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CMN 577 final exam questions
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CMN 577 final exam questions1. Knowing that treatment for deep vein thrombosis (DVT) involves the
administration of anticoagulants, which of the following patients can be safely
treated for DVT in the outpatient setting? - CORRECT ANSWER-an 80-year-old
woman who weighs 42 kg
B. a 22-year-old man who had an appendectomy 2 days ago
C. a 32-year-old woman with peptic ulcer disease
D. a 55-year-old man with lung cancer in remission*
Most patients with DVT may be treated in the outpatient setting. However, there
are multiple contraindications to outpatient treatment, most involving increased
bleeding risk, including: active peptic ulcer disease, recent surgery, and weight
<55 kg for males and <45 kg for females. Lung cancer or any other cancer that
does not involve brain metastases is not a contraindication for outpatient
treatment.
2. The nurse practitioner is examining a 65-year-old man with a history of type 2
diabetes mellitus and a complaint of cramping pain in his calves when walking.
The patient reports the pain is alleviated with rest but returns when the patient
must walk again. The nurse practitioner expects to find all of the following on
exam consistent with the diagnosis of peripheral artery disease, except: -
CORRECT ANSWER-weak or absent dorsalis pedis pulses
B. large ulcerations at the medial ankles*
C. bruits over the femoral arteries
D. an ABI of 0.6
Peripheral artery disease (PAD) causes intermittent claudication, pulses in the
lower extremities to be faint or absent, may cause bruits over the larger arteries,
and usually results in an ABI of less than 0.9 (normal is 0.9-1.2). PAD can also
cause ischemic and arterial ulcers; however, these are generally found in the
toes and feet. Large ulcers near the ankles are characteristic of venous ulcers
and chronic venous insufficiency.
3. 43-year-old female presents with complaints of weight gain, constipation,
memory fog, and fatigue. Her labs reveal a TSH of 6.7 and Free T4 of 5. Your
plan for this patient includes: - CORRECT ANSWER-Her labs are within normal
range, and no treatment is needed.
,B. Start her on Synthroid at 1.6mcg/kg/day and recheck labs in 4-6 weeks.*
C. Instruct her to take her Synthroid on a full stomach for best absorption.
D. Start her on Synthroid at 0.8mcg/kg/day and recheck labs in 2 weeks.
Normal TSH values are 0.4-4 mIU/L and normal FreeT4 is 10-27pmlol/L. This
patient has both the symptoms and lab values for hypothyroidism. Synthroid
(synthetic levothyroxine) is the first line medication for hypothyroidism and
starting dose is 1.6mcg/kg/day based on ideal body weight. TSH and Free T4
should be rechecked every 4-6 weeks until euthyroid and normal lab values
should be obtained within 1-2 months of starting therapy.
4. Cigarette smoking may falsely increase the levels of: - CORRECT
ANSWER-gamma-glutamyl transpeptidase
B. sodium and potassium concentrations
C. hepatic enzymes*
D. serum protein electrophoresis
Cigarette smoking may increase hepatic enzymes which in turn will reduce the
levels of substances metabolized by the liver such as theophylline.
5. A 75-year-old female patient who is healthy and active reports that she has
recently been having trouble getting to the bathroom on time to urinate and also
has some leaks when she sneezes or coughs. She reports having to wear an
incontinence pad daily. She is very independent and is embarrassed and worried
that this is going to affect her lifestyle. As her provider, your best next steps for
this patient would be: - CORRECT ANSWER-Refer her to urology, her symptoms
will only get worse and she will more than likely need surgery
B. Suggest bladder training and pelvic floor muscle exercises (Kegel's) to
decrease incidences of stress and urge incontinence *
C. Prescribe an antimuscarinic agent such as oxybutynin immediately
D. Schedule the patient for insertion of a pessary
For women with mixed stress/urge incontinence, pelvic floor muscle exercises
can be effective for decreasing this problem. The other choices are more invasive
and would not be first-line conservative treatments.
