Nurs 6531 final exam (2 versions) & nurs 6531 midterm exam (2

  
NURS 6531 FINAL EXAM (2 VERSIONS) & NURS 6531 MIDTERM EXAM (2 VERSIONS) (100 CORRECT Q & A IN EACH VERSION, TOTAL: 400 Q & A)
  
NURS 6531 Final Exam / NURS6531 Final Exam (Latest): Walden University
Walden NURS 6531 Final Exam / Walden NURS6531 Final Exam (Latest)
· Question 1
       
When   completing this quiz, did you comply with Walden University’s Code of Conduct   including the expectations for academic integrity?
· Question 2
       
Central obesity, “moon” face, and dorsocervical fat pad   are associated with:
  
A.
Metabolic     syndrome
 
B.
Unilateral     pheochromocytoma
 
C.
Cushing’s     syndrome
 
D.
None     of the above
            
· Question 3
       
An elderly man is started on lisinopril and   hydrochlorhiazide for hypertension. Three days later, he returns to the   office complaining of left great toe pain. On exam, the nurse practitioner   notes an edematous, erythematous tender left great toe. The likely   precipitant of this patient’s pain is:
  
A.
Trauma
 
B.
Tight     shoes
 
C.
Arthritis     flare
 
D.
Hydrochlorothiazide
            
· Question 4
       
The most effective treatment of non-infectious bursitis   includes:
            
· Question 5
       
What conditions must be met for you to bill “incident to”   the physician, receiving 100% reimbursement from Medicare?
      
Answers:
You must initiate the plan     of care for the patient
  
The physician must be     on-site and engaged in patient care
  
You must be employed as an     independent contractor
  
You must be the main health     care provider who sees the patient
            
· Question 6
       
Which of the following is not a risk factor associated   with the development of syndrome X and type 2 diabetes mellitus?
            
· Question 7
       
Which of the following is not a common early sign of   benign prostatic hyperplasia (BPH)?
A.   NocturiaB. Urgency incontinenceC. Strong urinary stream flowD. Straining to void
            
· Question 8
       
Steve, age 69, has gastroesophageal reflux disease (GERD).   When teaching him how to reduce his lower esophageal sphincter pressure,   which substances do you recommend that he avoid?
§ Food that is very hot or very cold 
§ Fatty or fried foods 
§ Peppermint or spearmint, including flavoring 
§ Coffee, tea, and soft drinks that contain caffeine 
§ Spicy, highly seasoned foods 
§ Fried foodDT caffeine, chocolate and anticholinergics
            
· Question 9
       
Which drug category contains the drugs that are the first   line Gold standard therapy for COPD?
            
· Question 10
       
The most commonly recommended pharmacological treatment   regimen for low back pain (LBP) is:
            
· Question 11
       
Which of the following is not appropriate suppression   therapy for chronic bacterial prostatitis?
            
· Question 12
       
A patient presents with dehydration, hypotension, and   fever. Laboratory testing reveals hyponatremia, hyperkalemia, and   hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks   later with the same symptoms of hyperpigmentation, weakness, anorexia,   fatigue, and weight loss. What action(s) should the nurse practitioner take?
.A Obtain a   thorough history and physical, and check serum cortisol and ACTH levels. 
  B. Perform a diet history and check CBC and FBS. 
  C. Provide nutritional guidance and have the patient return in one month. 
  D. Consult home health for intravenous administration
                                                
· Question 13
The nurse practitioner diagnoses epididymitis in a 24 year old sexually active male patient. The drug of choice for treatment of this patient is:  
· Question 14
How do you respond when Jessica, age 42, asks you what constitutes a good minimum cardiovascular workout?
· Question 15
       
The intervention known to be most effective in the   treatment of severe depression, with or without psychosis, is:
· Question 16
       
You are assessing a patient after a sports injury to his   right knee. You elicit a positive anterior/posterior drawer sign. This test   indicates an injury to the: he  A. lateral meniscus  B. cruciate ligament  C. medial meniscus  D. collateral ligament.
            
· Question 17
   
  
A 32 year old female patient presents with fever, chills,   right flank pain, right costovertebral angle tenderness, and hematuria. Her   urinalysis is positive for leukocytes and red blood cells. The nurse   practitioner diagnoses pyelonephritis. The most appropriate management is:
                        
· Question 18
       
A 21-year-old female presents to the office   complaining of urinary frequency and urinary burning. The nurse practitioner   suspects a urinary tract infection when the urinalysis reveals
· Question 19
       
A middle-aged man presents to urgent care complaining of   pain of the medial condyle of the lower humerus. The man works as a carpenter   and describes a gradual onset of pain. On exam, the medial epicondyle is   tender and pain is increased with flexion and pronation. Range of motion is   full The most likely cause of this patient’s pain is: 
                        
· Question 20
       
The initial clinical sign of Dupuytren’s contracture is:
·  
· Question 21
       
The best test to determine microalbuminuria to assist in   the diagnosis of diabetic neuropathy
            
· Question 22
       
What is the first symptom seen in the majority of patients   with Parkinson’s disease?
            
· Question 23
       
The most commonly recommended method for prostate cancer   screening in a 55 year old male is:
            
· Question 24
       
Martin, age 24, presents with an erythematous ear canal,   pain, and a recent history of swimming. What do you suspect?
            
· Question 25
       
Which of   the following symptoms suggests a more serious cause of back pain?
                                    
· Question 26
       
Josh, age 22, is a stock boy and has an acute episode of   low back pain. You order and NSAID and tell him which of the following?
· Question 27
       
A 72 year old female patient reports a 6 month   history of gradually progressive swollen and painful distal interphalangeal   (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte   sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor   (RF) are all minimally elevated. What is the most likely diagnosis?
· Question 28
       
A patient taking levothyroxine is being   over-replaced. What condition is he at risk for?
            
· Question 29
       
Which of the following is the most common cause of low   back pain?
  
A.
Lumbar     disc disease
 
B.
Spinal     stenosis
 
C.
Traumatic     fracture
 
D.
Osteoporosis
            
· Question 30
       
Which is the most common cause of end-stage renal disease   in the United States?
            
