NURSING MISC APEA TEST BANK
A patient with iron deficiency anemia takes iron supplementation daily. What should he be advised to avoid within a couple of
... [Show More] hours of taking iron?
Leukemia may have varied clinical presentations. Which characteristic would be unusual to find in a patient with leukemia?
A 66 year-old African American male complains of pain in his trunk, especially his ribs. Cardiovascular disease is ruled out. He has a normocytic, normochromic anemia with hypercalcemia. The differential diagnosis should include:
What hallmark finding is associated with both B12 and folate deficiencies?
A patient demonstrates leukocytosis. This means:
What statement is true about anemia in older adults?
A patient has been treated for HIV infection with anti-retroviral therapy. He is stable. How often should CD4 counts be repeated?
A patient presents with hematuria, RBC casts, and proteinuria. What is a likely explanation?
A patient demonstrates leukocytosis. This means:
A patient is having an allergic reaction to seafood. Which white cell will probably be increased?
A female patient has been diagnosed with Glucose-6-phosphate dehydrogenase deficiency (G6PD). What should be done to prevent lysis of red cells in this patient?
A 75 year-old patient who has multiple chronic diseases has been in very poor health for a decade. What type of anemias is he most likely to exhibit?
A patient has been diagnosed with HIV. The patient’s viral load was ordered. What other test may be ordered to assess the status of the patient’s immune system?
A 70 year-old male has lymph nodes in his axillary and inguinal areas that are palpable but non-tender. He states that he feels well today. What should be included in a
An antacid Sickle shaped cells multiple myeloma. Macrocytosis he has an infection of unknown origin.
Anemia may have more than one origin and co-exist in older adults.
Every 3-6 months Glomerulonephritis
he has an infection of unknown origin.
Eosinophils Avoid aspirin and sulfa drugs Folic acid and pernicious CD4 cell count Lymphomadifferential diagnosis for this patient?
A two year-old with sickle cell anemia (SCA)
should receive which immunizations?
A three year-old child presents with
hematuria, petechiae, and a platelet count
of 50,000 (Normal = 150,000-450,000/ml).
The rest of his CBC is normal. He had an
upper respiratory infection about 2 weeks
ago. On exam today, he is found to have
petechiae and bruises. The most likely
diagnosis is:
A child and father live in an old house. They
both are found to be lead toxic. What type
anemia is typically observed in patients who
are lead toxic?
A patient with diarrhea has a stool
specimen positive for WBCs. What does this
indicate?
A 26 year-old female has thalassemia minor.
What should be limited in her diet to avoid
hepatotoxicity?
A patient is found to have eosinophilia. An expected
finding is:
An African American male complains of pain
in his back and trunk. He is diagnosed with
multiple myeloma. He is probably:
A patient has heavy menses. Which lab
value below reflects an iron deficiency
anemia?
An obese 78 year-old male with poorly
controlled hypertension and diabetes has a
normocytic, normochromic anemia. This
anemia is likely:
An elderly male diagnosed with a microcytic,
hypochromic anemia:
All routine childhood
immunizations at the usual
time
idiopathic
thrombocytopenia
purpura (ITP).
Iron deficiency anemia
A viral infection
Multi-vitamin with iron
asthma exacerbation.
about 65 years old.
Increased TIBC
associated with chronic disease. .
.
may have a GI bleed.
Which suggestion below is the standard for
treating iron deficiency anemia in infants
and children?
Iron supplementation in
divided doses between meals
with orange juice
A patient with pernicious anemia may be
observed to have:
Lead toxicity can be associated with:
glossitis.
sideroblastic anemia.A patient is being treated for iron deficiency
anemia. Iron is better absorbed:
on an empty stomach.
What choice below can be attributed to the
two most common causes of iron deficiency
anemia in adults?
The laboratory identifies metamyelocytes in
a 50 year-old patient who had a CBC
performed. What might be an expected
finding in this patient?
A patient is found to have an anemia. The
patient’s MCH is normal. The patient’s
anemia can be described as:
Which statement is true about Vitamin B-
12?
A serum ferritin level:
Which anemias are described as microcytic,
hypochromic anemias?
The nurse practitioner sees a child who
presents with fatigue and purpura on his
lower extremities. His temperature is
normal. The differential includes:
An older adult has suspected B12 deficiency.
Which of the following lab indices is most
indicative of a B12 deficiency?
A patient with anemia of chronic disease
probably has a:
A vitamin B-12 deficiency might be
suspected in an older patient with what
complaints?
A measure of the degree of variation in red
cell size is indicated by:
A definitive diagnosis of sickle cell anemia
can be made:
An example of a macrocytic anemia is:
An older adult has suspected B12 deficiency.
Which of the following lab indices is more
indicative of a B12 deficiency?
Besides inadequate intake of Vitamin D in
elder adults, what other factor contributes
to deficiencies?
Which white cell should be present in the
greatest number in a patient who is healthy
today?
A patient has CBC results that indicate a
microcytic, hypochromic anemia. The nurse
practitioner should suspect:
A 12 month-old was screened for iron
Gynecologic losses and
bleeding in the
gastrointestinal tract
Splenomegaly
normochromic.
