Transcript File

Integumentary Medication
Integumentary Medication
• . EMOLLIENTS AND LOTIONS
• A.Emollients (Box 41-1)
– 1.Oily or fatty substances that soften and soothe irritated skin by allowing the
skin to retain water
– 2.Available as creams or ointments
– 3.Used for dry, scaly, itchy inflammatory conditions
• B.Solutions and lotions (Box 41-2)
– 1.Liquid suspensions or dispersions
– 2.Require shaking before application
– 3.Although lotions are predominantly water, they have a drying effect on the
skin when the water evaporates
– 4.Used as a wash for the skin, as soaks, or as wet dressings on ulcers or burns
– 5.Used for subacute inflammatory lesions after the severe exudate phase has
ceased
– 6.Medicated lotions are often used as anti-inflammatory agents because they
provide a drying, protective, and cooling effect
EMOLLIENTS AND LOTIONS
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BOX 41-1 Emollients
Cold cream
Glycerin
Lanolin
Lubriderm
Petrolatum
Zinc ointment
Vitamin A and D ointment
BOX 41-2 Solutions and Lotions
Aluminum acetate solution (Burow's solution)
Calamine lotion (Caladryl lotion)
RUBS AND LINIMENTS
• RUBS AND LINIMENTS (Box 41-3)
• A.Used for the temporary relief of muscular aches,
rheumatism, arthritis, sprains, and neuralgia
• B.Over-the-counter (OTC) products contain
combinations of antiseptics, local anesthetics,
analgesics, and counterirritants
• C.Some products contain salicylates and, if used over a
large area of the skin, may cause salicylate side effects
such as tinnitus, nausea, or vomiting
• D.A heating pad is not used with these products,
because irritation or burning of the skin may occur
• ANTI-INFECTIVE AGENTS
• A.Description
– 1.Includes antiseptics and antibacterial, antifungal, antiviral, and
antiparasitic medications
– 2.Topical antibiotics are safe and effective in certain conditions;
extensive use may encourage the emergence of resistant bacteria
• B.Antiseptics
– 1.Sodium hypochlorite (Dakin solution)
• a.A chloride solution that loosens, dissolves, and deodorizes necrotic tissue
and blood clots
• b.It kills most common bacteria, including spores, amebas, fungi, protozoa
viruses, and yeast
• c.It is used for irrigating and cleaning necrotic or purulent wounds
• d.Loses its potency during storage, so fresh solution is prepared frequently
• e.It should not be in contact with healing or normal tissue
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BOX 41-3 Rubs and Liniments
Aspercreme
Ben-Gay
Icy Hot
Myoflex
– 2.Chlorhexidine gluconate (Hibiclens)
• a.Effective for cleaning wounds caused by staphylococci
and other gram-positive bacteria
• b.Used for irrigating and cleansing wounds, but not for
packing wounds because it may cause contact
dermatitis
– 3.Acetic acid
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• a.Effective for irrigating, cleansing, and packing wounds
infected by Pseudomonas aeruginosa
• b.Healthy skin surrounding the wound must be protected
with a petroleum barrier because it excoriates the skin
– 4.Hydrogen peroxide
• a.As a 3% solution, it has effervescent action that
releases gas and breaks up necrotic tissue
• b.It is used to irrigate and clean necrotic tissue and pus
from open wounds
• c.It is not used to pack wounds because it decomposes
too rapidly
• d.When epithelial tissue begins to form, hydrogen
peroxide is discontinued because it inhibits tissue
formation
– 5.Hexachlorophene (pHisoHex, Septisol)
• a.A combination of hexachlorophene and alcohol
• b.Hexachlorophene is a bacteriostatic agent with activity
against staphylococci and other gram-positive bacteria
• c.Hexachlorophene is heavily absorbed through broken skin
and can cause neurotoxicity; it should not be used on
wounds
• d.The alcohol component dries and irritates tissue, is not a
very effective germicide, and forms a film that can actually
promote infection
• e.All hexachlorophene products are well rinsed from the skin
after their use to prevent systemic absorption
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C.Antibacterials (Box 41-4)
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– 1.Description: Used for superficial skin infections
– 2.Mupirocin (Bactroban)
• a.Topical antibacterial active against Staphylococcus aureus, betahemolytic streptococci, or Streptococcus pyogenes
• b.Applied three times daily; if improvement is not observed within
3 to 5 days, it is discontinued
• D.Antifungals
– 1.May cause erythema, stinging, blistering,
peeling, pruritus, urticaria, and general skin
irritation
– 2.Client is re-evaluated if no results are obtained
after 4 weeks of treatment
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E.Antiviral: Acyclovir (Zovirax)
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CHAPTER 41 Integumentary Medications (page 6 of 33 — printed
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– 1.Inhibits DNA replication in the virus
– 2.Used for herpes simplex virus types 1 and 2, varicella-zoster virus,
Epstein-Barr virus, and cytomegalovirus
– 3.Can cause mild pain and transient burning and stinging.
