Download Urinary Incontinence, Interstitial Cystitis, UTIs, and Prostatitis: NR601 Exam Study Guide and more Exams Advanced Education in PDF only on Docsity!
NR601 FINAL EXAM STUDY SET WITH COMPLETE
SOLUTIONS!!
What is the initial workup for UI in men? - ANSWER>>Complete PMH PE (DRE, prostate eval) UA PSA if new onset UI
What is the initial workup for UI in women? - ANSWER>>Complete PMH PE (Pelvic: perineal/vag exam to eval estrogen status, pelvic prolapse, fistula) UA Cough test
When do you refer male pt to urology? - ANSWER>>h/o pelvic surgery/radiation/pain Severe UI Severe lower urinary tract symptoms Recurrent urologic infections Abnormal prostate exam Elevated PSA
What symptoms should you be alert to with new onset and underlying new onset urinary symptoms? - ANSWER>>UI Hematuria Pelvic pain Abd mass
Dysuria Proteinuria Glucosuria CVA tenderness Nodular prostate Any neuro symptoms
What are treatment goals for UI? - ANSWER>>Individualized Similar for men and women Reduce urgency symptoms Reduce frequency Reduce nocturia Reduce UI episodes Improve QOL Increase social activities Reduce leakage volume Increase dryness Use less protection Avoid leakage during certain activities Increase independence in UI management Decrease caregiver burden
What are first-line management guidelines for UI? - ANSWER>>Behavioral therapy (bladder training, prompted/timed voiding, Kegels, pelvic floor training) Lifestyle modification Wt loss Eliminate bladder irritants: Smoking, ETOH, sodas, coffee, acidic/spicy foods
What is MOA for beta-3 adrenergic agonists? - ANSWER>>Stimulates beta- adrenergic receptors, which relaxes bladder smooth muscle
What is 2nd line management for UI in males? - ANSWER>>Alpha-1 blockers (doxazosin, terazosin, tamsulosin, alfuzosin, silodosin)
What are common SE of alpha-1 blockers? - ANSWER>>Dizziness (doxazosin, terazosin, tamsulosin, alfuzosin) Dyspnea (doxazosin) Edema (doxazosin) Fatigue (doxazosin) Somnolence (doxazosin) Postural hypotension (terazosin) Asthenia (terazosin, tamsulosin) Abnormal ejaculation (tamsulosin) Back pain (tamsulosin) Increased cough (tamsulosin) URI (alfuzosin) Retrograde ejaculation (silodosin)
What is the main MOA of alpha-1 blockers? - ANSWER>>Prostatic smooth muscle relaxation
Definition of interstitial cystitis - ANSWER>>Chronic bladder inflammation syndrome Pelvic pain and irritative voiding symptoms Pathology unknown Related to autoimmune, allergic, or infection etiology Dx of exclusion Mostly women
Age of presentation for interstitial cystitis - ANSWER>>30-
Symptoms of interstitial cystitis - ANSWER>>Voiding small amounts Uncomfortable constant urge to void May worsen the week of menstruation
What are some diff dx's for interstitial cystitis? - ANSWER>>UTI Prostatitis Cystitis Vaginitis Endometriosis Neuropathic bladder dysfunction Neoplasm Overactive bladder
What are some diagnostic tests for interstitial cystitis? - ANSWER>>UA Urine cx Potassium sensitivity test Cystoscopy
What is the treatment goal for interstitial cystitis? - ANSWER>>Symptom management
What should be avoided in interstitial cystitis? - ANSWER>>Acidic food Caffeine ETOH Artificial sweeteners
Constipation Diaphragm use Meatal stenosis Bowel incontinence
What are the most common abx for UTI? - ANSWER>>Bactrim Fluoroquinolone (no pregnant women!)
