NRNP 6540 MIDTERM EXAM|WALDEN UNIVERSITY | Questions And Answers Verified 100% Correct

NRNP 6540 MIDTERM EXAM|WALDEN UNIVERSITY | Questions And Answers Verified 100% Correct Identify three common causes of lymphedema. Correct Answer: Lymphedema is most commonly caused by surgery, radiation, or infection that damages the lymphatic system. Your patient has herpes zoster ophthalmicus (HZO) as shown in the photo. What would your treatment plan for this patient be? Correct Answer: Your treatment plan for this patient with HZO would be oral antivirals (e.g., acyclovir, famciclovir, valacyclovir), topical corticosteroids for itch and pain as needed, and referral to ophthalmologist immediately to prevent blindness. Early treatment with acyclovir 800 mg po five times/day or famciclovir 500 mg or valacyclovir 1 g po tid for 7 days reduces ocular complications. Referral to ophthalmology is critical as HZO can cause blindness if not treated promptly. The pupil should be dilated with atropine 1% or scopolamine 0.25% 1 drop tid. Intraocular pressure must be monitored and treated if it rises significantly above normal values. Patients with uveitis or keratitis require topical corticosteroids (e.g., prednisolone acetate 1% instilled q 1 h for uveitis or qid for keratitis initially, lengthening the interval as symptoms lessen). Your 78-year-old patient comes in yearly for a skin check. She was a self- proclaimed “sun worshipper” in her younger days. She has multiple freckles over her face, arms, and back. She is concerned about a freckle on her back that seems to be getter larger. This is what you see, what is your impression? Correct Answer: Because of its irregular border, various colors, and its growth, you suspect a melanoma. Define wheal, pustule, and vesicle. Correct Answer: A wheal is a plague or papule with a red border and pale center, a pustule is a raised lesion with pus filled fluid; vesicles are lesions up to 1 cm diameter filled with clear fluid. 5. Tinea pedis is also known as “athlete’s foot.” What is the most common presentation of athlete’s foot? Correct Answer: Tinea pedis, or athlete’s foot, often presents as interdigital erythematous pruritic scaly skin, hyperkeratotic skin of soles, and vesiculobullous painful eruptions on medial foot. 6. Cellulitis is most commonly caused by which pathogens? Correct Answer: Cellulitis is most often caused by group A strep (pyrogenes) and staph aureus. 7. List the four steps of decongestive physiotherapy (CDP) for lymphedema. Correct Answer: Complete decongestive physiotherapy (CDP) is the gold standard for lymphedema management. CDP is a specialized massage technique designed to stimulate the lymph vessels, break up subcutaneous fibrous tissue, and redirect the lymph fluid to areas where lymph flow is normal. It involves four steps: manual lymph drainage (MLD), compression bandaging, exercises, and skin care. 8. Your 78-year-old patient comes to the clinical with the chief complaint of a lesion on his arm that has been there for two years. He states it alternately crusts and heals, and it began as a shiny papule, but now looks like this. You suspect basal cell carcinoma. What would be your primary reason for suspecting it is a basal cell carcinoma? Correct Answer: Basal cell carcinoma typically alternately crusts and heals. Most commonly, the carcinoma begins as a shinypapule, enlarges slowly, and, after a few months or years, develops a shiny, pearly border with prominent engorged vessels (telangiectases) on the surface and a central dell or ulcer. 9. A 75-year-old male patient returns to the clinic with complaints of worsening psoriasis. Describe two treatments you might prescribe for this patient. Correct Answer: Possible treatments include: corticosteroids, vitamin D analogues, calcipotriene topical, retinoids, tazarotene topical, calcineurin inhibitors, pimecrolimus topical, salicylic acid, anthralin. 10. Based on your primary diagnosis of melanoma, what is your treatment plan for this patient’s lesion? Correct Answer: Surgical excision and biopsy. Malignant melanoma arises from melanocytes in a pigmented area (e.g., skin, mucous membranes, eyes, or CNS). Metastasis is correlated with depth of dermal invasion. With spread, prognosis is poor. Diagnosis is by biopsy. Wide surgical excision is the rule for operable tumors. Metastatic disease requires systemic therapy but is difficult to cure. 11. You are performing a Medicare home assessment on an 84-year-old male. Part of this exam is checking for carotid bruits. Describe two reasons this exam is important in an older adult: Correct Answer: The carotid arteries should be assessed routinely for the presence of bruit. Asymptomatic carotid bruit is a risk factor for stroke (Bickley, 2017). Studies demonstrate that a vessel is occluded more than 50% by the time a bruit can be heard. 22 When performing an assessment on patients over 65 years of age, what are at least . three (3) key symptoms that may indicate cardiovascular disease? Correct Answer: Key symptoms for cardiovascular assessment include dizziness, syncope, orthopnea, angina, edema, and claudication. (Bickley, 2013; Kane, Ouslander, Resnick, & Malone, 2018). 23. Your 72-year-old patient comes in for a checkup. His BMI is 32, BP is 152/79, and BG 139. He is currently not taking his HTN medications. You check his HgA1C and it is 9. He admits he does not get much exercise and smokes half a pack of cigarettes a day. Describe the three most important strategies you will plan for this patient to decrease his risk for a cardiovascular event.