NSG 554/ NSG554 Exam 2 V2 – Nurse Practitioners in Primary Care I Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 554/ NSG554 Exam 2 V2 – Nurse Practitioners in Primary Care I Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A What are triggers for Bullous pemphigoid? Trauma, Infection (HIV, Hep, EBV), Meds (ACE, NSAIDS, Lasix, PCN, cephalexin). Dx of bullous pemphigoid DIF Treatment for bullous pemphigoid immunosuppressive drugs like azathioprine - should be done with a consultant. Oral medication for severe seborrheic dermatitis Itraconazole - What are the 4 key processes of acne vulgaris? Inflammation, abnormal desquamation of keratinocytes which clog pilosebaceous follicles, increased or altered sebum production, colonization with propionibacterium acne What is first line therapy for acne vulgaris? HOw do they work? Topical retinoids: tretinoin, adapalene, tazarotene, azelaic acid, benzoyl peroxide, and salicylic acid Work by regulating keratinocyte desquamation, inhibiting growth of pilosebaceous follicles and decreasing inflammation Common topical antibiotics for acne vulgaris erythromycin, sulfonamide, metronidazole, clindamycin Oral antibiotics that are commonly used for acne vulgaris erythromycin, tetracycline, minocycline, doxycycline Hormone therapy for acne vulgaris COC, spironolactone, drospirenone Oral retinoid therapy and precautions Isotretinoin - monthly managment Trigs, hepatic fcn, and at least 2 forms of B.C. Acne Inversa (Hidradenitis Suppurativa). Primary hyperkeratosis of sebaceous gland follicle w/ 2ndary infection of apocrine glands. Chronic disease - recurrent abscesses. Hx, PE - predisposing factors [recognize]. TX - Ora/Topical ABX, pain mgmt, adjunctive meds like spironolactone, oral retinoids, TNF alpha, finasterid Refer. What are Hurley Stages? Stages of Hidradenitis suppurativa I. lesions but with no sinus tract involvement II. some sinus tract involvement and scarring III. Lost of sinus involvement and scars involve an entire area of body Characteristics of Erythmetotelangiectatic Rosacea central on face nose/cheeks, often after a trigger and lasts 10min. Characteristics of papulopustular rosacea increase telangiectasis, transient papules, pustules - resembles acne Characteristics of phymatous rosacea Bulbous thickening of the nose (more commonly seen in men), slow growth of thick pink plaques with enlarged irregular nodular surface which may include eyelids and ear Characteristics of ocular rosacea Honey crusting of eye (blepharitis) Lid telangectasias foreign body sensation, Meibomian gland formation Treatment for rosacea Topical metronidazole gel or cream with oral antibiotics (tetracycline, doxycycline, minicycline) if severe. Isotretinoin. Pulsed light or laser treatments. Flushing might be improved with COC, BB, clonidine, spironolactone, SSRIs, naloxone, ondansetron, ASA Two types of alopecia Cicatricial/scarring vs noncicatricial/nonscarring Hair growth phases Anagen (growth), Catagen (involution- shortest phase), Telogen - (sheds) Anagen Phase Disturbances Androgenetic - r/t hereditary thinning d/t shortened anagen phase Anagen effluvium - rapid and dramatic loss of anagen hair (chemo) Alopecia areata - T-cell mediated Autoimmune condition - impacted by stress - addisons, lupus, thyroid **all of these are noncicatrical Telogen phase alopecia telogen effluvium - Hair enters telogen phase permanently - can be caused by high fevers, meds, endocrine, childbirth, anemia, malnutrition A postive hair test is defined by 5 of more hairs include anagen hairs with follicle sheath Differential diagnosis for alopecia TSH, CBC Pharmacological treatment for androgenetic alopecia Minoxidil (only FDA approved med for women) Finasteride - inhibits the change of T to DHT Nonpharm tx includes UV light. When should a bite wound be left open? If older than 6-12 hours, if from a cat, if it's on the hand Standard antimicrobial therapy following a bite wound and precautionary treatments amx/clav 5-7 days, clinda + doxy for pcn allergy Tdap Rabies HRIG day of bite, and days 3,7,14 Consider inpt for wound from bite If it is an older bite with infection - requires IV abx for 7-14 days. What is referral criteria for burns respiratory injury due to inhaled or facila burns, burns of the hands , feet, genitals, 2% BSA full thickness burns, 10% BSA minor burn + 50yrs or 10yrs, or 15% BSA minor burn aged 10 50 The rule of nines for burns -Head = 9 -Each arm = 9 -Each leg = 18 -Front torso = 18 -Back torso = 18 -groin = 1 Treatment for burns and areas recommend to have open dressings Sulfadiazine (silvadene) - can cause tattooing, not ideal for face Open dressings of face, neck, perineum Acute exanthematous generalized pustulosis (AGEP) characterized by dozens to hundreds of pinsized pustules on a background of edematous erythema with accentuation at the flexural area of the body. May include facial edema, fever, leukocytosis, mild eosinophilia. Meds that may cause AGEP aminopenicillins, macrolides, antifungals, CCB diltiazem, antimalarials SX onset hours to days Signs of exanthematous drug reactions - most common form - usually involves mucous membranes and the face , marked with diffuse and symmetric distribution of erythematous macules and papules, pruritis, low grade fever, mild eosinophilia. Drugs associated with Exanthematous drug rxns bactrim, anticonvulsants(carbamazepine and phenytoin), NSAIDs, sx take days to weeks more susceptible in patient with immunodeficiency Fixed Drug Eruption Painful purple patch same spot every time might be a bullae dc the drug NSAIDs, sudafed, Sulfa, ABX Drug reaction with eosinophilia and systemic symptoms (DRESS) Eruption develops on the face and upper body becomes edematous and may be accompanied by vesicle, bullae, and follicular or non-follicular pustules. Facial edema is hallmark and occurs in 75% of patients. Systemic symptoms may include fever, malaise, lymphadenopathy, and arthralgia. Eosinophilia and Leukocytosis is usually present. S/S acute hepatitis, myocarditis, interstitial pneumonitis, interstitial nephritis, and thyroiditis are complications that may require hospitalization and serial monitoring. Severe hepatitis is responsible for most DRESS related deaths. MEDS: anticonvulsants, allopurinol, dapsone, and sulfonamides Stevens-Johnson Syndrome A severe, possibly fatal reaction that mimics a burn; may be due to a medication. Toxic Epidermal Necrolysis -severe erythema multiforme with widespread involvement -due to drug hypersensitivity -target lesion-- widespread full thickness necrosiss of skin 30% body -prodrome fever, flue sx -mucous membranes affected -tx: hospitalization, fluids, systemic steroids Nikelsky sign skin that shears easily and is tender to touch Classic presentation of SJS fever, sore mouth, burnign eyes, congestion, aches, rash starts on trunk and extends to limbs, rash diffuse red/purple that may blister Medications associated with SJS/TENS macrolides, valproic acid, NSAIS, bactrim, allopurinol, anticonvulsants, PCN Indications for sulfonamides UTI, MRSA, SKin infections - should be renally dosed!! CI for sulfonamides sulfa allergy, hx of drug induced thrombocyopenia Adverse rxns leukopenia, neutropenia, thrombocytopenia, RASH, SJS, tinnitus, GI SE Atopic dermatitis symptoms/ treatment incessant itching that leads to lichenification and if left untreated = crusting and oozing Most common in 3-6mnth old Antihistamines, nonsedating antihistamines (cetirizine/zyrtec, loratiadine/claritin), hydrocortisone ointment, nonsteroidal calsineurin inhibitor topical meds Two groups of cellulitis: Purulent and non prurulent Three types of purulent cellulitis Epidermoid cyst, furuncle (follicle and into dermis), carbuncle (group of furuncles) Two types of non-purulent cellulitis Erysipelas and necrotizing fascitis What is erysipelas? lower legs, face, ears s/s erythema that spreads, induration and is painful and may include systemic sx like chlls, fever, malaise. TX PCN 500mg 4x/day for 10 days prevalent organism responsible for cellulitis and treatment Group A strep S. Aureaus - especially if deep/penetration Pateurella considered in animal bites TMP-SMX, Doxycycline Treatment for MRSA Uncomplicated - PO bactrim IV - Vancomycin Cause of impetigo S. Aureas is most common cause in USA Two kinds of impetigo Bullous vs nonbullous (more common) Treating impetigo ointment first, then oral antibiotics Mupirocin 3x/day for 10 days or Retapamulin 2x/dayx5day ORAL - dicloxacillin, cephalexin, azithromycin, augmention Preventation treatment for HSV If more than 4 outbreaks/year acyclovir 400mg BID reassess need for tx in oral 4mnths, Tinea capitis treatment Aluminum sulfate soaks (dry out) Topical antifungals: terbinafine, naftifine, betenafine, clotrimazole, econozole, ketoconozole Medicate shampoo with oral meds - selenium sulfid 2z/wk x 2 weeks or Ketoconazole 2x/wk x 4 wks. Orals - Griseofulvin 2-4mnths (take with high fat food) or 2 wks after - cx Diflucam for 2-4wks ***Avoid oral ketoconazole due to hepatotoxicity Pruritic eruption that is poorly defined, often includes linear burrows between fingers/breasts/genitals which are complicated by scratching Scabies tx for scabies -Topical permethrin over entire body, leave on for 8-12 hours, repated in 1 week Note: itching will continue for several weeks even after mites are dead Off label - oral ivermectin 200mcg/kg once daily Secondary tx - sulfur ointment Ivermectin for 3 days Last resort - lindane kwell but has high toxicity concerns What is intertrigo a superficial inflammatory skin condition of the skin's flexural surfaces, prompted or irritated by warm temperatures, friction, moisture, maceration, and poor ventilation Treatment for intertrigo burrow's solution, zinc oxide, antifungal This rash causes a unilateral eruption usually along one dermatone Shingles/ zoster TX for H. Zoster antiviral therapy - Valacyclovir 1000mg TID x 7 days, Famciclovier 500mg TID x 7 days or acyclovir 800 mg 5x/day 7-10 days. Vaccine Shingrix 50 or Zostavax 60 What is herpetic whitlow? HOw long infectious? recurrent HSV on the finger - infectious until lesion are healed tx for herpetic whitlow Acyclovir - monitor crt clr I/D is AVOIDED Herpetic whitlow is referred when.... tenosynovitis with sever redness, swelling, pain , and stiffness Paroncychia treatment and symptoms acute or chronic (6wks) inflammation of tissue around nail, throbbing pain. TX SUlfa Clindamycin, augmentin, cephalexin What is auspitz sign the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques Psoriasis increases risk of cardiovascular disease, HTN, DM, sleep issues, ETOH, depression, arthritis, IBS This form of psorias is seen after strep Guttate and increases likely hood of psoriasis vulgaris later in life Treatment for psoriasis topical steroids limited to 3% body coverage Intralesional injuections - derm referral systemic meds - oral retinoids, methotrexate, cyclosporine (nephrotoxic), biolgic agents like TNG antagonists, monoclonal antibody, IL/7A inhibitors PHototherapy What is vitiligo? What causes it? localized loss of skin pigmentation, autoimmune destruction of melanocytes Treatment for Vitiligo High SPF sunscreen (45+) phototherapy topical steroids, immunomodulators (calcineurin inhibitors) Oral steroids Surgical Mental health referral