CMN 577 final exam questions WITH COMPLETE SOLUTIONS

CMN 577 final exam questions WITH
COMPLETE SOLUTIONS

1. |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 |