Pharmacology Chapter 52:Skin Disorder Topical Drugs

A nursing student identifies which drug class exerts a localized anti-inflammatory effect when applied topically? germicides corticosteroids antifungals anti-infectives

corticosteroids Topical corticosteroids exert localized anti-inflammatory activity. When applied to the skin they reduce itching, redness, and swelling. The other options do not exert an anti-inflammatory action.

The nurse understands the actions of keratolytics when salicylic acid is used to treat which of the following? (Select all that apply.) burns corns warts decubitus ulcers calluses

warts calluses corns

Nursing diagnoses for a patient with a skin disorder

• Impaired Skin Integrity: related to the inflammatory process (increased sensitivity to the drug) • Acute Pain: related to skin condition or increased sensitivity to drug therapy • Risk for Infection: related to entry of pathogens into affected areas • Body Image: related to changes in skin and mucous membranes

What interventions should the nurse teach a client interested in maintaining healthy skin? Select all that apply. "Eat a balanced diet." "Moisturize the skin daily." "Avoid excessive exposure to sunlight" "Clean the skin daily with soap and water." "Use triple antibiotic ointment once a week."

"Eat a balanced diet." "Clean the skin daily with soap and water." "Avoid excessive exposure to sunlight" "Moisturize the skin daily."

A client diagnosed with an infection is prescribed an antimicrobial. The client asks when antimicrobials are used. What is the nurse's best response? "They are used to treat infections caused by bacteria, fungi, and viruses." "They suppress the inflammatory response produced by the bacteria, viruses, and fungi." "They are used to eradicate the growth of bacteria, viruses, and fungi." "They produce exudate caused by infectious agents like bacteria, viruses, and fungi."

"They are used to treat infections caused by bacteria, fungi, and viruses." Antimicrobials are used to treat infections caused by bacteria, fungi, and viruses. Antimicrobials slow the spread of the microorganism by inhibiting (not eradicating) the growth of them. They do not suppress the inflammatory response or produce exudate caused by bacteria, viruses, and fungi.

A child presents to the clinic with several growths on his fingers. His mother says she thinks he got them because he plays with frogs. The provider chuckles and says, "I doubt that, but use this and they should go away." What teaching will the nurse provide to this client and his mother? "Warts are not caused by touching frogs. They are bacterial infections that are transmitted from one child to another by touching." "Warts are caused by touching frogs and other water dwelling animals. Put this medicine on and they will disappear quickly." "Warts are excessive growths of the top layer of skin caused by a virus. Follow the directions inside the package." "Warts may take a while to go away, but if you pick at them and cut them with tiny scissors they will go away faster."

"Warts are excessive growths of the top layer of skin caused by a virus. Follow the directions inside the package."

A boy 16 years of age is seen in the clinic for a progressed rash in his groin which begun shortly after he begun working full time as a lifeguard. The nurse knows that the provider would most likely order which type of medication? A topical antiviral A topical antifungal A topical antibiotic A topical corticosteroid

A topical antifungal Jock itch is a fungal infection of the groin. It usually occurs in moist areas of the body. A topical antifungal is the most likely treatment. A topical antiviral medication is used to treat viral skin infections such as HSV. A topical antibiotic will not treat a fungal infection; in fact, it may make it worse. Topical corticosteroid medications are used to treat psoriasis, dermatitis, eczema, insect bites, and first- or second-degree burns, not fungal infections.

A client has come into the emergency department after crashing on a bike. There is the "road rash" covering the client's legs. After cleansing the affected area with chlorhexidine, what type of drug would the nurse use topically on the "road rash" area? A topical anti-infective A germicidal A topical antipsoriatic A topical corticosteroid

A topical anti-infective A topical anti-infective would most likely be applied to the "road rash" area to help prevent the area from becoming infected. Chlorhexidine is a germicidal and that was already applied to the area. A topical corticosteroid would not help prevent infection. A antipsoriatic is a medication used to treat psoriasis, not to treat infections.

