Appropriate initial treatment for plaque psoriasis would be:

Topical anthralin (Dritho-Creme) used once a week

Topical pimecrolimus (Elidel) used twice a day.

Wet soaks with aluminum acetate (Burow's) solution used as needed

Topical triamcinolone 0.1% (Kenalog) used as "pulse" therapy (2-4 weeks at a time)

Answer and Explanation

The Correct Answer is D

Plaque psoriasis is a chronic inflammatory skin disorder characterized by well-demarcated erythematous plaques with silvery scaling, resulting from rapid keratinocyte turnover and immune-mediated inflammation. Initial treatment is typically based on disease severity, with mild to moderate cases managed using topical therapies that reduce inflammation and control plaque formation. Corticosteroids are the mainstay of first-line therapy due to their strong anti-inflammatory effects and rapid symptom control when used appropriately.

Rationale:
A. Anthralin (Dritho-Creme) is effective for psoriasis by slowing keratinocyte proliferation, but it is not commonly used as initial therapy due to its irritant properties, staining of skin and clothing, and need for careful application. It is generally reserved for more resistant plaques or as an adjunct therapy rather than first-line treatment.

B. Pimecrolimus (Elidel) is primarily indicated for atopic dermatitis, especially in sensitive areas such as the face or intertriginous regions. It is not considered a first-line treatment for plaque psoriasis because it has limited efficacy on thick, scaly plaques found in typical psoriatic lesions.

C. Burow’s solution (aluminum acetate) wet soaks are used for soothing inflamed or weeping skin conditions, such as acute dermatitis or minor skin infections. While they may provide symptomatic relief, they do not address the underlying immune-mediated inflammation of plaque psoriasis and are not effective as primary treatment.

D. Triamcinolone 0.1% (Kenalog) is an appropriate initial treatment for plaque psoriasis because it effectively reduces inflammation, erythema, and scaling. Intermittent “pulse” therapy helps minimize side effects such as skin atrophy while maintaining disease control. Topical corticosteroids are considered first-line therapy for localized mild to moderate plaque psoriasis due to their efficacy and rapid symptom relief.

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Correct Answer is A

Explanation

Recurrent urinary tract infections (UTIs) with systemic symptoms suggest a more complicated infection, possibly involving upper urinary tract involvement such as pyelonephritis or resistant organisms. Treatment selection must consider local antimicrobial resistance patterns, severity of symptoms, and prior antibiotic exposure. Broader-spectrum antibiotics are often required when resistance is a concern or when infection is not limited to the lower urinary tract. Therapy duration is also extended in more complex presentations.

Rationale:
A. Ciprofloxacin (Cipro) is an appropriate option in this scenario because it provides broad-spectrum coverage against common urinary pathogens and achieves good tissue penetration, including renal tissue. In a patient with recurrent UTI and systemic symptoms, there is concern for resistant organisms or upper tract involvement, making fluoroquinolones a reasonable choice when resistance patterns support their use. A 7-day course is consistent with treatment for complicated infection.

B. Trimethoprim-sulfamethoxazole (Bactrim) is typically used for uncomplicated cystitis with a short 3-day course when local resistance rates are low. However, in recurrent infections with systemic symptoms and concern for resistance, it may be ineffective due to increasing E. coliresistance. It is not the best empiric choice in this higher-risk presentation.

C. Clarithromycin (Biaxin) is not appropriate for urinary tract infections because it has poor activity against common uropathogens such as E. coli. Macrolides are primarily used for respiratory and certain atypical infections, not urinary tract infections. Therefore, it would not provide adequate empiric coverage in this case.

D. Fosfomycin (Monurol) is used as a single-dose therapy for uncomplicated lower urinary tract infections. It is not appropriate for recurrent UTIs with systemic symptoms or suspected upper urinary tract involvement. Its limited systemic penetration makes it unsuitable for more complicated or resistant infections.

A. Heart rate at each visit, discontinue therapy when heart rate <60 beats per minute B. For good oral hygiene, as therapy can cause gingival hyperplasia C. CBC due to black box warning for agranulocytosis D. For pedal edema due to fluid retention risk

Correct Answer is B

Explanation

Anticonvulsants such as Phenytoin (Dilantin) are used in seizure management to stabilize neuronal membranes and prevent abnormal electrical activity in the brain. While effective, phenytoin is associated with several long-term adverse effects that require ongoing monitoring and patient education. One of the most characteristic and common side effects is gingival overgrowth, which can be minimized with proper oral care. Nursing care focuses on preventing complications and promoting adherence to therapy.

Rationale:
A. Heart rate monitoring and discontinuation of Phenytoin (Dilantin) based on bradycardia is not a standard monitoring parameter. Phenytoin toxicity primarily affects the central nervous system (e.g., nystagmus, ataxia, confusion) rather than causing clinically significant bradycardia. Heart rate thresholds are not used to guide discontinuation of this medication.

B. Maintaining good oral hygiene is essential because Phenytoin (Dilantin) is well known to cause gingival hyperplasia due to fibroblast proliferation and collagen accumulation in the gums. Regular brushing, flossing, and dental care help reduce plaque buildup and minimize the severity of gum overgrowth. This is a key nursing teaching point for patients on long-term therapy, especially children.

C. While CBC monitoring may be done in some anticonvulsant therapies, agranulocytosis is not a classic black box warning for Phenytoin (Dilantin). More commonly, phenytoin is associated with rare but serious effects such as blood dyscrasias, including leukopenia or aplastic anemia, but routine monitoring focuses more on drug levels and neurological toxicity.

D. Pedal edema due to fluid retention is not a typical adverse effect of Phenytoin (Dilantin). While some anticonvulsants may cause weight changes or metabolic effects, phenytoin is primarily associated with neurologic, dermatologic, and gingival side effects rather than fluid overload. Monitoring for edema is not a key priority in patients receiving this medication.

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Appropriate initial treatment for plaque psoriasis would be:

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Naxlex Comprehensive Predictor Exams

You are treating AM, a 28 y/o female with no allergies, who has a repeat diagnosis of UTI within the last 4 months. She has systemic symptoms. You have concerns for antimicrobial resistance patterns for treating UTIs in your community. Which of the following is an appropriate therapy option for AM?

Correct Answer is A

Explanation

A child is prescribed phenytoin (Dilantin) chewable tablets for his seizure diagnosis. Monitoring for this drug includes assessing:

Correct Answer is B

Explanation

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