Saunders NCLEX Review Pharmacology Integumentary Medications

3."I cannot use any cosmetics while I am using this medication." Rationale:Tretinoin is applied liberally to the skin. The skin needs to be cleansed thoroughly before applying the medication. The hands are washed thoroughly immediately after applying the medication. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The client may use cosmetics.

The nurse provides instructions to a client regarding the use of topical tretinoin. Which statement by the client indicates a need for further instruction? 1."I should begin to see results in about 3 weeks." 2."I will apply the medication liberally to the skin." 3."I cannot use any cosmetics while I am using this medication." 4."I will wash my hands thoroughly after applying this medication."

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

The primary health care provider has prescribed coal tar treatments for a client with psoriasis, and the nurse provides information to the client about the treatments. Which statement made by the client indicates a need for further education about the treatments? 1."The medication has an unpleasant odor." 2."The medication can cause phototoxicity." 3."The medication can stain the skin and hair." 4."The medication always causes systemic toxicity."

4."I need to take my vitamin A supplement so that the treatment will work." Rationale:Isotretinoin is used to inhibit inflammation in the client with severe cystic acne. Adverse effects include elevated triglyceride levels, skin dryness, and eye discomfort, such as dryness and burning. Lip inflammation, called cheilitis, can also occur. Vitamin A supplements are stopped during this treatment because of their additive effects.

An adolescent with severe cystic acne has been prescribed isotretinoin. Which statement by the client would suggest the need for further teaching? 1."I will return to the clinic for blood tests." 2."If my lips begin to burn, it is probably because of the medication." 3."My eyes may become dry and burn as a result of the medication." 4."I need to take my vitamin A supplement so that the treatment will work."

2.Triglyceride level Rationale:Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. There is no indication that isotretinoin affects potassium, hemoglobin A1C, or total cholesterol levels.

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

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 sunscreens should be reapplied after swimming or sweating.

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? 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

2."The medication will act as a local anesthetic." Rationale:A topical anti-inflammatory cream may be prescribed for temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia. These types of products contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants. A heating pad should not be applied because irritation or burning of the skin may occur. The medication is not addicting, does not act in a systemic manner, and does not cause sleepiness.

The primary health care provider has prescribed a topical anti-inflammatory cream for a client with a muscular sprain. The nurse provides instructions to the client regarding the medication. Which statement by the client indicates an understanding of this prescribed treatment? 1."The medication is addicting." 2."The medication will act as a local anesthetic." 3."I will apply a heating pad to the area after applying the medication." 4."The medication may make me sleepy but will stop the muscle spasms."

2.Triglyceride level Rationale:Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. There is no indication that isotretinoin affects potassium, hemoglobin A1C, or total cholesterol levels.

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

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 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

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 that a systemic effect has occurred? 1.Hyperventilation 2.Elevated blood pressure 3.Local rash at the burn site 4.Local pain at the burn site

1."The medication can cause diarrhea." 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, frequently can stain the skin and hair, and can cause phototoxicity. It does not cause diarrhea.

Coal tar has been prescribed for the client with psoriasis, and the nurse provides instructions to the client regarding this treatment. Which statement by the client indicates a need for further instruction? 1."The medication can cause diarrhea." 2."The medication can cause phototoxicity." 3."The medication has an unpleasant odor." 4."The medication can stain the skin and hair."

4."I need to be sure to take my vitamin A supplement so that the treatment will work." Rationale:Isotretinoin is used to inhibit inflammation in the client with severe cystic acne. Vitamin A supplements are stopped during this treatment because isotretinoin is a derivative of vitamin A, and taking vitamin A concurrently will induce additive effects. Adverse effects include elevated triglycerides, skin dryness, and eye discomfort, such as dryness and burning. Lip inflammation, called cheilitis, also can occur.

Isotretinoin has been prescribed for an adolescent with a diagnosis of severe cystic acne. The nurse provides instructions to the adolescent regarding the use of the medication. Which statement, if made by the adolescent, indicates a need for further instruction? 1."I will return to the clinic for blood tests." 2."My eyes may become dry and burn as a result of the medication." 3."If my lips begin to burn, this is probably because of the medication." 4."I need to be sure to take my vitamin A supplement so that the treatment will work."

1.A child Rationale:Lindane can penetrate the intact skin and cause seizures if absorbed in sufficient quantities. Clients at highest risk for convulsions are premature infants, children, and clients with preexisting seizure disorders. Lindane should not be used in pediatric clients unless safer medications have failed to control the infection.

Lindane is prescribed. The nurse reviews the client's record, knowing that this medication therapy would be contraindicated in which client? 1.A child 2.A young adult 3.An older client 4.A middle-age client

1.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.

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

4."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 assist in healing. It does not cause stinging when applied.

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 should be applied directly to the wound." 4."The medication is likely to cause stinging every time it is applied."

2."The medication is used to treat my eczema." Rationale:Azelaic acid is a topical medication used to treat mild to moderate acne. It appears to work by suppressing growth of Propionibacterium acnes and decreasing proliferation of keratinocytes. Options 1, 3, and 4 are accurate statements regarding the use of this medication.

