Author Question: An 18-month-old child who attends day care has head lice and has been treated with permethrin 1 ... (Read 61 times)

jake · **on:** Jul 24, 2018

An 18-month-old child who attends day care has head lice and has been treated with permethrin 1 (Nix). The parent brings the child to the clinic 1 week later, and the primary care NP notes live bugs on the child's scalp. The NP should order:

a. lindane.
b. malathion.
c. ivermectin.
d. permethrin 5.

Question 2

A patient undergoes a routine electrocardiogram (ECG), which reveals occasional premature ventricular contractions that are present when the patient is resting and disappear with exercise.

The patient has no previous history of cardiovascular disease, and the cardiovascular examination is normal. The primary care NP should: a. prescribe quinidine (Quinidex Extentabs).
b. tell the patient that treatment is not indicated.
c. refer the patient to a cardiologist for further evaluation.
d. consider using amiodarone if the patient develops other symptoms.

ryrychapman11 · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

D
Permethrin is the first-line drug of choice for treating head lice and is usually effective in one application. Significant resistance to permethrin 1 has developed, and permethrin 5 is more effective. In pediculosis, if live lice can be found after 1 week, reapply treatment. This child may have been reinfected at day care and so should be treated again. Malathion is a second-line drug and is not recommended in children younger than age 2 . Lindane is a third-line drug. Ivermectin is a fourth-line drug.

Answer to Question 2

B
The most important factor in determining whether to treat premature ventricular contractions is the presence of underlying heart disease, such as myocardial ischemia, previous myocardial infarction, cardiac scarring or hypertrophy, or left ventricular dysfunction. Because of the risks associated with antiarrhythmic therapy, patients should not be treated unless clear indications are present. Premature ventricular contractions are not treated if the patient is asymptomatic, if the patient has a normal heart, if the premature ventricular contractions are simple, and if they disappear with exercise. Amiodarone is not used to treat acute premature ventricular contractions but is used for long-term prophylaxis.