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1. A middle-age fe- Tetracycline
male patient pre- Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line treat-
sents to the ment for hidradenitis suppurativa.
clinic with a
recurrence of __________________________________________________
mild hidradenitis
Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apoc-
suppurativa af-
rine gland-bearing skin. It is a chronic, disabling disorder that progresses, often
ter topical thera-
causing keloids, contractures, and immobility. It is characterized by comedone-like
pies failed. Which
follicular occlusion, chronic and relapsing inflammation, mucopurulent discharge,
first-line treat-
and progressive scarring.
ment is recom-
Arthropathy associated with hidradenitis may be present. Typical presentation
mended?
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 recom-
mended 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.
2. When providing The "Medicine Wheel" is used by many for the purpose of health and healing
culturally compe- The "Medicine Wheel" is traditionally used and contains four directions; north,
tent health care south, east, and west. Traditionally each tribe has different meanings for each
services to an direction and they may represent the season of the year or stage of life. It is aimed
American Indi- at providing a holistic view of life.
an elder, the
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nurse practition- ________________________________________
er understands
which is tradi- An understanding of different cultural preferences leads to cultural competence
tionally true? 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 as-
sess each individual's healthcare literacy in order to provide culturally competent
care.
3. The nurse prac- Cerumen, commonly called earwax, is a combination of secretions and sloughed
titioner sees an epithelial cells that protects the ears from infection, water, and insects. It is
older adult pa- normally expelled from the ear canal through natural jaw movement. When this
tient in the clinic self-cleaning process fails, cerumen can become impacted. Cerumen impaction
with the primary occludes the ear canal and can press against the tympanic membrane, resulting
report of hearing in conductive hearing loss.
loss and a sen-
sation of fullness _________________________________________
in the right ear.
Conductive hearing is the transition of sound from the external and middle ear
The nurse prac-
to the inner ear. Conductive hearing loss is caused by problems in the external
titioner suspects
and middle ear that interfere with the transmission of sound and its conversion
conductive hear-
to mechanical vibration. Causes of conductive hearing loss include obstruction of
ing loss. Which
the external auditory canal by cerumen, foreign bodies, debris from otitis externa,
could contribute
and large exocytosis and osteomas.
to this?
Sensorineural hearing loss involves difficulty converting mechanical vibrations
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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.
4. An otherwise Amoxicillin
healthy adult High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line
patient presents therapy for adults without comorbidities.
to the clinic with
a diagnosis of _____________________________________________
community-ac-
Community-acquired pneumonia (CAP) is pneumonia not acquired in a hospital
quired
or long-term care facility. Patients with suspected CAP should receive a chest X-ray
pneumonia and
for diagnosis. The Pneumonia Severity Index should be used to assist in decisions
no recent
regarding the need for hospitalization in patients with CAP.
antibiotic
According to the American Thoracic Society (ATS) and the Infectious Diseases
therapy. Which is
Society of America (IDSA) 2019 guidelines, the initial treatment of CAP for most
the best option
patients is amoxicillin or doxycycline. Macrolides are an option for treatment, but
for treatment?
are no longer recommended routinely as first-line treatment, given increased
macrolide resistance. This is a change from the 2007 ATS/IDSA guidelines. Res-
piratory fluoroquinolones and amoxicillin/clavulanate should be used in patients
who fail first-line medications, have significant comorbidities, have had recent an-
tibiotic therapy, are allergic to alternative agents, or have a documented infection
with highly drug-resistant pneumococci.
5.
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A patient pre-
sents to the
clinic for con-
ception counsel-
ing. She recent-
ly stopped taking
oral contracep-
tives and would
like to become
pregnant. Which
statement about
conception safe-
ty after stopping
oral contracep-
tives is correct?
6. You have a Tinel's sign
35-year-old fe-
male patient who
is complaining of
wrist pain. She
is an adminis-
trative 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