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NR511 Clinical Analysis Final Exam With Answers (190 Solved Questions)

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    NR i 511 i / i NR511 i FINAL i EXAM i 1 The i effectiveness i of i benzodiazepines i in i treating i anxiety i disorders i suggests i that i which i of i the i following i neurotransmitters i plays i a i role i in i anxiety? Gamma - aminobutyric i acid i (GABA) The i criteria i for i diagnosing i generalized i anxiety i disorder i in i the i American i Psychiatric i Associations i Diagnostic i and i Statistical i Manual i of i Mental i Disorders, i 5th i edition i (text i revision) i state i that i excessive i worry i or i apprehension i must i be i present i more i days i than i n ot i for i at i least? 6 i months A i 20 - year - old i woman i is i seen i in i the i clinic i because i her i boyfriend i was i found i to i have i gonorrhea. i Which i of i the i following i is i the i treatment i of i choice i for i gonorrhea? a. Ceftriaxone b. Doxycycline c. Acyclovir d. Metronidazole i Ceftriaxone A i patient i is i seen i in i the i clinic i with i a i chief i complaint i of i hematuria. i To i make i a i differential i diagnosis, i which i of i the i following i questions i should i be i asked? a. "Do i you i have i a i history i of i liver i disease?" b. "What i medications i are i you i currently i taking?" c. "Have i you i noticed i swelling i in i your i ankles?" d. All i of i the i above "What i medications i are i you i currently i taking" A i patient i is i seen i in i the i clinic i with i hematuria i confirmed i on i microscopic i examination. i The i clinician i should i inquire i about i the i ingestion i of i which i of i these i substances i that i might i be i the i cause i of i hematuria? a. NSAIDs b. Beets c. Vitamin i A d. Red i meat i NSAIDS A i 27 - year - old i female i presents i with i a i chief i complaint i of i burning i and i pain i on i urination. i She i has i no i previous i history i of i urinary i tract i infection i (UTI). i What i are i some i additional i symptoms i consistent i with i a i diagnosis i of i lower i UTI? a. Back i and i abdominal i pain b. Fever, i chills, i costovertebral i angle i (CVA) i tenderness

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    c. Blood i in i urine i and i frequency d. Foul - smelling i discharge, i perineal i itch i Blood i in i urine i ad i frequency A i 30 - year - old i patient i presents i with i pain i on i urination. i The i urine i microscopy i of i unspun i urine i shows i greater i than i 10 i leukocytes/mL, i and i a i dipstick i is i positive i for i nitrites. i What i is i the i probable i diagnosis? i a. i Lower i urinary i tract i infection b. Chlamydia i infection c. Candidiasis d. Pyelonephritis Lower i urinary i tract i infection A i patient i presents i with i CVA i tenderness i and i a i several - day i history i of i high i fever, i chills, i and i dysuria. i Which i of i the i following i diagnoses i is i most i likely i given i the i above i information? a. Pyelonephritis b. Cystitis c. Renal i calculi d. Bladder i tumor i Pyelonephritis A i patient i is i diagnosed i with i urge i incontinence. i Before i prescribing i Detrol i XL, i the i provider i should i question i the i patient i about i which i of i these i contraindications i to i this i medication? a. Diarrhea b. Parkinson's i disease c. Closed - angle i glaucoma d. Breast i cancer i Closed - angle i glaucoma A i patient i is i seen i in i the i office i complaining i of i severe i flank i pain. i The i clinician i should i assess i this i patient i for i which i risk i factor i for i kidney i stones? a. Hypertension b. Constipation c. Tubal i ligation d. Diabetes i Hypertensio n A i patient i is i diagnosed i with i overactive i bladder. i Which i of i the i following i instructions i should i be i given i to i this i woman? a. i "Limit i the i amount i of i water i that i you i drink." i b. i "Eliminate i caffeine i from i your i diet." c. i "Wear i panty i liners." d. i All i of i the i above Eliminate i caffeine i from i your i diet

