Pain Management Nurse Exam Sample QuestionsThe following sample questions are similar to those on the examination but do not represent the full range of content or levels of difficulty. The answers to the sample questions are provided after the last question. Please note: Taking these or any sample question(s) is not a requirement to sit for an actual certification examination. Completion of these or any other sample question(s) does not imply eligibility for certification or successful performance on any certification examination. Show
To respond to the sample questions, first enter your first and last names in the boxes below (this information will not be recorded; it is strictly for purposes of identifying your results). Then click the button corresponding to the best answer for each question. When you are finished, click the "Evaluate" button at the bottom of the page. A new browser window will open, displaying your results, which you may print, if you wish. This practice exam is not timed, and you may take it as many times as you wish. Good luck! Introduction[edit | edit source]Cellulitis is a common bacterial skin infection, with over 14 million cases occurring in the United States annually. A severe case of cellulitis that developed under a cast Cellulitis typically presents as a poorly demarcated, warm, erythematous area with associated edema and tenderness to palpation.
Etiology[edit | edit source]The skin serves as a protective barrier preventing normal skin flora and other microbial pathogens from reaching the subcutaneous tissue and lymphatic system. When a break in the skin occurs, it allows for normal skin flora and other bacteria to enter into the dermis and subcutaneous tissue, these bacteria below the skin surface can lead to an acute superficial infection affecting the deep dermis and subcutaneous tissue, causing cellulitis. Cellulitis most commonly results from infection with group A beta-hemolytic streptococcus (i.e., Streptococcus pyogenes). Risk factors for cellulitis include any culprit that could cause a breakdown in the skin barrier such as
Studies show lymphedema is a major risk factor for the development of cellulitis. There is known to be a link between the two, but it is not known which of the two comes first. Patients with lymphedema or chronic edema are more prone to infection due to damage to lymphatic vessels and immune deficiency in that area. Cellulitis on the other hand, can cause damage to the lymphatics and the development of lymphedema.[1] Epidemiology[edit | edit source]
Pathophysiology[edit | edit source]Cellulitis is characterized by erythema, warmth, edema, and tenderness to palpation resulting from cytokine and neutrophil response from bacteria breaching the epidermis.
Clinical Presentation[edit | edit source]A classic presentation of cellulitis: poorly demarcated erythema[3] Typical symptoms include acute poorly demarcated and spreading erythema along with pain, swelling, and warmth of the lower extremity but can occur on any area of skin or underlying subcutaneous tissue.[4][5]
Examination[edit | edit source]Patients with cellulitis will reveal an affected skin area typically with a poorly demarcated area of erythema. The erythematous area is often warm to the touch with associated swelling and tenderness to palpation. The patient may present with constitutional symptoms of generalized malaise, fatigue, and fevers.
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]Cultures are typically not beneficial in making a cellulitis diagnosis. It is most commonly diagnosed by history and physical examination alone.
Medical Management[edit | edit source]Patients presenting with mild cellulitis and displaying no systemic signs of infection should be covered with antibiotics that target the treatment of streptococcal species. The duration of oral antibiotic therapy should be for a minimum duration of 5 days.
NB It is beyond a physiotherapists scope to know the individual antibiotics and best choices. The pharmacist ideally will have a board specialty in infectious disease to assist and work with the clinician on the best antibiotic selection.[2] Physical Therapy Management[edit | edit source]While there is lack of evidence that discusses specific physical therapy interventions for cellulitis, therapists should be aware of the signs and symptoms in order to refer the patient appropriately. Physical therapists should have awareness of risk factors and various causes of cellulitis, in
addition to signs and symptoms.
Preventative Measures[edit | edit source]
Differential Diagnosis[edit | edit source]Cellulitis is a frequently encountered infection of the deep dermis and subcutaneous tissue, mainly affecting the lower extremities, but it can have many mimickers. Common differential diagnoses for Cellulitis include
Complications[edit | edit source]Without prompt diagnosis and treatment, cellulitis could lead to several complications. Cellulitis that leads to bacteremia, endocarditis, or osteomyelitis will require a longer duration of antibiotics and possibly surgery.[2]
Prognosis[edit | edit source]Overall, cellulitis has a good prognosis
Resources[edit | edit source]A video link by dermatologist Dr. Noah Craft MD, PhD, DTMH discusses Cellulitis from the provider point of view and includes case studies, differential diagnosis, and treatment approaches. References[edit | edit source]
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