An adolescent is at the pediatrician's office because he has been experiencing intense itching, particularly in the axilla and between the fingers.
The itching is worse during the night and he has not been sleeping well.
With what is this symptom associated?
Scabies.
Pediculosis capitis.
Tinea corporis.
Eczema.
The Correct Answer is A
Choice A rationale
Scabies is caused by the mite Sarcoptes scabiei, which burrows into the stratum corneum of the epidermis to lay eggs. This infestation triggers a hypersensitivity reaction (type IV) in the host, resulting in intense pruritus (itching) due to inflammatory mediators. The itching is often worse at night because mite activity increases with warmth, and the host's body temperature rises under bed covers. The characteristic burrows and vesicles are commonly found in interdigital spaces and the axilla.
Choice B rationale
Pediculosis capitis, or head lice, is an infestation caused by the head louse, Pediculus humanus capitis. This parasite feeds on human blood from the scalp, leading to intense itching (pruritus) primarily on the head. Itching is a result of an allergic reaction to the louse saliva. Unlike scabies, pediculosis does not typically present with a rash in the interdigital spaces or axilla, but rather nits (eggs) and lice on the hair shaft and scalp.
Choice C rationale
Tinea corporis, commonly known as ringworm, is a superficial fungal infection of the skin caused by dermatophytes. It presents as an erythematous, circular, scaling patch with a raised border and central clearing, giving it the characteristic ring-like appearance. While it can cause itching (pruritus), it is a localized infection and does not typically manifest with generalized, nocturnal pruritus in the axilla and between the fingers like scabies.
Choice D rationale
Eczema, or atopic dermatitis, is a chronic inflammatory skin condition characterized by dry, erythematous, pruritic patches. While it causes intense itching, which can be worse at night, the distribution and presentation are different from scabies. Eczema typically affects the flexural areas (e.g., antecubital and popliteal fossae) in adolescents, and does not involve the characteristic burrows or interdigital rash associated with a mite infestation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Wool fibers have a rough, coarse texture that can mechanically irritate the delicate skin of an infant with eczema. This physical abrasion can trigger an inflammatory response and exacerbate the itching and rash associated with the condition. The goal is to use smooth, breathable fabrics like cotton to minimize skin friction.
Choice B rationale
Fragrances and dyes in laundry detergents are common chemical irritants and allergens that can cause contact dermatitis and worsen eczema symptoms. Avoiding these additives is crucial for minimizing exposure to potential triggers and reducing inflammation and itching in sensitive skin.
Choice C rationale
Putting cotton gloves or socks on an infant's hands is a practical strategy to prevent the infant from scratching their skin. The mechanical trauma from scratching can break the skin barrier, leading to secondary infections and worsening the eczema flare-up.
Choice D rationale
Keeping fingernails short is a fundamental measure to prevent the skin damage caused by scratching. Long, sharp nails can tear the skin, creating entry points for bacteria and increasing the risk of infection, a common complication of poorly controlled eczema.
Correct Answer is C
Explanation
Choice A rationale
The 44-year-old client with pneumonia receiving intravenous antibiotics is at some risk due to potential immobility and fever, which can lead to diaphoresis and skin maceration. However, this client is likely mobile enough to shift positions independently or with minimal assistance, reducing the risk of sustained pressure. The client's age and general health status, aside from the acute infection, suggest good tissue perfusion and skin integrity.
Choice B rationale
A 26-year-old who is bedridden with a fractured leg is at significant risk due to immobility. The inability to shift weight and relieve pressure on bony prominences can lead to ischemia and tissue damage. However, younger individuals generally have better vascular supply, skin turgor, and faster cellular regeneration compared to older adults, which provides some protective physiological advantage against pressure injury development.
Choice C rationale
This 65-year-old client is at the greatest risk due to a combination of multiple risk factors. Hemiparesis leads to immobility and the inability to reposition, causing prolonged pressure on one side of the body. Incontinence exposes the skin to moisture and chemical irritants from urine and feces, leading to maceration and a breakdown of the skin's protective barrier, making it more susceptible to injury.
Choice D rationale
A 78-year-old requiring a walker for ambulation is at a lower risk for pressure injuries compared to a bedridden individual. Although advanced age and the need for assistive devices suggest some mobility limitations, the ability to ambulate, even with assistance, indicates the capacity to shift weight and relieve pressure on a regular basis. This regular movement promotes circulation and prevents prolonged periods of immobility.
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