A patient taking isotretinoin for severe acne asks about donating blood at a campus drive. What should the nurse say?
Do not donate blood during treatment or for a time after it ends
✓
Donating blood is encouraged to lower vitamin A levels
Donating is safe once a pregnancy test is negative
Only plasma donation needs to be avoided
Correct Answer
Do not donate blood during treatment or for a time after it ends
Blood donated by someone taking isotretinoin could reach a pregnant recipient and harm the fetus, so donation is avoided during treatment and for a period after the last dose. Donating blood is encouraged to lower vitamin A levels is false and not a reason to donate. Donating is safe once a pregnancy test is negative is wrong because the risk is to the recipient, not the donor. Only plasma donation needs to be avoided is wrong; whole blood donation is also off limits.
Category: Isotretinoin Safety
Question 2
Taking isotretinoin together with a tetracycline antibiotic raises the risk of which serious adverse effect?
Serotonin syndrome
Increased intracranial pressure
✓
Severe hypoglycemia
Hearing loss
Correct Answer
Increased intracranial pressure
Both isotretinoin and tetracyclines can cause benign intracranial hypertension (pseudotumor cerebri), with headache, nausea and vision changes, so the two are not used together. Serotonin syndrome is linked to serotonergic drugs, not this pair. Severe hypoglycemia is not an effect of the combination. Hearing loss is not the recognized risk of combining these drugs.
Category: Isotretinoin Safety
Question 3
A patient taking isotretinoin tells the nurse about feeling hopeless and avoiding friends over the past few weeks. What should the nurse do?
Explain that acne often causes sadness
Suggest taking the dose at bedtime instead
Report the mood change to the prescriber right away
✓
Recommend adding a vitamin A supplement
Correct Answer
Report the mood change to the prescriber right away
Isotretinoin labeling warns of depression, psychosis and, rarely, suicidal thoughts, so new mood changes are reported promptly, and the drug may need to be stopped. Explain that acne often causes sadness dismisses a possible serious adverse effect. Suggest taking the dose at bedtime instead does not address the symptom. Recommend adding a vitamin A supplement is unsafe because extra vitamin A adds to isotretinoin toxicity.
Category: Isotretinoin Safety
Question 4
Which laboratory tests are monitored during isotretinoin therapy?
Serum sodium and potassium
Thyroid hormone levels
Platelet aggregation studies
Lipid levels and liver function tests
✓
Correct Answer
Lipid levels and liver function tests
Isotretinoin can raise triglycerides and cholesterol and can elevate liver enzymes, so lipids and liver function are checked before and during treatment. Serum sodium and potassium are not the main concerns with this drug. Thyroid hormone levels are not routinely affected. Platelet aggregation studies are not part of isotretinoin monitoring.
Category: Isotretinoin Safety
Question 5
Why must prescribers, pharmacies and patients enroll in a restricted program before isotretinoin can be dispensed?
To prevent fetal exposure to a drug that causes severe birth defects
✓
To track misuse because it is a controlled substance
To limit liver damage from accidental overdose
To monitor for antibiotic resistance in acne bacteria
Correct Answer
To prevent fetal exposure to a drug that causes severe birth defects
Isotretinoin is a potent teratogen, so the FDA requires a risk management program in which patients who can become pregnant use contraception and have negative pregnancy tests before, during and after treatment. To track misuse because it is a controlled substance is wrong; isotretinoin is not a controlled substance. To limit liver damage from accidental overdose is not the program's purpose. To monitor for antibiotic resistance in acne bacteria is wrong because isotretinoin is not an antibiotic.
Category: Isotretinoin Safety
Question 6
Why is topical clindamycin for acne usually combined with benzoyl peroxide?
Benzoyl peroxide makes clindamycin act systemically
Benzoyl peroxide reduces the development of bacterial resistance
✓
Benzoyl peroxide prevents clindamycin from bleaching fabric
Benzoyl peroxide reduces the development of bacterial resistance
Acne bacteria can become resistant to topical antibiotics used alone, and benzoyl peroxide kills them by a different action to which resistance does not develop, so the combination limits resistance. Benzoyl peroxide makes clindamycin act systemically is false; the goal is local action on the skin. Benzoyl peroxide prevents clindamycin from bleaching fabric is backward, since benzoyl peroxide is the agent that bleaches fabric. Benzoyl peroxide blocks clindamycin-induced photosensitivity is not a recognized effect.
Category: Acne Drugs
Question 7
Which teaching should the nurse give a patient starting topical tretinoin for acne?