The nurse demonstrates appropriate understanding use when recommending which herbal preparation for the treatment of minor skin conditions? Gingko biloba Aloe Melatonin Nystatin

Aloe vera

The nurse knows that which of the following can effect the potency of a corticosteroid? Select all that apply. Concentration of the drug Temperature of the product Vehicle in which the drug is suspended Length of air drying after application Skin integrity where the drug is applied

Concentration of the drug Vehicle in which the drug is suspended Skin integrity where the drug is applied Length of air drying after application Concentration (percentage) of the drug, vehicle in which the drug is suspended (lotion, cream, aerosol spray), and skin integrity where the drug is applied all can affect the potency of a corticosteroid. Clients should be instructed to let the topical corticosteroid dry on the skin prior to putting on clothing as this can reduce the amount of the drug that is actually absorbed. Temperature of the product when used is not known to effect the potency of a corticosteroid.

A child is seen in the clinic with a rash after playing in foliage during a camping trip. The nurse expects the provider to prescribe what type of medication to help with the itching and irritation? Aloe vera Antibiotic Antifungal Corticosteroid

Corticosteroid Corticosteroid creams are often prescribed for topical skin irritation and itching that occurs after contact with irritants like poison ivy. Antifungal agents treat fungal infections such as yeast. Antibiotic agents treat bacterial infections. Aloe vera is used to treat minor burns.

A college student is seen in the clinic for a cold sore on her upper lip. The nurse knows that what type of topical medication may be prescribed? Docosanol Imiquimod Oxiconazole Bactroban

Docosanol Docosanol (Abreva) is a topical medication prescribed for HSV1 and 2. It increases the speed of recovery. Bactroban is a topical antibiotic and will not help a cold sore. Imiquimod (Aldara) is a topical agent for external genitalia and perianal warts. Oxiconazole is a topical antifungal.

Actions of topical corticosteroids

Exert localized anti-inflammatory activity, reducing itching, redness, and swelling

Uses for antibiotic topicals

Primary and secondary skin infections Minor cuts and burns Acne vulgaris, bacterial vaginitis (clindamycin)

When writing a plan of care for a client with psoriasis, the nurse would know that an appropriate nursing diagnosis for this client would be: Anxiety and depression related to disfigurement Impaired skin integrity related to scaly lesions Acute pain of skin and oral cavity related to blistering and erosions Impaired tissue integrity related to epidermal shedding

Impaired skin integrity related to scaly lesions The nursing assessment focuses on the appearance of the normal skin, the appearance of the skin lesions, and how the patient is coping with the psoriatic skin condition. An appropriate diagnosis for a client with psoriasis would include Impaired skin integrity as it relates to scaly lesions. Acute pain of the skin and oral cavity relates to the diagnosis of pemphigus. Impaired tissue integrity related to epidermal shedding would be an important nursing diagnosis for the disorder of toxic epidermal necrolysis (TEN). Anxiety and depression related to disfigurement may be seen in the plan of care for a client undergoing reconstructive surgery.

After teaching a group of nursing students about the actions of an antiseptic drug, the instructor determines that additional teaching is needed when the students identify which action? Stops bacterial growth. Slows bacterial growth. Prevents bacterial growth. Kills bacteria.

Kills bacteria. An antiseptic is a drug that stops, slows, or prevents the growth of microorganisms, but does not kill bacteria.

Uses for topical corticosteroids

Psoriasis Dermatitis Rashes Eczema Insect bites First- and second-degree burns, including sunburn

The mother of a 5-year-old boy calls the clinic to ask for guidance on treating an abrasion on the child's knee. The nurse advises the mother to clean the abrasion with alcohol. clean the abrasion with soap and tap water. take the child to the nearest emergency department. apply a topical corticosteroid.

Minor wounds and abrasions can typically be treated by washing with soap and water. If an antiseptic is required, an iodine preparation is preferred. Alcohol should not be applied to a wound.

