ANCC FNP Board Questions and Correct Answers |
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A middle-age female patient presents to the clinic with a recurrence of
mild hidradenitis suppurativa after topical therapies failed. Which first-
line treatment is recommended? Ans: Tetracycline
Twelve weeks of oral tetracycline (Sumycin) is the recommended first-
line treatment for hidradenitis suppurativa.
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Assignment Expert
Hidradenitis suppurativa is a disorder of the terminal follicular
epithelium in apocrine gland-bearing skin. It is a chronic, disabling
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disorder that progresses, often causing keloids, contractures, and
immobility. It is characterized by comedone-like follicular occlusion,
chronic and relapsing inflammation, mucopurulent discharge, and
progressive scarring.
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Arthropathy associated with hidradenitis may be present. Typical
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presentation 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 recommended 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
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moderate to severe hidradenitis suppurativa, adalimumab (Humira) may
possibly be considered.
When providing culturally competent health care services to an American
Indian elder, the nurse practitioner understands which is traditionally
true? Ans: The "Medicine Wheel" is used by many for the purpose of
health and healing
The "Medicine Wheel" is traditionally used and contains four directions;
north, south, east, and west. Traditionally each tribe has different
meanings for each direction and they may represent the season of the
Assignment Expert
year or stage of life. It is aimed at providing a holistic view of life.
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An understanding of different cultural preferences leads to cultural
competence in healthcare. Some patients may value traditional culture
and preferences as it relates to healthcare. These individual preferences
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should be included in the interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to
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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 assess each individual's healthcare literacy in order to provide
culturally competent care.
The nurse practitioner sees an older adult patient in the clinic with the
primary report of hearing loss and a sensation of fullness in the right ear.
The nurse practitioner suspects conductive hearing loss. Which could
contribute to this? Ans: Cerumen, commonly called earwax, is a
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combination of secretions and sloughed epithelial cells that protects the
ears from infection, water, and insects. It is normally expelled from the
ear canal through natural jaw movement. When this self-cleaning process
fails, cerumen can become impacted. Cerumen impaction occludes the
ear canal and can press against the tympanic membrane, resulting in
conductive hearing loss.
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Conductive hearing is the transition of sound from the external and
middle ear to the inner ear. Conductive hearing loss is caused by
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problems in the external and middle ear that interfere with the
transmission of sound and its conversion to mechanical vibration. Causes
of conductive hearing loss include obstruction of the external auditory
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canal by cerumen, foreign bodies, debris from otitis externa, and large
exocytosis and osteomas.
Sensorineural hearing loss involves difficulty converting mechanical
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vibrations to electrical potential in the cochlea or in auditory nerve
transmission to the brain. It is mostly caused by permanent damage in
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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.
An otherwise healthy adult patient presents to the clinic with a diagnosis
of community-acquired pneumonia and no recent antibiotic therapy.
Which is the best option for treatment? Ans: Amoxicillin