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

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NR511 Clinical Analysis Final Exam With Answers (190 Solved Questions) - Page 1 preview image

NRi511i/iNR511iFINALiEXAMi1Theieffectivenessiofibenzodiazepinesiinitreatingianxietyidisordersisuggestsithatiwhichiofitheifollowingineurotransmittersiplaysiairoleiinianxiety?Gamma-aminobutyriciacidi(GABA)TheicriteriaiforidiagnosingigeneralizedianxietyidisorderiinitheiAmericaniPsychiatriciAssociationsiDiagnosticiandiStatisticaliManualiofiMentaliDisorders,i5thieditioni(textirevision)istateithatiexcessiveiworryioriapprehensionimustibeipresentimoreidaysithaninotiforiatileast?6imonthsAi20-year-oldiwomaniisiseeniinitheiclinicibecauseiheriboyfriendiwasifounditoihaveigonorrhea.iWhichiofitheifollowingiisitheitreatmentiofichoiceiforigonorrhea?a.Ceftriaxoneb.Doxycyclinec.Acyclovird.MetronidazoleiCeftriaxoneAipatientiisiseeniinitheicliniciwithiaichieficomplaintiofihematuria.iToimakeiaidifferentialidiagnosis,iwhichiofitheifollowingiquestionsishouldibeiasked?a."Doiyouihaveiaihistoryiofiliveridisease?"b."Whatimedicationsiareiyouicurrentlyitaking?"c."Haveiyouinoticediswellingiiniyouriankles?"d.Alliofitheiabove"Whatimedicationsiareiyouicurrentlyitaking"Aipatientiisiseeniinitheicliniciwithihematuriaiconfirmedionimicroscopiciexamination.iTheiclinicianishouldiinquireiaboutitheiingestioniofiwhichiofitheseisubstancesithatimightibeitheicauseiofihematuria?a.NSAIDsb.Beetsc.VitaminiAd.RedimeatiNSAIDSAi27-year-oldifemaleipresentsiwithiaichieficomplaintiofiburningiandipainioniurination.iSheihasinoipreviousihistoryiofiurinaryitractiinfectioni(UTI).iWhatiareisomeiadditionalisymptomsiconsistentiwithiaidiagnosisiofiloweriUTI?a.Backiandiabdominalipainb.Fever,ichills,icostovertebralianglei(CVA)itenderness

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NR511 Clinical Analysis Final Exam With Answers (190 Solved Questions) - Page 2 preview image

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c.Bloodiiniurineiandifrequencyd.Foul-smellingidischarge,iperinealiitchiBloodiiniurineiadifrequencyAi30-year-oldipatientipresentsiwithipainioniurination.iTheiurineimicroscopyiofiunspuniurineishowsigreaterithani10ileukocytes/mL,iandiaidipstickiisipositiveiforinitrites.iWhatiisitheiprobableidiagnosis?ia.iLoweriurinaryitractiinfectionb.Chlamydiaiinfectionc.Candidiasisd.PyelonephritisLoweriurinaryitractiinfectionAipatientipresentsiwithiCVAitendernessiandiaiseveral-dayihistoryiofihighifever,ichills,iandidysuria.iWhichiofitheifollowingidiagnosesiisimostilikelyigivenitheiaboveiinformation?a.Pyelonephritisb.Cystitisc.Renalicalculid.BladderitumoriPyelonephritisAipatientiisidiagnosediwithiurgeiincontinence.iBeforeiprescribingiDetroliXL,itheiproviderishouldiquestionitheipatientiaboutiwhichiofitheseicontraindicationsitoithisimedication?a.Diarrheab.Parkinson'sidiseasec.Closed-angleiglaucomad.BreasticanceriClosed-angleiglaucomaAipatientiisiseeniinitheiofficeicomplainingiofisevereiflankipain.iTheiclinicianishouldiassessithisipatientiforiwhichiriskifactoriforikidneyistones?a.Hypertensionb.Constipationc.Tubaliligationd.DiabetesiHypertensionAipatientiisidiagnosediwithioveractiveibladder.iWhichiofitheifollowingiinstructionsishouldibeigivenitoithisiwoman?a.i"Limititheiamountiofiwaterithatiyouidrink."ib.i"Eliminateicaffeineifromiyouridiet."c.i"Wearipantyiliners."d.iAlliofitheiaboveEliminateicaffeineifromiyouridiet

