Ch 52- Skin Disorders and Topical Drugs

These flashcards cover key concepts, actions, uses, adverse reactions, counseling points, and nursing processes related to topical drugs for treating skin disorders.

A client is prescribed a topical retinoid for acne. What is the primary physiological action of this drug class?

Retinoids are chemically related to Vitamin A. They regulate epithelial cell growth and stimulate the development of new blood vessels to deliver nutrients to the skin.

Which adverse reaction is a nurse most likely to observe in a client starting a retinoid treatment?

Local irritation, erythema (redness), dryness, and a stinging or burning sensation are frequent early side effects.

A nurse is teaching a female client about starting Tretinoin. What is the most critical requirement before therapy begins?

The client must have a negative pregnancy test due to the high risk of teratogenic effects to the fetus.

When taking a history for a client starting topical retinoids, what environmental sensitivity should the nurse emphasize?

Increased sensitivity to weather extremes (such as cold or wind) and sun exposure; clients should use sunscreen and protective clothing.

What is the difference between bactericidal and bacteriostatic topical antibiotics?

1. Bactericidal: Kills the bacteria directly.

2. Bacteriostatic: Inhibits the growth and reproduction of bacteria.

A client presents with tinea pedis (athlete's foot). Which drug class does the nurse anticipate being prescribed?

Topical antifungal drugs, designed to inhibit the growth of various fungi.

What is the therapeutic goal for a client prescribed a topical antiviral like acyclovir?

To inhibit viral replication, primarily used to treat initial episodes of genital herpes and to speed up the recovery of lesions.

A nurse observes a new rash and urticaria on a client using a topical antibiotic. What is the priority nursing action?

Discontinue the medication and notify the healthcare provider, as these are signs of a hypersensitivity (allergic) reaction.

What is the primary definition and function of a germicide?

A substance that kills bacteria, often used as a surgical scrub or preoperative skin cleanser to reduce the risk of infection.

How do topical antiseptics differ from germicides or antibiotics?

They stop, slow, or prevent the growth of microorganisms but their exact action is less specific than antibiotics and they are generally used on living tissue to reduce bacterial count.

Which topical medication class is specifically used to treat inflammatory skin conditions like psoriasis and eczema?

Topical corticosteroids, which exert localized anti-inflammatory activity.

A nurse is monitoring a client who has been using high-potency corticosteroids over a large body surface area. Which systemic symptoms are concerning?

Signs of Cushing's syndrome: moon face, hyperglycemia, glycosuria, and thinning of the hair.

Where should a nurse advise a client NOT to apply topical corticosteroids unless specifically directed?

Areas with thin skin or high friction: the face, groin, or axilla (armpit), as these areas increase the risk of systemic absorption.

What is the mechanism of action for topical immunomodulators?

They reduce inflammation by stopping the production of cytokines, which are mediators of the immune response.

A client is seeking treatment for actinic keratosis. Which drug category might be indicated?

Topical immunomodulators (e.g., Imiquimod).

What are the common adverse reactions specific to antipsoriatics?

Burning, itching, and temporary discoloration of the hair and nails.

A client has a deep wound with necrotic (dead) tissue. Which medication will assist in debridement?

Topical enzymes, which hasten protein reduction to remove dead tissue.

What is a major contraindication for the use of topical enzymes like collagenase?

Wounds that are in contact with major body cavities or known hypersensitivity to the drug components.

A client needs a medication to remove a stubborn callus or wart. Which drug type is appropriate?

Keratolytics, which remove excess epidermal growth (e.g., Salicylic acid).

Why should a nurse exercise caution when a diabetic client is using keratolytics?

Diabetics often have impaired wound healing and peripheral vascular disease; prolonged use of keratolytics can lead to severe skin damage or infection.

What is the primary action of benzocaine or lidocaine when applied topically?

They are local anesthetics that temporarily inhibit the conduction of impulses from sensory nerve fibers, relieving pain and itching.