Topical azelaic acid is prescribed for a client, and the clinic nurse provides instructions regarding the use of this medication. Which statement by the client indicates a need for further instruction? 1."I need to apply the medication twice daily." 2."The medication is used to treat my eczema." 3."I need to massage a thin film gently into the affected area." 4."I need to wash and dry my skin before I apply the medication."

4.Doxycycline Rationale:Doxycycline is a tetracycline. Adverse effects of isotretinoin can be increased by the use of tetracyclines. Tetracyclines increase the risk of pseudotumor cerebri and papilledema. Because of the potential for increased toxicity, tetracyclines should be discontinued before isotretinoin therapy. Phenytoin, digoxin, and furosemide are not contraindicated.

A primary health care provider (PHCP) prescribes isotretinoin for a client with severe acne. The nurse reviews the client's record and notifies the PHCP if which prescribed medication is noted on the medication record? 1.Digoxin 2.Phenytoin 3.Furosemide 4.Doxycycline

3.Mupirocin Rationale:Mupirocin is a topical antibacterial agent active against impetigo caused by staphylococci or streptococci. Cortisone would not be effective in treating impetigo. Benzoyl peroxide is a keratolytic. Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. It inhibits the activity of herpes simplex types 1 and 2, varicella zoster, Epstein-Barr virus, and cytomegalovirus.

A child is diagnosed with impetigo. The primary health care provider prescribes a topical medication for treatment. The nurse anticipates that which medication will be prescribed? 1.Cortisone 2.Acyclovir 3.Mupirocin 4.Benzoyl peroxide

3.Wash, rinse, and towel-dry the hair before applying. Rationale:Permethrin is toxic to adult mites and lice but less toxic to the ova. For this reason, retreatment may be required. It is required to wash, rinse, and towel-dry the hair before applying the medication. It is left in for 10 minutes and removed by a warm water rinse.

A client is seen in the clinic for a complaint of scalp itching that has been persistent over the past several weeks. After an assessment, it is determined that the client has head lice. Permethrin shampoo is prescribed, and the nurse provides instructions to the client regarding the use of the medication. The nurse should tell the client to take which measure? 1.Put the medication in 1 time only. 2.Leave the medication in for at least 4 hours. 3.Wash, rinse, and towel-dry the hair before applying. 4.Leave the shampoo on for 8 to 12 hours and then remove by washing.

4.Increased respirations Rationale:Salicylic acid is readily absorbed through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, hyperpnea, dizziness, and psychological disturbances. Lower leg pains, constipation, and diarrhea are not associated with salicylism.

A client with acute seborrheic dermatitis of the back, chest, and legs is receiving treatments with salicylic acid. The nurse should monitor the client for which symptom that indicates the presence of systemic toxicity from this medication? 1.Diarrhea 2.Constipation 3.Lower leg pain 4.Increased respirations

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.

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? 1.Digoxin 2.Phenytoin 3.Vitamin A 4.Furosemide

2.Rash Rationale:Clotrimazole is a topical antifungal agent used in the treatment of cutaneous fungal infections. It is not used for pain, fever, or sneezing.

A home health nurse is visiting a client who has been started on therapy with clotrimazole. The nurse determines the effectiveness of the medication by noting a decrease in which problem? 1.Pain 2.Rash 3.Fever 4.Sneezing

4."I will apply the ointment once a day and cover it with a sterile dressing." Rationale:Collagenase is used to promote debridement of dermal lesions and severe burns. It is applied once daily and covered with a sterile dressing. The remaining options are incorrect.

Collagenase is prescribed for a client with a severe burn to the hand. The home care nurse provides instructions to the client regarding the use of the medication. Which client statement indicates an accurate understanding of the use of this medication? 1."I will apply the ointment at bedtime and in the morning." 2."I will apply the ointment once a day and leave it open to the air." 3."I will apply the ointment twice a day and leave it open to the air." 4."I will apply the ointment once a day and cover it with a sterile dressing."

1."I need to continue to take my vitamin A supplements." Rationale:In severe cystic acne, isotretinoin is used to inhibit inflammation. Adverse effects include elevated triglyceride levels, skin dryness, eye discomfort such as dryness and burning, and cheilitis (lip inflammation). Close medical follow-up is required, and dry skin and cheilitis can be decreased by the use of emollients and lip balms. Vitamin A supplements are stopped during this treatment.

Isotretinoin is prescribed for a client with severe cystic acne. The nurse provides instructions to the client regarding administration of the medication. Which phrase stated by the client indicates a need for further teaching regarding this medication? 1."I need to continue to take my vitamin A supplements." 2."The medication may cause dryness and burning in my eyes." 3."I need to use emollients and lip balms for my dry skin and lips." 4."I will need to return for a blood test to check my triglyceride level."

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

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

3.Applied to a reddened, itchy area underneath an occlusive dressing Rationale:Topical glucocorticoids can be absorbed into the systemic circulation. Toxicity is a concern if a glucocorticoid is used for an extended period of time, if it is applied underneath an occlusive dressing, or if it is applied to a large area of the body.

The nurse is applying a topical glucocorticoid as prescribed for a client with psoriasis. The nurse would be concerned about the potential for systemic absorption of the medication if it were being applied in which situation? 1.Applied for 2 days until the irritation has resolved 2.Applied to a small area on the arm underneath a gauze dressing 3.Applied to a reddened, itchy area underneath an occlusive dressing 4.Applied to a small area on the neck and another small area on the back