CMN 577 ACTUAL EXAM PAPER 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ periorbital cellulitis treatment:.
Answer: Usually Related to Sinusits:- Bacterial pathogens = S. pneumoniae,
NTHI, S. aureus, GABHS- 1st Line Therapy = Amoxicillin/Clavulanic acid-
Duration = 7-10 daysSecondary to trauma:- Bacterial pathogens = S. aureus,
GABHS- 1st Line Therapy = Cephalexin - Duration = 10-21
daysEMERGENCY - CONSULT/REFER
◍ S3 heart sound is....
Answer: "normal" in later pregnancy, children, and some young adults < age
35 to 40 years. S3 can also be a sign of heart failure (dyspnea, cough,
wheeze, rapid weight gain, edema, fatigue, exertional dyspnea).
◍ 2) Which of the following are characteristics of bulimia nervosa? a) below
average BMIb) sick or unwell appearancec) normal or above average BMId)
dieting or restricting food intake.
Answer: c) normal or above average BMI*Sigel (2016) describes the typical
BN patient as normal or above average weight with no physical appearance
of illness. This information is found on page 167. Dieting and restricting
food intake are more likely to be characteristics of anorexia nervosa.
◍ A 24 year-old patient complains of intermittent heartburn, which has
become worse since he started his new job. The discomfort is worse after
eating and at night, and is relieved by antacids. Your most likely diagnosis
is:a. diffuse esophageal spasmb. infectious esophagitisc. gastroesophageal
reflux diseased. carcinoma of the esophagus.
Answer: c. gastroesophageal reflux diseaseAANP
◍ A newly diagnosed middle-aged type 2 diabetic wants to start an exercise
program. All of the following statements are true except:A) If the patient is
, unable to eat due to illness, antidiabetic agents can be continued with
frequent glucose monitoringB) Strenuous exercise is contraindicated for
type 2 diabetics because of a higher risk of hypoglycemic episodesC)
Exercise increases the body's ability to metabolize glucoseD) Patients who
exercise vigorously in the afternoon may have hypoglycemic episodes in the
evening or at night if they do not eat.
Answer: B) Strenuous exercise is contraindicated for type 2 diabetics
because of a higher risk of hypoglycemic episodesExercise is recommended
because exercise helpsto use the glucose stores and reduce blood sugar.
Blood sugar should be monitored closely, especially if on insulin, when
exercising to avoid hypoglycemia.
◍ First line treatment for gastroparesis.
Answer: Initial management of gastroparesis consists of dietary
modification, optimization of glycemic control and hydration, and in
patients with continued symptoms, pharmacologic therapy with prokinetic
and antiemetics. Dietary modification — Dietary modification is considered
first-line therapy in patients with mild gastroparesis. Patients with
gastroparesis should be advised by a dietician to consume small, frequent
meals four to five times a day that are low in fat and contain only soluble
fiber. Optimize glycemic control — Diabetes mellitus is a common cause of
delayed gastric emptying [11]. In patients with diabetes, incretin-based
therapies such as pramlintide (amylin analog) and GLP1 analogues or
agonists (eg, liraglutide, exenatide) should be avoided as they can delay
gastric emptying. In contrast, dipeptidyl peptidase IV inhibitors (eg,
vildagliptin, sitagliptin) do not affect gastric emptying. Prokinetics —
Metoclopramide — Metoclopramide is first-line therapy for gastroparesis
for no longer than 12 weeks unless patients have a therapeutic benefit that
outweighs the risks. The side effects associated with metoclopramide
include central side effects of anxiety, restlessness, and depression,
hyperprolactinemia, and QT interval prolongation. We initiate treatment
with a low-dose liquid formulation (eg, 5 mg, 15 minutes before meals and
at bedtime), titrating up to identify the lowest effective dose. Macrolide
, antibioticsErythromycin — Erythromycin, a motilin agonist, induces
high-amplitude gastric propulsive contractions that increase gastric
emptying [33,34]. Erythromycin also stimulates fundic contractility, or at
least inhibits the accommodation response of the proximal stomach after
food ingestion [35]. Patients who fail to respond to a trial of metoclopramide
should be treated with oral erythromycin (liquid formulation, 40 to 250 mg
three times daily before meals) (algorithm 1) [2].Oral erythromycin should
be administered for no longer than four weeks at a time, as the effect of
erythromycin decreases due to tachyphylaxis. Azithromycin —
Azithromycin has a longer half-life, and fewer gastrointestinal adverse
effects and drug interactions as compared with erythromycin. However,
azithromycin is a weak inhibitor of CYP3A4 and like erythromycin may
prolong cardiac repolarization and the QT interval, increasing the risk of
cardiac arrhythmias and torsade de pointes.
