Author Question: A patient who has scabies has been treated by the primary care NP twice with permethrin (Elimite). ... (Read 41 times)

SGallaher96 · **on:** Jul 24, 2018

A patient who has scabies has been treated by the primary care NP twice with permethrin (Elimite). The second application was administered 10 days after the first. The patient returns to the clinic with mild pruritus and erythema.

The NP does not observe new burrows on the skin. The NP should: a. order lindane.
b. order malathion.
c. re-treat with permethrin.
d. prescribe triamcinolone 0.1.

Question 2

The primary care NP sees a new patient for a routine physical examination. When auscultating the heart, the NP notes a heart rate of 78 beats per minute with occasional extra beats followed by a pause.

History reveals no past cardiovascular disease, but the patient reports occasional syncope and shortness of breath. The NP should: a. order an ECG and refer to a cardiologist.
b. schedule a cardiac stress test and a graded exercise test.
c. order a complete blood count (CBC) and electrolytes and consider a trial of procainamide.
d. prescribe a B-blocker and anticoagulant and order 24-hour Holter monitoring.

wuly · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

D
In scabies, pruritus may persist for several weeks after treatment and does not necessarily indicate the need for re-treatment. Dermatitis may persist for months. Triamcinolone 0.1 may be used to help with pruritus and dermatitis. Lindane and malathion are not indicated. Re-treatment is not necessary.

Answer to Question 2

A
Premature ventricular contractions are premature ventricular beats with a compensatory pause. This patient has no prior history, but does have syncope and shortness of breath. The NP should order an ECG and refer the patient to a cardiologist for further evaluation. If there were no other symptoms, the NP could order stress testing. Medications are not indicated without further testing and without consultation with a cardiologist.