CMN 577 FINAL EXAM 220+ QUESTIONS AND
VERIFIED CORRECT ANSWERS LATEST
UPDATE 2024 VERSION ALREADY GRADED A+
- A 62-year-old female presents to your clinic with new onset of muscle weakness,
muscle cramps, and increased fatigue. The patient states that she also has increased urinary output since she has been prescribed Lasix (furosemide) for a recent diagnosis of CHF. What is the best clinical diagnosis for this patient according to her medical
history? - CORRECT ANSWER: Hyponatremia
- Hyperkalemia
- Hypocalcemia
- Hypokalemia*
Rationale: Hypokalemia is a common side effect of loop diuretics (i.e. Lasix). Signs and symptoms of mild to moderate hypokalemia include fatigue, muscle cramps and weakness.
- A 72-year-old female complains of shortness of breath, nonproductive cough, weight
- R sided heart failure
- L sided heart failure*
- Atrial Fibrillation
gain in the last 2 weeks, and dyspnea with exertion. On auscultation, you hear fine crackles and no wheezes. She most likely has: - CORRECT ANSWER: Chronic Bronchitis
Rationale: The most common symptoms of Left heart failure are shortness of breath, dyspnea with exertion, and nonproductive cough. Crackles represent fluid collection in the alveoli. Fluid retention causes rapid weight gain. Symptoms of R sided heart failure include edema, ascites, hepatic congestion, decreased appetite and nausea.
- 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 ANSWER: an 80-year-old woman who weighs 42 kg
- a 22-year-old man who had an appendectomy 2 days ago
- a 32-year-old woman with peptic ulcer disease
- 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.
- Jan, a 52-year-old female smoker, presents to your clinic for her annual wellness
exam. As the practitioner, you discuss the risks associated with tobacco use. Jan states she has considering quitting, however she needs some form of nicotine cessation. After discussing several options with Jan, she agrees to try the Nicotine patch. Which type of 1 / 4
health promotion and disease prevention is this an example of? - CORRECT ANSWER: Secondary prevention
- Primary prevention*
- Tertiary prevention
- Smoking Cessation
Rationale: Primary prevention helps reduce the risk of disease. By initiating a cessation plan, the clinician is aiding in preventing further diseases caused from cigarette smoking such as cardiovascular disease, Strokes, COPD, and cancer. Cigarette Smoking is still one of the highest factors related to death and morbidities in the United States. It is essential that tobacco use be discussed and documented at every visit. Data reports patients are more likely to try cessation if their provider advises them to quit. It is important to set goals that ate achievable such as a quit date.
- The nurse practitioner is examining a 65-year-old man with a history of type 2
- large ulcerations at the medial ankles*
- bruits over the femoral arteries
- an ABI of 0.6
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 ANSWER: weak or absent dorsalis pedis pulses
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.
- Which of the following signs of pregnancy are typically present at 12 weeks
- breast tenderness and fetal heart tone on doppler
- fetal heart tone on doppler and Chadwick's sign (cyanosis of vagina and cervix)*
- quickening (perception of fetal movement) abd Chadwick's sign
gestation? - CORRECT ANSWER: Goodell's sign (cervical softening) and palpation of the uterine fundus at the umbilicus
Rationale: Goodell's sign, Chadwick's sign, palpation of the uterine fundus, and fetal heart tone are all signs of pregnancy; however, the fundus is not palpable at the umbilicus until 20-22 weeks gestation. Quickening, which usually occurs around 18 weeks, and breast tenderness are considered symptoms of pregnancy, not signs.
- 43-year-old female presents with complaints of weight gain, constipation, memory
- Start her on Synthroid at 1.6mcg/kg/day and recheck labs in 4-6 weeks.*
- Instruct her to take her Synthroid on a full stomach for best absorption.
- Start her on Synthroid at 0.8mcg/kg/day and recheck labs in 2 weeks. 2 / 4
fog, and fatigue. Her labs reveal a TSH of 6.7 and Free T4 of 5. Your plan for this patient includes: - CORRECT ANSWER: Her labs are within normal range, and no treatment is needed.
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.
