CMN 577 Final 254-301
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. -
ANS-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 800
IU daily."
255. A 24-year-old pregnant female patient presents to urgent care today with right side
facial stiffness and eye drooping and states she has had a change in taste for one day.
She is alarmed she is having a stroke. All of the following could be included in your next
course of action except?
a.) Call EMS and have her transferred to a higher level of care, as she is having a
stroke.
b.) After CT head performed and negative, advise the patient that she is experiencing
Bells Palsy and prescribe a five-day course of corticosteroids.
c.) Order stat MRI of brain.
d.) Order lubricating eye drops in order to protect the eye. - ANS-Answer: a.)
Rationale: "Bell Palsy most common in pregnant women and in diabetics. Face is stiff
and pulled to side with a change in taste buds. Concern for stroke or other central lesion
if facial palsies occur bilaterally,
,256. A 6-year-old child weighing 18kg presents to clinic and has been diagnosed with
acute knee pain. As the FNP, which of the following analgesics are you least likely to
prescribe?
A-Tylenol 10-15mg/kg/dose q4-6h
B-Ibuprofen 4-10mg/kg/dose q6-8h
*C-Aspirin 10-15mg/kg q4-6h
D-Ketorolac 0.5mg/kg/dose/dose q6-8h - ANS-Answer C
Tylenol, Ibuprofen, and ketorolac are all NSAIDs used for the treatment of acute pain
with Tylenol being the most popular option for outpatient treatment. Aspirin should not
be considered for treatment due to its association with Reye's syndrome.
257. A pediatric patient is transitioning from palliative to end of life care. The family
wants to know the difference between palliative and end of life care. Which of the
following is a correct statement?
A- End of life care no longer focuses on quality of life
B- End of life care will focus on a cure and stabilization of the disease
C- End of life care does not treat pain because the patient can not feel anything
D- End of life care focuses less on a cure and more on providing comfort and dignity -
ANS-Answer D
the goals of palliative care will shift to end of life care when a cure or unreasonable cost
to a child's quality of life is determined. During end of life care, the focus is on quality of
life but more so dying with dignity and in comfort opposed to focusing on a
cure/treatment for the disease itself.
258. Which of the following would you order your patient as a first line treatment to help
with his Myasthenia Gravis symptoms?
a. Neostigmine
b. Thymectomy
c. Prednisone
d. Azathioprine - ANS-Answer A
Rationale: Anticholinesterase drugs provide symptomatic benefit without influencing the
course of the disease. Thymectomy should only be performed if a thymoma is present.
Sometimes this can be delayed for several years in the hope that spontaneous
remission will occur. Treatment with corticosteroids is indicated for patients who have
, responded poorly to anticholinesterase drugs. Treatment with azathioprine may be
effective in allowing a lower dose of corticosteroids.
259. The mother of a 12-year-old boy states that her son has been extremely secretive,
hyperalert, oversensitive, defensive, and suspicious. Which personality disorder do
these clinical findings represent?
a. Schizoid
b. Dependent
c. Avoidant
d. Paranoid - ANS-D
Rationale: Schizoid Personality Disorder is described as superstitious, socially isolated,
suspicious, eccentric behaviors, and odd speech. Dependent clinical findings are
passive, over accepting, unable to make decisions, lacks confidence, and has poor
self-esteem. Avoidant finding would be if the boy fears rejection, hyper reacts to
rejection and failure, has poor social endeavors and low self-esteem. The clinical
findings described in the question demonstrate Paranoid Personality Disorder.
260. Which of the following would you consider the first line treatment for lupus in your
pediatric patient?
a. Cyclophosphamide
b. Azathioprine
c. NSAIDs
d. Prednisone - ANS-D
Rationale: Prednisone is the mainstay of treatment and has significantly lowered the
mortality rate in SLE. If disease control is inadequate with prednisone, a steroid -sparing
agent, such as azathioprine and cyclophosphamide should be added. Pleuritic pain or
arthritis can often be managed with NSAID.
261. A 31-year-old woman comes to the clinic complaining of trouble sleeping and
focusing, as well as constant worry about getting various things done for her family. She
states that she has had an increase in headaches and upset stomach for the past 6
months, but diagnostic testing has been negative for any abnormalities. She denies
depressive symptoms, delusions, or hyper-reactivity. This patient most likely has:
A) Schizophrenia
B) Bipolar I
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. -
ANS-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 800
IU daily."