During the pre-administration assessment of a skin disorder, what must the nurse document?

1. Size and color of lesions

2. Presence of drainage or odor

3. Client's subjective report of pain or itching

4. Baseline vital signs

In the nursing process, what is the 'Implementation' phase for topical drugs?

Applying the medication using the correct technique (e.g., thin layer, gloves used), ensuring the skin is clean, and following provider orders for dressing changes.

A nurse is applying a topical antiviral to a herpes lesion. Why is using a finger cot or glove mandatory?

To prevent 'autoinoculation' (spreading the virus to other parts of the client's body) and to protect the nurse from infection.

What is the specific teaching regarding the 'sparing' application of corticosteroids?

Apply only as much as needed to cover the area; over-application increases the risk of skin thinning (atrophy) and systemic absorption.

A client is prescribed a 'surgical scrub' with chlorhexidine. What is the nurse's priority instruction?

Follow the specific timing and rinsing instructions strictly to ensure the maximum reduction of skin bacteria before the procedure.

How does the nurse evaluate the effectiveness of an antipsoriatic?

Observation of reduced plaque thickness, decreased scaling, and improved skin integrity.

What is a 'superinfection' in the context of topical antibiotic therapy?

An overgrowth of non-susceptible organisms (like fungi) that occurs when the normal skin flora is disrupted by antibiotic use.

Which assessment finding would indicate a systemic reaction to a topical local anesthetic?

While rare, excessive absorption can lead to CNS stimulation or cardiovascular depression if applied to broken skin/large areas.

True or False: Topical corticosteroids can be used as a monotherapy for bacterial skin infections.

False. Corticosteroids suppress the immune response and can mask or worsen an untreated bacterial infection.

A nurse is caring for a client with a deep pressure ulcer. Which medication would the nurse expect to be ordered to assist in removing necrotic tissue?

A) Tretinoin
B) Collagenase
C) Lidocaine
D) Hydrocortisone

B) Collagenase.

Rationale: Collagenase is a topical enzyme used for the debridement of wounds. It works by breaking down and removing necrotic (dead) tissue, promoting the healing of healthy tissue. Tretinoin is for acne, Lidocaine is an anesthetic, and Hydrocortisone is an anti-inflammatory steroid.

A client starting Tretinoin for acne therapy asks why they need a pregnancy test. What is the nurse's best response?

A) The medication causes severe fluid retention.
B) Retinoids are highly teratogenic and can cause birth defects.
C) The drug causes maternal hypertension.
D) Hormonal changes from pregnancy make the drug ineffective.

B) Retinoids are highly teratogenic and can cause birth defects.

Rationale: Retinoids, which are chemically related to Vitamin\ A, are known teratogens. A negative pregnancy test is a mandatory safety requirement before a female of childbearing age starts this therapy to prevent severe fetal abnormalities.

Which assessment finding should the nurse prioritize when a client is using a topical antibiotic for the first time?

A) Mild localized peeling
B) Slight warmth at the site
C) Urticaria and a new rash
D) Improved skin texture

C) Urticaria and a new rash.

Rationale: Urticaria (hives) and a new rash are signs of a hypersensitivity or allergic reaction. The nurse must discontinue the medication and notify the provider immediately to prevent anaphylaxis. Mild peeling or warmth are common, non-urgent side effects.

A nurse prepares to apply a topical antiviral to a client with a herpes simplex lesion. What is the primary reason for wearing gloves or using a finger cot?

A) To prevent the drug from staining the nurse's skin
B) To ensure the medication remains sterile
C) To prevent autoinoculation of the client and infection of the nurse
D) To increase the absorption rate of the drug

C) To prevent autoinoculation of the client and infection of the nurse.

Rationale: Viral lesions are highly infectious. Using gloves prevents the nurse from contracting the virus and prevents 'autoinoculation,' which is the spread of the virus to other areas of the client's body.