6. A 40-year-old female waitress presents to the clinic complaining of pain,
burning, and tingling in her hands and fingers. She reports the symptoms are
most bothersome at night. The NP has carpal tunnel syndrome as a differential
,diagnosis. All of the following are used to rule in or out this diagnosis EXCEPT: -
CORRECT ANSWER-Tinel test
B. Phalen test
C. Spurling test *
D. Carpal compression test
Rationale: A Tinel or Phalen sign may be positive. A Tinel sign is tingling or
shock-like pain on volar wrist percussion. The Phalen sign is pain or paresthesia
in the distribution of the median nerve when the patient flexes both wrists to 90
degrees for 60 seconds. The carpal compression test, in which numbness and
tingling are induced by the direct application of pressure over the carpal tunnel,
may be more sensitive and specific than the Tinel and Phalen tests.
7. A 66-year-old Hispanic female presents with a two-year history of detrusor
overactivity or "urge incontinence. She has been treated by a physical therapist
with bladder training therapy for one year, buts fail to provide appropriate relief.
The next possible treatment would be: - CORRECT ANSWER-Tolterodine 1-2
mg orally 2x daily
B. Oxybutynin 2.5 - 5mg orally 2-3x daily
C. Refer to OB/Gyn for a pessary fitting
D. All of the above*
Antimuscarinic agents such as tolterodine or oxybutynin may provide additional
benefit in stress incontinence issues. These medications must be used with
caution due to the side effects of dry mouth, urine retention, and delirium. A
pessary may also be of additional benefit but should be prescribed only by
providers who are experienced in the selection, placement, and management of
these devices.
8. A 23-year-old male patient presents to the clinic with complaints of fever,
irritative voiding symptoms, and perineal/suprapubic pain for 2 days. On exam,
the CBC shows leukocytosis and a left shift. UA is positive for pyuria and
bacteriuria. There is no CVA tenderness or painful scrotal enlargement. The NP
suspects the patient has which of the following diagnosis? - CORRECT
ANSWER-Acute Bacterial Prostatitis *
B. Chronic Bacterial Prostatitis
C. Acute Epididymitis
D. Prostatodynia
, Acute Bacterial Prostatitis presents with fever, irritative voiding symptoms,
perineal and/or suprapubic pain, and a positive UA. Chronic bacterial prostatitis
does not present with fever or a positive UA. Acute epididymitis will present with
painful scrotal swelling due to enlargement of the epididymitis. Prostatodynia is a
noninflammatory disorder presenting with a normal UA and no fever.
9. A 24-year-old female who identifies as a lesbian, presents for her annual
wellness visit. She has multiple female sexual partners. She did not receive the
HPV vaccine and has not had a cervical cancer screening since she was 21
years old. Which of the following is not recommended in the treatment plan for
this patient? - CORRECT ANSWER-HPV vaccination series
B. Papanicolaou (PAP) smear with HPV co-testing*
C. Chlamydia trachomatis and Neisseria gonorrheae testing
D. Screen for Intimate Partner Violence (IPV)
Chlamydial infections were higher in 14- to 24-year-old women who reported
same-sex behavior when compared with exclusively heterosexual women.
Untreated chlamydial infection places a woman's future fertility at risk due to
potential tubal occlusion. Some women who have a chlamydia infection do not
have symptoms. Secondary sequelae of chlamydia include intra-abdominal
abscesses, chronic pain, and the need for mul¬tiple surgeries. Regardless of
sexual orientation, the CDC recommends annual Chlamydia trachomatis (and
Neisseria gonorrheae) screening from the age of first sexual activity to the age of
25 years for all women. Compared to heterosexual women, lesbians and
bisexual women have higher exposure to violence throughout their lifetimes. The
lifetime prevalence of sexual assault may be as high as 85%. It is essential to
screen all women for IPV but especially those in the LGBTQ community due to
these alarming statistics. The primary prevention of cervical cancer is essential.
All females between the ages of 12 and 26 years should receive the HPV
vaccine series even if they never have been or plan to be sexually active with
men. HPV is transmitted sexually between lesbian or heterosexual partners. The
rate of HPV immunization among lesbians is significantly less than for
heterosexual women, which creates a health disparity that needs to be corrected.
While she is due for a PAP smear, the PAP with HPV co-testing is not
recommended in women under the age of 30 years old.
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