CMN 577 Fall 2022 Final Exam Combined Sets (1-305) questions and answers with rationales

181. Lesbian women have increased risk factors for breast cancer. These include all except: a. Nulliparity b. Increased alcohol use c. Increased smoking rates d. Increased rates of HPV Correct Answer: d. Increased rates of HPV Rationale: Lesbians have increased risk factors that predispose them to breast cancer. These include nulliparity, obesity, alcohol use and smoking. HPV is a known cause of cervical cancer. HPV can be transmitted between lesbian or heterosexual partners and HPV immunization rates for lesbians are significantly lower than for heterosexual women, increasing the risk for cervical cancer (Papadakis & McPhee, 2018, pp. ). 58.A 6-month-old baby girl presents to your office for a well visit. She is up to date on all previously, required vaccinations. Which vaccinations do you anticipate ordering today? A.No vaccinations today. B.Influenza, PCV 13, Hepatitis B, and Hib. C.Hepatitis B, DTaP, Rotavirus, and Hib. D.Influenza, Hepatitis B, DTaP, Hib, Inactivated Polio, Rotavirus, and PCV 13. Correct Answer: Answer: D At 6 months of age, the CDC recommends: 3rd dose of Hepatitis B, 3rd dose of Diphtheria, tetanus, and acellular pertussis (DTaP), 3rd dose of RotaTeq (Rotavirus), 3rd dose of Haemophilus influenzae type b (Hib), 3rd dose of Inactivated Poliovirus, 3rd dose of Pneumococcal conjugate (PCV 13), and seasonal influenza (Daley, O'Leary, & Nyquist, 2018, pp. 248-251) 205. A 67-year-old woman comes to the clinic with complaints of vaginal bleeding. She states she hasn't had a period for almost 10 years now and is concerned. The NP suspects the patient most likely has endometrial cancer. Which of the following test is required for diagnosis? A. Pap smear B. Blood work C. Endometrial biopsy D. Abdominal CT Correct Answer: Answer: C Endometrial tissue biopsy is required to confirm the diagnosis of endometrial cancer. Pap smear is frequently negative due to lack of endometrial cells. Blood work and CT are not needed to confirm diagnosis. 1. A 56-year-old patient comes in for a routine well visit. He has a history of a previous stroke and Type 2 Diabetes. Which of the following orders would be appropriate for a patient with a previous stroke? A. Initiate statin therapy B. EEG C. Warfarin therapy with an INR goal of 2-3 D. MRI Correct Answer: A. Patients with a history of an ASCVD should be started on statin therapy regardless of current LDL. The question did not mention any other symptoms that would warrant additional diagnostics. Warfarin therapy is only indicated if indicated. AFIB would be the primary indication for anticoagulation after a stroke. 156. The NP sees a 7-year-old female in the office whose mother says she had an episode of hematuria earlier in the day. She also states she notices her daughter's eyes are "puffy". The only history she reports is strep throat 10 days ago and she completed antibiotic therapy. The NP might suspect: a. Postinfectious Glomerulonephritis b. UTI c. Polycystic Kidney Disease d. Hemolytic-uremic Syndrome Correct Answer: a. Postinfectious Glomerulonephritis 107. A 23-year-old premenopausal women presents to the office concerned about a milky discharge from various areas around the areola of her breast. Patient's breast exam is negative. She has no other complaints and only takes a combination oral contraceptive. Which of the following options would not be appropriate, during initial evaluation? A. Stop the combination oral contraceptive pill, use a different form of abstinence. Follow- up in three months to see if the discharge has stopped. B. Order an ultrasonography, follow- up in 3 months. C. Refer to oncologist because a milky discharge is a sign of breast cancer. D. Order a prolactin level, follow-up in 3 months. Correct Answer: C Answer choices (A), (B), and (D) are all appropriate diagnostic strategies to evaluate the milky discharge. If the patient had a bloody discharge or other symptoms related to possible cancer then the initial step to continue evaluation would be to refer to specialist. 254. George is a 73year-old man seen in clinic today for his annual wellness exam. He ambulates with a cane and lives alone. He also has reported having to get up frequently at night to urinate and has some dribbling with urination. We know that falls and mobility issues are a common complication of aging. All of the following can be included in his plan of care except: a) Encourage regular exercise and/or physical therapy. b) Start Vitamin D 800IU daily. c) Start Flomax (Tamsulosin) for current BPH symptoms and refer to Urology. d) Recommend routine eye exams to detect and treat cataracts to help prevent falls. Correct Answer: Answer: c.) Rationale: "Emphasis is placed on treating all contributory medical conditions (ex. Cataracts), minimizing environmental hazards, and eliminating medications where the harms may outweigh the benefits—particularly those that induce orthostasis and parkinsonism (alpha-blockers, nitrates, antipsychotics). Table 4-4 also states: To consider for all patients: Exercise or physical therapy, Vitamin D supplementation of 8