Integumentary System

1. 1. The serum sodium level is not affected by mafenide acetate (Sulfamylon); it is affected when administering silver nitrate, a topical antimicrobial that is also used to treat burns. 2. Urine concentration may be affected by silver sulfadiazine (Silvadene), a topical antimicrobial that is used to treat burns, but Sulfamylon does not affect urine concentration. 3. This should have been done prior to the emergency room physician prescribing this medication; therefore, this would not be an appropriate intervention. 4. The medication causes pain or a burning sensation following its application; therefore, the client should be premedicated.

1. The client with a partial-thickness burn to the right arm is prescribed mafenide acetate (Sulfamylon), a topical antimicrobial. Which intervention should the emergency department nurse implement when applying this medication? 1. Do not administer if the serum sodium level is decreased. 2. Assess the client's urine for any increased concentration. 3. Determine the amount of burned skin using the Rule of Nine. 4. Premedicate the client prior to administering the medication.

10. 1. The client should drink large amounts of fluids to prevent sulfa crystals from forming in the urine. 2. The client should eat foods high in protein for healing purposes, but this does not specifically concern this medication. 3. Ketones are a byproduct of fat breakdown and would not be specific for teaching about Silvadene. 4. The client should change the dressing twice a day, but this is not part of teaching about the medication Silvadene.

10. The client is prescribed silver sulfadiazine (Silvadene), a topical antimicrobial agent, for a partial-thickness burn to the back. Which information should the nurse discuss concerning this medication? 1. Encourage the client to drink 3000 mL of water. 2. Discuss the need to eat foods high in protein. 3. Teach the client how to test the urine for ketones. 4. Instruct to change the dressing twice a day.

11. 1. The dressing may be left in place for up to 7 days or may be changed every 24 hours, but it would not be changed twice a day. This does not allow the dressing adequate time to increase healing of the wound. 2. The nurse should avoid cutting the dressing because particles of activated charcoal may get into the wound and cause discoloration. 3. The dressing change does not warrant administering a narcotic analgesic to the client. 4. Tape should be used to hold the secondary dressing in place or the antimicrobial binding dressing will not remain in the pressure ulcer.

11. The nurse is using the antimicrobial binding dressing Actisorb Silver 222 for a stage 3 pressure ulcer on the left hip area. The dressing is a combination of silver and activated charcoal. Which intervention should the nurse implement? 1. Perform the sterile dressing change twice a day. 2. Avoid cutting the dressing when applying it to the wound. 3. Premedicate the client with a narcotic analgesic. 4. Do not use tape to hold the secondary dressing in place.

12. 1. There is no reason to contact the HCP because this is an expected reaction to the pressure dressing. 2. The client may have an infection and is taking antibiotics, but this is not causing the foul odor. 3. This is an expected reaction to the pressure dressing. The foul odor is produced by the breakdown of cellular debris and does not indicate that the wound is infected. 4. Bathing the husband will not help the odor; therefore, this response is not appropriate.

12. The male client with a stage 4 pressure ulcer on the coccyx area is being treated with an autolytic medication for debridement and an occlusive dressing. The wife of the client asks the nurse, "Why isn't someone doing something about that foul odor my husband has?" Which statement is the nurse's best response? 1. "I will contact your husband's doctor when he makes rounds." 2. "The odor is secondary to an infection and he is taking antibiotics." 3. "The odor is an expected reaction to the pressure dressing." 4. "I am sorry the odor bothers you. We will bathe your husband."

13. 1. The nurse should rinse the wound with physiologically normal saline, but this is not the first intervention. 2. Removing the old dressing and assessing the pressure ulcer for healing is the first intervention. 3. This dressing must be held in place for 5 seconds after applying it to the pressure ulcer. 4. The dressing change is performed with nonsterile gloves using aseptic technique; therefore, this is not an appropriate intervention.

13. The nurse is changing a hydrocolloid antimicrobial barrier dressing with silver for a client with a stage 4 pressure ulcer. Which intervention should the nurse implement first? 1. Rinse the wound with physiologically normal saline. 2. Remove the old dressing and assess the pressure ulcer. 3. Hold the dressing in place for 5 seconds after applying. 4. Apply sterile gloves when performing the procedure.

14. 1. This would indicate when an alginate dressing, not a hydrocolloidal dressing, is ready to be removed. 2. The Iodosorb gel, not the CombiDerm dressing, should be changed when the color changes from brown to a yellow-gray. 3. The nurse does not need a written order from the health-care provider to change the dressing. 4. This dressing is an absorbent hydrocolloidal dressing that provides a moist environment, absorbs exudates, and is nondamaging to the skin. When the softened area approaches the edge of the dressing, it must be removed and a new one must be applied.

14. The nurse is caring for a client with a stage 3 pressure ulcer. The client has a CombiDerm nonadhesive, sterile, hydrocolloidal dressing. Which data indicates the dressing is ready to be removed? 1. The exudate begins to pool on the wound surface. 2. The color of the drainage changes from brown to a yellow-gray. 3. The health-care provider must write an order to remove the dressing. 4. The softened area is approaching the edge of the dressing.

15. 1. Hydrogels help maintain a moist healing environment, granulation, and epithelialization, and they facilitate autolytic debridement. One advantage of a hydrogel dressing is that it is soothing and reduces pain. 2. One of the disadvantages of hydrogel dressings is that they are not recommended for wounds with heavy exudate. 3. An advantage of using hydrogel dressings is that they can be used when infection is present. 4. An advantage of using hydrogel dressings is that they are easily applied and removed from the wound.