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    A i 34 - year - old i patient i was i treated i for i a i UTI i and i has i not i responded i to i antibiotic i therapy. i Which i of i the i following i actions i should i be i taken i next? a. Send i a i urine i specimen i for i microscopy i and i evaluate i for i fungal i colonies. b. Increase i the i dose i of i antibiotic. c. Order i a i cytoscopy. d. Order i a i different i antibiotic. Send i a i urine i specimen i for i microscopy i and i evaluate i for i fungal i colonies i Which i of i the i following i are i predisposing i factors i for i pyelonephritis? a. Pregnancy b. Dehydration c. Smoking d. Alkaline i urine i Pregnancy A i 42 - year - old i woman i is i seen i in i the i clinic i with i fever, i chills, i vomiting, i and i severe i dysuria. i She i is i diagnosed i with i acute i pyelonephritis. i How i should i this i patient i be i managed? a. i 3 - day i course i of i oral i antibiotics i b. i Hospitalization c. i Encourage i cranberry i juice i intake. d. i 6 - week i course i of i antibiotics i Hospitalization Oral i antibiotics i may i be i prescribed i in i mild i cases i of i acute i pyelonephritis, i characterized i by i the i absence i of i nausea i and i vomiting i or i signs i of i sepsis. i First - line i therapy i includes i ciprofloxacin i (Cipro) i 500 i mg i two i times i daily i for i 7 i days, i or i ciprofloxacin i extended - release i (Cipro i XR) i 1,000 i mg i daily i for i 7 i days, i or i levofloxacin i (Levaquin) i 750 i mg i daily i for i 5 i days. Hospitalization i may i be i indicated, i depending i on i the i patient's i ability i to i maintain i adequate i fluid i intake and i to i tolerate i oral i antibiotics, i along i with i the i severity i of i the i symptoms i and i evidence i of i bacteremia. Hospitalization i of i patients i who i are i pregnant, i vomiting, i or i dehydrated i should i be i strongly i considered. Likewise, i the i patient's i degree i of i systemic i illness i (bacteremia i or i urosepsis), i age, i history i of i chronic disease, i or i nonadherence i to i therapy i may i lead i to i the i assessment i that i hospitalization i is i necessary. Ninety - i five i percent i of i patients i demonstrate i a i good i response i within i 48 i hours i to i IV i antibiotic i treatment and i may i be i discharged i on i appropriate i oral i medication, i once i urine i culture i and i antibiotic i sensitivity results i are i available i and i subsequent i antimicrobial i therapy i may i be i narrowed i in i spectrum. A i patient i is i seen i with i a i sudden i onset i of i flank i pain i accompanied i by i nausea, i vomiting, i and i diaphoresis. i In i addition i to i nephrolithiasis, i which i of i the i following i should i be i added i to i the i list i of i differential i diagnoses? a. Pancreatitis b. Peptic i ulcer i disease

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    c. Diverticulitis d. All i of i the i above i All i of i the i above Which i of i the i following i instructions i should i be i given i to i the i patient i with i nephrolithiasis? i a. i Take i ibuprofen, i 600 i mg i every i 8 i hours. b. Take i Tums® i for i stomach i upset. c. Drink i more i black i tea. d. Increase i intake i of i vegetables, i like i spinach. i Take i ibuprofen, i 600 i mg i every i 8 i hours Which i of i the i following i patients i is i at i risk i for i developing i urinary i tract i cancer? a. The i 45 - year - old i woman i who i is i 100 i lbs i overweight b. The i 78 - year - old i man i who i smokes i three i packs i of i cigarettes i a i day c. The i 84 - year - old i man i who i worked i in i the i asbestos i mines i d. i All i of i the i above All i of i the i above Obesity; i exposure i to i asbestos, i cadmium, i and/or i gasoline; i the i use i of i phenacetin - i and i aspirin - containing i analgesics; i and i chronic i hemodialysis i for i acquired i polycystic i kidney i disease i are i all i risk i factors i for i renal i cell i carcinoma. i Cigarette i smoking i has i a i 25% i to i 30% i correlation i with i the i development i of i renal i cell i carcinoma. An i 86 - year - old i woman i is i seen i in i the i clinic i for i recurrent i hematuria. i The i provider i suspects i bladder i cancer. i Which i of i the i following i data i from i the i history i is i considered i a i risk i factor i for i this i type i of i cancer? a. History i of i alcoholism b. Sedentary i lifestyle c. Obesity d. 65 - year i smoking i history i 65 - year i smoking i history Which i of i the i following i diagnostic i tests i should i be i ordered i for i a i patient i suspected i of i having i bladder i cancer? a. i Kidneys, i ureter, i bladder i x - ray i b. i Cystoscopy i with i biopsy c. i Magnetic i resonance i imaging d. i Urine i tumor i marker i (NMP22) i Cystoscopy i with i biopsy A i 78 - year - old i man i is i diagnosed i with i Stage i D i bladder i cancer i and i asks i the i provider i what i that i means. i Which i is i the i best i response? a. "There i is i no i such i thing i as i Stage i D i cancer." b. "You i have i cancer i that i has i spread i to i the i surrounding i tissue."

