Adult Genitourinary System Practice Questions

A patient has had a cystectomy and ill conduit diversion. Four days after surgery, you note mucous shreds in the drainage bag. The nurse should: 1. Notify the provider. 2. Notify the charge nurse. 3. Irrigate the drainage tube. 4. Document it as a normal observation.

4. Document it as a normal observation.

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? 1. Hematuria and pyuria. 2. Dysuria and proteinuria. 3. Hematuria and urgency. 4. Dysuria and penile discharge.

4. Dysuria and penile discharge.

The nurse is providing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item should the nurse instruct the client to exclude from the diet? 1. Red meats 2. Orange juice 3. Grapefruit juice 4. Green leafy vegetables

3. Grapefruit juice

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? 1. Hyperkalemia and hyponatremia. 2. Hyperkalemia and hypernatremia. 3. Hypokalemia and hyponatremia. 4. Hypokalemia and hypernatremia.

3. Hypokalemia and hyponatremia.

Common assessment findings of BPH include all of the following except? 1. Nocturia 2. Hematuria 3. Increase in force of stream 4. Bladder distention

3. Increase in force of stream

To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should: Select all that apply 1. Irrigate the graft daily with low-dose heparin. 2. Monitor the BP in the affected arm. 3. Listen with a stethoscope over the graft for presence of a bruit. 4. Assess the pulses and neuromuscular status distal to the graft. 5. Palpate the area of the graft to feel a normal thrill.

3. Listen with a stethoscope over the graft for presence of a bruit. 4. Assess the pulses and neuromuscular status distal to the graft. 5. Palpate the area of the graft to feel a normal thrill.

A nurse is planning discharge teaching for a female client who has a new prescription for trimethoprim-sulfamethoxazole. Which of the following information should the nurse include? 1. Take the medication even if pregnant. 2. Maintain a fluid restriction while taking it. 3. Take it on an empty stomach. 4. Stop taking it when manifestations subside.

3. Take it on an empty stomach.

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition? 1. Pyelonephritis 2. Glomerulonephritis 3. Trauma to the bladder or abdomen. 4. Renal cancer in the client's family.

3. Trauma to the bladder or abdomen.

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has a renal function disorder. On review of the laboratory results, the nurse most likely would expect to note which finding?1. 1. Elevated creatinine level. 2. Decreased hemoglobin level. 3. Decreased red blood cell count. 4. Decreased white blood cell count.

1. Elevated creatinine level.

A patient is admitted to the hospital with severe renal colic. The nurse's first priority in management of the patient is to: 1. Administer opioids as prescribed. 2. Obtain supplies for straining all urine. 3. Encourage fluid intake of 3 to 4 L/day. 4. Keep the patient NPO in preparation for surgery.

1. Administer opioids as prescribed.

A kidney transplant recipient has had fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? 1. Assess temperature and initiate workup to rule out infection. 2. Reassure the patient that this is common after transplantation. 3. Provide warm covers to the patient and give 1 gram oral acetaminophen. 4. Notify the nephrologist that the patient has manifestations of acute rejection.

1. Assess temperature and initiate workup to rule out infection.

The nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Blood glucose of 200 mg/dL. 2. Potassium level of 3.8 mEq/L. 3. Platelet count of 300,000 cells/mm. 4. White blood cell count of 6000 cells/mm.

1. Blood glucose of 200 mg/dL.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply. 1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 3. Contact the health care provider. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. 6. Increase the flow rate of the peritoneal dialysis solution.

1. Check the level of the drainage bag. 2. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks.

The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The priority action for the nurse is to: 1. Discontinue dialysis and notify the physician. 2. Monitor vital signs every 15 minutes for the next hour. 3. Continue dialysis at a slower rate after checking the lines for air. 4. Bolus the client with 500 mL of normal saline to break up the embolus.

1. Discontinue dialysis and notify the physician

A client with chronic kidney disease is receiving epoetin alfa (Epogen). Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 32% 2. Platelet count of 400,000 cells/mm 3. Blood urea nitrogen level of 15 mg/dL 4. White blood cell count of 6000 cells/mm.

1. Hematocrit of 32%

A nurse reviewing a client's medication history notes an allergy to sulfonamides. This allergy is a contraindication for taking which of the following medications? Select all that apply 1. Hydrochlorothiazide 2. Metoprolol 3. Acetaminophen 4. Glipizide 5. Furosemide

1. Hydrochlorothiazide 4. Glipizide 5. Furosemide

Patients with chronic kidney disease have an increased incidence of cardiovascular disease related to: Select all that apply 1. Hypertension 2. Vascular calcification 3. A genetic predisposition 4. Hyperinsulinemia causing dyslipidemia 5. Increased high-density lipoprotein levels

1. Hypertension 2. Vascular calcification 4. Hyperinsulinemia causing dyslipidemia

A client with a urinary tract infection is receiving ciprofloxacin (Cipro) by the intravenous route. The nurse appropriately administers the medication by performing which action? 1. Infusing slowly over 60 minutes. 2. Infusing in a light-protective bag. 3. Infusing only through a central line. 4. Infusing rapidly as a direct intravenous push medication.

1. Infusing slowly over 60 minutes.

A client is admitted to the emergency department following a fall from a horse and the health care provider prescribes insertion of a Foley catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 1. Notify the HCP. 2. Use a small-sized catheter. 3. Administer pain medication before inserting the catheter. 4. Use extra povidone-iodine solution in cleansing the meatus.

1. Notify the HCP.

A nurse is teaching a client who has a new prescription for nitrofurantoin. Which of the following information should the nurse include? Select all that apply 1. Observe for bruising on the skin. 2. Take the medication with milk or meals. 3. Expect brown discoloration of urine. 4. Crush the medication if it is difficult to swallow. 5. Expect insomnia when taking it.

1. Observe for bruising on the skin. 2. Take the medication with milk or meals. 3. Expect brown discoloration of urine.

A nurse is teaching a client who has a severe UTI about ciprofloxacin. Which of the following information about adverse reactions should the nurse include? Select all that apply 1. Observe for pain and swelling of the Achilles tendon. 2. Watch for a vaginal yeast infection. 3. Expect excessive nighttime perspiration. 4. Inspect the mouth for cottage cheese-like lesions. 5. Take the medication with a dairy product.

1. Observe for pain and swelling of the Achilles tendon. 2. Watch for a vaginal yeast infection. 4. Inspect the mouth for cottage cheese-like lesions.

Nurses can screen patients at risk for developing chronic kidney disease. Those considered to be at increased risk include: Select all that apply 1. Older black patients 2. Patients more than 60 years old 3. Those with a history of pancreatitis 4. Those with a history of hypertension 5. Those with a history of type 2 diabetes.

1. Older black patients 2. Patients more than 60 years old 4. Those with a history of hypertension 5. Those with a history of type 2 diabetes.

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula. 2. Presence of a radial pulse in the left wrist. 3. Absence of a bruit on auscultation of the fistula. 4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand.

1. Palpation of a thrill over the fistula.

Tacrolimus (Program) is prescribed for a client. Which disorder, if noted in the client's record, would indicate that the medication needs to be administered with caution? 1. Pancreatitis 2. Ulcerative colitis 3. Diabetes insipidus 4. Coronary artery disease

1. Pancreatitis

Common assessment findings for urinary obstructions include all of the following except: 1. Polyuria 2. Flank pain 3. Bladder distention 4. Diaphoresis

1. Polyuria

A patient is admitted to the hospital which chronic kidney disease. The nurse understands that this condition is characterized by: 1. Progressive irreversible destruction of the kidneys. 2. A rapid decrease in urine output with an elevated BUN. 3. An increasing creatinine clearance with a decrease in urine output. 4. Prostration, somnolence, and confusion with coma and imminent death.

