52 Skin Disorder Topical Drugs

A nurse is providing care to two clients, one with a Staphylococcus aureus skin infection and another with a Streptococcus pyogenes infection. Which of the following would the nurse expect the primary health care provider to prescribe? Select all that apply. A) Mupirocin (Bactroban) B) Acyclovir (Zovirax) C) Ketoconazole (Nizoral) D) Metronidazole (Metro-Gel) E) Retapamulin (Altabax)

Ans: A, E Feedback: Mupirocin (Bactroban) and retapamulin (Altabax) are topical anti-infectives that can be used to treat Staphylococcus aureus and Streptococcus pyogenes infections of the skin.

A client is prescribed topical benzocaine. The nurse would monitor the client for which of the following as a possible adverse reaction? A) Stinging, tenderness, and sloughing B) Erythema, flaking, and dryness C) Transient burning sensation D) Oiliness or dryness of hair

Ans: A Feedback: The nurse should monitor for stinging, tenderness, and sloughing in the client as adverse reactions to benzocaine. Erythema, flaking, and dryness are adverse reactions to masoprocol. A transient burning sensation is an adverse reaction to collagenase. Oiliness or dryness of the hair is an adverse reaction to selenium sulfide.

A client is prescribed topical betamethasone. Which of the following would the nurse include when explaining the possible adverse reactions that may occur? Select all that apply. A) Burning B) Dryness C) Pruritus D) Nausea E) Fever

Ans: A, B, C Feedback: Localized reactions caused by the topical administration of betamethasone that the nurse should discuss with the client include burning, pruritus, irritation, redness, dryness, allergic contact dermatitis, and secondary infection.

Which of the following would be most important to include in the preadministration assessment of a client who is receiving topical therapy for a skin disorder? Select all that apply. A) Size of the area affected B) Appearance of the lesions C) Report of pain or burning D) Client's weight E) Blood pressure

Ans: A, B, C Feedback: The preadministration assessment involves a visual inspection and palpation of the involved area(s). The areas of involvement, including the size, color, and appearance, are carefully measured and documented. The appearance of the skin lesions, such as rough and itchy patches, cracks between the toes, and sore and reddened areas, is noted so treatment can begin with an accurate database. A specific description is important so that changes indicating worsening or improvement of the lesions can be readily identified. Measuring the client's weight or blood pressure would not be important.

A client is prescribed topical clindamycin therapy. The nurse instructs the client and family about possible systemic effects. The nurse determines that the teaching was successful when they state that they should contact the primary health care provider immediately if which of the following occur? Select all that apply. A) Stomach cramps B) Severe diarrhea C) Bloody stools D) Burning E) Pruritus

Ans: A, B, C Feedback: Topical clindamycin can be absorbed in sufficient amounts to cause systemic effects. If severe diarrhea, stomach cramps, or bloody stools occur, the client should contact the primary health care provider immediately.

A nurse may use a topical antiseptic or germicide for which of the following reasons? Select all that apply. A) To reduce the number of bacteria on skin surfaces B) As a surgical scrub C) As a preoperative skin cleanser D) For washing the hands before and after caring for clients E) On minor cuts and abrasions to prevent infection

Ans: A, B, C, D, E Feedback: A nurse may use a topical antiseptic or germicide for the following reasons: to reduce the number of bacteria on skin surfaces, as a surgical scrub, as a preoperative skin cleanser, for washing the hands before and after caring for clients, and on minor cuts and abrasions to prevent infection.

After teaching a group of nursing students about the use of salicylic acid (Duofilm), the instructor determines that the teaching was successful when the students identify which of the following as a contraindication? Select all that apply. A) Genital warts B) Facial warts C) Mucous membrane warts D) Moles E) Birthmarks

Ans: A, B, C, D, E Feedback: The use of salicylic acid (Duofilm) is contraindicated in the following situations: on moles, birthmarks, warts with hair growing from them, genital or facial warts, warts on mucous membranes, or infected skin.

