CMN 574 exam questions with answers
|\ |\ |\ |\ |\
A female patient, currently at 26 weeks gestation, has
|\ |\ |\ |\ |\ |\ |\ |\ |\
experienced a slow rise of her blood pressure over the |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
past 2 weeks. Her urine specimen is negative for protein.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
She has reduced her sodium intake and has begun a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
walking program. The patient's blood pressure today is
|\ |\ |\ |\ |\ |\ |\ |\
155/102, which is consistent with her readings at home.
|\ |\ |\ |\ |\ |\ |\ |\ |\
Associated symptoms include a dull headache. The nurse |\ |\ |\ |\ |\ |\ |\ |\
practitioner's best response is: |\ |\ |\
a. "Try yoga and meditation to decrease your blood
|\ |\ |\ |\ |\ |\ |\ |\ |\
pressure." |\
b. Start the patient on methyldopa 250 mg po twice daily.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
c. "Monitor your blood pressure at home and call the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
office if you have swelling or a pounding headache."
|\ |\ |\ |\ |\ |\ |\ |\
d. Start the patient on metoprolol 100mg po twice daily. -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔*b. Start the patient on |\ |\ |\ |\ |\ |\ |\
methyldopa 250 mg po twice daily. |\ |\ |\ |\ |\
Rationale: Methyldopa has the longest record of safety at|\ |\ |\ |\ |\ |\ |\ |\ |\
a starting dosage of 250 mg po bid or tid. Therapy with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
beta blockers or calcium channel blockers is also
|\ |\ |\ |\ |\ |\ |\ |\
acceptable. (Papadakis& McPhee, 2015. P. 801.) |\ |\ |\ |\ |\ |\
Metoprolol is a Category C medication and 100 mg po bid |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is not the lowest possible starting dose. The initiation of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,anti-hypertensive therapy in pregnant women is indicated |\ |\ |\ |\ |\ |\
if the sustained blood pressure is > 150/100 or if there is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
evidence of end-organ damage (Papadakis &McPhee,
|\ |\ |\ |\ |\ |\
2015, p. 801) |\ |\
Resistant hypertension may be caused by which of the
|\ |\ |\ |\ |\ |\ |\ |\ |\
following? |\
a. NSAIDs
|\ |\
b. Oral Contraceptives
|\ |\ |\
c. Obesity
|\ |\
d. All of the above - CORRECT ANSWERS ✔✔*d. All of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
above |\
Rationale: JNC 7 defines resistant hypertension as the
|\ |\ |\ |\ |\ |\ |\ |\
inability to control blood pressure in those patients who
|\ |\ |\ |\ |\ |\ |\ |\ |\
are compliant with the appropriate three-drug regimen,
|\ |\ |\ |\ |\ |\ |\
including a diuretic. Causes of resistant hypertension
|\ |\ |\ |\ |\ |\ |\
listed in table 11-11 include nonadherence, NSAIDs, oral
|\ |\ |\ |\ |\ |\ |\ |\
contraceptives, adrenal steroids, licorice, obesity, and |\ |\ |\ |\ |\ |\
excessive alcohol intake (Sutters, 2015, p.458-459).
|\ |\ |\ |\ |\
Cholesterol medication that works by obstructing the |\ |\ |\ |\ |\ |\ |\
absorption of cholesterol by blocking the passage of |\ |\ |\ |\ |\ |\ |\ |\
,cholesterol across the intestinal wall through the |\ |\ |\ |\ |\ |\ |\
inhibition of a cholesterol transporter is ? |\ |\ |\ |\ |\ |\ |\
a. Statins|\ |\
b. Fibric Acid
|\ |\ |\
c. Ezetimibe
|\ |\
d. Bile Acid - CORRECT ANSWERS ✔✔*c. Ezetimibe (Zetia)
|\ |\ |\ |\ |\ |\ |\ |\
[Cholesterol absorption inhibitor]
|\ |\ |\
Rationale: "Ezetimibe is the lipid lower drug that works by |\ |\ |\ |\ |\ |\ |\ |\ |\
inhibiting the intestinal absorption of biliary and dietary
|\ |\ |\ |\ |\ |\ |\ |\ |\
cholesterol by blocking passage across the intestinal wall |\ |\ |\ |\ |\ |\ |\ |\
by inhibiting a cholesterol transporter. Statins block the
|\ |\ |\ |\ |\ |\ |\ |\
rate-limiting enzyme in the formation of cholesterol. |\ |\ |\ |\ |\ |\ |\
Fibrates are peroxisome proliferative-activated receptor-
|\ |\ |\ |\
alpha agonists that results in potent reductions of plasms
|\ |\ |\ |\ |\ |\ |\ |\ |\
triglycerides and increases in HDL. Bile acids work by |\ |\ |\ |\ |\ |\ |\ |\ |\
binding bile acid in the intestine" (Baron, 2015).
