Advanced Patho/Pharm: Integumentary Medications Saunders ?'s

The school nurse has provided instructions regarding the use of permethrin rinse to the parents of children diagnosed with pediculosis capitis (head lice). Which statement by one of the parents indicates a need for further instruction? 1. "It is applied to the hair and then shampooed out." 2. "The hair should not be shampooed for 24 hours after treatment." 3. "The permethrin rinse can be obtained over the counter in a local pharmacy." 4. "It is applied to the hair after shampooing, left on for 10 minutes, and then rinsed out."

Correct answer: 1 Rationale: Permethrin rinse is an over-the-counter scabicide that kills lice and eggs with 1 application and has residual activity for 10 days. It is applied to the hair after shampooing (using a conditioner-free shampoo) and left for 10 minutes before rinsing out. The hair should not be shampooed for 24 hours after the treatment.

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

Correct answer: 4 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.

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

Correct answer: 1 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.

Sodium hypochlorite solution is prescribed for a client with a wound on the left foot that is draining purulent material. Which action should the nurse plan to take? 1. Irrigate the wound with the solution. 2. Soak the foot in the solution for 20 minutes daily. 3. Place the solution in the wound, and cover with an occlusive dressing. 4. Soak a sterile dressing with the solution, and pack the dressing into the wound.

Correct answer: 1 Rationale: Sodium hypochlorite is a solution that is used for irrigating and cleaning necrotic or purulent wounds. It can be used for packing necrotic wounds but cannot be used to pack purulent wounds because the solution is inactivated by copious pus. It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation.

A client with an infected leg wound that is draining purulent material has a prescription for sodium hypochlorite to be used in the care of the wound. The nurse should implement which action while using this solution? 1. Rinse off immediately following irrigation. 2. Pour onto sterile sponges, and pack in wound. 3. Let the solution run freely over normal skin tissue. 4. Use each bottle of solution for 2 weeks before replacing.

Correct answer: 1 Rationale: Sodium hypochlorite is a solution that is used for irrigating and cleaning necrotic or purulent wounds. It cannot be used to pack purulent wounds because the solution is inactivated by copious pus. (It can be used to pack necrotic wounds, however.) It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. The solution is unstable, and it is best to prepare a fresh solution for use during each dressing change.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse should 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

Correct answer: 1, 4, 5 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.

A hydrocolloid dressing is prescribed for a client with a leg ulcer. The home health nurse is preparing a plan of care for the client and should appropriately document which intervention? 1. Change the hydrocolloid dressing daily. 2. Change the hydrocolloid dressing every 3 to 5 days. 3. Apply the hydrocolloid dressing over a dry, sterile dressing. 4. Apply the hydrocolloid dressing over a normal saline-soaked dressing.

Correct answer: 2 Rationale: A hydrocolloid dressing contains hydroactive particles embedded in a polymer base that are softened by wound moisture and act as a protective gel over healing tissue. It is applied directly to the wound and should be changed every 3 to 5 days (or more frequently if drainage from the wound is excessive). It is not applied over a dry, sterile dressing or a normal saline-soaked dressing because it then would not be able to act as a protective gel.

A client has a wound with a moderate amount of drainage and is scheduled for a dressing change. Which dressing, if selected by the student nurse, requires further intervention by the nursing instructor? 1. Foam 2. Alginate dressing 3. Hydrocolloid dressing 4. Semipermeable transparent film

Correct answer: 4 Rationale: The client's wound has moderate drainage. Recall that foam, alginate, and hydrocolloid dressings are applied to wounds with moderate to heavy drainage. Semipermeable transparent films are applied to dry wounds.

The health care provider has prescribed a topical antiinflammatory 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."

Correct answer: 2 Rationale: A topical antiinflammatory 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.

A topical corticosteroid is prescribed for an infant with dermatitis in the gluteal area. The nurse provides instructions to the mother regarding the use of the medication. Which statement by the mother indicates an understanding of the use of the medication? 1. "I should not rub the medication into the skin." 2. "The medication will help relieve the inflammation." 3. "I need to apply the medication in a thick layer to protect the skin." 4. "I should protect the area by covering it with a diaper and plastic pants."

Correct answer: 2 Rationale: A topical corticosteroid will relieve inflammation. The mother should be advised not to apply a tight-fitting diaper or plastic pants after applying the medication because these items will act as an occlusive dressing. The use of occlusive dressings (bandages or plastic wraps) over the affected site is avoided after application of the topical corticosteroid unless the health care provider specifically prescribes this wound coverage. The medication is gently rubbed into the skin after a thin layer is applied.

