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CNS-CP Sample Questions

1. A 9-month old girl has presented to the Eye/Ear/Nose/Throat (EENT) clinic with recurrent severe right ear pain and fever. On examination the right tympanic membrane is inflamed and bulging The CNS diagnoses acute otitis media and places the child on Amoxicillin until surgery can be scheduled. The child weighs 18 pounds. Standard dosing for otitis media is 80mg/kg/day. Using a BID schedule and dosage of 400 mg/5mL, what is the individual dose in mL?

A. 0.4 mL
B. 0.8 mL
C. 4.10 mL
D. 8.1 mL

Correct answer: C. 4.10 mL

Reference: www.epocrates.com

Rationale:

18 pounds/2.2= 8.18kg
8.18 (KG) x 80 (mg/kg/day) = 654.4
654.4/2= 327.2 mg/dose
X= 4.09 mL (may round up to 4.10 mL)

2. A 36 year-old female patient scheduled for a subtotal thyroidectomy presents with a TSH of 1.6 mU/L (SI units) and a total T4 of 20 mcg/dL. The differential diagnosis includes which of the following conditions?

A. Medullary thyroid cancer
B. Grave’s disease
C. Pituitary adenoma
D. Hashimoto’s disease

Correct answer: B. Grave’s disease 

References: McCance, K.L., & Huether, S.E. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby Elsevier, pp. 726-727. 

Pagana, K.D., & Pagana, T. J. (2013). Mosby’s diagnostic and laboratory test reference (12th ed.). St. Louis, MO: Elsevier Mosby, pp. 903,911. 

Rationale: The patient’s sex, age, and decreased TSH and elevated T4 levels are all indicative of Grave’s disease. Hashimoto’s disease and pituitary adenoma are both hypothyroid conditions, with elevated TSH and decreased total T4 levels. Thyroid cancers typically have normal T4 levels; of the four types, papillary accounts for the majority of thyroid cancers.

3. Based on the answer to #2 above, the CNS should consider the possibility which of the following intraoperative emergencies?

A. Thyroid storm
B. Myxedema coma
C. Malignant hyperthermia crisis
D. Pituitary infarct

Correct answer: A. Thyroid storm 

Reference: McCance, K.L., & Huether, S.E. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Loius, MO: Mosby Elsevier, pp. 728. 

Pagana, K.D., & Pagana, T. J. (2013). Mosby’s diagnostic and laboratory test reference (12th ed.). St. Louis, MO: Elsevier Mosby, p. 911. 

Rationale: Thyroid storm occurs most often in individuals with undertreated severe hyperthyroidism who are subjected to stress. A total T4 value greater than 20 mcg/dL is considered a critical value.

4. The CNS has been asked to assist in developing an orientation tool for perioperative staff based on Patricia Benner’s “Novice to Expert” model. The CNS recognizes that the novice nurse will benefit most from:

A. exposure to multiple unfamiliar situations.
B. applying context-free principles and theories to direct patient care.
C. caring for complex patients requiring a high level of technical expertise.
D. being asked to anticipate patient care needs and respond appropriately.

Correct answer: B. applying context-free principles and theories to clinical practice. 

Reference: Fulton, J.S., Lyon, B.L., & Goudreau, K.A. (2010). Clinical Nurse Specialist Practice. New York: Springer Publishing Co, pp. 117-118. 

Rationale: Since the novice nurse does not have the experience on which to base actions, he/she must rely on knowledge gained from other means. A competent nurse has the experience to anticipate a likely course of events in a familiar situation and respond appropriately.

5. A significant increase in surgical site infections has been noted in total knee arthroplasties. The organism cultured from wound drainage has been identified as Clostridium difficile (C. difficile). The CNS knows that the most effective way to prevent this type of infection is through:

A. increasing the number of alcohol-based hand washing stations in the department.
B. ensuring that prophylactic antibiotics are administered within 60 minutes of surgical intervention.
C. implementing airborne precautions for all patients admitted from long-term care facilities.
D. appropriate hand washing using antimicrobial soap and water.

Correct answer: D. appropriate hand washing using antimicrobial soap and water. 

Reference: Rothrock, J.C. (ed.). (2015). Alexander’s care of the patient in surgery (15th ed.). St. Louis, MO: Elsevier Mosby, p. 72. 

Rationale: C. difficile is a gram-positive organism found in the colon. It is transmitted through contact between individuals and contaminated objects. Alcohol-based hand rubs are ineffective in removing C. difficile from hands.