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NURS 6531 FINAL EXAM SRING SUMMER
SESSION GENUINE EXAM (VERIFIED
ANSWERS) HIGHLY RECCOMMENDED
The daughter of an elderly confused patient reports that her parent is having urinary incontinence several times each day. What will the provider do initially? a. Obtain a urine sample for urinalysis (UA) and possible culture b. Order serum creatinine and blood urea nitrogen tests c. Perform a bladder scan to determine distention and retention d. Tell the daughter that this is expected given her mother's age and confusion - ANSWER>>>ANS: A When incontinence occurs, UA is performed initially to exclude hematuria, pyuria, glucosuria, or proteinuria and possible infection. Serum creatinine and BUN may be performed if renal disease is suspected. Bladder scans may be performed if the UA is normal to evaluate physiologic causes. It is not correct to offer reassurance without ruling out other causes. The provider is evaluating a patient for potential causes of urinary incontinence and performs a postvoid residual (PVR) test which yields 30 mL of urine. What is the interpretation of this result? a. The patient may have overflow incontinence. b. The patient probably has a urinary tract infection (UTI). c. This is a normal result. d. This represents incomplete emptying. - ANSWER>>>ANS: C A PVR less than 50 mL is considered normal and this result does not indicate any abnormality. The provider is counseling a patient who has stress incontinence about ways to minimize accidents. What will the provider suggest initially?
a. Increasing fluid intake to dilute the urine b. Referral to a physical therapist c. Taking pseudoephedrine daily d. Voiding every 2 hours during the day - ANSWER>>>ANS: D Timed voiding is useful to help minimize stress incontinence and is used initially. Increasing fluid intake will increase symptoms. PT referral may be done if other measures fail to help with exercises to strengthen the pelvic floor muscles. Pseudoephedrine is useful, but not an initial therapy. An older male patient reports urinary frequency, back pain, and nocturia. A dipstick urinalysis reveals hematuria. What will the provider do next to evaluate this condition? a. Order a PSA and perform a digital rectal exam (DRE) b. Refer for a biopsy c. Refer the patient to a urologist d. Schedule a transurethral ultrasound (TRUS) - ANSWER>>>ANS: A Patients with symptoms of potential prostate cancer should be screened with PSA and DRE. Referral to a urologist is the next step even with normal findings, since PSA is occasionally normal. The urologist may order TRUS or biopsy. An older male patient has a screening prostate-specific antigen (PSA) which is 12 ng/mL. What does this value indicate? a. A normal result b. Benign prostatic hypertrophy c. Early prostate cancer d. Prostate cancer - ANSWER>>>ANS: D A PSA greater than 10 ng/mL suggests prostate cancer. A level between 4 and 10 ng/mL may be early prostate cancer or a benign condition. A level less than 4 ng/mL is normal. A patient is diagnosed with prostate cancer and diagnostic testing reveals disease that has gone past the prostatic capsule without evidence of metastasis. The patient does not wish to undergo treatment. What will the provider tell this patient? a. Chemotherapy is indicated to provide cure for this cancer.