15. The client with a stage 2 pressure ulcer is prescribed a hydrogel dressing. Which statement indicates the client understands the teaching about the hydrogel dressing? 1. "The hydrogel dressing is soothing and reduces pain." 2. "It must be used because my pressure ulcer drains a lot." 3. "This dressing can only be used if my wound is not infected." 4. "This dressing is very difficult to apply and remove from the wound."

16. 1. The wound care nurse is usually not contacted until the pressure ulcer is at a stage 2. 2. Bio-occlusive transparent dressing is a semiocclusive bacterial and viral barrier that protects skin from exogenous fluid and contaminants. It is used for areas where the skin is intact. 3. A stage 1 pressure ulcer does not require systemic antibiotic therapy because the skin remains intact. 4. The nurse should turn the client from side to side to remove pressure from the reddened area on the coccyx. 5. A Gel-Overlay mattress uniformly distributes pressure and reduces friction and shear with gel bladders inside a foam core. It is designed to be placed directly on an existing mattress.

16. While giving the elderly client a bath, the nurse notices a reddened area over the coccyx area but the skin is intact. Which interventions should the nurse implement? Select all that apply. 1. Notify the wound care nurse to assess the wound. 2. Apply a bio-occlusive transparent dressing to the area. 3. Contact the HCP to request a systemic antibiotic. 4. Turn the client every 2 hours from side to side. 5. Request a Gel-Overlay mattress for the client's bed.

17. 1. A Catrix wound dressing, which is a topically applied powder made from bovine tracheal cartilage, not an Iodosorb dressing, would be contraindicated in a client with a pressure ulcer who has an adverse reaction to bovine products. 2. The nurse would question use of Iodosorb in certain clients because there are some contraindications to its use. 3. Iodosorb gel cleanses the wound by absorbing; the nurse would not question the use of this gel for the client with an infection. 4. Iodosorb gel, cadexomer iodine, is an iodine-based wound filler. If the client has a known sensitivity to iodine, the nurse would not use this dressing. MEDICATION MEMORY JOGGER: If the test taker has no idea what the answer to the question is, then the test taker should look at the name of the medication. In this question, the medication has "iodo" in the name. This should make the nurse think about iodine and select option 4.

17. Which client with a stage 2 pressure ulcer should the nurse question the use of Iodosorb gel, a wound filler? 1. The client with an adverse reaction to bovine products. 2. The gel can be used on any client. 3. The client who has a pressure ulcer that is infected. 4. The client who has a known sensitivity to iodine.

18. 1. Hydrogen peroxide solution should not be used because it may inactivate the papain. 2. Cream should not be rubbed into the wound because it will cause further tissue damage. 3. This ointment is made from the proteolytic enzyme from the fruit of Carica papaya and is a debriding product. After cleansing the pressure ulcer, the nurse should apply 1/8-inch thickness of ointment. 4. Accuzyme papain-urea is a potent digestant of nonviable protein matter, but it is harmless to viable tissue.

18. The nurse is applying Accuzyme papain-urea, a debriding agent, to a client who has a stage 3 pressure ulcer. Which intervention should the nurse implement? 1. Cleanse the wound with hydrogen peroxide solution. 2. Rub the papain cream directly into the wound. 3. Apply 1/8-inch papain ointment to the pressure ulcer. 4. Be sure that no medication is applied on viable tissue.

19. 1. Inserting the medicated dressing is an appropriate intervention; therefore, the nurse should not question this order. 2. Topical anesthetic is not used to dress a stage 4 pressure ulcer. 3. The nurse must insert the roped dressing into the tunnel to ensure wound healing. Using a sterile cotton swab will allow the dressing to be inserted into the tunnel and will not cause damage to the tissue. 4. The wound should be cleansed with normal saline or some type of sterile solution before dressing the wound, not after dressing the wound.

19. The client has a stage 4 pressure ulcer with tunneling. Which intervention should the nurse implement when instructed to apply a medicated roped dressing to the wound? 1. Question inserting any medicated dressing into the tunnel. 2. Apply a topical anesthetic to the wound before entering the tunnel. 3. Use a sterile cotton swab and insert the dressing into the tunnel. 4. Insert sterile normal saline into the tunnel after inserting dressing.

2. 1. This is the incorrect way to apply silver nitrate. 2. Silver nitrate solution causes a black discoloration on all skin surfaces and dressings with which it comes into contact; therefore, the client would not need to notify the HCP. 3. Sliver nitrate is used as a 0.5% solution in distilled water and should be applied to the bulky gauze dressing every 2 hours, and the dressing should be changed twice a day. 4. The bulky wound dressing must be changed twice a day; therefore, the nurse must teach the client to change the dressing. A dressing change does not have to be done only by the HCP.

2. The nurse is discussing the application of silver nitrate, an antimicrobial agent, to a client with a partial-thickness burn to the left leg. Which information should the nurse teach the client when discussing how to apply this medication after discharge? 1. Administer the silver nitrate ointment directly to the burned area twice a day. 2. Notify the HCP if a black discoloration occurs on the burned area. 3. Apply the silver nitrate solution to the wound dressing every 2 hours.

20. 3, 2, 4, 5, 1 3. The wound needs to be cleaned with some type of solution. Even if the test taker were not familiar with Derma - Klenz, he or she should select this option as the first intervention. 2. DermaDress is a multilayered waterproof sterile dressing, and the nurse must remove one side of the backing before applying to the wound. 4. After the backing is removed, the nurse should apply the dressing to the wound. 5. The nurse should then remove the remaining back and cover the wound. 1. The nurse should then secure the dressing in place.