A client is prescribed a topical corticosteroid. The nurse understands that this drug would be contraindicated in which of the following circumstances? Select all that apply. A) Monotherapy for bacterial skin infections B) Ophthalmic use C) Otic use D) Monotherapy for widespread plaque psoriasis E) Low-potency corticosteroids on the face, groin, or axilla

Ans: A, B, D Feedback: The use of topical corticosteroids is contraindicated in the following circumstances: known hypersensitivity to the drug or any component of the drug; as monotherapy for bacterial skin infections; high-potency corticosteroids for use on the face, groin, or axilla; for ophthalmic use; and as monotherapy in widespread plaque psoriasis.

The nurse might suspect a hypersensitivity reaction has occurred in a client using azelaic acid (Azelex) if the client experiences a combination of which of the following? Select all that apply. A) Pruritus B) Urticaria C) Vomiting D) Erythema E) Mental status changes

Ans: A, B, D Feedback: Topical anti-infectives, like azelaic acid (Azelex), result in a rash, pruritus, urticaria, dermatitis, irritation, and erythema, which may indicate a hypersensitivity reaction to the drug.

The nurse should discuss which of the following adverse reactions with a client prior to the topical administration of anthralin (Miconal)? Select all that apply. A) Hair discoloration B) Discoloration of fingernails C) Discoloration of skin D) Pruritus E) Burning

Ans: A, B, D, E Feedback: Localized reactions caused by the topical administration of anthralin (Miconal) that the nurse should discuss with the client prior to administration include burning, pruritus, irritation, and temporary discoloration of the fingernails and hair.

A client is prescribed a topical corticosteroid. The nurse understands that this drug is used in the treatment of which of the following conditions? Select all that apply. A) Psoriasis B) Eczema C) Asthma exacerbation D) Rheumatoid arthritis E) Insect bites

Ans: A, B, E Feedback: Topical corticosteroids are used in the treatment of the following conditions: psoriasis, eczema, dermatitis, rashes, insect bites, and first- and second-degree burns.

A client is prescribed topical triamcinolone. The nurse is aware that the client may experience systemic adverse reactions. Which of the following might the nurse assess? Select all that apply. A) Hyperglycemia B) Myasthenia gravis C) Cushing's syndrome D) Nausea E) Fever

Ans: A, C Feedback: Systemic reactions caused by the topical administration of triamcinolone (Aristocort) that the nurse should be alert for include hypothalamic-pituitary-adrenal axis suppression, Cushing's syndrome, hyperglycemia, and glycosuria.

Which of the following might nurses use to clean their hands before and after caring for a client? Select all that apply. A) Chlorhexidine (Hibiclens) B) Fluocinonide (Lidex) C) Hexachlorophene (pHisoHex) D) Imiquimod (Aldara) E) Ketoconazole (Nizoral)

Ans: A, C Feedback: Topical antiseptics, like chlorhexidine (Hibiclens) and hexachlorophene (pHisoHex), can be used by nurses to clean their hands before and after caring for a client. Fluocinonide is a topical corticosteroid. Imiquimod is a topical antiviral agent. Ketoconazole is a topical antifungal drug.

1. A nursing instructor is evaluating the students' understanding of topical anti-infectives. The instructor determines that the group understands the information when they pair which drug with the infection treated correctly? Select all that apply. A) Erythromycin (Erygel) - acne vulgaris B) Ketoconazole (Nizoral) - episodes of HSV C) Ciclopirox (Loprox) - tinea pedis D) Acyclovir (Zovirax) - episodes of HSV E) Bacitracin (Baci-Rx) - tinea corporis

Ans: A, C, D Feedback: The following topical anti-infective drugs are matched correctly with the infection they treat: erythromycin (Erygel) - acne vulgaris; ciclopirox (Loprox) - tinea pedis; and acyclovir (Zovirax) - episodes of HSV.

A nurse is instructing a client about how to apply the topical medication prescribed. Which of the following would the nurse identify as an appropriate way to remove the drug from the container? Select all that apply. A) Finger cot B) Clean finger C) Tongue blade D) Gauze pad E) Cotton swab

Ans: A, C, D, E Feedback: The nurse should instruct the client to use a finger cot, tongue blade, gauze pad, or cotton swab to remove the drug from the container and then apply it to the skin.