– 4.Applied completely over the lesion every 3 hours six times daily for 1
week
– 5.Rubber gloves are used to apply the ointment to prevent the spread
of infection
• F.Antiparasitics
– 1.Used to treat scabies (mites) and pediculosis
(lice)
– 2.May be harmful during pregnancy and in young
children
– 3.May irritate the skin, eyes, and mucous
membranes
– 4.May cause allergic reactions
– 5.Permethrin 5% (Elimite)
• a.Wash, rinse, and towel dry the hair; apply sufficient
volume to saturate the hair and scalp
• b.Allow to remain on the hair 10 minutes and then
rinse with water
– 6.Lindane (Kwell)
• a.Applied in a thin layer to the entire body below the
head; no more than 30 g (1 oz) should be used
• b.The medication is removed by washing 8 to 12 hours
later; usually, only one application is required
• BOX 41-4 Antibacterials, Antifungals, Antiviral, and
Antiparasitics
• ANTIBACTERIALS
• Bacitracin
• Chlortetracycline
• Chloramphenicol
• Erythromycin
• Gentamicin
• Mupirocin (Bactroban)
• Mycitracin Triple Antibiotic (neomycin, bacitracin,
polymyxin B)
• Neomycin
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ANTIFUNGALs
Amphotericin B (Fungizone)
Betamethasone and clotrimazole (Lotrisone)
Ciclopirox olamine (Loprox)
Clioquinol (Vioform)
Clotrimazole (Lotrimin, Mycelex)
Econazole nitrate (Spectazole)
Haloprogin (Halotex)
Ketoconazole (Nizoral)
Miconazole (Micatin)
Nystatin (Mycostatin)
Tolnaftate (Tinactin)
Triacetin (Fungoid)
Undecylenic acid (Desenex)
• ANTIVIRAL
• Acyclovir (Zovirax)
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ANTIPARASITICS
Crotamiton (Eurax)
Lindane (Kwell)
Permethrin 5% (Elimite)
Malathion (Ovide)
• . ANTIPRURITICS (Box 41-5)
• A.Used to relieve itching
• B.Applied as wet dressings, pastes, lotions,
creams, or ointments
• C.Persons with dry skin should be instructed
to bathe less frequently
• . KERATOLYTICS (Box 41-6)
• A.Description
– 1.Preparations that dissolve keratin
– 2.Soften scales and loosen the horny layer of the
skin, resulting in minimal peeling or extensive
desquamation
– 3.Used to treat superficial fungal infections,
dermatitis, psoriasis, and localized dermatitis
• VB.Salicylic acid
– 1.Used to treat seborrheic dermatitis, acne,
psoriasis, and to thin and remove calluses
– 2.Can be absorbed systematically and can cause
salicylism, characterized by dizziness and tinnitus;
is not applied to large surface areas or open
wounds
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C.Podophyllum resin
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CHAPTER 41 Integumentary Medications (page 9 of 33
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– 1.Used for various types of skin cancer
– 2.Causes lesions to slough off, leaving a superficial ulcer
and moderate dermatitis
– 3.After the therapy is discontinued, the lesions are treated
with a mild antiseptic ointment; healing usually occurs
within a few days
• D.Cantharidin (Cantharone)
– 1.Used in treating warts
– 2.Has an exfoliation effect only on epidermal cells
– 3.May cause tingling, itching, and burning
– 4.Site may be very tender for a period of 2 to 6
days
• E.Masoprocol (Actinex)
– 1.Has antiproliferative activity against
keratinocytes and is used to treat keratosis
– 2.Occlusive dressings are not to be used
– 3.Transient burning may be experienced after
administration
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BOX 41-5 Antipruritics
Calamine lotion
Cornstarch or oatmeal baths
Solutions of bismuth salts, aluminum acetate, or boric acid
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CHAPTER 41 Integumentary Medications (page 10 of 33 — printed page 494)
BOX 41-6 Keratolytics
Cantharidin (Cantharone)
Imiquimod (Aldara)
Masoprocol (Actinex)
Podophyllum resin
Podofilox (Condylox)
Resorcinol
Salicylic acid
BOX 41-7 Stimulants and Irritants
Coal tar
Compound benzoin tincture
• . STIMULANTS AND IRRITANTS (Box 41-7)
• A.Description: Produce a mild irritation to the
surface of the skin, causing hyperemia and
inflammation that promote the healing
process
• VIB.Coal tar
– 1.Used in treating psoriasis, seborrheic dermatitis,
and atopic dermatitis
– 2.Has an unpleasant odor and frequently stains
the skin and hair
– 3.Can cause phototoxicity
• C.Compound benzoin tincture
– 1.Protects the skin when the client has bed sores,
ulcers, cracked nipples, and fissures of any orifice
– 2.Causes a mild irritation that produces increased
blood flow and healing
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• . PROTECTIVES (Box 41-8)
• A.Description
– 1.Preparations that provide a film on the skin to protect it from
irritations such as light, moisture, air, and dust
– 2.Promote natural healing without the usual formation of dry
crust over the wound
– 3.Allow exudate to collect beneath the dressing, forming an
artificial blister
– 4.Designed to be left in place for up to 7 days or until leakage
occurs around the dressing
– 5.Uniflex and PolySkin may be used to cover central and
peripheral IV sites
– 6.Opsite, Tegasorb, Mediskin, and Vigilon may be used for skin
burns
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BOX 41-8 Protectives
Benzoin
DuoDerm
Mediskin
Opsite
Polyskin
Tegaderm
Tegasorb
Uniflex
Vigilon
Zinc oxide paste (Unna Boot)
• B.Sunscreens
– 1.Act by absorbing ultraviolet rays
– 2.Most effective when applied about 30 to 60
minutes before exposure to the sun; should be
reapplied every 2 to 3 hours after swimming or
sweating
– 3.Can cause contact dermatitis and
photosensitivity reactions
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C.Nonadherent dressings
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CHAPTER 41 Integumentary Medications (page 13
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– 1.Woven or nonwoven dressings that may be
impregnated with saline, petrolatum, or
antimicrobials
– 2.Nonadherent dressings include Adaptic, Exu-Dry,
Sofsorb, Telfa, vaseline gauze, and Xeroform
• GROWTH FACTORS
• A.Description
– 1.Used to promote wound healing
– 2.Stimulate cells to divide and migrate, which
results in wound healing, formation of granulation
tissue, and new epidermis
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. B.Procuren solution
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– 1.Promotes healing by actively stimulating growth and
granulation tissue, capillaries, and epithelium
– 2.Applied to the wound and covered with petrolatumimpregnated gauze
– 3.Left in place for 12 hours and then washed off; during the
remaining 12 hours of the day, the wound is covered with
sulfadiazine (Silvadene)
• ENZYMES
• A.Description
– 1.Used to promote healing of wounds and to debride skin
ulcers
– 2.Reduce inflammation resulting from trauma and
infection
– 3.Dissolve fibrin clots, which helps reduce the size of
surface hematomas
– 4.To be effective, must be in contact with affected tissue in
adequate concentrations for a sufficient length of time
– 5.Wound may need to be surgically debrided prior to
application; if not administered to a clean, debrided
wound, healing may be delayed
• BOX 41-9 Enzymes That Promote Wound
Healing
• Hyaluronidase (Wydase)
• Papain (Panafil, Panafil White)
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B.Enzymes that promote wound healing (Box 41-9)
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CHAPTER 41 Integumentary Medications (page 15 of 33 — printed page
495)
– 1.Papain (Panafil, Panafil White)
