Nokea
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.
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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 female patient will be starting therapy with oral isotretinoin as part of treatment for severe acne, and the nurse is providing teaching. Which teaching point will the nurse include in her teaching plan about isotretinoin?
- A. You will have to use two contraceptive methods while on this drug.
- B. You must avoid sexual activity while on this drug.
- C. You will have to avoid pregnancy for 2 weeks after taking this drug.
- D. If you are taking an oral contraceptive, you may take this drug.
Correct Answer: A
Rationale: It is now required that at least two contraceptive methods be used by sexually active women during and for 1 month after completion of therapy with isotretinoin.
A teenage boy is taking tretinoin for acne. Which statement will the nurse include in the teaching plan?
- A. Avoid foods that are heavy in salt and oils.
- B. This drug may cause increased redness of your skin.
- C. Try using an abrasive cleanser to remove old skin layers.
- D. Being out in the sunlight will help your skin heal.
Correct Answer: B
Rationale: Tretinoin may cause increased redness and drying, and the patient needs to avoid weather extremes, ultraviolet light, and abrasive cleansers. Certain foods do not need to be avoided.
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.
A 55-year-old obese patient was diagnosed with candidiasis in the skin folds under her breasts. When the nurse sees her at a follow-up visit 2 months later, she complains that it has returned. She said she applied the medicine for 1 week and stopped because the itching stopped and the cream was messy. Which statement is true regarding fungal infections of the skin?
- A. Fungal infections often require prolonged therapy.
- B. The patient has a new infection now.
- C. The patient needs to apply a dressing if the cream is too messy.
- D. This infection will probably never be cured.
Correct Answer: A
Rationale: Topical fungal infections are difficult to treat and may require prolonged therapy of several weeks to as long as 1 year. Occlusive dressings should not be applied unless recommended by the medication's manufacturer.