CMN 577 Final Exam Questions and Answers Latest Updated Graded A+

CMN 577 Final Exam Questions and Answers Latest Updated Graded A+. 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: Ans- 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 CMN 577 Final Exam Questions and Answers Latest (100% Correct) 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: Ans- 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: Ans- 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: Ans- 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: Ans- 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? Ans- 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? Ans- 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. 10. All of the following can help reduce the risk of adolescents developing STIs except: Ans- a monogamous sexual relationship with one partner B. the use of a condom C. abstinence D. birth control Abstinence, a monogamous sexual relationship with one partner, and proper condom use has shown to reduce the risk of adolescents developing sexually transmitted infections. On the other hand, birth control only helps to prevent pregnancy and does not offer any protection against STIs. 11. A 57-year-old female comes into the clinic with complaints of hot flashes and vaginal dryness. She is a smoker and has hypertension. When giving her hormone replacement options, the NP informs her best option is: Ans- Oral estrogen B. Oral estrogen with progesterone C. Estradiol injections D. Transdermal estrogen* Transdermal or vaginal estrogen avoids the risks of deep vein thrombosis and ischemic strokes. 12. When evaluating a patient with intermittent claudication, the Nurse Practitioner would expect to find all the following except: Ans- Diminished femoral pulses B. An ankle-brachial index of 1.0 * C. Reproducible pain in the calf muscles when walking D. An ankle-brachial index of 0.8 Intermittent claudication is pain that occurs because of insufficient blood flow during times of increased demand, such as exercise. The pain is relieved with rest and is reproducible when the patient begins to walk again. Femoral pulses are usually absent or very weak and the ankle-brachial index is below 0.9. 13. A 17-year-old sexually active female presents to the clinic with complaints of vaginal pruritis, dysuria, and a thick, greenish, malodorous discharge. After further testing, it is confirmed that she is positive for Trichomoniasis. Which of the following treatment options would the NP choose for this patient? Ans- Ceftriaxone, 250 mg IM x 1 and Azithromycin, 1 g orally as a single dose B. Metronidazole, 2 g orally as single dose* C. Azithromycin, 1 g orally as single dose D. Benzathine penicillin G, 2.4 million units IM Of all the following option choices, Metronidazole, 2 g orally as a single dose is the only correct treatment for Trichomoniasis. An alternative treatment choice is Metronidazole, 500 mg orally twice a day for 7 days, but that is not an answer choice. 14. A woman presents to the clinic at 12 weeks gestation. She has a history of preeclampsia with a previous pregnancy. The NP should consider prescribing which of the following? Ans- low salt diet B. vitamin C C. hydrochlorothiazide D. low dose aspirin * Rationale: ACOG recommends considering starting aspiring at 81 mg between 12-28 wks gestation for women at increased risk of preeclampsia (hx of preeclampsia, multifetal pregnancy chronic HTN, DM, kidney disease, or autoimmune disorders). Sodium restriction, vitamin supplement, and diuretic have not been found to be effective. 15. Jane is 26 weeks pregnant. Her 50-g one-hour oral glucose tolerance test results at 164 mg/dL. What is the NP's next step? Ans- start Jane on metformin B. start Jane on insulin C. order a 100-g oral glucose tolerance test * D. inform Jane that her results are normal Rationale: According to the ACOG, a 100-g three-hour glucose tolerance test should be ordered to diagnosis gestation diabetes for those with a result of >= 140 mg/dL on their 50-g one-hour glucose tolerance test between 24-28 wks gestation. 16. A 50-year-old white male presents to the clinic for a recheck of his recent acute attack of Gouty Arthritis. He explains that the gouty attacks occur as a painful, red, and swollen right great toe. He states this has happened several times this year. He was treated for the acute attack, but he is interested in having a medication to take every day to keep this from happening so much. PMH for this patient includes moderate kidney disease. Which is the best way to prescribe Colchicine for this patient? AnsColchicine 1.2mg po x 1, then 0.6mg po BID. B. Colchicine 1.2mg po q day. C. Colchicine 0.6mg po QOD. D. Colchicine 0.6mg po BID. Colchicine is cleared through the kidneys. Patients with moderate chronic kidney disease should take Colchicine once a day or once every other day to be sure to avoid complications from peripheral neuromyopathy or developing colchicine toxicity. 