CMN 577 EXAM REVIEW 2026 COMPLETE
QUESTIONS AND ANSWERS
◉ 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:
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:
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:
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:
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:
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:
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
QUESTIONS AND ANSWERS
◉ 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:
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:
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:
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:
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:
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:
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
