Family Nurse Practitioner Exam

What should be the best intervention for a 75-year-old woman with a persistent scaly, reddened rash on her left nipple?

1. Prescribe another potent topical steroid and tell the patient to use it twice a day for 4 weeks

2. Order a mammogram and refer the patient to a breast surgeon

3. Advise her to stop using soap on both breasts

4. Order a sonogram and fine-needle biopsy of the breast

The correct answer is: Order a mammogram and refer the patient to a breast surgeon

In this scenario, the best intervention for a 75-year-old woman with a persistent scaly, reddened rash on her left nipple is to order a mammogram and refer her to a breast surgeon. The rationale behind this approach is that a scaly and reddened rash, particularly on the nipple, could be indicative of an underlying malignancy, such as Paget's disease of the nipple, which is associated with breast cancer. Early evaluation through imaging, such as a mammogram, is critical to identify any possible abnormalities in the breast tissue. Referral to a breast surgeon is also essential for further diagnostic evaluation and management. This may include additional imaging or biopsy procedures that could confirm or rule out malignancy, allowing for timely and appropriate treatment if needed. In contrast, prescribing another potent topical steroid does not address the potential underlying condition causing the rash, and using steroids could mask symptoms and delay appropriate diagnosis. Advising the patient to stop using soap on both breasts may provide symptomatic relief but does not tackle the underlying issue. Similarly, ordering a sonogram and fine-needle biopsy might be necessary steps later on, but they would typically follow an initial mammogram, particularly if there's a suspicion of malignancy. Therefore, prioritizing a mammogram and