1. Progressive irreversible destruction of the kidneys.

Nutritional support and management are essential across the entire continuum of chronic kidney disease. Which statements are true related to nutritional therapy? Select all that apply 1. Sodium and salt may be restricted in someone with advanced CKD. 2. Fluid is not usually restricted for patients receiving peritoneal dialysis. 3. Decreased fluid intake and a low-potassium diet are part of the diet for a patient receiving hemodialysis. 4. Decreased fluid intake and a low-potassium diet are part of the diet for a patient receiving peritoneal dialysis. 5. Decreased fluid intake and a diet in protein-rich foods are part of a diet for a patient receiving hemodialysis.

1. Sodium and salt may be restricted in someone with advanced CKD. 2. Fluid is not usually restricted for patients receiving peritoneal dialysis. 3. Decreased fluid intake and a low-potassium diet are part of the diet for a patient receiving hemodialysis.

An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In helping the patient to make a decision about treatment, the nurse informs the patient that: 1. Successful transplantation usually provides a better quality of life than that offered by dialysis. 2. If rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. 3. Hemodialysis replaces the normal functioning of the kidneys and patients do not have to live with the continual fear of rejection. 4. The immunosuppressive therapy after transplantation makes the person ineligible to receive other treatment if the kidney fails.

1. Successful transplantation usually provides a better quality of life than that offered by dialysis.

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes: Select all that apply 1. Teaching the patient to use Kegel exercises. 2. Clamping and releasing a catheter to increase bladder tone. 3. Teaching the patient biofeedback mechanisms to train pelvic floor muscles. 4. Counseling the patient concerning choice of incontinence containment device. 5. Developing a fluid modification plan, focusing on decreasing intake before bedtime.

1. Teaching the patient to use Kegel exercises. 3. Teaching the patient biofeedback mechanisms to train pelvic floor muscles.

Normal findings expected by the nurse on physical assessment of the urinary system include: Select all that apply 1. non palpable bladder 2. non palpable left kidney 3. auscultation of renal artery bruit 4. no CVA tenderness elicited by a kidney punch 5. full bladder percusses as dullness above the symphysis pubis.

1. non palpable bladder 2. non palpable left kidney 4. no CVA tenderness elicited by a kidney punch 5. full bladder percusses as dullness above the symphysis pubis.

During physical assessment of the urinary system, the nurse: 1. performs first percussion to detect tenderness in the flank area. 2. expects a dull percussion sound when 100 mL of urine is present in the bladder. 3. palpates the lower pole of the right kidney as a smooth mass that descends on expiration. 4. percusses above the symphysis pubis to determine the level of using in the bladder.

1. performs first percussion to detect tenderness in the flank area.

One of the nurse's most important roles in relation to acute post-streptococcal glomerulonephritis is to: 1. promote early diagnosis and treatment of sore throats and skin lesions. 2. encourage patients to obtain antibiotic therapy for upper respiratory tract infections. 3. teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence. 4. monitor patients for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane.

1. promote early diagnosis and treatment of sore throats and skin lesions.

During the oliguric phase of AKI, the nurse monitors the patient for: Select all that apply 1. Hypotension 2. ECG changes 3. Hypernatremia 4. Pulmonary edema 5. Urine with high specific gravity

2. ECG changes 4. Pulmonary edema

A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes: 1. Clamping the tube for 10 minutes every hour to decrease spasms. 2. Encouraging fluids of at least 2 to 3 L/day after nausea has subsided. 3. Notifying the provider if nephrostomy tube drainage is more than 30 mL/hr. 4. Irrigating the nephrostomy tube with 10 mL of normal saline solution as needed.

2. Encouraging fluids of at least 2 to 3 L/day after nausea has subsided.

A nurse is planning to administer ciprofloxacin IV to a client who has cystitis. Which of the following actions should the nurse take? 1. Administer a concentrated solution. 2. Infuse the medication over 60 min. 3. Infuse the solution through the primary IV fluid's tubing. 4. Choose a small peripheral vein for administration.

2. Infuse the medication over 60 min.

Which of the following treatments involves the use of sound, laser or dry shock waves to break stones in the GU tract? 1. Retrograde ureteroscopy 2. Lithotripsy 3. Stenting 4. Computed tomography

2. Lithotripsy

The nurse is providing discharge instructions to a client receiving sulfamethoxazole. Which instruction should be included in the list? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. If the urine turns dark brown, call the health care provider immediately. 4. Decrease the dosage when symptoms are improving to prevent allergic response.

2. Maintain a high fluid intake.

A client with acute kidney injury has a serum potassium level of 6.0 mEq/L. The nurse should plan which action as a priority? 1. Check the sodium level. 2. Place the client on a cardiac monitor. 3. Encourage increased vegetables in the diet. 4. Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration.

2. Place the client on a cardiac monitor.

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find 1. a pH of 8.4. 2. RBCs of 4/hpf. 3. color: yellow, cloudy. 4. specific gravity of 1.035.

2. RBCs of 4/hpf.

A client admitted to the emergency department following a motor vehicle accident. The client was wearing a lap seat belt when the accident occurred and now the client has hematuria and lower abdominal pain. To assess further whether the pain is caused by bladder trauma, the nurse should ask the client if the pain is referred to which area? 1. Hip 2. Shoulder 3. Umbilicus 4. Costovertebral angle

2. Shoulder

The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of: 1. Aspirin use 2. Tobacco use 3. Chronic alcohol use 4. Use of artificial sweeteners

2. Tobacco use

Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication? 1. Gastric atony 2. Urinary strictures 3. Neurogenic atony 4. Gastroesophageal reflux

2. Urinary strictures

The edema that occurs in nephrotic syndrome is due to: 1. Increased hydrostatic pressure caused by sodium retention. 2. Decreased aldosterone secretion from adrenal insufficiency. 3. Increased fluid retention caused by decreased glomerular filtration. 4. Decreased colloidal osmotic pressure caused by loss of serum albumin.

2. decreased aldosterone secretion from adrenal insufficiency.

A patient with kidney disease has oliguria and a creatinine clearance of 40 mL/min. These findings most directly reflect abnormal function of: 1. tubular secretion. 2. glomerular filtration. 3. capillary permeability. 4. concentration of filtrate.

2. glomerular filtration.

The nurse teaches the female patient who has frequent UTIs that she should: 1. take tub baths with bubble bath 2. void before and after sexual intercourse 3. take prophylactic sulfonamides for the rest of her life 4. restrict fluid intake to prevent the need for frequent voiding

2. void before and after sexual intercourse

The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? 1. Fever, diarrhea, groin pain, and epididymitis. 2. Nausea, vomiting, scrotal edema, and ecchymosis. 3. Fever, nausea, vomiting, and painful scrotal edema. 4. Diarrhea, groin pain, testicular torsion, and edema.

3. Fever, nausea, vomiting, and painful scrotal edema.

The most common pathogen responsible for UTI's is? 1. Pseudomonas 2. Staphylococcus aureus 3. E. coli 4. Lactobacillus

3. E. coli

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin (Furadantin) for a urinary tract infection. The nurse should make which appropriate response? 1. "Discontinue taking the medication and make an appointment for a urine culture." 2. "Decrease your medication to half the dose because your urine is too concentrated." 3. "Continue taking the medication because the urine is discolored from the medication." 4. "Take magnesium hydroxide (Maalox) with your medication to lighten the urine color."

3. "Continue taking the medication because the urine is discolored from the medication."

The nurse, who is administering bethanechol chloride (Urecholine), is monitoring for cholinergic overdose associated with the medication. The nurse should check the client for which sign of overdose? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration

3. Bradycardia

Which of the following urological procedures requires intermittent catheterization? 1. Ileal condult 2. Conventional urostomy 3. Continent urinary reservoir 4. Ureterostomy

3. Continent urinary reservoir

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 100.2 F. Which nursing action is most appropriate? 1. Encourage fluids. 2. Notify the health care provider. 3. Continue to monitor vital signs. 4. Monitor the site of the shunt for infection.

3. Continue to monitor vital signs.

Diminished ability to concentrate urine, associated with aging of the urinary system, is attributed to: 1. a decrease in bladder sensory receptors. 2. a decrease in the number of functioning nephrons. 3. decreased function of the loop of Henle and tubules. 4. thickening of the basement membrane of Bowman's capsule.

