NSG 554 Exam 2 – Nurse Practitioners in Primary Care I |
Questions and correct detailed Answers | 2026/27 Updates | 100%
correct
1. Malignant Melanoma: Characteristics
• A) Pigmented lesions, irregular borders, color variation, history of evolution is
most important; bleeding and ulceration; distinct from other moles
• B) Round, symmetrical, uniformly colored lesions with well-defined borders
• C) Flesh-colored, waxy papules with telangiectasias
• D) Scaly, erythematous plaques with silvery scales
Correct Answer: A) Pigmented lesions, irregular borders, color variation, history of
evolution is most important; bleeding and ulceration; distinct from other moles
Expert Rationale: Melanoma is a type of skin cancer arising from melanocytes that is
less common than basal or squamous cell carcinoma but more aggressive with higher
metastatic potential . The ABCDE criteria (Asymmetry, Border irregularity, Color variation,
Diameter >6mm, Evolution/changes over time) are key. A history of evolution—meaning
the lesion has changed in size, shape, or color—is the most important warning sign.
Lesions may bleed, ulcerate, or appear distinctly different from the patient's other moles
(the "ugly duckling" sign).
2. Papule: Definition
• A) Small, solid skin elevation of less than 1 cm
• B) Flat skin lesion with only a color change
• C) Large, fluid-filled blister greater than 1 cm
• D) Thin, flattened epidermal cells forming a scale
Correct Answer: A) Small, solid skin elevation of less than 1 cm
Expert Rationale: A papule is a primary skin lesion defined as a small, solid, raised
elevation on the skin that is less than 1 cm in diameter. Examples include warts, moles,
and acne lesions.
,3. Macule: Definition
• A) Small, solid skin elevation of less than 1 cm
• B) Flat skin lesion with only a color change; examples include freckles, sun spots,
flat moles
• C) Large, fluid-filled blister greater than 1 cm
• D) Elevated, pus-filled lesion
Correct Answer: B) Flat skin lesion with only a color change; examples include freckles,
sun spots, flat moles
Expert Rationale: A macule is a flat, distinct, discolored area of skin that is not palpable
(i.e., cannot be felt). It represents a change in skin color without any elevation or
depression. Common examples include freckles, flat moles, and sunspots.
4. Pharyngitis/Tonsillitis: Causes
• A) Beta-hemolytic streptococcal infection (GABHS); can lead to rheumatic fever
and glomerulonephritis; also viral, Neisseria gonorrhoeae, Mycoplasma,
Chlamydia
• B) Only viral pathogens
• C) Only Group A Streptococcus
• D) Fungal infections only
Correct Answer: A) Beta-hemolytic streptococcal infection (GABHS); can lead to
rheumatic fever and glomerulonephritis; also viral, Neisseria gonorrhoeae, Mycoplasma,
Chlamydia
Expert Rationale: Pharyngitis and tonsillitis are most commonly viral; however, the
most important bacterial cause is Group A beta-hemolytic Streptococcus (GABHS).
Untreated GABHS can lead to serious complications such as acute rheumatic fever and
post-streptococcal glomerulonephritis. Other less common bacterial causes include N.
gonorrhoeae, Mycoplasma, and Chlamydia, particularly in specific populations .
5. Pharyngitis/Tonsillitis: Signs and Symptoms
, • A) Sore throat, odynophagia, tender adenopathy, rash; GABHS criteria: fever
>38°C, tender anterior cervical adenopathy, lack of cough, pharyngotonsillar
exudate
• B) Only sore throat and fever
• C) Cough, rhinorrhea, and conjunctivitis
• D) Hoarseness and stridor
Correct Answer: A) Sore throat, odynophagia, tender adenopathy, rash; GABHS criteria:
fever >38°C, tender anterior cervical adenopathy, lack of cough, pharyngotonsillar
exudate
Expert Rationale: The Centor criteria (fever >38°C, tender anterior cervical adenopathy,
lack of cough, tonsillar exudate) are used to estimate the likelihood of GABHS
pharyngitis. Presence of these findings increases suspicion for bacterial etiology. Viral
pharyngitis more commonly presents with cough and rhinorrhea.
6. Pharyngitis/Tonsillitis: Treatment
• A) PCN V Potassium for 10 days, or Cefuroxime axetil for 10 days; Erythromycin
for PCN allergy; analgesics/anti-inflammatories
• B) Only analgesics for symptom management
• C) Antivirals as first-line therapy
• D) Corticosteroids for all cases
Correct Answer: A) PCN V Potassium for 10 days, or Cefuroxime axetil for 10 days;
Erythromycin for PCN allergy; analgesics/anti-inflammatories
Expert Rationale: Penicillin V (or amoxicillin) is the first-line antibiotic for GABHS
pharyngitis, given for 10 days to prevent rheumatic fever. For patients with penicillin
allergy, erythromycin or other macrolides are alternatives. Symptomatic relief with
NSAIDs or acetaminophen is also important. Cephalosporins (e.g., cefuroxime) are also
effective alternatives.