Apply a thick layer for faster results
Scrub the skin with an abrasive cleanser first
Acne may seem to worsen early in treatment
✓
Cover treated areas with plastic wrap overnight
Correct Answer
Acne may seem to worsen early in treatment
Tretinoin speeds turnover of cells lining the pores, so existing lesions can surface and acne may look worse in the early weeks before it improves; patients should keep using it as directed. Apply a thick layer for faster results only increases irritation. Scrub the skin with an abrasive cleanser first worsens redness and peeling. Cover treated areas with plastic wrap overnight would increase absorption and irritation, and occlusion is avoided.
Category: Acne Drugs
Question 8
An infant is prescribed hydrocortisone cream for a rash in the diaper area. Which instruction should the nurse give the parent?
Apply a thick layer at every diaper change
Cover the cream with plastic wrap before diapering
Continue the cream indefinitely to prevent new rashes
Avoid tight-fitting diapers or plastic pants over the area
✓
Correct Answer
Avoid tight-fitting diapers or plastic pants over the area
Tight diapers and plastic pants act like an occlusive dressing, which increases absorption of the corticosteroid and the risk of systemic effects in an infant. Apply a thick layer at every diaper change overuses the drug; a thin layer is used. Cover the cream with plastic wrap before diapering creates occlusion. Continue the cream indefinitely to prevent new rashes is wrong because topical steroids are used for the shortest effective time.
Category: Topical Corticosteroids
Question 9
A patient is prescribed clobetasol, a very high-potency topical corticosteroid, for psoriasis. Where should the patient avoid applying it?
On the face, groin or underarms
✓
On the elbows
On the knees
On the scalp
Correct Answer
On the face, groin or underarms
Skin on the face, groin and underarms is thin and absorbs more drug, so very potent steroids there readily cause atrophy and systemic effects. On the elbows is a common psoriasis site with thick skin where clobetasol may be used. On the knees is likewise a thick-skinned plaque site. On the scalp is a site where clobetasol solutions and foams are used.
Category: Topical Corticosteroids
Question 10
Which local adverse effect is linked to long-term use of a potent topical corticosteroid?
Thick, silvery scaling plaques
Thinning of the skin with stretch marks
✓
Excess oil and new comedones
Hardened, leathery calluses
Correct Answer
Thinning of the skin with stretch marks
Prolonged use of potent topical steroids causes skin atrophy, with thin skin, stretch marks (striae), easy bruising and visible small blood vessels. Thick, silvery scaling plaques describe psoriasis, which steroids treat. Excess oil and new comedones are not the typical steroid effect. Hardened, leathery calluses are the opposite of the thinning steroids cause.
Category: Topical Corticosteroids
Question 11
What can happen if a topical corticosteroid alone is applied to a fungal skin infection such as tinea?
The fungus is killed more quickly
The rash is cured without other drugs
The infection can spread and worsen
✓
The skin becomes resistant to infection
Correct Answer
The infection can spread and worsen
A corticosteroid suppresses local immune defenses and does not kill fungi, so the infection can spread and look atypical; topical steroids are contraindicated when fungal infection is present unless an antifungal is also prescribed. The fungus is killed more quickly is false because steroids have no antifungal action. The rash is cured without other drugs is false. The skin becomes resistant to infection is the reverse of what happens.
Category: Topical Corticosteroids
Question 12
Pimecrolimus cream carries a boxed warning about which risk?
Fatal liver failure
Tendon rupture
Severe hypoglycemia
Rare cases of skin cancer and lymphoma
✓
Correct Answer
Rare cases of skin cancer and lymphoma
Rare skin malignancies and lymphomas have been reported with topical calcineurin inhibitors such as pimecrolimus, so they are used only for short or intermittent periods, not continuously. Fatal liver failure is not the boxed warning for this drug. Tendon rupture is a fluoroquinolone warning. Severe hypoglycemia is not a pimecrolimus risk.
Category: Atopic Dermatitis Drugs
Question 13
A patient applying calcipotriene to large areas of psoriasis should be monitored for which imbalance?
Hypercalcemia
✓
Hyponatremia
Hypoglycemia
Hypokalemia
Correct Answer
Hypercalcemia
Calcipotriene is a vitamin D analog, and enough absorption from large areas can raise serum calcium, so patients avoid using more than prescribed and report signs such as nausea, thirst or confusion. Hyponatremia is not linked to calcipotriene. Hypoglycemia is not an effect of vitamin D analogs. Hypokalemia is not a calcipotriene concern.
Category: Psoriasis Drugs
Question 14
Before applying anthralin to psoriasis plaques, what does the nurse do to protect the surrounding healthy skin?
Cover the plaques with plastic wrap overnight
Apply petrolatum to the healthy skin around the plaques
✓
Rub the drug into the normal skin around each plaque
Apply the drug right after a hot bath
Correct Answer
Apply petrolatum to the healthy skin around the plaques
Anthralin irritates and stains normal skin, so a barrier of petrolatum or zinc oxide is placed around the plaques first and the drug is applied only to the lesions. Cover the plaques with plastic wrap overnight would increase irritation through occlusion. Rub the drug into the normal skin around each plaque causes the irritation the nurse is trying to prevent. Apply the drug right after a hot bath is not the protective step.
