Adams4e Tif Ch48

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 48Question 1Type: MCMA

The nursing instructor teaches the student nurses about the structure and function of the skin. What will the best teaching plan of the instructor include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The outermost layer of the epidermis serves as the major waterproof barrier to the environment.

2. The epidermis provides a foundation for the accessory structures such as hair and nails.

3. The amount of subcutaneous tissue varies, and is determined by nutritional status and heredity.

4. Most receptor nerve endings, oil glands, sweat glands, and blood vessels are found within the subcutaneous fat.

5. The deepest epidermal layer provides new cells.

Correct Answer: 1,3,5

Rationale 1: The outermost layer of the epidermis, or stratum coneum, forms an effective barrier. Most substances cannot penetrate this barrier.

Rationale 2: The dermis, not the epidermis, provides a foundation for the accessory structures such as hair and nails.

Rationale 3: The amount of subcutaneous tissue varies, and is determined by nutritional status and heredity.

Rationale 4: Most receptor nerve endings, oil glands, sweat glands, and blood vessels are found within the dermis, not the subcutaneous fat.

Rationale 5: The deepest epidermal sublayer supplies the epidermis with new cells after older superficial cells have been damaged or lost through normal wear.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 48-1Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Question 2Type: MCSA

The client asks the nurse how skin cells are replaced. What is the best response by the nurse?

1. "The epidermis supplies new cells after older cells have been damaged or lost."

2. "The dermis supplies new cells after older cells have been damaged or lost."

3. "The stratum corneum supplies new cells after older cells have been damaged or lost."

4. "The stratum germinativum supplies new cells after older cells have been damaged or lost."

Correct Answer: 1

Rationale 1: The deepest epidermal sublayer, the stratum basale, supplies the epidermis with new cells after older superficial cells have been damaged or lost through normal wear.

Rationale 2: The deepest epidermal sublayer, the stratum basale, not the dermis, supplies the epidermis with new cells.

Rationale 3: The deepest epidermal sublayer, the stratum basale, not the stratum corneum, supplies the epidermis with new cells.

Rationale 4: The deepest epidermal sublayer, the stratum basale, not the stratum germinativum, supplies the epidermis with new cells.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 48-2


The client has scabies. The nurse has taught the client about safety in using topical scabicide medications, and evaluates that teaching has been effective when the client makes which statement?

1. "I should cover the area with a clean cloth."

2. "I will need help in showering to remove the lotion."

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

3. "I need to sign a consent for this medication."

4. "I must avoid putting this lotion on my face."

Correct Answer: 4

Rationale 1: It is not necessary to cover the area with a cloth.

Rationale 2: The client should not need assistance to shower.

Rationale 3: A consent is not necessary for these medications.

Rationale 4: These medications are irritating to sensitive skin and eyes, so the facial area should be avoided.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 48-3

Question 4Type: MCMA

The client receives a topical medication for treatment of an acne-like skin disorder. The nurse completes medication education and evaluates learning has occurred when the client makes which statements?



1. "My daughter has a similar problem so she can use this too."

2. "I will call my doctor if I notice a change in my symptoms."

3. "I will apply the medication only to the affected area."

4. "I do not need to shower prior to using this medication."

5. "My medication only needs to be applied once a day."

Correct Answer: 2,3

Rationale 1: Clients should not share medications; the daughter should have an evaluation herself.


Rationale 2: The client must notify the physician if the symptoms change.

Rationale 3: Medications can be irritating so they should be applied only to the affected area.

Rationale 4: The medication should be applied to clean skin, so it is a good idea to shower prior to using this medication.

Rationale 5: Some topical medications need to be applied more than once a day.

Global Rationale:



The nurse's neighbor has a severe sunburn and cannot sleep. What is the best advice by the nurse?

1. "Apply emollients to keep the skin moist until it heals."

2. "Call your physician for a prescription for pain medication."

3. "Take acetaminophen (Tylenol) or ibuprofen (Advil) for pain."

4. "Apply a local anesthetic to the area that is sunburned."

Correct Answer: 4

Rationale 1: Emollients will not stop the pain of the sunburn.

Rationale 2: The client does not need a prescription pain medication.

Rationale 3: Acetaminophen (Tylenol) or ibuprofen (Advil) are good medications, but this is not the best answer.

Rationale 4: A local anesthetic will relieve the pain and allow the neighbor to sleep..

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 48-4Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.


The client calls the clinic and is frantic that her two children have been sent home from school with head lice. She has treated their scalps, but does not know what else to do. What will be the best teaching by the nurse?

1. "Wash the bed linens and clothing that have come into contact with the children."

2. "Just continue to apply the medication to their scalps as directed."

