CMN 577 UNIT 5 QUESTIONS & VERIFIED ANSWERS
A 55 year-old male presents to the office with his wife for evaluation of the patient's left
arm tremors. The symptoms are increased when he gets upset. The wife has noticed
that the patient's movements are slowed, "It seems as if he's shuffling his feet when he
walks". The Nurse Practitioner knows these are signs of:
a. Huntington Disease
b. Parkinson's Disease
c. Dementia
d. Bell's Palsy - Answers - * b. Parkinson's Disease
Rationale: According to Papadakis and McPhee (2015), In Parkinson's Disease, tremor
is commonly confined to one limb and is exacerbated by emotional stress. The disease
is also manifested by slowed voluntary movements and gait is characterized by shuffling
steps. Page 988
A twenty-five year old college student presents to the outpatient clinic today with
complaints of a "bug in my ear." The FNP is able to visualize the insect with an
otoscope. The next best action is to:
a. Use a cotton tipped applicator to remove the insect.
b. Use an aqueous solution to irrigate the ear
c. Fill the ear with lidocaine prior to removing.
d. Apply heat to the ear to make the bug crawl out. - Answers - *c. Fill the ear with
lidocaine prior to removing.
Rationale: Lidocaine helps to immobilize insect for easier removal.
A 46 year old male presents to the office with complaints of the room "spinning", noting
that these symptoms last several seconds after he rolls over to get out of bed in the
mornings. He denies symptoms of the 'spinning' otherwise. Which of the following would
be the best initial treatment?
a. Prescribe steroid dose pack
b. Valsalva maneuver
c. Hall Pike
d. Epley Maneuver - Answers - *d. Epley Maneuver
Rationale: Benign Paroxysmal Positioning Vertigo (BPPV) is recognized by positional
changes, most often described as spinning or dizziness that occurs with head position
changes such as rolling over in bed. This is caused by loose, freely moving otoconia
located in the semicircular canal. Treatment includes the Epley maneuver which can
cause the otoliths to settle back into place.
,Source: (Lustig & Schindler, 2015) (page 211 in McPhee 2015)
A mom brings her 6 year old who is complaining with headache and sore throat for 2
days. Temperature on arrival is 102.1 F orally. Examination reveals tonsillar erythema
and edema and soft palate petechiae. What is your first best action?
a. Start Amoxicillin immediately
b. Perform rapid strep throat culture
c. Have patient gargle with warm salty water
d. Refer to ENT specialist - Answers - *b. Perform rapid strep throat culture
Rationale: None listed
Which of the following statements is true regarding the treatment of patients with HIV-
associated nephropathy?
a. A patient with ESRD, who is otherwise in good health, is a potential candidate for
renal transplant.
b. Calcium channel blockers are the best choice to control blood pressure
c. HAART has not been shown to slow progression in these patients
d. Serum blood values can be used for diagnosis - Answers - * a. A patient with ESRD,
who is otherwise in good health, is a potential candidate for renal transplant.
Rationale: In McPhee & Papadakis (2015), Watnick and Dirkx note several key points
for the treatment of patients with HIV-associated nephropathy. Kidney biopsy is needed
to locate a focal segment of glomerulosclerosis pattern of injury with glomerular
collapse. Studies have shown that HAART slows progression of disease. ACE inhibitors
and ARBs can be used to control blood pressure
and slow disease progression. Patients who progress to ESRD and are otherwise
healthy are good candidates for renal transplantation (Watnick & Dirkx, 2015).
A 65-year-old man has a 10-month history of dysphagia, noted primarily with solid
foods. The dysphagia has progressed and he has noted a 20 lb. weight loss over that
same period of time. His wife states he now eats very slowly and throws his shoulders
back when he swallows. Barium esophagography shows a "bird's beak" tapering of the
distal esophagus. The most likely diagnosis is:
a. Esophageal Cancer
b. Achalasia
c. Esophageal Stricture
d. Zencker's Diverticulum - Answers - * b. Achalasia
Rationale: Rationale: Achalasia is an idiopathic motility disorder in which peristalsis is
absent or diminished in the distal 2/3 of the esophagus. Incidence of the disorder
steadily increases with age. Most patients complain of dysphagia for solid foods, which
gradually includes liquids also. Symptoms are often present for months to years before
the patient seeks treatment. Patients with achalasia typically eat more slowly and use
, certain maneuvers, such as lifting the neck or throwing the shoulders back to increase
esophageal emptying. Weight loss is common. (McPhee & Papadakis, 2015, pp. 601-
602).