· Question 31
       
A 77-year-old female presents to the office complaining a   sudden swelling on her right elbow. She denies fever, chills, trauma, or   pain. The physical exam reveals a non-tender area of swelling over the   extensor surface over the right elbow with evidence of trauma or irritation.   The nurse practitioner suspects:
  
A.
Arthritis
 
B.
Ulnar     neuritis
 
C.
Septic     arthritis
 
D.
Olecranon     bursitis
            
· Question 32
       
A 60 year old female patient complains of sudden onset   unilateral, stabbing, surface pain in the lower part of her face lasting a   few minutes, subsiding, and then returning. The pain is triggered by touch or   temperature extremes. Physical examination is normal. Which of the following   is the most likely diagnosis?
            
· Question 33
       
Beth, age 49, comes in with low back pain. An x-ray of the   lumbosacral spine is within normal limits. Which of the following diagnoses   do you explore further?
            
· Question 34
       
A patient exhibits extrapyramidal side effects of   antipsychotic medications. Which of the following symptoms would lead you to   look for another diagnosis?
            
· Question 35
       
Phalen’s test, 90°wrist flexion for 60 seconds, reproduces   symptoms of:
                        
· Question 36
       
Jennifer says that she has heard that caffeine can cause   osteoporosis and asks you why. How do you respond?
· Question 37
       
The most common cause of elevated liver function tests is:
            
· Question 38
       
Reed-Sternberg B lymphocytes are associated with which of   the following disorders:
  
A.
Aplastic anemia
 
B.
Hodgkin’s lymphoma
 
C.
Non Hodgkin’s lymphoma
 
D.
Myelodysplastic syndromes
            
· Question 39
       
Which of the following is a potential acquired cause of   thrombophilia?
  
A.
Homocysteinuria
 
B.
Protein C deficiency
 
C.
Factor V Leiden
 
D.
Antiphospholipid antibodies
                        
· Question 41
       
A 75-year-old female is diagnosed with primary   hyperparathyroidism and asks the nurse practitioner what the treatment for   this disorder is. The nurse practitioner explains:
  
Primary     hyperparathyroidism is treated with Vitamin D restriction
 
Primary     hyperparathyroidism is treated with parathyroidectomy
 
Primary     hyperparathyroidism is treated with daily magnesium
 
Primary     hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)
                         
· Question 42
       
Diagnostic confirmation of acute leukemia is based on:
·  
· Question 43
       
A 25 year old overweight patient presents with a   complaint of dull achiness in his groin and history of a palpable lump in his   scrotum that “comes and goes”. On physical examination, the nurse   practitioner does not detect a scrotal mass. There is no tenderness, edema,   or erythema of the scrotum, the scrotum does not transilluminate. What is the   most likely diagnosis?
A. Testicular   torsion 
  B. Epididymitis 
  C. Inguinal hernia 
  D. Varicocele
            
· Question 44
       
Dave, age 38, states that he thinks he has an ear   infection because he just flew back from a business trip and feels unusual   pressure in his ear. You diagnose barotrauma. What is your next action?
A. Prescribe nasal steroids and oral decongestants  B. Prescribe antibiotic eardrops  C. Prescribe systemic eardrops  D. Refer David to an ear, nose, and throat specialist
                        
· Question 45
       
Which of the following antibiotics should not be   prescribed for a pregnant woman in the 3rd trimester?
· Question 46
       
The physiological explanation of syncope is:
            
· Question 47
   
  
A 20 year old male patient complains of “scrotal   swelling.” He states his scrotum feels heavy, but denies pain. On   examination, the nurse practitioner notes transillumination of the scrotum.   What is the most likely diagnosis?
            
· Question 48
       
A 32 year old male patient complains of urinary   frequency and burning on urination for 3 days. Urinalysis reveals   bacteriuria. He denies any past history of urinary tract infection. The   initial treatment should be: nclude nitrofurantoin monohydrate/macrocrystals,   trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin. 
            
· Question 49
       
Diagnostic radiological studies are indicated for low back   pain:
                        
· Question 50
      
Who is at a higher risk for developing nephrolithiasis?
·  
· Question 51
      
An 81-year-old female is diagnosed with type 2 diabetes.   When considering drug therapy for this patient, the nurse practitioner is   most concerned with which of the following side effects?
  
A.
Weight     gain
 
B.
Fracture     risk
 
C.
Hypoglycemia
 
D.
Weight     loss
                        
· Question 52
       
A 28-year-old female presents to the office requesting   testing for diagnosis of hereditary thrombophilia. Her father recently had a   deep vein thrombosis and she is concerned about her risk factors. The nurse   practitioner explains that:
· Question 53
       
The diagnosis of human papilloma virus (HPV) infection in   males is usually made by:
            
· Question 54
       
Which history is commonly found in a patient with   glomerulonephritis?
            
· Question 55
       
A   patient complains of generalized joint pain and stiffness associated with   activity and relieved with rest. This patient history is consistent with   which of the following disorders?
            
· Question 56
       
The most common presentation of thyroid cancer is:
            
· Question 57
       
The obligatory criteria for diagnosis of muscular   dystrophy (MD) are:
            
· Question 58
       
The diagnosis which must be considered in a patient who   presents with a severe headache of sudden onset, with neck stiffness and   fever, is:
            
· Question 59
       
A 60 year old male patient with multiple health   problems presents with a complaint of erectile dysfunction (ED). Of the   following, which medication is most likely to be causing the problem?
            
· Question 60
       
A 72 year old patient exhibits sudden onset of fluctuating   restlessness, agitation, confusion, and impaired attention. This is   accompanied by visual hallucinations and sleep disturbance. What is the most   likely cause of this behavior?
A. Dementia 
  C. Parkinson’s disease 
  D. Depression
            
· Question 61
       
Which of the following set of symptoms should raise   suspicion of a brain tumor?  
            
