MARYVILLE NURS 623 EXAM 1 REAL EXAM GUIDE
NEWEST VERSION 2026-2027 EXPECTED QUESTION
AND CORRECT ANSWER FROM VERIFIED
SOURCES.
QUESTION
What is the appropriate treatment for localized cellulitis?
CORRECT ANS: Diagnostic testing—most cases are diagnosed by history and physical
examination. Usually no discharge or obvious wound is present, therefore unable to
obtain a culture. If an open wound or purulent discharge is present, a culture and Gram
stain should be obtained. For patients with fever, a CBC should be done. If periorbital
cellulitis is suspected, extraocular movement (EOM) and cranial nerve testing should be
performed. Management must take into consideration the severity of infection, site of
infection, underlying disease, and virulence of the pathogen. For those who have
cellulitis not related to human or animal bites, treatment is with dicloxacillin or
cephalexin for 10-14 days. Patients with a penicillin allergy receive erythromycin.
Infected human and animal bites are treated with Augmentin for at least 2 weeks. Lower
extremity cellulitis requires bedrest and elevation of the leg. Comorbid conditions must
be considered, and referral for specialized treatment may be necessary. Haemophilus
influenzae can be treated with Ceftin. If a Gram-negative microorganism is suspected,
treat with fluoroquinolones such as levofloxacin. Diabetic patients are typically treated
with Augmentin.
EXPERT RATIONALE
Cellulitis is a common bacterial skin infection that requires a systematic approach to
diagnosis and management. Diagnostic testing is guided by clinical presentation;
cultures are only obtained when there is an open wound or purulent discharge. The
choice of antibiotic is based on the likely pathogen, the severity of the infection, and
patient-specific factors such as allergies and comorbidities. Penicillinase-resistant
penicillins (dicloxacillin) or first-generation cephalosporins (cephalexin) are first-line for
non-bite cellulitis. Augmentin is preferred for bite wounds due to the polymicrobial
nature of these infections. Special populations, such as diabetics, require broad-
spectrum coverage, and lower extremity infections benefit from elevation and rest to
reduce edema and promote healing.
,QUESTION
What is the treatment for purulent cellulitis?
CORRECT ANS: Incision and drainage (I&D) is first-line treatment. No first-generation
cephalosporins should be used. Consider methicillin-resistant Staphylococcus
aureus (MRSA) and treat with Bactrim, Cleocin, or Doxycycline.
EXPERT RATIONALE
Purulent cellulitis, characterized by the presence of purulent drainage or an abscess,
requires drainage of the purulent material as the primary intervention. Antibiotic therapy
must be directed against MRSA, which is a common pathogen in these infections. First-
generation cephalosporins, such as cephalexin, are not effective against MRSA.
Alternative agents with MRSA coverage include trimethoprim-sulfamethoxazole
(Bactrim), clindamycin (Cleocin), and doxycycline. This approach aligns with current
Infectious Diseases Society of America (IDSA) guidelines.
QUESTION
What are viral skin infections?
CORRECT ANS: Chicken pox, shingles, measles, warts, herpes.
EXPERT RATIONALE
Viral skin infections are caused by various viruses and present with distinct cutaneous
manifestations. Common examples include varicella-zoster virus (chicken pox and
shingles), measles virus, human papillomavirus (warts), and herpes simplex virus
(herpes). Each has a characteristic clinical presentation and requires specific
management strategies.
QUESTION
What is Herpes Zoster (shingles) and how is it treated?
,CORRECT ANS: Unexplained pain along a dermatome. Unilateral vesicular rash along a
dermatome lasting 3-5 days, up to 30 days. Treatment includes Famciclovir, Acyclovir,
Valacyclovir, a Prednisone taper, and vaccination.
EXPERT RATIONALE
Herpes zoster, caused by reactivation of the varicella-zoster virus, presents with a
painful, unilateral vesicular rash in a dermatomal distribution. Antiviral therapy (acyclovir,
valacyclovir, famciclovir) is most effective when initiated within 72 hours of rash onset to
reduce the severity and duration of symptoms. A short course of corticosteroids may be
used to reduce acute pain and inflammation. The recombinant zoster vaccine (Shingrix)
is recommended for prevention in older adults.
QUESTION
What is herpes simplex and how is it treated?
CORRECT ANS: Oral or genital, can be asymptomatic. Tenderness, pain, mild
paresthesias, or burning before onset. Prodrome can include headache, fever, muscle
ache, lymphadenopathy, local pain. Grouped vesicles on an erythematous base. No cure.
Oral: lip ointment Blistex, OTC Abreva, Denavir for extensive lesions. Genital: Valacyclovir
and famciclovir are better choices.