17. A 40-year-old woman presents to the clinic for complaints of her hands waking her up at night feeling numb with aching pain. You diagnose her with Carpal Tunnel Syndrome. All of the following are conditions do you commonly see with Carpal Tunnel Syndrome except which one? Ans- Pregnancy B. Diabetes Mellitus C. Rheumatoid Arthritis D. Lupus Commonly seen conditions that present with Carpal Tunnel Syndrome are pregnancy, Diabetes Mellitus, and Rheumatoid Arthritis. 18. Substance abuse is common in adolescents, what common comorbid condition is seen in adolescents that suffer from substance abuse? Ans- Bipolar disorder** B. Down syndrome C. Turner's Syndrome D. Epilepsy Rationale: Adolescents who suffer from ADHD, bipolar, depression, and anxiety are more associated with substance abuse. 19. You have an adolescent in your office who suffers from bulimia nervosa, mother states therapy did not help and wants to know if there is a medicine that can be prescribed to help the patient stop the cycle. What medication would you anticipate to start for the patient? Ans- (Alprazolam) Xanax B. (AmphetamineDextroamphetamine) Adderall C. (Fluoxetine) Prozac ** D. Multivitamin Fluoxetine 60mgday has been proven to break the bingepurge cycle. If Prozac is not tolerated another SSRI can be tried. 20. A 32-year-old female comes into clinic with fatigue and dyspnea on exertion. She reports heavy menstrual cycles. She craves and loves to eat ice chips. What abnormal lab values would you find on this patient diagnosed with iron deficiency anemia? AnsSerum ferritin level 9ng/mL * B. Hemoglobin 14g/dL C. Serum ferritin level 50ng/mL D. Mean corpuscular volume (MCV): 86fL Ferritin value less than 12ng/mL is a high reliable indicator of reduced iron stores. A ferritin level less than 30ng/mL almost always indicates iron deficiency in anyone who is anemic. 21. A patient presents to the office with a complaint of knee pain. They report an inability to go downstairs, swelling and tenderness along the medial aspect of the knee. The nurse practitioner would perform which of the following maneuvers to assist with confirming an anterior cruciate ligament injury? Ans- Posterior Drawer Test B. McMurray Test C. Lachman Test *** D. Valgus Stress Test Lachman and Anterior Drawer Tests are utilized to identify ligament laxity and are associated with a high sensitivity and specificity for ACL injury. McMurray Test is used for meniscal injury, posterior drawer test for posterior ligament injury, and the valgus stress test for collateral ligament injury to identify laxity in the MCL. 22. A 6-year-old male with no recent history of illness presents to the office with a chief complaint of persistent hip pain, limping, and limited motion of the affected extremity. The provider should suspect which of the following conditions? Ans- Unstable Slipped Capital Femoral Epiphysis B. Avascular Necrosis of the Proximal Femur *** C. Osgood-Schlatter Disease D. Transient Synovitis of the Hip (A) Unstable SCFE would present with a patient in sudden, severe pain and completely non-weightbearing in the affected leg. It is most commonly seen in obese, adolescent males. (B) ***Also known as Legg-Calve-Perthes Disease; most commonly presents in children 4-8 years of age. Persistent pain is the most common symptom with a limp or limited range of motion in the joint. (C) Most common in boys between ages of 12-15 due to recurrent traction on the tibial tubercle. (D) Presents with anterior knee pain, swelling, and pain. Transient Synovitis is the most common cause of limping and hip pain in children between the ages of 3-10, however it is most preceded by an upper respiratory or gastrointestinal infection. 24. A nurse practitioner is reviewing the completed laboratory results for a child suspicious for juvenile idiopathic arthritis (JIA). Which of the following results would support this diagnosis? Ans- Elevated ESR, Elevated CRP *** B. Low ESR, Normal CRP C. Normal ESR, Elevated CRP D. Normal ESR, Low CRP Rationale: A normal ESR does not rule out JIA, however, most patients with this diagnosis demonstrate an elevated ESR, CRP, WBC, and platelet count. RF may be positive in some patients, anti-CCP may be detectable prior to RF in some patients. 