3. decreased function of the loop of Henle and tubules.

A diagnosis study that evaluates renal blood flow, glomerular filtration, tubular function, and excretion is a (n): 1. IVP 2. VCUG 3. renal scan 4. loopogram

3. renal scan

Phenazopyridine (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy? 1. Take the medication at bedtime. 2. Take the medication before meals. 3. Discontinue the medication if a headache occurs. 4. A reddish orange discoloration of the urine may occur.

4. A reddish orange discoloration of the urine may occur.

The nurse recommends genetic counseling for the children of a patient with 1. Nephrotic syndrome. 2. Chronic pyelonephritis. 3. Malignant nephrosclerosis. 4. Adult-onset polycystic kidney disease.

4. Adult-onset polycystic kidney disease.

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the health care provider? 1. Red bloody urine. 2. Pain related to bladder spasms. 3. Urinary output of 200 mL higher than intake. 4. Blood pressure, 100/50 mm, pulse, 130 beats/minute.

4. Blood pressure, 100/50 mm, pulse, 130 beats/minute.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history if benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1. Diuretics 2. Antibiotics 3. Antitussives 4. Decongestants

4. Decongestants

The nurse is collecting data from a client who has a history of benign prostatic hyperplasia. To determine whether the client currently is experiencing this condition , the nurse should ask the client about the presence of which early symptom? 1. Nocturia. 2. Urinary retention. 3. Urge incontinence. 4. Decreased force in the stream of urine.

4. Decreased force in the stream of urine.

Following kidney transplantation, cyclosporine (Sandimmune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Normal hemoglobin level 2. Decreased creatinine level 3. Decreased white blood cell count 4. Elevated blood urea nitrogen level

4. Elevated blood urea nitrogen level

A client newly diagnosed with chronic kidney disease has just been started on peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is most appropriate? 1. Stop the dialysis. 2. Slow the infusion. 3. Decrease the amount to be infused. 4. Explain that the pain will subside after the first few exchanges.

4. Explain that the pain will subside after the first few exchanges.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1. Hypertension, tachycardia, fever. 2. Hypotension, bradycardia, and hypothermia. 3. Restlessness, irritability, and generalized weakness. 4. Headache, deteriorating level of consciousness, and twitching.

4. Headache, deteriorating level of consciousness, and twitching.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the most appropriate nursing action? 1. Monitor the client. 2. Elevate the head of the bed. 3. Medicate the client for nausea. 4. Notify the health care provider.

4. Notify the health care provider.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess the client for which manifestations of this complication? 1. Warmth, redness, and pain in the left hand. 2. Aching pain, pallor, and edema of the left arm. 3. Edema and reddish discoloration of the left arm. 4. Pallor, diminished pulse, and pain in the left hand.

4. Pallor, diminished pulse, and pain in the left hand.

Oxybutynin chloride (Ditropan XL) is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness

4. Restlessness

RIFLE defines the first 3 stages of AKI based on changes in: 1. Blood pressure and urine osmolality. 2. Fractional excretion of urinary sodium. 3. Estimation of GFR with the MDRD equation. 4. Serum creatinine or urine output from baseline.

4. Serum creatinine or urine output from baseline.

Trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim) is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4. Sore throat

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder? 1. Soft and swollen prostrate gland. 2. Reddened, swollen, and boggy prostate gland. 3. Tender and edematous prostate gland with ecchymosis. 4. Tender, indurated prostate gland that is warm to the touch.

4. Tender, indurated prostate gland that is warm to the touch.

Nitrofurantoin (Macrodantin) is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints? 1. The client may have contracted the flu. 2. The client is experiencing anaphylaxis. 3. The client is experiencing expected effects of the medication. 4. The client is experiencing a pulmonary reaction requiring cessation of the medication.

4. The client is experiencing a pulmonary reaction requiring cessation of the medication.

What waste product is excreted by the kidneys? 1. Sodium 2. Potassium 3. Aldosterone 4. Urea

4. Urea

A renal stone in the pelvis of the kidney will change kidney function by interfering with the: 1. structural support of the kidney. 2. regulation of the concentration of urine. 3. entry and exit of blood vessels at the kidney. 4. collection and drainage of urine from the kidney.

4. collection and drainage of urine from the kidney.

The nurse identifies a risk for urinary stones in a patient who relates a health history that includes: 1. hyperaldosteronism 2. serotonin deficiency 3. adrenal insufficiency 4. hyperparathyroidism

4. hyperparathyroidism

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1. Infection. 2. Hyperglycemia. 3. Hypophosphatemia. 4. Disequilibrium syndrome.

A week after kidney transplantation, a client develops a temperature of 101 F, the blood pressure is elevated, and the kidney is tender. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse suspects which complication? 1. Acute rejection 2. Kidney infection 3. Chronic rejection 4. Kidney obstruction

A middle aged patient presents to the clinic today with complaints of burning upon urination and feeling as if she is unable to fully empty her bladder. The nurse practitioner suspects that the patient may have a possible urinary tract infection (UTI). Her current medications include warfarin (Coumadin), levothyroxine (Synthroid), and fluoxetine (Prozac). She has no known drug allergies. Which of the following medications would be the most inappropriate to prescribe for treatment of this patient's UTI? A. Bactrim (Trimethoprim/Sulfamethoxazole) B. Macrobid (Nitrofurantoin) C. Keflex (Cephalexin) D. Augmentin (Amoxicillin/Clavulanic acid)

A. Bactrim (Trimethoprim/Sulfamethoxazole) Sulfamethoxazole is a competitive inhibitor of the CYP2C9 enzyme which is responsible for metabolizing warfarin. Therefore, in those taking warfarin, we want to avoid bactrim as it can cause delayed metabolism of the warfarin, increasing the risk of bleeding in the patient. If the only drug of choice is bactrim, we would decrease the dosage of warfarin - or in some instances, completely hold, during the course of the antibiotic.

"An adult patient has 2+ leukocytes, 2+ nitrites, and 2+ blood on a urinalysis. Due to this and their presenting symptoms of urinary frequency, pain with urination, and blood in their urine, the nurse practitioner decides that they likely have a urinary tract infection (UTI). Considering the patient is allergic to sulfas, which of the following treatments would be the most appropriate? " A. Ciprofloxacin (Cipro) BID x 3 days B. Phenazopyridine (Pyridium) BID x 2 days C. Doxycycline (Vibramycin) BID x 7 days D. Bactrim (sulfamethoxazole/trimethoprim) BID x 3 days E. Treatment is not indicated until the results of the culture come back due to antibiotic resistance

A. Ciprofloxacin (Cipro) BID x 3 days "Given the urinalysis results, it is reasonable to treat this patient prophylactically for a UTI. Once the culture is back, we would adjust medication if necessary, but for this patient, the only reasonable option provided is Ciprofloxacin. Phenazopyridine is a useful analgesic, but will not treat the actual infection, and doxycycline is not typically used for UTIs. Other options could be Bactrim (trimethoprim-sulfamethoxazole) if they were not allergic to sulfas, and Macrobid (nitrofurantoin). "

A 21 year old male patient was recently diagnosed with testicular cancer. Which of the following items in the patient's past medical history is considered a risk factor for this type of cancer? A. Cryptorchidism B. Testicular torsion C. Epididymitis D. Varicocele

A. Cryptorchidism One of the biggest risk factors for the development of testicular cancer is a past medical history of cryptorchidism, which is commonly known as an undescended testicle. It is estimated that approximately 10% of men with this condition will later develop testicular cancer.