3. "Do not let your children return to the school until it is fumigated."

4. "Isolate the affected children from other family members for three days."

Correct Answer: 1

Rationale 1: Lice are spread by direct contact and can live many days on inanimate objects. The children could be re-infected if household items are not treated.

Rationale 2: It is not necessary to continue applying medication to the children's scalps.

Rationale 3: Head lice are spread by direct contact; it is not necessary to fumigate the school.

Rationale 4: It is not necessary to isolate the affected children.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 48-3


The client is recovering from a severe sunburn. What will the best teaching by the nurse include?

1. "Apply lotion or oil to your skin the next time you go out into the sun."

2. "Apply a sunscreen when you are going to be in the sun."

3. "Do not go out into the sun again; you are more susceptible to burn again."

4. "Use a water-soluble sunscreen the next time that you go out into the sun."


Correct Answer: 2

Rationale 1: Lotion or oil will keep the skin moist, but will not prevent another sunburn.

Rationale 2: Sunscreens are used to protect the skin from excessive sun exposure.

Rationale 3: It is not necessary to avoid the sun, but precautions should be taken.

Rationale 4: Sunscreens should be water-resistant, not water-soluble.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 48-5


A teenager is taking isotretinoin (Accutane) for treatment of severe acne. The nurse has completed medication education with her mother, and evaluates additional learning is required when the mother makes which statement?

1. "We can expect that her skin will be less oily."

2. "She needs to be on a reliable method of birth control now."

3. "At least I do not need to worry about her self-concept now."

4. "I will pay particular attention to her mood now."

Correct Answer: 3

Rationale 1: Isotretinoin (Accutane) decreases oil production.

Rationale 2: Isotretinoin (Accutane) is Pregnancy Category X.

Rationale 3: Severe depression with resulting suicidal ideation can be caused by this drug; the mother must pay attention to her mood.

Rationale 4: Isotretinoin (Accutane) can cause severe depression with resulting suicidal ideation; the mother needs to talk to her daughter about her self-concept.

Global Rationale:

Cognitive Level: AnalyzingAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 48-5


The client receives topical glucocorticoids for the treatment of dermatitis. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement?

1. "A pill would be more effective than this messy lotion that I have to use."

2. "If this medication doesn't help me, there is nothing left to try."

3. "Use of this lotion is really a lot safer and more effective than a pill."

4. "Long-term use of this lotion can lead to dependence on the drug."

Correct Answer: 3

Rationale 1: Topical agents, not oral agents, are the most effective treatment for dermatitis.

Rationale 2: If topical medications are ineffective, they can be augmented with oral agents.

Rationale 3: Topical agents are less likely to cause systemic effects than are oral medications, so they are safer and they are more effective..

Rationale 4: Dependence does not occur with glucocorticoids.

Global Rationale:



The mother of a young child calls the clinic and tells the nurse that she has just discovered head lice in her daughter's hair. What is the best instruction by the nurse?

1. "Purchase an over-the-counter lice medication and follow the package directions exactly."


2. “Take her to your beautician for treatment.”

3. “Bring her to the clinic for evaluation.”

4. ”Be certain to eliminate all the lice with the first application of medication as treatment cannot be done again for a month.”

Correct Answer: 1

Rationale 1: Package directions should be followed exactly.

Rationale 2: Lice are easily spread. Exposing those in the beauty shop to lice is not the best plan.

Rationale 3: It is easy to identify lice at home and instruction for treatment can be given over the telephone. Lice are easily spread, so it is not the best plan to have the child in the clinic waiting room.

Rationale 4: Treatment can be repeated, usually in one week, if necessary.

Global Rationale:



A client has psoriasis. Prior to beginning education, the nurse assesses the client. Which statement indicates the client has a correct knowledge base about his illness?

1. "I wish there were some way besides medications to treat my psoriasis."

2. "Treatment can help lessen the discomfort of my psoriasis."

3. "Systemic medications are the only medications that are effective."

4. "No medications are effective for treating my disorder."

Correct Answer: 2

Rationale 1: . Ultraviolet light is also effective as an alternative to medication.

Rationale 2: There are some medications that are effective in treating psoriasis.

Rationale 3: Topical medications are also effective for treating psoriasis. Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 4: At this time, treatment can help lessen the discomfort of psoriasis.

Global Rationale:



The mother of a client with head lice has completed the applications of topical medication. What is the best instruction by the nurse at this time?

1. "Keep your child's hair short so it will be easier to treat next time."

2. "You are fine now; just watch your child for a re-infection."

3. "Check the heads of your child's friends before allowing them to play together."

4. "Remove all nits from the hair shaft with a nit comb or a fine-tooth comb."

