PHARM REVIEW UNIT 5 - INTEGUMENTARY SYSTEM MEDICATIONS
The nurse is caring for a patient with extensive third-degree burns scattered across the left leg and hip. Orders for chemical debridement using collagenase (Santyl) are noted. The nurse will take which of the following actions? Apply the collagenase to the blackened, dead tissue within the burned area. Work the collagenase into sterile dressings and apply these uniformly across the burned area. Mix the collagenase with sterile normal saline and apply soaked dressing to entire wound bed. Apply the collagenase to the pink, open areas within the burned area.
Apply the collagenase to the blackened, dead tissue within the burned area. Collagenase will remove dead tissue; the blackened color of the tissue indicates it is dead and needs to be removed. The collagenase should be used on this.
Family members at a reunion on the beach return from a long walk with sunburn on their shoulders and feet. Which of the following recommendations will the nurse make? . "Take oral antihistamines to help reduce the chance of blistering." "Apply cold cloths to the sunburn for 20 minutes, then apply aloe vera ointment." "Apply butter to the area to stop the burn and allow healing." "Apply hydrocortisone cream to the area to reduce swelling and pain."
"Apply cold cloths to the sunburn for 20 minutes, then apply aloe vera ointment." Nonpharmacologic treatment of sunburn includes cool water and aloe vera application.
A nurse working for a family practice physician sees a 48-year-old patient who reports severe itching of his hands and underarms. Examination reveals redness and irritation in the webbing of both hands and axillae. The physician orders permethrin (Elimite) cream, a scabicide. The nurse recognizes that teaching has been effective by which of the following statements? "I will need to use a fine-tooth comb to go through my hair daily for the next full week." "Scabies only live on top of the skin, so the itch should disappear within a day." "I can't believe I have lice. I wonder if I got it from my niece." "Applying this cream between my fingers and arm pits will kill the mites and eggs."
"Applying this cream between my fingers and arm pits will kill the mites and eggs." - The patient will need to apply the cream to the areas commonly affected by the mite that leads to scabies infection.
The nurse is providing instructions for a patient who will begin taking docosanol 10% (Abreva) for HSV-1 infection. Which of the following indicates that further teaching is necessary? "I don't need a prescription for this medication." "Side effects of this medication could include headache." "The medication helps block the spread of the virus." "I should apply this medication once daily."
"I should apply this medication once daily."- This medication should be applied at the first sign of a cold sore and repeated up to five times daily.
The nurse is educating a patient who is to start a prescription for tacrolimus (Protopic) for the treatment of atopic dermatitis. The nurse knows further teaching is necessary when the patient states which of the following? "I will have to take this medication by mouth at least three times a day." "This medication will help reduce the swelling and redness on my skin." "I should notice a big improvement in the constant itch I've been having." "This medication alters the local immune response on my skin but won't increase my risk for other infections."
"I will have to take this medication by mouth at least three times a day." Further teaching is needed because this medication is a topical preparation for the skin.
While working with a patient who has extensive third-degree burns, the nurse applies becaplermin (Regranex) gel to the patient's wound bed. The patient asks, "What will that do?" Which of the following responses is best? "The gel helps new tissue grow within the wound bed and increase healing." "By stimulating phagocytosis, the gel reduces the amount of fluid loss within your burns." "This will kill topical bacteria and help reduce the risk of infection." "The gel helps slow tissue growth to prevent scarring that may cause contractures."
"The gel helps new tissue grow within the wound bed and increase healing." Becaplermin speeds tissue growth to improve healing.
While working in the hospital with patients who have been burned, the nurse prepares to apply the initial dressings to a patient with second- and third-degree burns. Place the following steps in order for this procedure: A. Apply silver sulfadiazine (Silvadene) to the burn area. B. Cover the burn with sterile dressing. C. Set up a sterile field and don sterile gloves. D. Assess and measure the wounds.
1. First ANS: D. The first step is to assess the wounds (nursing process) to determine the dressings that will be needed. 2. Second ANS: C. Sterile dressings are then used to prevent infection in the wounds. 3. Third ANS: A. Sulfadiazine is an antibiotic used for burns to prevent infections. 4. Fourth ANS: B. Finally, burns are covered with a sterile dressing to prevent infection and absorb any exudate leaking from the burns.