Inadequate amounts can produce
cognitive changes.
demonstrates the amount
of iron in storage.
Iron deficiency anemia and
thalassemia
acute leukemia.
Increased MCV
normocytic anemia.
Memory issues and glossitis
RDW.
by a hemoglobin electrophoresis. .
pernicious anemia.
Macrocytosis
Impaired synthesis of previtamin D
Neutrophils
iron deficiency anemia.A patient is found to have an anemia. The
patient’s MCV is normal. The patient’s
anemia can be described as:
normocytic.
A B-12 deficiency can produce:
Thalassemia minor can be recognized by:
pernicious anemia.
microcytic, hypochromic
red cells.
A patient had a splenectomy after an automobile accident 3 months ago. Patients
who are asplenic are:
An example of a first generation
cephalosporin used to treat a skin
infection is:
cephalexin.
A 4 year-old has been diagnosed
with measles. The nurse
practitioner identifies Koplik’s
spots. These are:
The main difference between cellulitis
and erysipelas is the:
A patient reports that he found a
tick on himself about one month
ago. He reports that there is a red
circle and a white center near
where he remembers the tick bite.
He did not seek treatment at the
time. Today he complains of
myalgias and arthralgias. What
laboratory test can be used to help
diagnose Lyme disease?
A patient who is at high risk for
skin cancer should:
A patient has a “herald patch” and
is diagnosed with pityriasis rosea.
Where is the “herald patch” found?
Which of the following antibiotics
found on the
inside of the
cheek and are
granular.
layer of skin
involvement.
more
suscep
tible
to
bacter
ial
infecti
on.
ELISA
examine his
skin monthly
for changes.
On the chest
Fluoroquinolonesmay increase the likelihood of
photosensitivity?
A 60 year-old patient is noted to
have rounding of the distal
phalanx of the fingers. What might
have caused this?
Hepatic cirrhosis
A patient exhibits petechiae on
both lower legs but has no other
complaints. How should the NP
proceed?
When can a child with chickenpox
return to daycare?
Hand-foot-and-mouth disease and
herpangina:
What is the proper technique to
safely remove a tick from a
human?
Most cases of atopic dermatitis
exacerbation are treated with:
The primary therapeutic
intervention for patients who
present with hives is:
A patient is diagnosed with tinea
pedis. A microscopic examination
of the sample taken from the
infected area would likely
demonstrate:
A patient has been diagnosed with
scabies. What is the medication of
choice to treat this?
An adolescent has acne. The nurse
practitioner prescribed a benzoyl
peroxide product for him. What
important teaching point should
be given to this adolescent
regarding the benzoyl peroxide?
A patient presents with plaques on
the extensor surface of the elbows,
knees, and back. The plaques are
erythematous and there are thick,
silvery scales. This is likely:
An infant is diagnosed with diaper
dermatitis. Satellite lesions are
Order a CBC
After all lesions have crusted over
are viral infections caused by
Coxsackie viruses.
Pull it off with tweezers
topical steroids.
anti-histamines.
hyphae.
Permethrin
Photosensitivity of the skin can
occur
plaque psoriasis.
topical anti-fungal agent.visible. This should be treated with
a:
A key component of the approach
to a patient who has atopic
dermatitis is hydration. Which
agent should be avoided?
Patients with atopic dermatitis are
likely to exhibit:
A 16 year-old has been diagnosed
with Lyme disease. Which drug
should be used to treat him?
A 28 year-old has thick,
demarcated plaques on her
elbows. Which features are
suggestive of psoriasis?
A 71 year-old female presents
with a vesicular rash that burns
and itches. Shingles is diagnosed.
An oral antiviral:
A patient was burned with hot
water. He has several large fluid
filled lesions. What are these
termed?
A patient with a primary case of
scabies was probably infected:
A patient has a lower leg wound
that appears infected. It is red,
warm to touch and edematous. He
had an acute onset of pain,
symptoms, and low grade fever.
What is this?
A 15 year-old male has worked
this summer as a lifeguard at a
local swimming pool. He
complains of itching in the groin
area. He is diagnosed with tinea
cruris. The nurse practitioner is
likely to identify:
A patient has been diagnosed with
MRSA. She is sulfa allergic. Which
medication could be used to treat
her?
Lotions
Itching.
Doxycycline
Silvery scales that are not pruritic
should be started within 72 hours
of the onset of symptoms.
Bullae
3-4 weeks ago.
Erysipelas
well marginated half moon macules
on the inner thigh.
Doxycycline
A skin lesion which is a solid mass papule.is described as a:
Impetigo is characterized by:
A 10 year-old has thick,
demarcated plaques on her
elbows. Which features are
suggestive of psoriasis?
The agent commonly used to treat
patients with scabies is
permethrin. How often is it applied
to eradicate scabies?
Which test is NOT suitable to
diagnose shingles if the clinical
presentation is questionable?
A 74 year-old is diagnosed with
shingles. The NP is deciding how
to best manage her care. What
should be prescribed?