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    c. "Your i cancer i has i spread i to i other i organs." d. "Your i cancer i can i be i cured i by i removing i your i bladder." i "Your i cancer i has i spread i to i other i organs" In i general, i TRANSITIONAL i CELL i CARCINOMAS i are i staged i from i A i to i D, i according i to i level i of i invasion: i stage i 0 i tumors i are i confined i to i the i mucosa; stage i A i tumors i invade i the i lamina i propria; i stage i B i tumors i invade i the i muscular i layer; stage i C i tumors i extend i to i the i peripelvic i fat i or i renal i parenchyma; i and i stage i D i indicates i metastatic i disease. The i tumor - node - metastasis i (TNM) i system i of i the i American i Joint i Committee i on i Cancer i may i also i be i used, i with i nodal i metastases i reflecting i stage i IV i cancer. i When i transitional i cell i carcinomas i are i looked i at i as i a i whole, i in i situ i disease i has i a i 5 - year i survival i rate i of i 95%, i localized i disease i nearly i 90%, i regional i disease i just i over i 60%, i and i distant i disease i only i 17% Hema turia i differential i diagnosis i include? UTI, i pylyonephritis, i cancer, i BPH i Hematuria i physical i exam i should i include? Abdominal i exam, i tenderness, i massess, i CVA i tenderness, i pelvic/prostate i exam i Diagnostic i tests i needed i in i evaluation i of i hematuria? UA, i C&S, i CMP, i BMP, i IVP i intravenous i pyelogram, i cystoscopy, i US, i CT i scan Hematuria i management i and i follow - up If i bacterial i such i as i UTI - i antibiotic i therapy **if i not i further i evaluation i refer i to i urology i or i nephrology i Lower i UTI i occurs i where? urethra, i bladder, i prostate Most i common i pathogen i of i UTI i includes? E.coli Clinical i presentation i of i UTI i S/S? dysuria, i urinary i frequency/urgency, i nocturia, i hematuria, i low i back i or i suprapubic i pain, i urinary i incontinence, i foul i smelling i urine **elderly i alterned i mental i status i may i be i only i manifestation!

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    Clean i catch i urine i sample i showing i presence i of i bacteria **>100 i organisms/ml i with i presence i of i clinical i symptoms What i diagnostic i tests i would i one i use i for i UTI? *Urine i culture i may i be i indicated i if i complicated i infection i is i suspected, i if i atypical i symptoms i are i present i or i if i symtpoms i persist i or i recur i within i a i month i of i pt i recieving i empiric i course i of i antibiotics. What i antibiotics i would i be i prescribed i for i an i uncomplicated i UTI? Bactrim i (TMP - SMP) i 160/800 i mg i BID i for i 3 i days **for i pts i with i no i drug i allergies, i previous i hospitalization i or i antibioitc i use i in i 3 i months Macrobid i (Nitrofurantoin) i 100 i mg i BID i x i 7 i days i used i as i an i alternative i for i pts i with i sulfa i allergies i or i those i with i previous i antibiotics i within i last i 3 i months Fluoroquinolones i such i as i Cipro i 250 i mg i BID i x i 3 i days i or i levaquin i 250 i mg i daily i x i 3 i days i What i would i you i treat i a i patient i with i a i fungal i UTI? What i is i usually i the i cause? Diflucan i (Fluconazole) i 200 i mg i PO i daily i for i 7 - 14 i days. **usuallyis i associated i with i indwelling i catheter i ALMOST i HALF i CASES i RESOLVE i ON i THEIR i OWN i WHEN i CATHETER i IS i REMOVED i AND i does i not i need i treatment. What i is i pyelonephritis? infection i of i the i kidney i that i is i characterized i by i infection i within i renal i pelvis, i tubules, i or i interstial i tissue i that i may i be i unilateral i or i bilateral What i are i the i pre - disposing i risk i factors i for i pyelonephritis? i a. i Pregnancy b. Dehydration c. Smoking d. Alkaline i urine i Pregnancy increased i in i patients i with i predisposing i factors i including i anatomical i abnormalities i such i as i ureterovesical i reflux, i urinary i obstruction, stress i incontinence, multiple i or i recurrent i urinary i tract i infections i (UTIs), i renal i disease, kidney i trauma,

