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Chapter 40: Dermatologic Disorder Drugs

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Chapter 40: Dermatologic Disorder Drugs

12 problems · 0 figures

Case Study 40.4.1 §40.4 source ↗

Read the following clinical scenario to answer the questions that follow.

Within the last year, Melissa Allen, a 27-year old patient, has gotten married, moved to a new city, and begun graduate school. Recently, she has noticed feeling a little more tired than usual and has experienced generalized joint pain.

History
Right ankle fracture
Seasonal sinusitis

Current Medications
Ibuprofen, 400 mg every 4 hours as needed
Yasmin birth control pill (drospirenone 3 mg/ethinyl estradiol 0.03 mg)

Based on Melissa’s subjective and objective assessment data, what diagnosis should the nurse anticipate from the health care provider?
  1. a.
    Acne vulgaris
  2. b.
    Psoriasis
  3. c.
    Impetigo
  4. d.
    Rosacea
Table 40.15 in the book ↗
Vital Signs Physical Examination
Temperature: 97.4°F

• Head, eyes, ears, nose, throat (HEENT): Denies any changes in vision; responds to questions appropriately without requests for repeats

• Neurological: Alert and oriented × 4, pleasant affect; denies numbness, tingling, dizziness, or headache

• Cardiovascular: Regular heart rate and rhythm; denies palpitations; S1, S2 audible; no extra sounds noted; capillary refill +3; mucous membranes pink, moist, and intact

• Respiratory: Lungs clear to auscultation in all fields; denies shortness of breath

• GI: Abdomen soft, nontender, without distention; bowel sounds active in all quadrants; denies nausea, vomiting, diarrhea, or constipation

• GU: Last menstrual period 16 days ago

• Integumentary: Nails with cracking noted; scalp with excessive silvery scaling and reddened areas noted; skin intact to limbs and trunk except for small scaling; red areas noted bilaterally on elbows; client states she has noticed more “itching and dandruff” lately
Blood pressure: 126/64 mm Hg
Heart rate: 88 beats/min
Respiratory rate: 14 breaths/min
Oxygen saturation: 100% on room air
Pain: 3/10
Height: 5'5"
Weight: 144 lb

Answer

B. Psoriasis
Red, scaling skin on the scalp and elbows and joint pain are findings consistent with psoriasis.

Case Study 40.4.2 §40.4 source ↗

Read the following clinical scenario to answer the questions that follow.

Within the last year, Melissa Allen, a 27-year old patient, has gotten married, moved to a new city, and begun graduate school. Recently, she has noticed feeling a little more tired than usual and has experienced generalized joint pain.

History
Right ankle fracture
Seasonal sinusitis

Current Medications
Ibuprofen, 400 mg every 4 hours as needed
Yasmin birth control pill (drospirenone 3 mg/ethinyl estradiol 0.03 mg)

The health care provider prescribes topical coal tar. Which statement by Melissa indicates a need for further teaching from the nurse regarding the use of topical coal tar?
  1. a.
    “I guess this means that I will need to cancel my tanning bed membership.”
  2. b.
    “I should cover the surrounding margins of lesions with a thick coat of medication.”
  3. c.
    “I will wash my skin, apply the medication, and leave it open to the air.”
  4. d.
    “I will refrain from using the medication on my face, especially near my eyes.”
Table 40.15 in the book ↗
Vital Signs Physical Examination
Temperature: 97.4°F

• Head, eyes, ears, nose, throat (HEENT): Denies any changes in vision; responds to questions appropriately without requests for repeats

• Neurological: Alert and oriented × 4, pleasant affect; denies numbness, tingling, dizziness, or headache

• Cardiovascular: Regular heart rate and rhythm; denies palpitations; S1, S2 audible; no extra sounds noted; capillary refill +3; mucous membranes pink, moist, and intact

• Respiratory: Lungs clear to auscultation in all fields; denies shortness of breath

• GI: Abdomen soft, nontender, without distention; bowel sounds active in all quadrants; denies nausea, vomiting, diarrhea, or constipation

• GU: Last menstrual period 16 days ago

• Integumentary: Nails with cracking noted; scalp with excessive silvery scaling and reddened areas noted; skin intact to limbs and trunk except for small scaling; red areas noted bilaterally on elbows; client states she has noticed more “itching and dandruff” lately
Blood pressure: 126/64 mm Hg
Heart rate: 88 beats/min
Respiratory rate: 14 breaths/min
Oxygen saturation: 100% on room air
Pain: 3/10
Height: 5'5"
Weight: 144 lb

Answer

B. “I should cover the surrounding margins of lesions with a thick coat of medication.”
Coal tar is very damaging to unaffected skin and therefore should not be applied outside of the lesion borders. Zinc oxide or petrolatum should be used to protect the wound margins.

40-1 §40.RQ source ↗

The nurse is conducting a follow-up visit with a client who is being treated for psoriasis with adalimumab. Which finding demonstrates a therapeutic response has occurred?
  1. a.
    Negative wound cultures
  2. b.
    Decreased neutrophils
  3. c.
    Decreased scaling
  4. d.
    Absence of drainage

Answer

C. Decreased scaling
Adalimumab decreases the mitotic rate of skin cells to decrease scaling plaques in psoriasis.

40-2 §40.RQ source ↗

A 32-year-old client diagnosed with acne has been prescribed tretinoin. Which teaching point should the nurse include in the client’s discharge instructions?
  1. a.
    It is essential that you avoid pregnancy throughout therapy with tretinoin.
  2. b.
    This medication should be used liberally across the affected area four times daily.
  3. c.
    You may take this medication only during the first 12 weeks of pregnancy.
  4. d.
    You should stop taking your birth control because it reacts negatively with tretinoin.