A patient with condylomata acuminata who the nurse practitioner treated with trichloroacetic acid (TCA) calls the office back and states the skin around the application area is white and looks mildly irritated. Which of the following is the most appropriate plan of care for this patient? A. Gentle washing with soap and water will help clear the healthy skin of the trichloroacetic acid (TCA) B. Come back into the office for steroid cream treatment for the superficial burns C. Make an appointment with dermatology for possible biopsy of the area to rule out malignancy D.Come back into the office for another application of trichloroacetic acid (TCA) to continue to treat the HPV (human papillomavirus)

A. Gentle washing with soap and water will help clear the healthy skin of the trichloroacetic acid (TCA) "When trichloroacetic acid (TCA) is applied to genital warts (condylomata acuminata), a white coating is often left behind. It can be irritating to the skin around the warts, and gentle washing with soap and water can help remove the trichloroacetic acid (TCA) from the healthy skin. Multiple treatments may be required to resolve warts, and it is likely they recur over time. "

The nurse practitioner starts a patient on ciprofloxacin (Cipro) for a urinary tract infection. What is the most important thing to educate the patient on regarding follow up? A. If you develop any heel pain while taking this medication, be sure to follow up as soon as possible B. If you develop any new rash while taking this medication, be sure to call or come in right away C. If your symptoms resolve with the medication, there is no need for follow up D. You should follow up after the course of this antibiotic is over to test that the bacteria are gone

A. If you develop any heel pain while taking this medication, be sure to follow up as soon as possible Fluoroquinolones have a black box warning for achilles tendon rupture. While our patient is on a fluoroquinolone such as ciprofloxacin, they should be educated to be seen immediately for any new heel pain. Antibiotics that contain sulfa such as Bactrim, may cause Stevens-Johnson syndrome so these patients need to be sure to follow up if any new rash develops.

The nurse practitioner performs a wet mount on a female patient who is complaining of a foul smelling vaginal discharge. On the prep, the nurse practitioner notes squamous epithelial cells with blurred edges, and there is also a positive whiff test. Which of the following is the most appropriate treatment plan? A. Metronidazole (Flagyl) 500mg B. 1g of Azithromycin (Z-pak) C. 250mg IM of ceftriaxone (Rocephin) D. This condition will resolve on its own and does not need treatment

A. Metronidazole (Flagyl) 500mg "Bacterial vaginosis, or BV, is a condition in which the pH of the vagina changes, thus allowing for the overgrowth of anaerobic vaginal bacteria. Hallmark parts of diagnosing BV are the presence of clue cells on the wet prep, a homogenous, white, fishy smelling vaginal fluid (positive whiff test) and pH >4.5. BV is not sexually transmitted, so the infected person's partner does not need to be treated. "

The nurse practitioner is doing a chart review of a new patient presenting to the clinic for erectile dysfunction. Which item in the patient's history would not contraindicate the use of sildenafil (Revatio)? A. Muscular dystrophy B. Myocardial infarction in the last year C. Multiple myeloma D. Pigmentary retinopathy

A. Muscular dystrophy Sildenafil has actually been shown in studies to potentially reduce respiratory muscle weakness and lung fibrosis. Therefore, it is not contraindicated to use sildenafil in patients with muscular dystrophy. Cardiac conditions almost always contraindicate the use of PDE-5 inhibitors.

A 23 year old female patient presents with fever, chills, nausea, and painful urination. During the physical examination, the nurse practitioner notes positive costovertebral angle (CVA) tenderness. The patient was recently treated with a 3 day course of nitrofurantoin (Macrobid) for a urinary tract infection, but denies any other past medical history. What does the nurse practitioner suspect? A. Pyelonephritis B. Nephrolithiasis C. Uncomplicated urinary tract infection D. Complicated urinary tract infection

A. Pyelonephritis A patient with a recent history of a urinary tract infection that is now complaining of fever and chills and has costovertebral angle (CVA) tenderness is highly suspicious of pyelonephritis. It often occurs from an untreated or under-treated urinary tract infection that ascends up the ureters to the kidneys. Pyelonephritis is typically treated with ciprofloxacin (Cipro) or referred to the emergency room for treatment.

A sexually active 20-year-old patient comes into your office for evaluation. She states she would like to be tested for all possible sexually transmitted diseases as she is unsure of her last partner's status. Which of the following would be an inappropriate test to order? A. Reflex human papilloma virus (HPV) DNA testing B. Rapid plasma reagin (RPR) test C. Nucleic acid amplification test (NAAT) D. HIV-1/HIV-2 antibody antigen assay test

A. Reflex human papilloma virus (HPV) DNA testing "All of the above choices are reasonable tests to run when a patient, regardless of age, comes in for sexually transmitted infection (STI) testing. Rapid plasma reagin tests can test for syphilis, while the nucleic acid amplification test can be used to detect gonorrhea and chlamydia. The HIV-1/HIV-2 antibody antigen assay test is an extremely specific test to determine HIV infection status. However, due to her age, this patient does not need HPV testing. This is because younger females typically clear any infection so quickly, it is not of a concern. Routine HPv testing begins at age 21 in the presence of an abnormal pap-smear."

A provider has diagnosed a patient with a history significant for falls with benign prostatic hyperplasia. Which medication should the provider prescribe? A. Terazosin (Hyrtin) B. Tadalafil (Cialis) C. Finasteride (Proscar) D. Alendronate (Fosamax)

A. Terazosin (Hyrtin) First line treatment for benign prostatic hypertrophy is generally the alpha blocker class which includes terazosin (Hytrin) and tamsulosin (Flomax). These have a first time dose effect of orthostatic hypotension and this patient should be educated to take the first dose at night when he goes to bed to lower the risk of falls. A 5-alpha reductase inhibitor like finasteride (Proscar) could be a good second line option. These work by reducing the size of the prostate over time, but may take up to 6 months to see full effect.Tadalafil (Cialis) is used for erectile dysfunction. Alendronate (Fosamax) is used for osteoporosis.

A 23-year-old male patient comes into the office complaining of post-ejaculation discharge. He states it is yellow/green in nature and has been staining his underwear. He also has had some pain with urination, but he attributes this to not hydrating well in the warmer weather. He states he has had 4 new female partners this year and "mostly" uses condoms. A nucleic acid amplification test comes back positive for gonorrhea but negative for chlamydia. His vital signs today are as follows: weight 180 lbs, blood pressure 120/60, pulse 68, and temperature 98.4 orally. What is the best treatment plan for this patient today? A. Treat with 500 mg intramuscular ceftriaxone (Rocephin) today and bring back in 3 months to retest B. Treat with 1g intramuscular ceftriaxone (Rocephin) today and bring back in 3 months to retest C. Treat with 500 mg intramuscular ceftriaxone (Rocephin) as well as 1g oral Azithromycin and no retestin

A. Treat with 500 mg intramuscular ceftriaxone (Rocephin) today and bring back in 3 months to retest "The CDC recently updated the treatment guidelines for gonorrhea and chlamydia to exclude co-treatment unless the nucleic acid amplification test for chlamydia also comes back positive. 500mg IM ceftriaxone is the newly recommended treatment for patients who weigh less than 300lbs. For patients over 300lbs, 1g IM ceftriaxone should be used. Gonorrhea can be recognized symptomatically in males by the green/yellow penile discharge and dysuria. "

A patient recently starting the herbal supplement saw palmetto. Which of the following symptoms is the patient likely taking this for? A. Urinary frequency and nocturia B. Mild depressed mood and fatigue C. Dysuria and perineal pain D. Increased forgetfulness

A. Urinary frequency and nocturia Saw palmetto is an herbal supplement used by patients who have benign prostatic hyperplasia (BPH). Symptoms of BPH often include urinary frequency, hesitancy and nocturia. They may also have a weak stream and post-void dribbling.

The provider is performing a digital rectal exam to assess the prostate. What finding is consistent with benign prostatic hyperplasia? A. A swollen and boggy prostate B. An enlarged and rubbery prostate C. A prostate with a painless nodule present D. A firm prostate accompanied with a positive Prehn's sign

An enlarged and rubbery prostate A prostate with BPH typically feels enlarged, symmetrical, smooth, and rubbery. In a patient with prostatitis, the provider would feel a warm, tender, swollen, and boggy prostate. If a provider felt an asymmetrical firm, fixed painless nodule, they should suspect possible prostate cancer. A positive Prehn's sign is associated with epididymitis.