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a.Does not injure or affect healthy tissue or cells
b.Enzyme must be in immediate contact with the purulent wound material
c.Wounds are cleansed with prescribed irrigating solution between applications
d.Hydrogen peroxide cannot be used to irrigate the wound, because it inactivates the
papain
• e.Light dressings and cellophane wrap may be used over the wound to prevent soiling of
clothing
• f.Dressings are changed frequently to prevent contamination and to remove necrotic
debris
– 2.Hyaluronidase (Wydase)
• a.Facilitates the absorption of fluid administered by
subcutaneous hypodermoclysis
• b.Can be injected subcutaneous into an infiltrated IV
site when a potent vasoconstrictor such as
norepinephrine (Levophed) or metaraminol (Aramine)
has infiltrated
• c.It reduces the sloughing of tissue likely to occur
secondarily to infiltration
– C.Enzymes to debride and remove exudates (Box
41-10)
• 1.Description
– a.Alter the thick, purulent drainage to a thin, liquid material
that can be easily wiped or irrigated off the wound
– b.Enzyme contact with the wound is necessary to promote
wound healing
– c.Wound needs to be cleansed; cross-hatching of eschar on
burns is performed prior to application
• 2.Sutilains (Travase)
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• CHAPTER 41 Integumentary Medications
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– a.Used to remove nonviable or necrotic tissue and purulent
enzymes from burns, ulcers, traumatic injury, and peripheral
vascular disease wounds
• BOX 41-10 Enzymes to Debride and Remove
Exudates
• Collagenase (Santyl)
• Dextranomer (Debrisan)
• Fibrinolysin and desoxyribonuclease (Elase)
• Sutilains (Travase)
– b.Inactive on viable tissue
– c.The wound is moistened with normal saline or sterile water
before application
• 3.Collagenase (Santyl)
– a.Used as a topical debriding agent
– b.Provides effective debridement of the collagen tissue at the
wound edges where necrotic tissue is anchored
– c.Encourages the formation of granulation tissue at the wound
edges and quicker epithelization of wounds
– d.Apply with a tongue depressor directly into deep wounds
– e.Prior to application, cleanse wound of debris by gently rubbing
with a gauze pad with sterile water or Dakin solution, followed by
sterile normal saline
– f.Remove all excess ointment each time dressing is changed
– g.Apply only to injured area; causes erythema in healthy tissues
– h.Protect healthy tissue by applying zinc oxide paste
– i.Discontinued when necrotic tissue is gone
• 4.Fibrinolysin and desoxyribonuclease (Elase)
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• CHAPTER 41 Integumentary Medications (page 17
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– a.Used to debride wounds, including burns, decubitus ulcers, and
inflamed or infected lesions
– b.Clean wound with sterile water, pat dry; flush away necrotic
debris with normal saline, then apply a thin layer and cover with
petrolatum gauze
– D.Dextranomer (Debrisan)
• 1.Not a debriding agent but a cleansing agent that
actually absorbs peptides and proteins
• 2.Effective in wet wounds only
• 3.It is not packed tightly into the wound because
maceration of surrounding tissue may occur from
contact with the agent
• . CORTICOSTEROIDS
• A.Have anti-inflammatory, antipruritic, and
vasoconstrictive actions
• B.Contraindications
– 1.Clients demonstrating previous sensitivity to
corticosteroids
– 2.Those with current systemic fungal, viral, or bacterial
infections
– 3.Those with current complications related to
corticosteroid therapy
• XC.Local adverse effects
– 1.Hypopigmentation
– 2.Acneform eruptions
– 3.Contact dermatitis
– 4.Burning, dryness, irritation, itching
– 5.Overgrowth of bacteria, fungi, and viruses
– 6.Skin atrophy
• D.Systemic adverse effects
– 1.Occur rarely
– 2.Adrenal suppression
– 3.Cushing's syndrome
– 4.Striae, skin atrophy
– 5.Ocular effects (glaucoma and cataracts)
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E.Topical steroids
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– 1.Monitor plasma cortisol levels if prolonged therapy is necessary
– 2.Wash area just prior to application to increase medication
penetration
– 3.Apply sparingly in a light film, rubbing gently
– 4.May apply to skin alone or with a dry occlusive dressing if prescribed
by the physician
– 5.Instruct the client to report burning, irritation, or signs of infection
to the physician
• ACNE PRODUCTS (Box 41-11)
• A.Description
– 1.Mild acne can be treated with bar soaps, soap-free cakes,
liquid cleansers, lotions, gels, and creams
– 2.For moderate acne, topical anti-inflammatory medication such
as benzoyl peroxide, tretinoin (Retin-A), isotretinoin (Accutane),
azelaic acid (Azelex), and adapalene (Differin) may be
prescribed; antibiotics may also be prescribed
– 3.Side effects can include excessive redness, extreme dryness of
the skin leading to blistering and crusting, temporary
pigmentation changes, and peeling of the skin
– 4.All products are kept away from the eyes, inside the nose,
mucous membranes, and hair
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. B.Benzoyl peroxide: A keratolytic agent that is bacteriostatic and may decrease the production of
irritant free fatty acids in the follicle
C.Tretinoin (Retin-A) and adapalene (Differin): Acids of vitamin A that are used to treat acne
vulgaris; may also be used to treat skin cancer and aging of the skin
D.Tretinoin (Retin-A)
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CHAPTER 41 Integumentary Medications (page 20 of 33 — printed page 497)
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1.Decreases cohesiveness of the epithelial cells, increasing cell mitosis and turnover; potentially irritating,
particularly when used correctly
2.Within 48 hours of use, the skin generally becomes red and begins to peel
3.Temporary hyperpigmentation and hypopigmentation can occur
4.Client should avoid sun exposure because photosensitivity may occur
5.Applied liberally to the skin; hands are washed thoroughly immediately after applying
6.Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks
7.Client may use cosmetics, but the skin needs to be cleaned thoroughly before applying the cosmetics
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BOX 41-11 Acne Products
CLEANSERS
Acnomel
Brevoxyl
Clearasil
Fostex
pHisoDerm
Stri-Dex
DRYING AGENTS
Acnomel
Ionax
Listerex
MISCELLANEOUS
Adapalene (Differin)
Alpha hydroxy acids
Antibiotics
Azelaic acid (Azelex)
Bensulfoid cream (benzoyl peroxide and sulfur)
Benzamycin gel (benzoyl peroxide and sulfur)
Benzoyl peroxide wash, gel
Isotretinoin (Accutane)
Rosorcinol (as an ingredient in other preparations)
Salicylic acid (as an ingredient in other preparations)
Tazarotene (Tazorac)
Tretinoin (Retin-A)
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– 1.A metabolite of vitamin A
– 2.Used to treat severe cystic acne; its use is reserved for persons who have not responded to
other therapies, including systemic antibiotics
– 3.Can cause xerosis and facial desquamation, palmoplantar desquamation, pruritus, brittle
nails, and hair loss
– 4.Administered with meals two times daily for a 15- to 20-week course; if another course of
therapy is needed, an 8-week interval should occur
– 5.Photosensitivity may occur, so the client needs to be instructed to decrease sun exposure