|\ |\ |\ |\ |\ |\ |\
A 2 year girl arrives to your clinic with a history of a fever
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for 7 days, cervical lymphadenopathy, edema and
|\ |\ |\ |\ |\ |\ |\
desquamation of extremities, bilateral, non-exudative |\ |\ |\ |\ |\
conjunctivitis, and polymorphous exanthema. You |\ |\ |\ |\ |\
correctly diagnose the girl with : |\ |\ |\ |\ |\ |\
, a. Rheumatic fever
|\ |\ |\
b. Kawasaki disease
|\ |\ |\
c. Lyme disease
|\ |\
d. Infective endocarditis - CORRECT ANSWERS ✔✔*b.
|\ |\ |\ |\ |\ |\ |\
Kawasaki disease |\ |\
Rationale: The diagnostic criteria for Kawasaki disease
|\ |\ |\ |\ |\ |\ |\
are fever that lasts for greater than 5 days and at least 4
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
of the following other manifestations: (1) cervical
|\ |\ |\ |\ |\ |\ |\
lymphadenopathy, usually unilateral and great than or |\ |\ |\ |\ |\ |\ |\
equal to 1.5 cm in diameter, (2) extremity changes
|\ |\ |\ |\ |\ |\ |\ |\ |\
(redness and swelling of the hands and feet with
|\ |\ |\ |\ |\ |\ |\ |\ |\
subsequent desquamation), (3) polymorphous |\ |\ |\ |\
exanthema, (4) oral cavity or lip changes, (such as |\ |\ |\ |\ |\ |\ |\ |\ |\
strawberry tongues, fissuring and cracking, and |\ |\ |\ |\ |\ |\
inflammation of the oral mucosa), and (5) painless, |\ |\ |\ |\ |\ |\ |\ |\
bilateral, non-exudative conjunctivitis. Rheumatic fever
|\ |\ |\ |\ |\
consists of 2 major criteria such as carditis, erythema
|\ |\ |\ |\ |\ |\ |\ |\ |\
marginatum, Sydenham chorea, or polyarthritis, or 1 |\ |\ |\ |\ |\ |\ |\
major criteria and 1 minor criteria, such as polyarthalgia,
|\ |\ |\ |\ |\ |\ |\ |\ |\
fever, and previous rheumatic heart disease or fever, plus
|\ |\ |\ |\ |\ |\ |\ |\
evidence to support streptococcal infection. Infective
|\ |\ |\ |\ |\ |\ |\
endocarditis often presents with weight loss, malaise, and |\ |\ |\ |\ |\ |\ |\
fever. (Darst, Collins, & Miyamoto, 2014, p. 628). Lyme
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
disease may develop after a tick bite, and is
|\ |\ |\ |\ |\ |\ |\ |\ |\
|\ |\ |\ |\ |\
A female patient, currently at 26 weeks gestation, has
|\ |\ |\ |\ |\ |\ |\ |\ |\
experienced a slow rise of her blood pressure over the |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
past 2 weeks. Her urine specimen is negative for protein.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
She has reduced her sodium intake and has begun a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
walking program. The patient's blood pressure today is
|\ |\ |\ |\ |\ |\ |\ |\
155/102, which is consistent with her readings at home.
|\ |\ |\ |\ |\ |\ |\ |\ |\
Associated symptoms include a dull headache. The nurse |\ |\ |\ |\ |\ |\ |\ |\
practitioner's best response is: |\ |\ |\
a. "Try yoga and meditation to decrease your blood
|\ |\ |\ |\ |\ |\ |\ |\ |\
pressure." |\
b. Start the patient on methyldopa 250 mg po twice daily.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
c. "Monitor your blood pressure at home and call the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
office if you have swelling or a pounding headache."
|\ |\ |\ |\ |\ |\ |\ |\
d. Start the patient on metoprolol 100mg po twice daily. -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔*b. Start the patient on |\ |\ |\ |\ |\ |\ |\
methyldopa 250 mg po twice daily. |\ |\ |\ |\ |\
Rationale: Methyldopa has the longest record of safety at|\ |\ |\ |\ |\ |\ |\ |\ |\
a starting dosage of 250 mg po bid or tid. Therapy with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
beta blockers or calcium channel blockers is also
|\ |\ |\ |\ |\ |\ |\ |\
acceptable. (Papadakis& McPhee, 2015. P. 801.) |\ |\ |\ |\ |\ |\
Metoprolol is a Category C medication and 100 mg po bid |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is not the lowest possible starting dose. The initiation of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,anti-hypertensive therapy in pregnant women is indicated |\ |\ |\ |\ |\ |\
if the sustained blood pressure is > 150/100 or if there is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
evidence of end-organ damage (Papadakis &McPhee,
|\ |\ |\ |\ |\ |\
2015, p. 801) |\ |\
Resistant hypertension may be caused by which of the
|\ |\ |\ |\ |\ |\ |\ |\ |\
following? |\
a. NSAIDs
|\ |\
b. Oral Contraceptives
|\ |\ |\
c. Obesity
|\ |\
d. All of the above - CORRECT ANSWERS ✔✔*d. All of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
above |\
Rationale: JNC 7 defines resistant hypertension as the
|\ |\ |\ |\ |\ |\ |\ |\
inability to control blood pressure in those patients who
|\ |\ |\ |\ |\ |\ |\ |\ |\
are compliant with the appropriate three-drug regimen,
|\ |\ |\ |\ |\ |\ |\
including a diuretic. Causes of resistant hypertension
|\ |\ |\ |\ |\ |\ |\
listed in table 11-11 include nonadherence, NSAIDs, oral
|\ |\ |\ |\ |\ |\ |\ |\
contraceptives, adrenal steroids, licorice, obesity, and |\ |\ |\ |\ |\ |\
excessive alcohol intake (Sutters, 2015, p.458-459).
