CMN 577 Final Exan
Study Guide
Highlighted Answers
Fall 2020
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.1134-1137). 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: https://accessmedicine-mhmedical- com.libproxy.usouthal.edu/content.aspx?
bookid=2957§ionid=249389479#1175378669
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 providers who are
experienced in the selection, placement, and management of these devices.
Harper G, & Johnston C, & Landefeld C (2021). Overview: geriatric disorders. Papadakis M.A., & McPhee S.J., &
Rabow M.W.(Eds.), Current Medical Diagnosis & Treatment 2021. McGraw-Hill. https://accessmedicine-mhmedical-
com.libproxy.usouthal.edu/content.aspx?bookid=2957§ionid=249362728
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?
A. 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 (Papadakis & McPhee, 2019, p. 970-973).
Papadakis, M.A., McPhee, S.J. (2019). Urologic Disorders. In M.V., Wang, T.J., Walsh, & T.D.,
Chi (Eds.), Current medical diagnosis & treatment (58th ed., pp. 970 - 973). United States of America: McGraw-Hill
Education.
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?
A. HPV vaccination series
B. Papanicolaou (PAP) smear with HPV co-testing
C. Chlamydia trachomatis and Neisseria gonorrhea 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 multiple 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 especially those in the LGBTQ community due to these alarming
statistics. The primary prevention of cervical cancer is essential. All females between the ages of 12 and 26 years
Study Guide
Highlighted Answers
Fall 2020
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.1134-1137). 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: https://accessmedicine-mhmedical- com.libproxy.usouthal.edu/content.aspx?
bookid=2957§ionid=249389479#1175378669
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 providers who are
experienced in the selection, placement, and management of these devices.
Harper G, & Johnston C, & Landefeld C (2021). Overview: geriatric disorders. Papadakis M.A., & McPhee S.J., &
Rabow M.W.(Eds.), Current Medical Diagnosis & Treatment 2021. McGraw-Hill. https://accessmedicine-mhmedical-
com.libproxy.usouthal.edu/content.aspx?bookid=2957§ionid=249362728
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?
A. 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 (Papadakis & McPhee, 2019, p. 970-973).
Papadakis, M.A., McPhee, S.J. (2019). Urologic Disorders. In M.V., Wang, T.J., Walsh, & T.D.,
Chi (Eds.), Current medical diagnosis & treatment (58th ed., pp. 970 - 973). United States of America: McGraw-Hill
Education.
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?
A. HPV vaccination series
B. Papanicolaou (PAP) smear with HPV co-testing
C. Chlamydia trachomatis and Neisseria gonorrhea 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 multiple 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 especially those in the LGBTQ community due to these alarming
statistics. The primary prevention of cervical cancer is essential. All females between the ages of 12 and 26 years