Correct Answer: 4

Rationale 1: There is no need to cut the child's hair, just remove the nits from the child's hair shaft.

Rationale 2: The treatment is not complete until the nits are removed from the hair shaft; the mother is not finished.

Rationale 3: The mother does not need to check the friends’ hair.

Rationale 4: After the shampoo treatment, the mother should remove all nits from the hair shaft with a nit comb or a fine-tooth comb.

Global Rationale:




The physician orders lindane (Kwell) for nursing home clients who have contracted head lice. The nurse will contact the physician when one of the clients has which medical diagnosis?

1. Diabetes mellitus

2. Seizures

3. Stroke

4. Hypothyroidism

Correct Answer: 2

Rationale 1: There is no contraindication to the use of lindane (Kwell) in a client with diabetes mellitus.

Rationale 2: Lindane (Kwell) can cause serious nervous system toxicity and should not be used in clients with seizure disorder.

Rationale 3: . There is no contraindication to the use of lindane (Kwell) in a client who has had a stroke.

Rationale 4: There is no contraindication to the use of lindane (Kwell) in a client with hypothyroidism.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 48-5


The primary function of the epidermis is to

1. provide foundation for hair growth.

2. insulate the body.

3. provide a source of energy.

4. form a protective barrier to foreign matter.

Correct Answer: 4

Rationale 1: The dermis provides for hair growth.


Rationale 2: The subcutaneous layer insulates the body.

Rationale 3: The subcutaneous layer provides energy.

Rationale 4: The epidermis is the outermost layer, and provides a protective barrier to foreign material and bacteria.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 48-1


Skin cells in the epidermis are replaced and supplied by the

1. stratum lucidum.

2. dermis basale.

3. melanocytes.

4. stratum basale.

Correct Answer: 4

Rationale 1: The stratum lucidum is the middle layer.

Rationale 2: This is not the layer that supplies new cells.

Rationale 3: Melanocytes provide pigment.

Rationale 4: The stratum basale is the deepest layer, and provides new skin cells.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Learning Outcome: 48-2



Dermatitis is characterized by

1. flaky, silver scales.

2. swelling of nasal tissues.

3. small papules.

4. pruritus.

Correct Answer: 4

Rationale 1: Psoriasis produces red plaques with silver scales.

Rationale 2: Rosacea psoriasis causes swelling around the nasal tissue.

Rationale 3: Rosacea produces small papules with no pus.

Rationale 4: Dermatitis is characterized by redness, pain, and pruritus.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 48-3


The nurse will know that a client with head lice understands principles of scabicides when she can discuss

1. contraceptive measures.

2. proper application with gloves.

3. sun protection.

4. antifungal creams.

Correct Answer: 2


Rationale 1: Contraceptive measures are not necessary with the scabicides.

Rationale 2: Proper application is important, as is the use of gloves.

Rationale 3: Sun protection is no more necessary than usual.

Rationale 4: Antifungal creams are not effective with scabies or lice.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 48-5


A client’s medical record reveals presence of an erythematous urticaric rash with pruritus. What assessment findings would the nurse expect?



1. The area of the rash is red.

2. The area has a raised, bumpy texture.

3. The area involved is warm to the touch.

4. The area itches.

5. The area is scaly.


Rationale 1: Erythema refers to redness often associated with skin rashes.

Rationale 2: Urticaria refers to hives which present as raised “bumps.”

Rationale 3: This may be the case, but the nurse would not expect that from the description given.

Rationale 4: Pruritus is itching.


Rationale 5: While pruritus is often associated with scaly skin, there is nothing in the description that indicates the area is scaly.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 48.7


A client calls the clinic and asks the nurse how to treat a skin injury. What questions should the nurse ask prior to formulating a response?



1. “How deep is the injury?”

2. “How large is the injured area?”

3. “How did the injury happen?”

4. “Did the injury happen over 3 hours ago?”

5. “Where is the injury?”

Correct Answer: 1,2,3,5

Rationale 1: The depth of injury is important in determining if treatment should be topical, systemic, or both.

Rationale 2: Size of skin injury is important in determining if the treatment should be topical, systemic, or both.

Rationale 3: The mechanism of injury is important in determining the potential for the injury to become infected.

Rationale 4: There is no specific length of time that would change therapy.

Rationale 5: The position of the injury is important in determining potential for infection.

Global Rationale:

Cognitive Level: Applying


Client Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 48.5


A client has been prescribed permethrin (Nix) for the treatment of body mites. What medication information should the nurse provide?



1. “Make certain you get the 1% lotion.”

2. “You should leave the lotion on your body for 10 minutes.”

3. “You should expect almost immediate relief from the itching.”