Answer

A. It is essential that you avoid pregnancy throughout therapy with tretinoin.
Risks for embryo/fetal loss or abnormalities prevent the use of tretinoin during pregnancy.

40-3 §40.RQ source ↗

For which client would the nurse question an order for tetracycline hydrochloride?
  1. a.
    A 48-year-old client with a history of frequent UTIs
  2. b.
    A 16-year-old client with severe acne
  3. c.
    A 6-year-old client diagnosed with impetigo
  4. d.
    An 86-year-old client undergoing treatment for an infected sebaceous cyst

Answer

C. A 6-year-old client diagnosed with impetigo
Tetracycline drugs, when taken by children under the age of 8 years, may cause damage to bones and teeth; therefore, they are contraindicated in this population.

40-4 §40.RQ source ↗

A client newly diagnosed with plaque psoriasis asks the nurse how this condition will be treated. Which is the correct response by the nurse?
  1. a.
    “You will need surgical intervention to remove these lesions.”
  2. b.
    “Combination therapy to exfoliate and reduce cell maturation will be used.”
  3. c.
    “A steroidal cream should clear this condition in 2 weeks.”
  4. d.
    “You will be given an antibiotic to eliminate bacterial organisms.”

Answer

B. “Combination therapy to exfoliate and reduce cell maturation will be used.”
Psoriasis treatment requires exfoliation to remove plaque formation and drugs to decrease rapid skin cell growth to prevent plaques.

40-5 §40.RQ source ↗

Which statement, when made by a client, demonstrates that further teaching by the nurse is necessary regarding the use of topical corticosteroids?
  1. a.
    “I will cover the lesion with an occlusive dressing after I apply the steroid cream.”
  2. b.
    “I should use a thin layer of this medication directly on the lesion.”
  3. c.
    “This medication will reduce irritation and swelling.”
  4. d.
    “I should cleanse my skin before applying this medication.”

Answer

A. “I will cover the lesion with an occlusive dressing after I apply the steroid cream.”
Covering topical steroids may cause both local irritation and systemic absorption of the drug.

40-6 §40.RQ source ↗

A nursing student asks the nurse how impetigo treatment works. The nurse explains that the primary goal in the treatment of impetigo is to:
  1. a.
    Reduce swelling and scaling
  2. b.
    Decrease scarring as the lesion heals
  3. c.
    Soften the tissues to reduce pain
  4. d.
    Eliminate the causative bacteria

Answer

D. Eliminate the causative bacteria
Impetigo is a localized infection that requires treatment with antibiotics to eliminate the causative bacteria.

40-7 §40.RQ source ↗

For which client would a nurse question an order for acitretin?
  1. a.
    A 48-year-old client with a history of renal failure
  2. b.
    A 32-year-old client with a documented sulfa allergy
  3. c.
    A 52-year-old client with a diagnosis of osteoarthritis
  4. d.
    A 68-year-old client with a serum hemoglobin of 10.5 g/L

Answer

A. A 48-year-old client with a history of renal failure
Acitretin is contraindicated in clients with decreased renal function.

40-8 §40.RQ source ↗

The nurse is applying silver sulfadiazine to burns on a client’s arm. The client asks that the nurse cover the area with a dressing to protect it and keep the medication from getting on their clothes. What is the best response by the nurse?
  1. a.
    “I will apply a gauze dressing, which will protect the area but still allow air to pass through it.”
  2. b.
    “I will apply an occlusive dressing to keep the keep the area sterile.”
  3. c.
    “I will apply an occlusive dressing to ensure the medication is fully absorbed.”
  4. d.
    “It is best to not apply a dressing and leave this open to the air.”

Answer

A. “I will apply a gauze dressing, which will protect the area but still allow air to pass through it.”
Applying a nonocclusive dressing to protect the area is appropriate, but applying an occlusive dressing is contraindicated because it will increase the systemic effects of the medication.

40-9 §40.RQ source ↗

Upon entering the examination room, the nurse finds a 15-year-old client in tears. The client states, “This acne has ruined my life. No one will ever want to date me with this awful stuff on my face.” Which of the following statements by the nurse is most appropriate?
  1. a.
    “You can manage this with lifelong medications.”
  2. b.
    “I think you should see a psychologist to talk about this.”
  3. c.
    “With proper hygiene and medications, you can manage your acne well.”
  4. d.
    “You must avoid cosmetics and lotions so that your acne will go away.”

Answer

C. “With proper hygiene and medications, you can manage your acne well.”
With proper treatment, most forms of acne can be controlled with resolution or improvement in skin lesions.

40-10 §40.RQ source ↗

The nurse is preparing to discharge a client with a new prescription for metronidazole. Which statement should be included in the discharge teaching?
  1. a.
    “Limit your oral fluid intake to 2000 mL/day.”
  2. b.
    “You may stop taking this medication when your skin looks better.”
  3. c.
    “You will experience severe side effects if you drink alcohol while on this drug.”
  4. d.
    “This medication will eliminate the bacterial organisms on your skin.”

Answer

C. “You will experience severe side effects if you drink alcohol while on this drug.”
Drinking alcoholic beverages when taking metronidazole results in a disulfiram-like reaction, which is evidenced by diaphoresis, hypotension, and nausea/vomiting.

End of the book.

Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.