Uses for antiviral topicals

Oral herpes simplex virus (HSV) Varicella-zoster (chicken pox and shingles)

Uses for local anesthetics

Relieve itching and pain caused by skin conditions, such as: Minor burns Fungal infections Insect bites Rashes Sunburn Plant poisoning (e.g., Poison ivy) Local anesthetic for mucous membranes

Uses for keratolytics

Removal of warts Calluses Corns Seborrheic keratoses (benign, variously colored skin growths arising from oil glands of the skin)

Actions of the keratolytics

Remove excess growth of the epidermis

Uses for topical enzymes

Remove necrotic (dead) tissue from: Chronic dermal ulcers Severely burned areas

Uses for antifungal topicals

Superficial mycotic infections, including: Athlete's foot (tinea pedis) Jock itch (tinea cruris) Ringworm (tinea corporis) Cutaneous candidiasis, a.k.a. nail fungus (onychomycosis) Generalized fungal infection (tinea versicolor)

A client is preparing for open heart surgery. The provider gave her a bottle of chlorhexidine and told her to scrub her chest the night before surgery. The nurse knows that this was done for what reason? Encouraging the client to prepare for surgery can help lessen anticipation anxiety. The health care provider wants to eliminate as many organisms from the skin as possible by prescrubbing the area the night before surgery. Chlorhexidine discolors the skin slightly so it will be easier and acts as a surgical site marker Chlorhexidine kills hair follicles that may cause problems during the open heart surgery

The health care provider wants to eliminate as many organisms from the skin as possible by prescrubbing the area the night before surgery.

A nursing student correctly identifies the action of a keratolytic when stating which of the following? This drug promotes growth of the epidermis. This drug promotes growth of the dermis. This drug removes excess growth of the epidermis. This drug removes excess growth of the dermis.

This drug removes excess growth of the epidermis.

Uses for antiseptics and germicides

To reduce the number of bacteria on skin surfaces As a surgical scrub and preoperative skin cleanser For performing hand hygiene before and after caring for patients In home to cleanse skin On minor cuts and abrasions to prevent infection

A client has been prescribed acyclovir by the primary health care provider to treat the start of herpes simplex virus infection. Which action should the nurse ensure while applying the ointment to the client? Use a finger cot or glove. Apply sparingly in a light film. Wash the area with providone iodine. Wear protective clothing.

Use a finger cot or glove. When applying acyclovir ointment, the nurse should use a finger cot or glove to prevent autoinoculation of other body sites. The nurse need not wear protective clothing, apply the ointment sparingly, or wash the area with povidone-iodine. A client being treated with anti-infectives is instructed to wear protective clothing since anti-infectives cause photosensitivity. Topical corticosteroids are applied sparingly in a light film. If for any reason it becomes necessary to deactivate collagenase, it can be accomplished by washing the area with povidone-iodine.

A client is admitted to the hospital with severe poison ivy over the entire body. It has even spread to the eyes and genitalia. The nurse correctly identifies these nursing diagnoses for this client. (Select all that apply.) impaired immobility acute pain impaired skin integrity disturbed body image risk for infection

acute pain impaired skin integrity disturbed body image risk for infection Impaired skin integrity related to the inflammatory process, acute pain related to the skin condition, risk for infection related to entry of pathogens into affected areas, and disturbed body image related to changes in the skin are all applicable diagnoses for this client. Based on the data given, this client does not have a problem with mobility.

When planning care for a client with herpes zoster, what medication, if administered within the first 24 hours of the initial eruption, can arrest this virus? Deltasone (Prednisone) Azanthioprine (Imuran) Triamcinolone (Kenalog) Acyclovir (Zovirax)

acyclovir (Zovirax) Intravenous acyclovir, if started early, is effective in significantly reducing the pain and halting the progression of the disease. There is evidence that infection is arrested if oral antiviral agents are administered within the first 24 hours. Prednisone is an anti-inflammatory agent used in a variety of skin disorders. Imuran is an immunosuppressive agent used in the treatment of pemphigus. Kenalog is utilized in the treatment of psoriasis.