Before applying povidone-iodine as a surgical scrub, the nurse must assess the client for an allergy to which substance?

A) Latex
B) Penicillin
C) Shellfish
D) Peanuts

C) Shellfish.

Rationale: Povidone-iodine contains iodine. There is a frequent cross-sensitivity between iodine-based antiseptics and shellfish allergies. Assessing this beforehand is a critical safety step to prevent allergic reactions.

A client is prescribed a high-potency topical corticosteroid for psoriasis. Which area of application poses the highest risk for systemic absorption?

A) Forearms
B) Heels of the feet
C) Axilla (armpit)
D) Scalp

C) Axilla (armpit).

Rationale: Areas with thin skin, high moisture, or high friction (like the axilla, groin, or face) have significantly higher rates of systemic absorption, which increases the risk of side effects like Cushing's syndrome.

A diabetic client is using a keratolytic for a foot callus. Why must the nurse monitor this client closely?

A) Keratolytics can cause severe hyperglycemia.
B) Diabetics have impaired wound healing and a higher risk of infection.
C) The drug may interfere with insulin absorption.
D) Keratolytics increase the risk of peripheral neuropathy.

B) Diabetics have impaired wound healing and a higher risk of infection.

Rationale: Keratolytics like salicylic acid soften and remove skin layers. Because diabetic clients often have poor circulation and impaired healing, any skin damage or excessive shedding caused by the drug can lead to non-healing ulcers or infection.

A nurse notes 'moon face' and thinning hair in a client using long-term topical corticosteroids. These are signs of which condition?

A) Hypothyroidism
B) Cushing's Syndrome
C) Addison's Disease
D) Toxic Epidermal Necrolysis

B) Cushing's Syndrome.

Rationale: Excessive systemic absorption of corticosteroids (even topical ones used over large areas) can lead to Cushingoid symptoms, including a moon-shaped face, hyperglycemia, and skin/hair thinning due to adrenal suppression.

What is the correct technique for applying a topical antipsoriatic like Anthralin?

A) Apply a thick layer and cover with a heavy bandage
B) Rub vigorously into the surrounding healthy skin
C) Apply only to the plaques and avoid contact with healthy skin
D) Apply the medication once every 24 hours without washing

C) Apply only to the plaques and avoid contact with healthy skin.

Rationale: Antipsoriatics can be highly irritating and may cause temporary discoloration or staining. They should be applied precisely to the affected plaques to avoid damaging the surrounding healthy tissue.

A client asks why their antibiotic is 'bacteriostatic.' How should the nurse explain this?

A) It kills the bacteria directly.
B) It prevents the bacteria from multiplying.
C) It dissolves the bacterial cell wall.
D) It targets only fungal organisms.

B) It prevents the bacteria from multiplying.

Rationale: Bacteriostatic agents inhibit growth and reproduction but do not necessarily kill the organism instantly. Bactericidal agents are those that kill the bacteria directly.

A nurse is teaching a client about a new retinoid prescription for acne. Which instruction is most important?

A) Wash your face 5 times a day while using this.
B) Use a tanning bed to help the drug work faster.
C) Use sunscreen and wear protective clothing when outside.
D) Discontinue use if your skin feels slightly dry.

C) Use sunscreen and wear protective clothing when outside.

Rationale: Retinoids cause significant photosensitivity, making the skin much more susceptible to severe sunburn. Clients must avoid sun exposure and use high-ranking SPF.

Which finding on a client's skin indicates a 'superinfection' during topical antibiotic therapy?

A) Decreased redness of the primary wound
B) New white, cheesy patches or intense itching
C) Rapid closure of the wound edges
D) A decrease in drainage

B) New white, cheesy patches or intense itching.

Rationale: A superinfection occurs when the normal flora is killed off, allowing non-susceptible organisms like fungi (Candidiasis) to overgrow. White patches and itching are classic signs of a secondary fungal infection.

A client is prescribed a topical immunomodulator like Imiquimod. What is a common indication for this drug?