◍ The sentinel nodes (Virchow's nodes) are found at the:A) Right axillary
areaB) Left supraclavicular areaC) Posterior cervical chainD)
Submandibular chain.
Answer: B) Left supraclavicular areaThe sentinel nodes are found at the
supraclaviculararea of the chest. They are the first lymph nodes that a cancer
lesion will drain into. Therefore, when cancer is diagnosed, these nodes are
biopsied to see if the cancer has spread into the lymph system.
◍ Which religion states that after death, the body should not be touched for 3 -
8 hours?.
Answer: In the Culture Powerpoint it states that in Buddhism the body is not
to be touched for 3 to 8 hours after the person stops breathing because the
spirit is still there.
◍ A child presents to the clinic with warts on her fingers. The parent is asking
you, the FNP, how her child got warts. Your best response is:a. Warts are
spread by wet skin to skin contact.b. Warts are caused by the enterovirusc.
Warts are a bacterial infection that is very contagious.d. Warts are caused by
infection with the human papillomavirus (HPV).
, Answer: d. Warts are caused by infection with the human papillomavirus
(HPV)Warts are caused by the HPV virus. There are over 200 types of the
virus, and each type is associated with different wart types. Molluscum are
spread by wet skin to skin contact. Hand foot and mouth disease is caused
by enterovirus. Although warts are contagious, they are viral not bacterial.
◍ 2. A 46 year old female, presents to the clinic with complaints of muscle and
abdominal cramps, carpopedal spasms, tingling in her lips and hands, and
tetany. During your assessment, you confirm a positive Chvostek sign. You
know that a positive Chvostek sign is indicative of which abnormal
findings?a) Hypothyroidism, Hypercalcemiab) Hypocalcemia,
Hypoparathyroidismc) Hypercalcemia, Hyponatremiad) Hypocalcemia,
Hyperparathyroidism.
Answer: b) Hypocalcemia, HypoparathyroidismChvostek sign, which is
facial contraction upon tapping the facial nerve in front of the ear, is positive
in both hypocalcemia and hypoparathyroidism.
◍ 1) Which of the following laboratory tests are recommended for an adult
male with a podagra who is on furosemide (Lasix) 20 mg BID:1. CBC with
differential 2. Serum uric acid 3. Serum creatinine4. 24-hour urine for
protein and creatinine clearance.
Answer: 2. Serum uric acid
◍ 3) All of the following are correct statements about G6PD anemia except:1.
It is classified as a hemolytic anemia2. The intake of sulfa-containing drugs
should be avoided3. These patients are at higher risk of autoimmune
disorders4. Foods such as fava beans can precipitate hemolysis in these
patients..
Answer: 3. These patients are at higher risk of autoimmune disorders
◍ Which of the following drugs can increase the risk of bleeding in patients
who are on anticoagulation therapy with warfarin sodium (Coumadin)?A)
Trimethoprim/sulfamethoxazole (Bactrim DS)B) Carafate (Sucralfate)C)
Losartan (Cozaar)D) Furosemide (Lasix).
