Ch. 45: Dermatologic Disorders

A patient who has psoriasis is taking methoxsalen (Oxsoralen) to treat the condition along with receiving therapeutic ultraviolet A. The nurse notes burning and blistering of the patient's skin. Which action will the nurse take? A. Ask the patient about any recent exposure to sunlight. B. Explain to the patient that these signs mean the treatment is working. C. Report spread of the psoriasis to the patient's provider. D. Tell the patient to take the methoxsalen after the ultraviolet A treatment.

A. Ask the patient about any recent exposure to sunlight. Rationale: Patients taking methoxsalen can develop burning and blistering with exposure to sunlight. These signs do not indicate efficacy of the treatment and do not mean the psoriasis is worsening. There is no indication for taking the drug after the UVA exposure.

A female patient has begun using 2% minoxidil (Rogaine) to treat thinning of her hair. After several weeks of treatment, she reports minimal effectiveness but has noticed some improvement. The nurse will counsel her to perform which action? A. Continue to use the 2% minoxidil. B. Change to finasteride (Propecia). C. Discontinue the minoxidil. D. Increase to 5% minoxidil.

A. Continue to use the 2% minoxidil. Rationale: The patient has shown some improvement, so she should keep using the product if she wants to maintain the results, since stopping treatment will result in hair loss in a few months. Finasteride and 5% minoxidil are not approved for women.

A patient who works outdoors has frequent contact dermatitis flares secondary to exposure to plant irritants. The patient asks the nurse how to minimize these episodes. The nurse will counsel this patient to perform which action? A. Apply topical glucocorticoid medication prior to exposure. B. Cleanse the skin immediately after any contact with plants. C. Take systemic diphenhydramine (Benadryl) after being outdoors. D. Use calamine lotion prior to working outdoors.

B. Cleanse the skin immediately after any contact with plants. Rationale: Cleansing is one of the chief methods to decrease the irritation that has been caused by contact dermatitis.

A patient has second- and third-degree burns, and the nurse is applying silver sulfadiazine (Silvadene) to the burns with each dressing change. The patient reports a burning sensation. The nurse understands that this is A. a hypersensitivity reaction to the medication. B. an expected adverse reaction to the medication. C. a sign of localized tissue infection. D. a sign of skin necrosis.

B. an expected adverse reaction to the medication. Rationale: A common adverse reaction to silver sulfadiazine is a burning sensation. It does not indicate a hypersensitivity reaction, localized tissue infection, or skin necrosis.

The nurse is providing teaching for an adolescent who has acne vulgaris. In addition to teaching about correct administration of the prescribed medications, the nurse will instruct this patient to A. apply topical vitamin D3. B. cleanse the skin gently several times a day. C. cleanse the affected skin vigorously twice daily. D. take supplemental vitamin A.

B. cleanse the skin gently several times a day. Rationale: Gentle cleansing is one of the chief nonpharmacologic treatments of acne. Vigorous scrubbing should be avoided. Topical vitamin D is sometimes used to treat psoriasis.

The nurse assists the provider to treat a patient who has warts with cantharidin (Cantharone). After the cantharidin is applied to the warts, the nurse will A. apply gauze dressings to the warts and secure them with tape. B. cover the warts with nonporous tape when the solution dries. C. prepare to assist the provider with cryotherapy to complete the procedure. D. treat the warts with Burrow's soaks and apply a wet-to-dry dressing.

B. cover the warts with nonporous tape when the solution dries. Rationale: To prevent damage to the surrounding skin, the wart should be covered with nonporous tape after the application of cantharidin is allowed to dry. This procedure can be repeated in 1 to 2 weeks. Gauze dressings are porous and would allow the solution to come in contact with intact skin. Cryotherapy is a separate procedure and not done after treatment with cantharidin. Burrow's soaks are not indicated.

The nurse is teaching a female patient who will begin taking isotretinoin (Amnesteem) to treat severe cystic acne. Which statement by the patient indicates understanding of the teaching? A. "I may get a 3-month supply of the medication with each refill." B. "I must abstain from intercourse while taking this drug." C. "I should avoid strenuous exercise when I am taking this medication." D. "I should take a vitamin A supplement while I am taking the medication."

