PHARM - Integumentary Medications

The nurse is caring for a client with a burn injury to the lower legs. Silver sulfadiazine is prescribed to be applied to the sites of injury. Which indicates the appropriate method to apply this medication?

Apply to cleansed, debrided wounds as prescribed. Rationale: This medication is classified as an anti-infective and acts by producing a bactericidal effect, and it commonly is used to treat burns. This medication should be applied to cleansed, debrided wounds as prescribed using sterile gloves and sterile procedure. Burn areas should be kept covered with this medication at all times and should be reapplied to areas removed by client activity. Dressings covering the injury sites also may be prescribed. The medication should be applied only to the affected site, not the surrounding unaffected areas.

The nurse is assigned to care for a client with a leg ulcer. Sutilains treatments are prescribed. The nurse should avoid which action when performing the treatment?

Applying the sutilains immediately followed by a dry sterile dressing Rationale: The wound should be cleansed with a sterile solution before treatment. The nurse then should thoroughly moisten the wound with sterile normal saline or sterile water and apply a loose thin dressing after applying a thin film of sutilains extending ¼ to ½ inch beyond the area to be debrided. The ointment should be refrigerated.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse should apply the medication to which body area? Select all that apply.

Back, Soles of the feet, and Palms of the hands Rationale: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles). The nurse should avoid areas of higher absorption to prevent systemic absorption.

A client with eczema has a prescription for a topical corticosteroid. The nurse cautions the client to use the product carefully in which area where the risk of systemic absorption is greater?

Face Rationale: It is possible for topical corticosteroids to be absorbed into the systemic circulation. This occurs more frequently in areas where the skin is especially permeable (scalp, axillae, face, eyelids, neck, perineum, genitalia) and less in areas where penetration is poorer (back, palms, soles).

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid. The nurse determines that which client complaint may be associated with the use of this medication?

Itching Rationale: Azelaic acid is a topical medication used to treat mild to moderate acne. Adverse effects include burning, itching, stinging, redness of the skin, and hypopigmentation of the skin in clients with a dark complexion. The effects noted in the other options are not specifically associated with this medication.

A client is seen in the clinic for complaints of skin itchiness that has been persistent over the past several weeks. Following data collection, it has been determined that the client has scabies. Lindane is prescribed, and the nurse is asked to provide instructions to the client regarding the use of the medication. How should the nurse teach the client to apply the cream?

Leave the cream on for 8 to 12 hours and then remove by washing. Rationale: Lindane is applied in a thin layer to the entire body below the head. No more than 30 g (1 oz) should be used. The medication is removed by washing 8 to 12 hours later. Usually, only one application is required.

The primary health care provider has prescribed a bacteriostatic agent effective against both gram-positive and gram-negative organisms for application to a burn wound. The nurse determines that which medication has been prescribed?

Mafenide acetate Rationale: Mafenide acetate is a bacteriostatic agent effective against both gram-positive and gram-negative organisms. Silver nitrate has antimicrobial action. Silver sulfadiazine interferes with DNA synthesis by binding to bacterial cell membrane. Polymyxin B-bacitracin has wide-spectrum antibiotic action.

The nurse reviews the laboratory results for a client diagnosed with leukemia who is receiving chemotherapy. The nurse notes that the white blood cell (WBC) count is 2000 mm3. The nurse identifies the finding as indicative of which?

Signifying leukopenia Rationale: Chemotherapy agents cause medication-induced leukopenia, and treatment focuses on this side effect. The normal WBC count is 5000 to 10,000 mm3. An elevated WBC count would most likely indicate infection. Option 3 is an incorrect statement. Clients with cancer can experience widely varying WBC counts.

The nurse is caring for a client diagnosed with herpes simplex virus (HSV) who has just been prescribed acyclovir. The nurse explains that which statement is true about treatment with this medication?

The medication can help reduce the severity of the outbreak. Rationale: Herpes simplex infections are treated with acyclovir. Antiviral drugs may reduce the severity and frequency of outbreaks. Herpes simplex virus (HSV) remains in a dormant state in the body after the initial infection. Acyclovir does not cure HSV infections. The full course of the medication should be taken and not stopped once the lesions are gone. Clients can still transmit the infection to others despite antiviral therapy and the absence of lesions.

The primary health care provider has prescribed butenafine for a client. The nurse recognizes that this has been prescribed to treat which disorder?

Tinea pedis Rationale: Butenafine is used for tinea pedis, tinea corporis, tinea cruris, and tinea versicolor. Oral candidiasis is treated with clotrimazole troches, nystatin mouthwash or lozenges, or oral amphotericin B. Candidiasis of the vulva and vagina may be treated with topical azoles (e.g., clotrimazole, miconazole, tioconazole) or oral fluconazole. Systemic fungal infections require intravenous amphotericin B, an effective but very toxic drug.

