Ch. 56 Dermatologic Drugs

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

ANS: 2 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.

The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse provide? Select all that apply. 1. Sunscreen should be applied every 8 hours. 2. Use sunscreen when participating in outdoor activities. 3. Wear a hat, opaque clothing, and sunglasses when in the sun. 4. Avoid sun exposure in the late afternoon and early evening hours. 5. Examine your body monthly for any lesions that may be suspicious.

ANS: 2, 3, 5 Rationale: The client should be instructed to avoid sun exposure between the hours of brightest sunlight: 10 a.m. and 4 p.m. Sunscreen, a hat, opaque clothing, and sunglasses should be worn for outdoor activities. The client should be instructed to examine the body monthly for the appearance of any cancerous or any precancerous lesions. Sunscreen should be reapplied every 2 to 3 hours and after swimming or sweating; otherwise, the duration of protection is reduced.

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

ANS: 3 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.

8. A female patient will be starting therapy with oral isotretinoin (Amnesteem) as part of treatment for severe acne, and the nurse is providing teaching. Which teaching point will the nurse include in her teaching plan about isotretinoin? a. "You will have to use two contraceptive methods while on this drug." b. "You must avoid sexual activity while on this drug." c. "You will have to avoid pregnancy for 2 weeks after taking this drug." d. "If you are taking an oral contraceptive, you may take this drug."

ANS: A It is now required that at least two contraceptive methods be used by sexually active women during and for 1 month after completion of therapy with isotretinoin. The other statements are incorrect.

7. A 55-year-old obese patient was diagnosed with candidiasis in the skin folds under her breasts. When the nurse sees her at a follow-up visit 2 months later, she complains that it has returned. She said she applied the medicine for 1 week and stopped because the itching stopped and the cream was messy. Which statement is true regarding fungal infections of the skin? a. Fungal infections often require prolonged therapy. b. The patient has a new infection now. c. The patient needs to apply a dressing if the cream is too messy. d. This infection will probably never be cured.

ANS: A Topical fungal infections are difficult to treat and may require prolonged therapy of several weeks to as long as 1 year. Occlusive dressings should not be applied unless recommended by the medication's manufacturer.

1. Which adverse effects will the nurse expect in a teenage patient who is using topical tretinoin (Retin-A)? (Select all that apply.) a. Crusted skin b. Itching c. Altered skin pigmentation d. Rosacea e. Red and edematous blisters

ANS: A, C, E Some of the most common adverse effects of tretinoin are excessively red and edematous blisters, crusted skin, and temporary alterations in skin pigmentation. Itching and rosacea are not potential adverse effects.

When the nurse is teaching a patient about the mechanism of action of tretinoin, which statement by the nurse is correct? a. "This medication acts by killing the bacteria that cause acne." b. "This medication actually causes skin peeling." c. "This medication acts by protecting your skin from UV sunlight." d. "This medication has antiinflammatory actions."

ANS: B

10. The nurse is reviewing laboratory results for a patient and notes that the patient has positive results for nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA). The nurse anticipates an order for which medication? a. Acyclovir (Zovirax) b. Mupirocin (Bactroban) c. Clindamycin (Cleocin T) d. Clotrimazole (Lotrimin)

ANS: B Mupirocin (Bactroban) is used on the skin for treatment of staphylococcal and streptococcal impetigo. It is used topically and intranasally to treat nasal colonization by MRSA; however, it MRSA is becoming increasingly resistant to the drug. The other options are incorrect. Acyclovir (an antiviral drug) and clindamycin are not indicated for the treatment of MRSA; clotrimazole is an antifungal drug.

11. The nurse is reviewing the medical record of a patient who is to receive wound care with topical silver sulfadiazine (Silvadene). Which finding, if noted, would be a potential contraindication? a. The patient has an open wound from a burn on her arm. b. The patient is allergic to sulfonamide drugs. c. The patient is allergic to shellfish. d. The patient's burn wound has been débrided

ANS: B Patients with allergies to sulfonamide drugs must not receive silver sulfadiazine. The other options are incorrect.

3. The preoperative nurse is ready to perform a skin prep with povidone-iodine (Betadine) on a patient who is about to have abdominal surgery. Which allergies, if present, would be a contraindication to the Betadine prep? a. Peanuts b. Shellfish c. Adhesives d. Latex

ANS: B Povidone-iodine, a widely used antiseptic, cannot be used in patients who are allergic to iodine or have shellfish allergies.

12. A patient is considering taking oral aloe supplements and asks the nurse about potential problems with this therapy. Which statement by the nurse is correct? a. "Aloe is not taken orally; it is only used topically to aid in wound healing." b. "Aloe is used by some to treat constipation; it may cause diarrhea." c. "This is a safe herbal supplement, with no known drug interactions." d. "This is a safe herbal supplement, with no known adverse effects."

ANS: B The dried juice of the leaves of the aloe plant contains anthranoids, which give aloe a laxative effect when taken orally. The topical application of the plant juice has been known for years to help the healing of wounds. Common adverse effects include diarrhea, nephritis, abdominal pain, and dermatitis when used topically. Potential drug interactions include digoxin, antidysrhythmics, diuretics, and corticosteroids.