· Question 62
       
The cornerstone of treatment for   stress fracture of the femur or metatarsal stress fracture is: 
            
· Question 63
       
Sally, a computer programmer, has just been given a new diagnosis   of carpal tunnel syndrome. Your next step is to:
            
· Question 64
       
Marsha presents with symptoms resembling both fibromyalgia   and chronic fatigue syndrome, which have many similarities. Which of the   following is more characteristic of fibromyalgia?
A.   Musculosckeletal pain  B. Difficulty sleeping  C. Depression  D. Fatigue
            
· Question 65
       
The cardinal sign of infectious arthritis is:
             
            
· Question 66
       
Diagnostic evaluation for urinary calculi includes:
                                                
· Question 67
       
Martin, a 58 year old male with diabetes, is at your   office for his diabetes follow up. On examining his feet with monofilament,   you discover that he has developed decreased sensation in both feet. There are   no open areas or signs of infection on his feet. What health teaching should   Martin receive today regarding the care if his feet?
See a   podiatrist yearly; wash your feet daily with   warm, soapy water and towel dry between the   toes; inspect your feet daily for any lesions; and   apply lotion to any dry areas.
· Question 68
       
Potential causes of septic   arthritis include which of the following?
· Question 69
       
Which of the following is the best response to a woman who   has just admitted she is a victim of spousal abuse?
· Question 70
       
A 15 year-old female patient is 5 feet tall and weighs 85   pounds. You suspect anorexia and know that the best initial approach is to:
Having   the client in view of staff for 90 minutes after each meal
            
· Question 71
       
A 63-year-old man presents to the office with hematuria,   hesitancy, and dribbling. Digital rectal exam (DRE) reveals a moderately   enlarged prostate that is smooth. The PSA is 1.2. What is the most   appropriate management strategy for you to follow at this time?
A. Prescribe   an alpha adrenergic blocker.  B. Recommend saw palmetto.  C. Prescribe an antibiotic  D. Refer the client to urology.
                        
· Question 72
       
A patient has been diagnosed with generalized anxiety disorder   (GAD). Which of the following medications may be used to treat generalized   anxiety disorder?
· Question 73
       
A positive drawer sign supports a diagnosis of:
                        
· Question 74
       
Sam, age 67, is a diabetic with worsening renal function.   He has frequent hypoglycemic episodes, which he believes means that his   diabetes is getting “better.” How do you respond?
·  
· Question 75
       
A 14 year old female cheerleader reports gradual and   progressive dull anterior knee pain, exacerbated by kneeling. The nurse   practitioner notes swelling and point tenderness at the tibial tuberosity.   X-ray is negative. What is the most likely diagnosis?
                        
· Question 76
       
A 35 year old male presents with a complaint of low   pelvic pain, dysuria, hesitancy, urgency, and reduced force of stream. The   nurse practitioner suspects acute bacterial prostatitis. Which of the   following specimens would be least helpful for diagnosis?
· Question 77
       
Jack, age 55, comes to the office with a blood pressure of   144/98 mm Hg. He states that he did not know if it was ever elevated before.   When you retake his blood pressure at the end of the exam, it remains at   144/98. What should your next action be?
                        
· Question 78
       
A patient has just been diagnosed with Bell’s palsy. He is   understandably upset and has questions about the prognosis. You response   should be:
·  
· Question 79
       
Martin is complaining of erectile dysfunction. He also has   a condition that has reduced arterial blood flow to his penis. The most   common cause of this condition is:
            
· Question 80
       
Successful management of a patient with attention deficit hyperactivity   disorder (ADHD) may be achieved with:
            
· Question 81
       
What diabetic complications result from hyperglycemia?
1.  
1.  
1.  Retinopathy
2.  Hypertension   resistant to treatment
3. Peripheral   neuropathy
4.  Accelerated   atherogenesis
            
· Question 82
                        
· Question 83
       
The most common symptoms of transient ischemic attack   (TIA) include:
                        
· Question 84
       
What is the first step in the treatment of uric acid   kidney stones?
· Question 85
       
Establishment of a definitive diagnosis of osteomyelitis   requires:
            
· Question 86
       
Which of the following is the most common causative   organism of nongonococcal urethritis?
  
A.
Chlamydia     trachomatis
 
B.
Ureaplasma     urealyticum
 
C.
Mycoplasma     hominis
 
D.
Trichonomas     vaginalis
                        
· Question 87
       
Urine cultures should be obtained for which of the   following patients?
·  
· Question 88
       
A 30 year old female patient presents to the clinic with   heat intolerance, tremors, nervousness, and weight loss inconsistent with   increased appetite. Which test would be most likely to confirm the suspected   diagnosis?
                        
· Question 89
       
A patient has been diagnosed with   hypothyroidism and thyroid hormone replacement therapy is prescribed. How   long should the nurse practitioner wait before checking the patient’s TSH?
· Question 90
       
Potential causes of hypocalcemia include which of the   following?
                        
· Question 91
       
Which of the following patients most warrants screening   for hypothyroidism?
· Question 92
       
Which of the following is a contraindication for metformin   therapy?
            
· Question 93
       
The organism most often associated with prostatitis is:
  
A.
Klebsiella
 
B.
Neiserria     gonorrhoaes
 
C.
Chlamydia     trachomatis
 
D.
Escherichia     coli
            
· Question 94
       
The most effective intervention(s)   to prevent stroke is (are):
            
· Question 95
       
What is the most commonly abused substance?
                                    
· Question 96
       
The hallmark of neurofibromatosis (von Recklinghausen’s   disease) present in almost 100% of patients is:
· Question 97
       
Diagnostic evaluation of   hypothyroidism reveals:
· Question 98
       
An obese hyperlipidemic patient, newly diagnosed with type   2 diabetes mellitus, has fasting glucose values 180 to 250 mg/Dl. What is the   most appropriate initial treatment to consider?
A. A   low-calorie diet and exercise  B. Sliding-scale NPH insulin every 12 hours  C. A sulfonylurea and/or metformin (Glucophage® -XR)  D. Sliding-scale regular insulin every 6 hours
                        
· Question 99
   
The correct treatment for ankle sprain during the first 48   hours after injury includes:
· Question 100
       
Prolonged PT suggests:
  
A.
Platelet abnormality
 
B.
Abnormality in intrinsic     coagulation pathway
 
C.
Abnormality in extrinsic     coagulation pathway
 
D.
None of the above
       
Question 101 
·  
A patient presenting for an annual physical exam has a BMI of 25 kg/m2 This patient would be classified as:
· Question 102
       
The most reliable indicator(s) of neurological deficit   when assessing a patient with acute low back pain is(are):
· Question 103
       
Risk factors for Addison’s disease   include which of the following? 
            
· Question 104
       
Major depression occurs most often   in which of the following conditions?
            
