Question 1

A primary care nurse practitioner (NP)prescribes a topical cream medication.Which statement by the patient indicates understanding of proper application of this medication?&#10;A) &#34;I should apply this medication after bathing.&#34;&#10;B) &#34;I need to use a tongue blade to apply this medication.&#34;&#10;C) &#34;I should apply this medication liberally to all affected areas.&#34;&#10;D) &#34;I will apply this medication using circular strokes to ensure absorption.&#34;

Accepted Answer

For optimal absorption of topical medications,apply them to moist skin either immediately after bathing or after wet soaks.A tongue blade is used for topicals in paste form.Topical medications should be applied in a thin layer,not liberally.Topical medications should be applied using long,downward strokes because back-and-forth strokes can cause irritation.

Question 2

A patient who has scabies has been treated by the primary care NP twice with permethrin (Elimite).The second application was administered 10 days after the first.The patient returns to the clinic with mild pruritus and erythema.The NP does not observe new burrows on the skin.The NP should:

A) order lindane.
B) order malathion.
C) re-treat with permethrin.
D) prescribe triamcinolone 0.1%.

prescribe triamcinolone 0.1%.

Accepted Answer

In scabies,pruritus may persist for several weeks after treatment and does not necessarily indicate the need for re-treatment.Dermatitis may persist for months.Triamcinolone 0.1% may be used to help with pruritus and dermatitis.Lindane and malathion are not indicated.Re-treatment is not necessary.

Question 3

A patient has been treated for severe contact dermatitis on both arms with clobetasol propionate cream.At a follow-up visit,the primary care NP notes that the condition has cleared.The NP should:&#10;A) prescribe triamcinolone cream for 2 weeks.&#10;B) recommend continuing treatment for 2 more weeks.&#10;C) discontinue the clobetasol and schedule a follow-up visit in 2 weeks.&#10;D) discontinue the clobetasol and recommend prn use for occasional flare-ups.

Accepted Answer

Treatment should be discontinued when the skin condition has resolved.Tapering the corticosteroid will prevent recurrence of the skin condition.Tapering is best done by gradually reducing the potency and dosing frequency at 2-week intervals.This patient was on a very high potency steroid,so changing to a medium frequency with follow-up in 2 weeks is an appropriate action.Discontinuing the steroid abruptly can lead to recurrence.

Question 4

A primary care NP is preparing to irrigate and suture a laceration on a patient's thumb.To anesthetize the site,the NP should use:&#10;A) lidocaine hydrochloride.&#10;B) lidocaine with epinephrine.&#10;C) bupivacaine hydrochloride.&#10;D) bupivacaine with epinephrine.

Accepted Answer

Vasoconstrictors,such as epinephrine,help to prolong local anesthetic action by decreasing systemic absorption,but they are not safe to use at the ends of arteries in fingers,toes,the nose,or the penis.Lidocaine is an intermediate-acting local anesthetic and,when used without epinephrine,is appropriate to use on a thumb.Bupivacaine is a very long-acting anesthetic and is not needed for a short procedure.

Question 5

A primary care NP is performing a well-child checkup on an adolescent patient and notes approximately 20 papules and comedones and 10 pustules on the patient's face,chest,and back.The patient has not tried any over-the-counter products to treat these lesions.The NP should begin treatment with:

A) salicylic acid.
B) topical tretinoin.
C) oral antibiotics.
D) benzoyl peroxide and topical clindamycin.

Accepted Answer

Mild acne consists of a lesion count of less than 30 with less than 15 pustules.Benzoyl peroxide and topical clindamycin are both indicated for treatment of mild to moderate acne and are first-line choices.Topical tretinoin is used as a second-line or third-line treatment.Oral antibiotics are used when topical antibiotics fail.Salicylic acid is an appropriate first-line treatment,but because this patient has pustular lesions,topical antibiotics must be included.

Question 6

A 5-year-old child has atopic dermatitis that is refractory to treatment with hydrocortisone acetone 2.5% cream.The primary care NP should prescribe:&#10;A) desonide cream 0.01%.&#10;B) triamcinolone acetonide.&#10;C) fluocinolone cream 0.2%.&#10;D) betamethasone dipropionate ointment 0.05%.

