CMN 577 final exam questions Perfectly Answered
2024
1. Knowing that treatment for deep vein thrombosis (DVT) involves the administration of anticoagulants,
which of the following patients can be safely treated for DVT in the outpatient setting? -CORRECT ANS-
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.
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: -CORRECT ANS-
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.
3. 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: -CORRECT ANS-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.
4. Cigarette smoking may falsely increase the levels of: -CORRECT ANS-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.
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: -CORRECT ANS-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.
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:
-CORRECT ANS-Tinel test
B. Phalen test
C. Spurling test *
,D. Carpal compression test
Rationale: 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.
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: -CORRECT ANS-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.
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? -CORRECT ANS-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.
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? -CORRECT ANS-HPV vaccination series
, B. Papanicolaou (PAP) smear with HPV co-testing*
C. Chlamydia trachomatis and Neisseria gonorrheae 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 mul¬tiple 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 should receive the HPV vaccine series even if they never have been
or plan to be sexually active with men. HPV is transmitted sexually between lesbian or heterosexual
partners. The rate of HPV immunization among lesbians is significantly less than for heterosexual
women, which creates a health disparity that needs to be corrected. While she is due for a PAP smear,
the PAP with HPV co-testing is not recommended in women under the age of 30 years old.
10. All of the following can help reduce the risk of adolescents developing STIs except: -CORRECT ANS-a
monogamous sexual relationship with one partner
B. the use of a condom
C. abstinence
D. birth control
Abstinence, a monogamous sexual relationship with one partner, and proper condom use has shown to
reduce the risk of adolescents developing sexually transmitted infections. On the other hand, birth
control only helps to prevent pregnancy and does not offer any protection against STIs.
11. A 57-year-old female comes into the clinic with complaints of hot flashes and vaginal dryness. She is
a smoker and has hypertension. When giving her hormone replacement options, the NP informs her
best option is: -CORRECT ANS-Oral estrogen
B. Oral estrogen with progesterone
C. Estradiol injections
D. Transdermal estrogen*
Transdermal or vaginal estrogen avoids the risks of deep vein thrombosis and ischemic strokes.
2024
1. Knowing that treatment for deep vein thrombosis (DVT) involves the administration of anticoagulants,
which of the following patients can be safely treated for DVT in the outpatient setting? -CORRECT ANS-
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.
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: -CORRECT ANS-
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.
3. 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: -CORRECT ANS-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.
4. Cigarette smoking may falsely increase the levels of: -CORRECT ANS-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.
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: -CORRECT ANS-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.
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:
-CORRECT ANS-Tinel test
B. Phalen test
C. Spurling test *
,D. Carpal compression test
Rationale: 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.
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: -CORRECT ANS-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.
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? -CORRECT ANS-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.
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? -CORRECT ANS-HPV vaccination series
, B. Papanicolaou (PAP) smear with HPV co-testing*
C. Chlamydia trachomatis and Neisseria gonorrheae 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 mul¬tiple 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 should receive the HPV vaccine series even if they never have been
or plan to be sexually active with men. HPV is transmitted sexually between lesbian or heterosexual
partners. The rate of HPV immunization among lesbians is significantly less than for heterosexual
women, which creates a health disparity that needs to be corrected. While she is due for a PAP smear,
the PAP with HPV co-testing is not recommended in women under the age of 30 years old.
10. All of the following can help reduce the risk of adolescents developing STIs except: -CORRECT ANS-a
monogamous sexual relationship with one partner
B. the use of a condom
C. abstinence
D. birth control
Abstinence, a monogamous sexual relationship with one partner, and proper condom use has shown to
reduce the risk of adolescents developing sexually transmitted infections. On the other hand, birth
control only helps to prevent pregnancy and does not offer any protection against STIs.
11. A 57-year-old female comes into the clinic with complaints of hot flashes and vaginal dryness. She is
a smoker and has hypertension. When giving her hormone replacement options, the NP informs her
best option is: -CORRECT ANS-Oral estrogen
B. Oral estrogen with progesterone
C. Estradiol injections
D. Transdermal estrogen*
Transdermal or vaginal estrogen avoids the risks of deep vein thrombosis and ischemic strokes.