24. The NP is prescribing a patient a medication for pharmacologic prophylaxis of VTE. Which medication requires routine monitoring? Ans- Warfarin* B. Apixaban C. Enoxaparin D. Aspirin Once the INR has reached the therapeutic range, it should be checked every 6 weeks or more often if needed. The Warfarin dose should then be adjusted according to the INR result and warfarin adjustment guidelines. 25. A member of the high school wrestling team has just been diagnosed with a methicillin-resistant Staphylococcus aureus (MRSA) skin infection by his primary care provider. Per his provider's recommendations, he may return to wrestling practice when: Ans- he may participate at any time if the lesion is covered B. After at least 24 hours of treatment with appropriate antibiotics C. After 30 days if no new infection occurs D. If no new lesions occur for 48 hours, no moist or draining lesions, and on appropriate antibiotic treatment for at least 72 hours. * Athletes are at high risk of MRSA skin infections through skin to skin contact. Clinical symptoms are localized skin infection or soft tissue abscess. To reduce transmission, he/she must be on antibiotic therapy for at least 72 hours, no new lesions that could indicate worsening infection, and no drainage. 26. An evaluation of a patient with an anterior cruciate ligament (ACL) injury would include: Ans- Lachman test* B. Drawer test C. Spurling test D. McMurray The Lachman test provides the most accurate information about knee stability in relation to the ACL. The Drawer test is used to evaluate posterior cruciate ligament injuries. The Spurling test is used to evaluate nerve root pain in the cervical spine. The McMurray test is used to evaluate meniscus tears in the knee. 27. A 23-year-old male patient presents to the clinic with complaints of pain and swelling to his left knee. Medical history reveals a weekend outdoor camping trip two weeks prior and the patient admits to dysuria. Physical exam results include temperature 100.8, bilateral conjunctivitis, mouth ulcers, and fluid to the left knee without warmth or erythema. When considering the diagnosis of Reactive Arthritis what else should the Nurse Practitioner inquire about? Ans- Contaminated drinking water B. Type of fish consumption C. Sexually transmitted diseases** D. Cut or lacerations from a camping trip Reactive arthritis most commonly occurs in young men and usually follows a gastrointestinal illness such as dysentery or sexually transmitted disease. He presents with classic symptoms: fever, ulcers, conjunctivitis, and asymmetric oligoarthritis of weight bearing joint. No gastrointestinal complaints were mentioned, patient should be screened for gonorrhea and chlamydia. 28. Mr. Smith is a 78-year-old male that presents to your office with complaints of intermittent, non-significant abdominal pain and fatigue. He mentions that he has just lost his wife. The FNP recognizes these complaints may indicate: Ans- anxiety b. constipation c. gastroesophageal reflux disease (GERD) d. depression ** The patient did not report symptoms of anxiety. Although the abdominal pain may be related to constipation, the fatigue is not relative to constipation. GERD would be described as burning pain and likely associated with meals and bedtime, fatigue would not be a symptom of GERD. The geriatric patient population will often present with somatic symptoms, such as abdominal pain, and fatigue rather than depression ** 29. A 58-year-old male patient presents to the clinic at 1015 with complaints of right facial drooping, and right arm weakness that started around 0800. This patient has hx of obesity, hyperlipidemia, and uncontrolled diabetes. The NP is concerned about a CV Ans- What immediate action must be completed by the NP? A. Obtain a CBC and CMP in the clinic. B. Refer to Neurologist. C. Order a carotid US and echocardiogram. D. Send to ED immediately for STAT CT head without contrast and stroke evaluation.* Essentials of Diagnosis: sudden onset of neurological deficit of cerebrovascular origin. Risk factors are: HTN, DM, tobacco use, atrial fibrillation, or atherosclerosis. If a stroke is suspected, a Head CT without contrast should be performed immediately, before administering aspirin or other antithrombotic agents. IV thrombolytic therapy is effective up to 4.5 hours from stroke onset. 30. A post-menopausal woman is in the office with complaints of low libido. She is interested in starting hormone replacement therapy (HRT) to increase her libido. Which of the following statements would be correct teaching on the risks related to HRT in post-menopausal women? Ans- "There are no known risk factors to HRT in postmenopausal women. Therefore, it would be an appropriate therapy for you." B. "The risks of long-term HRT include heart attack, stroke, gallstones, breast cancer, and increased mortality. These risks are increased if you start HRT after menopause."