NURS 6531 ACTUAL LATEST EXAM

NURS 6531 ACTUAL LATEST EXAM

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NURS 6531 FINAL EXAM [BRAND NEW]

An adult patient has been diagnosed with atopic dermatitis and seborrheic dermatitis with lesions on the forehead and along the scalp line. Which is correct when prescribing a corticosteroid medication to treat this condition? p. 238

• Initiate treatment with 0.1% triamcinolone acetonide.
• Monitor the patient closely for systemic adverse effects during use.
• Place an occlusive dressing over the medication after application.

d. Prescribe 0.05% fluocinonide to apply liberally. - ANSWER- ANS: A

Treatment with 0.1% triamcinolone acetonide is appropriate in this case, because it is a class 4 corticosteroid and may be used on the face and is suggested for use for these conditions. Systemic side effects are rare when topical corticosteroids are used appropriately. Occlusive dressings increase the risk of adverse effects and are not recommended. 0.05% fluocinonide is a class III corticosteroid and should not be used on the face.

During a total body skin examination for skin cancer, the provider notes a raised, shiny, slightly pigmented lesion on the patient's nose. What will the provider do?

• Consult with a dermatologist about possible melanoma.
• Reassure the patient that this is a benign lesion.
• Refer the patient for possible electrodessication and curettage. 1 / 4

d. Tell the patient this is likely a squamous cell carcinoma. - ANSWER- ANS: C

This lesion is characteristic of basal cell carcinoma, which is treated with electrodessication and curettage. Melanoma lesions are usually asymmetric lesions with irregular borders, variable coloration, >6 mm diameter, which are elevated; these should be referred immediately. All suspicious lesions should be biopsied; until the results are known, the provider should not reassure the patient that the lesion is benign. Squamous cell carcinoma is roughened, scaling, and bleeds easily.

What is the initial approach when obtaining a biopsy of a potential malignant melanoma lesion?

• Excisional biopsy
• Punch biopsy
• Shave biopsy

d. Wide excision - ANSWER- ANS: A

A suspected malignant melanoma lesion should be biopsied with excisional biopsy; if diagnosed, a wide excision should follow. Punch and shave biopsy procedures are appropriate for diagnostic evaluation of NMSC lesions.

Scaling on the scalp is suggestive of tinea capitis. To confirm this, the provider will perform scalp scraping or test hair samples with KOH preparation to look for hyphae. Grasping and pulling on hairs is used to identify anagen or telogen hairs by appearance. Serum iron and aCBC are used if anemia is suspected as a cause.VDRL is performed if syphilis is suspected.

A female patient is diagnosed with androgenetic alopecia. Which medication will the primary health care provider prescribe?

• Anthralin
• Cyclosporine
• Finasteride

d. Minoxidil - ANSWER- ANS: D 2 / 4

Either minoxidil or finasteride are used for androgenetic alopecia, but finasteride is Pregnancy Category X, so minoxidil is the only medication approved by the FDA for use in women. Anthralin and cyclosporine are used to treat alopecia areata.

A young adult has been bitten by a dog resulting in several puncture wounds near the thumb of one hand but can move all fingers and the bleeding has stopped. What understanding regarding dog bites should direct the care of this patient?

• Infection is a likely outcome for a dog bite.
• Dog bites generally result in serious injury.
• Neurovascular and destructive soft tissue injuries can occur from such a bite.
• Oral antibiotics are needed to address the increased risk for the development of

osteomyelitis. - ANSWER- ANS: C

Dog bites account for most of the domestic animal bites that require medical care, yet dog bites have had the lowest incidence of wound infection (2% to 13%). Even though most dog bites are relatively minor, severe injuries can occur. These can include crush injuries, destructive soft tissue injuries, neurovascular injuries, orthopedic injuries, and death. Osteomyelitis is a risk for human bites.

A patient has sustained a human bite on the hand during a fist fight. Which is especially concerning with this type of bite injury?

• Possible exposure to rabies virus
• Potential septic arthritis or osteomyelitis
• Sepsis from Capnocytophaga canimorsus infection

d. Transmission of human immunodeficiency virus - ANSWER- ANS: B

Clenched-fist injury, or "fight bite," has a high complication rate from the high penetrating 3 / 4

force with the potential for osteomyelitis, tendinitis, and septic arthritis. Humans do not transmit rabies unless infected, which is highly unlikely. Humans do not transmit C. canimorsus. HIV transmission is potential, but the risk is extremely low.

A patient has acne and the provider notes lesions on half of the face, some nodules, and two scarred areas. Which treatment will be prescribed?

• Oral clindamycin for 6 to 8 weeks
• Oral isotretinoin
• Topical benzoyl peroxide and clindamycin

d. Topical erythromycin - ANSWER- ANS: C

This patient has moderate acne, based on symptoms of lesions on half of the face with nodules and a few scars. A combination of topical benzoyl peroxide and clindamycin is recommended. Oral antibiotics are reserved for severe cases. Oral isotretinoin is used only for recalcitrant cases which are severe and have not responded to other treatments. Topical antibiotics should be used as monotherapy.

A provider is considering an oral contraceptive medication to treat acne in an adolescent female. Which is an important consideration when prescribing this drug? p. 246

• A progesterone-only contraceptive is most beneficial for treating acne.
• Combined oral contraceptives are effective for non-inflammatory acne only.
• Oral contraceptives are effective because of their androgen enhancing effects.
• Yaz, Ortho Tri-Cyclen, and Estrostep, are approved for acne treatment. -

ANSWER- ANS: D

Three oral contraceptives have a labeled use for acne treatment: Yaz, Ortho Tri- Cyclen, and Estrostep. Progesterone-only contraceptives may worsen acne.Combined oral contraceptives are effective in reducing inflammatory and non- inflammatory acne. Oral contraceptives are effective because of their antiandrogen effects, since androgen induces sebum production.

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