infection and renal function. A bladder scan is ordered at the discretion of the urologist. The prostate exam isn't consistent with prostate cancer, so PSA and bladder imaging are not necessary. Symptoms of prostatitis would indicate a need for evaluation of possible infection. A patient has been taking terazosin daily at bedtime to treat benign prostatic hyperplasia (BPH) and reports persistent daytime dizziness. What will the provider do? a. Prescribe finasteride instead of terazosin b. Recommend taking the medication in the morning c. Suggest using herbal preparations d. Switch the prescription to doxazosin - ANSWER>>>ANS: A Patients who cannot tolerate the side effect of alpha-adrenergic antagonists, the provider may initiate therapy with a 5a-reductase inhibitor such as finasteride. Terazosin should be given at bedtime to minimize these adverse effects. Herbal preparations have not been proven to be safe or effective. Doxazosin is in the same drug class as terazosin. A pregnant woman at 30 weeks gestation presents with proteinuria. What will the provider do next? a. Evaluate her blood pressure and discuss with OB/GYN b. Monitor serum glucose for gestational diabetes c. Perform a 24-hour urine collection d. Reassure her that this normal at this stage of pregnancy - ANSWER>>>ANS: A Proteinuria after 24 weeks gestation is usually a sign of preeclampsia, so her blood pressure should be evaluated and discussed with the OB/GYN. Serum glucose evaluation for gestational diabetes is performed as part of routine screening but is not related to the finding of proteinuria. A 24 - hour urine collection is not indicated. An older male patient reports gross hematuria but denies flank pain and fever. What will the provider do to manage this patient? a. Monitor blood pressure closely b. Obtain a urine culture
c. Perform a 24-hour urine collection d. Refer for cystoscopy and imaging - ANSWER>>>Gross hematuria in older men denotes a significant risk of malignant disease, so cystoscopy and imaging are indicated. Proteinuria is concerning for hypertension. The patient does not have flank pain or fever, so the likelihood of infection is lower. A 24-hour urine collection is not indicated. A female patient reports hematuria and a urine dipstick and culture indicate a urinary tract infection. After treatment for the urinary tract infection (UTI), what testing is indicated for this patient? a. 24-hour urine collection to evaluate for glomerulonephritis b. Bladder scan c. Repeat urinalysis d. Voiding cystourethrogram - ANSWER>>>ANS: C After treatment has been completed, repeated urinalysis is necessary to ensure that the hematuria has resolved. Failure to follow hematuria to resolution may result in failure to diagnose a serious condition. Which is a prerenal cause of acute kidney injury (AKI)? a. Hemorrhagic shock b. Hydronephrosis c. Hypertension d. Renal calculi - ANSWER>>>ANS: A Hemorrhagic shock interferes with perfusion of the kidney, which is a prerenal cause of AKI. Hydronephrosis and renal calculi are postrenal causes leading to obstruction to renal pelvis, ureters, bladder, or urethra. Hypertension is an intrinsic cause. A primary care provider sees a new patient who reports having a diagnosis of chronic kidney disease for several years. The patient is taking one medication for hypertension which has been prescribed since the diagnosis was made. The provider orders
A 50-year-old man reports having erectile dysfunction (ED). What is an important response by the provider when developing a plan of care for this patient? a. Considering testosterone hormone replacement therapy b. Evaluating the patient for cardiovascular disease c. Prescribing an oral phosphodiesterase type 5 inhibitor d. Referring the patient for psychotherapy and counseling - ANSWER>>>ANS: B Men under age 60 years with ED are at higher risk for cardiovascular disease, so this patient should be evaluated for this condition. Until the underlying cause is found, prescribing medications or hormones is not indicated. Psychotherapy and counseling are used when psychogenic ED is present. The provider prescribes the oral phosphodiesterase type 5 inhibitor sildenafil to treat erectile dysfunction (ED) in a 65-year-old male patient. What will be included when teaching this patient about taking this medication? (Select all that apply.) a. The medication is best taken on an empty stomach. b. The medication should be taken with a fatty food or meal. c. The medication's effects may last for 24 to 36 hours. d. This medication has a rapid onset and short duration of action. e. This medication may be taken once daily. - ANSWER>>>ANS: A, D Sildenafil has a rapid onset and short duration of action and should be taken on an empty stomach. Fatty foods may delay or interfere with absorption. This medication is given when sexual activity is desired and not once daily. A young adult male reports a dull pain in the right scrotum and the provider notes a bluish color showing through the skin on the affected side. Palpation reveals a bag of worms on the proximal spermatic cord. What is an important next step in managing this patient? a. Anti-infective therapy with ceftriaxone or doxycycline b. Consideration of underlying causes of this finding
c. Reassurance that this is benign and may resolve spontaneously d. Referral to an emergency department for surgical consultation - ANSWER>>>ANS: B This patient has symptoms of varicocele. Because varicocele is rare on the right side, the provider should look for underlying causes of these findings. Anti infective therapy is indicated for epididymitis. Varicocele requires surgical intervention or ablation to resolve. Testicular torsion is an emergency. An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention? a. Doppler ultrasound to assess testicular blood flow b. Immediate referral to the emergency department c. Prescribing anti-infective agents to treat the infection d. Transillumination to assess for "blue dot" sign - ANSWER>>>ANS: B This patient has symptoms of testicular torsion, which is a surgical emergency. An immediate referral is warranted. Doppler US and transillumination are useful in establishing a diagnosis, but the referral is the most important. Anti-infective agents are used if epididymitis is suspected. A 3-month-old male infant has edema and painless swelling of the scrotum. On physical examination, the provider can transilluminate the scrotum. What will the provider recommend? a. A Doppler ultrasound to evaluate the scrotal structures b. A short course of empirical antibiotic therapy c. Immediate referral to a genitourinary surgeon for repair d. Observation and reassurance that spontaneous resolution may occur - ANSWER>>>ANS: D This infant has symptoms of hydrocele; these disorders often resolve spontaneously during infancy and do not require treatment unless symptoms, such as pain, occur. It is not necessary to perform other studies or refer to a surgeon. Antibiotics are not indicated, since this is not infectious.