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Ai34-year-oldipatientiwasitreatediforiaiUTIiandihasinotirespondeditoiantibioticitherapy.iWhichiofitheifollowingiactionsishouldibeitakeninext?a.Sendiaiurineispecimeniforimicroscopyiandievaluateiforifungalicolonies.b.Increaseitheidoseiofiantibiotic.c.Orderiaicytoscopy.d.Orderiaidifferentiantibiotic.SendiaiurineispecimeniforimicroscopyiandievaluateiforifungalicoloniesiWhichiofitheifollowingiareipredisposingifactorsiforipyelonephritis?a.Pregnancyb.Dehydrationc.Smokingd.AlkalineiurineiPregnancyAi42-year-oldiwomaniisiseeniinitheicliniciwithifever,ichills,ivomiting,iandisevereidysuria.iSheiisidiagnosediwithiacuteipyelonephritis.iHowishouldithisipatientibeimanaged?a.i3-dayicourseiofioraliantibioticsib.iHospitalizationc.iEncourageicranberryijuiceiintake.d.i6-weekicourseiofiantibioticsiHospitalizationOraliantibioticsimayibeiprescribediinimildicasesiofiacuteipyelonephritis,icharacterizedibyitheiabsenceiofinauseaiandivomitingiorisignsiofisepsis.iFirst-lineitherapyiincludesiciprofloxacini(Cipro)i500imgitwoitimesidailyifori7idays,ioriciprofloxaciniextended-releasei(CiproiXR)i1,000imgidailyifori7idays,iorilevofloxacini(Levaquin)i750imgidailyifori5idays.Hospitalizationimayibeiindicated,idependingionitheipatient'siabilityitoimaintainiadequateifluidiintakeanditoitolerateioraliantibiotics,ialongiwithitheiseverityiofitheisymptomsiandievidenceiofibacteremia.Hospitalizationiofipatientsiwhoiareipregnant,ivomiting,ioridehydratedishouldibeistronglyiconsidered.Likewise,itheipatient'sidegreeiofisystemiciillnessi(bacteremiaioriurosepsis),iage,ihistoryiofichronicdisease,iorinonadherenceitoitherapyimayileaditoitheiassessmentithatihospitalizationiisinecessary.Ninety-ifiveipercentiofipatientsidemonstrateiaigoodiresponseiwithini48ihoursitoiIViantibioticitreatmentandimayibeidischargedioniappropriateioralimedication,ionceiurineicultureiandiantibioticisensitivityresultsiareiavailableiandisubsequentiantimicrobialitherapyimayibeinarrowediinispectrum.Aipatientiisiseeniwithiaisuddenionsetiofiflankipainiaccompaniedibyinausea,ivomiting,iandidiaphoresis.iIniadditionitoinephrolithiasis,iwhichiofitheifollowingishouldibeiaddeditoitheilistiofidifferentialidiagnoses?a.Pancreatitisb.Pepticiulceridisease

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NR511 Clinical Analysis Final Exam With Answers (190 Solved Questions) - Page 5 preview image