20. The nurse is applying a DermaDress dressing to a client with a stage 2 pressure ulcer on the coccyx. Which interventions should the nurse implement? Rank in the order of performance. 1. Secure the edges of the dressing with gentle pressure. 2. Remove one side of the backing of the dressing. 3. Clean the wound with DermaKlenz wound cleaner. 4. Place the dressing gently over the wound. 5. Remove the remaining backing to cover the wound.

21. 1. The glomerular filtration rate (GFR) monitors for renal function. Methotrexate is not toxic to the kidneys so monitoring of GFR would not be needed. 2. The BUN and creatinine tests monitor for renal problems. Methotrexate is not toxic to the kidneys. 3. Methotrexate causes hematopoietic depression. The nurse should monitor for leukopenia, thrombocytopenia, and anemia. The CBC provides information in all these areas. 4. Methotrexate does not interfere with the iron-binding capacity.

21. The client is prescribed methotrexate (Rheumatrex), an antineoplastic agent, for psoriasis. Which data should the nurse monitor? 1. The glomerular filtration rate. 2. The BUN and creatinine. 3. The complete blood count. 4. The iron-binding capacity.

22. 1. Washing the feet with soap and water and drying thoroughly will keep the area clean so the fungus will not grow in this area. 2. Tinea pedis is athlete's foot. The nurse should recommend that the client soak the feet twice a day in a vinegar and water solution. If this is not successful in treating the problem, then the client should contact an HCP for a prescription antifungal agent. 3. Sporanox is the treatment for tinea unguium, a toenail infection. The HCP would have to prescribe this treatment. 4. Wearing clean cotton socks and changing frequently prevents the area from being wet, which is where fungus grows. 5. Over-the-counter antifungal powders or creams can help control the infection. These generally contain miconazole, clotrimazole, or tolnaftate. Keep using the medicine for 1-2 weeks after the infection has cleared to prevent the infection from returning.

22. The client diagnosed with tinea pedis complains of intense itching. Which interventions should the nurse discuss with the client? Select all that apply. 1. Wash feet with soap and water and dry thoroughly at least twice a day. 2. Soak the feet in vinegar and water twice a day until better. 3. Take the prescribed Sporanox for 1 week a month for 3 months. 4. Wear clean cotton socks and change frequently to keep feet dry. 5. Use over-the-counter antifungal powders such as miconazole.

23. 1. Balneotherapy involves therapeutic baths with or without medications. Tar baths are recommended for clients with severe psoriasis or eczema. Because tars are volatile, the bath area should be well ventilated. The nurse would question this medication at this time. 2. Oatmeal baths are useful in relieving the itching associated with poison ivy rashes. The nurse would not question this medication. 3. Although the therapeutic duration of relief from powders is brief, powders act as a hygroscopic agent to retain and absorb moisture from the air and reduce friction between skin surfaces and clothing or bedding. The nurse would not question this medication. 4. Desitin ointment is a zinc oxide-based preparation used to treat erythema and excoriated areas of the perineum or around the anus (perianal). The nurse would not question this medication.

23. The nurse is administering medications. Which intervention or medication should the nurse question? 1. Balneotherapy with medicated tar to a client when the exhaust fan is broken. 2. A colloidal oatmeal (Aveeno) bath to a client with itching from poison ivy. 3. Sprinkling zinc oxide powder on a client on continuous bed rest. 4. Using Desitin topical ointment on a client who has an excoriated perianal area.

24. 1. This client has a fungal infection of the body that is not life threatening, and the option did not state the client was uncomfortable. The client with a comfort problem (itching) should receive the medication first. 2. Atarax is prescribed to relieve itching. Pruritus is an uncomfortable sensation. This client should receive the medication first. 3. Zovirax is administered several times a day for herpes infections. The viral infection is not life threatening. The client who is uncomfortable should receive the medication first. 4. Vibramycin is an antibiotic that is administered orally for acne, but acne is not life threatening, and the client who is uncomfortable should receive medication first.

24. Which medication should the nurse administer first? 1. Griseofulvin (Fulvicin), an antifungal, to a client with tinea corporis. 2. Hydroxyzine (Atarax), an antihistamine, to a client who is itching. 3. Acyclovir (Zovirax), an antiviral, to a client with herpes zoster. 4. Doxycycline (Vibramycin), an antibiotic, to a client with acne.

25. 1. The medication is a cream, not an ointment, and scabies infestations occur on the body, usually between the fingers or toes, wrists, elbows, and waistline. When Kwell is used on the scalp, it is used to treat lice and it is shampooed in. 2. All creams, lotions, powders, and the like should be removed before applying a cream to the body, so the client should be bathed prior to the application of the cream. The nurse then applies a thin layer of cream over the entire body starting at the neck, avoiding the face and urethral meatus, and including the soles of the feet. The skin is allowed to dry and cool after the application. The medication is removed after 8-12 hours by a bath or shower. 3. The nurse does not scrape the lesions. Scabies mites burrow under the client's skin and the medication is applied to the entire body surface area, excluding the face and urethral meatus. 4. This is how to apply Kwell for head lice, not for scabies.

25. The HCP ordered lindane (Kwell), a scabicide, to be administered to the client from an extended care facility who is diagnosed with scabies. Which intervention should the nurse implement? 1. Apply the ointment by thoroughly massaging it into the scalp. 2. Bathe the client, and then apply the lotion to the patient from the neck down. 3. Scrape the scabies lesions with a sterile needle. 4. Shampoo the head with the Kwell and comb with a fine-toothed comb.