An 11-year-old female develops gross hematuria approximately 10 days after a sore
throat. Her blood pressure is 160/100 and she has 2+ pedal and pre-tibial edema.
Which of the following is the most likely diagnosis?
a. Post-streptococcal Glomerulonephritis
b. Hemolytic Uremic Syndrome
c. Minimal Change Disease
d. Urinary Tract Infection - Answers - *a. Post-streptococcal Glomerulonephritis
Rationale: Rationale: The post-streptococcal GN diagnosis is supported by a recent
history (usually 7-14 days prior) of a group A beta-hemolytic streptococcal infection of
the skin or throat. This infection causes acute kidney injury. The typical clinical
presentation includes gross hematuria, which may appear as coffee or tea-colored
urine, edema, and hypertension. (Hay, Levin, Deterding, & Abzug, 2014, pp. 757-758).
Mammogram screenings used to detect a disease process or identify a lesion is what
method of prevention?
a. Primary Prevention
b. Secondary Prevention
c. Tertiary Prevention
d. Quinary Prevention - Answers - *b. Secondary Prevention
Rationale: According to Pigone and Salazar (2015), the primary goal of screening is to
promote early detection of a disease, disease precursor, or disease process. A
screening tool utilized to detect breast cancer is a mammogram thus would be
recognized as a method of secondary prevention (p.2). It is secondary and not primary
because it is a tool used for screening, primary prevention aims to remove or reduce
risk factors.
A mother brings her infant into your clinic and states she needs her second Rotavirus
vaccine. What is the maximum age limit for administration for the first vaccination?
a. 17 weeks 6 days
b. 14 weeks 6 days
c. 6 weeks 2 days
d. Can be administered anytime - Answers - * b. 14 weeks 6 days
Rationale: According to Daley, O'Leary, and Nyquist (2014), the lack of safety data
around administering the initial dose of the rotavirus is the reason for the maximum age
for administration is 14w 6d.
A 55 year-old male presents to the office with his wife for evaluation of the patient's left
arm tremors. The symptoms are increased when he gets upset. The wife has noticed
that the patient's movements are slowed, "It seems as if he's shuffling his feet when he
walks". The Nurse Practitioner knows these are signs of:
a. Huntington Disease
b. Parkinson's Disease
c. Dementia
d. Bell's Palsy - Answers - * b. Parkinson's Disease
Rationale: According to Papadakis and McPhee (2015), In Parkinson's Disease, tremor
is commonly confined to one limb and is exacerbated by emotional stress. The disease
is also manifested by slowed voluntary movements and gait is characterized by shuffling
steps. Page 988
A twenty-five year old college student presents to the outpatient clinic today with
complaints of a "bug in my ear." The FNP is able to visualize the insect with an
otoscope. The next best action is to:
a. Use a cotton tipped applicator to remove the insect.
b. Use an aqueous solution to irrigate the ear
c. Fill the ear with lidocaine prior to removing.
d. Apply heat to the ear to make the bug crawl out. - Answers - *c. Fill the ear with
lidocaine prior to removing.
Rationale: Lidocaine helps to immobilize insect for easier removal.
A 46 year old male presents to the office with complaints of the room "spinning", noting
that these symptoms last several seconds after he rolls over to get out of bed in the
mornings. He denies symptoms of the 'spinning' otherwise. Which of the following would
be the best initial treatment?
a. Prescribe steroid dose pack
b. Valsalva maneuver
c. Hall Pike
d. Epley Maneuver - Answers - *d. Epley Maneuver
Rationale: Benign Paroxysmal Positioning Vertigo (BPPV) is recognized by positional
changes, most often described as spinning or dizziness that occurs with head position
changes such as rolling over in bed. This is caused by loose, freely moving otoconia
located in the semicircular canal. Treatment includes the Epley maneuver which can
cause the otoliths to settle back into place.