c.Diverticulitisd.AlliofitheiaboveiAlliofitheiaboveWhichiofitheifollowingiinstructionsishouldibeigivenitoitheipatientiwithinephrolithiasis?ia.iTakeiibuprofen,i600imgieveryi8ihours.b.TakeiTums®iforistomachiupset.c.Drinkimoreiblackitea.d.Increaseiintakeiofivegetables,ilikeispinach.iTakeiibuprofen,i600imgieveryi8ihoursWhichiofitheifollowingipatientsiisiatiriskiforidevelopingiurinaryitracticancer?a.Thei45-year-oldiwomaniwhoiisi100ilbsioverweightb.Thei78-year-oldimaniwhoismokesithreeipacksioficigarettesiaidayc.Thei84-year-oldimaniwhoiworkediinitheiasbestosiminesid.iAlliofitheiaboveAlliofitheiaboveObesity;iexposureitoiasbestos,icadmium,iand/origasoline;itheiuseiofiphenacetin-iandiaspirin-containingianalgesics;iandichronicihemodialysisiforiacquiredipolycysticikidneyidiseaseiareialliriskifactorsiforirenalicellicarcinoma.iCigaretteismokingihasiai25%itoi30%icorrelationiwithitheidevelopmentiofirenalicellicarcinoma.Ani86-year-oldiwomaniisiseeniinitheicliniciforirecurrentihematuria.iTheiproviderisuspectsibladdericancer.iWhichiofitheifollowingidataifromitheihistoryiisiconsiderediairiskifactoriforithisitypeioficancer?a.Historyiofialcoholismb.Sedentaryilifestylec.Obesityd.65-yearismokingihistoryi65-yearismokingihistoryWhichiofitheifollowingidiagnosticitestsishouldibeiorderediforiaipatientisuspectediofihavingibladdericancer?a.iKidneys,iureter,ibladderix-rayib.iCystoscopyiwithibiopsyc.iMagneticiresonanceiimagingd.iUrineitumorimarkeri(NMP22)iCystoscopyiwithibiopsyAi78-year-oldimaniisidiagnosediwithiStageiDibladdericanceriandiasksitheiprovideriwhatithatimeans.iWhichiisitheibestiresponse?a."ThereiisinoisuchithingiasiStageiDicancer."b."Youihaveicancerithatihasispreaditoitheisurroundingitissue."

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c."Youricancerihasispreaditoiotheriorgans."d."Youricancericanibeicuredibyiremovingiyouribladder."i"Youricancerihasispreaditoiotheriorgans"Inigeneral,iTRANSITIONALiCELLiCARCINOMASiareistagedifromiAitoiD,iaccordingitoileveliofiinvasion:istagei0itumorsiareiconfineditoitheimucosa;stageiAitumorsiinvadeitheilaminaipropria;istageiBitumorsiinvadeitheimuscularilayer;stageiCitumorsiextenditoitheiperipelvicifatiorirenaliparenchyma;iandistageiDiindicatesimetastaticidisease.Theitumor-node-metastasisi(TNM)isystemiofitheiAmericaniJointiCommitteeioniCancerimayialsoibeiused,iwithinodalimetastasesireflectingistageiIVicancer.iWhenitransitionalicellicarcinomasiareilookediatiasiaiwhole,iinisituidiseaseihasiai5-yearisurvivalirateiofi95%,ilocalizedidiseaseinearlyi90%,iregionalidiseaseijustioveri60%,iandidistantidiseaseionlyi17%Hematuriaidifferentialidiagnosisiinclude?UTI,ipylyonephritis,icancer,iBPHiHematuriaiphysicaliexamishouldiinclude?Abdominaliexam,itenderness,imassess,iCVAitenderness,ipelvic/prostateiexamiDiagnosticitestsineedediinievaluationiofihematuria?UA,iC&S,iCMP,iBMP,iIVPiintravenousipyelogram,icystoscopy,iUS,iCTiscanHematuriaimanagementiandifollow-upIfibacterialisuchiasiUTI-iantibioticitherapy**ifinotifurtherievaluationireferitoiurologyiorinephrologyiLoweriUTIioccursiwhere?urethra,ibladder,iprostateMosticommonipathogeniofiUTIiincludes?E.coliClinicalipresentationiofiUTIiS/S?dysuria,iurinaryifrequency/urgency,inocturia,ihematuria,ilowibackiorisuprapubicipain,iurinaryiincontinence,ifoulismellingiurine**elderlyialternedimentalistatusimayibeionlyimanifestation!