26. 1. Clostridium botulinum is Botox, which is used to decrease the appearance of wrinkles. It is not used to treat acne. 2. Clients with acne have too much oil production. Applying vitamin E oil would increase the client's problem. 3. Accutane has serious side effects, and its use is restricted to only those with severe, disfiguring acne. 4. Benzoyl peroxide is used for mild acne to suppress the growth of P. acnes and promote keratolysis (peeling of the horny layer of epidermis).

26. The nurse is discussing skin care with a teenaged client who has mild acne. Which medication or treatment should the nurse discuss with the client? 1. Injections of Clostridium botulinum into the acne lesions. 2. Applying vitamin E oil directly to the acne pimples to keep them moist. 3. Taking isotretinoin (Accutane) by mouth daily. 4. Washing the face and neck morning and night with benzoyl peroxide.

27. 1. This not a true statement. The paralysis of the facial muscles lasts from 3-6 months. 2. Facial edema is expected after the procedure. The nurse should teach the client to apply ice to the site and avoid using alcohol or NSAID products for a week prior to the procedure. 3. The results are neither instantaneous nor permanent. Results develop over 3-10 days. 4. In addition to mild edema, there can be more side effects to Botox injections. Excessive dosing can cause facial paralysis, and clients can lose the ability to smile, frown, raise the eyebrows, or squint.

27. The nurse in a plastic surgeon's office is discharging a client who had Botox injections. Which discharge instructions should the nurse provide? 1. The client can expect permanent paralysis of the muscles. 2. The client should notify the HCP if edema is noted. 3. The results will develop slowly over 3-10 days. 4. The only side effect is a localized reaction at the injection site.

28. 1. Tacrolimus increases the risk of skin cancer when the client is exposed to UV light. The clients should be told to avoid direct sunlight or use of tanning beds. 2. Common side effects of Protopic are erythema, pruritus, and a burning sensation at the site of application. These reactions lessen as the skin heals. The client should not stop using the medication. 3. This is the normal dosing schedule. 4. The skin should be left uncovered. 5. The client does not have to take a bath before each application. The first application will have absorbed into the skin prior to the next dose.

28. The client diagnosed with atopic dermatitis (eczema) is prescribed tacrolimus ointment (Protopic). Which interventions should the nurse implement? Select all that apply. 1. Avoid sunlight getting to the treated areas. 2. Stop using the medication if redness or itching occurs. 3. Apply a thin layer to the skin twice a day. 4. Cover the area with an occlusive dressing. 5. Take a bath in tepid water before each application.

29. 1. The juice from the aloe plant is used topically to treat minor burns, insect bites, and sunburn. This is an appropriate suggestion by the nurse. 2. Calamine is used to decrease the itching associated with poison ivy, oak, or sumac. It would not help a sunburn. 3. Echinacea is used topically to treat canker sores or fungal infections, not sunburn. 4. Baking soda paste is helpful in treating insect bites, not sunburn.

29. The female client calls the clinic to report that she has a painful sunburn. Which information should the nurse discuss with the client? 1. Rub the inside of the aloe plant leaves on the sunburn. 2. Apply calamine lotion to the most severely burned areas. 3. Apply Echinacea to the sunburn to take away the pain. 4. Use a cool compress of baking soda to help the sunburn heal.

3. 1. The nurse should administer this intravenous fluid as ordered. 2. There are formulas that are used to determine the client's fluid-volume resuscitation. The formulas specify the total amount of fluid that must be infused in 24 hours—50% in the first 8 hours, followed by the other 50% over the next 16 hours. This is a large amount of fluid, but its administration is not uncommon in clients with full-thickness burns over more than 20% of their total body surface. 3. The intravenous fluids must be infused on a pump to ensure the client receives the correct amount for fluid resuscitation. 4. This is not an unusual amount of fluid to be infused. There is no absolute amount of fluid that a client may require during fluid resuscitation. 5. There is no reason to verify this order with another nurse in the burn unit.

3. The client with a full-thickness burn over 38% of the body is admitted to the burn unit 4 hours after the fire. The HCP writes an order for Ringer's lactate 450 mL/hour. Which interventions should the nurse implement? Select all that apply. 1. Question the health-care provider's orders. 2. Administer the intravenous fluid as prescribed. 3. Infuse the intravenous fluid via a pump. 4. Do not administer more than 200 mL an hour. 5. Verify the order with another nurse in the burn unit.

30. 1. Sunglasses will help prevent eye damage and skin cancer around the eyes. 2. Sunlight does not affect the efficacy of antibiotics taken internally; some antibiotics might cause the client to be more susceptible to photosensitivity, but efficacy of the antibiotics would not be affected. 3. Clients should be told to use a sunscreen of at least SPF 15 when in the sun. The higher the number, the better the blocking of the sun's UV rays occurs. 4. Tanning beds use UV rays and may be more damaging than the sun because of the concentrated time clients stay under the tanning bed lamps. 5. Sunscreen without an expiration date has a shelf life of no more than 3 years, but its shelf life is shorter if it has been exposed to high temperatures.

30. The occupational health nurse is presenting information regarding prevention of skin cancer to a group of workers in an industrial plant. Which information should the nurse include in the program? Select all that apply. 1. Wear sunglasses that wrap around and block both UVA and UVB rays. 2. Many antibiotics lose efficacy if the client is exposed to sunlight. 3. Use a sunscreen of with at least a sun protective factor of 15. 4. Tanning beds do not have the same damaging rays as the sun. 5. Check the sunscreen's expiration date before applying to skin.

