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NUR 6111 Advanced Practice Nursing I
Comprehensive Q&A Bank - Set 2 (Questions 1-400)
1. A 72-year-old patient presents with a painless, pearly nodule with rolled
edges and visible telangiectasias on the nose. What is the most appropriate
initial management?
A) Cryotherapy with liquid nitrogen
B) Excisional biopsy
C) Topical 5-fluorouracil cream
D) Observation with annual follow-up
Answer: B) Excisional biopsy
Rationale: The clinical presentation is classic for basal cell carcinoma. Excisional biopsy
is indicated to confirm the diagnosis and ensure complete removal. Cryotherapy and
topical 5-fluorouracil are treatments for actinic keratosis, not definitive management
for suspected BCC. Observation would be inappropriate given the malignant potential.
2. A 65-year-old patient with a 40-pack-year smoking history presents with a
crusted, non-healing lesion on the lower lip that has been present for 4 months.
What is the most concerning diagnosis?
A) Actinic cheilitis
B) Herpes labialis
C) Squamous cell carcinoma
D) Contact dermatitis
Answer: C) Squamous cell carcinoma
Rationale: A crusted, non-healing lesion on the lower lip in a patient with significant
sun exposure and smoking history is highly suspicious for squamous cell carcinoma.
Actinic cheilitis is a premalignant condition but typically presents with scaling and
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dryness. Herpes labialis presents with vesicles and is self-limiting. Contact dermatitis is
typically pruritic and related to allergen exposure.
3. A patient presents with a rash characterized by silvery scales on
erythematous plaques located on the elbows, knees, and scalp. What is the
most appropriate initial treatment for mild disease?
A) Topical calcipotriene
B) Systemic methotrexate
C) Topical corticosteroids
D) Phototherapy
Answer: C) Topical corticosteroids
Rationale: Topical corticosteroids are the first-line treatment for mild to moderate
psoriasis. Calcipotriene is also used but typically as a second-line or combination
therapy. Systemic methotrexate is reserved for moderate to severe disease.
Phototherapy is used for more extensive disease or when topical therapy fails.
4. A 28-year-old patient presents with intense pruritus, erythema, and weeping
lesions in the antecubital fossae. The patient has a history of asthma. What is
the most appropriate initial management?
A) Oral antihistamines and emollients
B) Medium-potency topical corticosteroids and emollients
C) Systemic corticosteroids
D) Topical calcineurin inhibitors
Answer: B) Medium-potency topical corticosteroids and emollients
Rationale: Acute flares of atopic dermatitis are treated with medium-potency topical
corticosteroids to reduce inflammation and pruritus, along with emollients to restore
skin barrier function. Oral antihistamines help pruritus but are not primary therapy.
Systemic corticosteroids are reserved for severe, refractory cases. Topical calcineurin
inhibitors are used for maintenance or sensitive areas, not acute flares.
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5. A 55-year-old patient with a history of diabetes mellitus presents with a red,
swollen, painful lower leg. The area is warm to the touch and there is a well-
demarcated border. What is the most appropriate empiric antibiotic therapy?
A) Vancomycin
B) Cephalexin
C) Ciprofloxacin
D) Clindamycin
Answer: B) Cephalexin
Rationale: Cephalexin is a first-generation cephalosporin effective against
Streptococcus and methicillin-susceptible Staphylococcus aureus, the most common
pathogens in cellulitis. Vancomycin is reserved for MRSA or severe infections.
Ciprofloxacin has poor coverage for Streptococcus. Clindamycin may be used but is not
first-line for uncomplicated cellulitis.
6. A patient presents with a vesicular rash in a dermatomal distribution on the
right thorax. The rash began 48 hours ago and the patient reports severe
burning pain. What is the most appropriate antiviral regimen?
A) Acyclovir 400 mg five times daily for 5 days
B) Acyclovir 800 mg five times daily for 7-10 days
C) Valacyclovir 500 mg twice daily for 7 days
D) Famciclovir 250 mg three times daily for 3 days
Answer: B) Acyclovir 800 mg five times daily for 7-10 days
Rationale: The standard treatment for herpes zoster in immunocompetent adults is oral
acyclovir 800 mg five times daily for 7-10 days. Treatment should ideally be initiated
within 72 hours of rash onset. Valacyclovir and famciclovir are alternative agents with
different dosing regimens but acyclovir 800 mg five times daily is the classic regimen
for herpes zoster.
7. A patient presents with a painless, violaceous, flat-topped papule with a
reticulated white pattern (Wickham's striae) on the wrist. What is the most
likely diagnosis?