Which of the following patients would be instructed to avoid/discontinue using the noted treatment? A 21-year-old female with eczema using hydrocortisone (Cortaid) who reports she is pregnant A 16-year-old male with acne prescribed tretinoin (Retin-A) who reports a history of asthma A 26-year-old female with psoriasis using fluorouracil (Efudex) who reports photosensitivity since starting the medication A 34-year-old male with tinea infection who reports localized itching while using clotrimazole (Lotrimin)
A 21-year-old female with eczema using hydrocortisone (Cortaid) who reports she is pregnant This patient needs to stop using hydrocortisone cream due to the pregnancy; it is contraindicated.
While performing skin assessments during a local mall screening event, the nurse would be most concerned by which of the following findings? A 55-year-old patient with multiple nevi across his back and shoulders A 47-year-old patient with a small tan, flat, scaly patch noted on his cheek A 64-year-old patient with reddish, firm, dry, and peeling patches noted on his knuckles and elbows A 39-year-old patient with a purplish-black irregular shaped area on the shoulder blade
A 39-year-old patient with a purplish-black irregular shaped area on the shoulder blade . This describes a possible malignant melanoma and needs referral to a physician immediately due to the potential for metastasis.
Ultraviolet therapy will be most helpful for which of the following patients? A 55-year-old with squamous cell carcinoma A 15-year-old with atopic dermatitis A 28-year-old with basal cell carcinoma A 41-year-old with psoriasis
A 41-year-old with psoriasis Correct. This is the appropriate treatment for patients with psoriasis. It is combined with other antipsoriatic agents.
Which of the following individuals will need a referral to determine the potential need for systemic chemotherapy? A 66-year-old patient with squamous cell carcinoma who is receiving radiation after surgical excision of the primary lesion A 48-year-old patient with basal cell carcinoma who is being treated with topical fluorouracil A 61-year-old patient with malignant melanoma who had a wide surgical excision with clear margins A 54-year-old patient with basal cell carcinoma on the nose who is being treated with a topical immunomodulator
A 61-year-old patient with malignant melanoma who had a wide surgical excision with clear margins Malignant melanoma can metastasize easily and is unpredictable in its course; therefore, chemotherapy is often used in the treatment of the condition.
A nurse working in a gynecology office is asked to assist in the treatment of a patient with condylomas. Which of the following actions should the nurse take? Make a list of the patient's sexual partners for the past 3 weeks. Ask the patient to remove clothing below the waist. Ask the patient if there are any known allergies to iodine. Prepare the patient for full-body phototherapy.
Ask the patient to remove clothing below the waist. Condylomas are genital warts and are treated with cryotherapy, salicylic acid, or liquid nitrogen applied directly to the wart. The genital area will need to be exposed to allow for treatment.
A nurse's teenage daughter tearfully states, "I keep getting pimples on my face even though I wash it every day and I'm not eating any chips or cookies. What can I do?" While considering over-the-counter treatment options, what common ingredient will the nurse most likely find in topical creams and lotions?. Benzoyl peroxide Clotrimazole Lidocaine Hydrocortisone
Benzoyl peroxide - Benzoyl peroxide is bacteriostatic used to manage acne.
While performing a skin assessment for a newly admitted 82-year-old patient, the nurse notes the patient has reddened, peeling areas between his toes and around the soles of his feet. Which of the following medications would the nurse request? Nystatin Calcipotriene Lidocaine Clotrimazole
Clotrimazole . Clotrimazole is an antifungal medication used in the treatment of fungal infections on the feet, trunk, extremities, and groin.
While performing an admission history with a patient who has extensive eczema, the nurse should anticipate the patient will report a history of which other conditions? (Select all that apply.) Allergic rhinitis Frequent/severe sunburn Cardiomyopathy Recurrent urinary tract infections Asthma
Eczema is an allergic condition associated with other allergic conditions such as asthma. Eczema is an allergic condition associated with other allergic conditions, such as allergic rhinitis.
The nurse is admitting a 22-year-old patient to the hospital with suspected fractures of the right arm after a bicycle accident. The patient reports taking vitamin A daily. Which of the following would the nurse expect to see during the physical examination? Genital warts Dry, patchy, reddened areas on the hands and elbows Flushed nose and cheeks Oral fever blisters in various stages of healing
Flushed nose and cheeks - Vitamin A is used to treat rosacea, a type of skin irritation that appears as reddened areas on the nose and cheeks.
Antiviral medications can be used to treat which of the following conditions? (Select all that apply.) Scabies HSV-2 Thrush Herpes zoster HPV
HPV is an example of a viral infection that is treated with antiviral medication. Herpes zoster is an example of a viral infection that is treated with antiviral medication. HSV-2 is an example of a viral infection that is treated with antiviral medication.
