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

• 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

• 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 • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 4 of 33

— printed page 493) • 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

• C.Antibacterials (Box 41-4) • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 5 of 33 —

printed page 493) – 1.Description: Used for superficial skin infections – 2.Mupirocin (Bactroban)

• a.Topical antibacterial active against Staphylococcus aureus, beta-hemolytic 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

• E.Antiviral: Acyclovir (Zovirax) • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 6 of 33 —

printed page 493) – 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

• 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)

• 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

• C.Podophyllum resin • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 9 of 33 —

printed page 494) – 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

• BOX 41-5 Antipruritics• Calamine lotion• Cornstarch or oatmeal baths• Solutions of bismuth salts, aluminum acetate, or boric acid• Top of Form• Bottom of Form• • 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• Top of Form

• . 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

• 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

• C.Nonadherent dressings • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 13

of 33 — printed page 495) – 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

• . B.Procuren solution • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 14 of 33 —

printed page 495) – 1.Promotes healing by actively stimulating growth and granulation

tissue, capillaries, and epithelium – 2.Applied to the wound and covered with petrolatum-impregnated

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)

• B.Enzymes that promote wound healing (Box 41-9) • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 15 of 33 — printed page 495

) – 1.Papain (Panafil, Panafil White)

• 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)

• Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page

16 of 33 — printed page 496) – 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)

• Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 17 of

33 — printed page 496) – 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)

• E.Topical steroids • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 19 of 33 —

printed page 496) – 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

• . 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) • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 20 of 33 — printed page 497)

– 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

• 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)

• E.Isotretinoin (Accutane) • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 21 of 33 — printed page 497)

– 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

• 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

• XIIIC.Silver sulfadiazine (Silvadene) • Top of Form• Bottom of Form• • CHAPTER 41 Integumentary Medications (page 23 of 33

— printed page 498) – 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

• 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. 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: 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?

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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?

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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). 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. 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:

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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.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: 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. 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?

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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?

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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?

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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?

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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.