Excess antacids, obesity, and a history of gout are linked to renal stone risk. Tropical climates are also linked to renal stone development. Vitamin D excess is not a risk factor. A 30-year-old male patient has a positive leukocyte esterase and nitrites on a random urine dipstick during a well patient exam. What type of urinary tract infection does this represent? a. Complicated b. Isolation c. Uncomplicated d. Unresolved - ANSWER>>>ANS: A All urinary tract infections (UTIs) in males are considered complicated, because the infection source is not secondary to ascending infection. An asymptomatic pregnant woman has a positive leukocyte esterase and positive nitrites on a urine dipstick screening. What will the provider do next? a. Admit to the hospital b. Obtain a urine culture c. Order a renal ultrasound d. Prescribe trimethoprim-sulfamethoxazole (TMP-SMZ) - ANSWER>>>ANS: B Urine culture is the definitive test and should be obtained in all pregnant women. Admission to the hospital is usually not necessary. Renal ultrasound is used to identify abnormalities or obstructions that may be causing recurrent symptoms. TMP-SMZ is contraindicated in pregnant women. An asymptomatic female is concerned about having come into contact with sexually transmitted gonorrhea and asks about antibiotics. What will the provider recommend? a. Amoxicillin-clavulanate for 10 days b. Cultures and treatment if symptoms appear c. Empirical ceftriaxone and azithromycin
d. Trimethoprim-sulfamethoxazole - ANSWER>>>ANS: C Patients with gonorrhea usually have chlamydia as well, so treatment with both ceftriaxone and azithromycin is recommended. Amoxicillin-clavulanate and TMP-SMZ are used for urinary tract infections (UTIs). The patient should be treated empirically. Females are often asymptomatic. A patient is in the emergency department with confusion and fatigue and a corrected serum calcium concentration is 10.8 mg/dL. What is the initial treatment for this patient prior to admission to the inpatient unit? a. Administration of furosemide b. Correction of potassium and magnesium levels c. Parenteral salmon calcitonin d. Rapid administration of intravenous normal saline - ANSWER>>>ANS: D To help the kidneys excrete calcium, intravenous normal saline should be given initially. Furosemide may not be effective as once thought and is used less often today. Correction of other electrolytes may be done when these imbalances are assessed. Parenteral salmon calcitonin may be used later to enhance calcium losses. A patient experiences a carpal spasm when a blood pressure cuff is inflated. Which diagnostic testing will the provider consider evaluating to determine the cause of this finding? a. Calcitriol level b. C-reactive protein c. Magnesium and vitamin D d. Protein electrophoresis - ANSWER>>>ANS: C The Trousseau's sign indicates neuromuscular irritability, which occurs with hypocalcemia. Because hypomagnesemia and vitamin D deficiency may cause hypocalcemia, these should be evaluated to help determine a cause. Calcitriol levels are used to assess hypercalcemia. Inflammatory markers are not indicated. Protein electrophoresis is used in the evaluation of hypercalcemia.
