Level 1
Why are infants at higher risk for skin breakdown than older children?
A. Their epidermis is loosely bound to the dermis
B. Their skin is thicker and tougher
C. They have more subcutaneous fat
D. Their skin absorbs less medication
Correct answer: A
Rationale:Infant skin has a loosely bound epidermis and dermis, which makes friction-related blistering and skin breakdown more likely.
Which finding is most consistent with nonbullous impetigo?
A. Silvery plaques on elbows
B. Honey-colored crusted lesions around the nose and mouth
C. Bright red rash in the diaper folds with satellite lesions
D. Painful vesicles on the lips
Correct answer: B
Rationale: Impetigo commonly presents with thick yellow-brown or honey-colored crusts, often around the nose and mouth.
A child with a red, itchy rash after poison ivy exposure is most likely experiencing:
A. Urticaria
B. Contact dermatitis
C. Seborrheic dermatitis
D. Acne vulgaris
Correct answer: B
Rationale: Contact dermatitis is linked to skin exposure to substances like poison ivy, detergents, dyes, and chemicals, and may appear as an erythematous papulovesicular rash.
A 6-year-old hospitalized child has an IV infusing in the forearm. The nurse notes swelling at the site, a damp dressing, cool skin around the catheter, and a slower infusion rate. The child reports discomfort. Which complication should the nurse suspect?
A. Phlebitis
B. Infection
C. Infiltration
D. Hematoma
Correct answer: C
Rationale:Infiltration occurs when IV fluid leaks into surrounding tissue and presents with swelling, a damp site, coolness, pain, and slowed infusion.
A 5-year-old child with 18% TBSA burns is admitted 2 hours after injury. The child weighs 16 kg. The nurse knows the provider will likely use the pediatric Parkland formula. Which total fluid amount is calculated for the first 24 hours?
A. 432 mL
B. 768 mL
C. 864 mL
D. 1,344 mL
Correct answer: C
Rationale:Your notes use 3 mL × weight (kg) × %TBSA for pediatric burn fluid replacement.
3 × 16 × 18 = 864 mL in the first 24 hours, with about half given in the first 8 hours.
Which skin lesion is best described as a flat, distinct discolored area?
A. Papule
B. Pustule
C. Macule
D. Wheal
Correct answer: C
Rationale:A macule is a flat, distinct discolored area of skin.
Which treatment would the nurse expect for mild cellulitis?
A. Topical ketoconazole
B. Oral cephalexin
C. IV oxacillin
D. Oral antihistamine
Correct answer: B
Rationale:Your notes state that mild cellulitis is treated with oral cephalexin, while more severe cases may need IV cephalosporins.
Which medication class is commonly used to treat urticaria (hives)?
A. Antifungals
B. Antihistamines
C. Vasodilators
D. Corticosteroids only by injection
Correct answer: B
Rationale: Urticaria is treated with antihistamines.
A child receiving a vesicant medication through a peripheral IV suddenly reports burning pain. The nurse sees erythema, edema, and developing blisters at the site. Which complication is the priority concern?
A. Extravasation
B. Phlebitis
C. Air embolism
D. Local infection
Correct answer: A
Rationale:Extravasation occurs when a vesicant medication leaks into tissue, causing burning, edema, erythema, blisters, and possible necrosis.
A 17-kg child with major burns is receiving fluid resuscitation. Which finding best indicates that perfusion is currently adequate?
A. Urine output of 0.3 mL/kg/hr
B. Urine output of 1 mL/kg/hr
C. No tears when crying
D. Heart rate 160/min without change
Correct answer: B
Rationale:The minimum urine output goal in pediatric burns is 1 mL/kg/hr.
Which lesion is filled with clear fluid?
A. Vesicle
B. Plaque
C. Fissure
D. Keloid
Correct answer: A
Rationale:A vesicle is an elevated lesion filled with clear fluid.
Which finding best differentiates diaper candidiasis from simple diaper dermatitis?
A. It spares the skin folds
B. It causes only dry scaling
C. It has satellite lesions and involves the skin folds
D. It always causes a fever
Correct answer: C
Rationale:Diaper candidiasis is typically bright red, involves the skin folds, and has satellite lesions. Simple diaper dermatitis does not.
Which condition is most associated with cradle cap in infancy?
A. Psoriasis
B. Seborrheic dermatitis
C. Tinea capitis
D. Acne vulgaris
Correct answer: B
Rationale:Your notes identify cradle cap as infant seborrheic dermatitis.
A 3-year-old is brought to the emergency department after a house fire. The child has facial burns, hoarseness, black sputum, and increasing respiratory distress. Which provider prescription should the nurse anticipate implementing first?
