NUR 6111 EXAMS 1–3 STUDY GUIDE |
ADVANCED PRACTICE NURSING I |
WILLIAM PATERSON UNIVERSITY | 100
ORIGINAL PRACTICE QUESTIONS WITH
CORRECT ANSWERS AND RATIONALES
EXAM 1 — Dermatologic and Gastrointestinal Disorders
Section 1: Dermatologic Disorders — 13 Questions
1. Which lesion is most characteristic of actinic keratosis?
A) A rough, scaly lesion on chronically sun-exposed skin
B) A pearly papule with rolled borders
C) A painful grouped vesicular eruption
D) A thick plaque with silvery scale
Correct Answer: A) A rough, scaly lesion on chronically sun-exposed skin
Rationale: Actinic keratosis is a premalignant keratinocytic lesion caused primarily by
cumulative ultraviolet exposure. It typically appears as a rough, gritty, erythematous or
hyperkeratotic lesion on sun-exposed areas. Recognition matters because some lesions
progress to squamous cell carcinoma. A pearly rolled lesion suggests basal cell carcinoma,
while grouped vesicles suggest herpesvirus infection.
2. Which finding most strongly supports a diagnosis of basal cell carcinoma?
A) Symmetric brown macule with uniform pigmentation
B) Pearly papule with telangiectasia and rolled borders
C) Annular plaque with central clearing
D) Diffuse silvery plaques over extensor surfaces
Correct Answer: B) Pearly papule with telangiectasia and rolled borders
Rationale: Basal cell carcinoma classically presents as a pearly or translucent papule with
surface telangiectasia and rolled borders, frequently occurring on sun-exposed skin. It is
locally invasive but rarely metastasizes. Melanoma is more concerning for asymmetry and
,irregular pigmentation, psoriasis produces characteristic plaques, and tinea often produces
annular scaling.
3. Which management principle is most appropriate for uncomplicated herpes zoster?
A) Use topical corticosteroid monotherapy
B) Delay treatment until vesicles crust
C) Initiate an antiviral promptly, particularly within the early treatment window
D) Treat only if bacterial superinfection develops
Correct Answer: C) Initiate an antiviral promptly, particularly within the early treatment
window
Rationale: Herpes zoster results from reactivation of latent varicella-zoster virus. Antiviral
therapy such as acyclovir, valacyclovir, or famciclovir is most effective when started early,
especially within 72 hours of rash onset. Early treatment reduces viral replication and can
shorten symptom duration while potentially decreasing complications such as prolonged
pain.
4. Which characteristic best distinguishes psoriasis from atopic dermatitis?
A) Severe pruritus is always absent in psoriasis
B) Psoriasis occurs only in children
C) Atopic dermatitis never involves flexural surfaces
D) Psoriasis commonly produces well-demarcated plaques with silvery scale
Correct Answer: D) Psoriasis commonly produces well-demarcated plaques with silvery
scale
Rationale: Psoriasis commonly produces sharply demarcated erythematous plaques covered
by silvery-white scale, especially on extensor surfaces and the scalp. Atopic dermatitis more
commonly involves pruritic, eczematous lesions with characteristic distribution varying by
age. Both conditions can itch, so pruritus alone does not reliably distinguish them.
5. What is the principal therapeutic objective when managing cellulitis?
A) Eradicate the responsible bacterial infection with appropriate antimicrobial therapy
B) Suppress all immune activity with systemic corticosteroids
C) Treat only the associated pain
D) Apply antifungal medication to the affected area
Correct Answer: A) Eradicate the responsible bacterial infection with appropriate
antimicrobial therapy
,Rationale: Cellulitis is a bacterial infection involving the skin and subcutaneous tissues and
requires appropriate antimicrobial treatment based on severity, likely organisms, and risk
factors. Supportive measures such as elevation and analgesia may help symptoms but do not
eradicate infection. Corticosteroid monotherapy is inappropriate, and antifungal therapy
does not treat typical bacterial cellulitis.
6. Which finding is most suggestive of scabies?
A) A solitary pearly nodule on the nose
B) Intense nocturnal pruritus with burrows in characteristic locations
C) A sharply demarcated silvery plaque
D) A painless ulcer with rolled borders
Correct Answer: B) Intense nocturnal pruritus with burrows in characteristic locations
Rationale: Scabies is caused by infestation with Sarcoptes scabiei and classically produces
intense itching that often becomes worse at night. Burrows may be visible in the interdigital
spaces, wrists, waist, genital region, or other characteristic sites. Close contacts often require
simultaneous treatment because transmission occurs through prolonged skin-to-skin
contact.
7. Which presentation is most consistent with tinea corporis?
A) A pearly ulcerated papule with telangiectasia
B) A diffuse eruption limited to mucous membranes
C) An annular scaly plaque with central clearing
D) A painful unilateral vesicular rash
Correct Answer: C) An annular scaly plaque with central clearing
Rationale: Tinea corporis, commonly called ringworm, typically produces an annular lesion
with a raised, scaly advancing border and relative central clearing. It is a dermatophyte
infection rather than a helminthic or viral disease. The appearance can overlap with other
annular eruptions, so distribution, scale, exposure history, and diagnostic testing may be
important.
