NUR 6111 – Advanced Practice Nursing I
Exams 1–3 Questions and Answers| Latest Update
William Paterson University
,Exam 1
1. A 16-year-old presents with comedones, papules, and pustules on the face and
back. Which is the most appropriate first-line topical therapy for mild-moderate
acne vulgaris?
A. Oral isotretinoin
B. Topical retinoid (e.g., tretinoin or adapalene), with or without benzoyl peroxide
C. Oral corticosteroids
D. Topical clindamycin monotherapy long-term
E. Oral tetracycline as first-line monotherapy
Answer: B
Rationale: Topical retinoids are first-line for mild-moderate acne, normalizing follicular
keratinization; combining with benzoyl peroxide reduces P. acnes resistance. Oral
antibiotic monotherapy without a retinoid/benzoyl peroxide is discouraged due to
resistance, and isotretinoin is reserved for severe, nodulocystic, or treatment-refractory
acne.
2. A patient presents with well-demarcated, erythematous plaques with silvery scale
on the extensor surfaces of the elbows and knees, along with nail pitting. What is the
most likely diagnosis?
A. Atopic dermatitis
B. Psoriasis vulgaris
C. Seborrheic dermatitis
D. Tinea corporis
E. Lichen planus
Answer: B
Rationale: Plaque psoriasis classically presents with well-demarcated erythematous
plaques with silvery scale on extensor surfaces (elbows, knees), often with associated nail
pitting or onycholysis, distinguishing it from atopic dermatitis, which favors flexural
surfaces.
3. A 6-month-old has pruritic, erythematous, scaly patches on the cheeks and
flexural areas of the arms. What is the most likely diagnosis and appropriate first-
line management?
A. Contact dermatitis; avoidance of the specific allergen only
B. Atopic dermatitis; emollients and topical corticosteroids
C. Psoriasis; topical vitamin D analog first-line in infants
D. Tinea faciei; oral antifungal
, E. Seborrheic dermatitis; ketoconazole shampoo
Answer: B
Rationale: Atopic dermatitis in infants classically involves the face and extensor surfaces,
later shifting to flexural areas, and is treated first-line with regular emollient use and
low-potency topical corticosteroids for flares, alongside trigger avoidance.
4. A patient develops an intensely pruritic, vesicular rash in a linear pattern on the
forearm after gardening, consistent with poison ivy exposure. What is the most
appropriate initial management for a moderate, localized reaction?
A. Oral antibiotics
B. Topical corticosteroid and oral antihistamine for pruritus
C. Systemic antifungal
D. Immediate surgical debridement
E. Topical antiviral
Answer: B
Rationale: Allergic contact dermatitis from plant oleoresin (e.g., poison ivy) causing a
localized, linear vesicular rash is treated with topical corticosteroids and oral
antihistamines for pruritus; systemic corticosteroids are reserved for widespread or
facial/genital involvement.
5. A patient presents with a well-demarcated, warm, tender, erythematous area on
the lower leg with fever and leukocytosis, without purulence or abscess. What is the
most likely diagnosis and first-line oral treatment (outpatient, non-purulent)?
A. MRSA-covering agent as first-line for all cellulitis
B. Cephalexin or dicloxacillin targeting streptococci
C. Metronidazole monotherapy
D. Oral antifungal
E. No antibiotics needed, observation only
Answer: B
Rationale: Non-purulent cellulitis is most often caused by streptococcal species, so first-
line oral therapy targets strep (e.g., cephalexin or dicloxacillin). MRSA coverage is
reserved for purulent cellulitis, abscess, penetrating trauma, or risk factors for MRSA.
6. A 5-year-old presents with honey-colored crusted lesions around the mouth and
nose. What is the most likely diagnosis and appropriate treatment?
A. Impetigo; topical mupirocin for limited disease or oral antibiotics for extensive
disease
B. Herpes simplex; oral acyclovir only
C. Eczema herpeticum; IV antivirals only
, D. Tinea faciei; topical antifungal
E. Varicella; supportive care only
Answer: A
Rationale: Impetigo, caused by Staphylococcus aureus and/or Streptococcus pyogenes,
classically presents with honey-colored crusted lesions. Limited disease is treated with
topical mupirocin; more extensive disease warrants oral antibiotics covering these
organisms.
7. An older adult presents with a unilateral, painful vesicular rash in a dermatomal
distribution on the thorax. What is the most appropriate treatment if started within
72 hours of rash onset?
A. Oral acyclovir, valacyclovir, or famciclovir
B. Topical corticosteroid only
C. Oral antibiotics
D. Antifungal cream
E. No treatment needed, self-limited with no benefit from antivirals
Answer: A
Rationale: Herpes zoster (shingles) is treated with antiviral therapy (acyclovir,
valacyclovir, or famciclovir) ideally started within 72 hours of rash onset to reduce
severity, duration, and risk of postherpetic neuralgia, particularly important in older
adults.
8. A patient has recurrent painful vesicular lesions on an erythematous base on the
lip, triggered by sun exposure and stress. What is the most likely diagnosis?
A. Herpes simplex virus (recurrent orolabial)
B. Aphthous ulcer
C. Impetigo
D. Contact dermatitis
E. Herpes zoster
Answer: A
Rationale: Recurrent orolabial herpes simplex virus infection presents with grouped
vesicles on an erythematous base, commonly triggered by sun exposure, stress, or illness,
and can be managed with episodic or suppressive antiviral therapy in frequent
recurrences.
9. A patient presents with an annular, erythematous, scaly patch with central
clearing on the trunk. KOH prep shows hyphae. What is the most appropriate
treatment?
