CMN 574 EXAM QUESTIONS AND 100%
CORRECT ANSWERS
A 26-week pregnant female patient has slowly risen to a high blood pressure over the
past 2 weeks. Her urine specimen is negative for protein. She reduced her sodium
intake and started a walking program. Today, her blood pressure is 155/102, which her
home blood pressures confirm. Associated symptoms include a dull headache. The best
response of the nurse practitioner is:
a. "Try yoga and meditation to lower your blood pressure."
b. Start the patient on methyldopa 250 mg po bid.
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 bid.-Answer *b. Start the patient on
methyldopa 250 mg po bid.
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. Antihypertensive treatment
is indicated in pregnant women if the maintained blood pressure is above > 150/100 or
end-organ injury is evidenced, (Papadakis &McPhee, 2015, p. 801)
Resistance hypertension may be attributed to which of the following?
a. NSAIDs
b. Oral Contraceptives
c. Obesity
d. All of the above - Answer *d. All of the above
,Rationale: Resistant hypertension is defined 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 outlined in table 11-11 are nonadherence,
NSAIDs, oral contraceptives, adrenal steroids, licorice, obesity and excessive alcohol
intake. (Sutters, 2015, p.458-459).
Cholesterol medication that works by blocking the absorption of cholesterol by
preventing passage of cholesterol across the intestinal wall by inhibiting a cholesterol
transporter is ?
a. Statins
b. Fibric Acid
c. Ezetimibe
d. Bile Acid - Answer *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".
A 2-year-girl presents to your clinic with a history of fever that has lasted for 7 days,
cervical lymphadenopathy, edema, and desquamation of the extremities, bilateral
nonexudative conjunctivitis, and polymorphous exanthema. You correctly diagnose the
girl with:
a. Rheumatic fever
b. Kawasaki disease
c. Lyme disease
d. Infective endocarditis - Answer *b. Kawasaki disease
,Rationale: Diagnostic criteria for Kawasaki disease include fever > 5 days and at least 4
of the following additional manifestations: cervical lymphadenopathy, usually unilateral
and great than or equal to 1.5 cm in diameter; changes in the extremities such as
redness and swelling of the hands and feet with subsequent desquamation;
polymorphous exanthema; oral cavity or lip changes such as strawberry tongues,
fissuring and cracking, and inflammation of the oral mucosa; and finally, a condition
characterized by painless, bilateral and nonexudative conjunctivitis. The major criteria
for rheumatic fever are made up 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). The
complication of the tick bite is Lyme disease manifesting as erythema chronicum
migrans (Ogle & Anderson, 2014, p. 1350).
Moro Reflex:
a. Disappears at age 3 months.
b. Disappears at age 4 months
c. Disappears at age 8 months.
d. Disappears at age 12 months - Answer *a. Disappears at age 3 months.
Rationale: (pg 15) Moro (startle) reflex - hold the infant supine while supporting the
head. Allow head to drop 1-2 cm suddenly. Arms will abduct at shoulder and extend at
elbow with spreading of fingers. Adduction with flexion will follow. Develops by 28
weeks' gestation (incomplete) and disappears by age 3 months. The palmar grasp
disappears by age 4 months. The tonic neck reflex disappears by age 8 months.
Rosenberg, A. A., & Grover, T. (2014). The newborn infant. In W. W. Hay Jr, M. J. Levin,
R. R. Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 15). San
Francisco, CA: McGraw Hill Education.
*P. 568 Seidel-infant supported in semisitting position, allow head and trunk to
dropback*
Signs of hypoglycemia in the newborn infant include all of the following *except:*
a. Lethargy
, b. Apnea
c. Poor feeding
d. Kernicterus
Answer *d. Kernicterus
Explanation: (pg 27) Signs of hypoglycemia in newborn infant may be nonspecific and
subtle: lethargy, poor feeding, irritability, tremors, jitteriness, apnea, seizures.
Rosenberg, A. A., & Grover, T. (2014). The newborn infant. In W. W. Hay Jr, M. J. Levin,
R. R. Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 27). San
Francisco, CA: McGraw Hill Education.
*Kernicterus is Chronic Bilirubin Encephalopathy-irreversible brain injury char. by
cerebral palsy and hearing impairment*
A 7 month old male child is in your office for his checkup. The nurse practitioner expects
the child to be able to do which of the following:
a. Stands alone.
b. Roll from back to stomach.
c. Uses thumb and index finger to pick up cheerio.
d. Points to named object. - Answer *b. Roll from back to stomach.
Rationale: (pg 85) A & C - Standing alone 9-11 months. D - 24 mos.
Goldson, E., & Reynolds, A. (2014). Child development & behavior. In W. W. Hay Jr, M. J.
Levin, R. R. Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 85).
San Francisco, CA: McGraw Hill Education.