C. "I should avoid strenuous exercise when I am taking this medication." Rationale: Serious muscle damage may occur while taking this medication, so patients should avoid strenuous activity which can compound this effect. Patients must get monthly refills and must take a pregnancy test before each refill. Patients should use two reliable forms of birth control, but abstinence is not required. Vitamin A can compound the adverse effects of this medication.

A patient who has extensive second- and third-degree burns will use mafenide acetate (Sulfamylon) to treat the burns. What is an important aspect of care for this patient? A. Assess for fluid overload. B. Explain that this medication will decrease pain. C. Monitor the patient's electrolytes. D. Teach the patient how to use sterile technique at home.

C. Monitor the patient's electrolytes. Rationale: Mafenide acetate can cause electrolyte imbalances. Fluid overload is not likely. This medication does not decrease pain. Patients should be taught to use clean technique.

An adolescent patient is preparing to take a summer job as a landscaper and asks the nurse about insect repellents and sunscreens. Which statement by the nurse is correct? A. Apply sunscreen prior to applying insect repellents containing DEET. B. Apply sunscreen containing PABA 30 minutes prior to sun exposure. C. Most sunscreens block both UVB and UVA radiation. D. Reapply sunscreen every 2 hours if sweating occurs.

D. Reapply sunscreen every 2 hours if sweating occurs. Rationale: Sunscreen should be reapplied if exposed to moisture as through sweating. Sunscreen should be applied after using repellents containing DEET. Sunscreens with PABA should be applied at least 2 hours prior to exposure. Not all sunscreens block UVA radiation.

The nurse is teaching a group of adolescents about sun protection. What information will the nurse include when teaching this group? A. Effective sunscreens guard against melanoma and basal cell carcinoma. B. SPF numbers indicate UVB protection, and UVA protection is assumed for all products. C. SPF ratings are proportional to the amount of UVB radiation that they block. D. Sunscreen products of all SPF ratings will protect for 2 hours if not exposed to moisture.

D. Sunscreen products of all SPF ratings will protect for 2 hours if not exposed to moisture. Rationale: Sunscreen will protect about 2 hours if not exposed to moisture, such as swimming or sweating. Sunscreens do not guard against melanoma or basal cell carcinoma. UVA protection is not in all products. SPF ratings are not proportional.

A patient reports localized itching after contact with a new brand of laundry detergent. The nurse will suggest that the patient contact the provider to discuss treatment with which product? A. Calamine lotion B. Systemic glucocorticoid C. Topical diphenhydramine D. Topical glucocorticoid

D. Topical glucocorticoid Rationale: This patient has contact dermatitis related to contact with a chemical. Topical glucocorticoids may be used for the itching. Calamine lotion may contain diphenhydramine and is used mainly for contact with plant irritants. A topical diphenhydramine is not recommended because of an increased risk of allergic reaction to systemic diphenhydramine. Systemic glucocorticoids are used for more severe reactions.

A patient who has psoriasis will begin taking etanercept (Enbrel). The nurse will ensure that which laboratory test is performed prior to initiating treatment with this drug? A. Complete blood count (CBC) with differential B. CD4 and T-cell count C. Serum pregnancy test D. Tuberculin test

D. Tuberculin test Rationale: Enbrel can worsen infections, and patients taking this drug must have a tuberculin skin test prior to initiation of treatment. CBC, CD4, and T-cell counts are monitored during therapy with alefacept. A serum pregnancy test is not indicated.

A patient reports using benzoyl peroxide 2.5% for acne but doesn't feel that it is working. The nurse notes papules and nodules on the patient's face, neck, and back, consistent with moderate acne vulgaris. The nurse will counsel this patient to ask the provider about A. adding isotretinoin (Amnesteem) to the treatment regimen. B. increasing the benzoyl peroxide to a 5% solution. C. taking systemic antibiotics until symptoms improve. D. using benzoyl peroxide 10% and a topical antibiotic.

D. using benzoyl peroxide 10% and a topical antibiotic. Rationale: Moderate acne requires a stronger concentration of benzoyl peroxide (10%) and possibly topical antibiotics. Isotretinoin is used for severe cystic acne. Systemic antibiotics are given for severe acne.