- A 32-year-old primagravida comes to the office for her 38 week check-up. She has
protein in her urine, mild swelling in her ankles, a BP of 168/110, and a 'bad headache.' The nurse practitioner seeing the patient decides the best course of action is to? -
CORRECT ANSWER: start the patient on low-dose aspirin and labetalol to prevent
complications
- have the patient admitted to the hospital for close monitoring and management*
- schedule the patient for a cesarean section within the next 48 hrs
- explain to the patient that her signs and symptoms are common toward the end of
pregnancy and are not cause for concern Rationale: The patient has preeclampsia with severe features. Signs and symptoms of severe features may include headache, vision changes, BP greater than or equal to 160/110, thrombocytopenia, proteinuria, edema, epigastric pain, and elevated liver enzymes. The patient requires hospitalization for close monitoring of both mother and fetus, serial lab work, and eventually administration of magnesium sulfate and delivery.Though delivery is ultimately the only cure, preeclampsia, even with severe features, is not an indication for cesarean section. Low-dose aspirin may be started between 12-28 weeks gestation for those at increased risk for preeclampsia.
3. What is the treatment of choice for scabies? - CORRECT ANSWER: Bactrim DS
800/160 BID x 5 days
- Permethrin 5% topical applied overnight and then repeat in 7 days.*
- Fluconazole 400mg one-time dose.
- Warm compresses
Rationale-Permethrin 5% is the treatment of choice for scabies. It should be applied as a single overnight application and repeated in 7 days to patient and entire household.
- A 33-year-old male comes into your office with tender, localized, red swelling to his
upper eye lid for the past two days. What is the most likely causative organism for
hordeolum (stye)? - CORRECT ANSWER: Staphylococcus epidermidis
- Staphylococcus aureus *
- Gram-negative bacilli
- Streptococci
Rationale: Is an acute bacterial infection frequently caused by Staphylococcus aureus.
- A 52-year-old female who has been taking pravastatin 20 mg nightly for the past 6
months, comes into the clinic complaining of extreme fatigue, dark urine, and muscle pain for the past 3 weeks. Which of the following is the best treatment plan for the NP to
follow? - CORRECT ANSWER: Continue the pravastatin but at half the dose
- Recommend increasing fluid intake and rest. 3 / 4
- Discontinue the pravastatin and order a liver function panel *
- Switch to Simvastatin 40 mg nightly
Rationale: Side effects of statins include fatigue, elevated liver enzymes and muscle pain. When patients present with these symptoms, the drug should be discontinued, and liver enzymes should be checked to assess the effects on the liver. Simvastatin is associated with the highest risk of muscle injury and pain.
- Cigarette smoking may falsely increase the levels of: - CORRECT ANSWER:
- sodium and potassium concentrations
- hepatic enzymes*
- serum protein electrophoresis
gamma-glutamyl transpeptidase
Cigarette smoking may increase hepatic enzymes which in turn will reduce the levels of substances metabolized by the liver such as theophylline.
- A 3-year-old girl who is starting daycare this fall is at your clinic for her annual
checkup with her mother. Her mother states, "We have always kept up to date with her immunizations, what immunizations will she be getting today." As a nurse practitioner,
what is the most appropriate response? - CORRECT ANSWER: She does not need to
be vaccinated today because she is up to date
- We will be giving her a fifth dose of DTaP and Flu
- It is time for her to have her second doses of MMR and Varicella
- Since she is up to date, she will only be getting her Flu shot *
Rationale: Recommended immunization schedule for children ages 2-3 years is the
yearly influenza vaccination. The fifth dose of DTaP, second doses of MMR and VAR, and the fourth dose of IPV are administered between ages 4-6 years.
- A 45-year-old male patient comes to clinic after an episode of chest pain in his
substernal area that occurred while he was running. He says that the pain was relieved immediately when he stopped running. Which of the following should the NP
recommend to this patient? - CORRECT ANSWER: See a cardiologist for further
evaluation. *
- Take 600 mg ibuprofen every 6 hours as needed for pain.
- Begin an exercise program that includes walking instead of running.
- Consult a gastroenterologist to rule out gastroesophageal reflux disease.
Rationale: Because the chest pain was brought on by physical exertion and immediately relieved with rest, the pain is consistent with stable angina pectoris. The patient should see a cardiologist to rule out any potential cardiac problems and to ensure that physical exercise is safe.
- A 75-year-old female patient who is healthy and active reports that she has recently
- / 4
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