4. “You may feel some stinging or tingling while the lotion is being used.”

5. “You should not use this medication if you are sensitive to chrysanthemums.”


Rationale 1: The 1% lotion is for head lice. This client should obtain the 5% lotion.

Rationale 2: The medication should be allowed to remain on the body for 10 minutes before removal.

Rationale 3: Itching is caused by the penetration of the skin by the mites. It may persist up to 2 or 3 weeks.

Rationale 4: Transient stinging or tingling is often noted with this medication.

Rationale 5: Permethrin is obtained from chrysanthemums.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 48.6

Question 21


Type: MCMA

Lice and body mites have been discovered in an elementary school population. Which instructions should the school nurse send home to parents?



1. “Obtain over-the-counter antiparasitic lotion and apply to your children according to label directions.”

2. “Look for small bugs in your children’s hair or small objects attached to the hair shaft.”

3. “Look for bugs between fingers, under the arms, and in the pubic area.”

4. “Open the windows and doors of your house and let fresh air blow through to eliminate lice and mites in the home.”

5. “If lice or mites are found, stuffed animals should be washed or sealed in an airtight bag for 2 weeks.”

Correct Answer: 2,5

Rationale 1: If children do not have lice or mites treatment is not necessary.

Rationale 2: Lice are small bugs that are found in the hair. The eggs or nits are small objects found attached to the hair shaft.

Rationale 3: Mites are nearly invisible to the naked eye. The parents should look for signs of scratching or complaints of itching in these areas.

Rationale 4: Fresh air will not eliminate the lice or mites.

Rationale 5: Personal objects may harbor and spread the infestation to others or may re-infest the child. All objects should be washed, vacuumed, or sealed in plastic for 2 weeks.

Global Rationale:

Cognitive Level: ApplyingClient Need: Health Promotion and MaintenanceClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 48.5



A client has been prescribed tretinoin (Avita) for treatment of acne. Which medication information should the nurse provide?



1. “It will take several weeks for you to see improvement in your skin.”

2. “You should continue using your over-the-counter oil drying medication until you start to see effects from this medication.”

3. “Mild sun exposure will help this medication work more effectively.”

4. “You will likely notice redness and scaling of your skin while using this medication.”

5. “Continue to take the tetracycline previously prescribed for your cystic acne.”

Correct Answer: 1,4

Rationale 1: Initial improvement may take 4-8 weeks, while maximum therapeutic benefit may take 5-6 months.

Rationale 2: The client should avoid preparations that dry the skin.

Rationale 3: The client should avoid direct exposure to sunlight while using this medication.

Rationale 4: Redness and scaling are expected effects of this medication.

Rationale 5: Additive phototoxicity can occur if tretinoin is used concurrently with tetracycline.

Global Rationale:



A client’s medical record reveals the diagnosis of tinea unguium. The nurse would assess which body part for this disorder?

1. The foot


2. The pubic area

3. The head

4. The nails

Correct Answer: 4

Rationale 1: Tinea pedis is athlete’s foot.

Rationale 2: Tinea cruris or “jock itch” is located in the pubic area and groin.

Rationale 3: Tinea capitis is ringworm of the scalp.

Rationale 4: Tinea unguium is fungal infection of the nails.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 48.5


A client has lice infestation of the eyelids. What instruction should the nurse provide?

1. “Dilute the permethrin lotion with water before applying it to your eyelids.”

2. “These lice should be pulled off manually.”

3. “Apply a thin coat of petroleum jelly to your eyelashes once a day for a week.”

4. “The systemic effect of the lotion you are using on your hair will kill these lice, so no specific treatment is necessary.”

Correct Answer: 3

Rationale 1: Permethrin should not be used on the eyelids.

Rationale 2: While removing the lice manually will work, it is not the best solution to the problem.

Rationale 3: The petroleum jelly will kill the lice which can then be removed by combing.

Rationale 4: Specific treatment is necessary.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Global Rationale:



A client has been prescribed 0.1% tacrolimus (Protopic) for treatment of severe atopic dermatitis. The nurse would evaluate that medication teaching is successful when the client makes which statement?

1. “I could use this for my 1-year-old who also has atopic dermatitis.”

2. “I can use this ointment on an as needed basis for as long as I wish.”

3. “I am at increased risk for skin cancer because I am using this drug.”

4. “I cannot use this ointment on my face.”

Correct Answer: 3

Rationale 1: This medication is not approved for use in children under age 2.

Rationale 2: This drug is generally used for short-term treatment of severe disease.

Rationale 3: There is a small increase in risk of skin cancer when using this drug.

Rationale 4: This medication can be used on the face and neck.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 48.5


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Adams4e Tif Ch48