Other Dermatologic Condition Drugs and Topical Anti-infectives for Burns

Every question here, with the answer

1. A client with a large second-degree burn is prescribed silver sulfadiazine cream. Which item in the client's history should the nurse report before applying it?

   1. Seasonal allergies to pollen
   2. Sulfa allergy
   3. History of acne
   4. Lactose intolerance

   Answer: Sulfa allergy

   Silver sulfadiazine and mafenide acetate are sulfa compounds that should not be given to clients with sulfa allergies. The other history items are not contraindications named in the section.

2. A client using metronidazole gel for rosacea says she plans to have wine at a party this weekend. What should the nurse explain?

   1. She only needs to skip the evening dose.
   2. Alcohol with metronidazole may cause a disulfiram-like reaction with palpitations, flushing and nausea.
   3. Alcohol makes the gel work faster.
   4. Alcohol has no effect on topical medications.

   Answer: Alcohol with metronidazole may cause a disulfiram-like reaction with palpitations, flushing and nausea.

   When metronidazole is absorbed systemically, mixing it with alcohol may cause a life-threatening disulfiram-like reaction with palpitations, diaphoresis, flushing, nausea and tachycardia. Skipping one dose does not remove the risk described.

3. The nurse is applying silver sulfadiazine to a client's burn. Which actions are appropriate? Select all that apply.

   1. Apply the cream with gloves.
   2. Keep the burn completely covered with cream.
   3. Cover the cream with an occlusive dressing to hold it in place.
   4. Maintain aseptic technique.
   5. Monitor creatinine for effects of systemic absorption.

   Answer: Apply the cream with gloves., Keep the burn completely covered with cream., Maintain aseptic technique., Monitor creatinine for effects of systemic absorption.

   The nurse applies burn creams with gloves and aseptic technique, keeps the burn fully covered with cream to prevent colonization, and monitors creatinine for systemic absorption. Occlusive dressings are contraindicated because they increase systemic absorption.

4. A parent wants to cover their child's hydrocortisone-treated eczema with plastic wrap overnight to make it work better. What is the nurse's best response?

   1. "That is a good way to increase the effect."
   2. "Plastic wrap will prevent all side effects."
   3. "Plastic wrap is only a problem with antibiotic ointments."
   4. "Plastic wrap can cause the steroid to be absorbed into the body and cause systemic side effects."

   Answer: "Plastic wrap can cause the steroid to be absorbed into the body and cause systemic side effects."

   Topical steroids are meant to act locally; under an occlusive dressing systemic absorption may occur and cause systemic side effects. Breathable gauze may be used instead.

5. A client with a minor burn is going home with a topical anti-infective cream. Which findings should the client report to the provider? Select all that apply.

   1. Drainage from the burn
   2. Odor from the wound
   3. The cream feels cool on application
   4. Temperature above 100.4°F
   5. Excessive dryness or peeling

   Answer: Drainage from the burn, Odor from the wound, Temperature above 100.4°F, Excessive dryness or peeling

   Clients report drainage, odor, fever above 100.4°F and side effects such as redness, excessive dryness or peeling. A cool feeling on application is not listed as a problem.

6. A parent asks whether their child's eczema can be treated with pimecrolimus cream every day for years. Which response is accurate?

   1. Long-term use is preferred because it prevents all flares.
   2. It is safe for continuous use in any age group.
   3. Long-term use is contraindicated because it has been linked to lymphomas.
   4. It is recommended for infants under 2 years.

   Answer: Long-term use is contraindicated because it has been linked to lymphomas.

   Long-term use of pimecrolimus has been associated with lymphomas and skin malignancies, so continuous long-term use is contraindicated in any age group, and it is not indicated for children under 2.