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A nurse practitioner is working at a summer resort health clinic. Benny, a 19-year-old
male, presents with a first-degree burn covering his entire torso after prolonged sun
exposure without protection while taking a photosensitizing medication. To accurately
document his burned surface area, the nurse practitioner uses the rule of palms. In
evaluating a patient's surface area using this method, what percentage of the patient's
total body surface area is represented by the patient's palm?
a. 1%
b. 5%
c. 10%
d. 15%
✔️ Correct Answer: a. 1%
Rationale:
,The rule of palms is a quick method for estimating burn size, particularly for scattered
burns. The patient's palm, including the fingers, represents approximately 1% of their
total body surface area (TBSA). This method is useful for small or irregular burns.
Options B, C, and D are incorrect as they overestimate the surface area represented by a
single palm.
Patients with acute autoimmune disorder flares are routinely treated with medications to
reduce inflammation, but these agents do not typically manage the underlying disease
state. Which class of medication is typically used for long-term management of the
underlying disease process in most autoimmune disorders?
a. Corticosteroids
b. Monoclonal antibodies
c. Nonsteroidal anti-inflammatory drugs
d. Antimetabolites
✔️ Correct Answer: b. Monoclonal antibodies
Rationale:
Monoclonal antibodies are disease-modifying agents that target specific components of
the immune system to manage the underlying pathophysiology of autoimmune
disorders. Corticosteroids (Option A) and NSAIDs (Option C) are primarily used for acute
symptom management and inflammation control but do not alter the disease course.
Antimetabolites (Option D) are used in some autoimmune conditions but are not the
primary class for long-term disease management across most autoimmune disorders.
Shelley, a 19-year-old female, presents for a routine health visit and reports recent
symptoms of dysuria and urinary frequency, raising suspicion for a urinary tract
infection. Urinalysis confirms the diagnosis with positive leukocyte esterase, nitrates,
WBCs, and bacteria. Her most recent labs from six months ago showed normal CBC and
BMP. She has a history of anaphylaxis after antibiotic administration for an unrelated
illness two years ago. Based on her presentation, which is the best strategy for treating
her urinary tract infection?
a. Sulfamethoxazole/trimethoprim (Bactrim)
b. Ciprofloxacin
,c. Nitrofurantoin
d. Amoxicillin
✔️ Correct Answer: c. Nitrofurantoin
Rationale:
Nitrofurantoin is the first-line agent for uncomplicated urinary tract infections in women
of childbearing age, as it achieves high concentrations in the urine and has low
resistance rates. Option A (Bactrim) is a reasonable choice but may be contraindicated if
the patient has a sulfa allergy or history of anaphylaxis to antibiotics. Option B
(Ciprofloxacin) is a fluoroquinolone typically reserved for complicated UTIs due to
resistance concerns. Option D (Amoxicillin) has high resistance rates for E. coli and is not
first-line. Given her history of anaphylaxis to an unspecified antibiotic, nitrofurantoin
provides a safe and effective alternative.
Zeke, a 22-year-old male, presents to your primary care clinic with unilateral leg swelling
and tenderness after an all-nighter playing video games. You suspect a provoked DVT
from immobility and an ultrasound has been ordered. While awaiting the exam, you
preemptively discuss anticoagulation with the patient. Which of the following
statements indicates adequate understanding of the treatment plan?
a. "If they find a blood clot, I will need to take Lovenox and warfarin until my INR is 2.0."
b. "If they find a blood clot, I will only need to take aspirin daily."
c. "If they find a blood clot, I will need to take warfarin alone for six months."
d. "If they find a blood clot, I will need to use Lovenox in addition to warfarin until my
INR is 3.0."
✔️ Correct Answer: d. "If they find a blood clot, I will need to use Lovenox in addition to
warfarin until my INR is 3.0."
Rationale:
For acute DVT management, initial therapy typically involves bridging with a parenteral
anticoagulant (Lovenox/enoxaparin) while initiating warfarin therapy. Warfarin is
continued until the INR reaches a therapeutic range of 2.0 to 3.0 for a provoked DVT.
Option D correctly identifies the need for bridging therapy and the appropriate INR
target of 3.0. Option A is incorrect because INR 2.0 is at the lower end of therapeutic
range and not the typical target for initiation. Option B is incorrect because aspirin is not
adequate for DVT treatment. Option C is incorrect because warfarin alone without
bridging places the patient at risk for progression of thrombosis.
, Kia, a 22-year-old transgender female, is actively undergoing gender-affirming therapy
but abruptly stopped their medication regimen two weeks ago due to insurance issues.
They present with hypotension, pallor, and hypothermia. Assuming they are taking all of
the following medications, which is most likely the culprit for these symptoms after
abrupt withdrawal?
a. Estradiol
b. Spironolactone
c. Finasteride
d. Prednisone (Deltasone)
✔️ Correct Answer: d. Prednisone (Deltasone)
Rationale:
Abrupt withdrawal of chronic corticosteroid therapy (prednisone) can precipitate acute
adrenal crisis, presenting with hypotension, pallor, hypothermia, and potentially life-
threatening complications. Options A, B, and C (estradiol, spironolactone, finasteride)
are part of gender-affirming therapy but do not typically cause this constellation of
symptoms upon abrupt withdrawal. Estrogen withdrawal may cause mood changes and
hot flashes, spironolactone withdrawal may cause mild blood pressure changes, and
finasteride withdrawal does not produce these acute symptoms.
Your 55-year-old female patient, Eve, has been diagnosed with acute myeloid leukemia.
Which agent would be most likely to assist in managing her anticipated side effects of
cancer treatment?
a. Allopurinol
b. Ondansetron
c. Filgrastim
d. Epoetin alfa
✔️ Correct Answer: a. Allopurinol
Rationale:
Acute myeloid leukemia treatment involves chemotherapy that causes rapid tumor lysis,
releasing uric acid and increasing the risk of tumor lysis syndrome. Allopurinol reduces
uric acid production to prevent this complication. Ondansetron (Option B) is for nausea,
filgrastim (Option C) for neutropenia, and epoetin alfa (Option D) for anemia—all