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NR511 Clinical Analysis Final Exam With Answers (190 Solved Questions) - Page 7 preview image

Cleanicatchiurineisampleishowingipresenceiofibacteria**>100iorganisms/mliwithipresenceioficlinicalisymptomsWhatidiagnosticitestsiwouldioneiuseiforiUTI?*Urineicultureimayibeiindicatediificomplicatediinfectioniisisuspected,iifiatypicalisymptomsiareipresentioriifisymtpomsipersistiorirecuriwithiniaimonthiofiptirecievingiempiricicourseiofiantibiotics.WhatiantibioticsiwouldibeiprescribediforianiuncomplicatediUTI?Bactrimi(TMP-SMP)i160/800imgiBIDifori3idays**foriptsiwithinoidrugiallergies,ipreviousihospitalizationioriantibioitciuseiini3imonthsMacrobidi(Nitrofurantoin)i100imgiBIDixi7idaysiusediasianialternativeiforiptsiwithisulfaiallergiesiorithoseiwithipreviousiantibioticsiwithinilasti3imonthsFluoroquinolonesisuchiasiCiproi250imgiBIDixi3idaysiorilevaquini250imgidailyixi3idaysiWhatiwouldiyouitreatiaipatientiwithiaifungaliUTI?Whatiisiusuallyitheicause?Diflucani(Fluconazole)i200imgiPOidailyifori7-14idays.**usuallyisiassociatediwithiindwellingicatheteriALMOSTiHALFiCASESiRESOLVEiONiTHEIRiOWNiWHENiCATHETERiISiREMOVEDiANDidoesinotineeditreatment.Whatiisipyelonephritis?infectioniofitheikidneyithatiisicharacterizedibyiinfectioniwithinirenalipelvis,itubules,ioriinterstialitissueithatimayibeiunilateralioribilateralWhatiareitheipre-disposingiriskifactorsiforipyelonephritis?ia.iPregnancyb.Dehydrationc.Smokingd.AlkalineiurineiPregnancyincreasediinipatientsiwithipredisposingifactorsiincludingianatomicaliabnormalitiesisuchiasiureterovesicalireflux,iurinaryiobstruction,stressiincontinence,multipleiorirecurrentiurinaryitractiinfectionsi(UTIs),irenalidisease,kidneyitrauma,

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NR511 Clinical Analysis Final Exam With Answers (190 Solved Questions) - Page 8 preview image

pregnancy,iandmetabolicidisordersisuchiasidiabetesimellitus.Whatiareitheisignsiandisymptomsiofiacuteipylonephritissuddenionsetiofifever,ishaking,ichills,in/v,iunilateraliorilocalizediflankipain,ifatigue,idiarrhea**largelyiasymptomatic**elderlyiptsiwithialteredimentationWhaticanibeiseenioniphysicaliexamiforipylonephritis?markeditendernessionideepiabdominalipalpation**mayibeihypertensive.Diagnosticsineedediforipylonephritis?dxiconfirmedithroughiUAi(positiveiforibacteria,iproteinuria,ileukocytesiesterase,iurinaryinitrates,ihematuria,ipyuria,iWBCiCASTSi(passageithroughinuetrophilsithorughirenalitubules)**Urineiculturei>100,000icfu/mli(allowingiforiidentificationioficausitiveiorganism)**MOSTiIMPORTANTiisiWBCiCASTS*cystoscopyiwithiureteralicatheterization,irenaliultrasound,iintravenousipyelogramiWhatiassessmentiisiperformeditoitryiandidiagnoseipylonephritis?physicaliexam:iTendernessionideepipalpation/percussioniofiCVAitendernessi(back)**iptsimayibeihypertensiveWhatiantibioticsishouldibeiusediforipyleonephritis?Ciproi500imgiBIDifori7idaysiCiproiXRi1000mgidailyifori7idaysiLevaquini750imgidailyifori5idaysTXiforikidneyistonesiinclude?painireliefi(oraliNSAIDS,iopiates,iantispasmodics,iwarmicompresses,ifocusedibreathingidiversionalitherapy)*thiazideidiureticsi(calcium)iAllopurinoli(uriciacid)Dipenicillaminei(cystine)increaseiwateriintakenoninvasiveiandiinvasiveisurgicaliinterventions