* C. "The risks of long-term HRT include heart attack, stroke, gallstones, breast cancer, and increased mortality. These risks are reduced if HRT is started after menopause." D. "There are risks associated with HRT, but they are minimal; therefore, the benefits outweigh the risks." Double-blind randomized control trials have shown that the risks of long-term HRT include heart attack, stroke, gallstones, breast cancer, and increased mortality rates. There is a decreased risk for these occurring if the HRT was started in menopause. It is still generally considered not safe to maintain long-term HRT therapy as the risks do not outweigh the benefits. 31. A good clinician understands which of the following principles to be true about using diagnostic tests for diagnosis and management of disease? Ans- If a diagnostic test is positive, the patient definitely has the disease. B. If a diagnostic test is sensitive for a disease, it can correctly identify patients without the disease. C. If a diagnostic test is specific for a disease, it can correctly identify patients with the disease. D. If a diagnostic test is positive, sensitivity and specificity of the test should be considered along with the patient's clinical presentation.* Rationale: The usefulness of a diagnostic test should not be based solely on their predictive measures (sensitivity and specificity), but also the probability that the patient has the disease. The sensitivity of a test is the ability to correctly identify those with the disease. The specificity of a test is the ability to correctly identify those without the disease. 32. A 36-year-old female presents to your clinic with depression, ongoing fatigue, anterior neck tightness without pain, and weight gain. You palpate the thyroid notice goiter and a lumpy texture. There is a positive family history of thyroid problems; mother with hypothyroidism and T1DM. To work up the thyroid for this patient, what lab is specific to your potential diagnosis? Ans- TSH decreased B. T4 increased C. TPO elevation* D. ESR decreased In Hashimoto thyroiditis, antithyroperoxidase (TPO) antibodies will be elevated. TPO is initially checked for diagnosis and should not be routinely checked after initial diagnosis; TSH should be monitored routinely. This patient presents with hypothyroid symptoms thus we anticipate TSH to be increased and T4 to be decreased. ESR is elevated in subacute thyroiditis while antithyroid antibody titers are low. Suppurative thyroiditis both leukocyte count and ESR are usually elevated. Serum FT4 levels tend to be higher than t3 levels due to passive release of stored thyroid hormone, which is predominately T4. In autoimmune thyroiditis, the thyroid gland may be diffusely enlarged, firm, and finely nodular and they may complain of neck tightness, depression, and chronic fatigue. 33. A 9-year-old female patient presents to your clinic with her mother. She has a new onset malar rash to her face, two painless ulcers in her mouth, and is complaining of generalized joint pain. The nurse practitioner completes an assessment. Her NEXT step would be Ans- Order magic mouth rinse TID to help with pain when eating. B. Refer to Rheumatologist. C. Collect lab work consisting of a CBC, ESR, an ANA panel, and a UA. * D. treat her viral infection with supportive therapies. Systemic lupus erythematous (SLE) is an autoimmune disease. It usually presents in females ages 9-15. One must have 4/11 diagnostic criteria to be diagnosed. Common symptoms are fever, malaise, and joint pain. Others present with a malar rash (butterfly rash across cheeks), discoid rash, joint pain, + ANA, anemia, leukocytopenia, and thrombocytopenia. Once confirmation is made, a referral to a rheumatologist is warranted. 34. A 70-year-old male patient is newly diagnosed with Alzheimer disease; the NP would educate the patient and family on all of the following except: Ans- Alzheimer disease is the most common age-related neurodegenerative disease B. The incidence of Alzheimer disease doubles every 5 years after age 60 C. Short-term memory impairment is early and prominent in most cases of Alzheimer disease D. Familial cases result from mutations in genes for tau, progranulin, or others in Alzheimer disease* Familial cases result from mutations in genes for tau, progranulin, or others occurs in Frontotemporal dementia