– 6.Alcohol consumption should be eliminated during therapy because alcohol may potentiate
serum triglyceride elevation
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BOX 41-12 Poison Ivy Treatment Products
Calamine lotion
Calomox
IV-Chex
Ivy-Rid
Rhuli cream, spray, gel
• F.Local antibiotics
– 1.Used to treat acne; include clindamycin (Cleocin
T), erythromycin, tetracycline (Topicycline), and
meclocycline (Meclan)
– 2.Therapeutic response generally requires 6 to 12
weeks of therapy
– 3.Side effects include acute contact dermatitis,
transient stinging or burning, staining of the skin,
erythema, and skin tenderness
• BURN PRODUCTS(Box 41-13)
• A.Nitrofurazone (Furacin)
– 1.Applied topically to the burn as a solution,
ointment, or cream
– 2.Has a broad spectrum of antibacterial activity
– 3.Used in burns when bacterial resistance to other
agents is a problem
– 4.Topical: Apply 1/16-inch film directly to burn
– 5.Side effects: Contact dermatitis, rash
– 6.Less common side effects: Pruritus, local edema
• . B.Mafenide (Sulfamylon)
– 1.A water-soluble cream that is bacteriostatic for both gram-negative
and gram-positive organisms
– 2.Is used to treat burns to reduce the bacteria present in avascular
tissues
– 3.Diffuses through the devascularized areas of the skin; may
precipitate metabolic acidosis (usually compensated by
hyperventilation)
– 4.Apply 1/16-inch film directly to the burn
– 5.Side effects can include local pain, rash
– 6.Systemic effects include bone marrow depression, hemolytic
anemia, metabolic acidosis
– 7.Keep burn covered with mafenide at all times
– 8.Notify physician if hyperventilation occurs; if acidosis develops,
mafenide is washed off the skin
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– 1.Has a broad spectrum of activity against gram-negative
bacteria, gram-positive bacteria, and yeast
– 2.Released slowly from the cream, which is selectively
toxic to bacteria
– 3.Used primarily to prevent sepsis in clients with burns
– 4.Is not a carbonic anhydrase inhibitor and therefore
does not cause acidosis
– 5.Rash and itching occurs from topical application
– 6.Apply 1/16-inch film; keep burn covered at all times
with silver sulfadiazine
– 7.Systemic effects include leukopenia, interstitial
nephritis
– 8.Monitor complete blood cell (CBC) count,
particularly white blood cells (WBCs) frequently; if
leukopenia develops, the medication is discontinued
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BOX 41-13 Burn Products
Mafenide (Sulfamylon)
Nitrofurazone (Furacin)
Silver nitrate
Silver sulfadiazine (Silvadene)
• D.Silver nitrate
– 1.An antiseptic solution active against gram-negative
bacteria
– 2.Dressings are applied to the burn, which are then
kept moist with silver nitrate; this stains anything that
it comes into contact with; this discoloration is not
usually permanent
– 3.Used on extensive burns that may precipitate fluid
and electrolyte imbalances
– 4.Apply to dressing; do not apply to wounds, cuts, or
broken skin
• 1.A camp nurse asks the children preparing to
swim in the lake if they have applied
sunscreen. The nurse tells the children that
sunscreen is most effective when applied:
– 1.One hour before exposure to the sun
– 2.Immediately before exposure to the sun
– 3.15 minutes before exposure to the sun
– 4.Immediately after swimming
• 1.Answer: 1Rationale:: Sunscreens are most effective when applied
about 30 to 60 minutes before exposure to the sun so that they can
penetrate the skin. All sunscreens should be reapplied after
swimming or sweating.Test-Taking Strategy: Use the process of
elimination. Recalling that sunscreens need to penetrate the skin
will assist in eliminating options 2 and 3. From the remaining
options, noting the key words, most effective, will direct you to
option 1. Review protective skin measures if you had difficulty with
this question.Level of Cognitive Ability: ApplicationClient Needs:
Health Promotion and MaintenanceIntegrated Process: Nursing
Process/ImplementationContent Area: PharmacologyReference:
McKenry, L., & Salerno, E. (2003). Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1125.
• 2.The nurse is assigned to care for a client with
a burn injury to the lower legs. Nitrofurazone
(Furacin) is prescribed to be applied to the
sites of injury. The nurse plans to:
– 1.Apply saline-soaked dressings over the
medication
– 2.Apply 1-inch film directly to the burn sites
– 3.Apply 1/16-inch film directly to the burn sites
– 4.Apply 1/2-inch film directly to the burn sites
after cleansing the wounds
• 2.Answer: 3Rationale:: Furacin is applied topically to the burn and
has a broad spectrum of antibiotic activity. It is used in a burn injury
when bacterial resistance to other agents is a real or potential
problem. A film of 1/16 inch is applied directly to the burn. Salinesoaked dressings are not used.Test-Taking Strategy: Use the process
of elimination. Option 1 can be eliminated because infection is a
major concern with the burn client and a wet dressing can more
easily harbor bacteria. Recalling that a very thin film is required will
direct you to option 3 from the remaining options. Review the use
of this medication for burn therapy if you had difficulty with this
question.Level of Cognitive Ability: ApplicationClient Needs:
Physiological IntegrityIntegrated Process: Nursing
Process/PlanningContent Area: PharmacologyReference: McKenry,
L., & Salerno, E. (2003). Mosby's pharmacology in nursing (21st ed.).
St. Louis: Mosby, p. 1135.
• 3.Mafenide (Sulfamylon) is prescribed for the
client with a burn injury. When applying the
medication, the client complains of local
discomfort and burning. The nurse would:
– 1.Discontinue the medication
– 2.Notify the registered nurse immediately
– 3.Apply a thinner film than prescribed to the burn
site
– 4.Inform the client that this is normal
• 3.Answer: 4Rationale:: Mafenide acetate is bacteriostatic for both
gram-negative and gram-positive organisms and is used to treat
burn injuries to reduce bacteria present in avascular tissues. The
client should be informed that the medication will cause local
discomfort and burning.Test-Taking Strategy: Use the process of
elimination. Eliminate options 1 and 3 because it is not within the
scope of nursing practice to alter or discontinue a medication. From
the remaining options, recalling that this is a normal expected
occurrence will direct you to option 4. If you had difficulty with this
question, review this medication.Level of Cognitive Ability:
ApplicationClient Needs: Physiological IntegrityIntegrated Process:
Nursing Process/ImplementationContent Area:
PharmacologyReference: McKenry, L., & Salerno, E. (2003). Mosby's
pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 1135.
• 4.A burn client is receiving treatments of topical mafenide
(Sulfamylon) to the site of injury. The nurse would suspect
that a systemic effect has occurred if which of the following
is noted in the client?
• Top of Form
• Bottom of Form
•
• CHAPTER 41 Integumentary Medications (page 25 of 33 —
printed page 498)
–
–
–
–
1.Local pain at the burn site
2.Local rash at the burn site
3.Hyperventilation
4.Elevated blood pressure
• 4.Answer: 3Rationale:: Mafenide acetate can suppress renal excretion of
acid and cause acidosis, evidenced by hyperventilation. Clients receiving
this treatment should be monitored for acid-base status and, if the
acidosis becomes severe, the medication is discontinued for 1 to 2 days.