EXPERT RATIONALE
Herpes simplex virus (HSV) causes recurrent infections characterized by grouped vesicles
on an erythematous base. The prodromal symptoms of pain, burning, or tingling are
classic. While there is no cure, antiviral medications (acyclovir, valacyclovir, famciclovir)
can reduce the duration and severity of outbreaks. Topical agents like docosanol
(Abreva) and penciclovir (Denavir) can be used for oral lesions. Valacyclovir and
famciclovir have better oral bioavailability and are often preferred for genital herpes.
QUESTION
What is acne vulgaris and how is it classified and treated?
CORRECT ANS: Located on the face, chest, back, and upper outer arms. Mild = total
lesions <30, noninflammatory. Comedones with small papules. Moderate = total lesions
30-125, inflammation. Papules and pustules with yellow/green tops. Severe = lesions
, >125, nodulocystic acne. Treatments: Tretinoin, topical vs. systemic antibiotics,
Isotretinoin.
EXPERT RATIONALE
Acne vulgaris is a common skin condition affecting pilosebaceous units. Classification is
based on lesion type and count, guiding treatment selection. Mild acne is treated with
topical agents such as retinoids (tretinoin) or benzoyl peroxide. Moderate acne often
requires the addition of topical or oral antibiotics. Severe nodulocystic acne may
necessitate isotretinoin, a potent oral retinoid. Treatment is tailored to the patient's age,
severity, and response to therapy.
QUESTION
What are the basics of evaluating skin conditions?
CORRECT ANS: Alopecia, Rash, Pruritus, Urticaria, Pigmentation change. Skin lesion—
New vs. Change.
EXPERT RATIONALE
A thorough skin assessment begins with identifying the primary complaint: hair loss
(alopecia), rash, itching (pruritus), hives (urticaria), or changes in skin color
(pigmentation). It is critical to determine whether a lesion is new or has changed in size,
shape, or color. This initial evaluation guides further history-taking and differential
diagnosis.
QUESTION
What are the key Health History (HPI) questions for skin problems?
CORRECT ANS: Duration of symptoms; Precipitating factors; Medications; Food;
Occupation; Outdoors; Hobbies/Sport participation; Exposure to insects;
Jewelry/metals/chemicals; Family history. Is it: Local or systemic; Pruritus- all day or
worse at night; Urticaria - duration; Pigmented changes.
EXPERT RATIONALE
A comprehensive history is essential for diagnosing skin conditions. Inquiries should
cover the duration of symptoms, potential triggers (medications, food, occupation,
NEWEST VERSION 2026-2027 EXPECTED QUESTION
AND CORRECT ANSWER FROM VERIFIED
SOURCES.
QUESTION
What is the appropriate treatment for localized cellulitis?
CORRECT ANS: Diagnostic testing—most cases are diagnosed by history and physical
examination. Usually no discharge or obvious wound is present, therefore unable to
obtain a culture. If an open wound or purulent discharge is present, a culture and Gram
stain should be obtained. For patients with fever, a CBC should be done. If periorbital
cellulitis is suspected, extraocular movement (EOM) and cranial nerve testing should be
performed. Management must take into consideration the severity of infection, site of
infection, underlying disease, and virulence of the pathogen. For those who have
cellulitis not related to human or animal bites, treatment is with dicloxacillin or
cephalexin for 10-14 days. Patients with a penicillin allergy receive erythromycin.
Infected human and animal bites are treated with Augmentin for at least 2 weeks. Lower
extremity cellulitis requires bedrest and elevation of the leg. Comorbid conditions must
be considered, and referral for specialized treatment may be necessary. Haemophilus
influenzae can be treated with Ceftin. If a Gram-negative microorganism is suspected,
treat with fluoroquinolones such as levofloxacin. Diabetic patients are typically treated
with Augmentin.
EXPERT RATIONALE
Cellulitis is a common bacterial skin infection that requires a systematic approach to
diagnosis and management. Diagnostic testing is guided by clinical presentation;
cultures are only obtained when there is an open wound or purulent discharge. The
choice of antibiotic is based on the likely pathogen, the severity of the infection, and
patient-specific factors such as allergies and comorbidities. Penicillinase-resistant
penicillins (dicloxacillin) or first-generation cephalosporins (cephalexin) are first-line for
non-bite cellulitis. Augmentin is preferred for bite wounds due to the polymicrobial
nature of these infections. Special populations, such as diabetics, require broad-
spectrum coverage, and lower extremity infections benefit from elevation and rest to
reduce edema and promote healing.
,QUESTION
What is the treatment for purulent cellulitis?
CORRECT ANS: Incision and drainage (I&D) is first-line treatment. No first-generation
cephalosporins should be used. Consider methicillin-resistant Staphylococcus
aureus (MRSA) and treat with Bactrim, Cleocin, or Doxycycline.