The term caput succedaneum
refers to:
A pregnant mother in her first
trimester has a 5 year-old who has
Fifth Disease. What implication
does this have for the mother?
A topical treatment for basal cell
carcinoma is:
The most common form of skin
cancer is:
A skin disorder has a hallmark
finding of silvery scales. What
word below describes this
common condition?
The most common place for basal
cell carcinoma to be found is the:
A low potency topical
hydrocortisone cream would be
most appropriate in a patient who
has been diagnosed with:
A patient with a positive history of
a tick bite about 2 weeks ago and
erythema migrans has a positive
ELISA for Borrelia. The Western
blot is positive. How should he be
managed?
honey-colored crusts.
Silvery scales that are not pruritic
Once
Complete blood count (CBC)
An oral antiviral agent
scalp edema.
There is a risk of fetal death if she
becomes infected.
5-fluorouracil.
basal cell carcinoma.
Chronic
face.
atopic dermatitis.
He should receive doxycycline for
Lyme disease.A 16 year-old male has
nodulocystic acne. What might
have the greatest positive impact
in managing his acne?
A patient who has been in the sun
for the past few weeks is very
tanned. He has numerous 3-6 mm
light colored flat lesions on his
trunk. What is the likely etiology?
A skin lesion fluoresces under a
Wood’s lamp. What microscopic
finding is consistent with this?
An example of a premalignant
lesion that develops on sun-
damaged skin is:
Isotretinoin (Accutane®)
Tinea versicolor
Hyphae
actinic keratosis.
A 9 year-old female has presented
to your clinic because of a rash on
the left, upper area of her anterior
trunk. She is embarrassed and very
reticent to lift her blouse because
her nipple will be exposed. How
should the NP proceed?
A patient reports to the minor care
area of the emergency department
after being bitten by a dog. The
patient states that the dog had a
tag around his neck and had been
seen roaming around the
neighborhood. The dog did not
exhibit any odd behavior. How
should this be managed?
A patient has seborrheic
dermatitis. Which vehicle would be
most appropriate to use in the
hairline area to treat this?
A 68 year old female adult with
pendulous breasts complains of
“burning” under her right breast.
The nurse practitioner observes a
malodorous discharge with mild
maceration under both breasts.
What is this?
Examine all other areas of the trunk,
then ask the child to lift her blouse
Report the bite to animal control
and administer appropriate medical
care.
Foam
IntertrigoA patient is found to have
koilonychia. What laboratory test
would be prudent to perform?
Which of the following areas of the
body has the greatest
percutaneous absorption?
A patient calls your office. He
states that he just came in from the
woods and discovered a tick on his
upper arm. He states that he has
removed the tick and the area is
slightly red. What should he be
advised?
A patient will be taking oral
terbinafine for fingernail fungus.
The NP knows that:
An elderly patient has been
diagnosed with shingles on the
right lateral aspect of her trunk. It
appeared initially yesterday. It is
very painful. How should she be
managed?
A young child has developed a
circumferential lesion on her inner
forearm. It is slightly raised, red
and is pruritic. It is about 2.5 cm in
diameter. This is probably related
to:
Which chronic skin disorder
primarily affects hairy areas of the
body?
A microscopic examination of the
sample taken from a skin lesion
indicates hyphae. What type
infection might this indicate?
A 40 year-old female patient
presents to the clinic with
multiple, painful reddened nodules
on the anterior surface of both
legs. She is concerned. These are
probably associated with her
history of:
Seborrheic dermatitis
Fungal
Complete blood count
Genitalia
No treatment is needed.
Terbinafine is a potent inhibitor of
the CYP 3A4 enzymes.
An oral antiviral agent and pain
medication.
the child’s new cat.
ulcerative colitis.
What advice should be given to a A parent may experience jointparent who has a child with Fifth
Disease?
What finding characterizes
shingles?
A 70 year-old is diagnosed with
multiple cherry angiomas. The
nurse practitioner knows that:
A patient with diabetes has a right
lower leg that has recently become
edematous, erythematous, and
tender to touch over the anterior
shin. There is no evidence of pus,
but the leg is warm to touch. What
is the most likely diagnosis to
consider?
The American Cancer Society uses
an ABCDE pneumonic to help
patients develop awareness of
suspicious skin lesions. What does
the “B” represent?
A 9 year-old has been diagnosed
with chickenpox. A drug that
should be avoided in him is:
Mr. Johnson is a 74 year old who
presents with a pearly-domed
nodular looking lesion on the back
of the neck. It does not hurt or itch.
What is a likely etiology?
A 3 year-old female had a fever of
102 degrees F for 3 days. Today
she woke up from a nap and is
afebrile. She has a maculopapular
rash. Which statement is true?
The lesions seen in a patient with
folliculitis might be filled with:
A child has 8-10 medium brown
café au lait spots > 1 cm in
diameter. The differential
diagnosis should include:
A patient presents with small
vesicles on the lateral edges of his
fingers and intense itching. On
close inspection, there are small
aches and pains.
Unilateral dermatomal rash
these may bleed profusely if
ruptured.