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

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

An ambulatory care client with allergic dermatitis has been given a prescription for a tube of diphenhydramine 1% to use as a topical agent. The nurse determines that the medication was effective if which finding was noted? 1. Nighttime sedation 2. Decrease in urticaria 3. Absence of ecchymosis 4. Healing of burned tissue

Correct answer: 2 Rationale: Diphenhydramine reduces the symptoms of allergic reaction, such as itching or urticaria, when used as a topical agent on the skin. The oral form also has other uses, such as to provide mild nighttime sedation. It is not used to treat burns or ecchymosis.

A client has been given diphenhydramine as a topical agent for allergic dermatitis. The nurse should instruct the client to observe for which intended medication effect? 1. Nighttime sedation 2. A decrease in urticaria 3. Healing of burned tissue 4. Resolution of ecchymosis

Correct answer: 2 Rationale: Diphenhydramine reduces the symptoms of allergic reaction, such as itching or urticaria, when used as a topical agent on the skin. When taken orally it may provide mild nighttime sedation. It is not used to treat burns or ecchymosis.

Tetracycline is prescribed for a client with severe acne. The nurse instructs the client regarding the importance of reporting which finding if it occurs? 1. Sunburn 2. Persistent diarrhea 3. Epigastric burning 4. Abdominal cramping

Correct answer: 2 Rationale: Tetracycline can be used to treat severe acne. Adverse effects include gastrointestinal irritation manifested as epigastric burning, cramps, nausea, vomiting, and diarrhea. These effects do not need to be reported unless the diarrhea becomes persistent and severe. If this does occur, this could indicate another adverse effect, superinfection. Clostridium difficile infection is another potential adverse effect associated with tetracycline use. In addition, photosensitivity is another potential effect, which can more easily result in sunburn. Clients should be instructed to wear sunscreen. A sunburn does not need to be reported necessarily, as this is an expected and self-limiting effect. Other adverse effects include yellowing of the teeth (which can occur in the unborn fetus), hepatotoxicity, and renal toxicity.

A child with severe seborrheic dermatitis is receiving treatments of topical corticosteroid applied over an extensive area of the body, followed by the application of an occlusive dressing. The nurse should monitor the child closely, knowing that which systemic effect can occur as a result of this treatment? 1. Local infection 2. Growth retardation 3. Thinning of the skin 4. Adrenal hyperactivity

Correct answer: 2 Rationale: Topical corticosteroid can be absorbed in sufficient amounts to produce systemic toxicity. Principal concerns are growth retardation (in children) and adrenal suppression (in all age groups). Systemic toxicity is more likely under extreme conditions of use, such as with prolonged therapy in which extensive surfaces are treated with high doses of high-potency agents in conjunction with occlusive dressings.

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.

Correct answer: 3 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. Therefore, options 1, 2, and 4 are incorrect.

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."

Correct answer: 3 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.

The nurse is providing instructions to a mother of a child with atopic dermatitis (eczema) regarding the application of topical cortisone cream to the affected skin sites. Which statement made by the mother indicates an understanding of the use of this medication? 1. "I shouldn't rub the medication into the skin." 2. "The medication is applied everywhere except the face." 3. "I need to wash the sites gently before I apply the medication." 4. "I need to apply the medication generously and allow it to absorb."

Correct answer: 3 Rationale: Topical corticosteroids should be applied sparingly and rubbed into the area thoroughly. The affected area should be cleansed gently before application. It should not be applied everywhere or over extensive areas. Systemic absorption is more likely to occur with extensive application. It is applied to the affected sites.

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

Correct answer: 3 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. Therefore, options 1, 2, and 4 a

A burn client has been having 1% silver sulfadiazine applied to burns twice a day for the past 3 days. Which laboratory abnormality indicates that the client is experiencing a side or adverse effect of this medication? 1. Serum sodium of 120 mEq/L (120 mmol/L) 2. Serum potassium of 3.0 mEq/L (3.0 mmol/L) 3. White blood cell count of 3000 mm3 (3 × 109/L) 4. pH 7.30, PaCO2 of 32 mm Hg (32 mmHg), HCO3- of 19 mEq/L (19 mmol/L)

Correct answer: 3 Rationale: Transient leukopenia typically occurs after 2 to 3 days of treatment. Knowing this and knowing normal white blood cell values will direct you to option 3. Although options 1, 2, and 4 are abnormal findings, they are not associated with this medication.