A. Topical antibiotic ointment
B. 100% oxygen via nonrebreather
C. Oral acetaminophen
D. Warm soapy bath
Correct answer: B
Rationale:With severe burns and possible smoke inhalation, airway and breathing come first. The notes state that severe burn patients should receive 100% oxygen via nonrebreather or bag-valve-mask ventilation, especially when hoarseness, facial burns, or carbonaceous sputum are present.
A child with a large burn injury develops a wound that is becoming more red, swollen, and painful during early management. Which complication should the nurse suspect first?
A. Normal healing inflammation
B. Burn wound cellulitis
C. Superficial burn conversion only
D. Keloid formation
Correct answer: B
Rationale:Your notes state that burn wound cellulitis becomes increasingly red, swollen, and painful early during management.
A child has an annular rash with central clearing. Which condition does the nurse suspect first?
A. Psoriasis
B. Tinea corporis
C. Cellulitis
D. Impetigo
Correct answer: B
Rationale: Tinea corporis is described as an annular lesion that looks like a ring.
Which statement about atopic dermatitis is correct?
A. It is usually painless and nonpruritic
B. It is associated with allergies, asthma, and intense itching
C. It is caused only by bacteria
D. It is treated only with oral antibiotics
Correct answer: B
Rationale:Atopic dermatitis is associated with food allergies, seasonal allergies, asthma, and can progress to extreme itching with lichenification.
Which finding is most expected with fifth disease?
A. Honey-colored crusts
B. Slapped-cheek appearance with lacy rash
C. Rash on palms and soles only
D. Painful ulcers around the mouth only
Correct answer: B
Rationale:Fifth disease causes a bright red slapped-cheek appearance with a lacy body rash.
A 4-year-old has a burn on the arm with erythema, blisters, and severe pain. The area blanches, and the child has intact sensation. Which burn depth should the nurse document?
A. Superficial burn
B. Deep partial-thickness burn
C. Full-thickness burn
D. Partial-thickness burn
Correct answer: D
Rationale:A partial-thickness (second-degree) burn involves the epidermis and part of the dermis and presents with redness, blisters, and pain. Deep partial-thickness burns extend deeper and are noted as not blanching in your notes.
A child sustained an electrical burn but has only a small visible hand injury. The parent asks why the child is being admitted for monitoring. Which response by the nurse is best?
A. “Electrical burns always need skin grafting.”
B. “The main concern is fungal infection.”
C. “Electrical burns require ECG monitoring for 72 hours because arrhythmias can occur.”
D. “Children with electrical burns cannot receive IV fluids.”
Correct answer: C
Rationale:The notes specifically state that electrical burns require ECG monitoring for 72 hours to detect cardiac arrhythmias.
Which lab test is used to identify a fungal skin infection?
A. CRP
B. CBC
C. KOH prep
D. Skin biopsy
Correct answer: C
Rationale:A potassium hydroxide prep (KOH) is used to identify fungal infection.
Which disorder is most associated with silvery yellow-white scales and distinct plaques?
A. Psoriasis
B. Urticaria
C. Folliculitis
D. Herpes simplex 1
Correct answer: A
Rationale:Psoriasis causes erythematous papules that form plaques with a silvery yellow-white scale and distinct borders.
Which child is at greatest risk for CA-MRSA?
A. Child with cradle cap at home
B. Teen with acne using OTC cleansers
C. Wrestler who shares towels in a crowded locker room
D. Infant with diaper dermatitis
Correct answer: C
Rationale:CA-MRSA risk factors include contact sports, crowded conditions, and towel sharing.
A toddler is brought in with sharply demarcated burns of both feet and lower legs. The caregiver says the child “splashed into warm bath water,” but the burns have a uniform stocking pattern with no splatter marks, and care was delayed. What is the nurse’s priority interpretation?
A. This is most consistent with partial-thickness accidental splash burns
B. This pattern is concerning for abuse and requires reporting per protocol
C. This is expected with all scald burns in toddlers
D. The child likely only needs home care teaching
Correct answer: B
Rationale:Suspicious burn findings include an inconsistent history, delay in seeking care, uniform burns, and stocking or glove patterns from forced immersion.
A 2-year-old with extensive burns is undergoing dressing changes and debridement. Which nursing action is most important to include in the plan of care?
A. Delay pain medication until after the procedure so assessment is more accurate
B. Premedicate for pain before dressing changes and debridement
C. Pop intact blisters to reduce pressure before the provider arrives
D. Apply petroleum jelly to all wounds after cleansing
Correct answer: B
Rationale:Pain management is a major priority in burns, and your notes state that pain medications should be given before procedures, dressing changes, debridement, cleaning, or ointment application. The notes also say do not pop blisters and do not apply petroleum jelly to superficial burns at home.