A middle-age female patient presents to the clinic with a recurrence of mild hidradenitis suppurativa after topical therapies failed. Which first-line trea... [Show More] tment is recommended?
(Ans- Tetracycline
Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line treatment for hidradenitis suppurativa.
Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apocrine gland-bearing skin. It is a chronic, disabling disorder that progresses, often causing keloids, contractures, and immobility. It is characterized by comedone-like follicular occlusion, chronic and relapsing inflammation, mucopurulent discharge, and progressive scarring.
Arthropathy associated with hidradenitis may be present. Typical presentation includes nodules and sinus tracts (inflamed or noninflamed), abscesses, and scarring found in the axilla, genitofemoral area, perineum, gluteal area, and inframammary area in women.
Recommended treatments include antibiotics, steroids, retinoids, dapsone, and anti-tumor necrosis factor agents. A dermatology consultation should also be considered.
First-line treatment is a 12 week course of an oral tetracycline (Sumycin) such as doxycycline. For patients who do not respond to doxycycline, the next recommended step is a combination of twice-daily clindamycin (Cleocin) and rifampicin (Rifadin) for 10-12 weeks. If treatment fails, acitretin (Soriatane, for males and nonfertile females) or dapsone (Aczone) may be considered by a dermatologist. In patients with moderate to severe hidradenitis suppurativa, adalimumab (Humira) may possibly be considered.
When providing culturally competent health care services to an American Indian elder, the nurse practitioner understands which is traditionally true? (Ans-
The "Medicine Wheel" is used by many for the purpose of health and healing
The "Medicine Wheel" is traditionally used and contains four directions; north, south, east, and west. Traditionally each tribe has different meanings for each direction and they may represent the season of the year or stage of life. It is aimed at providing a holistic view of life.
An understanding of different cultural preferences leads to cultural competence in healthcare. Some patients may value traditional culture and preferences as it relates to healthcare. These individual preferences should be included in the interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to health care integrating the person, lifestyle, environment, family, and religion. Patients adhering to these traditional cultural practices often feel that illness is due to a lack of harmony with the physical body, mind, spirit, and emotions. Patients may seek care from western medicine for specific ailments while also consulting with traditional healers for spiritual guidance.
Healthcare providers should seek to understand relevant cultural factors and assess each individual's healthcare literacy in order to provide culturally competent care.
The nurse practitioner sees an older adult patient in the clinic with the primary report of hearing loss and a sensation of fullness in the right ear. The nurse practitioner suspects conductive hearing loss. Which could contribute to this?
(Ans- Cerumen, commonly called earwax, is a combination of secretions and sloughed epithelial cells that protects the ears from infection, water, and insects. It is normally expelled from the ear canal through natural jaw movement. When this self-cleaning process fails, cerumen can become impacted. Cerumen impaction occludes the ear canal and can press against the tympanic membrane, resulting in conductive hearing loss.
Conductive hearing is the transition of sound from the external and middle ear to the inner ear. Conductive hearing loss is caused by problems in the external and middle ear that interfere with the transmission of sound and its conversion to mechanical vibration. Causes of conductive hearing loss include obstruction of the external auditory canal by cerumen, foreign bodies, debris from otitis externa, and large exocytosis and osteomas.
Sensorineural hearing loss involves difficulty converting mechanical vibrations to electrical potential in the cochlea or in auditory nerve transmission to the brain. It is mostly caused by permanent damage in the organ of Corti. It can be caused by age-related hearing loss, noise trauma, medications, autoimmune diseases, mechanical trauma, Meniere disease, infection, and neoplasm (acoustic neuroma).
Approximately one-third of older adults between the ages of 61 and 70 years have hearing loss. More than 90% of adults older than 85 years of age have hearing loss. The most common type of hearing loss is age-related and sensorineural. All adults older than 60 years of age should be screened for hearing loss at periodic health examinations.
An otherwise healthy adult patient presents to the clinic with a diagnosis of community-acquired pneumonia and no recent antibiotic therapy. Which is the best option for treatment?
(Ans- Amoxicillin
High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line therapy for adults without comorbidities.
Community-acquired pneumonia (CAP) is pneumonia not acquired in a hospital or long-term care facility. Patients with suspected CAP should receive a chest X-ray for diagnosis. The Pneumonia Severity Index should be used to assist in decisions regarding the need for hospitalization in patients with CAP.
According to the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) 2019 guidelines, the initial treatment of CAP for most patients is amoxicillin or doxycycline. Macrolides are an option for treatment, but are no longer recommended routinely as first-line treatment, given increased macrolide resistance. This is a change from the 2007 ATS/IDSA guidelines. Respiratory fluoroquinolones and amoxicillin/clavulanate should be used in patients who fail first-line medications, have significant comorbidities, have had recent antibiotic therapy, are allergic to alternative agents, or have a documented infection with highly drug-resistant pneumococci.
You have a 35-year-old female patient who is complaining of wrist pain. She is an administrative assistant who does a great deal of computer work in her job. You will test her for carpal tunnel syndrome. When you tap at the volar surface of the wrist you are performing which of the following tests? (Ans- Tinel's sign
A gastrinoma located on the pancreas or the stomach which secretes gastrin, stimulating high levels of acid production in the stomach is which of the following?
(Ans- Zollinger-Ellison syndrome
A 16-year-old male is in the office. He has a insect bite on his left forearm and you suspect a brown recluse spider bite. What medical management would you provide?
(Ans- ice pack and elevation of the area
In addition to being overweight, the American Diabetes Association recommends type 2 diabetes mellitus testing in adults who:
(Ans- have an HDL level of < 35 mg/dL
Which of the following found on an ECG would confirm atrial fibrillation? (Ans-
-absent P waves
-irregular ventricular rate
As an FNP you understand that all of the following statements about chronic heart failure are accurate EXCEPT:
(Ans-
-The preponderance is in females until the age of 75, then there is equal occurrence in males and females. [Show Less]