Accepted Answer

An over-the-counter steroid has failed to treat this child's dermatitis,so the NP should prescribe something in a higher strength.Triamcinolone is a medium-strength steroid and should be used.The other three are in groups I and II,which are high-strength steroids and are not recommended in children.

Question 7

A patient is seen by a primary care NP to evaluate a rash.The NP notes three ring-shaped lesions with elevated,erythematous borders and two smaller,scaly patches on the patient's abdomen.The patient has not used any over-the-counter medications on the rash.The NP should prescribe:

A) terbinafine (Lamisil).
B) oxiconazole (Oxistat).
C) ketoconazole (Nizoral).
D) miconazole (Lotrimin AF).

Accepted Answer

When initiating treatment for tinea corporis,start with an older agent,such as miconazole,because this is available over-the-counter and in generic form and is cheaper.Other agents may be used if the infection does not respond to miconazole or if there are localized side effects to the product.

Question 8

An 18-month-old child who attends day care has head lice and has been treated with permethrin 1% (Nix).The parent brings the child to the clinic 1 week later,and the primary care NP notes live bugs on the child's scalp.The NP should order:

A) lindane.
B) malathion.
C) ivermectin.
D) permethrin 5%.

Accepted Answer

Permethrin is the first-line drug of choice for treating head lice and is usually effective in one application.Significant resistance to permethrin 1% has developed,and permethrin 5% is more effective.In pediculosis,if live lice can be found after 1 week,reapply treatment.This child may have been reinfected at day care and so should be treated again.Malathion is a second-line drug and is not recommended in children younger than age 2.Lindane is a third-line drug.Ivermectin is a fourth-line drug.

Question 9

A primary care NP prescribes fluocinolone cream for a patient who has contact dermatitis.At a follow-up visit in 2 weeks,the patient reports decreased pruritus but continues to have excoriated,erythematous areas.The NP should:

A) obtain a culture of the skin to monitor for superinfection.
B) discontinue the fluocinolone and order betamethasone cream.
C) begin gradually tapering the fluocinolone at 2-week intervals.
D) tell the patient to continue using the fluocinolone for 3 to 4 more weeks.

Accepted Answer

The risk of adverse effects is less if group II steroids are used for less than 6 to 8 weeks.If the condition is responding to treatment,and there are no signs of adverse effects,the NP should recommend continuing use.The patient does not have exudative lesions,so a culture is not necessary.

Question 10

An NP student asks the primary care NP about guidelines for using topical steroids.The NP should tell the student that:&#10;A) evidence-based guidelines are available for each product.&#10;B) standardized guidelines have been developed for use in children.&#10;C) standardized guidelines may be found for disease-specific conditions.&#10;D) evidence-based studies support limited corticosteroid use in pregnancy.

Accepted Answer

Standardized guidelines are available for disease-specific conditions; there are no evidence-based studies or standardized guidelines for using topical steroids.

Question 11

A primary care NP sees a child who has honey-crusted lesions with areas of erythema around the nose and mouth.The child's parent has been applying Polysporin ointment for 5 days and reports no improvement in the rash.The NP should prescribe:

A) mupirocin.
B) neomycin.
C) a systemic antibiotic.
D) Polysporin with a corticosteroid.

Accepted Answer

The answer of A primary care NP sees a child...

Question 12

A primary care NP is considering using a topical immunosuppressive agent for a patient who has atopic dermatitis that is refractory to treatment with topical corticosteroids.The NP should:&#10;A) begin therapy with pimecrolimus (Elidel).&#10;B) tell the patient that these agents may be used long-term.&#10;C) counsel the patient that these agents are more likely to cause skin atrophy.&#10;D) tell the patient that laboratory monitoring for hypothalamic-pituitary-adrenal (HPA) suppression will be necessary.

Accepted Answer

The answer of A primary care NP is considering using...

Deck 13: Dermatologic Agents