A nurse is preparing to insert a miconazole vaginal suppository for a client who has vulvovaginal candidiasis. Which of the following actions is appropriate for inserting this medication?

Assist the client to a left lateral position.

Insert the suppository along the posterior wall of the vaginal canal

Apply a light coating of petroleum jelly to the suppository.

Put on sterile gloves before handling the suppository.

Answer and Explanation

The Correct Answer is B

A. Assist the client to a left lateral position. The preferred position for vaginal suppository insertion is the dorsal recumbent (lying on the back with knees bent) or the lithotomy position. The left lateral position is typically used for rectal suppository administration, not vaginal medication insertion.

B. Insert the suppository along the posterior wall of the vaginal canal. The suppository should be inserted along the posterior vaginal wall, as this allows for proper absorption and helps ensure the medication remains in place. The client should be advised to lie down for at least 10-15 minutes after insertion to prevent the suppository from slipping out.

C. Apply a light coating of petroleum jelly to the suppository. Petroleum jelly should never be used as it can interfere with medication absorption and may break down the suppository. If lubrication is needed, a small amount of water-soluble lubricant (e.g., KY Jelly) can be applied to facilitate insertion.

D. Put on sterile gloves before handling the suppository. Clean gloves (not sterile gloves) are sufficient for vaginal suppository administration. The vaginal canal is not a sterile environment, so strict aseptic technique is not required. However, proper hand hygiene and glove use are essential to prevent contamination and infection.

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Correct Answer is B

Explanation

A. "Place a thick layer of the medication on open areas." Topical corticosteroids like fluticasone should not be applied in thick layers or to open wounds, as excessive absorption can lead to systemic side effects such as adrenal suppression. A thin layer is sufficient to achieve the desired anti-inflammatory effects while minimizing adverse reactions.

B. “Rub the medication until it disappears.” Topical corticosteroids should be applied in a thin layer and gently rubbed into the skin until no visible residue remains. This ensures even absorption without excessive medication buildup, reducing the risk of local and systemic side effects, especially in infants who have a higher risk of absorption due to their thinner skin.

C. "Cover the area with an occlusive dressing." Occlusive dressings increase medication absorption, which can lead to systemic corticosteroid effects such as skin thinning, delayed wound healing, and adrenal suppression. Occlusion should only be used under medical supervision, especially in infants who are more susceptible to these effects.

D. "Apply the medication to your infant's entire arm." Fluticasone should be applied only to affected areas, not the entire limb. Applying it over a larger area than necessary increases the risk of systemic absorption and side effects. The medication should be used only as directed for targeted treatment of atopic dermatitis.

A. Cover the administration area with plastic wrap. B. Massage the ointment into the skin. C. Spread the ointment in a 10 cm2 (4in2) area. D. Apply the ointment in a thick layer.

Correct Answer is A

Explanation

A. Cover the administration area with plastic wrap. After applying nitroglycerin ointment, the area should be covered with plastic wrap or a transparent dressing to prevent evaporation and ensure proper absorption through the skin. This also helps prevent the medication from accidentally transferring to another person or clothing.

B. Massage the ointment into the skin. Nitroglycerin ointment should not be massaged into the skin, as this can cause rapid absorption and lead to hypotension and dizziness due to vasodilation. Instead, it should be applied as a thin, even layer and covered with a dressing.

C. Spread the ointment in a 10 cm² (4 in²) area. The correct application method involves measuring the exact prescribed amount (e.g., using the applicator paper) and applying it in a thin layer. The area of application may vary based on the dosage, but the focus should be on accurate measurement, not a specific area size.

D. Apply the ointment in a thick layer. A thick application is unnecessary and could increase absorption too quickly, leading to side effects such as headache, dizziness, and hypotension. Instead, a measured dose should be spread thinly and evenly onto clean, dry skin.

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Body System	Findings
Vital Signs/General History	Temperature 36.4° C (97.6° F), oral Heart rate 75/min Respiratory rate 16/min Blood pressure 100/74mm Hg Oxygen saturation 99% on room air Client is a vegetarian and takes a multivitamin daily Client reports having three to four alcoholic beverages a couple times per week
Integumentary	Skin color is consistent with genetic background. No rashes or lesions. The client varicose veins.
Cardiovascular/ Respiratory	S1 S2 auscultated. No murmurs. All peripheral pulses 2+ Lung sounds clear bilaterally
Gastrointestinal/Genitourinary	Abdomen soft, nontender. Normoactive bowel sounds in all 4 quadrants. Last bowel movement was 3 days ago. Voids four to five times a day. Urine is clear, yellow, and odourless. Last menstrual period was 3 months ago
Neurologic/Musculoskeletal	Alert and oriented to person, place, and time. Client takes diazepam as needed for anxiety. Client has full range of motion and is able to maintain flexion against resistance in all four extremities

A nurse is preparing to insert a miconazole vaginal suppository for a client who has vulvovaginal candidiasis. Which of the following actions is appropriate for inserting this medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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