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NUR 6111 Advanced Practice Nursing I
Comprehensive Q&A Bank - Set 2 (Questions 1-400)
1. A 72-year-old patient presents with a painless, pearly nodule with rolled
edges and visible telangiectasias on the nose. What is the most appropriate
initial management?
A) Cryotherapy with liquid nitrogen
B) Excisional biopsy
C) Topical 5-fluorouracil cream
D) Observation with annual follow-up
Answer: B) Excisional biopsy
Rationale: The clinical presentation is classic for basal cell carcinoma. Excisional biopsy
is indicated to confirm the diagnosis and ensure complete removal. Cryotherapy and
topical 5-fluorouracil are treatments for actinic keratosis, not definitive management
for suspected BCC. Observation would be inappropriate given the malignant potential.
2. A 65-year-old patient with a 40-pack-year smoking history presents with a
crusted, non-healing lesion on the lower lip that has been present for 4 months.
What is the most concerning diagnosis?
A) Actinic cheilitis
B) Herpes labialis
C) Squamous cell carcinoma
D) Contact dermatitis
Answer: C) Squamous cell carcinoma
Rationale: A crusted, non-healing lesion on the lower lip in a patient with significant
sun exposure and smoking history is highly suspicious for squamous cell carcinoma.
Actinic cheilitis is a premalignant condition but typically presents with scaling and
,3|Page
dryness. Herpes labialis presents with vesicles and is self-limiting. Contact dermatitis is
typically pruritic and related to allergen exposure.
3. A patient presents with a rash characterized by silvery scales on
erythematous plaques located on the elbows, knees, and scalp. What is the
most appropriate initial treatment for mild disease?
A) Topical calcipotriene
B) Systemic methotrexate
C) Topical corticosteroids
D) Phototherapy
Answer: C) Topical corticosteroids
Rationale: Topical corticosteroids are the first-line treatment for mild to moderate
psoriasis. Calcipotriene is also used but typically as a second-line or combination
therapy. Systemic methotrexate is reserved for moderate to severe disease.
Phototherapy is used for more extensive disease or when topical therapy fails.
4. A 28-year-old patient presents with intense pruritus, erythema, and weeping
lesions in the antecubital fossae. The patient has a history of asthma. What is
the most appropriate initial management?
A) Oral antihistamines and emollients
B) Medium-potency topical corticosteroids and emollients
C) Systemic corticosteroids
D) Topical calcineurin inhibitors
Answer: B) Medium-potency topical corticosteroids and emollients
Rationale: Acute flares of atopic dermatitis are treated with medium-potency topical
corticosteroids to reduce inflammation and pruritus, along with emollients to restore
skin barrier function. Oral antihistamines help pruritus but are not primary therapy.
Systemic corticosteroids are reserved for severe, refractory cases. Topical calcineurin
inhibitors are used for maintenance or sensitive areas, not acute flares.
, 4|Page
5. A 55-year-old patient with a history of diabetes mellitus presents with a red,
swollen, painful lower leg. The area is warm to the touch and there is a well-
demarcated border. What is the most appropriate empiric antibiotic therapy?
A) Vancomycin
B) Cephalexin
C) Ciprofloxacin
D) Clindamycin
Answer: B) Cephalexin
Rationale: Cephalexin is a first-generation cephalosporin effective against
Streptococcus and methicillin-susceptible Staphylococcus aureus, the most common
pathogens in cellulitis. Vancomycin is reserved for MRSA or severe infections.
Ciprofloxacin has poor coverage for Streptococcus. Clindamycin may be used but is not
first-line for uncomplicated cellulitis.
6. A patient presents with a vesicular rash in a dermatomal distribution on the
right thorax. The rash began 48 hours ago and the patient reports severe
burning pain. What is the most appropriate antiviral regimen?
A) Acyclovir 400 mg five times daily for 5 days
B) Acyclovir 800 mg five times daily for 7-10 days
C) Valacyclovir 500 mg twice daily for 7 days
D) Famciclovir 250 mg three times daily for 3 days
Answer: B) Acyclovir 800 mg five times daily for 7-10 days
Rationale: The standard treatment for herpes zoster in immunocompetent adults is oral
acyclovir 800 mg five times daily for 7-10 days. Treatment should ideally be initiated
within 72 hours of rash onset. Valacyclovir and famciclovir are alternative agents with
different dosing regimens but acyclovir 800 mg five times daily is the classic regimen
for herpes zoster.
7. A patient presents with a painless, violaceous, flat-topped papule with a
reticulated white pattern (Wickham's striae) on the wrist. What is the most
likely diagnosis?