A 20 year old female presents after she found out her partner tested positive for chlamydia recently. She is requesting a pap smear and STD testing at this visit. What should the nurse practitioner tell this patient? A. We will test you for sexually transmitted infections at this visit and can treat the chlamydia with Doxycycline (Vibramycin) B. Even though your gonorrhea is negative, I am going to prescribe you azithromycin (Zithromax) and give you an injection of ceftriaxone (Rocephin). C. I will treat you for the chlamydia and test for other STIs with your pap smear today D. I am going to do a wet mount to assess for chlamydia and gonorrhea and we will talk about treatment based on those results

A. We will test you for sexually transmitted infections at this visit and can treat the chlamydia with Doxycycline (Vibramycin) Because this patient's partner is positive for chlamydia, we can treat this patient with Azithromycin or Doxycycline and test for other sexually transmitted infections. If their gonorrhea or chlamydia test is negative, we do not need to co-treat these conditions. We recommend routine pap smears starting at age 21 regardless of sexual activity. A wet mount is not an appropriate method to test for chlamydia and gonorrhea, but it may help diagnose conditions like trichomoniasis.

A 20 year old female presents after she found out her partner tested positive for chlamydia recently. She is requesting a pap smear and STD testing at this visit. What should the nurse practitioner tell this patient? A. We will test you for sexually transmitted infections at this visit and can treat the chlamydia with Doxycycline (Vibramycin) B. Even though your gonorrhea is negative, I am going to prescribe you azithromycin (Zithromax) and give you an injection of ceftriaxone (Rocephin). C. I will treat you for the chlamydia and test for other STIs with your pap smear today D.I am going to do a wet mount to assess for chlamydia and gonorrhea and we will talk about treatment based on those results

A. We will test you for sexually transmitted infections at this visit and can treat the chlamydia with Doxycycline (Vibramycin) Because this patient's partner is positive for chlamydia, we can treat this patient with Azithromycin or Doxycycline and test for other sexually transmitted infections. If their gonorrhea or chlamydia test is negative, we do not need to co-treat these conditions. We recommend routine pap smears starting at age 21 regardless of sexual activity. A wet mount is not an appropriate method to test for chlamydia and gonorrhea, but it may help diagnose conditions like trichomoniasis.

What serologic test is used to initially screen a patient for syphilis? A. Nucleic acid amplification test (NAAT) B. Rapid plasma reagin (RPR) C. Thayer-Martin test D. Skin culture

B. Rapid plasma reagin (RPR) There are two types of syphilis serologic testing: rapid plasma reagin (RPR) and venereal disease research laboratory (VDLR). If either one of these are positive (reactive), the sample is then sent for confirmatory testing with fluorescent treponemal antibody absorption (FTA-ABS), or another confirmatory test. If this also comes back reactive, it is a definitive diagnosis of syphilis. During treatment, a sequential RPR or VDRL can be used to determine treatment response.

Which of the following would likely be the vaginal pH of a female with a diagnosis of vulvovaginal candidiasis? A. 2.5 B. 4.3 C. 6.8 D. 10

B. 4.3 Vaginal pH is typically unaffected by the presence of vulvovaginal candidiasis, and therefore would be normal. A normal vaginal pH is between 4.0-4.5. Conditions such as bacterial vaginosis or trichomoniasis can increase the pH to >5.

Renal function is assessed in a variety of conditions. Which of the following is true regarding glomerular filtration rate (GFR) and creatinine? A. A serum creatinine is a more accurate indicator of kidney function than the glomerular filtration rate B. A glomerular filtration rate will decrease as a patient ages, but the creatinine will increase C. A low creatinine level may indicate the start of kidney disease D.African American patients have a slightly lower glomerular filtration rate than other ethnicities

B. A glomerular filtration rate will decrease as a patient ages, but the creatinine will increase The glomerular filtration rate (GFR) decreases as patients age as well as in kidney disease or failure. The GFR and creatinine usually have an inverse relationship. Therefore, as a patient develops kidney disease, their creatinine will rise. African Americans have a slightly higher GFR than other ethnicities and this is taken into account when measuring a patient's GFR levels. A normal glomerular filtration rate (GFR) is typically >90 mL/min.

Which of the following assessment findings would be an abnormal finding on a digital rectal exam? A. A sphincter that is reactive to stimulation B. A large, rubbery prostate C. The mucosal walls are smooth within the rectum D. A prostate that is 2-3 cm in size but wider at the top

B. A large, rubbery prostate A digital rectal exam is used to assess the prostate in male patients. A normal prostate is smooth, firm, and nontender. Any deviation from this including enlargement, rubbery feel, or a boggy, warm prostate, warrants further investigation.

A patient presents with worsening symptoms of urinary hesitancy, a weak stream, and post void dribbling. Which of the following medications would not exacerbate this patient's condition? A. Nortriptyline (Pamelor) B. Citalopram (Celexa) C. Diphenhydramine (Benadryl) D. Scopolamine patch

B. Citalopram (Celexa) Tricyclic antidepressants like amitriptyline and nortriptyline have anticholinergic side effects and may worsen symptoms of benign prostatic hypertrophy (BPH). Other medications that have anticholinergic side effects include older generation antihistamines like benadryl, scopolamine, some COPD medications like tiotropium or ipratropium, and atropine.

The nurse practitioner is reviewing the results of a urinalysis. The sample is positive for red blood cells, as well as red blood cell casts. Which of the following would be the biggest concern with this patient based on these results? A. Nephrolithiasis B. Glomerulonephritis C. Pyelonephritis D. Amyloidosis

B. Glomerulonephritis Casts, either white blood cell or red blood cell, are both concerning when seen on a urinalysis result. White blood cell casts can indicate pyelonephritis, while red blood cells can indicate glomerulonephritis. Both of these results would warrant a referral and further investigation.

A 24-year-old female patient comes in for her routine pap-smear. Her last pap smear was performed 3 years ago and was normal. Upon cervical exam, you notice an erythematous cervix with some purulent discharge around the cervical os. She states she has been having unprotected sex with "a few" males and was last tested for STIs a couple of years ago. Based on this information and these clinical findings, what would be the priority test to order today? A. Rapid plasma reagin (RPR) B. Nucleic acid amplification test (NAAT) C. Venereal disease research laboratory (VDRL) D. HIV-1/HIV-2 antibody antigen assay test

B. Nucleic acid amplification test (NAAT) "Chlamydial infection commonly presents with no symptoms, which is why cervical exams are so valuable. Female patients may experience post-coital bleeding, and vaginal discharge, but the majority experience no symptoms related to infection. Male patients sometimes experience urethritis, but can also transmit infection with no symptoms. The test of choice for both chlamydia and gonorrhea is a Nucleic acid amplification test (NAAT). "

A 45 year old female presents to the clinic with urinary frequency, urgency, and burning with urination. She denies flank pain and her temperature today is 98.6F. She has a history of type 2 diabetes, which she manages with metformin (Glucophage). The patient is concerned as she has had three urinary tract infections within the last six months. What should be included in the plan of care for this patient? Select all that apply by choosing two of the following answer choices. A. Refer the patient for a voiding cystourethrogram B. Order a urine culture and sensitivity C. Educate the patient to abstain from intercourse for at least one month after completing antibiotic treatment D. Prescribe Doxycycline (Vibramycin) and discuss low dose empiric antibiotic therapy to prevent recurrent urinary tract infections E. Order a Hemoglobin A1C

B. Order a urine culture and sensitivity E. Order a Hemoglobin A1C When a patient is having recurrent urinary tract infections, further investigation is warranted. Oftentimes, frequent infections are a sign of poorly controlled diabetes, so a HbA1C should be ordered at today's visit. It is also appropriate to order a urine culture to identify the bacterial cause of the UTI as it will ensure that the correct antibiotics are ordered for this patient. Doxycycline is not a first line treatment option for UTIs. A voiding cystourethrogram is typically indicated in children with suspected vesicoureteral reflux. In addition, there is no need to abstain from intercourse for a month after antibiotic treatment.