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication?

Tinnitus Rationale: Salicylic acid is absorbed readily through the skin and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?

Triglyceride level Rationale: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on triglycerides has been evaluated. There is no indication that isotretinoin affects potassium, hemoglobin A1c, or total cholesterol levels.

A client with severe acne is seen in the clinic and the primary health care provider (PHCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the PHCP if the client is also taking which medication?

Vitamin A Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. There are no contraindications associated with digoxin, phenytoin, or furosemide.

Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the need for monitoring by the nurse?

White blood cell count of 3000 mm3 (3.0 × 109/L) Rationale: Silver sulfadiazine is used for the treatment of burn injuries. Adverse effects of this medication include rash and itching, blue-green or gray skin discoloration, leukopenia, and interstitial nephritis. The nurse should monitor a complete blood count, particularly the white blood cells, frequently for the client taking this medication. If leukopenia develops, the PHCP is notified and the medication is usually discontinued. The white blood cell count noted in option 4 is indicative of leukopenia. The other laboratory values are not specific to this medication, and are also within normal limits.

Coal tar has been prescribed for a client with a diagnosis of psoriasis, and the nurse reinforces instructions to the client about the medication. Which statement by the client indicates a need for further teaching?

"The medication can cause systemic effects." Rationale: Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, can frequently stain the skin and hair, and can cause phototoxicity. Systemic toxicity does not occur.

Silver sulfadiazine is prescribed for a client with a partial-thickness burn and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments?

"The medication is likely to cause stinging initially." Rationale: Silver sulfadiazine is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not cause stinging when applied.

Isotretinoin is prescribed for a client to treat severe cystic acne. The nurse tells the client that the length of the usual prescribed course of treatment is which?

15 to 20 weeks Rationale: Isotretinoin is usually administered 2 times daily for a period of 15 to 20 weeks. The usual adult dosage is 0.5 to 1 mg/kg/day. If needed, a second course may be administered but not until 2 months have elapsed after completing the first course.

The nurse reinforces instructions to a client regarding the use of tretinoin. Which statement by the client indicates the need for further teaching?

"I should apply a very thin layer to my skin." Rationale: Tretinoin is applied liberally to the skin. The hands are washed thoroughly immediately after applying. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The skin needs to be cleansed thoroughly before applying the medication.

A client with dermatitis has been prescribed a topical corticosteroid for use on the affected areas, and the nurse has reinforced instructions about the use of this medication. Which statement by the client indicates a need for further teaching?

"I will apply a bandage over the site after applying the medication." Rationale: An occlusive dressing (such as a bandage or plastic wrap) should not be used to cover the skin following the application of the topical corticosteroid, unless specifically prescribed by the health care provider. Applying the medication in a thin film, the medication reduces inflammation and itching, and I will massage the medication gently into the skin are accurate statements about the use of this medication.

The nurse is providing instructions to a client with a diagnosis of scabies regarding the administration of crotamiton. Which statement by the client indicates an understanding regarding the application of this medication?

"I will massage the medication into the skin from my chin downward and apply a second application in 24 hours, followed by a cleansing bath 48 hours after the second application." Rationale: The client is instructed to massage the medication into the skin of the entire body, starting with the chin and working downward. The head and face are treated only if needed. Special attention should be given to skin folds and creases. Contact with eyes, mucous membranes, and any region of inflammation should be avoided. A second application is made 24 hours after the first. A cleansing bath should be taken 48 hours after the second application, and, if needed, treatment can be repeated in 7 days.

The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times?

At least 30 minutes before exposure to the sun Rationale: Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

A client with a burn injury is applying mafenide acetate to the wound. The client calls the health care provider's office and tells the nurse that the medication is uncomfortable and is causing a burning sensation. Which instructions should the nurse reinforce to the client?

Continue with the treatment because this is expected. Rationale: Mafenide acetate is used to treat burn injuries. It is bacteriostatic for both gram-negative and gram-positive organisms that are present in avascular tissues. The client should be warned that the medication will cause local discomfort and burning. The nurse does not instruct a client to alter a medication prescription (options 1 and 2). It is not necessary that the client see the health care provider immediately at this time.

A burn client is receiving treatments of topical mafenide acetate to the site of injury. The nurse monitors the client, knowing that which finding indicates the occurrence of a systemic effect?

Hyperventilation Rationale: Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication will probably be discontinued for 1 to 2 days. Options local rash and pain at burn site describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.