EXPERT RATIONALE
Purulent cellulitis, characterized by the presence of purulent drainage or an abscess,
requires drainage of the purulent material as the primary intervention. Antibiotic therapy
must be directed against MRSA, which is a common pathogen in these infections. First-
generation cephalosporins, such as cephalexin, are not effective against MRSA.
Alternative agents with MRSA coverage include trimethoprim-sulfamethoxazole
(Bactrim), clindamycin (Cleocin), and doxycycline. This approach aligns with current
Infectious Diseases Society of America (IDSA) guidelines.
QUESTION
What are viral skin infections?
CORRECT ANS: Chicken pox, shingles, measles, warts, herpes.
EXPERT RATIONALE
Viral skin infections are caused by various viruses and present with distinct cutaneous
manifestations. Common examples include varicella-zoster virus (chicken pox and
shingles), measles virus, human papillomavirus (warts), and herpes simplex virus
(herpes). Each has a characteristic clinical presentation and requires specific
management strategies.
QUESTION
What is Herpes Zoster (shingles) and how is it treated?
,CORRECT ANS: Unexplained pain along a dermatome. Unilateral vesicular rash along a
dermatome lasting 3-5 days, up to 30 days. Treatment includes Famciclovir, Acyclovir,
Valacyclovir, a Prednisone taper, and vaccination.
EXPERT RATIONALE
Herpes zoster, caused by reactivation of the varicella-zoster virus, presents with a
painful, unilateral vesicular rash in a dermatomal distribution. Antiviral therapy (acyclovir,
valacyclovir, famciclovir) is most effective when initiated within 72 hours of rash onset to
reduce the severity and duration of symptoms. A short course of corticosteroids may be
used to reduce acute pain and inflammation. The recombinant zoster vaccine (Shingrix)
is recommended for prevention in older adults.
QUESTION
What is herpes simplex and how is it treated?
CORRECT ANS: Oral or genital, can be asymptomatic. Tenderness, pain, mild
paresthesias, or burning before onset. Prodrome can include headache, fever, muscle
ache, lymphadenopathy, local pain. Grouped vesicles on an erythematous base. No cure.
Oral: lip ointment Blistex, OTC Abreva, Denavir for extensive lesions. Genital: Valacyclovir
and famciclovir are better choices.
EXPERT RATIONALE
Herpes simplex virus (HSV) causes recurrent infections characterized by grouped vesicles
on an erythematous base. The prodromal symptoms of pain, burning, or tingling are
classic. While there is no cure, antiviral medications (acyclovir, valacyclovir, famciclovir)
can reduce the duration and severity of outbreaks. Topical agents like docosanol
(Abreva) and penciclovir (Denavir) can be used for oral lesions. Valacyclovir and
famciclovir have better oral bioavailability and are often preferred for genital herpes.
QUESTION
What is acne vulgaris and how is it classified and treated?
CORRECT ANS: Located on the face, chest, back, and upper outer arms. Mild = total
lesions <30, noninflammatory. Comedones with small papules. Moderate = total lesions
30-125, inflammation. Papules and pustules with yellow/green tops. Severe = lesions
, >125, nodulocystic acne. Treatments: Tretinoin, topical vs. systemic antibiotics,
Isotretinoin.
EXPERT RATIONALE
Acne vulgaris is a common skin condition affecting pilosebaceous units. Classification is
based on lesion type and count, guiding treatment selection. Mild acne is treated with
topical agents such as retinoids (tretinoin) or benzoyl peroxide. Moderate acne often
requires the addition of topical or oral antibiotics. Severe nodulocystic acne may
necessitate isotretinoin, a potent oral retinoid. Treatment is tailored to the patient's age,
severity, and response to therapy.
QUESTION
What are the basics of evaluating skin conditions?
CORRECT ANS: Alopecia, Rash, Pruritus, Urticaria, Pigmentation change. Skin lesion—
New vs. Change.
EXPERT RATIONALE
A thorough skin assessment begins with identifying the primary complaint: hair loss
(alopecia), rash, itching (pruritus), hives (urticaria), or changes in skin color
(pigmentation). It is critical to determine whether a lesion is new or has changed in size,
shape, or color. This initial evaluation guides further history-taking and differential
diagnosis.
QUESTION
What are the key Health History (HPI) questions for skin problems?
CORRECT ANS: Duration of symptoms; Precipitating factors; Medications; Food;
Occupation; Outdoors; Hobbies/Sport participation; Exposure to insects;
Jewelry/metals/chemicals; Family history. Is it: Local or systemic; Pruritus- all day or
worse at night; Urticaria - duration; Pigmented changes.
EXPERT RATIONALE
A comprehensive history is essential for diagnosing skin conditions. Inquiries should
cover the duration of symptoms, potential triggers (medications, food, occupation,