· Question 105
       
Which of the following medications increase the risk for   metabolic syndrome?
                                                
· Question 106
       
A 27 year old female patient with epilepsy is well   controlled with phenytoin (Dilantin). She requests information about   contraception. The nurse practitioner should instruct her that while taking   phenytoin:
            
· Question 107
       
Risk factors for prostate cancer include all of the   following except: 
                                    
· Question 108
       
Maria, age 17, was raped when she was 13 year old. She is   now experiencing sleeping problems, flashbacks, and depression. What is your   initial diagnosis?Post-traumatic stress disorder
  
NURS 6531 Midterm Exam / NURS6531 Midterm Exam (Latest): Walden University
Walden NURS 6531 Midterm Exam / Walden NURS6531 Midterm Exam (Latest)
· Question 1
       
When   completing this quiz, did you comply with Walden University’s Code of Conduct   including the expectations for academic integrity?
         
Yes
  
No
· Question 2
       
The most common cancer found on   the auricle is:
         
Actinic keratosis
  
Basal cell carcinoma
  
Squamous cell carcinoma
  
Acral-lentiginous melanoma
· Question 3
       
Which of the following   medication classes should be avoided in patients with acute or chronic   bronchitis because it will contribute to ventilation-perfusion mismatch in   the patient?
         
Xanthines
  
Antihistimines
  
Steroids
  
Anticholinergics
· Question 4
       
A 47 year old male patient   presents to the clinic with a single episode of a moderate amount of bright   red rectal bleeding. On examination, external hemorrhoids are noted. How   should the nurse practitioner proceed?
         
Instruct the patient on     measures to prevent hemorrhoids such as bowel habits and diet. 
  
Order a topical hemorrhoid cream along with a stool softener.
  
Refer the patient for a barium enema and sigmoidoscopy. 
  
Refer the patient for a surgical hemorrhoidectomy.
· Question 5
       
Which of the following patient   characteristics are associated with chronic bronchitis?
         
Overweight, cyanosis, and normal or slightly increased respiratory     rate 
  
Underweight, pink skin, and increased respiratory rate 
  
Overweight, pink skin, and normal or slightly increased respiratory     rate 
  
Normal weight, cyanosis, and greatly increased respiratory rate
· Question 6
       
A 65-year-old female with   a past medical history of hypertension, hyperlipidemia, and polymyalgia   rheumatica presents to urgent care with new onset left lower quadrant pain.   Her current medications include omeprazole 20 milligrams po daily, lisinopril   20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12   milligrams po daily. The nurse practitioner suspects acute diverticulitis and   possibly an abscess. The most appropriate diagnostic test for this patient at   this time is:
         
CBCdiff 
  
Erythrocyte sedimentation rate 
  
Abdominal ultrasound 
  
CT scan
· Question 7
       
A patient reports “something   flew in my eye” about an hour ago while he was splitting logs. If there were   a foreign body in his eye, the nurse practitioner would expect to find all   except:
         
Purulent drainage 
  
Tearing 
  
Photophobia 
  
A positive fluorescein stain
· Question 8
       
A 21 year old college student   presents to the student health center with copious, markedly purulent   discharge from her left eye. The nurse practitioner student should suspect:
         
Viral conjunctivitis 
  
Common pink eye 
  
Gonococcal conjunctivitis 
  
Allergic conjunctivitis
· Question 9
       
A 35 year old man   presents with radicular pain followed by the appearance of grouped vesicles   consisting of about 15 lesions across 3 different thoracic dermatomes. He   complains of pain, burning, and itching. The nurse practitioner should   suspect:
         
A common case of shingles and prescribe an analgesic and an antiviral     agent 
  
A complicated case of shingles and prescribe acyclovir, an analgesic,     and a topical cortisone cream 
  
Herpes zoster and consider that this patient may be immunocompromised 
  
A recurrence of chickenpox and treat the patient’s symptoms
· Question 10
       
Which type of lung cancer has   the poorest prognosis?
         
Adenocarcinoma 
  
Epidermoid carcinoma 
  
Small cell carcinoma 
  
Large cell carcinoma
· Question 11
       
An 83-year-old female   presents to the office complaining of diarrhea for several days. She explains   she has even had fecal incontinence one time. She describes loose stools 3–4   times a day for several weeks and denies fever, chills, pain, recent antibiotic   use. The history suggests that the patient has:
         
Acute diarrhea 
  
Chronic diarrhea 
  
Irritable bowel 
  
Functional bowel disease
· Question 12
       
Margaret, age 32, comes into   the office with painful joints and a distinctive rash in a butterfly   distribution on her face. The rash has red papules and plaques with a fine   scale. What do you suspect?
         
An allergic reaction 
  
Relapsing polychondritis 
  
Lymphocytoma cutis 
  
Systemic lupus erythematosus
· Question 13
       
Antibiotic administration has   been demonstrated to be of little benefit to the treatment of which of the   following disease processes?
         
Chronic sinusitis
  
Acute bronchitis 
  
Bacterial pneumonia 
  
Acute exacerbation of chronic bronchitis
· Question 14
       
Lisa, age 49, has daily   symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily.   Her exacerbations affect her activities and they occur at least twice weekly   and may last for days. She is affected more than once weekly during the night   with an exacerbation. Which category of asthma severity is Lisa in?
         
Mild intermittent 
  
Mild persistent 
  
Moderate persistent
· Question 15
       
Which of the following is the   most appropriate therapeutic regimen for an adult patient with no known   allergies diagnosed with group A B-hemolytic strep?
         
Penicillin V 500 milligrams PO every 8 hours for 10 days 
  
Ampicillin 250 milligrams PO twice a day for 10 days 
  
Clarithromycin 500 milligrams po daily for 7 days
  
None of the above
· Question 16
       
A cashier complains of dull   ache and pressure sensation in her lower legs. It is relieved by leg   elevation. She occasionally has edema in her lower legs at the end of the   day. What is the most likely cause of these problems?
         
Congestive heart failure 
  
Varicose veins
  
Deep vein thrombosis
  
Arterial insufficiency
· Question 17
       
Which statement below is   correct about pertussis?
         
It is also called whooping cough 
  
It begins with symptoms like strep throat 
  
It lasts about 3 weeks 
  
It occurs most commonly in toddlers and young children
· Question 18
       
Which of the following is the   most important diagnosis to rule out in the adult patient with acute bronchitis?
         