The nursing student is learning about topical anti-infectives and correctly identifies the following to be included in this class: (Select all that apply.) antineoplastics antivirals antibiotics anticholinergics antifungals

antivirals antibiotics antifungals The topical anti-infectives include antibiotics, antifungals, and antivirals. The anticholinergics are used to block the neurotransmitter acetylcholine in the central and peripheral nervous systems. The antineoplastics are used to destroy or decrease cancer cells.

Which medication can be applied to the lesion related to a bacterial skin infection? clotrimazole bacitracin benzoyl peroxide butenafine

bacitracin Bacitracin is used to treat a bacterial skin infection. Butenafine is an antifungal agent. Clotrimazole is used to treat tinea infections. Benzoyl peroxide is used to treat acne.

A client is seen for a severe reaction to contact with poison ivy. The client will be treated with prednisone but requires secondary medication for the itching and pain. What other drug will the health care provider order for this client? benzocaine collagenase masoprocol salicylic acid

benzocaine The physician will order a topical anesthetic benzocaine (Lanacane) to help relieve the itching and discomfort. Salicylic acid and masoprocol are keratolytics, which remove excess growth of the epidermis and would be contraindicated in this case. Collagenase is an enzyme preparation used for for débriding chronic dermal ulcers and severely burned areas.

Which topical drugs would a client use to help remove the plaques associated with psoriasis? azelaic acid naftifine retapamulin calcipotriene

calcipotriene Calcipotriene, a topical antipsoriatic, is used by clients to help remove the plaques associated with psoriasis. Azelaic acid is an antibiotic drug used in the treatment of acne vulgaris and rosacea. Retapamulin is an antibiotic used in the treatment of impetigo due to Staphylococcus or Streptococcus. Naftifine is an antifungal used in the topical treatment of tinea pedis, tinea cruris, and tinea corporis.

What nursing diagnosis is likely to be the priority for a teen whose acne is not responding to initial treatment? risk for infection related to disruption in skin integrity disturbed body image related to visible skin lesions activity intolerance related to the presence of skin lesions pain related to acne vulgaris lesions

disturbed body image related to visible skin lesions The high visibility of the skin lesions that characterize acne vulgaris presents a significant threat to the client's body image. For many clients, this is a priority over the risk of infection. The lesions are rarely painful, and they pose no threat to activity level.

A male client being seen in the clinic states that he has multiple outbreaks of cold sores each year. The health care provider's drug of choice for this client would be: ciclopirox metronidazole butenafine docosanol

docosanol Docosanol is a topical antiviral used to treat cold sores. Butenafine and ciclopirox are antifungals. Metronidazole is an antibiotic used to treat rosacea and bacterial vaginitis.

Which medication can a nurse recommend to a client for the treatment of herpes simplex virus (HSV) that is available without a prescription? acyclovir docosanol imiquimod penciclovir

docosanol Docosanol is available over the counter and can be recommended for the treatment of the client's HSV. Acyclovir requires a prescription, is an antiviral and the cream is used to treat herpes simplex (cold sores) while the ointment is used to treat genital herpes. Penciclovir requires a prescription and also treat HSV-1 and HSV-2. Imiquimod requires a prescription and is an immunomodulator used to treat keratitis and external genitalia warts.

When applying a topical corticosteroid, the nurse avoids applying an occlusive dressing whenever possible. The rationale for this action is: applying dressings over ointments is time consuming. dressings can cause the client to itch more. localized adverse reactions are more likely when a dressing is applied. applying dressings allows multiple ointments to be applied at the same time.

localized adverse reactions are more likely when a dressing is applied. Localized reactions to topical corticosteroids include burning, itching, irritation, redness, dryness of the skin, allergic contact dermatitis, and secondary infection. These reactions are more likely if occlusive dressings are used.