Answer: A) Trimethoprim/sulfamethoxazole (Bactrim DS)
QUESTIONS WITH ANSWERS GRADED A+
◍ periorbital cellulitis treatment:.
Answer: Usually Related to Sinusits:- Bacterial pathogens = S. pneumoniae,
NTHI, S. aureus, GABHS- 1st Line Therapy = Amoxicillin/Clavulanic acid-
Duration = 7-10 daysSecondary to trauma:- Bacterial pathogens = S. aureus,
GABHS- 1st Line Therapy = Cephalexin - Duration = 10-21
daysEMERGENCY - CONSULT/REFER
◍ S3 heart sound is....
Answer: "normal" in later pregnancy, children, and some young adults < age
35 to 40 years. S3 can also be a sign of heart failure (dyspnea, cough,
wheeze, rapid weight gain, edema, fatigue, exertional dyspnea).
◍ 2) Which of the following are characteristics of bulimia nervosa? a) below
average BMIb) sick or unwell appearancec) normal or above average BMId)
dieting or restricting food intake.
Answer: c) normal or above average BMI*Sigel (2016) describes the typical
BN patient as normal or above average weight with no physical appearance
of illness. This information is found on page 167. Dieting and restricting
food intake are more likely to be characteristics of anorexia nervosa.
◍ A 24 year-old patient complains of intermittent heartburn, which has
become worse since he started his new job. The discomfort is worse after
eating and at night, and is relieved by antacids. Your most likely diagnosis
is:a. diffuse esophageal spasmb. infectious esophagitisc. gastroesophageal
reflux diseased. carcinoma of the esophagus.
Answer: c. gastroesophageal reflux diseaseAANP
◍ A newly diagnosed middle-aged type 2 diabetic wants to start an exercise
program. All of the following statements are true except:A) If the patient is
, unable to eat due to illness, antidiabetic agents can be continued with
frequent glucose monitoringB) Strenuous exercise is contraindicated for
type 2 diabetics because of a higher risk of hypoglycemic episodesC)
Exercise increases the body's ability to metabolize glucoseD) Patients who
exercise vigorously in the afternoon may have hypoglycemic episodes in the
evening or at night if they do not eat.
Answer: B) Strenuous exercise is contraindicated for type 2 diabetics
because of a higher risk of hypoglycemic episodesExercise is recommended
because exercise helpsto use the glucose stores and reduce blood sugar.
Blood sugar should be monitored closely, especially if on insulin, when
exercising to avoid hypoglycemia.
◍ First line treatment for gastroparesis.
Answer: Initial management of gastroparesis consists of dietary
modification, optimization of glycemic control and hydration, and in
patients with continued symptoms, pharmacologic therapy with prokinetic
and antiemetics. Dietary modification — Dietary modification is considered
first-line therapy in patients with mild gastroparesis. Patients with
gastroparesis should be advised by a dietician to consume small, frequent
meals four to five times a day that are low in fat and contain only soluble
fiber. Optimize glycemic control — Diabetes mellitus is a common cause of
delayed gastric emptying [11]. In patients with diabetes, incretin-based
therapies such as pramlintide (amylin analog) and GLP1 analogues or
agonists (eg, liraglutide, exenatide) should be avoided as they can delay
gastric emptying. In contrast, dipeptidyl peptidase IV inhibitors (eg,
vildagliptin, sitagliptin) do not affect gastric emptying. Prokinetics —
Metoclopramide — Metoclopramide is first-line therapy for gastroparesis
for no longer than 12 weeks unless patients have a therapeutic benefit that
outweighs the risks. The side effects associated with metoclopramide
include central side effects of anxiety, restlessness, and depression,
hyperprolactinemia, and QT interval prolongation. We initiate treatment
with a low-dose liquid formulation (eg, 5 mg, 15 minutes before meals and
at bedtime), titrating up to identify the lowest effective dose. Macrolide
, antibioticsErythromycin — Erythromycin, a motilin agonist, induces
high-amplitude gastric propulsive contractions that increase gastric
emptying [33,34]. Erythromycin also stimulates fundic contractility, or at
least inhibits the accommodation response of the proximal stomach after
food ingestion [35]. Patients who fail to respond to a trial of metoclopramide
should be treated with oral erythromycin (liquid formulation, 40 to 250 mg
three times daily before meals) (algorithm 1) [2].Oral erythromycin should
be administered for no longer than four weeks at a time, as the effect of
erythromycin decreases due to tachyphylaxis. Azithromycin —
Azithromycin has a longer half-life, and fewer gastrointestinal adverse
effects and drug interactions as compared with erythromycin. However,
azithromycin is a weak inhibitor of CYP3A4 and like erythromycin may
prolong cardiac repolarization and the QT interval, increasing the risk of
cardiac arrhythmias and torsade de pointes.
