ANCC FNP BOARD 2023-2024 149 QUESTIONS WITH
VERIFIED SOLUTIONS GRADED A+
A middle-age female patient presents to the clinic with a recurrence of mild hidradenitis
suppurativa after topical therapies failed. Which first-line treatment is recommended? -
ANSWER Tetracycline
Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line treatment for
hidradenitis suppurativa.
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Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apocrine gland-
bearing skin. It is a chronic, disabling disorder that progresses, often causing keloids,
contractures, and immobility. It is characterized by comedone-like follicular occlusion, chronic
and relapsing inflammation, mucopurulent discharge, and progressive scarring.
Arthropathy associated with hidradenitis may be present. Typical presentation includes
nodules and sinus tracts (inflamed or noninflamed), abscesses, and scarring found in the
axilla, genitofemoral area, perineum, gluteal area, and inframammary area in women.
Recommended treatments include antibiotics, 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 recommended step is a combination
of twice-daily clindamycin (Cleocin) and rifampicin (Rifadin) for 10-12 weeks. If treatment fails,
acitretin (Soriatane, for males and nonfertile females) or dapsone (Aczone) may be considered
by a dermatologist. In patients with moderate to severe hidradenitis suppurativa, adalimumab
(Humira) may possibly be considered.
,ANCC FNP BOARD 2023-2024 149 QUESTIONS WITH
VERIFIED SOLUTIONS GRADED A+
When providing culturally competent health care services to an American Indian elder, the
nurse practitioner understands which is traditionally true? - ANSWER 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 season of the year or stage of life. It is aimed at providing a holistic view of life.
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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
individual 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, environment, family, and religion. Patients adhering 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 understand relevant cultural factors and assess each
individual's healthcare literacy in order to provide culturally competent care.
The nurse practitioner sees an older adult patient in the clinic with the primary report of hearing
loss and a sensation of fullness in the right ear. The nurse practitioner suspects conductive
hearing loss. Which could contribute to this? - ANSWER Cerumen, commonly called
earwax, is a combination of secretions and sloughed epithelial cells that protects the ears from
, ANCC FNP BOARD 2023-2024 149 QUESTIONS WITH
VERIFIED SOLUTIONS GRADED A+
infection, water, and insects. It is normally expelled from the ear canal through natural jaw
movement. When this self-cleaning process fails, cerumen can become impacted. Cerumen
impaction occludes the ear canal and can press against the tympanic membrane, resulting in
conductive hearing loss.
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Conductive hearing is the transition of sound from the external and middle ear to the inner ear.
Conductive hearing loss is caused by problems in the external and middle ear that interfere
with the transmission of sound and its conversion to mechanical vibration. Causes of
conductive hearing loss include obstruction of the external auditory canal by cerumen, foreign
bodies, debris from otitis externa, and large exocytosis and osteomas.
Sensorineural hearing loss involves difficulty converting mechanical vibrations to electrical
potential in the cochlea or in auditory nerve transmission to the brain. It is mostly caused by
permanent damage in the organ of Corti. It can be caused by age-related hearing loss, noise
trauma, medications, autoimmune diseases, mechanical trauma, Meniere disease, infection,
and neoplasm (acoustic neuroma).
Approximately one-third of older adults between the ages of 61 and 70 years have hearing
loss. More than 90% of adults older than 85 years of age have hearing loss. The most
common type of hearing loss is age-related and sensorineural. All adults older than 60 years of
age should be screened for hearing loss at periodic health examinations.
