More insulin.
- Less insulin.
- Less protein and fat.
- The child needs more insulin during an illness, because the cells become more insulin
resistant during illness and need more insulin to achieve a normal blood glucose level. During an
acute illness, simple carbohydrates and fluids are usually tolerated best.CN: Physiological adaptation; CL: Evaluate
- The child needs more insulin during an illness, because the cells become more insulin
23. A nurse is assessing an 8-year-old with diabetes who is experiencing hyperglycemia. Which symptom(s) indicate(s) that the hyperglycemia requires immediate intervention? Select all that apply. 1. Weakness. 2. Thirst. 3. Shakiness. 4. Hunger. 5. Headache. 6. Dizziness.
- 1, 2, 6. Weakness, thirst, and dizziness are symptoms related to dehydration caused by
excretion of large amounts of glucose and water in the urine. The nurse should notify the primary
health care provider. Shakiness, hunger, headache, and irritability are related to hypoglycemia and
result from the brain and other cells being starved for nutrients.
CN: Physiological adaptation; CL: Analyze
- The nurse talks to an adolescent about how she can tell her friends about her new diagnosis
of diabetes. Which of the following behaviors by the adolescent indicates that the adolescent has
responded positively to the discussion? - She asks the nurse for material on diabetes for a school paper.
- She introduces the nurse to her friends as “the one who taught me all about my diabetes.”
- She says, “I’ll try to tell my friends, but they’ll probably quit hanging out with me.”
- She asks her friends what they think about someone who has a lifelong illness.
- The ability to talk about her diabetes indicates that the adolescent feels good enough about
herself to share her problem with her peers. Asking for reference material does not specifically
indicate that the client’s self-esteem has improved or that she has accepted her diagnosis. Saying that
her friends will probably desert her if she tells them about the illness indicates that the adolescent
still needs to work on her self-esteem and her feelings about the disease. Asking her friends what they
think of someone with a lifelong illness would not indicate that the nurse’s interventions targeted
toward improving self-esteem have been successful. Rather, this statement demonstrates the
adolescent’s uncertainty about herself.
CN: Psychosocial integrity; CL: Evaluate
- The ability to talk about her diabetes indicates that the adolescent feels good enough about