Pneumonia 
  
Asthma 
  
Sinusitis 
  
Pertussis
· Question 19
       
A 70 year old patient presents   with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable   abdominal wall, fever, and leukocytosis. Of the following terms, which   correctly describes the suspected condition?
         
Diverticulosis 
  
Diverticula
  
Diverticulitis 
  
Diverticulum
· Question 20
       
Sylvia, age 83, presents with a   3 day history of pain and burning in the left forehead. This morning she   noticed a rash with erythematous papules in that site. What do you suspect?
         
Varicella
  
Herpes zoster
  
Syphilis
  
Rubella
· Question 21
       
A 33-year-old female is   admitted with acute pancreatitis. The nurse practitioner knows that the most   common cause of pancreatitis is:
         
Alcohol 
  
Gallstones 
  
Medications 
  
Pregnancy
· Question 22
       
When a patient presents with symptoms   of acute gallbladder disease, what is the appropriate nurse practitioner   action?
         
Order abdominal x-rays 
  
Order an abdominal ultrasound 
  
Refer the patient to a surgeon for evaluation 
  
Prescribe pain medication
· Question 23
       
A false-positive result with   the fecal occult blood test can result from:
         
ingestion of large amounts of vitamin C 
  
a high dietary intake of rare cooked beef 
  
a colonic neoplasm that is not bleeding 
  
stool that has been stored before testing
· Question 24
       
A 76-year-old male   complains of weight loss, nausea, vomiting, abdominal cramping and pain.   Physical findings include an abdominal mass and stool positive for occult   blood. The nurse practitioner pain suspects a tumor in the small intestine.   The best diagnostic test for this patient is:
         
Colonoscopy 
  
Small bowel follow-through 
  
Barium enema 
  
CT abdomen
· Question 25
       
A patient presents to urgent   care complaining of dyspnea, fatigue, and lower extremity edema. The   echocardiogram reveals and ejection fraction of 38%. The nurse practitioner   knows that these findings are consistent with:
         
Mitral regurgitation 
  
Systolic heart failure 
  
Cardiac myxoma 
  
Diastolic heart failure
· Question 26
       
Maxine, Age 76, has just been   given a diagnosis of pneumonia. Which of the following is an indication that   she should be hospitalized?
         
Multilobar involvement on chest x-ray with the inability to take oral     medications 
  
Alert and oriented, slightly high but stable vital signs, and no one     to take care of her at home 
  
Sputum and gram positive organisms 
  
A complete blood count showing leukocytosis
· Question 27
       
A 55 year old man is diagnosed   with basal cell carcinoma. The nurse practitioner correctly tells him:
         
“It is the most common cause of death in patients with skin cancer.” 
  
“It can be cured with surgical excision or radiation therapy.” 
  
“It is a slow growing skin cancer that rarely undergoes malignant     changes.” 
  
“It can be cured using 5-flurouracil cream twice daily for 2 to 4     weeks.”
· Question 28
       
Expected spirometry readings   when the patient has chronic emphysema include:
         
Decreased residual volume (RV) 
  
Increased vital capacity (VC) 
  
Increased forced expiratory volume (FEV-1) 
  
Increased total lung capacity (TLC)
· Question 29
       
An 80-year-old male   admits to difficulty swallowing during the review of systems. The nurse   practitioner recognizes the differential diagnosis for this patient’s   dysphagia is:
         
Esophageal cancer 
  
Chest pain 
  
GERD 
  
A and C 
  
All of the above
· Question 30
       
A 40 year old female with   history of frequent sun exposure presents with a multicolored lesion on her   back. It has irregular borders and is about 11mm in diameter. What should the   nurse practitioner suspect?
         
Squamous cell carcinoma 
  
Malignant melanoma 
  
A common nevus 
  
Basal cell carcinoma
· Question 31
       
Which of the following is not a   goal of treatment for the patient with cystic fibrosis?
         
Prevent intestinal obstruction 
  
Provide adequate nutrition 
  
Promote clearance of secretions 
  
Replace water-soluble vitamins
· Question 32
       
The nurse practitioner is   performing a physical exam on a middle-aged African-American man. Which of   the following areas is a common site for melanomas in African-Americans and   other dark-skinned individuals?
         
Scalp 
  
Nails 
  
Feet 
  
B and C 
  
All of the above
· Question 33
       
An adult presents with tinea   corporis. Which item below is a risk factor for its development?
         
Topical steroid use 
  
Topical antibiotic use 
  
A recent laceration  
  
Cold climates
· Question 34
       
A patient has experienced   nausea and vomiting, headache, malaise, low grade fever, abdominal cramps,   and watery diarrhea for 72 hours. His white count is elevated with a shift to   the left. He is requesting medication for diarrhea. What is the most   appropriate response?
         
Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil)     and a clear liquid diet for 24 hours.  
  
Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro),     and symptom management. 
  
Offer an anti-emetic medication such as ondansetron (Zofran) and     provide oral fluid and electrolyte replacement instruction. 
  
Order stool cultures.
· Question 35
       
Janine, age 29, has numerous   transient lesions that come and go, and she is diagnosed with urticaria. What   do you order?
         
Aspirin
  
NSAIDs
  
Opioids
  
Antihistamines
· Question 36
       
Of the following signs   and symptoms of congestive heart failure (CHF), the earliest clinical   manifestation is:
         
Peripheral edema 
  
Weight gain 
  
Shortness of breath 
  
Nocturnal dyspnea
· Question 37
       
A 16 year old male presents   with mild sore throat, fever, fatigue, posterior cervical adenopathy, and   palatine petechiae. Without a definitive diagnosis for this patient, what   drug would be least appropriate to prescribe?
         
Ibuprofen
  
Erythromycin
  
Amoxicillin
  
Acetaminophen
· Question 38
       
A 70 year old man who walks 2   miles every day complains of pain in his left calf when he is walking. The   problem has gotten gradually worse and now he is unable to complete his 2   mile walk. What question asked during the history, if answered affirmatively,   would suggest a diagnosis of arteriosclerosis obliterans?
         
“Are you wearing your usual shoes?”  
  
“Do you also have chest pain when you have leg pain?” 
  
“Is your leg pain relieved by rest?” 
  