The nurse is applying topical collagenase to a client. The nurse would assess the client for which of the following as a possible adverse reaction? Select all that apply. A) Mild pain B) Urticaria C) Numbness D) Pruritus E) Dermatitis

Ans: A, C, E Feedback: Possible adverse reactions associated with the topical administration of collagenase (Santyl) include mild, transient pain; possible numbness; and dermatitis.

A nurse administering collagenase (Santyl) topically to a client must be certain not to use which of the following products that can inactivate the enzymes in collagenase (Santyl)? Select all that apply. A) Detergents B) Water C) Iodine D) Silver E) Mercury

Ans: A, D, E Feedback: A nurse administering collagenase (Santyl) topically to a client must be certain not to use detergents or products containing heavy metals, like mercury and silver, which can inactivate the enzymes in collagenase (Santyl).

A client is prescribed a topical corticosteroid. Which of the following would be appropriate for the nurse to do? A) Clean the area with an antiseptic before applying the drug. B) Apply the topical corticosteroid sparingly. C) Place a sterile cloth over the area of application. D) Rub the application into the skin vigorously.

Ans: B Feedback: Before drug application, the area is washed with soap and warm water unless the primary health care provider directs otherwise. Topical corticosteroids are usually ordered to be applied sparingly. The primary health care provider also may order the area of application to be covered or left exposed to the air. If covered, a dressing, not sterile cloth, would be used. The medication should be rubbed in gently.

After teaching a group of nursing students about topical drugs for skin disorders, the instructor determines that the teaching was successful when the students identify which of the following as used to prevent institutional outbreaks of methicillin-resistant Staphylococcus aureus (MRSA)? A) Bacitracin B) Mupirocin C) Retapamulin D) Clindamycin

Ans: B Feedback: Mupirocin is applied to the nasal mucosa to reduce the risk of institutional outbreaks of MRSA. Bacitracin is used for relief of skin infections and to prevent infections with minor cuts and burns. Retapamulin is used to treat impetigo due to staphylococcus or streptococcus. Clindamycin is used to treat acne vulgaris.

The primary health care provider has prescribed dexamethasone sodium phosphate for a client being treated for immunologic skin disorder. Assessment of which of the following would lead the nurse to suspect that the client is experiencing an adverse reaction to the drug? A) Redness or mild scaling B) Allergic contact dermatitis C) Dermatitis and irritation D) Photosensitivity

Ans: B Feedback: The nurse should monitor for allergic contact dermatitis as an adverse reaction to dexamethasone sodium phosphate. Redness or mild scaling and photosensitivity are adverse reactions to hexachlorophene. Dermatitis and irritation are adverse reactions to povidone-iodine.

After conducting an in-service program for a group of nurses about topical drugs used to treat skin disorders, the presenter determines that the teaching was successful when the group identifies which of the following as an appropriate use for topical enzymes? Select all that apply. A) Widespread psoriasis B) Chronic dermal ulcers C) First-degree sunburn D) Severely burned areas E) Tinea pedis

Ans: B, D Feedback: A nurse may apply a topical enzyme to a client with chronic dermal ulcers or severely burned areas. Topical enzymes are not used for widespread psoriasis, first-degree sunburn, or tinea pedis.

A nurse is applying a topical agent that aids in the removal of dead soft tissue by hastening the reduction of proteins into simpler substances. Which of the following might the nurse be applying? Select all that apply. A) Bacitracin (Baci-Rx) B) Papain and urea (Accuzyme) C) Vidarabine (Ara-A) D) Collagenase (Santyl) E) Anthralin (Miconal)

Ans: B, D Feedback: Topical enzymes, like papain and urea (Accuzyme) and collagenase (Santyl), aid in the removal of dead soft tissue by hastening the reduction of proteins into simpler substances.

