CMN 577 Final Exan Study Guide Highlighted Answers Fall 2,Exam with 100% Correct Answers 2023

Unit 7 Questions 1. Knowing that treatment for deep vein thrombosis (DVT) involves administration of anticoagulants, which of the following patients can be safely treated for DVT in the outpatient setting? A. 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. Leavitt, A.D., & Minichiello, T. (2019). Disorders of Hemostasis, Thrombosis, & Antithrombotic Therapy. In M.A. Papadakis & S.J. McPhee (Eds.), Current medical diagnosis and treatment 2019 (pp. 577-588). New York: McGraw-Hill Education. 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: A. 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. Gasper, W.J., Rapp, J.H., & Johnson, M.D. (2019). Blood Vessel & Lymphatic Disorders. In M.A. Papadakis & S.J. McPhee (Eds.), Current medical diagnosis and treatment 2019 (pp. 483-501). New York: McGraw-Hill Education. 3. 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: A. 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. Fitzgerald, P.A. (2019). Endocrine Disorders. In M.A. Papadakis & S.J. Mcphee (Eds.), Current medical diagnosis and treatment 2019 (pp.). New York: McGraw-Hill Education. 4. Cigarette smoking may falsely increase the levels of: A. 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. Online: 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: A. 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. Harper, G. M., Johnston, C. B., & Landefeld, C. S. (2019). Geriatric Disorders. In M. A. Papadakis, & S. J. McPhee, Current Medical Diagnosis and Treatment (pp. 65-67). McGraw-Hill Education. 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: A. Tinel test B. Phalen test C. Spurling test D. Carpal compression test 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. Papadakis, M. A., McPhee, S. J. (2019). Sports medicine & outpatient orthopedics. In A. Luke, & C. B. Ma (Eds.), Current Medical Diagnosis and Treatment 2019 (p. 1704). New York: McGraw-Hill Education. 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: A. 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 pro