◍ The sentinel nodes (Virchow's nodes) are found at the:A) Right axillary
areaB) Left supraclavicular areaC) Posterior cervical chainD)
Submandibular chain.
Answer: B) Left supraclavicular areaThe sentinel nodes are found at the
supraclaviculararea of the chest. They are the first lymph nodes that a cancer
lesion will drain into. Therefore, when cancer is diagnosed, these nodes are
biopsied to see if the cancer has spread into the lymph system.
◍ Which religion states that after death, the body should not be touched for 3 -
8 hours?.
Answer: In the Culture Powerpoint it states that in Buddhism the body is not
to be touched for 3 to 8 hours after the person stops breathing because the
spirit is still there.
◍ A child presents to the clinic with warts on her fingers. The parent is asking
you, the FNP, how her child got warts. Your best response is:a. Warts are
spread by wet skin to skin contact.b. Warts are caused by the enterovirusc.
Warts are a bacterial infection that is very contagious.d. Warts are caused by
infection with the human papillomavirus (HPV).
, Answer: d. Warts are caused by infection with the human papillomavirus
(HPV)Warts are caused by the HPV virus. There are over 200 types of the
virus, and each type is associated with different wart types. Molluscum are
spread by wet skin to skin contact. Hand foot and mouth disease is caused
by enterovirus. Although warts are contagious, they are viral not bacterial.
◍ 2. A 46 year old female, presents to the clinic with complaints of muscle and
abdominal cramps, carpopedal spasms, tingling in her lips and hands, and
tetany. During your assessment, you confirm a positive Chvostek sign. You
know that a positive Chvostek sign is indicative of which abnormal
findings?a) Hypothyroidism, Hypercalcemiab) Hypocalcemia,
Hypoparathyroidismc) Hypercalcemia, Hyponatremiad) Hypocalcemia,
Hyperparathyroidism.
Answer: b) Hypocalcemia, HypoparathyroidismChvostek sign, which is
facial contraction upon tapping the facial nerve in front of the ear, is positive
in both hypocalcemia and hypoparathyroidism.
◍ 1) Which of the following laboratory tests are recommended for an adult
male with a podagra who is on furosemide (Lasix) 20 mg BID:1. CBC with
differential 2. Serum uric acid 3. Serum creatinine4. 24-hour urine for
protein and creatinine clearance.
Answer: 2. Serum uric acid
◍ 3) All of the following are correct statements about G6PD anemia except:1.
It is classified as a hemolytic anemia2. The intake of sulfa-containing drugs
should be avoided3. These patients are at higher risk of autoimmune
disorders4. Foods such as fava beans can precipitate hemolysis in these
patients..
Answer: 3. These patients are at higher risk of autoimmune disorders
◍ Which of the following drugs can increase the risk of bleeding in patients
who are on anticoagulation therapy with warfarin sodium (Coumadin)?A)
Trimethoprim/sulfamethoxazole (Bactrim DS)B) Carafate (Sucralfate)C)
Losartan (Cozaar)D) Furosemide (Lasix).
Answer: A) Trimethoprim/sulfamethoxazole (Bactrim DS)