A client is to receive topical masoprocol. The nurse alerts the client to the possibility of which of the following as an adverse reaction? Select all that apply. A) Mild pain B) Scaling C) Numbness D) Flu-like syndrome E) Dry skin

Ans: B, D, E Feedback: Adverse reactions related to the topical administration of masoprocol (Actinex) include transient burning sensation, rash, dry skin, scaling, and flu-like syndrome.

A nurse is preparing to administer a keratolytic based on the understanding that this drug is used to treat which of the following skin disorders? Select all that apply. A) Psoriasis B) Warts C) Acne vulgaris D) Seborrheic keratoses E) Corns

Ans: B, D, E Feedback: Keratolytics are used to treat the following skin disorders: warts, calluses, corns, and seborrheic keratoses.

A client is diagnosed with psoriasis. Which of the following would the nurse expect the primary health care provider to prescribe as topical treatment? Select all that apply. A) Chlorhexidine (Hibiclens) B) Calcipotriene (Dovonex) C) Vidarabine (Ara-A) D) Imiquimod (Aldara) E) Anthralin (Miconal)

Ans: B, E Feedback: Anthralin (Miconal) and calcipotriene (Dovonex) are topical antipsoriatics used to treat psoriasis.

A client is diagnosed with dermatitis and the skin appears inflamed. Which topical drug would the nurse expect to administer to reduce itching, redness, and swelling caused by dermatitis? Select all that apply. A) Erythromycin (Erygel) B) Fluocinonide (Lidex) C) Penciclovir (Denavir) D) Imiquimod (Aldara) E) Hydrocortisone (Locoid)

Ans: B, E Feedback: Topical corticosteroids, like fluocinonide (Lidex) and hydrocortisone (Locoid), when applied to inflamed skin reduce itching, redness, and swelling caused by dermatitis. Erythromycin is a topical antibiotic; penciclovir and imiquimod are topical antiviral drugs.

When developing the plan of care for a client with a skin lesion requiring topical therapy, which nursing diagnosis would the nurse most likely identify? A) Acute Pain B) Risk for Infection C) Impaired Skin Integrity D) Disturbed Body Image

Ans: C Feedback: Although all the nursing diagnoses apply, the most likely nursing diagnosis would be Impaired Skin Integrity due to the presence of a skin lesion and need for treatment.

Chlorhexidine gluconate is being used in a client for preoperative skin preparation. Which of the following if noted would alert the nurse to a possible adverse reaction? A) Taste perversion B) Headache C) Deafness D) Mild erythema

Ans: C Feedback: The nurse should monitor for deafness as an adverse reaction to the use of chlorhexidine gluconate. Taste perversion, headache, and mild erythema are adverse reactions to penciclovir.

A nurse is reviewing topical drugs. The nurse demonstrates understanding of the information when the nurse identifies which drug as temporarily inhibiting the conduction of impulses from sensory nerve fibers? Select all that apply. A) Bacitracin (Baci-Rx) B) Papain and urea (Accuzyme) C) Lidocaine (Xylocaine) D) Dibucaine (Nupercainal) E) Anthralin (Miconal)

Ans: C, D Feedback: Topical local anesthetics, like lidocaine (Xylocaine) and dibucaine (Nupercainal), are examples of topical drugs that temporarily inhibit the conduction of impulses from sensory nerve fibers.

A nurse is caring for a client who has been prescribed lidocaine viscous to be used for pain control of the oral mucosa. Which of the following instructions regarding the intake of food should the nurse give the client? A) Drink plenty of water along with food. B) Avoid intake of heavy and fibrous food. C) Ensure the food is not too hot or cold. D) Do not eat food for 1 hour after use.

Ans: D Feedback: When lidocaine viscous is used for oral anesthesia to control pain, the nurse instructs the client not to eat food for 1 hour after use because local anesthesia of the mouth or throat may impair swallowing and increase the possibility of aspiration. The nurse need not instruct the client to drink plenty of water along with food, avoid intake of heavy and fibrous food, or ensure the food is not too hot or cold as these are not relevant with oral anesthesia.