While playing at the park with her children, the nurse notes a toddler who has honey-colored crusts and open areas on the lips and nose. Which of the following actions should the nurse take first? Ask the child's parent if the child has food allergies and suggest the use of an antihistamine. Suggest the child's parent seek treatment for suspected thrush with an oral antifungal agent. Inform the child's parent the child may have a common bacterial infection and should be seen by a physician for topical or systemic antibiotics. No action is required, as the child is exhibiting symptoms of a common cold, and medications will not alter the child's symptoms.
Inform the child's parent the child may have a common bacterial infection and should be seen by a physician for topical or systemic antibiotics. - The honey-colored crusts are a sign of impetigo, a contagious bacterial infection common in children, which can be treated with topical or systemic antibiotics.
A nursing instructor informs a nursing student that the assigned patient has been prescribed a pediculicide medication. The student recognizes the patient has been diagnosed with which of the following? Lice Eczema Impetigo Psoriasis
Lice - A pediculicide is used to treat an infestation of lice.
A school nurse is preparing a letter to parents to notify them of a recent case of head lice in a second-grade student. Which of the following statements should be included in the letter? (Select all that apply.) "Children's hair should be examined at home daily using a fine-toothed comb for small, round, white eggs or nits." "Any child found to have lice during the school day will immediately be given oral antibiotic therapy." "If your child is found to have lice, your health care provider should be seen to obtain a prescription for antifungal therapy." "Lice rarely spread from child to child, so no special precautions need to be taken." "Over-the-counter shampoo products are available for the treatment of lice."
Lice are also called nits. The eggs are small, round, and attached to the hair shaft. A fine-toothed comb will assist in seeing the signs of a lice infestation. Shampoos can be obtained over the counter for management of lice infestations.
A nurse at a dermatologist's office is working with a patient with suspected basal cell carcinoma. The nurse would most likely prepare for which of the following? Radiation therapy Topical treatment with corticosteroids Chemotherapy Liquid nitrogen cryotherapy
Liquid nitrogen cryotherapy . Liquid nitrogen cryotherapy is a common treatment for basal cell carcinoma, and the nurse should be prepared to assist with the procedure.
A nurse working with adolescents recognizes that which of the following could be used to help treat acne? (Select all that apply.) Topical immunomodulators Salicylic acid Systemic antibiotics Sulfur Oral contraceptives
Oral contraceptives can be helpful in managing acne and have been prescribed for this purpose. Systemic antibiotics are used to manage extreme cases of acne. Salicylic acid ointments or creams can be used to manage acne. Sulfur can be used topically to manage severe acne.
While working in a dermatologist's office, the nurse welcomes a new patient who is 15 years old. The patient has notable facial acne, and a quick examination reveals scattered areas of keratinization and multiple pustules and comedones across the patient's shoulders and back. The nurse anticipates that which of the following medications will be recommended? Etanercept (Enbrel) Lindane (Rid-X) Salicylic acid (Stri-Dex) Anthralin (Psoriatec)
Salicylic acid (Stri-Dex)
A nurse caring for a patient with psoriasis recognizes the patient is very knowledgeable about his disease by which of the following statements? (Select all that apply.) "The doctor said if the anthralin (Psoriatec) cream doesn't help, I may need to take methotrexate." "My skin peels because the cells underneath are damaged and don't replace themselves fast enough to maintain a protective barrier." "I keep hoping the doctor will find the medication that cures this so it will go away for good." "I traveled to Argentina and soaked in a hot spring—it was wonderful and did help my skin." "I've used topical steroids and antihistamine creams, but they haven't helped much lately."
Several countries claim to have hot springs that are helpful to people and provide healing for their condition. The topical steroids and antihistamines are commonly used to manage psoriasis, and sometimes the effectiveness decreases over time. Anthralin cream is used to manage psoriasis, and when it is not effective the next level of medication can be used.
An 18-year-old male seen routinely in the dermatology clinic has recently been given a prescription for tretinoin (Retin-A). Which of the following statements will the nurse include in the patient teaching? (Select all that apply.) "Be sure you drink at least ten glasses of water each day, as this medication can damage your kidneys." "It will be particularly important for you to immediately report any thoughts of suicide while you are taking this medication." "This medication acts by reducing oil production by the glands in your skin." "This medication may increase the risk of sun burn, so be sure to wear a hat and sunscreen." "I'm so glad the doctor started this medication for you; it will make your psoriasis clear right up."
The tretinoin can cause increased sensitivity to the sun, and protection from the sun is important to teach the patient. A serious side effect of tretinoin is suicide, so any thoughts of suicide need to be reported immediately. Tretinoin does reduce oil production in the skin to reduce acne in the patient.