31. 1. This odor does not indicate that the wound is infected; therefore, the nurse should not notify the wound care nurse who is usually responsible for treating a stage 4 pressure ulcer. 2. When an enzymatic debriding agent is used under a occlusive dressing, a foul odor is produced by the breakdown of cellular debris. The nurse should explain to the client that the odor is expected. 3. This odor does not indicate that the wound is infected; therefore, the nurse would not need to assess the client's temperature to determine if there is an elevation. 4. This odor does not indicate that the wound is infected; therefore, the client would not need to be receiving antibiotic therapy.

31. The client has a stage 4 pressure ulcer and is being treated with enzymatic debriding agent and occlusive dressing. The nurse notices a foul odor. Which intervention should the nurse implement? 1. Notify the wound care nurse that there is a foul odor. 2. Explain to the client that this odor is expected. 3. Assess the client's oral temperature. 4. Request an order for an antibiotic from the HCP.

32. 1. Decreasing inflammation is the scientific rationale for prescribing the steroid, but it is not the specific rationale for prescribing the dose pack. 2. Steroids must be tapered to prevent adrenal insufficiency. The dose pack is prescribed to ensure that the client takes the correct amount of medication daily. 3. The steroid dose pack is gradually decreased, not increased. 4. This is the scientific rationale for prescribing the steroid, not the rationale for prescribing the dose pack.

32. The client with poison ivy is prescribed a dose pack of the steroid prednisone. Which statement best describes the scientific rationale for prescribing the dose pack? 1. The steroid will help decrease the inflammation secondary to poison ivy. 2. The dose pack will ensure that the medication is tapered as needed. 3. The dose pack will gradually increase the dose of the steroid taken daily. 4. The steroid will reduce the amount of redness that is on the client's skin.

4. 1. A urine output of less than 30 mL/hour would not indicate the fluid resuscitation is effective. 2. This would indicate effective fluid resuscitation for a client with a thermal burn but not for a client with an electrical burn. 3. The client with an electrical burn should have a urine output of 75 to 100 mL/hour for the fluid resuscitation to be effective. 4. An output of greater than 100 mL/hour would indicate the client is losing too much fluid and that the fluid resuscitation is not effective.

4. The client experienced an electrical burn that resulted in full-thickness burns to the right and left hand. The HCP ordered the fluid resuscitation rates. Which data indicates the fluid resuscitation is effective? 1. The client's urine output is less than 30 mL/hour. 2. The client's urine output is at least 50 mL/hour. 3. The client's urine output is 75-100 mL/hour. 4. The client's urine output is greater than 200 mL/hour.

33. 1. The hair does not need to be shampooed with an antimicrobial solution prior to applying lindane. 2. The head must be scrubbed for 4 minutes before rinsing the shampoo. 3. This child has head lice and the treatment of choice is shampooing the hair with Kwell. It should be applied to dry hair with a small amount of water so that the medication is not washed off the hair but is rubbed into the hair to kill the lice. 4. The Kwell shampoo may be repeated in a week to kill newly hatched lice, but it should not be used daily nor does it matter what time of day the shampoo is used. Daily shampooing with Kwell may cause central nervous system toxicity, especially in children.

33. The child with pediculosis capitis is prescribed lindane (Kwell), a pediculocide. Which information should the nurse discuss with the parents? 1. Wash the hair with an antimicrobial shampoo prior to using lindane. 2. Scrub the head and wash the hair for 2 minutes and then remove the lindane. 3. Apply the shampoo to dry hair and use a small amount of water to lather. 4. Use the Kwell shampoo daily before going to bed for 1 week.

34. 1. A fine-toothed comb is used to remove nits in clients with head lice; it is not used to treat seborrheic dermatitis (dandruff). 2. Using the hair dryer at the high heat setting will further dry out the scalp and increase dandruff production. 3. Corticosteroids help symptoms by reducing inflammation, itching, and discomfort and are generally recommended for short-term use for the skin, not the scalp. 4. Two or three different types of shampoos should be used in rotation to prevent the seborrhea from becoming resistant to a specific shampoo. This treatment for dandruff is used initially; then, as the condition is improved, the treatment can be less frequent. 5. Antifungal agents such as ketoconazole work by reducing numbers of Malassezia yeast in affected areas of the body.

34. Which information should the nurse discuss with the client who has seborrheic dermatitis of the scalp? Select all that apply. 1. Use a fine-toothed comb to comb out the hair after shampooing. 2. Dry the hair using the high heat setting for at least 5 minutes. 3. Apply hydrocortisone 1% to the scalp area twice a day. 4. Rotate two or three different types of shampoos daily. 5. Use over the counter 1% ketoconazle shampoo and gels.

35. 1. Acid therapy (16% salicylic acid and 16% lactic acid) is a common way to remove warts. It should be applied every 12-24 hours for 2-3 weeks. 2. The wart should disappear in 2-3 weeks. 3. The acid therapy will not cause the wart to spread. 4. There is no reason the client cannot wear rings on the left hand while applying acid therapy to the wart.

35. The client with a verruca vulgaris (wart) on the left ring finger below the knuckle is prescribed a colloidal acid solution. Which information should the nurse discuss with the client? 1. Apply the solution to the wart every 12 hours. 2. Expect the wart to disappear within 1 week. 3. Be careful because the wart may spread easily. 4. Do not wear any rings on the left hand.

36. 1. The client must use two forms of birth control when taking Accutane because Accutane is extremely damaging to the fetus. The SMART protocol has been instituted to ensure that no female clients are or become pregnant while taking this medication. 2. Accutane is extremely damaging to the fetus, and because the client is having regular and heavy menses the HCP could prescribe this medication knowing that the client is not pregnant. 3. Accutane is prescribed for acne; therefore, this statement would not cause the HCP not to prescribe Accutane. 4. One of the requirements of the SMART protocol is a pregnancy test monthly because Accutane is extremely damaging to the fetus.