The nurse practitioner is reviewing the pap-smear results for a 30-year old patient. The report notes that there are atypical squamous cells of undetermined significance with positive HPV. What is the best plan of action for this patient? A. Reflex HPV DNA testing; refer for colposcopy if positive for HPV (human papillomavirus) types 16 or 18 B. Refer for colposcopy C. Reflex HPV (human papillomavirus) DNA testing; repeat in 1 year if not positive for HPV types 16 or 18 D. Refer for loop electrosurgical excision procedure

B. Refer for colposcopy "When cytology results come back as atypical squamous cells of undetermined significance and the patient is 30 years of age or older, it is recommended to have co-testing for HPV done. This is insurance dependant if we test for it at the same time as the initial pap-smear, or if it is to be done if the results come back abnormal. If the HPV is positive, referring for colposcopy is appropriate due to the lower HPV clearance rate in women 30 and older. "

"A 25-year-old patient comes in complaining of unilateral testicular pain. Upon examination, his scrotum is swollen and hot, and there is relief of pain when elevating the testicle. Which of the following would be the best treatment plan for this patient? " A. Refer to the ED immediately B. Start a course of doxycycline (vibramycin) C. Start a course of ciprofloxacin (cipro) D. Start a course of ciprofloxacin (cipro)

B. Start a course of doxycycline (vibramycin) This is a classic case of epididymitis. The key findings here are the positive Phren's sign and the unilateral, swollen scrotum. For patients under 35, doxycycline is the drug of choice. For patients over 35, we choose ciprofloxacin.

A 29-year-old female patient comes in for her annual well woman exam and she is also due for a pap-smear. She states she has had 3-4 male sexual partners over the last year, and "sometimes" uses condoms. She states she sometimes feels vaginal itching but it "comes and goes''. During her exam, the nurse practitioner notes an erythematous cervix with tiny papillary hemorrhages. This finding is typically indicative of which of the following? A. Bacterial vaginosis B. Trichomoniasis C. Syphilis D. Chlamydia

B. Trichomoniasis "Trichomoniasis is a sexually transmitted infection caused by a parasite. It is one of the most common sexually transmitted infections, and may present as vaginal itching and foul smelling discharge in women. Many infected people have no symptoms at all. A strawberry cervix,which presents as an erythematous cervix with hemorrhages, is a hallmark finding of trichomoniasis. Partners should also be treated as trichomoniasis is a sexually transmitted infection."

A 20 year old female patient comes into the clinic with complaints of greenish-yellow, purulent vaginal discharge and irritation. She has been noticing post-coital bleeding as well. She recently tried a 3 day course of over the counter miconazole (Monistat) vaginal cream with no relief. Which of the following should be included in the nurse practitioner's assessment? A. Pap smear only B. Wet mount without KOH prep C. Pap smear and wet mount D. Wet mount with KOH prep

B. Wet mount without KOH prep In this patient, the nurse practitioner should suspect trichomoniasis due to the green or yellow colored discharge and post-coital bleeding. This patient has also tried an over the counter antifungal with no relief. On a wet mount, KOH prep could kill the organisms and flagella seen with trichomoniasis. Therefore, it would be best to first assess without KOH prep. Due to this patient's age, she is not an appropriate candidate for a pap smear yet.

A symptomatic female patient presents with complaints of a possible vaginal infection. When looking at the wet mount you see that there is movement on the slide via flagella. What infection do you believe the patient has based on these wet mount findings? A. Herpes simplex virus B. Gonorrhea C. Trichomoniasis D. Bacterial Vaginosis

D. Bacterial Vaginosis A wet mount that shows mobile trichomonads that move with help of flagella is a positive test for trichomoniasis. Bacterial vaginosis would have clue cells on the wet mount. A wet mount is not used to identify gonorrhea or HSV.

A patient with type 2 diabetes comes in for a follow-up visit. He is wondering why he needs to have "kidney tests" done yearly if he feels fine and his diabetes is under control. With regards to chronic kidney disease, which is the most appropriate response to this patient by the nurse practitioner? A. "You can go to every other year testing now that your diabetes is controlled unless you start becoming symptomatic." B. "Chronic kidney disease never has symptoms, so it is important to screen for it frequently." C. "Chronic kidney disease often shows no symptoms until later stages, so it is important to screen frequently." D. "Since you have diabetes, you are already in at least stage 1 of chronic kidney disease, so it is important to screen to make sure it does not progress."

C. "Chronic kidney disease often shows no symptoms until later stages, so it is important to screen frequently." "Chronic kidney disease (CKD) is broken into 5 stages. Stage I has a GFR still >90 mL/min, but there is kidney damage, Stage II is 60-89mL/min, Stage III is GFR of 30-59 mL/min, Stage IV is 15-29 mL/min, and Stage V, or end stage, is a GFR < 15mL/min. To diagnose CKD, the GFR needs to be <60 mL/min for 3 months or longer. A common finding in CKD is that although the kidneys are damaged, there are no outward symptoms, which is why it is so important to screen high risk patients, like diabetics, frequently."

A 27-year-old male patient comes into the office for a follow up on an STI screening after recent intercourse with a new partner. All tests are negative except the Nucleic acid amplification test (NAAT) which is positive for chlamydia. What would be the best treatment option for this patient? A. 500mg IM injection of ceftriaxone (Rocephin) and 1g oral azithromycin B. 250mg oral azithromycin once a day for 5 days C. 100mg doxycycline twice a day for 7 days D. 100mg oral augmentin twice a day for 7 days

C. 100mg doxycycline twice a day for 7 days "Chlamydial infections should be treated when detected to avoid long term complications like pelvic inflammatory disease in females and sterility in males. Chlamydia is typically treated with 1g oral azithromycin, without co-treatment for gonorrhea. Another treatment option for chlamydia is 100mg doxycycline twice a day for 7 days. "

Which patient complaining of scrotal pain and fever mostly likely has an infection caused by the organism Neisseria gonorrhoeae? A. A 54-year-old who lost his wife 6 months ago to ovarian cancer B. A 16-year-old high school sophomore who is not yet sexually active C. A 21-year old college student who has unprotected intercourse on a regular basis D. A 78-year-old residing in an assisted living facility

C. A 21-year old college student who has unprotected intercourse on a regular basis Patients under the age of 35 who are sexually active with epididymitis obtain the infection from sexually transmitted infections such as gonorrhea. Patients over the age of 35 who are not sexually active typically get epididymitis from urinary tract infections caused by E. coli.

Which of the following labs is not a part of a routine urinalysis with microscopic exam? A. Gross evaluation B. Dipstick analysis C. Bacteria culture D. Urine sediment exam

C. Bacteria culture "A complete urinalysis (UA) consists of a gross evaluation, dipstick analysis and a microscopic examination of urine sediment. A UA can be used to screen patient urine for items like glucose, blood, leukocytes, and nitrites. While a UA is not a diagnostic test, it can be useful for guiding diagnostic tests."

A middle aged patient presents to the clinic for a follow up after requiring lithotripsy for several kidney stones. When reviewing the report from the urologist, it is noted that the patient had stones composed of calcium oxalate specifically. The patient be educated to avoid all of the following foods to ideally prevent these stones from occurring again except: A. Chocolate B. Spinach C. Broccoli D. Rhubarb E. Tangerines

C. Broccoli Calcium oxalate stones are the most common type of kidney stone. When a patient consumes too many foods that are high in oxalate, it is difficult for the kidneys to filter it out efficiently which leads to the oxalate binding with calcium. This binding then leads to the formation of kidney stones. Foods high in oxalate include items such as chocolate, spinach, rhubarb, beans, tangerines, coffee, cranberries, etc.

You are seeing a 31 year old patient who is 28 weeks pregnant for a routine check up. She reports doing well, however her routine urine screen came back positive for leukocytes and nitrites. What is the most appropriate plan for this patient? A. Do not initiate treatment day as she is asymptomatic. Advise that she monitor for signs and symptoms and call if she begins to experience any. B. Nitrofurantoin (Macrobid) C. Cephalexin (Keflex) D. Trimethoprim/Sulfamethoxazole (Bactrim)

C. Cephalexin (Keflex) Although this patient is asymptomatic, this urinary tract infection (UTI) must be treated as she is pregnant and it is considered a complicated urinary tract infection (UTI). At 28 weeks along, she is now in the third trimester making cephalexin (Keflex) the most appropriate and safe choice as it is category B and safe throughout the entire pregnancy.