Cellulitis
Border
aspirin.
Basal cell carcinoma
The rash will blanch.
pus.
neurofibromatosis.
Dyshidrotic dermatitisvesicles on the palmar surface of
the hand. What is this called?
The nurse practitioner examines a
patient who has had poison ivy for
3 days. She asks if she can spread it
to her family members. The nurse
practitioner replies:
A patient who is at high risk for
skin cancer should:
A patient has used a high potency
topical steroid cream for years to
treat psoriasis exacerbations when
they occur. She presents today and
states that this cream “just doesn’t
work anymore.” What word
describes this?
Topical 5-fluorouracil (5-FU) is
used to treat:
A “herald patch” is a hallmark
finding in which condition?
The nurse practitioner identifies
satellite lesions in a 6 month-old
infant. These are:
The nurse practitioner is
examining a 3-month old infant
who has normal development. She
has identified an alopecic area at
the occiput. What should be done?
A 6 year-old has been diagnosed
with Lyme disease. Which drug
should be used to treat him?
A child with a sandpaper textured
rash probably has:
An adolescent takes isotretinoin
for nodulocystic acne. She is on
oral contraceptives. Both were
prescribed by the dermatologist.
The adolescent arrives in your
clinic with a sinus infection. Her
temperature is 99.5 degrees F and
her blood pressure is 160/100.
How should this be managed?
“no, transmission does not occur
from the blister’s contents.”
examine his skin monthly for
changes.
Tachyphylaxis
basal cell carcinoma.
Pityriasis rosea
indicative of candidal infection.
Encourage the caregiver to change
the infant’s head position
Amoxicillin
strept infection.
Call the dermatologist to report the
elevated BP
Which of the following skin lesions Actinic keratosisin the elderly is a premalignant
condition?
A patient has suspected scarlet
fever. He likely has a sandpaper
rash and:
A 6 year-old patient with sore
throat has coryza, hoarseness, and
diarrhea. What is the likely
etiology?
A 74 year-old male patient has
sustained a laceration to his foot.
His last tetanus shot was more
than 10 years ago. He has
completed the primary series.
What should be recommended?
The best way to evaluate jaundice
associated with liver disease is to
observe:
a positive rapid strept test.
Viral etiology
Tetanus, diphtheria, and acellular
pertussis (Tdap)
the sclera, skin, and lips.
Question:
A 40 year-old female patient presents to the clinic with multiple, painful reddened nodules on the anterior
surface of both legs. She is concerned. These are probably associated with her history of:
deep vein thrombosis.phlebitis. Incorrectulcerative colitis. Correctalcoholism.
Explanation:
These nodules describe erythema nodosum. These are most common in women aged 15-40 years old. They
are typically found in pretibial locations and can be associated with infectious agents, drugs, or systemic
inflammatory disease like ulcerative colitis. They probably occur as a result of a delayed hypersensitivity
reaction to antigens. It is not unusual to find polyarthralgia, fever, and or malaise that precede or
accompany the skin nodules.
Question:
A patient reports that he found a tick on himself about one month ago. He reports that there is a red circle
and a white center near where he remembers the tick bite. He did not seek treatment at the time. Today he
complains of myalgias and arthralgias. What laboratory test can be used to help diagnose Lyme disease?
CBCLyme titerELISA CorrectSkin scraping
Explanation:
A detailed history should always precede testing for Lyme Disease. The red circle with the white center is
likely erythema migrans (EM). EM is the characteristic skin lesion of Lyme Disease (and other illnesses)
and usually occurs within one month following the tick bite. Many learned authorities including the
Infectious Diseases Society of America conclude that individuals should not be screened/tested for Lyme
disease unless they have a high probability of having Lyme disease. In this case, historical features coupledwith physical exam support the diagnosis, and thus screening. The most common initial serologic test for
screening is an ELISA. If it is positive, it should be confirmed with a Western blot. Unfortunately, there are
a large number of false positives and so a confirmation should be performed
Question:
An adolescent takes isotretinoin for nodulocystic acne. She is on oral contraceptives. Both were prescribed
by the dermatologist. The adolescent arrives in your clinic with a sinus infection. Her temperature is 99.5
degrees F and her blood pressure is 160/100. How should this be managed?
Call the dermatologist to report the elevated BP CorrectTreat the sinus infection and recheck the BP in one
week IncorrectDiscontinue the isotretinoin todayDiscontinue the oral contraceptive today
Explanation:
The nurse practitioner is responsible for treating the sinus infection but has also become aware of a
potentially harmful situation involving the elevated blood pressure and oral contraceptive use. The safest
and most professional action is to call the dermatologist to discuss your concerns regarding the elevated BP
and concomitant oral contraceptive use since this potentially increases the risk of stroke in this adolescent.
Care and professional courtesy should be exercised when discontinuing a medication that another provider
has initiated. Professional courtesy is extended to the prescriber by calling them prior to discontinuing a
medication they have ordered.
Question:
The agent commonly used to treat patients with scabies is permethrin. How often is it applied to eradicate
scabies?