a. A single infusion of hypertonic saline b. Addition of spironolactone c. Emergency volume repletion with 3% NaCl. d. Fluid and dietary sodium restriction - ANSWER>>>ANS: C This patient has hypovolemic hyponatremia with a sodium less than 120 mEq/L and requires fluid resuscitation with 3% NaCl. Diuretics and fluid restriction are part of treatment for hypervolemic hyponatremia. A patient has euvolemic hyponatremia secondary to chronic syndrome of inappropriate antidiuretic hormone (SIADH) and is hospitalized for fluid replacement. When preparing to discharge the patient home, what will be included in teaching? a. Limiting dietary protein intake b. Limiting fluids to 500 mL/day for several days c. Restriction of sodium intake d. The importance of adherence to vaptan therapy - ANSWER>>>ANS chronic hypovolemia secondary to SIADH require fluid restriction for Sodium and protein are not restricted. Vaptan therapy is started for t serum sodium fails to normalize in 24 to 48 hours. ith A patient has new-onset hypertension with a systolic blood pressure of 180 mm Hg. Which test will the provider order to diagnose this patient? a. ACTH suppression testing b. Adrenal antibody tests c. Cortisol excretion studies d. Fractionated metanephrine levels - ANSWER>>>ANS: D Patients with pheochromocytoma may present with new-onset hypertension with systolicpressure >170 mm Hg. Fractionated metanephrine will be elevated when the diagnosis is confirmed. ACTH suppression testing and cortisol excretion studies are performed to diagnose Cushing's syndrome. Adrenal antibody tests are performed as part of the evaluation for Addison's disease. : B Patients w several days. hose whose
A patient has rapid weight gain, amenorrhea without pregnancy, and mild hypertension. Once confirmatory tests are performed, what is a possible treatment for this patient? a. Antihypertensive therapy b. Mineralocorticoid replacement c. Oral hydrocortisone d. Pituitary tumor resection - ANSWER>>>ANS: D This patient has symptoms of Cushing's syndrome. When indicated, pituitary tumor resection is performed as the first choice. Antihypertensive therapy is initiated in patients with pheochromocytoma. Mineralocorticoids and glucocorticoids are given to patients with Addison's disease. A patient has unexplained weight loss and the provider notes increased skin pigmentation on light-exposed skin folds along with darkened palmar creases. Which laboratory tests will the provider order? (Select all that apply.) a. Serum ACTH b. Serum cortisol c. Serum electrolytes d. TB skin testing e. Urine cortisol - ANSWER>>>ANS: A, C, D This patient has symptoms of Addison's disease. Serum ACTH will be elevated in patients with Addison's disease. Hyponatremia and hyperkalemia may occur and are sometimes the initial finding. TB skin testing is done to exclude tuberculosis. Serum and urine cortisol levels are evaluated with Cushing's syndrome is suspected. An obese patient has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit? a. C-peptide level b. Hemoglobin A1C c. Random serum glucose d. Thyroid studies - ANSWER>>>ANS: B HbA1C, along with fasting plasma glucose or a 2 - hour plasma glucose during an oral glucose tolerance test (OGTT), is diagnostic of diabetes. This patient is probably not
A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known? a. Dipstick urinalysis for ketones b. Giving a rapid-acting carbohydrate c. Injection of rapid-acting insulin d. Performing a hemoglobin A1C - ANSWER>>>ANS: B This patient has signs of hypoglycemia, so a rapid-acting carbohydrate should be given once this is confirmed. Assessing for ketones is done if the patient is hyperglycemic, as is insulin administration. Hemoglobin A1C gives information about long-term and not immediate glucose control. An obese adolescent female patient reports irregular periods and excessive acne. The provider notes an increased amount of hair on her upper back, shoulders, and upper abdomen. What will the provider do, based on these findings? a. Consider treatment with oral contraceptive pills (OCPs) b. Counsel her about diet, exercise, and weight loss c. Recommend cosmetic laser hair removal d. Refer to an endocrinologist for evaluation - ANSWER>>>ANS: D All patients with suspected hirsutism should be referred to a specialist to determine the cause. OCPs, lifestyle changes, and cosmetic treatments may be part of the treatment, but the underlying causes must be determined first to ensure that a life-threatening condition is not present. A young adult woman is unable to conceive after trying to get pregnant for over 6 months. The woman reports having had irregular periods since the onset of menarche. The provider notes that the woman is overweight, has acanthosis nigricans, and an excess hair distribution. What does the provider suspect as the most likely primary cause of these symptoms? a. Congenital adrenal hyperplasia