In the primary care setting, what is considered the best measure for renal function? A. Blood urea nitrogen (BUN):Creatinine (Cr) ratio B. Blood urea nitrogen (BUN) C. Estimated glomerular filtration rate (eGFR) D. Serum creatinine

C. Estimated glomerular filtration rate (eGFR) While all of the labs listed above can help evaluate renal function, the best measure is the estimated glomerular filtration rate (eGFR). It varies according to age, race, body size, and gender. The GFR is used to diagnose which stage of kidney disease patients are in.

After speaking with a 35-year-old female patient, the nurse practitioner is concerned that the patient may have trichomoniasis. What symptoms, described by the patient, would lead the nurse practitioner to this differential diagnosis? A. Itching and discharge that looks like cottage cheese B. Pain with defecation and during intercourse C. Lower abdominal pain and green discharge D. Grey discharge that has a fishy odor

C. Lower abdominal pain and green discharge Classic symptoms that occur with trichomoniasis include lower abdominal pain, green-yellow, frothy, and malodorous discharge, and pain and itching around the vagina. Cottage cheese discharge is concerning for a yeast infection, painful intercourse and defecation could be indicative of endometriosis, and grey discharge with a fishy odor is a classic representation of bacterial vaginosis.

After initial testing, a 42-year-old female patient is diagnosed with a trichomoniasis infection. What is the treatment for this infection? A. Metronidazole (Flagyl) PO for the patient B. Ceftriaxone (Rocephin) IM for the patient C. Metronidazole (Flagyl) PO for both the patient and her partner D. Azithromycin (Zithromax) PO for both the patient and her partner

C. Metronidazole (Flagyl) PO for both the patient and her partner A trichomoniasis infection can be treated with an oral course of metronidazole (Flagyl). Trichomoniasis is a sexually transmitted infection (STI) so the patient's sexual partner should be treated as well. Ceftriaxone (Rocephin) is used to treat gonorrhea, and azithromycin (Zithromax) is used to treat chlamydia.

The nurse practitioner is reviewing the urinalysis results of a young adult patient with a suspected urinary tract infection (UTI). She does not have a frequent history of UTI's and is noted to be allergic to penicillins. It is noted in the sample that a multitude of squamous epithelial cells are present. Which of the following is the most appropriate treatment plan for this patient? A. Prescribe the patient a three day course of Macrobid (nitrofurantoin), and order a urine culture & sensitivity B. Prescribe the patient a seven day course of Ciprofloxacin (Cipro), and instruct the patient there is no need to follow up as long as symptoms resolve C. Order an additional urinalysis to review D. Educate the patient on lifestyle interventions for preventing urinary tract infections in the future such as cranberry tablets

C. Order an additional urinalysis to review Squamous epithelial cells in the patient's urine are oftentimes indicative of the sample being contaminated by cells in the patient's vaginal opening. Due to this possible contamination, a second urinalysis needs to be performed prior to deciding a possible empiric treatment plan.

The nurse practitioner is reviewing the pap-smear results for a 21-year old patient. The report notes that there are atypical squamous cells and can not exclude high-grade squamous intraepithelial cells (ASC-H). Which of the following is the best plan of action for this patient? A. Have her come back for a repeat pap-smear in 1 year B. Reflex HPV (human papillomavirus) DNA testing; repeat in 1 year if not positive for HPV types 16 or 18 C. Refer for colposcopy D. Have her come back in 3 years as this is not a concerning finding

C. Refer for colposcopy "When cytology results come back as atypical squamous cells that can not exclude high-grade intraepithelial changes, regardless of age, we refer for a colposcopy. This is because high-grade changes in the intraepithelial cells can indicate pre-cancerous cells. A colposcopy can visualize the cervix and collect biopsies if needed, which can help diagnose early cervical cancer, which is key to treatment and survival."

A patient presents to the office after testing positive for chlamydia. She states she recently had sex with a male partner who was not her boyfriend, and does not want her boyfriend to find out. She asks if the provider is going to tell anyone as she is very embarrassed. Which of the following is the most appropriate response? A. The provider does not have to tell anyone if the patient submits a written request B. The provider must witness the patient call and inform her most recent sexual partner C. She can be responsible for telling her partner(s) but the provider must report the positive chlamydia result D. She can "opt-out" of the provider reporting the results as long as she tells her partner(s)

C. She can be responsible for telling her partner(s) but the provider must report the positive chlamydia result She can "opt-out" of the provider reporting the results as long as she tells her partner(s) Chlamydia remains a reportable disease per the CDC. This means that every case needs to be reported. It is also imperative that all partners are treated, but it is not the provider's responsibility to make sure they are informed and treated. If necessary, additional doses of azithromycin can be sent for the patient's partner(s) without seeing them in office.

Which of the following wet mount descriptions would make the nurse practitioner suspect bacterial vaginosis? A. White blood cells that are too numerous to count B. Bacterial coated vaginal cells with sharp margins C. Squamous epithelial cells with blurred margins that are coated with bacteria D. There is movement present from several organisms and flagella

C. Squamous epithelial cells with blurred margins that are coated with bacteria Bacterial vaginosis would reveal a wet mount with clue cells, or squamous epithelial cells with blurred margins coated with bacteria, that may resemble peppered eggs. A wet mount that reveals too many white blood cells to count is indicative of an infection, such as chlamydia or gonorrhea. The presence of flagella may indicate trichomoniasis.

The nurse practitioner prescribes a patient with benign prostatic hyperplasia terazosin (Hytrin) to help treat his condition. What is an important teaching point in regards to this medication? A. This medication will shrink the prostate and help you urinate more easily B. This medication may make you drowsy, so take before bed C. This medication may make you dizzy the first time you take it, so take before bed D. This medication may raise your blood pressure

C. This medication may make you dizzy the first time you take it, so take before bed Alpha blockers, like terazosin, cause vasodilation. Because of this, they can cause a massive drop in blood pressure, and dizziness for patients - especially during the first dose. It is important to educate patients on this risk and have them take their medication before bedtime to avoid any complications from dizziness.

A nurse practitioner is teaching a student how to perform a pap smear. Which of the following statements would be the most appropriate to include in her teaching? A. "It is abnormal if there is mild pain during the pap smear. If that happens, you will need to stop and start over with a new speculum." B. "If the cervix is friable, you will need to go ahead and order HPV testing as well regardless of the patient's age." C. "After the pap smear, be sure to cleanse the cervix with normal saline to prevent abnormal cells from forming." D. "It is critical to obtain an adequate sample. This means you need to obtain cells from the transformation zone."

D. "It is critical to obtain an adequate sample. This means you need to obtain cells from the transformation zone." The transformation zone is the most common place for abnormal cells to develop in the cervix. The transformation zone consists of both squamous epithelial cells as well as endocervical cells. Obtaining an adequate sample from this zone is critical as otherwise possible precancerous or cancerous cells may be inadvertently missed.

"The nurse practitioner diagnoses a 19-year-old patient with condylomata acuminata in your office. The patient asks about possible treatment plans. Which of the following is an appropriate response?" A. "These should resolve on their own as your body turns over new cells." B. "We should refer you for a biopsy because these can be precancerous." C. "An injection of penicillin G benzathine (Bicillin) will treat the underlying syphilis and the condylomata acuminata." D. "Trichloroacetic acid (TCA) can be applied to the condylomata acuminata to help kill the cells."

D. "Trichloroacetic acid (TCA) can be applied to the condylomata acuminata to help kill the cells." Trichloroacetic acid (TCA) is used to treat condylomata acuminata, also known as genital warts. Genital warts are usually caused by the 6 and 11 strains of HPV. A small amount is applied to each wart, which starts to freeze the cells and help kill off the virus. Multiple treatments may be required to resolve warts, and it is likely they recur over time.