7. Mononucleosis: Signs and Symptoms
• A) Fever, sore throat, fatigue, malaise, myalgia, anorexia, lymphadenopathy, rash
• B) Only sore throat and fever
Questions and correct detailed Answers | 2026/27 Updates | 100%
correct
1. Malignant Melanoma: Characteristics
• A) Pigmented lesions, irregular borders, color variation, history of evolution is
most important; bleeding and ulceration; distinct from other moles
• B) Round, symmetrical, uniformly colored lesions with well-defined borders
• C) Flesh-colored, waxy papules with telangiectasias
• D) Scaly, erythematous plaques with silvery scales
Correct Answer: A) Pigmented lesions, irregular borders, color variation, history of
evolution is most important; bleeding and ulceration; distinct from other moles
Expert Rationale: Melanoma is a type of skin cancer arising from melanocytes that is
less common than basal or squamous cell carcinoma but more aggressive with higher
metastatic potential . The ABCDE criteria (Asymmetry, Border irregularity, Color variation,
Diameter >6mm, Evolution/changes over time) are key. A history of evolution—meaning
the lesion has changed in size, shape, or color—is the most important warning sign.
Lesions may bleed, ulcerate, or appear distinctly different from the patient's other moles
(the "ugly duckling" sign).
2. Papule: Definition
• A) Small, solid skin elevation of less than 1 cm
• B) Flat skin lesion with only a color change
• C) Large, fluid-filled blister greater than 1 cm
• D) Thin, flattened epidermal cells forming a scale
Correct Answer: A) Small, solid skin elevation of less than 1 cm
Expert Rationale: A papule is a primary skin lesion defined as a small, solid, raised
elevation on the skin that is less than 1 cm in diameter. Examples include warts, moles,
and acne lesions.
,3. Macule: Definition
• A) Small, solid skin elevation of less than 1 cm
• B) Flat skin lesion with only a color change; examples include freckles, sun spots,
flat moles
• C) Large, fluid-filled blister greater than 1 cm
• D) Elevated, pus-filled lesion
Correct Answer: B) Flat skin lesion with only a color change; examples include freckles,
sun spots, flat moles
Expert Rationale: A macule is a flat, distinct, discolored area of skin that is not palpable
(i.e., cannot be felt). It represents a change in skin color without any elevation or
depression. Common examples include freckles, flat moles, and sunspots.
4. Pharyngitis/Tonsillitis: Causes
• A) Beta-hemolytic streptococcal infection (GABHS); can lead to rheumatic fever
and glomerulonephritis; also viral, Neisseria gonorrhoeae, Mycoplasma,
Chlamydia
• B) Only viral pathogens
• C) Only Group A Streptococcus
• D) Fungal infections only
Correct Answer: A) Beta-hemolytic streptococcal infection (GABHS); can lead to
rheumatic fever and glomerulonephritis; also viral, Neisseria gonorrhoeae, Mycoplasma,
Chlamydia
Expert Rationale: Pharyngitis and tonsillitis are most commonly viral; however, the
most important bacterial cause is Group A beta-hemolytic Streptococcus (GABHS).
Untreated GABHS can lead to serious complications such as acute rheumatic fever and
post-streptococcal glomerulonephritis. Other less common bacterial causes include N.
gonorrhoeae, Mycoplasma, and Chlamydia, particularly in specific populations .
5. Pharyngitis/Tonsillitis: Signs and Symptoms
, • A) Sore throat, odynophagia, tender adenopathy, rash; GABHS criteria: fever
>38°C, tender anterior cervical adenopathy, lack of cough, pharyngotonsillar
exudate
• B) Only sore throat and fever
• C) Cough, rhinorrhea, and conjunctivitis
• D) Hoarseness and stridor
Correct Answer: A) Sore throat, odynophagia, tender adenopathy, rash; GABHS criteria:
fever >38°C, tender anterior cervical adenopathy, lack of cough, pharyngotonsillar
exudate
Expert Rationale: The Centor criteria (fever >38°C, tender anterior cervical adenopathy,
lack of cough, tonsillar exudate) are used to estimate the likelihood of GABHS
pharyngitis. Presence of these findings increases suspicion for bacterial etiology. Viral
pharyngitis more commonly presents with cough and rhinorrhea.
6. Pharyngitis/Tonsillitis: Treatment
• A) PCN V Potassium for 10 days, or Cefuroxime axetil for 10 days; Erythromycin
for PCN allergy; analgesics/anti-inflammatories
• B) Only analgesics for symptom management
• C) Antivirals as first-line therapy
• D) Corticosteroids for all cases
Correct Answer: A) PCN V Potassium for 10 days, or Cefuroxime axetil for 10 days;
Erythromycin for PCN allergy; analgesics/anti-inflammatories
Expert Rationale: Penicillin V (or amoxicillin) is the first-line antibiotic for GABHS
pharyngitis, given for 10 days to prevent rheumatic fever. For patients with penicillin
allergy, erythromycin or other macrolides are alternatives. Symptomatic relief with
NSAIDs or acetaminophen is also important. Cephalosporins (e.g., cefuroxime) are also
effective alternatives.
7. Mononucleosis: Signs and Symptoms
• A) Fever, sore throat, fatigue, malaise, myalgia, anorexia, lymphadenopathy, rash
• B) Only sore throat and fever