A topical corticosteroid is prescribed for a client with dermatitis. The nurse provides instructions to the client regarding the use of the medication. Which statement by the client would indicate a need for further instruction? 1. "I need to apply the medication in a thin film." 2. "I should gently rub the medication into the skin." 3. "The medication will help relieve the inflammation and itching." 4. "I should place a bandage over the site after applying the medication."

Correct answer: 4 Rationale: Clients should be advised not to use occlusive dressings (bandages or plastic wraps) to cover the affected site after application of the topical corticosteroid unless the health care provider specifically prescribes wound coverage. The remaining options are accurate statements related to the use of this medication.

The nurse is caring for a client at home with a diagnosis of actinic keratosis. The client tells the nurse that her skin is very dry and irritated. The treatment includes diclofenac sodium. The nurse teaches the client that this medication is from which class of medications? 1. Antiinfectives 2. Vitamin A lotions 3. Coal tar preparations 4. Nonsteroidal antiinflammatory drugs (NSAIDs)

Correct answer: 4 Rationale: Diclofenac sodium is an NSAID for topical use. It is indicated for use to treat actinic keratosis. The mechanism underlying its benefits is unknown. The most common side effects are dry skin, itching, redness, and rash at the site of application. Diclofenac sodium may sensitize the skin to ultraviolet radiation, and clients should therefore avoid sunlamps and minimize exposure to sunlight. Antiinfectives are used for infections. Vitamin A would be contraindicated in the treatment of actinic keratosis. Coal tar is for psoriasis.

The clinic nurse is caring for a client with a diagnosis of scabies who has just been prescribed crotamiton. The nurse instructs the client to perform which action when applying this medication? 1.Apply the medication to the entire body, washing it off after 2 hours. 2.Apply the application to the entire body, leave it on for 24 hours, and then take a cleansing bath. 3.Apply the medication to the entire body, avoiding the skin folds and creases, and wash it off in 12 hours. 4.Massage the medication into the skin from the chin downward. Apply a second application in 24 hours, followed by a cleansing bath 48 hours after the second application.

Correct answer: 4 Rationale: Several products are used to treat scabies, and it is important to instruct the client to follow the specific instructions because instructions may vary depending on the product. Crotamiton is massaged into the skin of the entire body, starting with the chin and working downward. The head and face are treated only if needed. Special attention should be given to skin folds and creases. Contact with eyes, mucous membranes, and any region of inflammation should be avoided. A second application is made 24 hours after the first. A cleansing bath should be taken 48 hours after the second application; if needed, treatment can be repeated in 7 days.

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 (5.65 mmol/L) 2. Magnesium level of 1.5 mEq/L (0.75 mmol/L) 3. Platelet level of 300,000 mm3 (300 × 109/L) 4. White blood cell count of 3000 mm3 (3.0 × 109/L)

Correct answer: 4 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 health care provider is notified and the medication is usually discontinued. The white blood cell count noted in option 4 is indicative of leukopenia. The other laboratory values are not specific to this medication, and are also within normal limits.

Sodium hypochlorite is prescribed for a client with a leg wound that is draining purulent material. The home health nurse teaches a family member how to perform wound treatments. Which statement, if made by the family member, indicates a need for further teaching? 1. "A fresh solution needs to be prepared frequently." 2. "I should rinse the solution off immediately after the irrigation." 3. "The solution should not come in contact with normal skin tissue." 4. "I will soak a sterile dressing with solution and pack it into the wound."

Correct answer: 4 Rationale: Sodium hypochlorite is a solution used for irrigating and cleaning necrotic or purulent wounds. It cannot be used to pack purulent wounds because the solution is inactivated by copious pus. The solution loses its potency during storage, so fresh solution should be prepared frequently. The solution should not come into contact with healing or normal tissue and should be rinsed off immediately after irrigation.

The home health care nurse makes a home visit to a client who has an ulcer on the medial aspect of the left ankle. The wound is being treated with a hydrocolloid dressing. The nurse removes the hydrocolloid dressing, cleanses the wound as prescribed, and reapplies the hydrocolloid dressing. The nurse schedules the next visit for wound care and changing the hydrocolloid dressing in how many days, which is the maximum number of days? Fill in the blank. _______ day(s)

Correct answer: 7 days Rationale: The nurse would schedule the next home care visit in 7 days. Protective hydrocolloid dressings are designed to be left in place for 7 days unless leakage occurs around the dressing or the wound gel appears to have migrated beyond the margins of the wound. However, the dressing will need to be changed sooner if increased exudate is present.