Once CorrectOnce daily for 3 daysTwice daily for 3 daysOnce daily for one week Incorrect
Explanation:
A single whole body application of permethrin is usually successful in eradicating infection with scabies. It
is applied over the entire body from the neck down. The lotion is left on and then showered off 8-12 hours
later. All contacts must be treated at the same time and all potential fomites (bed linen, mattresses, cloth
furniture, etc.) must be treated as well. Permethrin can be sprayed on cloth fomites or they can be bagged
for several days, washed and dried in washing machine and dryer. Ironing clothes after washing them is
acceptable.
Question:
An infant is diagnosed with diaper dermatitis. Satellite lesions are visible. This should be treated with a:
moisture barrier like zinc oxide.topical anti-fungal agent. Correcttopical anti-bacterial agent.low potency
steroid cream.
Explanation:
The finding of satellite lesions associated with diaper dermatitis indicates a Candidal infection. This patient
will be most effectively treated with a topical anti-fungal agent, allowing the lesions to be exposed to air for
periods of time (like during a nap). A moisture barrier like zinc oxide is more beneficial when the diaper
dermatitis is due to irritants like prolonged exposure to urine or feces. A low potency steroid cream should
be used with caution in an infant with a fungal infection. A low potency cream in conjunction with an anti-
fungal can be helpful if there is a great amount of underlying inflammation but has the potential to worsen
the infection.
Question:
A 16 year-old has been diagnosed with Lyme disease. Which drug should be used to treat him?
Doxycycline CorrectAmoxicillin-clavulanateTrimethoprim-sulfamethoxazoleCephalexin
Explanation:
Doxycycline is frequently chosen first line to treat Lyme Disease. However, numerous studies have
demonstrated that amoxicillin and cefuroxime have equal efficacy as doxycycline in treatment of early
Lyme Disease. These drugs are recommended in patients who exhibit erythema migrans. Doxycycline is
not recommended in children less than 9 years of age
Question:An elderly patient has been diagnosed with shingles on the right lateral aspect of her trunk. It appeared
initially yesterday. It is very painful. How should she be managed?
Treatment with a topical lidocaine patch only.An oral antiviral agent and NSAIDs. IncorrectAn oral
antiviral agent and pain medication. CorrectAn oral antiviral agent, pain medication, and oral steroids.
Explanation:
The primary goal of antiviral therapy in a patient diagnosed with shingles is to reduce the risk of, or
severity of post-herpetic neuralgia. Since she has been identified within 72 hours of onset of lesions, she
can be treated with most benefit with an oral antiviral agent. Studies do not demonstrate that patients have
reduction of pain or resolution of symptoms faster if oral steroids are given. They should be avoided in
older patients because there is no identified benefit. Shingles can be very painful and so treatment for pain
should be priority.
Question:
What advice should be given to a parent who has a child with Fifth Disease?
This commonly causes pruritis in young children.He can return to school when the rash has
disappeared.Acetaminophen should be avoided in this child. IncorrectA parent may experience joint aches
and pains. Correct
Explanation:
Fifth disease, erythema infectiosum, is a common viral exanthem seen in children 5-15 years of age. This
produces a maculopapular rash that blanches easily. This rash is not pruritic but may last for several weeks
before it completely goes away. Children are allowed to attend school as long as they have been fever free
for 24 hours. Discomforts of this illness (fever, body aches, etc.) may be treated with acetaminophen or
ibuprofen. Adults who are exposed to children with Fifth Disease can complain of arthralgias and myalgias
for several weeks.
Question:
A low potency topical hydrocortisone cream would be most appropriate in a patient who has been
diagnosed with:
psoriasis.impetigo.cellulitis.atopic dermatitis. Correct
Explanation:
Low potency steroid creams are almost never potent enough to treat psoriasis. These require higher potency
steroid preparation or systemic agents. Impetigo is a superficial bacterial infection and a steroid cream
would be contraindicated. Cellulitis is an infection of the subcutaneous layer of the skin and requires an
oral or systemic antibiotic. Atopic dermatitis is a chronic inflammatory disorder of the skin that involves a
genetic defect in the proteins supporting the epidermal layer. A patient with atopic dermatitis would be the
most appropriate (of those listed above) to use a low potency topical steroid cream.
Question:
Mr. Johnson is a 74 year old who presents with a pearly-domed nodular looking lesion on the back of the
neck. It does not hurt or itch. What is a likely etiology?
Basal cell carcinoma CorrectSquamous cell carcinoma IncorrectMalignant melanomaActinic keratosis
Explanation:
Basal cell’s classic description is “a pearly domed nodule with a telangiectatic vessel”. It is commonly
found on sun-exposed areas like the head or neck. Sending the patient to dermatology (since these represent
skin cancer) best treats these lesions. Sometimes these lesions can be treated with a topical agent like 5-
fluorouracil, but others require surgical intervention.
Question:
A patient is found to have koilonychia. What laboratory test would be prudent to perform?Liver function testsComplete blood count CorrectHepatitis B surface antigenArterial blood gases
Explanation:
Koilonychia is the term that describes spoon shaped nails. Spoon shaped nails may be present in patients
with long-standing iron deficiency anemia. A CBC should be performed to assess for anemia. The most
common symptoms of iron deficiency anemia are weakness, headache, irritability, fatigue, and exercise
intolerance.