Options 1 and 2 describe local rather than systemic effects. An elevated
blood pressure may be expected in the client with pain.Test-Taking
Strategy: Use the process of elimination. Note the key words, systemic
effect. Options 1 and 2 can be eliminated because these are local rather
than systemic effects. From the remaining options, recall that the client in
pain would likely have an elevated blood pressure. This should direct you
to option 3. Review the systemic effects of this medication if you had
difficulty with this question.Level of Cognitive Ability: AnalysisClient
Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data
CollectionContent Area: PharmacologyReference: McKenry, L., & Salerno,
E. (2003). Mosby's pharmacology in nursing (21st ed.). St. Louis: Mosby, p.
1135.
• 5.Sodium hypochlorite (Dakin solution) is prescribed
for a client with a leg wound containing purulent
drainage. The nurse is assisting in developing a plan of
care for the client and includes which of the following
in the plan?
– 1.Apply the solution to the wound and on normal skin
tissue surrounding the wound
– 2.Allow the solution to remain in the wound following
irrigation
– 3.Soak a sterile dressing with solution and pack into the
wound
– 4.Ensure that the solution is freshly prepared before use
• 5.Answer: 4Rationale:: Dakin solution is a chloride solution that is used for
irrigating and cleaning necrotic or purulent wounds. It can be used for
packing necrotic wounds. It 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. Solutions are unstable and must be
prepared fresh for each use.Test-Taking Strategy: Use the process of
elimination. Note the key words, purulent drainage. Eliminate options 2
and 3 first because they are similar. It makes sense to ensure that the
solution is freshly prepared; therefore, select option 4. If you are
unfamiliar with the use of this solution, review this content.Level of
Cognitive Ability: ApplicationClient Needs: Physiological
IntegrityIntegrated Process: Nursing Process/PlanningContent Area:
PharmacologyReferences: Black, J., & Hawks, J. (2005). Medical-surgical
nursing: Clinical management for positive outcomes (7th ed.).
Philadelphia: W.B. Saunders, p. 409.McKenry, L., & Salerno, E. (2003).
Mosby's pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 1202.
• 6.Tretinoin (Retin-A) is prescribed for a client with
acne. The client calls the physician's office and
tells the nurse that the skin has become very red
and is beginning to peel. The nurse responds by
telling the client:
–
–
–
–
1.To come to the clinic immediately
2.To discontinue the medication
3.To notify the physician
4.That this is a normal occurrence with the use of this
medication
• 6.Answer: 4Rationale:: Tretinoin decreases cohesiveness of the
epithelial cells, increasing cell mitosis and turnover. It is potentially
irritating particularly when used correctly. Within 48 hours of use,
the skin generally becomes red and begins to peel.Test-Taking
Strategy: Use the process of elimination. Options 1 and 3 can be
eliminated first because they are similar. Eliminate option 2 next
because it is not within the scope of nursing practice to advise a
client to discontinue a medication. Review the effects of this
medication if you had difficulty with this question.Level of Cognitive
Ability: ApplicationClient Needs: Physiological IntegrityIntegrated
Process: Nursing Process/ImplementationContent Area:
PharmacologyReference: Hodgson, B., & Kizior, R. (2005). Saunders
nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 1072.
• 7.A nurse provides instructions to a client regarding the use of
tretinoin (Retin-A). Which statement by the client indicates the
need for further instructions?
• Top of Form
• Bottom of Form
•
• CHAPTER 41 Integumentary Medications (page 26 of 33 — printed
page 499)
–
–
–
–
1.“I should wash my hands thoroughly after applying the medication.”
2.“Optimal results will be seen after 6 weeks.”
3.“I should apply a very thin layer to my skin.”
4.“I should cleanse my skin thoroughly before applying the
medication.”
• 7.Answer: 3Rationale:: Tretinoin is applied liberally to the skin. The
hands are washed thoroughly immediately after applying.
Therapeutic results should be seen after 2 to 3 weeks but may not
be optimal until after 6 weeks. The skin needs to be cleansed
thoroughly before applying the medication.Test-Taking Strategy:
Use the process of elimination and note the key words, need for
further instructions. These words indicate a false response question
and that you need to select the incorrect client statement.
Eliminate options 1 and 4 first using the principles of asepsis. From
the remaining options, knowledge regarding the use of the
medication will assist in directing you to option 3. Review this
medication if you had difficulty with this question.Level of Cognitive
Ability: ComprehensionClient Needs: Health Promotion and
MaintenanceIntegrated Process: Teaching/LearningContent Area:
PharmacologyReference: Hodgson, B., & Kizior, R. (2005). Saunders
nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 1071.
• 8.Isotretinoin (Accutane) is prescribed for a
client to treat severe cystic acne. The nurse
tells the client that the length of the usual
prescribed course of treatment is:
– 1.1 month
– 2.8 weeks
– 3.15 to 20 weeks
– 4.1 year
• 8.Answer: 3Rationale:: Isotretinoin is administered two
times daily for 15 to 20 weeks. If needed, a second course
may be given, but not until 2 months have elapsed after
completing the first course.Test-Taking Strategy: Knowledge
regarding the use of this medication is required to answer
this question. Remember, isotretinoin is administered two
times daily for 15 to 20 weeks. Review this medication if
you had difficulty with this question.Level of Cognitive
Ability: ApplicationClient Needs: Health Promotion and
MaintenanceIntegrated Process: Nursing
Process/ImplementationContent Area:
PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005. Philadelphia: W.B.
Saunders, p. 596.
• 9.Isotretinoin (Accutane) is prescribed for a
client with severe acne. Before the
administration of this medication, the nurse
would expect that which laboratory test will
be prescribed?
– 1.Complete blood count
– 2.White blood cell count
– 3.Triglyceride level
– 4.Platelet count
• 9.Answer: 3Rationale:: Isotretinoin can elevate triglyceride levels.
Blood triglyceride levels should be measured prior to treatment and
periodically thereafter until the effects of the medication on the
triglycerides have been evaluated.Test-Taking Strategy: Use the
process of elimination. Eliminate options 1 and 2 first because a
complete blood count will also measure the white blood cell count.
From the remaining options, it is necessary to know that the
medication can affect triglyceride levels in the client. Review this
medication if you had difficulty with this question.Level of Cognitive
Ability: AnalysisClient Needs: Physiological IntegrityIntegrated
Process: Nursing Process/PlanningContent Area:
PharmacologyReference: Hodgson, B., & Kizior, R. (2005). Saunders
nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 596.