Category: Psoriasis Drugs
Question 15
A patient receiving methoxsalen with UVA light therapy for psoriasis asks about eye care. What should the nurse teach?
Spend extra time in sunlight to boost the effect
Take the dose after the light session ends
Wear UVA-blocking wraparound sunglasses after each dose
✓
Use a tanning bed between scheduled sessions
Correct Answer
Wear UVA-blocking wraparound sunglasses after each dose
Methoxsalen makes the skin and eyes very sensitive to ultraviolet light and can cause cataracts, so patients wear UVA-blocking wraparound sunglasses for the period specified after each dose. Spend extra time in sunlight to boost the effect risks severe burns. Take the dose after the light session ends is wrong because the drug is taken before UVA exposure. Use a tanning bed between scheduled sessions adds dangerous UV exposure.
Category: Psoriasis Drugs
Question 16
Why must a patient who can become pregnant avoid alcohol while taking acitretin and for a time after stopping it?
Alcohol causes a disulfiram-like reaction with acitretin
Alcohol blocks the absorption of acitretin
Alcohol combined with acitretin causes severe hypoglycemia
Alcohol converts acitretin into a longer-lasting compound that harms a fetus
✓
Correct Answer
Alcohol converts acitretin into a longer-lasting compound that harms a fetus
Alcohol turns acitretin into etretinate, which stays in the body far longer, extending the time a pregnancy could be harmed. Alcohol causes a disulfiram-like reaction with acitretin describes metronidazole, not acitretin. Alcohol blocks the absorption of acitretin is not the reason. Alcohol combined with acitretin causes severe hypoglycemia is not the concern behind the warning.
Category: Psoriasis Drugs
Question 17
A patient treated with permethrin cream for scabies is still itchy after treatment. What should the nurse explain?
Itching can continue for a while after the mites are killed
✓
The treatment failed and must be repeated daily
The itch means the cream was applied too thinly
A topical corticosteroid should be applied under plastic wrap
Correct Answer
Itching can continue for a while after the mites are killed
Itching from scabies is an allergic reaction to the mites and their products, so it often continues for some time after successful treatment and does not by itself mean treatment failed. The treatment failed and must be repeated daily is wrong; repeat treatment is only as prescribed. The itch means the cream was applied too thinly is not a valid conclusion. A topical corticosteroid should be applied under plastic wrap is not advised; occlusion increases steroid absorption.
Category: Antifungals and Antiparasitics
Question 18
Which topical antifungal is effective against Candida but not against the dermatophytes that cause tinea?
Clotrimazole
Nystatin
✓
Miconazole
Terbinafine
Correct Answer
Nystatin
Nystatin is a polyene that acts on Candida yeasts but has no useful activity against dermatophytes, so it is not used for tinea pedis or ringworm. Clotrimazole is an azole active against both Candida and dermatophytes. Miconazole is another azole that treats both. Terbinafine is an allylamine that is highly active against dermatophytes.
Category: Antifungals and Antiparasitics
Question 19
Why is silver sulfadiazine contraindicated in premature infants and young newborns?
Silver blocks newborn thyroid hormone production
The cream causes severe low blood sugar in newborns
Sulfonamides can raise bilirubin and cause kernicterus
✓
Newborn skin cannot absorb the drug
Correct Answer
Sulfonamides can raise bilirubin and cause kernicterus
Silver sulfadiazine is a sulfonamide, and sulfonamides can displace bilirubin from albumin, raising the risk of kernicterus in newborns; for the same reason it is avoided in pregnancy near term and in premature infants. Silver blocks newborn thyroid hormone production is not the reason. The cream causes severe low blood sugar in newborns is not the concern. Newborn skin cannot absorb the drug is false; thin newborn skin absorbs drugs readily.
Category: Burn and Wound Agents
Question 20
A patient with a deep burn is to receive mafenide cream. What should the nurse plan before applying it?
Soak the dressing in cold tap water
Apply a thick layer of petrolatum first
Wrap the burn in plastic after applying
Give an analgesic before the application
✓
Correct Answer
Give an analgesic before the application
Mafenide commonly causes pain and burning when applied, so an analgesic is given beforehand. Soak the dressing in cold tap water is not part of mafenide care and risks contamination and chilling. Apply a thick layer of petrolatum first would block the drug from reaching the wound. Wrap the burn in plastic after applying is not done; mafenide is left uncovered or covered with a light dressing.
Category: Burn and Wound Agents