Nokea
A patient is admitted to the hospital for possible septicemia. He has a large pressure ulcer on his heel that is open and includes necrotic tissue. However, his prothrombin time/international normalized ratio (PT/INR) values are too high to permit surgical debridement at this time. The nurse expects that which wound-care product will be used to treat the wound?
- A. Cadexomer iodine
- B. Biafine topical emulsion
- C. Povidone-iodine
- D. Collagenase
Correct Answer: D
Rationale: Because this patient has an elevated PT/INR, he cannot receive surgical debridement because of concerns about excessive bleeding. Collagenase is useful for patients taking anticoagulants and for those in whom surgery is contraindicated; it selectively removes necrotic tissue but does not harm normal tissue.
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The nurse is reviewing the medical record of a patient who is to receive wound care with topical silver sulfadiazine. Which finding, if noted, would be a potential contraindication?
- A. The patient has an open wound from a burn on her arm.
- B. The patient is allergic to sulfonamide drugs.
- C. The patient is allergic to shellfish.
- D. The patient's burn wound has been debrided.
Correct Answer: B
Rationale: Patients with allergies to sulfonamide drugs must not receive silver sulfadiazine.
The nurse is reviewing laboratory results for a patient and notes that the patient has positive results for nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA). The nurse anticipates an order for which medication?
- A. Acyclovir
- B. Mupirocin
- C. Clindamycin
- D. Clotrimazole
Correct Answer: B
Rationale: Mupirocin (Bactroban) is used on the skin for treatment of staphylococcal and streptococcal impetigo. It is used topically and intranasally to treat nasal colonization by MRSA; however, MRSA is becoming increasingly resistant to the drug.
Which adverse effects will the nurse expect in a teenage patient who is using topical tretinoin? (Select all that apply.)
- A. Crusted skin
- B. Itching
- C. Altered skin pigmentation
- D. Rosacea
- E. Red and edematous blisters
Correct Answer: A,C,E
Rationale: Some of the most common adverse effects of tretinoin are excessively red and edematous blisters, crusted skin, and temporary alterations in skin pigmentation.
A woman suffered a second-degree burn of the skin on her arm and hand while cooking breakfast. After examination in the urgent care center, silver sulfadiazine cream is ordered for the burned area. The nurse will apply the medication using which procedure?
- A. Gently patting a moderate amount over the burned area
- B. Massaging the cream completely into the wound
- C. Applying a thick layer over the burned area, and then leaving the area open
- D. Applying a thin layer with a sterile, gloved hand to clean and debrided areas
Correct Answer: D
Rationale: Apply a thin layer of medication with a sterile, gloved hand to clean and debrided wounds.
A child is being treated for head lice with spinosad. Which of these statements about treatment with spinosad is true? (Select all that apply.)
- A. You will need a prescription for a second product, malathion.
- B. You will also need to decontaminate clothes and personal items.
- C. Be sure to use a nit comb to remove nits from the hair shafts.
- D. Try combing through the hair with mineral oil to loosen the lice from the hair shafts.
- E. It is not necessary to comb the nits when using spinosad.
Correct Answer: B,E
Rationale: The clothing and personal articles of the infested person must be decontaminated. This is best accomplished by washing them in hot, soapy water or by dry cleaning them. Spinosad offers the benefit of not requiring nit combing as do the other treatments, and is a single treatment drug.