• 10.A client with severe acne is seen at the physician's office. The
physician prescribes isotretinoin (Accutane). The nurse reviews the
client's health record and would notify the physician if the client is
presently taking which of the following medications?
• Top of Form
• Bottom of Form
•
• CHAPTER 41 Integumentary Medications (page 27 of 33 — printed
page 499)
–
–
–
–
1.Digoxin (Lanoxin)
2.Phenytoin (Dilantin)
3.Vitamin A
4.Furosemide (Lasix)
• 10.Answer: 3Rationale:: Vitamin A, a derivative of isotretinoin, can
produce generalized intensification of isotretinoin toxicity. Because
of the potential for increased toxicity, vitamin A supplements
should be discontinued prior to isotretinoin therapy.Test-Taking
Strategy: Use the process of elimination. Recalling that isotretinoin
is a derivative of vitamin A will easily direct you to the correct
option. If you are unfamiliar with this medication, review the
contraindications associated with its use.Level of Cognitive Ability:
ApplicationClient Needs: Safe, Effective Care EnvironmentIntegrated
Process: Nursing Process/ImplementationContent Area:
PharmacologyReference: Hodgson, B., & Kizior, R. (2005). Saunders
nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 597.
• 11.Fibrinolysin and desoxyribonuclease (Elase) dry
powder is prescribed to treat a skin ulcer. The nurse
assists in developing a plan of care for the client and
includes which intervention in the plan?
– 1.Clean the wound with tap water before applying the
medication
– 2.After applying the medication, cover the wound with a
dry, sterile dressing
– 3.Apply a thick layer of medication, followed by a second
layer
– 4.Apply a thin layer of medication and cover with a
petrolatum gauze
• 11.Answer: 4Rationale:: The wound should be cleansed
with a sterile solution and gently patted dry. A thin layer of
Elase is applied and covered with a petrolatum gauze. If a
dry powder is used, the solution should be prepared just
prior to use.Test-Taking Strategy: Use the process of
elimination. Noting the word “thin” in option 4 should
assist in directing you to this option. Review the method of
application of this medication if you had difficulty with this
question.Level of Cognitive Ability: ApplicationClient Needs:
Physiological IntegrityIntegrated Process: Nursing
Process/PlanningContent Area: PharmacologyReference:
McKenry, L., & Salerno, E. (2003). Mosby's pharmacology in
nursing (21st ed.). St. Louis: Mosby, p. 1146.
• 12.Sutilains (Travase) is prescribed to treat the
ulcer. The nurse avoids which action when
performing the dressing change?
– 1.Cleans the wound with a sterile solution
– 2.Dries the wound and covers the Travase
application with a dry sterile dressing
– 3.Moistens the wound with sterile normal saline
and then applies the Travase
– 4.Places the Travase in the refrigerator following
use
• 12.Answer: 2Rationale:: The wound should be cleansed with a sterile
solution prior to treatment. The nurse then thoroughly moistens the
wound with normal saline or sterile water, applies a thin film of Travase
extending ¼ to ½ inch beyond the area to be debrided, and then applies a
loose thin dressing. The ointment should be refrigerated.Test-Taking
Strategy: Note the key word, avoids, in the stem of the question. This word
indicates a false response question and that you need to select the
incorrect action. Recalling that the wound is moistened prior to applying
the Travase will direct you to the correct option. Review the method of
application of Travase if you had difficulty with this question.Level of
Cognitive Ability: ApplicationClient Needs: Physiological
IntegrityIntegrated Process: Nursing Process/ImplementationContent
Area: PharmacologyReferences: Black, J., & Hawks, J. (2005). Medicalsurgical nursing: Clinical management for positive outcomes (7th ed.).
Philadelphia: W.B. Saunders, pp. 411-412.McKenry, L., & Salerno, E.
(2001). Mosby's pharmacology in nursing (21st ed.). St. Louis: Mosby, p.
1146.
• 13.A nurse employed in a physician's office is collecting data from a
client. The nurse notes that the client is taking azelaic acid (Azelex).
Because of the medication prescription, the nurse suspects that the
client is being treated for:
• Top of Form
• Bottom of Form
•
• CHAPTER 41 Integumentary Medications (page 28 of 33 — printed
page 499)
–
–
–
–
1.Herpes simplex
2.Acne
3.Eczema
4.Hair loss
• 13.Answer: 2Rationale:: Azelaic acid is a topical medication
used to treat mild to moderate acne. It appears to work by
suppressing the growth of Propionibacterium acnes and by
decreasing proliferation of keratinocytes.Test-Taking
Strategy: Knowledge regarding the use of azelaic acid is
required to answer this question. Remember, Azelaic acid is
a topical medication used to treat mild to moderate acne.
Review this medication if you had difficulty with this
question.Level of Cognitive Ability: AnalysisClient Needs:
Physiological IntegrityIntegrated Process: Nursing
Process/Data CollectionContent Area:
PharmacologyReference: Lehne, R. (2004). Pharmacology
for nursing care (5th ed.). Philadelphia: W.B. Saunders, p.
1113.
• 14.Collagenase (Santyl) is prescribed for a client with a
severe burn to the hand. The nurse provides
instructions to the client regarding the use of the
medication. Which statement by the client indicates an
accurate understanding of the use of this medication?
– 1.“I will apply the ointment once a day and leave it open to
the air.”
– 2.“I will apply the ointment once a day and cover it with a
sterile dressing.”
– 3.“I will apply the ointment twice a day and leave it open
to the air.”
– 4.“I will apply the ointment at bedtime and in the morning
and cover it with a sterile dressing.”
• 14.Answer: 2Rationale:: Collagenase is used to promote
debridement of dermal lesions and severe burns. It is
applied once daily and covered with a sterile dressing.TestTaking Strategy: Note the key words, indicates an accurate
understanding. Knowledge regarding the use of this
medication will direct you to option 2. Review this
medication if you had difficulty with this question.Level of
Cognitive Ability: AnalysisClient Needs: Health Promotion
and MaintenanceIntegrated Process:
Teaching/LearningContent Area: PharmacologyReference:
McKenry, L., & Salerno, E. (2003). Mosby's pharmacology in
nursing (21st ed.). St. Louis: Mosby, p. 1145.
• 15.Dextranomer (Debrisan) is prescribed for a
client with a decubiti ulcer. The nursing instructor
asks the nursing student preparing to perform
the treatment about the medication and the
procedure. Which statement, if made by the
student, indicates a need for further research?
– 1.“It is effective in wet wounds only.”
– 2.“It should be packed lightly into the wound.”
– 3.“Maceration of tissue surrounding the wound can
occur from the medication.”
– 4.“The wound bed must be thoroughly dried prior to
applying the medication.”
