Ch 47 Integumentary Medications

Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the *need for follow-up* by the nurse? 1. Glucose level of 99 mg/dL 2. Magnesium level of 1.5 mEq/L 3. Platelet level of 300,000 4. White blood cell count of 3000

4. White blood cell count of 3000 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 healthcare provider is notified and the medication is usually discontinued. The white blood cell count noted an option for is indicative of leukopenia. The other laboratory values are not specific to this medication, and are also within normal limits.

A burn client is receiving treatments of topical mafenide acetate to the site of injury. the nurse monitors the clients, knowing that which finding indicates that a systemic effect has occurred? 1. Hyperventilation 2. Elevated blood pressure 3. Local rash at burn site 4. Local pain at burn site

1. 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 one to two days. Options three and four describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

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? 1. Potassium level 2. Triglyceride level 3. Hemoglobin A1C 4. Total cholesterol level

2. Triglyceride level Rationale: isotretinoin can Elevate triglyceride levels period 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 effects potassium, hemoglobin A1c, or total cholesterol levels.

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? 1. "The medication is an antibacterial." 2. "The medication will help heal the burn." 3. "The medication is likely to cause stinging every time it is applied." 4. "The medication should be applied directly to the wound."

3. "The medication is likely to cause stinging every time it is applied." 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 assistant healing. It does not cause stinging when applied.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse apply the medication to which body area? *Select all that apply.* 1. Back 2. Axilla 3. Eyelids 4. Soles of the feet 5. Palms of the hands

1. Back 4. Soles of the feet & 5. 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.

the clinic performing an admission assessment on a client votes the client is taking azelaic acid period the nurse determines that which client complaint may be associated with the use of this medication? 1. Itching 2. Euphoria 3. Drowsiness 4. Frequent urination

1. 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 hypo pigmentation of the skin in clients with a dark complexion. the effects noted in the other options are not specifically associated with this medication.

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? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations

1. Tinnitus Rationale: salicylic acid is absorbed readily through the skin, and systemic toxicity can result period symptoms include tinnitus, dizziness, hyperpnea comma and psychological disturbances period constipation and diarrhea are not associated with salicylism.

The Camp nurse asked 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? 1. Immediately before swimming 2. 5 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun

4. 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 sunscreen should be reapplied after swimming or sweating.

A client with severe acne is seen in the clinic and the healthcare provider prescribes isotretinoin. the nurse reviews the clients medication record and would contact the health care provider if the client is also taking which medication? 1. Digoxin 2. Phenytoin 3. Vitamin A 4. Furosemide

3. 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.

The the health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instruction should the nurse provide? *Select all that apply.* 1. Sunscreen should be applied every eight hours. 2. Use sunscreen when participating in outdoor activities. 3. Wear a hat, opaque clothing, and sunglasses when in the sun. 4. Avoid sun exposure in the late afternoon and early evening hours. 5. Examine your body monthly for any lesions that may be suspicious.

2. Use sunscreen when participating in out door activities. 3. Wear a hat, opaque clothing, and sunglasses when in the sun. & 5. Examine your body monthly for any lesions that may be suspicious. Rationale: the client should be instructed to avoid sun exposure between the hours of brightest sunlight: 10 a.m. and 4 p.m. Sunscreen, a hat, opaque clothing, and sunglasses should be warm for outdoor activities. The client should be instructed to examine the body monthly for appearances of any cancerous or pre-cancerous lesions. Sunscreen should be reapplied every 2 to 3 hours and after swimming or sweating; otherwise, the duration of protection is reduced.