Question:
A 60 year-old patient is noted to have rounding of the distal phalanx of the fingers. What might have caused
this?
Coronary artery diseaseHepatic cirrhosis CorrectLead toxicityIron deficiency anemia
Explanation:
Rounding of the distal phalanx describes clubbing. Clubbing of fingers is most often associated with
chronic hypoxia as seen in cigarette smokers and patients with COPD or lung cancer. Other causes are
cirrhosis, cystic fibrosis, pulmonary fibrosis and cyanotic heart disease.
Question:
Impetigo is characterized by:
honey-colored crusts. Correctsilvery scales.marble-like lesions.wheals with pus.
Explanation:
Impetigo is a superficial bacterial infection of the skin characterized by honey-colored crusts. Another form
of impetigo is characterized by the presence of bullae. These infections are treated with topical antibiotics,
good hygiene, and frequent hand washing. It is usually caused by Staphylococcus or Group A
Streptococcus.
Question:
A skin lesion fluoresces under a Wood’s lamp. What microscopic finding is consistent with this?
Clue cellsHerpes simplexHyphae CorrectLeukocytes
Explanation:
A Wood’s lamp emits ultraviolet light when turned on. If an area fluoresces under Wood’s lamp
illumination, a fungal (and sometimes bacterial) infection should be suspected. The test is most effectively
performed in a darkened room so the fluorescence can be more easily identified. Deodorant, soap, and
make-up may also fluoresce. About one-third of hyphae fluoresce.
Question:
A skin disorder has a hallmark finding of silvery scales. What word below describes this common
condition?
Chronic CorrectInfectiousContagiousAcute
Explanation:
“Silvery scales” describes the hallmark finding in psoriasis. This is a chronic condition. It is not infectious,
contagious, or acute. There are several variants, but “silvery scales” is the most common form.
Question:
A patient will be taking oral terbinafine for fingernail fungus. The NP knows that:
This will cure her infection 95% of the time. Incorrecta topical antifungal will work just as well when the
nail matrix is involved.Terbinafine is a potent inhibitor of the CYP 3A4 enzymes. Correcttoenail fungus
resolves faster than fingernail fungus after treatment.
Explanation:Most oral antifungal agents inhibit the 3A4 enzymes in the cytochrome P450 system. This is why they must
be used with extreme caution (or not used) in patients who consume medications that need 3A4 enzymes
for metabolism. And, liver enzymes must be monitored in patients who take oral antifungal medications
and discontinued if elevations are >2.5 times the upper limits of normal. There is no oral agent that has a
95% cure rate for fingernail fungus (tinea unguium). This can be a difficult infection to clear even if oral
antifungal agents are utilized. A topical antifungal agent typically will not clear the infection if the nail
matrix is involved. There is anecdotal evidence that menthol ointments or bleach may cause resolution
when used topically. Generally, resolution of fingernail fungus occurs more rapidly than toenail fungus
because toenails grow at slower rates than fingernails.
Question:
Which of the following areas of the body has the greatest percutaneous absorption?
Sole of the footScalp IncorrectForeheadGenitalia Correct
Explanation:
Genitalia have the highest percutaneous absorption across the entire body. This is important because low
potency creams will act with greater potency in this area. Always start with low potency creams in the
genitalia. The sole of the foot has the lowest percutaneous absorption followed by the scalp, forehead, and
genitalia. Therefore, the sole of the foot will require more potent vehicles to enhance absorption.
Question:
A patient who has been in the sun for the past few weeks is very tanned. He has numerous 3-6 mm light
colored flat lesions on his trunk. What is the likely etiology?
Tinea corporisTinea unguiumTinea versicolor CorrectHuman papilloma virus
Explanation:
Tinea versicolor is typically visualized during the spring and summer months when a patient has become
tanned. The areas that are infected do not tan and so become very noticeable. The chest and back are
common areas to observe tinea versicolor. There can be 100 or more in some infections. This can be treated
with topical selenium sulfide or an oral antifungal agent.
Question:
The nurse practitioner is examining a 3-month old infant who has normal development. She has identified
an alopecic area at the occiput. What should be done?
Order a TSHOrder a hydrocortisone creamSuspect child abuseEncourage the caregiver to change the
infant’s head position Correct
Explanation:
In a normally developing infant, an alopecic area at the occipital area is generally because the infant has
been placed in the supine position during sleeping and waking hours. Prolonged pressure on the occipital
area can restrict hair growth. This is normal and will resolve when the infant begins to have better head
control and movement; and he begins to have less pressure on the occipital area. Sometimes coarse, dry
hair can be indicative of hypothyroidism; not necessarily alopec
Question:
A patient calls your office. He states that he just came in from the woods and discovered a tick on his upper
arm. He states that he has removed the tick and the area is slightly red. What should he be advised?