255. A 24-year-old pregnant female patient presents to urgent care today with right side
facial stiffness and eye drooping and states she has had a change in taste for one day.
She is alarmed she is having a stroke. All of the following could be included in your next
course of action except?
a.) Call EMS and have her transferred to a higher level of care, as she is having a
stroke.
b.) After CT head performed and negative, advise the patient that she is experiencing
Bells Palsy and prescribe a five-day course of corticosteroids.
c.) Order stat MRI of brain.
d.) Order lubricating eye drops in order to protect the eye. - ANS-Answer: a.)
Rationale: "Bell Palsy most common in pregnant women and in diabetics. Face is stiff
and pulled to side with a change in taste buds. Concern for stroke or other central lesion
if facial palsies occur bilaterally,
,256. A 6-year-old child weighing 18kg presents to clinic and has been diagnosed with
acute knee pain. As the FNP, which of the following analgesics are you least likely to
prescribe?
A-Tylenol 10-15mg/kg/dose q4-6h
B-Ibuprofen 4-10mg/kg/dose q6-8h
*C-Aspirin 10-15mg/kg q4-6h
D-Ketorolac 0.5mg/kg/dose/dose q6-8h - ANS-Answer C
Tylenol, Ibuprofen, and ketorolac are all NSAIDs used for the treatment of acute pain
with Tylenol being the most popular option for outpatient treatment. Aspirin should not
be considered for treatment due to its association with Reye's syndrome.
257. A pediatric patient is transitioning from palliative to end of life care. The family
wants to know the difference between palliative and end of life care. Which of the
following is a correct statement?
A- End of life care no longer focuses on quality of life
B- End of life care will focus on a cure and stabilization of the disease
C- End of life care does not treat pain because the patient can not feel anything
D- End of life care focuses less on a cure and more on providing comfort and dignity -
ANS-Answer D
the goals of palliative care will shift to end of life care when a cure or unreasonable cost
to a child's quality of life is determined. During end of life care, the focus is on quality of
life but more so dying with dignity and in comfort opposed to focusing on a
cure/treatment for the disease itself.
258. Which of the following would you order your patient as a first line treatment to help
with his Myasthenia Gravis symptoms?
a. Neostigmine
b. Thymectomy
c. Prednisone
d. Azathioprine - ANS-Answer A
Rationale: Anticholinesterase drugs provide symptomatic benefit without influencing the
course of the disease. Thymectomy should only be performed if a thymoma is present.
Sometimes this can be delayed for several years in the hope that spontaneous
remission will occur. Treatment with corticosteroids is indicated for patients who have
, responded poorly to anticholinesterase drugs. Treatment with azathioprine may be
effective in allowing a lower dose of corticosteroids.
259. The mother of a 12-year-old boy states that her son has been extremely secretive,
hyperalert, oversensitive, defensive, and suspicious. Which personality disorder do
these clinical findings represent?
a. Schizoid
b. Dependent
c. Avoidant
d. Paranoid - ANS-D
Rationale: Schizoid Personality Disorder is described as superstitious, socially isolated,
suspicious, eccentric behaviors, and odd speech. Dependent clinical findings are
passive, over accepting, unable to make decisions, lacks confidence, and has poor
self-esteem. Avoidant finding would be if the boy fears rejection, hyper reacts to
rejection and failure, has poor social endeavors and low self-esteem. The clinical
findings described in the question demonstrate Paranoid Personality Disorder.
260. Which of the following would you consider the first line treatment for lupus in your
pediatric patient?
a. Cyclophosphamide
b. Azathioprine
c. NSAIDs
d. Prednisone - ANS-D
Rationale: Prednisone is the mainstay of treatment and has significantly lowered the
mortality rate in SLE. If disease control is inadequate with prednisone, a steroid -sparing
agent, such as azathioprine and cyclophosphamide should be added. Pleuritic pain or
arthritis can often be managed with NSAID.
261. A 31-year-old woman comes to the clinic complaining of trouble sleeping and
focusing, as well as constant worry about getting various things done for her family. She
states that she has had an increase in headaches and upset stomach for the past 6
months, but diagnostic testing has been negative for any abnormalities. She denies
depressive symptoms, delusions, or hyper-reactivity. This patient most likely has:
A) Schizophrenia
B) Bipolar I