“Do you ever have the same pain in the other leg?”
· Question 39
       
Which of the following   statements about malignant melanomas is true?
         
They usually occur in older adult males
  
The patient has no family history of melanoma
  
They are common in blacks
  
The prognosis is directly related to the thickness of the lesion
· Question 40
       
Sheila, age 78, presents with a   chief complaint of waking up during the night coughing. You examine her and   find an S3 heart sound, pulmonary crackles that do not clear with coughing,   and peripheral edema. What do you suspect?
         
Asthma
  
Nocturnal allergies 
  
Valvular disease 
  
Heart failure
· Question 41
       
Which antibiotic would be the   most effective in treating community acquired pneumonia (CAP) in a young   adult without any comorbid conditions? 
         
Erythromycin 
  
Clarithromycin (Biaxin) 
  
Doxycycline (Vibramycin) 
  
Penicillin
· Question 42
       
Which of the following   dermatologic vehicles are the most effective in absorbing moisture and   decreasing friction?
         
Powders 
  
Gels 
  
Creams 
  
Lotion
· Question 43
       
A 70 year old patient presents   with a slightly raised, scaly, erythematous patch on her forehead. She admits   to having been a “sun worshiper.” The nurse practitioner suspects actinic   keratosis. This lesion is a precursor to:
         
Squamous cell carcinoma 
  
Basal cell carcinoma 
  
Malignant melanoma 
  
Acne vulgaris
· Question 44
       
An elderly patient is being   seen in the clinic for complaint of “weak spells” relieved by sitting or   lying down. How should the nurse practitioner proceed with the physical   examination? 
         
Assist the patient to a standing position and take her blood     pressure.  
  
Assess the patient’s cranial nerves.  
  
Compare the patient’s blood pressure lying first, then sitting, and     then standing.  
  
Compare the amplitude of the patient’s radial and pedal pulses.
· Question 45
       
What oral medication might be   used to treat chronic cholethiasis in a patient who is a poor candidate for   surgery?
         
 Ursodiol 
  
 Ibuprofen 
  
Prednisone 
  
 Surgery is the only answer
· Question 46
       
A 46-year-old female with a   past medical history of diabetes presents with a swollen, erythematous right   auricle and is diagnosed with malignant otitis externa. The nurse   practitioner knows that the most likely causative organism for this patient’s   problem is:
         
Staphylococcus aureus 
  
Group A beta hemolytic streptococcus 
  
Haemophilus influenza 
  
Pseudomonas aeruginosa
· Question 47
       
Which of the following is not a   symptom of irritable bowel syndrome?
         
Painful diarrhea
  
Painful constipation
  
Cramping and abdominal pain
  
Weight loss
· Question 48
       
A patient comes in complaining   of 1 week of pain in the posterior neck with difficulty turning the head to   the right. What additional history is needed?
         
Any recent trauma
  
Difficulty swallowing
  
 Stiffness in the right shoulder
  
Change in sleeping habits
· Question 49
       
Marvin, age 56, is a smoker   with diabetes. He has just been diagnosed as hypertensive. Which of the   following drugs has the potential to cause the development of bronchial   asthma and inhibit gluconeogenesis?
         
ACE Inhibitor 
  
Beta Blocker 
  
Calcium channel blocker 
  
Diuretic
· Question 50
       
The differential diagnosis for   a patient complaining of a sore throat includes which of the following?
         
Gonococcal infection 
  
Thrush 
  
Leukoplakia 
  
B only 
  
A, B, and C
· Question 51
       
A patient presents to the   primary care provider complaining of a rash on his right forehead that   started yesterday and is burning and painful. The physical exam reveals an   erythematous, maculopapular rash that extends over the patient’s right eye to   his upper right forehead. Based on the history and examination, the most   likely cause of this patient’s symptoms is:
         
Rhus dermatitis 
  
Ophthalmic zoster 
  
Chemosis 
  
Optic neuritis
· Question 52
       
Before initiating an HMG   CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders   liver function studies. The patient’s aminotransferase (ALT) is elevated.   What laboratory test(s) should be ordered?
         
Serologic markers for hepatitis 
  
Serum bilirubin 
  
Serum cholesterol with HDL and LDL 
  
A liver biopsy
· Question 53
       
A patient with elevated lipids   has been started on lovastatin. After 3 weeks of therapy, he calls to report   generalized muscle aches. The nurse practitioner should suspect:
         
A drug interaction
  
Hepatic dysfunction 
  
Hypersensitivity to lovastatin
  
Rhabdomyolysis
· Question 54
       
Treatment of acute vertigo   includes:
         
Bedrest and an antihistamine 
  
Fluids and a decongestant 
  
A sedative and decongestant 
  
Rest and a low sodium diet
· Question 55
       
Treatment of H.pylori includes   which of the following?
         
Proton pump inhibitor 
  
Antibiotic therapy 
  
Bismuth subsalicylate 
  
A and B 
  
A, B, and C
· Question 56
       
Carl, age 78, is brought to the   office by his son, who states that his father has been unable to see clearly   since last night. Carl reports that his vision is “like looking through a   veil.” He also sees floaters and flashing lights but is not having any pain.   What do you suspect?
         
Cataracts 
  
Glaucoma 
  
Retinal detachment 
  
Iritis
· Question 57
       
In order to decrease deaths   from lung cancer:
         
All smokers should be screened annually 
  
All patients should be screened annually 
  
Only high risk patients should be screened routinely 
  
Patients should be counseled to quit smoking
· Question 58
       
John, age 33, has a total   cholesterol level of 188 mgdL. How often should he be screened for   hypercholesterolemia?
         
 Every 5 years 
  
Every 2 years 
  
Every year 
  
Whenever blood work is done
· Question 59
       
Mort is hypertensive. Which of   the following factors influenced your choice of using an alpha blocker as the   antihypertensive medication?
         
Mort is black 
  
Mort also has congestive heart failure 
  
 Mort has benign prostatic hyperplasia 
  
 Mort has frequent migraine headaches
· Question 60
       
John, age 59, presents with   recurrent, sharply circumscribed red papules and plaques with a powdery white   scale on the extensor aspect of his elbows and knees. What do you suspect?
         
