Question 1

A nurse is teaching a group of nursing students how to examine children in a day care center for pediculus humanus capitis (head lice). Which statement by a student indicates understanding of this teaching?

Accepted Answer

Individuals with head lice may have hives, boils, and impetigo on the scalp as a result of the infestation. Adult head lice are difficult to observe. Head lice occur in all socioeconomic groups. Head lice do not jump or fly.

Question 2

A child is seen in a clinic with a chief complaint of itching, especially at night. The nurse observes small ridges and dotted lines of erythema on the child's neck and buttocks. The nurse will expect the provider to order which medication initially?

Accepted Answer

This child has symptoms of scabies, and permethrin is the first treatment of choice. Benzyl alcohol is used to treat head lice. Ivermectin is an oral medication that can be used but is not a first-line treatment. Malathion may be used for scabies but is not the first choice.

Question 3

A nurse is teaching a parent about treating a child for scabies. Which statement by the parent indicates understanding of the treatment?

Accepted Answer

Besides applying a pesticide-containing cream or lotion, bedding and clothing should be washed to prevent reinfestation. The cream should be applied to the entire body from the neck down, not just areas of irritation. Only one application is necessary. The cream does not cause systemic side effects.

Question 4

Two days after a child is treated with permethrin [Nix] for head lice, a parent calls the clinic to report seeing nits and a few live lice on the child's scalp. The nurse will tell the parent to:

Accepted Answer

A few days after treatment with permethrin, dead lice and remaining live lice, along with nits, should be removed with a fine-toothed comb. It is not necessary to try a different product or to retreat with permethrin until 9 days after treatment. Eradication of head lice does not require shaving or cutting the hair.

Question 5

A patient who has scabies is treated with permethrin 5% cream. The patient calls the nurse 1 week after treatment to report continued intense itching. What will the nurse tell this patient?

Accepted Answer

Intense itching continues for a week or two following treatment with permethrin because the patient's hypersensitivity reaction to the burrowed dead mites, feces, and eggs continues, and itching will continue until the body recovers. It is not a hypersensitivity reaction to the medication. Permethrin is effective in just one application. Ivermectin is not indicated.

Question 6

A patient is treated for Phthirus pubis with permethrin 1% lotion. Two days after using the lotion as directed, the patient calls to report increased itching, erythema, and edema of the pubic skin. What will the nurse tell the patient?

Accepted Answer

Permethrin may cause some exacerbation of the itching, erythema, and edema normally associated with pediculosis, so this is expected. It does not indicate an allergic reaction. There is no need to change to another product or to repeat the application.

Question 7

Which patient should not use lindane?

Accepted Answer

Any patient with a history of seizures should not use lindane, because it is associated with seizures. Patients who have used lindane within the past 2 months are at increased risk for serious side effects with repeated use. Patients with psoriasis or atopic dermatitis should not use lindane. Lindane may be used in patients who weigh more than 110 pounds and in patients with autoimmune disorders.

Question 8

A public health nurse visits with the parents of a child who has body lice. It is most important that the nurse tell the parents that:

Accepted Answer

The nurse should tell the parents that all clothing and bedding must be disinfected. In addition to person-to-person transmission, body lice can be acquired from clothing, furniture, bedding, rugs, and other items. Treatment of skin surfaces does not eradicate the infestation, because body lice reside mainly on clothing. Vigorous scrubbing is not required and may damage the skin.

Question 9

The nurse is caring for a patient with head lice. The nurse practitioner orders malathion [Ovide] for treatment. What information should be provided to the patient?

Accepted Answer

The patient should be informed that scalp irritation occasionally occurs and that the drug does smell bad. Malathion lotion has a high concentration of alcohol and thus presents a risk around fire. A hair dryer should not be used until the alcohol-containing lotion has dried. No drug interactions have been reported with malathion.

Question 10

A parent has used permethrin [Nix] twice to treat head lice in a child. Two weeks after the last treatment, head lice are again found in the child's hair. The parent asks the nurse what to do. The nurse will recommend asking the child's provider about which therapy?

Accepted Answer

Permethrin 1% [Nix] is the drug of choice for lice, but it fails in about 5% of patients as the result of drug resistance. When drug resistance occurs, patients should be treated with malathion or benzyl alcohol. Lindane has serious central nervous system (CNS) side effects and should not be used unless other treatments fail. Cutting the child's hair is not necessary. Permethrin 5% [Elimite] is used to treat scabies.

Question 11

A nurse is teaching a class at a community center on communicable diseases. Which statement by a member of the class best demonstrates understanding of the epidemiology of head lice?

Accepted Answer

All socioeconomic groups are at risk for head lice infestation. Head lice do not only affect people in crowded environments. Humans are the only host for these obligate parasites. Head lice can be transmitted on clothing, hairbrushes, furniture, and other objects. The infestation cannot be acquired through contact with pets or any other animals.

Question 12

A patient has completed treatment with lindane shampoo for pediculosis, but the infestation has not been eradicated. The patient asks the nurse about repeating the treatment. What will the nurse tell the patient?

Accepted Answer

Repeated use of lindane carries a risk of seizures, so repeat dosing should be avoided. Patients should not use lindane if they have used it within the past few months, so 2 to 4 weeks is too soon. Lindane does not have residual therapeutic effects. The type of preparation does not change the recommendation about not repeating the treatments.

Question 13

A parent has been instructed to apply a combination product of pyrethrins with piperonyl butoxide [RID] to treat head lice in a child. The parent asks the nurse why it is necessary to repeat the application in 9 days. The nurse will respond by telling the parent that:

Accepted Answer

Pyrethrins plus piperonyl butoxide is given as two treatments, because the combination is active against adult lice. Ova are not affected, so a second dose is given when those hatch. A second dose does not affect medication resistance. The combination is not toxic in therapeutic doses. Nits and ova are not removed with a second treatment.

Quiz 100: Ectoparasiticides

A nurse is teaching a group of nursing students how to examine children in a day care center for pediculus humanus capitis (head lice) . Which statement by a student indicates understanding of this teaching?