What are abx alternatives for UTI in pregnancy? - ANSWER>>Sulfisoxazole Cephalosporins
How long are uncomplicated female UTIs treated for? - ANSWER>>3 days
Who should receive 7-10 day abx for UTI? - ANSWER>>Men Children Elderly DM Women w/pyelo Pregnancy
How is a relapsing UTI treated? - ANSWER>>Usually occurs within 3wks of first infection Treated similarly to 1st infection, but 2wks of abx
When do you prescribe prophylactic abx for UTI? - ANSWER>>Women w/2 or more symptomatic UTIs w/in 6mo or 3 or more in 1yr
How is urethritis in men treated? - ANSWER>>7 days of doxy or 1 day of azithromycin
What else should be tested for if a man has urethritis? - ANSWER>>Gonorrhea
What are contributing factors of UTI in men? - ANSWER>>Residual urine due to prostatic enlargement Naturopathic bladder Calculi Prostatitis Cath Instrumentation Meatal stenosis
What is pyuria? - ANSWER>>10 WBCs per high power
What are some common dipstick results in UTI? - ANSWER>>Leukocyte esterase: positive (WBCs present) Nitrates: positive Protein: pos Blood: pos
What is the definition of acute bacterial prostatitis? - ANSWER>>Inflammation, infection of prostate, usually by E. coli or other gram-neg
What are some common physical findings in acute bacterial prostatitis? - ANSWER>>Fever Bladder distention Edematous/warm/tender prostate (can be firm or boggy)
Is nonbacterial prostatitis more common in younger or older males? -
Type Different types of sexual dysfunction? - ANSWER>>Interest Arousal Orgasm Pain
Increases Risk factors to acquire ED - ANSWER>>CVD DM obesity Passive personality
Types Forms of elder abuse: - ANSWER>>physical emotional Sexual neglect financial abandonmen Self -neglect
Risk factor For elder abuse are: - ANSWER>>Age Sex Ethnicity, Culture/ beliefs Status of one mind Residency Social loneliness, emotional isolate
What are some physical signs of elder abuse? - ANSWER>>Bruises
Slap marks Unexplained burns Fractures Increased home accidents
What are some signs of neglect or abandonment? - ANSWER>>Lack of hygiene Failure to meet medical needs
What is the provider's responsibility in elder abuse? - ANSWER>>Physical exam Diagnostic tests Reporting
What is the goal of palliative care? - ANSWER>>To prevent and relieve suffering and support the best QOL, regardless of dz stage or need for other therapies and can be concurrent with other life-prolonging therapies.
What are the differences between palliative care and hospice? ANSWER>>Palliative: to relieve pain and improve quality of life. Used early in dz process. Interdisciplinary care. Provides care for entire dz process, from dx to death, including bereavement services.
Hospice: for the last 6mo of life. Uses palliative care principles to support pt AND family. Includes bereavement services. Covered by Medicare/caid, most private insurances. Interdisciplinary care. Medical services/supplies. Drugs.
What are the 5 leading COD in elderly? - ANSWER>>Heart dz Malignant neoplasms Chronic resp dz Cerebrovascular dz Accidents
Chronic home O2 use. Out of hospital cardiac arrest. Limited social support.
What are some pain assessment tools? - ANSWER>>Visual Analogue Scale Numerical Analogue Scale Wong-Baker FACES Pain Assessment in Advanced Dementia scale
What are the different types of pain? - ANSWER>>Somatic Visceral Neuropathic
What provides a framework for pharmacological interventions for pain? - ANSWER>>The WHO Step Ladder
What is the first step on the WHO Step Ladder for pain? - ANSWER>>NSAIDs and acetaminophen for mild pain
What is step 2 on the WHO Step Ladder for pain? - ANSWER>>Opioids added, usually w/APAP, for moderate-to-severe pain w/functional impairment and/or decreased QOL.
What is step 3 on the WHO Step Ladder for pain? - ANSWER>>Opioid pain meds, sometimes around the clock, for severe pain.