A) Bacterial impetigo
B) Actinic keratosis
C) Pain relief from burns
D) Athlete's foot

B) Actinic keratosis.

Rationale: Topical immunomodulators are used to treat conditions like actinic keratosis (pre-cancerous skin lesions) and genital warts by modifying the immune response to target abnormal cells.

When assessing a skin lesion, the nurse documents it as 'erythematous.' What does this mean?

A) It is leaking yellow fluid.
B) it is raised and hard.
C) It is red in color.
D) It has a foul odor.

C) It is red in color.

Rationale: Erythema is the medical term for redness of the skin, which is often a sign of inflammation, infection, or drug reaction.

What is the primary action of topical anesthetics like Benzocaine?

A) They kill bacteria on contact.
B) They inhibit the conduction of sensory nerve impulses.
C) They reduce the thickness of the epidermal layer.
D) They stimulate local blood flow.

B) They inhibit the conduction of sensory nerve impulses.

Rationale: Local anesthetics temporarily block the conduction of impulses from sensory nerve fibers, which relieves symptoms of pain and itching.

Which nursing action is essential during the 'Implementation' phase of administering topical medications?

A) Checking the client's blood pressure every 15 minutes
B) Applying the medication in a thick, opaque layer
C) Cleaning the area and removing old medication before applying a new dose
D) Always applying an occlusive dressing over every drug

C) Cleaning the area and removing old medication before applying a new dose.

Rationale: To ensure maximum absorption and prevent the buildup of bacteria or debris, the skin must be clean and free of old medication/exudate before a fresh dose is applied.

A client reports a 'stinging sensation' immediately after applying a topical retinoid. What is the nurse's best action?

A) Tell the client this is a common early reaction and to continue use.
B) Immediately call the emergency room.
C) Perform a full cardiac assessment.
D) Apply an occlusive dressing to the area.

A) Tell the client this is a common early reaction and to continue use.

Rationale: Local irritation, including stinging, burning, and redness, is very common during the first few weeks of retinoid therapy. It usually subsides as the skin acclimates to the medication.

Why should topical corticosteroids NOT be used as a treatment for a known fungal infection?

A) They make the skin too dry for the fungus to live.
B) They can suppress the immune response and mask the spread of the infection.
C) They turn the fungus into a more dangerous bacteria.
D) They cause the fungus to stain the skin permanently.

B) They can suppress the immune response and mask the spread of the infection.

Rationale: Corticosteroids reduce inflammation and immune activity. If used on an untreated infection, they can hide the symptoms while the infection actually worsens because the body's natural defense is suppressed.

A client is prescribed chlorhexidine gluconate as a preoperative scrub. What should the nurse emphasize?

A) Rinse it off immediately after applying.
B) Use a very large amount and let it drip.
C) Follow the specific 'scrub time' or contact time instructed.
D) Only use it on the hands, never the surgical site.

C) Follow the specific 'scrub time' or contact time instructed.

Rationale: Antiseptics and germicides require a specific amount of contact time with the skin to effectively reduce the bacterial count to safe levels for surgery.

A nurse is evaluating the effectiveness of a client's treatment for tinea pedis. Which finding indicates the antifungal is working?

A) Increased scaling between the toes
B) Decreased itching and clear skin integrity
C) Spread of the rash to the ankles
D) Softening of the toenails

B) Decreased itching and clear skin integrity.

Rationale: Tinea pedis (athlete's foot) is a fungal infection characterized by itching and skin breakdown. Improvement is evidenced by the resolution of these clinical symptoms.

A nurse is applying a topical medication used to remove warts. What is this class of drug called?

A) Antivirals
B) Keratolytics
C) Germicides
D) Corticosteroids

B) Keratolytics.

Rationale: Keratolytics (like salicylic acid) are drugs that dissolve or soften the keratin layer of the skin, making them effective for removing warts, corns, and calluses.