Actinic keratosis
  
Eczema
  
Psoriasis
  
Seborrheic dermatitis
· Question 61
       
Harriet, a 79-year-old woman,   comes to your office every 3 months for follow up on her hypertension. Her   medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium   1500 mg daily. At today’s visit. Her blood pressure is 17089. According to   JNC VIII guidelines, what should you do next to control Harriet’s blood   pressure?
         
Increase her Lisinopril to 20mg daily  
  
Add a thiazide diuretic to the Lisinopril 5mg daily 
  
Discontinue the Lisinopril and start a combination of ACE Inhibitor     and calcium channel blocker 
  
Discontinue the Lisinopril and start a diuretic
· Question 62
       
An active 65-year-old man under   your care has known acquired valvular aortic stenosis and mitral   regurgitation. He also has a history of infectious endocarditis. He has   recently been told he needs elective replacement of his aortic valve. When he   comes into the office you discover that he has 10 remaining teeth in poor   repair. Your recommendation would be to:
         
defer any further dental work until his valve replacement is completed
  
instruct him to have dental     extraction done cautiously, having no more than 2 teeth per visit removed.
  
suggest he consult with his     oral surgeon about having all the teeth removed at once and receiving     appropriate antibiotic prophylaxis
  
coordinate with his cardiac and oral surgeons to have the tooth     extractions and valve replacement done at the same time to reduce the risk     of anesthetic complications.
· Question 63
       
Appropriate therapy for peptic   ulcer disease (PUD) is:
         
Primarily by eradication of infection 
  
Based on etiology 
  
Aimed at diminishing prostaglandin synthesis 
  
Dependent on cessation of NSAID use
· Question 64
       
Shirley, age 58, has been a   diabetic for 7 years. Her blood pressure is normal. Other than her diabetes   medications, what would you prescribe today during her routine office visit?
         
A calcium channel blocker 
  
A beta blocker 
  
An ACE Inhibitor 
  
No hypertension medication   
· Question 65
       
Medicare is a federal program   administered by the Centers for Medicare and Medicaid Services (CMS). The CMS   has developed guidelines for Evaluation and Management coding, which all providers   are expected to follow when coding patient visits for reimbursement. Which of   the following is an important consideration regarding billing practices?
         
It is important to “undercode” so that one does not get charged with     Medicare fraud
  
The practice of “overcoding” is essential in this age of decreasing     reimbursements
  
Failing to bill for billable services will lead to unnecessarily low     revenues
  
Time spent with the patient is a very important determinant of billing
· Question 66
       
A 2 year old presents with a   white pupillary reflex. What is the most likely cause of this finding?
         
Viral conjunctivitis
  
Glaucoma
  
Corneal abrasion
  
Retinoblastoma
· Question 67
       
Harvey has had Meniere’s   disease for several years. He has some hearing loss but now has persistent   vertigo. What treatment might be instituted to relieve the vertigo?
         
Pharmacological therapy 
  
A labyrinthectomy 
  
A vestibular neurectomy 
  
Wearing an earplug in the ear with the most hearing loss
· Question 68
       
Which of the following is not a   risk factor for coronary arterial insufficiency?
         
Hyperhomocysteinemia 
  
Smoking 
  
Genetic factors 
  
Alcohol ingestion
· Question 69
       
An 18-year-old female presents   to the urgent care center complaining of severe pruritus in both eyes that   started 2 days ago. Associated symptoms include a headache and fatigue. On   examination, the nurse practitioner notes some clear discharge from both eyes   and some erythema of the eyelids and surrounding skin. Which of the following   is the most likely cause of this patient’s symptoms?
         
Allergic conjunctivitis 
  
Bacterial conjunctivitis 
  
Gonococcal conjunctivitis 
  
Viral conjunctivitis
· Question 70
       
A 20 year old is diagnosed with   mild persistent asthma. What drug combination would be most effective in   keeping him symptom-free?
         
A long-acting bronchodilator
  
An inhaled corticosteroid and cromolyn 
  
Theophylline and a short acting bronchodilator 
  
A bronchodilator PRN and an inhaled corticosteroid
· Question 71
       
Acute rheumatic fever is an   inflammatory disease which can follow infection with:
         
Group A Streptococcus 
  
Staphlococcus areus 
  
Β-hemolytic Streptococcus 
  
Streptococcus pyogenes
· Question 72
       
A 60 year old male diabetic   patient presents with redness, tenderness, and edema of the left lateral   aspect of his face. His left eyelid is grossly edematous. He reports history   of a toothache in the past week which “is better.” His temperature is 100°F and   pulse is 102 bpm. The most appropriate initial action is to:
         
Start an oral antibiotic, refer the patient to a dentist immediately,     and follow up within 3 days 
  
Order mandibular x-rays and question the patient about physical abuse 
  
Start an oral antibiotic, mouth swishes with an oral anti-infective,     and an analgesic 
  
Initiate a parenteral antibiotic and consider hospital admission
· Question 73
       
If a patient presents with a   deep aching, red eye and there is no discharge, you should suspect:
         
Iritis 
  
Allergic conjunctivitis 
  
Viral conjunctivitis
  
Bacterial conjunctivitis
· Question 74
       
The National Cholesterol   Education Program’s Adult Treatment Panel III recommends that the goal for   low density lipoproteins in high risk patients be less than:
         
160 mgdL 
  
130 mgdL 
  
100 mgdL 
  
70 mgdL
· Question 75
       
A patient presents with   classic symptoms of gastroesophageal reflux disease (GERD). He is instructed   on life style modifications and drug therapy for 8 weeks. Three months later   he returns, reporting that he was “fine” as long as he took the medication.   The most appropriate next step is:
         
Referral for surgical intervention such as a partial or complete     fundoplication 
  
Dependent upon how sever the practitioner believes the condition 
  
To repeat the 8 week course of drug therapy while continuing lifestyle     modifications 
  
Investigation with endoscopy, manometry, andor pH testing
· Question 76
       
Group A β-hemolytic   streptococcal (GABHS) pharyngitis is most common in which age group?
         
Under 3 years of age 
  
Preschool children 
  
6 to 12 years of age 
  
Adolescents
· Question 77
       
The most appropriate treatment   for a child with mild croup is:
         
A bronchodilator 
  
An antibiotic 
  
A decongestant  
  
A cool mist vaporizer
· Question 78
       
A child complains that his   “throat hurts” with swallowing. His voice is very “throaty” and he is   hyperextending his neck to talk. Examination reveals asymmetrical swelling of   his tonsils. His uvula is deviated to the left. What is the most likely   diagnosis?
         
