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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 sun 2. Immediately before exposure to the sun 3. 15 minutes before exposure to the sun 4. Immediately after swimming Answer: 1 Rationale: 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: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: 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: 3 Rationale: 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. Saline-soaked 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: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning

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Content Area: Pharmacology Reference: 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. Call the physician. 3. Apply a thinner film than prescribed to the burn site. 4. Inform the client that this is normal. Answer: 4 Rationale: 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: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: 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? 1. Local pain at the burn site 2. Local rash at the burn site 3. Hyperventilation 4. Elevated blood pressure Answer: 3 Rationale: 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: Comprehension Client Needs: Physiological Integrity

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Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: 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. Answer: 4 Rationale: 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: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology References: 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 Answer: 4 Rationale: 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

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you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: 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? 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.” Answer: 3 Rationale: 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: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: 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 Answer: 3 Rationale: 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: Application Client Needs: Health Promotion and Maintenance

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Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: 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 Answer: 3 Rationale: 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: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: 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? 1. Digoxin (Lanoxin) 2. Phenytoin (Dilantin) 3. Vitamin A 4. Furosemide (Lasix) Answer: 3 Rationale: 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: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005.

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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. Answer: 4 Rationale: 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: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: 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 Answer: 2 Rationale: 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: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology References: Black, J., & Hawks, J. (2005). Medical-surgical 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:

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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: 1. Herpes simplex 2. Acne 3. Eczema 4. Hair loss Answer: 2 Rationale: 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: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: 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.” Answer: 2 Rationale: Collagenase is used to promote debridement of dermal lesions and severe burns. It is applied once daily and covered with a sterile dressing. Test-Taking 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: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: 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

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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.” Answer: 4 Rationale: 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: Analysis Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Pharmacology References: Black, J., & Hawks, J. (2005). Medical-surgical 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. 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? 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.” Answer: 3 Rationale: 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: Comprehension Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Pharmacology References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes. (7th ed.). Philadelphia: W.B. Saunders, p. 1393.

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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) Answer: 2 Rationale: 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: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: 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 Answer: 4 Rationale: 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 acetylsalicylic acid (aspirin). If you are unfamiliar with the toxic effects of salicylic acid, review this content. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: Lehne, R. (2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B.

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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? 1. Adrenal suppression 2. Adrenal hyperactivity 3. Local infection 4. Thinning of the skin Answer: 1 Rationale: 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: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology References: 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 Answer: 2 Rationale: 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 substance. 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: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology

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Reference: 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.” Answer: 3 Rationale: 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: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: 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? 1. A 42-year-old female 2. An older client 3. A 6-year-old child 4. A 52-year-old male with hypertension Answer: 3 Rationale: 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: Comprehension Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Pharmacology

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Reference: 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. Answer: 1 Rationale: 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: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: 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. Answer: 4 Rationale: 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: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Lehne, R. (2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B.

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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? 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. Answer: 4 Rationale: 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: Application Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: Kee, J., & Hayes, E. (2003). Pharmacology: A nursing process approach (4th ed.). Philadelphia: W.B. Saunders, pp. 254-255. <AQ>26. A nurse is caring for a client who has an ulcer on the medial aspect of the left ankle that is being treated with DuoDerm. The nurse removes the DuoDerm, cleanses the wound as prescribed, and reapplies the DuoDerm. The nurse documents that the DuoDerm needs to be changed in how many days? Answer: 7 Rationale: Protective dressings such as DuoDerm are designed to be left in place for 7 days unless leakage occurs around the dressing. Test-Taking Strategy: Note the key word, DuoDerm. Recalling that these dressings are designed to be left in place for 7 days will assist in answering this question. Review the purpose and procedure for using protective dressings if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 1147.

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