A. Topical antifungal (e.g., terbinafine or clotrimazole)
Exams 1–3 Questions and Answers| Latest Update
William Paterson University
,Exam 1
1. A 16-year-old presents with comedones, papules, and pustules on the face and
back. Which is the most appropriate first-line topical therapy for mild-moderate
acne vulgaris?
A. Oral isotretinoin
B. Topical retinoid (e.g., tretinoin or adapalene), with or without benzoyl peroxide
C. Oral corticosteroids
D. Topical clindamycin monotherapy long-term
E. Oral tetracycline as first-line monotherapy
Answer: B
Rationale: Topical retinoids are first-line for mild-moderate acne, normalizing follicular
keratinization; combining with benzoyl peroxide reduces P. acnes resistance. Oral
antibiotic monotherapy without a retinoid/benzoyl peroxide is discouraged due to
resistance, and isotretinoin is reserved for severe, nodulocystic, or treatment-refractory
acne.
2. A patient presents with well-demarcated, erythematous plaques with silvery scale
on the extensor surfaces of the elbows and knees, along with nail pitting. What is the
most likely diagnosis?
A. Atopic dermatitis
B. Psoriasis vulgaris
C. Seborrheic dermatitis
D. Tinea corporis
E. Lichen planus
Answer: B
Rationale: Plaque psoriasis classically presents with well-demarcated erythematous
plaques with silvery scale on extensor surfaces (elbows, knees), often with associated nail
pitting or onycholysis, distinguishing it from atopic dermatitis, which favors flexural
surfaces.
3. A 6-month-old has pruritic, erythematous, scaly patches on the cheeks and
flexural areas of the arms. What is the most likely diagnosis and appropriate first-
line management?
A. Contact dermatitis; avoidance of the specific allergen only
B. Atopic dermatitis; emollients and topical corticosteroids
C. Psoriasis; topical vitamin D analog first-line in infants
D. Tinea faciei; oral antifungal
, E. Seborrheic dermatitis; ketoconazole shampoo
Answer: B
Rationale: Atopic dermatitis in infants classically involves the face and extensor surfaces,
later shifting to flexural areas, and is treated first-line with regular emollient use and
low-potency topical corticosteroids for flares, alongside trigger avoidance.
4. A patient develops an intensely pruritic, vesicular rash in a linear pattern on the
forearm after gardening, consistent with poison ivy exposure. What is the most
appropriate initial management for a moderate, localized reaction?
A. Oral antibiotics
B. Topical corticosteroid and oral antihistamine for pruritus
C. Systemic antifungal
D. Immediate surgical debridement
E. Topical antiviral
Answer: B
Rationale: Allergic contact dermatitis from plant oleoresin (e.g., poison ivy) causing a
localized, linear vesicular rash is treated with topical corticosteroids and oral
antihistamines for pruritus; systemic corticosteroids are reserved for widespread or
facial/genital involvement.
5. A patient presents with a well-demarcated, warm, tender, erythematous area on
the lower leg with fever and leukocytosis, without purulence or abscess. What is the
most likely diagnosis and first-line oral treatment (outpatient, non-purulent)?
A. MRSA-covering agent as first-line for all cellulitis
B. Cephalexin or dicloxacillin targeting streptococci
C. Metronidazole monotherapy
D. Oral antifungal
E. No antibiotics needed, observation only
Answer: B
Rationale: Non-purulent cellulitis is most often caused by streptococcal species, so first-
line oral therapy targets strep (e.g., cephalexin or dicloxacillin). MRSA coverage is
reserved for purulent cellulitis, abscess, penetrating trauma, or risk factors for MRSA.
6. A 5-year-old presents with honey-colored crusted lesions around the mouth and
nose. What is the most likely diagnosis and appropriate treatment?
A. Impetigo; topical mupirocin for limited disease or oral antibiotics for extensive
disease
B. Herpes simplex; oral acyclovir only
C. Eczema herpeticum; IV antivirals only
, D. Tinea faciei; topical antifungal
E. Varicella; supportive care only
Answer: A
Rationale: Impetigo, caused by Staphylococcus aureus and/or Streptococcus pyogenes,
classically presents with honey-colored crusted lesions. Limited disease is treated with
topical mupirocin; more extensive disease warrants oral antibiotics covering these
organisms.
7. An older adult presents with a unilateral, painful vesicular rash in a dermatomal
distribution on the thorax. What is the most appropriate treatment if started within
72 hours of rash onset?
A. Oral acyclovir, valacyclovir, or famciclovir
B. Topical corticosteroid only
C. Oral antibiotics
D. Antifungal cream
E. No treatment needed, self-limited with no benefit from antivirals
Answer: A
Rationale: Herpes zoster (shingles) is treated with antiviral therapy (acyclovir,
valacyclovir, or famciclovir) ideally started within 72 hours of rash onset to reduce
severity, duration, and risk of postherpetic neuralgia, particularly important in older
adults.
8. A patient has recurrent painful vesicular lesions on an erythematous base on the
lip, triggered by sun exposure and stress. What is the most likely diagnosis?
A. Herpes simplex virus (recurrent orolabial)
B. Aphthous ulcer
C. Impetigo
D. Contact dermatitis
E. Herpes zoster
Answer: A
Rationale: Recurrent orolabial herpes simplex virus infection presents with grouped
vesicles on an erythematous base, commonly triggered by sun exposure, stress, or illness,
and can be managed with episodic or suppressive antiviral therapy in frequent
recurrences.
9. A patient presents with an annular, erythematous, scaly patch with central
clearing on the trunk. KOH prep shows hyphae. What is the most appropriate
treatment?
A. Topical antifungal (e.g., terbinafine or clotrimazole)