A client is using an antipsoriatic and notices their hair has a temporary yellowish tint. What is the nurse's best response?

A) 'This is a sign of liver failure.'
B) 'You must stop the medication immediately.'
C) 'This is a known, temporary side effect of some antipsoriatic drugs.'
D) 'You should dye your hair to cover it.'

C) 'This is a known, temporary side effect of some antipsoriatic drugs.'

Rationale: Some antipsoriatic medications, particularly those containing coal tar or anthralin, can cause temporary discoloration of the skin, hair, and nails.

The nurse records the size of a wound as 2\ cm \times 4\ cm. Which part of the nursing process does this represent?

A) Implementation
B) Planning
C) Assessment
D) Diagnosis

C) Assessment.

Rationale: Documenting the baseline physical characteristics of a lesion (size, color, drainage) occurs during the assessment phase, providing a comparison for future evaluation.

Which of the following is a symptom of systemic toxicity from excessive topical lidocaine absorption?

A) Localized redness
B) Increased hair growth
C) CNS stimulation or confusion
D) Hardening of the skin

C) CNS stimulation or confusion.

Rationale: While rare, if topical anesthetics are absorbed systemically in large amounts (e.g., through broken skin or large surface areas), they can affect the central nervous system, causing tremors, confusion, or even seizures.

A client is prescribed Neomycin. The nurse should explain that this medication works by:

A) Softening the skin
B) Stopping the growth of fungus
C) Interfering with bacterial protein synthesis
D) Increasing sun sensitivity

C) Interfering with bacterial protein synthesis.

Rationale: Neomycin is an aminoglycoside antibiotic that prevents bacterial growth by interfering with the way the bacteria make proteins.

When teaching a client about applying a 'thin layer' of corticosteroid, what is the primary goal?

A) To save money on the prescription
B) To minimize systemic absorption and skin atrophy
C) To make the medication dry faster
D) To prevent the medication from smelling

B) To minimize systemic absorption and skin atrophy.

Rationale: Corticosteroids are powerful drugs. Using a thin layer reduces the risk that the drug will enter the bloodstream or cause local thinning (atrophy) of the skin.

A nurse is using a topical enzyme on a wound. Where should the nurse avoid applying this medication?

A) On necrotic tissue
B) On the edges of a pressure ulcer
C) In contact with major body cavities
D) On a client's arm

C) In contact with major body cavities.

Rationale: Topical enzymes are contraindicated for use in areas that might communicate with major body cavities (like the abdomen or chest) due to the risk of internal damage.

What is a 'germicide' primarily used for?

A) Treating chronic eczema
B) Relieving pain from a sting
C) Reducing bacteria on the skin before surgery
D) Helping a wound close faster

C) Reducing bacteria on the skin before surgery.

Rationale: Germicides (like surgical scrubs) are used to kill as many microorganisms as possible on the skin's surface to prevent surgical site infections.

A client has been using a topical drug for 2 weeks but the skin condition is worsening. What is the priority nursing action?

A) Apply twice as much medication
B) Instruct the client to wait another month
C) Notify the healthcare provider
D) Change the dressing more frequently

C) Notify the healthcare provider.

Rationale: If a condition does not improve or worsens despite treatment, the provider must be notified to re-evaluate the diagnosis or the medication choice.

A nurse is teaching a client about topical acyclovir for genital herpes. Which statement by the client indicates understanding?

A) 'This medicine will cure my herpes forever.'
B) 'I should only use it when I feel a tingle before a sore appears.'
C) 'I must wear a glove when putting this on my sores.'
D) 'I can share this cream with my partner.'

C) 'I must wear a glove when putting this on my sores.'

Rationale: Acyclovir does not cure herpes; it only manages symptoms and frequency. Wearing a glove is essential to prevent spreading the virus to the hands or other people.

A client with actinic keratosis is prescribed Imiquimod. The nurse should monitor for which local reaction?