• 15.Answer: 4Rationale:: Debrisan is a cleansing rather than a debriding
agent. It is effective in wet wounds only. It is not packed tightly into the
wound because maceration of surrounding tissue may result.Test-Taking
Strategy: Use the process of elimination. Note the key words, indicates a
need for further research. These words indicate a false response question
and that you need to select the incorrect statement. Noting that option 1
indicates that the wound should be wet and option 4 indicates that the
wound should be dry provides the clue that one of these options is
correct. If you are unfamiliar with the use of Debrisan, review the
procedure associated with its use.Level of Cognitive Ability: AnalysisClient
Needs: Physiological IntegrityIntegrated Process:
Teaching/LearningContent Area: PharmacologyReferences: Black, J., &
Hawks, J. (2005). Medical-surgical nursing: Clinical management for
positive outcomes (7th ed.). Philadelphia: W.B. Saunders, pp. 411412.McKenry, L., & Salerno, E. (2001). Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1147.
• 16.Coal tar has been prescribed for a client with a diagnosis
of psoriasis, and the nurse provides instructions to the
client about the medication. Which statement by the client
indicates a need for further instructions?
• Top of Form
• Bottom of Form
•
• CHAPTER 41 Integumentary Medications (page 29 of 33 —
printed page 499)
–
–
–
–
1.“The medication has an unpleasant odor.”
2.“The medication can stain the skin and hair.”
3.“The medication can cause systemic effects.”
4.“The medication can cause phototoxicity.”
• 16.Answer: 3Rationale:: Coal tar is used to treat psoriasis and other
chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity,
and cell proliferation. It has an unpleasant odor, can frequently stain the
skin and hair, and can cause phototoxicity. Systemic toxicity does not
occur.Test-Taking Strategy: Use the process of elimination and note the key
words, need for further instructions. These words indicate a false response
question and that you need to select the incorrect client statement. The
name of the medication will assist in eliminating options 1 and 2. From the
remaining options, it is necessary to know that the medication does not
cause systemic effects. Review this treatment if you had difficulty with this
question.Level of Cognitive Ability: AnalysisClient Needs: Physiological
IntegrityIntegrated Process: Teaching/LearningContent Area:
PharmacologyReferences: Black, J., & Hawks, J. (2005). Medical-surgical
nursing: Clinical management for positive outcomes. (7th ed.).
Philadelphia: W.B. Saunders, p. 1393.Lehne, R. (2004). Pharmacology for
nursing care (5th ed.). Philadelphia: W.B. Saunders, p. 1116.
• 17.A client is diagnosed with herpes simplex.
The physician tells the nurse that a topical
medication for treatment will be prescribed.
The nurse expects that which of the following
medications will be prescribed?
– 1.Triple antibiotic
– 2.Acyclovir (Zovirax)
– 3.Mupirocin (Bactroban)
– 4.Masoprocol (Actinex)
• 17.Answer: 2Rationale:: Acyclovir is a topical antiviral agent that
inhibits DNA replication in the virus. It has activity against herpes
simplex virus types 1 and 2, varicella-zoster virus, Epstein-Barr virus,
and cytomegalovirus. Triple antibiotic would not be effective in
treating herpesvirus. Mupirocin is a topical antibacterial active
against impetigo caused by staphylococcus or streptococcus.
Masoprocol is a keratolytic.Test-Taking Strategy: Use the process of
elimination. Recalling that herpes simplex is a virus will direct you
to the option that identifies an antiviral medication. Review this
medication if you had difficulty with this question.Level of Cognitive
Ability: AnalysisClient Needs: Physiological IntegrityIntegrated
Process: Nursing Process/PlanningContent Area:
PharmacologyReference: Hodgson, B., & Kizior, R. (2005). Saunders
nursing drug handbook 2005. Philadelphia: W. B. Saunders, p. 12.
• 18.Salicylic acid is prescribed for a client with
a diagnosis of psoriasis. The nurse suspects
the presence of systemic toxicity from this
medication if which of the following occurs in
the client?
– 1.Decreased respirations
– 2.Diarrhea
– 3.Constipation
– 4.Tinnitus
• 18.Answer: 4Rationale:: Salicylic acid is readily absorbed through
the skin and systemic toxicity (salicylism) can result. Symptoms
include tinnitus, hyperpnea, dizziness, and psychological
disturbances. Constipation and diarrhea are not associated with
salicylism.Test-Taking Strategy: Use the process of elimination.
Noting the name of the medication will assist in directing you to the
correct option if you can recall the toxic effects that occur with
acetyl salicylic acid (aspirin). If you are unfamiliar with the toxic
effects of salicylic acid, review this content.Level of Cognitive
Ability: AnalysisClient Needs: Physiological IntegrityIntegrated
Process: Nursing Process/Data CollectionContent Area:
PharmacologyReference: Lehne, R. (2004).Pharmacology for
nursing care (5th ed.). Philadelphia: W.B. Saunders, p. 1108.
• 19.A hospitalized client with severe seborrheic dermatitis is
receiving treatments of topical glucocorticoid applications followed
by the application of an occlusive dressing. The nurse monitors for
which systemic effect that can occur from this treatment?
• Top of Form
• Bottom of Form
•
• CHAPTER 41 Integumentary Medications (page 30 of 33 — printed
page 500)
–
–
–
–
1.Adrenal suppression
2.Adrenal hyperactivity
3.Local infection
4.Thinning of the skin
• 19.Answer: 1Rationale:: Topical glucocorticoids can be absorbed in
sufficient amounts to produce systemic toxicity. Principal concerns
are growth retardation (in children), and adrenal suppression in all
age groups. Options 3 and 4 identify local rather than systemic
reactions.Test-Taking Strategy: Use the process of elimination.
Options 3 and 4 can be eliminated first because they are local
reactions. From the remaining options, recalling the concerns
related to systemic toxicity is required to answer the question.
Review these systemic effects if you had difficulty with this
question.Level of Cognitive Ability: ApplicationClient Needs:
Physiological IntegrityIntegrated Process: Nursing Process/Data
CollectionContent Area: PharmacologyReferences: Lehne, R. (2004).
Pharmacology for nursing care (5th ed.). Philadelphia: W.B.
Saunders, p. 1108.McKenry, L., & Salerno, E. (2003). Mosby's
pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 852.
• 20.A nurse is applying a topical glucocorticoid
to a client with eczema. The nurse monitors
for systemic absorption of the medication if
the medication is being applied to which of
the following body areas?
– 1.Back
– 2.Axilla
– 3.Palms of the hands
– 4.Soles of the feet
• 20.Answer: 2Rationale:: Topical glucocorticoids 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
penetrability is poor (back, palms, soles).Test-Taking Strategy: Focus
on the issue of the question, “systemic absorption.” Eliminate
options 3 and 4 because these body areas are similar in terms of
skin characteristics. From the remaining options, think about
permeability of the skin area. This will direct you to option 2.