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    pregnancy, i and metabolic i disorders i such i as i diabetes i mellitus. W hat i are i the i signs i and i symptoms i of i acute i pylonephritis sudden i onset i of i fever, i shaking, i chills, i n/v, i unilateral i or i localized i flank i pain, i fatigue, i diarrhea **largely i asymptomatic **elderly i pts i with i altered i mentation What i can i be i seen i on i physical i exam i for i pylonephritis? marked i tenderness i on i deep i abdominal i palpation **may i be i hypertensive. Diagnostics i needed i for i pylonephritis? dx i confirmed i through i UA i (positive i for i bacteria, i proteinuria, i leukocytes i esterase, i urinary i nitrates, i hematuria, i pyuria, i WBC i CASTS i (passage i through i nuetrophils i thorugh i renal i tubules) **Urine i culture i >100,000 i cfu/ml i (allowing i for i identification i of i causitive i organism) **MOST i IMPORTANT i is i WBC i CASTS *cystoscopy i with i ureteral i catheterization, i renal i ultrasound, i intravenous i pyelogram i What i assessment i is i performed i to i try i and i diagnose i pylonephritis? physical i exam: i Tenderness i on i deep i palpation/percussion i of i CVA i tenderness i (back) ** i pts i may i be i hypertensive What i antibiotics i should i be i used i for i pyleonephritis? Cipro i 500 i mg i BID i for i 7 i days i Cipro i XR i 1000mg i daily i for i 7 i days i Levaquin i 750 i mg i daily i for i 5 i days TX i for i kidney i stones i include? pain i relief i (oral i NSAIDS, i opiates, i antispasmodics, i warm i compresses, i focused i breathing i diversional i therapy) *thiazide i diuretics i (calcium) i Allopurinol i (uric i acid) D i penicillamine i (cystine) increase i water i intake noninvasive i and i invasive i surgical i interventions

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    AVOID i TUMS, i loop i diuretics, i vitamin i supplements i Stress i incontinence i can i be i brought i on i easily i by? coughing i sneezing, i straining Management i of i stress i incontinence i includes? kegals i 40 - 60 i contractions i daily i (slow i tighten i 10 i seconds, i hold i 10 i seconds, i release i over i 10 i seconds) Pelvic i floor i muscle i training Vaginal i cones i or i pessaries lose i wt limit i fluids i in i evening MEDS: i vaginal i estrogen i Surgical i intervention Over i Active i Bladder i medications i include? Anticholinergic/Antimuscarinic i medications Oxybutynin - i Ditropan i and i XL i PO i or i patch i Tolterodine i (Detrol i and i Detrol i LA) Side i effects: i dry i mouth, i constipation, i blurred i vision The i result i of i the i patient's i 24 - hour i urine i for i protein i was i 4.2 i g/day. i The i clinician i should i take i which i of i the i following i actions? a. Repeat i the i test. b. Refer i to i a i nephrologist. c. Measure i the i serum i protein. d. Obtain i a i blood i urea i nitrogen i (BUN) i and i creatinine. Refer i to i a i nephrologist. If i the i excretion i rate i is i above i 3.0 i to i 3.5 i g/day, i the i patient, i by i definition, i has i nephrotic i syndrome i and i must i be i referred i to i a i nephrologist. Can i lead i to i AKI, i End i stage i renal i failure i and i hypertension

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    A i patient i is i seen i complaining i of i "leaking i urine i when i I i sneeze." i Which i of i the i following i actions i should i the i clinician i take i first? a. Order i a i cystometrogram. b. Obtain i a i computed i tomography i scan. i c. i Instruct i the i patient i on i Kegel i exercises. d. i Prescribe i imipramine. Instruct i the i patient i on i Kegel i exercises. Which i of i the i following i information i is i essential i before i prescribing i Bactrim i DS i to i a i 24 - year - old i woman i with i a i UTI? a. Last i menstrual i period b. Method i of i birth i control c. Last i unprotected i sexual i contact i d. i All i of i the i above All i of i the i above Certain i patterns i of i pain, i numbness, i and i tingling i are i associated i with i carpal i tunnel i syndrome. Katz i hand i diagram Tinel i sign Median i nerve i integrity Tinel i sign i is i tested i by i striking i the i patient's i wrist i with i your i index i or i middle i finger i where i the i median i nerve i passes i under i the i flexor i retinaculum i and i volar i carpal i ligament. A i tingling i sensation i radiating i from i the i wrist i to i the i hand i in i the i distribution i of i the i median i nerve i is i a i positive i Tinel i sign i and i is i suggestive i of i carpal i tunnel i syndrome. Median i Nerve i Integrity/ i Carpal i Tunnel i testing Tinel i sign, i Phalen, i Thumb i abduction Thumb i abduction Have i the i patient i place i the i hand i palm i up i and i raise i the i thumb i perpendicular i to i it. i Apply i downward i pressure i on i the i thumb i to i test i muscle i strength. Full i resistance i to i pressure i is i expected. i Weakness i is i associated i with i carpal i tunnel i syndrome. Phalen i test To i perform i the i Phalen i test, i ask i the i patient i to i hold i both i wrists i in i a i fully i palmar - flexed i position i with i the i dorsal i surfaces i pressed i together i for i 1 i minute Numbness i and i paresthesia i in i the i distribution i of i the i median i nerve i are i suggestive i of i carpal i tunnel i syndrome.

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