ANCC FNP Board Questions with Answers

A middle-age female patient presents to the clinic with a recurrence of mild hidradenitis suppurativa after topical therapies failed. Which first-line treat- ment is recommended? Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apoc￾rine gland-bearing skin. It is a chronic, disabling disorder that progresses, of￾ten causing keloids, contractures, and immobility. It is characterized by come- done-like follicular occlusion, chronic and relapsing inflammation, mucopuru￾lent discharge, and progressive scarring. Arthropathy associated with hidradeni￾tis may be present. Typical presentation includes nodules and sinus tracts (in￾flamed or noninflamed), abscesses, and scarring found in the axilla, genitofemoral area, perineum, gluteal area, and infra- mammary area in women. Recommended treatments include an￾tibiotics, steroids, retinoids, dapsone, and anti-tumor necrosis factor agents. A dermatology consultation should also be considered. First-line treatment is a 12 week course of an oral tetracycline (Sumycin) such as doxycycline. For patients who do not respond to doxycycline, the next rec- ommended step is a combination of twice-daily clindamycin (Cleocin) and ri￾fampicin (Rifadin) for 10-12 weeks. If treatment fails, acitretin (Soriatane, for males and nonfertile females) or dap- sone (Aczone) may be considered by a dermatologist. In patients with moderate ANCC FNP Board Questions 2 / 23 to severe hidradenitis suppurativa, adalimumab (Humira) may possibly be con- sidered. The "Medicine Wheel" is used by many for the purpose of health and healing The "Medicine Wheel" is traditionally used and contains four directions; north, south, east, and west. Traditionally each tribe has different meanings for each direction and they may represent the sea- son of the year or stage of life. It is aimed at providing a holistic view of life. When providing culturally competent health care services to an American In- dian elder, the nurse practitioner under- stands which is traditionally true? An understanding of different cultural preferences leads to cultural competence in healthcare. Some patients may value traditional culture and preferences as it relates to healthcare.These individ- ual preferences should be included in the interview and treatment plan for patients. Traditionally, the American Indian culture values a holistic approach to health care integrating the person, lifestyle, environ- ment, family, and religion. Patients ad- hering to these traditional cultural practices often feel that illness is due to a lack of harmony with the physical body, mind, spirit, and emotions. Patients may seek care from western medicine for specific ailments while also consulting with traditional healers for spiritual guidance. Healthcare providers should seek to un- derstand relevant cultural factors and as- sess each individual's healthcare literacy in order to provide culturally competent care