Peritonsillar abscess 
  
Thyroiditis 
  
Mononucleosis 
  
Epiglottitis
· Question 79
       
Salmeterol (Servent) is   prescribed for a patient with asthma. What is the most important teaching   point about this medication?
         
It is not effective during an acute asthma attack. 
  
It may take 2 to 3 days to begin working.  
  
This drug works within 10 minutes.  
  
This drug may be used by patients 6 years and older.
· Question 80
       
Which intervention listed below   is safe for long term use by an adult with constipation?
         
Bulk-forming agents 
  
Stool softeners 
  
Laxatives 
  
Osmotic agents
· Question 81
       
A 40 year old presents with a   hordeolum. The nurse practitioner teaches the patient to:
         
Apply a topical antibiotic and warm compresses.  
  
Apply cool compresses and avoid touching the hordeolum.  
  
Use an oral antibiotic and eye flushes.  
  
Apply light palpation to facilitate drainage.
· Question 82
       
Sarah has allergic rhinitis and   is currently being bothered by nasal congestion. Which of the following meds   ordered for allergic rhinitis would be most appropriate?
         
An antihistamine intranasal spray
  
A decongestant nasal spray 
  
Ipratropium 
  
Omalizumab
· Question 83
       
What is the Gold standard for   the diagnosis of asthma?
         
Patient’s perception of clogged airways 
  
Validated quality-of-life questionnaires
  
 Bronchoscopy 
  
Spirometry
· Question 84
       
A patient complains of “an aggravating   cough for the past 6 weeks.” There is no physiological cause for the cough.   Which medication is most likely causing the cough?
         
Methyldopa 
  
Enalapril  
  
Amlodipine 
  
Hydrochlorothiazide
· Question 85
       
Stacy, age 27, states that she   has painless, white, slightly raised patches in her mouth. They are probably   caused by:
         
Herpes simplex 
  
Aphthous ulcers 
  
Candidiasis 
  
Oral cancer
· Question 86
       
Risk factors for acute otitis   media (AOM) include all of the following except:
         
Household cigarette smoke 
  
Group daycare attendance 
  
Sibling history of acute otitis media 
  
African-American ethnicity 
· Question 87
       
Which of the following can   result from chronic inflammation of a meibomian gland?
         
A chalazion 
  
Uveitis 
  
Keratitis 
  
A pterygium
· Question 88
       
What conditions must be met for   you to bill “incident to” the physician, receiving 100% reimbursement from   Medicare?
         
You must initiate the plan of care for the patient
  
The physician must be on-site and engaged in patient care
  
You must be employed as an independent contractor
  
You must be the main health care provider who sees the patient
· Question 89
       
Of the following choices, the   least likely cause of cough is:
         
Asthma 
  
Gastroesophageal reflux 
  
Acute pharyngitis
  
Allergic rhinitis
· Question 90
       
The most common correlate(s)   with chronic bronchitis and emphysema is(are):
         
Familial and genetic factors 
  
Cigarette smoking 
  
Air pollution 
  
Occupational environment
· Question 91
       
Which choice below is least   effective for alleviating symptoms of the common cold?
         
Antihistamines
  
Oral decongestants
  
Topical decongestants
  
Antipyretics
· Question 92
       
When teaching a patient with   hypertension about restricting sodium, you would include which of the   following instructions?
         
Diets with markedly reduced intakes of sodium may be associated with     other beneficial effects beyond blood pressure     control     
  
Sodium restriction can cause serious adverse effects 
  
A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily     achievable 
  
Seventy-five of sodium intake is derived from processed foods
· Question 93
       
Which of the following heart   murmurs warrants the greatest concern?
         
Systolic murmur 
  
Venous hum murmur 
  
Diastolic murmur 
  
Flow murmur
· Question 94
       
A patient presents with an   inflamed upper eyelid margin. The conjunctiva is red and there is particulate   matter along the upper eyelid. The patient complains of a sensation that   “there is something in my eye.” What is the diagnosis and how should it be   treated?
         
Hordeolum; treat with a topical antibiotic and warm compress 
  
Conjunctivitis; treat with topical antibiotic and warm compresses 
  
Blepharitis; treat with warm compresses and gentle debridement with a     cotton swab 
  
Chalazion; refer to an ophthalmologist for incision and drainage
· Question 95
       
A 57-year-old male presents to   urgent care complaining of substernal chest discomfort for the past hour. The   EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner   is aware that these changes are consistent with which myocardial infarction   territory?
         
Inferior wall 
  
Anterior wall 
  
Apical wall 
  
Lateral wall
· Question 96
       
The nurse practitioner observes   a tympanic membrane that is opaque, has decreased mobility, and is without   bulging or inflammation. The least likely diagnosis for this patient   is:  
         
Acute otitis media (AOM) 
  
Otitis media with effusion 
  
Mucoid otitis media 
  
Serous otitis media
· Question 97
       
Alan, age 54, notices a bulge   in his midline every time he rises from bed in the morning. You tell him it   is a ventral hernia, also known as:
         
inguinal hernia
  
epigastric hernia 
  
umbilical hernia 
  
incisional hernia   
· Question 98
       
A 58-year-old man is diagnosed   with Barrett’s esophagus after an endoscopy. He has no known allergies. Which   of the following medications is MOST appropriate to treat this patient’s   disorder?
         
Omeprazole 
  
Ranitidine 
  
An antacid 
  
None of the above
· Question 99
       
Larry, age 66, is a smoker with   hyperlipidemia and hypertension. He is 6 months post-MI. To prevent   reinfarction, the most important behavior change that he can make is to:
         
Quit smoking 
  
Maintain aggressive hypertension therapy 
  
Stick to a low-fat, low-sodium diet 
  
Continue with his exercise program
· Question 100
       
Risk factors for acute arterial   insufficiency include which of the following?
         
Recent myocardial infarction 
  
Atrial fibrillation 
  
Atherosclerosis 
  
All of the above
· Question 101
       
Impetigo and folliculitis are   usually successfully treated with:
         
Systemic antibiotics 
  
Topical antibiotics 
  
Topical steroid creams 
  
Cleansing and debridement

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