36. The nurse is discussing the System to Manage Accutane-Related Teratogenicity (SMART) with a client who has severe acne. Which statement by the female client would cause the HCP to not prescribe Accutane? 1. "The only contraception I use is birth control pills." 2. "My menstrual cycles have been regular and heavy." 3. "I hope this works because I am so tired of being ugly." 4. "I will have to come in every month for a pregnancy test."

37. 1. The tetracycline should not be taken with milk or milk products because those products prevent the absorption of the medication in the stomach. 2. Tetracycline may cause discoloration or a yellow-brown color of the teeth in children younger than 8 years old or in the fetus of a client who is pregnant. This client is not pregnant and is an adult; therefore, this intervention is not appropriate. 3. Photosensitivity (sun reaction) may occur in persons taking tetracycline; therefore, the client should be taught to use safety precautions when in the sunlight. 4. The female client should use a nonhormonal method of contraception because birth control pills interact with the tetracycline and the client will be unprotected from pregnancy.

37. The female client diagnosed with acne is prescribed tetracycline. Which intervention should the nurse include in the medication teaching? 1. Take the medication with milk or milk products. 2. Explain that this medication may cause the teeth to discolor. 3. Tell the client to use sunscreen and protective clothing when outside. 4. Advise the client to take birth control pills.

38. 1. The medication is not being prescribed for birth control; it is being prescribed for acne. The client is 16 years old, and if she is sexually active, a condom should be worn to prevent sexually transmitted disease. 2. Birth control pills can be taken on an empty stomach or with food. 3. Birth control pills do not turn body fluids orange. 4. This medication may be used as a birth control pill, but it is also used to treat acne by suppressing sebum production and reducing skin oiling. The client must take the medication exactly as prescribed.

38. Which information should the nurse discuss with the 16-year-old female client diagnosed with acne who is prescribed estrogen, a dominant oral contraceptive compound, to treat her acne? 1. This medication will prevent the client from getting pregnant. 2. Do not take this medication on an empty stomach. 3. The medication will turn the urine and body fluids orange. 4. Take the medication daily for 3 weeks, then stop for 1 week.

39. 1. The parents should wash their hands prior to administering the medication and can use nonsterile gloves or a tongue depressor when applying the medication. They do not need to use sterile gloves, but they should not touch the affected area. 2. Scraping the lesions would hurt the child and cause bleeding, which results in a scab, which, in turn, must be removed prior to applying ointment. Do not scrape the lesions. 3. The soapy water will help to remove the central site of bacterial growth, giving the topical antibiotic the opportunity to reach the infected site. 4. Hydrogen peroxide is not used to cleanse impetigo. A 1:20 Burow's solution may be used to put compresses on the impetigo.

39. The child has impetigo on the hands. The HCP prescribes topical mupirocin (Bactroban), an antibiotic. Which intervention should the nurse demonstrate to the parents when discussing this medication? 1. Apply the ointment with sterile gloves. 2. Scrape the lesions prior to applying ointment. 3. Soak the hands in soapy water. 4. Cleanse the impetigo with hydrogen peroxide

40. 1. Cellulitis is not a topical infection and is not treated with topical ointments. 2. Systemic antibiotic therapy is the treatment of choice for cellulitis, an inflammation of the skin and subcutaneous tissue. 3. Apply hot, moist compresses, not cold, dry compresses, to the area to help decrease pain and redness. 4. The HCP would prescribe rest with immobilization of the extremity. 5. Elevating the arm will help decrease edema.

40. The client with cellulitis of the left arm is seen in the clinic. Which interventions should the nurse expect the HCP to prescribe when discharging the client home? Select all that apply. 1. Apply topical corticosteroid ointment to the affected area. 2. Take a 7-10-day regimen of systemic antibiotics. 3. Apply warm, moist compresses to the reddened, inflamed skin. 4. Continue activity as needed with no specific restrictions. 5. Elevate the left arm on two pillows.

41. 1. There is no reason the client cannot wear makeup prior to the procedure, especially for 1 week. Makeup is not allowed for a few weeks after the procedure. 2. Use of a heat lamp is not prescribed prior to having a chemical face peel. 3. A chemical face peel does not necessitate antibiotic therapy before the procedure, but the client may be prescribed antibiotics after the procedure. 4. Cleaning the face and hair with hexachlorophene will decrease the risk of infection during and after the procedure.

41. Which procedure should the nurse teach the client who is scheduled for a chemical face peel? 1. Do not wear any type of makeup for 1 week prior to the scheduled procedure. 2. Apply a heat lamp to the face for 10 minutes three times a day. 3. Take all the prescribed antibiotics for 5 days prior to the procedure. 4. Clean the face and hair with hexachlorophene for 3 days prior to the procedure.

42. 563/hr. Because half of the total dose of 9000 mL should be administered in the first 8 hours, the nurse should determine how many milliliters should be given in the first 8 hours: 9000 mL ÷ 2 = 4500 mL. Then, the 4500 must be divided by 8 to determine the rate per hour: 4500 ÷ 8 = 562.5, or rounded up to 563. There are formulas that are used to determine the client's fluid-volume resuscitation. The formulas specify the total amount of fluid that must be infused in 24 hours, 50% in the first 8 hours followed by the other 50% over the next 16 hours. This is a large amount of fluid, but it is not uncommon in clients with full-thickness burns covering more than 20% of the total body surface area burned.