|\ |\ |\ |\ |\
Cholesterol medication that works by obstructing the |\ |\ |\ |\ |\ |\ |\
absorption of cholesterol by blocking the passage of |\ |\ |\ |\ |\ |\ |\ |\
,cholesterol across the intestinal wall through the |\ |\ |\ |\ |\ |\ |\
inhibition of a cholesterol transporter is ? |\ |\ |\ |\ |\ |\ |\
a. Statins|\ |\
b. Fibric Acid
|\ |\ |\
c. Ezetimibe
|\ |\
d. Bile Acid - CORRECT ANSWERS ✔✔*c. Ezetimibe (Zetia)
|\ |\ |\ |\ |\ |\ |\ |\
[Cholesterol absorption inhibitor]
|\ |\ |\
Rationale: "Ezetimibe is the lipid lower drug that works by |\ |\ |\ |\ |\ |\ |\ |\ |\
inhibiting the intestinal absorption of biliary and dietary
|\ |\ |\ |\ |\ |\ |\ |\ |\
cholesterol by blocking passage across the intestinal wall |\ |\ |\ |\ |\ |\ |\ |\
by inhibiting a cholesterol transporter. Statins block the
|\ |\ |\ |\ |\ |\ |\ |\
rate-limiting enzyme in the formation of cholesterol. |\ |\ |\ |\ |\ |\ |\
Fibrates are peroxisome proliferative-activated receptor-
|\ |\ |\ |\
alpha agonists that results in potent reductions of plasms
|\ |\ |\ |\ |\ |\ |\ |\ |\
triglycerides and increases in HDL. Bile acids work by |\ |\ |\ |\ |\ |\ |\ |\ |\
binding bile acid in the intestine" (Baron, 2015).
|\ |\ |\ |\ |\ |\ |\
A 2 year girl arrives to your clinic with a history of a fever
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for 7 days, cervical lymphadenopathy, edema and
|\ |\ |\ |\ |\ |\ |\
desquamation of extremities, bilateral, non-exudative |\ |\ |\ |\ |\
conjunctivitis, and polymorphous exanthema. You |\ |\ |\ |\ |\
correctly diagnose the girl with : |\ |\ |\ |\ |\ |\
, a. Rheumatic fever
|\ |\ |\
b. Kawasaki disease
|\ |\ |\
c. Lyme disease
|\ |\
d. Infective endocarditis - CORRECT ANSWERS ✔✔*b.
|\ |\ |\ |\ |\ |\ |\
Kawasaki disease |\ |\
Rationale: The diagnostic criteria for Kawasaki disease
|\ |\ |\ |\ |\ |\ |\
are fever that lasts for greater than 5 days and at least 4
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
of the following other manifestations: (1) cervical
|\ |\ |\ |\ |\ |\ |\
lymphadenopathy, usually unilateral and great than or |\ |\ |\ |\ |\ |\ |\
equal to 1.5 cm in diameter, (2) extremity changes
|\ |\ |\ |\ |\ |\ |\ |\ |\
(redness and swelling of the hands and feet with
|\ |\ |\ |\ |\ |\ |\ |\ |\
subsequent desquamation), (3) polymorphous |\ |\ |\ |\
exanthema, (4) oral cavity or lip changes, (such as |\ |\ |\ |\ |\ |\ |\ |\ |\
strawberry tongues, fissuring and cracking, and |\ |\ |\ |\ |\ |\
inflammation of the oral mucosa), and (5) painless, |\ |\ |\ |\ |\ |\ |\ |\
bilateral, non-exudative conjunctivitis. Rheumatic fever
|\ |\ |\ |\ |\
consists of 2 major criteria such as carditis, erythema
|\ |\ |\ |\ |\ |\ |\ |\ |\
marginatum, Sydenham chorea, or polyarthritis, or 1 |\ |\ |\ |\ |\ |\ |\
major criteria and 1 minor criteria, such as polyarthalgia,
|\ |\ |\ |\ |\ |\ |\ |\ |\
fever, and previous rheumatic heart disease or fever, plus
|\ |\ |\ |\ |\ |\ |\ |\
evidence to support streptococcal infection. Infective
|\ |\ |\ |\ |\ |\ |\
endocarditis often presents with weight loss, malaise, and |\ |\ |\ |\ |\ |\ |\
fever. (Darst, Collins, & Miyamoto, 2014, p. 628). Lyme
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
disease may develop after a tick bite, and is
|\ |\ |\ |\ |\ |\ |\ |\ |\