,Source: (Lustig & Schindler, 2015) (page 211 in McPhee 2015)
A mom brings her 6 year old who is complaining with headache and sore throat for 2
days. Temperature on arrival is 102.1 F orally. Examination reveals tonsillar erythema
and edema and soft palate petechiae. What is your first best action?
a. Start Amoxicillin immediately
b. Perform rapid strep throat culture
c. Have patient gargle with warm salty water
d. Refer to ENT specialist - Answers - *b. Perform rapid strep throat culture
Rationale: None listed
Which of the following statements is true regarding the treatment of patients with HIV-
associated nephropathy?
a. A patient with ESRD, who is otherwise in good health, is a potential candidate for
renal transplant.
b. Calcium channel blockers are the best choice to control blood pressure
c. HAART has not been shown to slow progression in these patients
d. Serum blood values can be used for diagnosis - Answers - * a. A patient with ESRD,
who is otherwise in good health, is a potential candidate for renal transplant.
Rationale: In McPhee & Papadakis (2015), Watnick and Dirkx note several key points
for the treatment of patients with HIV-associated nephropathy. Kidney biopsy is needed
to locate a focal segment of glomerulosclerosis pattern of injury with glomerular
collapse. Studies have shown that HAART slows progression of disease. ACE inhibitors
and ARBs can be used to control blood pressure
and slow disease progression. Patients who progress to ESRD and are otherwise
healthy are good candidates for renal transplantation (Watnick & Dirkx, 2015).
A 65-year-old man has a 10-month history of dysphagia, noted primarily with solid
foods. The dysphagia has progressed and he has noted a 20 lb. weight loss over that
same period of time. His wife states he now eats very slowly and throws his shoulders
back when he swallows. Barium esophagography shows a "bird's beak" tapering of the
distal esophagus. The most likely diagnosis is:
a. Esophageal Cancer
b. Achalasia
c. Esophageal Stricture
d. Zencker's Diverticulum - Answers - * b. Achalasia
Rationale: Rationale: Achalasia is an idiopathic motility disorder in which peristalsis is
absent or diminished in the distal 2/3 of the esophagus. Incidence of the disorder
steadily increases with age. Most patients complain of dysphagia for solid foods, which
gradually includes liquids also. Symptoms are often present for months to years before
the patient seeks treatment. Patients with achalasia typically eat more slowly and use
, certain maneuvers, such as lifting the neck or throwing the shoulders back to increase
esophageal emptying. Weight loss is common. (McPhee & Papadakis, 2015, pp. 601-
602).
An 11-year-old female develops gross hematuria approximately 10 days after a sore
throat. Her blood pressure is 160/100 and she has 2+ pedal and pre-tibial edema.
Which of the following is the most likely diagnosis?
a. Post-streptococcal Glomerulonephritis
b. Hemolytic Uremic Syndrome
c. Minimal Change Disease
d. Urinary Tract Infection - Answers - *a. Post-streptococcal Glomerulonephritis
Rationale: Rationale: The post-streptococcal GN diagnosis is supported by a recent
history (usually 7-14 days prior) of a group A beta-hemolytic streptococcal infection of
the skin or throat. This infection causes acute kidney injury. The typical clinical
presentation includes gross hematuria, which may appear as coffee or tea-colored
urine, edema, and hypertension. (Hay, Levin, Deterding, & Abzug, 2014, pp. 757-758).
Mammogram screenings used to detect a disease process or identify a lesion is what
method of prevention?
a. Primary Prevention
b. Secondary Prevention
c. Tertiary Prevention
d. Quinary Prevention - Answers - *b. Secondary Prevention
Rationale: According to Pigone and Salazar (2015), the primary goal of screening is to
promote early detection of a disease, disease precursor, or disease process. A
screening tool utilized to detect breast cancer is a mammogram thus would be
recognized as a method of secondary prevention (p.2). It is secondary and not primary
because it is a tool used for screening, primary prevention aims to remove or reduce
risk factors.
A mother brings her infant into your clinic and states she needs her second Rotavirus
vaccine. What is the maximum age limit for administration for the first vaccination?
a. 17 weeks 6 days
b. 14 weeks 6 days
c. 6 weeks 2 days
d. Can be administered anytime - Answers - * b. 14 weeks 6 days
Rationale: According to Daley, O'Leary, and Nyquist (2014), the lack of safety data
around administering the initial dose of the rotavirus is the reason for the maximum age
for administration is 14w 6d.