42. The client has second- and third-degree burns to 40% of the body. The HCP writes an order for 9000 mL of fluid to be infused over the next 24 hours. The order reads that 1/2 of the total amount should be administered in the first 8 hours with the other 1/2 being infused over the remaining 16 hours. What rate would the nurse set the intravenous pump for the first 8 hours?

43. 1. The client must understand that no medication will cure a herpes viral infection. Zovirax shortens the time of symptoms and speeds healing, but it does not cure the shingles. The client needs more medication teaching. 2. This medication is prescribed for five times a day dosing because of the short half-life of the medication. 3. The medication is prescribed for 7-10 days when the client has an acute exacerbation of a herpes virus. 4. If the herpes zoster occurs near or in the eyes, it could cause blindness and is considered an ophthalmic emergency.

43. The client with acute herpes zoster is prescribed oral acyclovir (Zovirax), an antiviral medication. Which statement by the client indicates the client needs more medication teaching? 1. "I am so glad this medication will cure my shingles." 2. "I will have to take the pill five times a day." 3. "I should take this medication for 7-10 days." 4. "If the shingles gets near my eyes, I will call my HCP."

44. 1. The medication must be taken for at least 1 year before determining adequate response to the medication. 2. Not finding any hair in the comb does not indicate the medication is stimulating hair growth. 3. The hair texture and color have nothing to do with determining the effectiveness of the medication. 4. Only 50% of clients regrow hair, and it may require up to 1 year of daily treatment to determine if the medication is effective.

44. The client with male pattern baldness is prescribed finasteride (Propecia), a hair growth stimulant. When should the nurse evaluate for effectiveness of the medication? 1. After the client has been taking the medication for 1 month. 2. When the client states there are no hair strands in the comb. 3. At the time the client's hair changes texture and color. 4. One year after taking the hair growth stimulant medication daily.

45. 1. This is an expected action of the tar preparation, and the client does not need to come to the clinic. 2. Preparations made of coal tar are messy, they cause staining, and they have an unpleasant odor, but they are an effective form of treatment for psoriasis. 3. Psoriasis is extremely difficult to treat, and tar preparations are an effective form of treatment and should not be discontinued because of expected effects. 4. Bleach will not treat the stains on the skin and will dry out the skin.

45. The client with psoriasis who is being treated with a tar preparation (Estar) calls the clinic nurse and reports an odor and staining of the client's shirt. Which intervention should the nurse implement? 1. Have the client come to the clinic immediately. 2. Tell the client that the odor and staining are expected. 3. Discontinue the tar preparation immediately. 4. Apply a diluted bleach solution to the affected area.

46. 1. Turning, coughing, and encouraging the client to turn, cough, and deep-breathe is a task that can be delegated but will not address pruritis. 2. The UAP can place mittens on the client's hands to discourage the client from scratching. 3. The nurse cannot delegate the administration of medication. 4. Caffeine will keep the client awake and should be discouraged but will not address pruritis. 5. The UAP can put a moisturizing lotion on the client. This is not considered a medication.

46. The nurse and the unlicensed assistive personnel (UAP) are caring for a client experiencing pruritus. Which tasks should be delegated to the UAP? Select all that apply. 1. Turn, cough, and deep-breathe the client every 2 hours. 2. Place mittens on both of the client's hands. 3. Administer the antihistamine diphenhydramine (Benadryl). 4. Remove all caffeine-containing products from the room. 5. Apply a moisturizing lotion to the client's skin.

47. 1. The client would not experience signs of systemic withdrawal because of a steroid being applied topically. 2. The client would not experience signs of prednisone toxicity because topical steroids are used. 3. After prolonged use of topical steroids, the dermis and epidermis will atrophy, resulting in thinning of the skin, striae, and purpura; therefore, the nurse should assess for this data. 4. The client would not have elevated blood glucose levels because the medication is a topical cream.

47. The client has been applying a topical hydrocortisone cream to dry, rough skin for more than 2 years. Which data should the nurse assess in the client? 1. Check for signs or symptoms of adrenal insufficiency. 2. Assess for a buffalo hump and a moon face. 3. Assess for thin, fragile skin in the area near the dry, rough skin. 4. Monitor the client's serum blood glucose level.

48. 1. A child should not take aspirin because it may cause Reye's syndrome. 2. Benadryl ointment should not be applied to the rash area. 3. Tylenol elixir is the drug of choice for children to decrease irritability and any discomfort. 4. There is no treatment for the measles; it must run its course, but a mild nonnarcotic analgesic such as Tylenol can decrease irritability and discomfort.

48. The parents of a 2-year-old child with measles call the pediatric clinic and tell the nurse the child is very uncomfortable, irritable, and fretful. Which recommendation should the nurse discuss with the parents? 1. Alternate Motrin with children's aspirin every 4 hours. 2. Apply diphenhydramine (Benadryl) cream to the rash. 3. Administer acetaminophen (Tylenol) elixir to the child. 4. Tell the parents that there is no medication for the child

49. 1. Atarax is an antihistamine medication that decreases itching and is also prescribed as a sedative at bedtime because it is effective in producing a restful and comfortable sleep. 2. Antibacterial ointment will not help the client sleep; therefore, it is not information the nurse should discuss with the client. 3. Warm, soapy water will not help decrease the itching and may increase the skin irritation. 4. An occlusive dressing will not help decrease the client's complaints of itching.

49. The client is complaining of inability to sleep because of pruritus secondary to a skin irritation on the lower extremities. Which information should the nurse discuss with the client? 1. Take the antihistamine hydroxyzine (Atarax) at bedtime. 2. Apply antibacterial ointment to the skin irritation. 3. Soak the lower extremities in warm, soapy water. 4. Place an occlusive dressing over the irritated skin.