13. A female patient has been taking isotretinoin (Amnesteem) for 3 months. During a follow-up appointment, which statement by the patient would be of highest concern to the nurse? a. "I am using two forms of contraception while on this drug." b. "I have been feeling rather down and lonely lately." c. "I wish I didn't have to be on this medication." d. "It's scary to know that this drug can cause birth defects."

ANS: B There have been case reports of suicide and suicide attempts in patients receiving isotretinoin. Instruct patients to report immediately to their prescribers any signs of depression. Follow-up treatment may be needed, and simply stopping the drug may be insufficient.

2. A teenage boy is taking tretinoin (Retin-A) for acne. Which statement will the nurse include in the teaching plan? a. "Avoid foods that are heavy in salt and oils." b. "This drug may cause increased redness of your skin." c. "Try using an abrasive cleanser to remove old skin layers." d. "Being out in the sunlight will help your skin heal."

ANS: B Tretinoin may cause increased redness and drying, and the patient needs to avoid weather extremes, ultraviolet light, and abrasive cleansers. Certain foods do not need to be avoided.

2. A patient has a prescription for topically applied 5% fluorouracil (Efudex) cream as part of treatment for basal cell carcinoma on her cheek. Which instructions will the nurse provide to the patient? (Select all that apply.) a. "You must use gloves to apply this medication." b. "You can use clean fingertips to apply the cream, but be sure to wash your hands afterward." c. "You will need to stay out of the sun during therapy with this medication." d. "Apply this medication to the affected site once a day in the evening." e. "Apply this medication to the affected site twice daily." f. "You may have swelling, scaling, burning, and tenderness in the affected area."

ANS: B, C, E, F Fluorouracil may be applied with gloves or clean fingertips, but if fingertips are used, the medication must be washed off thoroughly after application. The medication may cause photosensitivity, as well as local swelling, scaling, burning, and tenderness. The medication is applied twice daily.

The nurse is performing wound care on a burned area using silver sulfadiazine cream in a patient with an arm wound. Which actions by the nurse are correct? (Select all that apply.) a. Applying the cream over the previous layer to avoid disturbing the wound bed b. Gently cleansing the wound to remove the previous layer of cream and wound debris c. Using clean gloves to apply the ointment d. Using sterile gloves to apply the ointment e. Always covering the wound with a dressing after applying the cream f. Washing hands before and after the procedure

ANS: B, D, F

1. A father calls because his son has head lice. He reports that he used Kwell shampoo three times, but nothing happened." He wants to know what to do now. What will the nurse advise first? a. "It sounds like you need a prescription for a second product, malathion." b. "Try one of the lotion products instead." c. "Be sure to use a nit comb to remove nits from the hair shafts." d. "Try combing through the hair with mineral oil to loosen the lice from the hair shafts."

ANS: C Before trying another product, ensure that he is performing the regimen correctly. Because he only mentioned shampooing, ensure that after each shampoo he is using a nit comb to remove nits, or eggs, from the hair shafts.

4. A woman suffered a second-degree burn of the skin on her arm and hand while cooking breakfast. After examination in the urgent care center, silver sulfadiazine cream (Silvadene) is ordered for the burned area. The nurse will apply the medication using which procedure? a. Gently patting a moderate amount over the burned area b. Massaging the cream completely into the wound c. Applying a thick layer over the burned area, and then leaving the area open d. Applying a thin layer with a sterile, gloved hand to clean and débrided areas

ANS: D Apply a thin layer of medication with a sterile, gloved hand to clean and débrided wounds. The other options are incorrect.

6. A child has been diagnosed with impetigo, a skin infection. The nurse anticipates that which drug will be used to treat this condition? a. Spinosad (Natroba) b. Nystatin (Mycostatin) c. Acyclovir (Zovirax) d. Bacitracin

ANS: D Bacitracin is applied topically for the treatment of local skin infections caused by susceptible aerobic and anaerobic gram-positive organisms, which can lead to impetigo. Spinosad (Natroba) is used for pediculosis; nystatin is an antifungal drug; and acyclovir is an antiviral drug.

9. A patient is admitted to the hospital for possible septicemia. He has a large pressure ulcer on his heel that is open and includes necrotic tissue. However, his prothrombin time/international normalized ratio (PT/INR) values are too high to permit surgical débridement at this time. The nurse expects that which wound-care product will be used to treat the wound? a. Cadexomer iodine (Iodosorb) b. Biafine topical emulsion c. Povidone-iodine (Betadine) d. Collagenase (Santyl)

ANS: D Because this patient has an elevated PT/INR, he cannot receive surgical débridement because of concerns about excessive bleeding. Collagenase is useful for patients taking anticoagulants and for those in whom surgery is contraindicated; it selectively removes necrotic tissue but does not harm normal tissue. Cadexomer iodine is not appropriate for a wound with necrotic tissue. Betadine is used as a skin cleanser; biafine is indicated for radiation dermatitis.

5. A patient asks about using minoxidil (Rogaine) for hair thinning. Which statement about minoxidil is accurate? a. The product is applied once daily in the morning. b. Systemic absorption of topically applied minoxidil is rare. c. Results may be seen as soon as 2 weeks after beginning therapy. d. Systemic absorption may cause tachycardia, fluid retention, and weight gain.

ANS: D Results of minoxidil therapy may not be seen for 4 months after beginning therapy. The product is applied twice daily, morning and evening, and systemic effects may result because of absorption.