No treatment is needed. CorrectHe should be prescribed doxycycline. IncorrectHe needs a topical scrub to
prevent Lyme Disease.He should come to the office for a ceftriaxone injection.
Explanation:
Many factors must be present for a patient to develop Lyme Disease from a tick bite. First, the tick must
belong to Ixodes species. The tick must have been attached for at least 48-72 hours before disease can be
spread. Time of year, stage of organism's development, and others all affect transmission. There is no need
for prophylactic treatment in this case because the tick has not been present long enough, though, many
patients will feel antibiotics are necessary.Question:
An example of a first generation cephalosporin used to treat a skin infection is:
cephalexin. Correctcefuroxime.cefdinir.ceflamore.
Explanation:
Two common first generation cephalosporins used to treat skin and skin structure infections are cephalexin
and cefadroxil. These are taken 2-4 times daily and are generally well tolerated. These antibiotics provide
coverage against Staphylococcus and Streptococcus, common skin pathogens
Question:
Which of the following skin lesions in the elderly is a premalignant condition?
XanthelasmaChalazionHordeolumActinic keratosis Correct
Explanation:
Actinic keratosis is a premalignant condition of the skin and is considered an evolving carcinoma in situ. It
is a precursor of squamous cell carcinoma. The lesions are usually multiple in occurrence and sit on an
erythematous base. They appear dry, scaly, and flat and are usually secondary to sun damaged skin so can
be found on sun exposed areas. The most common sites are the face, ears, lateral forearms, and tops of
hands.
Question:
A 74 year-old is diagnosed with shingles. The NP is deciding how to best manage her care. What should be
prescribed?
An oral antiviral agent CorrectAn oral antiviral agent plus an oral steroidAn oral antiviral agent plus a
topical steroidA topical steroid only
Explanation:
An oral antiviral agent such as acyclovir, famciclovir, valacyclovir should be prescribed, especially if it can
be initiated within 72 hours after the onset of symptoms. The addition of oral corticosteroids to oral
antiviral therapy demonstrates only modest benefit. Adverse events to therapy are more commonly reported
in patients receiving oral corticosteroids. There is no evidence that corticosteroid therapy decreased the
incidence or duration of post-herpetic neuralgia or improved quality of life. Corticosteroids should be
limited to use in patients with acute neuritis who have not derived benefit from opioid analgesics.
Question:
A child with a sandpaper textured rash probably has:
rubeola.strept infection. Correctvaricella.roseola. Incorrect
Explanation:
Streptococcal infections can present as a sandpaper textured rash that initially is felt on the trunk. Rubeola,
measles, produces a blanching erythematous “brick-red” maculopapular rash that begins on the back of the
neck and spreads around the trunk and then extremities. Varicella infection produces the classic crops of
eruptions on the trunk that spread to the face. The rash is maculopapular initially and then crusts. Roseola
produces a generalized maculopapular rash preceded by 3 days of high fever.
Question:
Patients with atopic dermatitis are likely to exhibit:
Itching. Correctasthma and allergic bronchitis.nasal polyps and asthma.allergic conjunctivitis and
wheezing.
Explanation:
Atopic dermatitis is diagnosed on clinical presentation and includes evidence of pruritic skin. It is recurrent
and often begins in childhood. For decades the "atopic triad" has been used to refer to patients with atopicdermatitis, asthma, and allergic rhinitis. This has recently been called in to question. A similar triad, known
as Samter’s triad, consists of asthma, aspirin sensitivity, and nasal polyps. Samter’s triad is not the same as
the atopic triad.
Question:
The most common place for basal cell carcinoma to be found is the:
scalp.face. Correctanterior shin.upper posterior back.
Explanation:
The most common presentation of basal cell carcinoma (BCC) is on the face. This is probably because
BCC occurs secondary to sun damage. The most common sun exposure occurs on the face. In fact, 70% of
BCC occurs on the face, 15% is found on the trunk.
Question:
A key component of the approach to a patient who has atopic dermatitis is hydration. Which agent should
be avoided?
Lotions CorrectCreamsThick creamsOintments
Explanation:
In contrast to creams and ointments, lotions have a high water content and a low oil content. These can
worsen xerosis (dry skin) due to evaporation of water on the skin. Creams have a lower water content.
Ointments have no water and are excellent agents to use on dry skin as well as to prevent dry skin.
Question:
A young child has developed a circumferential lesion on her inner forearm. It is slightly raised, red and is
pruritic. It is about 2.5 cm in diameter. This is probably related to:
a genetic disorder.the child’s new cat. Correctjuvenile rheumatoid arthritis.a psoriatic lesion.
Explanation:
This describes ringworm. It is a fungal infection that is common in children. A typical precipitant is a new
animal like a cat. Since it appears on the inner forearm, it is likely the child got this from holding the cat. It
should be treated with a topical anti-fungal agent
Question:
A patient has used a high potency topical steroid cream for years to treat psoriasis exacerbations when they
occur. She presents today and states that this cream “just doesn’t work anymore.” What word describes
this?