Mom brings her 6-year-old son in for episodic visit stating he has started having bowel
movements at least two times a week in his underwear at school for about 9 weeks. She
states he says it hurts when he has a bowel movement at home. You suspect which of
the following:
CORRECT ANSWERS
A 26-week pregnant female patient has slowly risen to a high blood pressure over the
past 2 weeks. Her urine specimen is negative for protein. She reduced her sodium
intake and started a walking program. Today, her blood pressure is 155/102, which her
home blood pressures confirm. Associated symptoms include a dull headache. The best
response of the nurse practitioner is:
a. "Try yoga and meditation to lower your blood pressure."
b. Start the patient on methyldopa 250 mg po bid.
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 bid.-Answer *b. Start the patient on
methyldopa 250 mg po bid.
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. Antihypertensive treatment
is indicated in pregnant women if the maintained blood pressure is above > 150/100 or
end-organ injury is evidenced, (Papadakis &McPhee, 2015, p. 801)
Resistance hypertension may be attributed to which of the following?
a. NSAIDs
b. Oral Contraceptives
c. Obesity
d. All of the above - Answer *d. All of the above
,Rationale: Resistant hypertension is defined 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 outlined in table 11-11 are nonadherence,
NSAIDs, oral contraceptives, adrenal steroids, licorice, obesity and excessive alcohol
intake. (Sutters, 2015, p.458-459).
Cholesterol medication that works by blocking the absorption of cholesterol by
preventing passage of cholesterol across the intestinal wall by inhibiting a cholesterol
transporter is ?
a. Statins
b. Fibric Acid
c. Ezetimibe
d. Bile Acid - Answer *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".
A 2-year-girl presents to your clinic with a history of fever that has lasted for 7 days,
cervical lymphadenopathy, edema, and desquamation of the extremities, bilateral
nonexudative conjunctivitis, and polymorphous exanthema. You correctly diagnose the
girl with:
a. Rheumatic fever
b. Kawasaki disease
c. Lyme disease
d. Infective endocarditis - Answer *b. Kawasaki disease
,Rationale: Diagnostic criteria for Kawasaki disease include fever > 5 days and at least 4
of the following additional manifestations: cervical lymphadenopathy, usually unilateral
and great than or equal to 1.5 cm in diameter; changes in the extremities such as
redness and swelling of the hands and feet with subsequent desquamation;
polymorphous exanthema; oral cavity or lip changes such as strawberry tongues,
fissuring and cracking, and inflammation of the oral mucosa; and finally, a condition
characterized by painless, bilateral and nonexudative conjunctivitis. The major criteria
for rheumatic fever are made up 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). The
complication of the tick bite is Lyme disease manifesting as erythema chronicum
migrans (Ogle & Anderson, 2014, p. 1350).
Moro Reflex:
a. Disappears at age 3 months.
b. Disappears at age 4 months
c. Disappears at age 8 months.
d. Disappears at age 12 months - Answer *a. Disappears at age 3 months.
Rationale: (pg 15) Moro (startle) reflex - hold the infant supine while supporting the
head. Allow head to drop 1-2 cm suddenly. Arms will abduct at shoulder and extend at
elbow with spreading of fingers. Adduction with flexion will follow. Develops by 28
weeks' gestation (incomplete) and disappears by age 3 months. The palmar grasp
disappears by age 4 months. The tonic neck reflex disappears by age 8 months.
Rosenberg, A. A., & Grover, T. (2014). The newborn infant. In W. W. Hay Jr, M. J. Levin,
R. R. Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 15). San
Francisco, CA: McGraw Hill Education.
*P. 568 Seidel-infant supported in semisitting position, allow head and trunk to
dropback*
Signs of hypoglycemia in the newborn infant include all of the following *except:*
a. Lethargy
, b. Apnea
c. Poor feeding
d. Kernicterus
Answer *d. Kernicterus
Explanation: (pg 27) Signs of hypoglycemia in newborn infant may be nonspecific and
subtle: lethargy, poor feeding, irritability, tremors, jitteriness, apnea, seizures.
Rosenberg, A. A., & Grover, T. (2014). The newborn infant. In W. W. Hay Jr, M. J. Levin,
R. R. Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 27). San
Francisco, CA: McGraw Hill Education.
*Kernicterus is Chronic Bilirubin Encephalopathy-irreversible brain injury char. by
cerebral palsy and hearing impairment*
A 7 month old male child is in your office for his checkup. The nurse practitioner expects
the child to be able to do which of the following:
a. Stands alone.
b. Roll from back to stomach.
c. Uses thumb and index finger to pick up cheerio.
d. Points to named object. - Answer *b. Roll from back to stomach.
Rationale: (pg 85) A & C - Standing alone 9-11 months. D - 24 mos.
Goldson, E., & Reynolds, A. (2014). Child development & behavior. In W. W. Hay Jr, M. J.
Levin, R. R. Deterding, & M. J. Abzug, Current diagnosis & treatment (22nd ed., p. 85).
San Francisco, CA: McGraw Hill Education.
Mom brings her 6-year-old son in for episodic visit stating he has started having bowel
movements at least two times a week in his underwear at school for about 9 weeks. She
states he says it hurts when he has a bowel movement at home. You suspect which of
the following:
