A nurse is teaching a patient about taking high doses of oral glucocorticoids for an extended period to treat rheumatoid arthritis.
Which of the following instructions should the nurse include in the teaching?

Choice A rationale

Providing mittens might prevent scratching and subsequent skin damage, but it does not address the underlying cause of the pruritus, which is likely residual irritation from the scabies treatment or the scabies mites themselves. While preventing secondary infection from scratching is important, alleviating the itch is the priority for client comfort.

Choice B rationale

Encouraging the client to gently rub the affected area can actually worsen the pruritus. Rubbing can stimulate nerve endings in the skin, further intensifying the sensation of itching and potentially leading to skin irritation and excoriation. Gentle patting or cool compresses are generally more soothing for itchy skin.

Choice C rationale

Applying additional scabicide after the initial treatment is usually not indicated for pruritus following scabies treatment, unless there is evidence of ongoing infestation. Pruritus can persist for several weeks after successful treatment due to the inflammatory response of the skin to the dead mites and their products. Overuse of scabicides can cause further skin irritation.

Choice D rationale

Assisting the client to take a cool shower can help to relieve pruritus by causing vasoconstriction of the superficial blood vessels and reducing the release of histamine and other inflammatory mediators in the skin. The cool temperature can also have a soothing effect on the nerve endings, temporarily alleviating the sensation of itching.

Choice A rationale

Pediculosis refers to an infestation of lice, which typically presents with intense itching and the presence of nits (lice eggs) attached to hair shafts. While there may be redness and irritation from scratching, oozing lesions are not a primary characteristic of pediculosis.

Choice B rationale

Contact dermatitis is an inflammatory skin condition caused by direct contact with an allergen or irritant. It often manifests as pruritus (itching), redness (erythema), and oozing lesions (vesiculation and weeping) at the site of contact. The client's report of pruritus and reddened, oozing lesions on her lower leg is consistent with contact dermatitis.

Choice C rationale

Alopecia refers to hair loss, which can be localized or widespread. It does not typically involve pruritus or oozing lesions on the skin.

Choice D rationale

Tinea pedis, also known as athlete's foot, is a fungal infection of the feet. It commonly presents with scaling, itching, redness, and sometimes blistering, but oozing lesions are less typical unless there is a secondary bacterial infection. The location on the lower leg is also less common for tinea pedis, which primarily affects the feet. .