Rebound effectTachyphylaxis CorrectTolerance IncorrectLichenification
Explanation:
Tachyphylaxis is the word used to describe a gradual and progressively poorer clinical response to a
treatment or medication. This is particularly true of topical glucocorticoids, bronchodilators, nitroglycerine,
and antihistamines when they are overused. The rebound effect describes a condition where initial clinical
improvement occurred, but worsening now has occurred. Lichenification refers to a thickening of the skin.
Drug free intervals are important to prevent tachyphylaxis.
Question:
A 28 year-old has thick, demarcated plaques on her elbows. Which features are suggestive of psoriasis?
Scaly lesions on the scalpPruritis around the lesionsA scaly border around the plaquesSilvery scales that are
not pruritic Correct
Explanation:
There are many different presentations of psoriasis. Plaque psoriasis, which is described in this question, isusually found in a symmetrical distribution on the scalp, elbows, knees, and/or back. The size of the lesions
ranges from 1-10 cm in diameter. Usually the plaques are asymptomatic, but may be mildly pruritic. Scaly
lesions found on the scalp are not specific to psoriasis and could be seborrheic dermatitis. A scaly border
around the plaque could describe the lesions associated with pityriasis rosea.
Question:
What finding characterizes shingles?
Pain, burning, and itchingUnilateral dermatomal rash CorrectGrouped vesiclesResolution of rash and
crusting
Explanation:
Shingles is herpes zoster. It characteristically affects a single dermatome. Grouped vesicles on an
erythematous base can be seen in some patients with shingles, but this is not unique to shingles. In fact, it is
typical in many viral infections. Crusting may be seen with shingles, chicken pox, or impetigo. Pain,
burning, and itching describes the symptoms that some patients have with shingles, but not all patients
report itching with shingles.
Question:
A patient presents with small vesicles on the lateral edges of his fingers and intense itching. On close
inspection, there are small vesicles on the palmar surface of the hand. What is this called?
Seborrheic dermatitisDyshidrotic dermatitis CorrectHerpes zosterVaricella zoster
Explanation:
This dermatitis is intensely pruritic and involves the palms and soles and lateral aspects of the fingers. Over
a couple of weeks, the vesicles desquamate. Recurrences are common. Seborrheic dermatitis affects only
hairy areas of the body. The vesicles might raise suspicion of a viral infection, but this is not the case.
Question:
A patient exhibits petechiae on both lower legs but has no other complaints. How should the NP proceed?
Refer to hematologyOrder a CBC CorrectOrder blood culturesStop aspirin and re-assess in one week
Explanation:
The presence of petechiae on the lower legs (or anywhere on the body) should prompt the NP to consider a
problem that is platelet related. A CBC should be checked to assess the platelet count and any evidence of
anemia from blood loss. If the platelet count is found to be low, referral to hematology should be done.
Blood cultures are of no value in this patient who has no other complaints.
Question:
A 16 year-old male has nodulocystic acne. What might have the greatest positive impact in managing his
acne?
Retin-A® plus minocyclineBenzoyl peroxide plus erythromycinIsotretinoin (Accutane®) CorrectOral
antibiotics
Explanation:
Nodulocystic acne is the most severe form of acne vulgaris. Nodules and cysts characterize this disease.
They can be palpated and usually seen on the skin, although, they actually are under the skin’s surface.
They develop when the follicle wall ruptures and leaks pus and cell contents in the dermis. The
contaminated material infects adjoining follicles and the nodule develops. Isotretinoin is the only known
effective treatment.
Question:
A patient with a positive history of a tick bite about 2 weeks ago and erythema migrans has a positive
ELISA for Borrelia. The Western blot is positive. How should he be managed?He should receive doxycycline for Lyme disease. CorrectHe should receive penicillin for Rocky Mountain spotted fever (RMSF).He does not have Lyme disease or RMSF.He needs additional testing to confirm Lyme disease. Explanation: The first serologic test for Lyme disease is the ELISA. If this is positive, it should be confirmed. In this case, it was confirmed by a Western blot and it is positive. This patient can be diagnosed with Lyme disease. The appropriate treatment for treatment of erythema migrans is doxycycline, amoxicillin, or cefuroxime for 21 days. All three medications were found to be of equal efficacy.
Question: A pregnant mother in her first trimester has a 5 year-old who has Fifth Disease. What implication does this have for the mother?
She does not have to worry about transmission to the fetus.She may get a mild case of Fifth disease.There is a risk of fetal death if she becomes infected. CorrectThe mother should have a fetal ultrasound today. Explanation: Pregnant mother should avoid exposure to patients with known Fifth disease. However, the risk of transmission is very low. She should avoid exposure to aplastic patients who are infected because they are highly contagious. Infection during pregnancy is associated with 10% fetal death. There is no need for an ultrasound today. This pregnant patient does not have evidence of disease. She should be monitored for a rash which could indicate infection.
Question: A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the infected area would likely demonstrate:
hyphae. Correctyeasts.rods or cocci.a combination of hyphae and spores. Explanation: Under microscopic exam, hyphae are long, thin and branching, and indicate dermatophytic infections. Hyphae are typical in tinea pedis, tinea cruris [Show Less]