A 2-year-old child presents to the nurse practitioner with eight café-au-lait spots on the back and chest. These lesions have irregular borders and measure between 1.5 and 2 cm in diameter. The nurse practitioner should:
reassure the patient that these lesions are birth marks and of no concern.
order 2% hydrocortisone cream to be applied twice a day for 2 weeks.
order an antifungal cream to be applied three times a day for 14 days.
refer the patient to a neurologist for further evaluation.
The Correct Answer is D
Rationale:
A. While café-au-lait spots can appear as benign birthmarks, the presence of six or more spots greater than 0.5 cm in prepubertal children is a diagnostic criterion for neurofibromatosis type 1 (NF1). Reassurance alone is inappropriate in this scenario.
B. Topical hydrocortisone is not indicated, as café-au-lait spots are pigmented lesions, not inflammatory or eczematous conditions.
C. Antifungal cream is irrelevant, as café-au-lait spots are not caused by fungal infections.
D. Referral to a neurologist or pediatric geneticist is warranted for further evaluation, as NF1 can be associated with neurologic, skeletal, and ophthalmologic complications. Early identification allows for monitoring and management of potential systemic involvement.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Retapamulin is an antibiotic used for bacterial skin infections, not for scabies.
B. Permethrin 5% cream is the first-line treatment for scabies. It should be applied to the entire body from the neck down (and in infants, also the scalp and face) and left on for 8–14 hours before washing off. A single application is often sufficient, though a second dose may be recommended after 7–14 days if symptoms persist.
C. Clotrimazole is an antifungal used for dermatophyte infections and candidiasis, not for scabies.
D. Hydrocortisone 1% cream can help relieve itching and inflammation but does not treat the underlying scabies infestation.
Correct Answer is A
Explanation
Rationale:
A. Applying acetic acid to the external genitalia before chemical ablation is NOT recommended. Acetic acid is sometimes used for diagnostic purposes (to highlight lesions by turning them white), but it can irritate the skin and increase the risk of chemical injury when combined with podophyllin.
B. Applying petroleum jelly around the lesions is appropriate because it protects surrounding healthy skin from the caustic effects of podophyllin.
C. Using a cotton-tipped wooden applicator is the correct technique to apply podophyllin precisely to the lesions without spreading it to healthy tissue.
D. Dusting the lesions with talcum powder after ablation helps absorb residual medication and reduce local irritation, which is considered standard post-application care.
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