What are some common SE in opioid administration? - ANSWER>>Constipation Nausea Sedation Respiratory depression
What can be added to any step of the WHO Step Ladder for pain? - ANSWER>>Adjuvant meds such as: -Tricyclic antidepressants -Nortriptyline -Desipramine -Duloxetine -Gabapentin -Pregabalin -Lidocaine 5% patch -Capsaicin cream -Corticosteroids -Calcitonin -Baclofen
What are some nonpharm approaches to pain management? - ANSWER>>Relaxation Mindfulness Distraction Imagery Prayer Cognitive reframing Heat/cold application Repositioning Massage Acupuncture
What are some sequelae with unrelieved pain? ANSWERFunctional impairment
What are the stages of grief? - ANSWER>>Notification and shock Experiencing loss emotionally and cognitively Reintegration
What are the tasks of grieving? - ANSWER>>Acknowledge the reality of death SHARE in process of working through pain of grief REORGANIZE family system RESTRUCTURE relationship w/the deceased REINVEST in other relationships and life pursuits
A - ANSWER>>You are reviewing a pt chart before the exam. You note that the pt is using topical capsaicin. You know that topical capsaicin is often used for tx of:
a. Diabetic neuropathy b. Stress reduction c. All answers are appropriate d. Depression
Symptoms of depression distinct to elderly include:
a. Loss of pleasure in usual activities b. Lack of emotions c. Flat affect d. Appetite/wt disturbances - ANSWER>>B
55yo female presents with somatic complaints. You suspect anxiety. You know that somatic symptoms of anxiety include:
a. All answers are appropriate b. Palpitations, CP, tachycardia c. Fatigue, insomnia, diaphoresis d. Diarrhea, nausea, vomiting - ANSWER>>A
KK, 53yo male, presents w/concerns about low energy, lack of joy. You assess him using SIG-E-CAPS. You know the C stands for:
a. Catatonia b. Concentration c. Cognition d. Control - ANSWER>>B
Pt presents w/neuropathic pain. You know the most effective meds include:
a. Opioids & tramadol b. Gabapentin c. Tramadol d. Topical lidocaine e. Opioids f. Gabapentin and topical lidocaine - ANSWER>>F
Justification for ordering CBC, TSH, serum B12 for a pt you suspect may have clinical depression is:
a. Overlapping symptoms w/anemia, thyroid dysfunction, nutritional deficiencies b. Rule out vascular dz c. Differentiate between depression and anxiety
a. Glaucoma b. Headache c. Ejaculatory dysfunction d. HTN - ANSWER>>C
Pt is prescribed metformin (Glucophage). Three days later, he c/o nausea and stomach cramping. How should you respond?
a. D/C med immediately b. Reassure pt that this is anticipated side effect c. Double the dosage and have pt return in 1 wk d. Order chem 7 to check for lactic acidosis - ANSWER>>B
The ADA guidelines stated which of the following as appropriate screening tests for T2DM?
a. Fasting plasma glucose b. 2-hour OGTT c. HgbA1C d. All of the above - ANSWER>>D
Which dx should be considered in a pt presenting with erectile dysfunction?
a. HTN b. DM c. Atherosclerosis d. All of the above - ANSWER>>D
Which would be an appropriate tx for pt with minimal symptoms of BPH?
a. Watchful waiting b. Refer to urology for surgery c. Prescribe trial of tamsulosin d. Recommend cranberry supplements - ANSWER>>A
Lifestyle approaches to postmenopausal symptom management include:
a. Avoid sugar, caffeine, chocolate, ETOH b. Sleeping > 8hrs per night c. Decreasing levels of physical activity d. > 1000 iu/day of Vit E - ANSWER>>A
59yo female c/o pain when she urinates. She has been seen three times for this in the last 3mo. Each time, dx'd with UTI, given abx. She followed instructions carefully, but has no relief of symptoms. Last UA: WBC: 2- RBC: 0- Epithelial cells: few Nitrite: neg Leuk: neg
Which should be done next?
a. Perform pelvic exam b. Reassure the pt that she has asymptomatic bacteriuria and does not need abx