b. Cushing's syndrome c. Polycystic ovary syndrome (PCOS) d. Type 2 diabetes - ANSWER>>>ANS: C PCOS is the most likely cause of oligo- or amenorrhea, so this is the most likely cause. The other conditions are possible, but less likely. A woman who has hirsutism with acne, and oligomenorrhea will most likely be treated with which medication to control these symptoms? a. Finasteride b. Levonorgestrel c. Norgestimate d. Spironolactone - ANSWER>>>ANS: C Norgestimate is a progestin with low androgenic activity and is used to suppress testosterone and control symptoms. Finasteride, which decreases the peripheral conversion of testosterone to dihydrotestosterone (DHT), is not approved for this use. Levonorgestrel is an androgenic oral contraceptive pill (OCP) and should be avoided. Spironolactone is a second-line medication approved for this purpose. A patient has a serum potassium level of 3 mEq/L and a normal blood pressure. Which test should be performed initially to assist with the differential diagnosis? a. Plasma aldosterone b. Plasma renin activity c. Serum bicarbonate d. Serum magnesium - ANSWER>>>ANS: D Hypomagnesemia often accompanies hypokalemia indicating the importance of also obtaining a serum magnesium level. Sodium bicarbonate is occasionally used in the treatment of hyperkalemia and is most effective when hyperkalemia is a result of metabolic acidosis. Plasma aldosterone and renin activity are assessed in patients with hypokalemia who are hypertensive. A patient with normal renal function has a potassium level of 6.0 mEq/L. Which underlying cause is possible in this patient? a. Adrenocortical deficiency
A patient with type 2 diabetes has a low-density lipoprotein (LDL) level of 110 gm/dL. What is recommended to manage this patient? a. Dietary and lifestyle changes to modify risk b. Initial treatment with a low intensity statin medication c. Prescription of a moderate or high intensity statin d. Statin therapy until the LDL level is below 75 mg/dL - ANSWER>>>ANS: C This patient is in one of the four groups of patients identified in current guidelines as one who would benefit from statin therapy because of type 2 diabetes. A moderate to high intensity statin should be prescribed. Statins will be used in conjunction with dietary and lifestyle changes, but these treatments alone do not reduce risk in this patient. Titration of statins is not recommended, and goal levels are no longer part of the protocol. A patient who is taking a statin drug to treat dyslipidemia has begun a diet and exercise program. The patient reports new onset of muscle pain several weeks after beginning therapy. What is the initial action by the provider? a. Discontinue the statin drug immediately b. Obtain a creatine kinase level c. Prescribe acetaminophen or ibuprofen d. Recommend reducing exercise intensity - ANSWER>>>ANS: B A potential serious side effect of statin drugs is drug-induced myopathy. Patients who report new-onset muscle pain should have creatine kinase levels evaluated. If this is elevated, the drug should be stopped, and renal function should be evaluated. It is not safe to assume that the muscle pain is related to the exercise until CK levels are determined. What is important about increased PAI- 1 levels in patients? a. They cause increased insulin resistance. b. They are associated with metabolic syndrome. c. They lower the risk of hypertension. d. They predispose patients to dyslipidemia. - ANSWER>>>ANS: B
Increased PAI- 1 levels increase the risk of atherothrombosis. They are correlated, but do not cause insulin resistance and do not affect the relative risk of hypertension or dyslipidemia. Which medication given for patients with metabolic syndrome is most likely to lower PAI- 1 levels? a. Aspirin b. Atorvastatin c. Metformin d. Niacinc - ANSWER>>>ANS: C Metformin is given not only to reduce hyperinsulinemia and lower insulin resistance, but also to lower plasma PAI-1 levels. Aspirin is given to reduce MI risk. Atorvastatin helps with dyslipidemia. Niacin may be given to lower triglycerides. Which findings are part of the diagnostic criteria for metabolic syndrome? (Select all that apply.) a. Decreased plasminogen activator inhibitor 1 levels b. Elevated waist circumference c. Fasting plasma glucose > 100 mg/dL d. HDL cholesterol > 45 mg/dL e. Triglycerides > 150 mg/dL - ANSWER>>>ANS: B, C, E The current criteria for diagnosing metabolic syndrome include increased waist circumference, elevated fasting plasma glucose, and elevated triglycerides. According to these criteria, patients will have HDL levels <40 mg/dL. The old criteria included elevated plasminogen activator inhibitor 1 levels. Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? a. Appropriately high PTH along with hypocalcemia b. Appropriately increased PTH and low or normal serum calcium c. Inappropriate secretion of PTH along with hypercalcemia