Review this medication if you had difficulty with this question.Level
of Cognitive Ability: ApplicationClient Needs: Physiological
IntegrityIntegrated Process: Nursing Process/Data
CollectionContent Area: PharmacologyReference: Lehne, R. (2004).
Pharmacology for nursing care (5th ed.). Philadelphia: W.B.
Saunders, p. 1108.
• 21.A topical glucocorticoid is prescribed for a
client with dermatitis. The nurse provides
instructions to the client regarding the use of the
medication. Which of the following, if stated 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.“I should place a bandage over the site after
applying the medication.”
– 4.“The medication will help to relieve the
inflammation and itching.”
• 21.Answer: 3Rationale:: Clients should be advised not to use
occlusive dressings (bandages or plastic wraps) to cover the
affected site following the application of the topical glucocorticoid,
unless the physician specifically prescribes wound coverage.
Options 1, 2, and 4 are accurate statements related to the use of
this medication.Test-Taking Strategy: Use the process of elimination
and note the key words, need for further instruction. Eliminate
option 4 knowing that this is the action for glucocorticoids. The
words “thin” in option 1 and “gently” in option 2 should assist you
in eliminating these options. If you had difficulty with this question,
review this medication.Level of Cognitive Ability: AnalysisClient
Needs: Health Promotion and MaintenanceIntegrated Process:
Teaching/LearningContent Area: PharmacologyReference: Lehne, R.
(2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B.
Saunders, p. 1108.
• 22.Lindane (Kwell) is prescribed for the treatment of
scabies. The nurse would question the order if the
medication were prescribed for which of the following
clients?
• Top of Form
• Bottom of Form
•
• CHAPTER 41 Integumentary Medications (page 31 of 33 —
printed page 500)
–
–
–
–
1.A 42-year-old female
2.An older client
3.A 6-year-old child
4.A 52-year-old male with hypertension
• 22.Answer: 3Rationale:: Lindane can penetrate the intact skin and
can cause convulsions if absorbed in sufficient quantities. Clients at
highest risk for convulsions are premature infants, children, and
clients with preexisting seizure disorders. Lindane should not be
used on pediatric clients unless safer medications have failed to
control the infection.Test-Taking Strategy: Knowledge regarding the
contraindications associated with the use of lindane is required to
answer this question. Remember, lindane should not be used on
pediatric clients unless safer medications have failed to control the
infection. If you are unfamiliar with these contraindications, review
this content.Level of Cognitive Ability: AnalysisClient Needs: Safe,
Effective Care EnvironmentIntegrated Process: Nursing
Process/ImplementationContent Area: PharmacologyReference:
McKenry, L., & Salerno, E. (2003). Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1137.
• 23.A client is seen in the clinic for complaints of skin
itchiness that has been persistent over the past several
weeks. Following data collection, it has been
determined that the client has scabies. Lindane (Kwell)
is prescribed and the nurse is asked to provide
instructions to the client regarding the use of the
medication. The nurse tells the client to:
– 1.Leave the cream on for 8 to 12 hours and then remove
by washing
– 2.Apply a thick layer of cream to the entire body
– 3.Apply the cream as prescribed for 2 days in a row
– 4.Apply to the entire body and scalp, excluding the face
• 23.Answer: 1Rationale:: Lindane is applied in a thin layer to the
entire body below the head. No more than 30 g (1 oz) should be
used. The medication is removed by washing 8 to 12 hours later.
Usually, only one application is required.Test-Taking Strategy:
Knowledge regarding the use of lindane is required to answer this
question. Remember, the medication is removed by washing 8 to 12
hours after application. If you are unfamiliar with the use of this
medication, review this procedure.Level of Cognitive Ability:
ApplicationClient Needs: Health Promotion and
MaintenanceIntegrated Process: Nursing
Process/ImplementationContent Area: PharmacologyReference:
McKenry, L., & Salerno, E. (2003). Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1136.
• 24.An outbreak of pediculosis capitus has
occurred at the local school. The nurse is helping
provide instructions to the mothers of the
children attending the school regarding the
application of permethrin 5% (Elimite). The nurse
tells the mothers to:
–
–
–
–
1.Apply at bedtime and rinse off in the morning
2.Apply prior to washing the hair
3.Avoid saturating the hair and scalp when applying
4.Allow to remain on the hair 10 minutes and then
rinse with water
• 24.Answer: 4Rationale:: The instructions for the use of permethrin
include wash, rinse, and towel-dry the hair; apply sufficient volume
to saturate the hair and scalp; allow to remain on the hair 10
minutes and then rinse with water. Options 1, 2, and 3 are incorrect
instructions.Test-Taking Strategy: Note that both options 1 and 4
address a time frame for allowing the medication to remain on the
hair. Recognizing this may provide you with the clue that one of
these options is correct. From this point, it is necessary to know the
procedure for this treatment. If you are unfamiliar with this
treatment, review this content.Level of Cognitive Ability:
ApplicationClient Needs: Health Promotion and
MaintenanceIntegrated Process: Nursing
Process/ImplementationContent Area: PharmacologyReference:
Lehne, R. (2004). Pharmacology for nursing care (5th ed.).
Philadelphia: W.B. Saunders, p. 1055.
• 25.The physician has prescribed Myoflex topical cream for a
client with a diagnosis of rheumatism who is complaining of
muscular aches. Which of the following information does
the nurse provide to the client regarding this medication?
• Top of Form
• Bottom of Form
•
• CHAPTER 41 Integumentary Medications (page 32 of 33 —
printed page 500)
–
–
–
–
1.Apply a heating pad to the area after applying the medication
2.The medication acts by decreasing muscle spasms
3.The medication is prescribed to cause the skin to peel
4.The medication will act as a local anesthetic
• 25.Answer: 4Rationale:: Myoflex is one of the many products used for the
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. These
medications do not act in a systemic manner (option 2). They are not
prescribed to cause the skin to peel and, if this sort of reaction occurs, the
physician should be notified.Test-Taking Strategy: Use the process of
elimination. Noting the key words, topical cream, may assist in eliminating
option 2. Eliminate option 3, knowing that this is not an expected
therapeutic effect. Recalling the principles related to the application of
heat will assist in eliminating option 1. Review this medication if you had
difficulty with this question.Level of Cognitive Ability: ApplicationClient
Needs: Physiological IntegrityIntegrated Process:
Teaching/LearningContent Area: PharmacologyReference: Kee, J., & Hayes,
E. (2003). Pharmacology: A nursing process approach (4th ed.).
Philadelphia: W.B. Saunders, pp. 254-255.