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AVOIDiTUMS,iloopidiuretics,ivitaminisupplementsiStressiincontinenceicanibeibroughtionieasilyiby?coughingisneezing,istrainingManagementiofistressiincontinenceiincludes?kegalsi40-60icontractionsidailyi(slowitighteni10iseconds,iholdi10iseconds,ireleaseioveri10iseconds)PelvicifloorimuscleitrainingVaginaliconesioripessariesloseiwtlimitifluidsiinieveningMEDS:ivaginaliestrogeniSurgicaliinterventionOveriActiveiBladderimedicationsiinclude?Anticholinergic/AntimuscarinicimedicationsOxybutynin-iDitropaniandiXLiPOioripatchiTolterodinei(DetroliandiDetroliLA)Sideieffects:idryimouth,iconstipation,iblurredivisionTheiresultiofitheipatient'si24-houriurineiforiproteiniwasi4.2ig/day.iTheiclinicianishoulditakeiwhichiofitheifollowingiactions?a.Repeatitheitest.b.Referitoiainephrologist.c.Measureitheiserumiprotein.d.Obtainiaibloodiureainitrogeni(BUN)iandicreatinine.Referitoiainephrologist.Ifitheiexcretionirateiisiabovei3.0itoi3.5ig/day,itheipatient,ibyidefinition,ihasinephroticisyndromeiandimustibeireferreditoiainephrologist.CanileaditoiAKI,iEndistageirenalifailureiandihypertension

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NR511 Clinical Analysis Final Exam With Answers (190 Solved Questions) - Page 10 preview image

Aipatientiisiseenicomplainingiofi"leakingiurineiwheniIisneeze."iWhichiofitheifollowingiactionsishoulditheiclinicianitakeifirst?a.Orderiaicystometrogram.b.Obtainiaicomputeditomographyiscan.ic.iInstructitheipatientioniKegeliexercises.d.iPrescribeiimipramine.InstructitheipatientioniKegeliexercises.WhichiofitheifollowingiinformationiisiessentialibeforeiprescribingiBactrimiDSitoiai24-year-oldiwomaniwithiaiUTI?a.Lastimenstrualiperiodb.Methodiofibirthicontrolc.Lastiunprotectedisexualicontactid.iAlliofitheiaboveAlliofitheiaboveCertainipatternsiofipain,inumbness,ianditinglingiareiassociatediwithicarpalitunnelisyndrome.KatzihandidiagramTinelisignMedianinerveiintegrityTinelisigniisitestedibyistrikingitheipatient'siwristiwithiyouriindexiorimiddleifingeriwhereitheimedianinerveipassesiunderitheiflexoriretinaculumiandivolaricarpaliligament.AitinglingisensationiradiatingifromitheiwristitoitheihandiinitheidistributioniofitheimedianinerveiisiaipositiveiTinelisigniandiisisuggestiveioficarpalitunnelisyndrome.MedianiNerveiIntegrity/iCarpaliTunnelitestingTinelisign,iPhalen,iThumbiabductionThumbiabductionHaveitheipatientiplaceitheihandipalmiupiandiraiseitheithumbiperpendicularitoiit.iApplyidownwardipressureionitheithumbitoitestimuscleistrength.Fulliresistanceitoipressureiisiexpected.iWeaknessiisiassociatediwithicarpalitunnelisyndrome.PhalenitestToiperformitheiPhalenitest,iaskitheipatientitoiholdibothiwristsiiniaifullyipalmar-flexedipositioniwithitheidorsalisurfacesipresseditogetherifori1iminuteNumbnessiandiparesthesiaiinitheidistributioniofitheimedianinerveiareisuggestiveioficarpalitunnelisyndrome.

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