8. Which feature should raise the greatest concern for melanoma?
A) Uniformly colored lesion that has remained unchanged for years
B) Symmetric papule with a smooth border
C) Small lesion without pigmentation
D) Pigmented lesion with asymmetry, border irregularity, color variation, and evolution
, Correct Answer: D) Pigmented lesion with asymmetry, border irregularity, color variation,
and evolution
Rationale: The ABCDE characteristics—Asymmetry, Border irregularity, Color variation,
Diameter, and Evolution—help identify suspicious melanocytic lesions. Evolution is
particularly important because a changing lesion warrants evaluation even if it is initially
small. Clinical examination cannot definitively diagnose melanoma, so suspicious lesions
require appropriate diagnostic evaluation, usually including biopsy.
9. Which intervention is most appropriate for uncomplicated atopic dermatitis?
A) Regular emollient use and avoidance of known irritants
B) Routine systemic antibiotics regardless of infection
C) Prolonged high-potency systemic corticosteroids
D) Antifungal therapy as the primary treatment
Correct Answer: A) Regular emollient use and avoidance of known irritants
Rationale: Atopic dermatitis management emphasizes restoration of the skin barrier with
regular emollients, avoidance of triggers, appropriate bathing practices, and anti-
inflammatory therapy when needed. Topical corticosteroids are commonly used for flares.
Antibiotics are reserved for clinically infected lesions, while antifungals are not routine
therapy unless a fungal infection is separately identified.
10. Which finding is most characteristic of a bacterial skin infection such as impetigo?
A) Silvery scale over extensor plaques
B) Honey-colored crusted superficial lesions
C) Burrows between the fingers
D) Annular plaques with central clearing
Correct Answer: B) Honey-colored crusted superficial lesions
Rationale: Impetigo is a superficial bacterial skin infection commonly associated with
Staphylococcus aureus or Streptococcus pyogenes. Nonbullous impetigo often produces
vesicles or pustules that rupture and form characteristic honey-colored crusts. Burrows
indicate scabies, annular scaling suggests dermatophyte infection, and silvery plaques are
characteristic of psoriasis.
11. Which assessment finding would most strongly support herpes zoster rather than
herpes simplex?
A) Recurrent lesions confined to the lips
B) Bilateral diffuse urticaria
ADVANCED PRACTICE NURSING I |
WILLIAM PATERSON UNIVERSITY | 100
ORIGINAL PRACTICE QUESTIONS WITH
CORRECT ANSWERS AND RATIONALES
EXAM 1 — Dermatologic and Gastrointestinal Disorders
Section 1: Dermatologic Disorders — 13 Questions
1. Which lesion is most characteristic of actinic keratosis?
A) A rough, scaly lesion on chronically sun-exposed skin
B) A pearly papule with rolled borders
C) A painful grouped vesicular eruption
D) A thick plaque with silvery scale
Correct Answer: A) A rough, scaly lesion on chronically sun-exposed skin
Rationale: Actinic keratosis is a premalignant keratinocytic lesion caused primarily by
cumulative ultraviolet exposure. It typically appears as a rough, gritty, erythematous or
hyperkeratotic lesion on sun-exposed areas. Recognition matters because some lesions
progress to squamous cell carcinoma. A pearly rolled lesion suggests basal cell carcinoma,
while grouped vesicles suggest herpesvirus infection.
2. Which finding most strongly supports a diagnosis of basal cell carcinoma?
A) Symmetric brown macule with uniform pigmentation
B) Pearly papule with telangiectasia and rolled borders
C) Annular plaque with central clearing
D) Diffuse silvery plaques over extensor surfaces
Correct Answer: B) Pearly papule with telangiectasia and rolled borders
Rationale: Basal cell carcinoma classically presents as a pearly or translucent papule with
surface telangiectasia and rolled borders, frequently occurring on sun-exposed skin. It is
locally invasive but rarely metastasizes. Melanoma is more concerning for asymmetry and
,irregular pigmentation, psoriasis produces characteristic plaques, and tinea often produces
annular scaling.
3. Which management principle is most appropriate for uncomplicated herpes zoster?
A) Use topical corticosteroid monotherapy
B) Delay treatment until vesicles crust
C) Initiate an antiviral promptly, particularly within the early treatment window
D) Treat only if bacterial superinfection develops
Correct Answer: C) Initiate an antiviral promptly, particularly within the early treatment
window
Rationale: Herpes zoster results from reactivation of latent varicella-zoster virus. Antiviral
therapy such as acyclovir, valacyclovir, or famciclovir is most effective when started early,
especially within 72 hours of rash onset. Early treatment reduces viral replication and can
shorten symptom duration while potentially decreasing complications such as prolonged
pain.
