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Silvestri Chapter 41 Ed#565

Silvestri Chapter 41 Ed#565

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Published by Linda Kuglarz

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Published by: Linda Kuglarz on Oct 14, 2008
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Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 041 (edited file)—"Integumentary Medications"10/14/08, Page 1 of 13, 0 Figure(s), 0 Table(s ),13 Box(es)
41: Integumentary Medications
PRACTICE QUESTIONS
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 sun2. Immediately before exposure to the sun3. 15 minutes before exposure to the sun4. Immediately after swimmingAnswer: 1Rationale: Sunscreens are most effective when applied about 30 to 60 minutes before exposureto the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimmingor 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, notingthe 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 ½-inch film directly to the burn sites after cleansing the wounds.Answer: 3Rationale: Furacin is applied topically to the burn and has a broad spectrum of antibioticactivity. 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. Saline-soaked dressings are notused.Test-Taking Strategy: Use the process of elimination. Option 1 can be eliminated becauseinfection 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 theremaining options. Review the use of this medication for burn therapy if you had difficulty withthis question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Planning
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 041 (edited file)—"Integumentary Medications"10/14/08, Page 2 of 13, 0 Figure(s), 0 Table(s ),13 Box(es)
Content 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 themedication, the client complains of local discomfort and burning. The nurse would:1. Discontinue the medication.2. Call the physician.3. Apply a thinner film than prescribed to the burn site.4. Inform the client that this is normal.Answer: 4Rationale: Mafenide acetate is bacteriostatic for both gram-negative and gram-positiveorganisms and is used to treat burn injuries to reduce bacteria present in avascular tissues. Theclient 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 notwithin the scope of nursing practice to alter or discontinue a medication. From the remainingoptions, recalling that this is a normal expected occurrence will direct you to option 4. If youhad 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 inthe client?1. Local pain at the burn site2. Local rash at the burn site3. Hyperventilation4. Elevated blood pressureAnswer: 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 statusand, if the acidosis becomes severe, the medication is discontinued for 1 to 2 days. Options 1and 2 describe local rather than systemic effects. An elevated blood pressure may be expected inthe 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 theremaining 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 haddifficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological Integrity
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 041 (edited file)—"Integumentary Medications"10/14/08, Page 3 of 13, 0 Figure(s), 0 Table(s ),13 Box(es)
Integrated 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 includeswhich 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.Answer: 4Rationale: Dakin solution is a chloride solution that is used for irrigating and cleaning necroticor 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 intocontact 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 solutionis 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 officeand tells the nurse that the skin has become very red and is beginning to peel. The nurseresponds by telling the client:1. To come to the clinic immediately2. To discontinue the medication3. To notify the physician4. That this is a normal occurrence with the use of this medicationAnswer: 4Rationale: Tretinoin decreases cohesiveness of the epithelial cells, increasing cell mitosis andturnover. It is potentially irritating particularly when used correctly. Within 48 hours of use, theskin 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 

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