A nurse is reinforcing teaching about fluticasone topical lotion with the parent of a 9-month-old infant who has atopic dermatitis on the wrist. Which of the following instructions should the nurse include?

"Place a thick layer of the medication on open areas.”

“Rub the medication until it disappears.”

"Cover the area with an occlusive dressing.”

"Apply the medication to your infant's entire arm.”

Answer and Explanation

The Correct Answer is B

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.

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Correct Answer is C

Explanation

A. "Limit potassium-containing foods in your diet." Long-term prednisone use can lead to hypokalemia (low potassium levels) due to its mineralocorticoid effects, which increase potassium excretion. Clients on chronic corticosteroid therapy may actually need to consume potassium-rich foods to help maintain electrolyte balance, rather than restricting them.

B. "Withhold prednisone for 48 hours prior to receiving contrast dye." There is no general recommendation to withhold prednisone before contrast dye administration. However, clients on long-term steroid therapy may require stress-dose steroids if undergoing procedures that could trigger an adrenal crisis. Withholding prednisone without provider guidance could increase the risk of adrenal insufficiency.

C. "Measure your blood glucose levels periodically." Prednisone can cause hyperglycemia by increasing insulin resistance and promoting gluconeogenesis. Clients, especially those with diabetes or at risk for metabolic syndrome, should monitor blood glucose levels regularly to detect potential steroid-induced diabetes. Adjustments in diet or medication may be needed based on blood glucose trends.

D. "Take prednisone on an empty stomach." Taking prednisone on an empty stomach can increase the risk of gastrointestinal irritation, ulcers, and gastritis. It should be taken with food or milk to help reduce stomach irritation and minimize gastrointestinal side effects. Clients should be advised to follow this guideline to prevent discomfort and potential complications.

A. Baker's yeast B. Nuts C. Wheat D. Egg yolk

Correct Answer is A

Explanation

A. Baker's yeast. The hepatitis B vaccine is contraindicated in individuals with a severe allergy to baker’s yeast. This is because the vaccine is produced using Saccharomyces cerevisiae (baker’s yeast), which can trigger an allergic reaction in susceptible individuals. Symptoms of a yeast allergy may include rash, difficulty breathing, and anaphylaxis, requiring the vaccine to be withheld and an alternative plan considered.

B. Nuts. Nut allergies are not related to the hepatitis B vaccine, as it does not contain nut-derived ingredients. While nut allergies can be severe and cause anaphylaxis, they do not pose a specific risk in the administration of this vaccine. Therefore, the presence of a nut allergy alone does not require withholding the immunization.

C. Wheat. A wheat allergy is not a contraindication for the hepatitis B vaccine. Wheat allergies primarily cause reactions to gluten-containing foods or products but do not have any connection to the components used in the production of the vaccine. The vaccine can be safely administered to individuals with wheat allergies.

D. Egg yolk. While some vaccines, such as the influenza vaccine, may be derived from egg proteins, the hepatitis B vaccine is not produced using egg-based components. An allergy to egg yolk does not pose a risk for adverse reactions to this vaccine, so it should not be withheld in individuals with an egg allergy.

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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 reinforcing teaching about fluticasone topical lotion with the parent of a 9-month-old infant who has atopic dermatitis on the wrist. Which of the following instructions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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