4. Which characteristic best distinguishes psoriasis from atopic dermatitis?
A) Severe pruritus is always absent in psoriasis
B) Psoriasis occurs only in children
C) Atopic dermatitis never involves flexural surfaces
D) Psoriasis commonly produces well-demarcated plaques with silvery scale
Correct Answer: D) Psoriasis commonly produces well-demarcated plaques with silvery
scale
Rationale: Psoriasis commonly produces sharply demarcated erythematous plaques covered
by silvery-white scale, especially on extensor surfaces and the scalp. Atopic dermatitis more
commonly involves pruritic, eczematous lesions with characteristic distribution varying by
age. Both conditions can itch, so pruritus alone does not reliably distinguish them.
5. What is the principal therapeutic objective when managing cellulitis?
A) Eradicate the responsible bacterial infection with appropriate antimicrobial therapy
B) Suppress all immune activity with systemic corticosteroids
C) Treat only the associated pain
D) Apply antifungal medication to the affected area
Correct Answer: A) Eradicate the responsible bacterial infection with appropriate
antimicrobial therapy
,Rationale: Cellulitis is a bacterial infection involving the skin and subcutaneous tissues and
requires appropriate antimicrobial treatment based on severity, likely organisms, and risk
factors. Supportive measures such as elevation and analgesia may help symptoms but do not
eradicate infection. Corticosteroid monotherapy is inappropriate, and antifungal therapy
does not treat typical bacterial cellulitis.
6. Which finding is most suggestive of scabies?
A) A solitary pearly nodule on the nose
B) Intense nocturnal pruritus with burrows in characteristic locations
C) A sharply demarcated silvery plaque
D) A painless ulcer with rolled borders
Correct Answer: B) Intense nocturnal pruritus with burrows in characteristic locations
Rationale: Scabies is caused by infestation with Sarcoptes scabiei and classically produces
intense itching that often becomes worse at night. Burrows may be visible in the interdigital
spaces, wrists, waist, genital region, or other characteristic sites. Close contacts often require
simultaneous treatment because transmission occurs through prolonged skin-to-skin
contact.
7. Which presentation is most consistent with tinea corporis?
A) A pearly ulcerated papule with telangiectasia
B) A diffuse eruption limited to mucous membranes
C) An annular scaly plaque with central clearing
D) A painful unilateral vesicular rash
Correct Answer: C) An annular scaly plaque with central clearing
Rationale: Tinea corporis, commonly called ringworm, typically produces an annular lesion
with a raised, scaly advancing border and relative central clearing. It is a dermatophyte
infection rather than a helminthic or viral disease. The appearance can overlap with other
annular eruptions, so distribution, scale, exposure history, and diagnostic testing may be
important.
8. Which feature should raise the greatest concern for melanoma?
A) Uniformly colored lesion that has remained unchanged for years
B) Symmetric papule with a smooth border
C) Small lesion without pigmentation
D) Pigmented lesion with asymmetry, border irregularity, color variation, and evolution
, Correct Answer: D) Pigmented lesion with asymmetry, border irregularity, color variation,
and evolution
Rationale: The ABCDE characteristics—Asymmetry, Border irregularity, Color variation,
Diameter, and Evolution—help identify suspicious melanocytic lesions. Evolution is
particularly important because a changing lesion warrants evaluation even if it is initially
small. Clinical examination cannot definitively diagnose melanoma, so suspicious lesions
require appropriate diagnostic evaluation, usually including biopsy.
9. Which intervention is most appropriate for uncomplicated atopic dermatitis?
A) Regular emollient use and avoidance of known irritants
B) Routine systemic antibiotics regardless of infection
C) Prolonged high-potency systemic corticosteroids
D) Antifungal therapy as the primary treatment
Correct Answer: A) Regular emollient use and avoidance of known irritants
Rationale: Atopic dermatitis management emphasizes restoration of the skin barrier with
regular emollients, avoidance of triggers, appropriate bathing practices, and anti-
inflammatory therapy when needed. Topical corticosteroids are commonly used for flares.
Antibiotics are reserved for clinically infected lesions, while antifungals are not routine
therapy unless a fungal infection is separately identified.
10. Which finding is most characteristic of a bacterial skin infection such as impetigo?
A) Silvery scale over extensor plaques
B) Honey-colored crusted superficial lesions
C) Burrows between the fingers
D) Annular plaques with central clearing
Correct Answer: B) Honey-colored crusted superficial lesions
Rationale: Impetigo is a superficial bacterial skin infection commonly associated with
Staphylococcus aureus or Streptococcus pyogenes. Nonbullous impetigo often produces
vesicles or pustules that rupture and form characteristic honey-colored crusts. Burrows
indicate scabies, annular scaling suggests dermatophyte infection, and silvery plaques are
characteristic of psoriasis.
11. Which assessment finding would most strongly support herpes zoster rather than
herpes simplex?
A) Recurrent lesions confined to the lips
B) Bilateral diffuse urticaria