5. 1. A tetanus toxoid is administered intramuscularly early in the acute phase of burn care to prevent Clostridium tetani infection. If the client has not had a tetanus shot within the last 10 years or if the time is in doubt, a booster of tetanus toxoid should be administered. 2. This may be an appropriate question, but it is not the most important question. 3. This is an appropriate question, but it is not the most important question. 4. This question would not be pertinent to the client's burn and medical care in the emergency department.

5. The client is admitted to the emergency department with a partial- and full-thickness burn to the left leg. Which question is most important for the nurse to ask the client? 1. "When was your last tetanus shot?" 2. "Can you tell me how this burn happened?" 3. "Will you need any help when you go home?" 4. "Have you taken any antibiotics in the last week?"

50. 1. Valtrex costs more than acyclovir; therefore, the cost is not an advantage. 2. Acyclovir requires the client to take medication five times a day and Valtrex is taken only three times a day. Fewer dosing times increase compliance with the medication and are an advantage of Valtrex. 3. Both antiviral medications are taken for the same period of time; therefore, there is not an advantage to taking Valtrex. 4. Both medications can be taken with or without food; therefore, this is not an advantage to taking Valtrex.

50. Which statement describes the advantage for the client with acute herpes infection taking valacyclovir (Valtrex) over acyclovir (Zovirax)? 1. Valtrex does not cost as much as the acyclovir. 2. Valtrex only requires taking medication three times a day. 3. Acyclovir has to be taken for a longer period of time. 4. Acyclovir must be taken on an empty stomach.

6. 1. Leukopenia improves over the course of the treatment with Silvadene and does not warrant discontinuing the medication. 2. Many clients develop marked leukopenia in response to Silvadene. The leukopenia will improve spontaneously over the course of treatment. Leukopenia does not contraindicate use of this medication. 3. Leukopenia secondary to Silvadene therapy does not warrant the administration of aminoglycoside antibiotics. 4. Hydrocortisone cream does not treat leukopenia secondary to Silvadene.

6. The client with a partial-thickness burn to the entire right leg who is being treated with silver sulfadiazine (Silvadene), a sulfonamide antibacterial agent, develops leukopenia. Which medication should the nurse suspect the health-care provider will prescribe? 1. Discontinue the Silvadene ointment immediately. 2. Continue administering the Silvadene ointment. 3. Administer aminoglycoside antibiotics intravenously. 4. Administer a hydrocortisone cream to the burned area.

7. 1. Sulfamylon affects the acid-base balance in the body and should not be administered to clients with renal disease. A 0.8 mg/dL serum creatinine level is within normal range of 0.5 to 1.5 mg/dL; therefore, the nurse would not need to use caution with this client. 2. Sulfamylon impairs the renal mechanism involved in the buffering of the blood, thereby increasing the excretion of bicarbonate in the urine. When this occurs, the pulmonary system effects a compensatory hyperventilatory status to maintain normal acid-base balance. If this compensation cannot take place as a result of pulmonary disease, the client develops metabolic acidosis. 3. This client has adequate respiratory status; therefore, the nurse would not need to use caution with this client. 4. There is no reason a client with diabetes could not be prescribed mafenide acetate.

7. Which client should the nurse use caution when applying mafenide acetate (Sulfamylon), a topical antimicrobial agent, to a burned area? 1. A client with a creatinine level of 0.8 mg/dL. 2. A client with chronic obstructive pulmonary disease. 3. A client with a pulse oximeter reading of 95%. 4. A client with type 2 diabetes who is taking insulin.

8. 1. Silver sulfadiazine (Silvadene), not Pepcid, acts on the cell membrane and cell wall of susceptible bacteria and binds to cellular DNA. 2. Intravenous opioid medications, not Silvadene, will help decrease the client's pain. 3. Antiemetics, not Silvadene, will help prevent the client's nausea and vomiting. 4. Curling's ulcer (stress ulcer) is an acute ulceration of the stomach or duodenum that forms following a burn injury. Histamine2 antagonists like Pepcid are administered to decrease gastric acid secretion in the acute phase of burn care.

8. The client with partial- and full-thickness burns to 35% of the body is admitted to the burn department. The HCP has prescribed famotidine (Pepcid), a histamine2 antagonist. Which statement best describes the scientific rationale for administering this medication? 1. Pepcid acts on the cell wall to prevent bacterial growth. 2. Pepcid will help control the client's pain. 3. Pepcid will help decrease the client's nausea and vomiting. 4. Pepcid will help decrease gastric acid production.

9. 1. The client should receive intravenous (IV) medication, not intramuscular (IM) medication. 2. The client should receive IV medication, not IM medication; therefore, the nurse should be a client advocate and notify the health-care provider for a change in the route of the morphine. 3. The client should have intravenous pain medication until hemodynamic stability and unimpaired tissue perfusion return. The PCA pump provides an intravenous route, and the client can control the amount of medication administered with the PCA, ensuring safe limits of pain medication. 4. The client should receive IV medication, not IM medication; therefore, the nurse should not administer this medication after assessing the client.

9. The HCP prescribed morphine 2-5 mg IM every 2 hours for the client with full-thickness burns to the chest and abdominal area. The client reports pain of 10 on a pain scale from 1 to 10. Which intervention should the nurse implement? 1. Administer 5 mg of morphine IM to the client immediately. 2. Contact the HCP to request an increase in the medication. 3. Request a patient-controlled analgesia (PCA) pump for the client. 4. Assess the client for complications and then administer the medication.