A) Excessive hair growth
B) Numbness
C) Redness and swelling at the application site
D) Improvement in vision

C) Redness and swelling at the application site.

Rationale: Imiquimod works by stimulating the immune system locally. Common reactions include inflammatory responses like redness, swelling, and itching where the drug is applied.

A nurse is applying a drug to 'debride' a wound. What does the term 'debridement' mean?

A) To sew the wound shut
B) To remove dead or damaged tissue
C) To apply a numbing agent
D) To stop local bleeding

B) To remove dead or damaged tissue.

Rationale: Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.

How do topical antiseptics differ from topical antibiotics?

A) Antiseptics are more specific to certain bacteria
B) Antiseptics primarily slow the growth of a broad range of organisms on living tissue
C) Antibiotics are only used on dead surfaces
D) There is no difference between them

B) Antiseptics primarily slow the growth of a broad range of organisms on living tissue.

Rationale: Antiseptics are less specific and have a broader spectrum of action compared to antibiotics; they are usually applied to living tissue to lower the microbial count.

A nurse is teaching a client about using a keratolytic for a corn on their toe. When should they stop using it?

A) Never, it must be used for life
) When the corn is removed and skin is smooth
C) When the skin starts to bleed
D) Only when the bottle is empty

B) When the corn is removed and skin is smooth.

Rationale: Keratolytics should be discontinued once the excess keratin (the corn/callus) has been successfully removed to prevent damage to the healthy skin underneath.

Which instruction should the nurse provide to a client using topical corticosteroids for eczema?

A) 'Apply it to your face every morning.'
B) 'If you miss a dose, apply a triple layer next time.'
C) 'Do not use this more often than prescribed.'
D) 'Stop taking the med as soon as you feel better, without telling the doctor.'

C) 'Do not use this more often than prescribed.'

Rationale: Overuse of corticosteroids can lead to skin thinning (atrophy), stretch marks, and systemic absorption. Clients must follow exact dosing and frequency instructions.

A nurse is treating a patient with anthrax-related skin lesions. Which topical drug class is most appropriate?

A) Antivirals
B) Antifungals
C) Antibiotics
D) Keratolytics

C) Antibiotics.

Rationale: Anthrax is caused by the bacterium Bacillus anthracis, requiring antibiotic therapy to treat the infection.

What is the goal of assessing 'vital signs' before administering topical medications for a large burn?

A) To see if the medication is working
B) To establish a baseline because large-area application can have systemic effects
C) To check for a shellfish allergy
D) Vital signs are not necessary for topical drugs

B) To establish a baseline because large-area application can have systemic effects.

Rationale: When drugs are applied to large areas (especially broken skin like burns), systemic absorption is more likely. Baseline vitals help the nurse detect any changes in the cardiovascular or central nervous systems.

True or False: Most topical medications should be applied to skin that has been thoroughly dried after cleaning.

True.

Rationale: Applying medication to clean, dry skin ensures better adherence and predictable absorption, unless the specific drug (like some moisturizers) is intended for damp skin.

A client asks if they can use their leftover topical antibiotic for a new rash. What is the nurse's priority response?

A) 'Yes, as long as it isn't expired.'
B) 'No, the new rash might be fungal or a different type of bacteria.'
C) 'Only if you apply a very thick layer.'
D) 'Check with your neighbor first.'

B) 'No, the new rash might be fungal or a different type of bacteria.'

Rationale: Using an incorrect medication can worsen a condition (e.g., using an antibiotic on a fungal rash) or contribute to antibiotic resistance. The provider must diagnose the new rash.

A client has a low-grade fever and a red, warm wound. Which medication class does the nurse expect?

A) Topical Local Anesthetic
B) Topical Antibiotic
C) Topical Keratolytic
D) Topical Immunomodulator

B) Topical Antibiotic.

Rationale: Fever, redness, and warmth are signs of a bacterial infection, making a topical antibiotic the appropriate choice to target the causative organisms.