Which of the following assessment findings on a digital rectal exam is consistent with acute bacterial prostatitis? A. A symmetrically enlarged, rubbery prostate B. A prostate with multiple hard nodules present on the posterior surface C. A smooth, peach shaped prostate D. A tender, warm, and boggy prostate

D. A tender, warm, and boggy prostate Acute bacterial prostatitis is an infection of the prostate gland itself. This can cause a wide variety of symptoms, both localized and systemic. The prostate is typically tender to palpation, warm to the touch and boggy overall. A symmetrically enlarged, rubbery prostate is common to see with benign prostatic hyperplasia. Nodules on the prostate may indicate neoplasms are present.

A 24-year-old male patient calls the office asking for a renewal of his oral antiviral medication he was prescribed for recurrent HSV1 lesions. He states he feels "tingling" near the corner of his lip, which is what happens before he gets an outbreak. Which of the following is the most appropriate response? " A. He should try an over the counter treatment like Abreva (docosanol 10%) before he tries oral medication B. Oral antivirals are only effective after lesions appear, so it is too soon to treat him C. He should be seen in the office for an FTA-ABS test to determine the root cause of these outbreaks D. Call in a prescription renewal as oral antivirals are most effective when taken within the first few days of an outbreak

D. Call in a prescription renewal as oral antivirals are most effective when taken within the first few days of an outbreak HSV1 (Herpes simplex virus) is a common virus that an estimated 80% of the population carries. It causes recurrent outbreaks of vesicular lesions or "cold sores" usually around the mouth. Treatment is not curative, but can shorten the duration of the outbreak. Antiviral therapy should be initiated in the first 48-72 hours of the outbreak beginning. Patients often describe itching or burning in the area before the vesicles appear, cluing them in that an outbreak is beginning.

A middle aged patient presents with complaints of numbness and tingling in her buttocks and the inner aspects of her thighs. She also states that in the last several days, she has been having new bouts of incontinence which she has never had before. Which of the following is the most likely differential diagnosis? A. Reflex incontinence B. Functional incontinence C. Sciatica D. Cauda equina syndrome

D. Cauda equina syndrome Cauda equina syndrome presents with several early signs and symptoms such as "saddle anesthesia," incontinence and bilateral lower extremity weakness. Saddle anesthesia is when there is numbness, tingling, and/or loss of sensation in the areas of the body that would normally touch a saddle when riding a horse. Various types of incontinence would not present with symptoms such as numbness, tingling or loss of sensation. New concerns with incontinence would be unrelated to a sciatica diagnosis.

The nurse practitioner is teaching a young adult patient about how to prevent a urinary tract infection through lifestyle modifications. Lifestyle modifications are imperative in preventing future urinary tract infections. The nurse practitioner knows this is because which of the following bacteria is the leading cause? A. Klebsiella pneumoniae B. Enterococcus faecalis C. Staphylococcus aureus D. Escherichia coli

D. Escherichia coli Escherichia coli (E. coli) causes almost ninety percent of all urinary tract infections. This is due to the fact that E. coli is commonly present in the feces. This leads to easy contamination of the urinary tract if the patient has poor hygiene practices.

Which of the following labs is most specific to the kidneys? A. Blood urea nitrogen (BUN) is most specific to the kidneys because it measures how well the kidneys are filtering out the urea build up in the bloodstream B. Creatinine clearance is most specific to the kidneys as it is freely filtered out by the glomerulus C. Potassium level is most specific to the kidneys because they are responsible for filtering out potassium from the bloodstream D. Glomerular filtration rate (GFR) is most specific to the kidneys because it measures the blood that is passed through the glomeruli every minute

D. Glomerular filtration rate (GFR) is most specific to the kidneys because it measures the blood that is passed through the glomeruli every minute "GFR is the most specific test to the kidneys, and for this reason, it is used to stage chronic kidney disease (CKD). CKD is staged off of the worsening glomerular filtration rate. Remember, a normal GFR is >90 mL/min. Stage I has a GFR still >90 mL/min, but there is kidney damage, Stage II is 60-89mL/min, Stage III is 30-59 mL/min, Stage IV is 15-29 mL/min, and Stage V, or end stage, is a GFR < 15mL/min. To diagnose CKD, the GFR needs to be <60 mL/min for 3 months or longer. "

When educating a middle-aged patient about how to stay healthy, what suggestions could the nurse practitioner give to help reduce the patient's overall risk of kidney disease? A. Initiate measures to lower their blood pressure that was 155/93 today, Promote at least 150 minutes of physical activity per week B. Promote at least 150 minutes of physical activity per week, Discuss smoking cessation due to the fact that he smokes 1 pack per day C. Discuss smoking cessation due to the fact that he smokes 1 pack per day, Implement ways to lower his glycosylated hemoglobin (HgbA1c) from 8.4% today D. Implement ways to lower his glycosylated hemoglobin (HgbA1c) from 8.4% today, Initiate measures to lower their blood pressure that was 155/93 today E. Discuss dietary supplements to increase his hemoglobin that was 11.7 mg/dL today, Initiate measures to lower their blood pressure that was 155/93 today

D. Implement ways to lower his glycosylated hemoglobin (HgbA1c) from 8.4% today, Initiate measures to lower their blood pressure that was 155/93 today In the United States, the two leading causes of chronic kidney disease (CKD) are high blood pressure and diabetes. A sedentary lifestyle can lead to obesity that can contribute to CKD, but is not a leading cause of the disease. Smoking can cause heart disease, which may impact the kidneys, but is not a leading cause. CKD can cause anemia, but anemia does not increase the risk of developing CKD.

Chlamydia is one of the most common sexually transmitted diseases throughout the United States. In females specifically, if Chlamydia is left untreated, which of the following may occur? A. Pelvic Inflammatory Disease (PID), Eye infections, Ectopic Pregnancy C. Ectopic Pregnancy, Polycystic ovarian syndrome (PCOS), Pelvic Inflammatory Disease (PID) C. Urethral strictures, Uterine prolapse, Recurrent bacterial vaginosis D. Infertility, Pelvic Inflammatory Disease (PID), Urethral strictures, Ectopic Pregnancy E. Eye infections, Pelvic Inflammatory Disease (PID), Intrauterine growth restriction

D. Infertility, Pelvic Inflammatory Disease (PID), Urethral strictures, Ectopic Pregnancy Eye infections are most commonly seen with a diagnosis of Gonorrhea, not Chlamydia. Untreated chlamydia can lead to a wide host of complications including PID, ectopic pregnancy, urethral strictures, and infertility. That is why it is so important that it is treated promptly.

A 25 year old female patient presents with lower abdominal pain as well as pain when urinating and having intercourse. During the physical exam, there are copious amounts of yellow-green vaginal discharge present. Which of the following would be the best diagnostic tool to use for this condition? A. Buccal swab B. Rapid plasma reagin (RPR) test C. Fluorescent treponemal antibody absorption (FTA-ABS) test D. Nucleic acid amplification (NAAT) test

D. Nucleic acid amplification (NAAT) test Both the RPR & FTA-ABS diagnostic tests are used for a diagnosis of syphilis. As it appears this patient has gonorrhea, a NAAT test would be most appropriate. A buccal swab would be inappropriate at this time.

The nurse practitioner is examining the results of a wet mount for a patient suspected to have a vulvovaginal candidiasis infection. Which of the following on a wet mount would indicate that this is the likely differential? A. Overgrowth of squamous epithelial cells B. Flagellated organisms C. Clue cells D. Pseudohyphae

D. Pseudohyphae "Vulvovaginal candidiasis, commonly referred to as a yeast infection, is one of the most common causes of vaginal irritation and discharge. It can be identified by pseudohyphae, spores, and bud cells present on a wet mount. Patients also commonly describe a chunky white vaginal discharge and intense itching. Flagellated organisms are seen with Trichomoniasis infections, and clue cells are seen with bacterial vaginosis."

A young adult female patient was recently treated for Chlamydia, and returns to the clinic today for a new painless sore present on her left labia. Which diagnostic test would be most appropriate in the diagnosis of possible syphilis? A. Gen-probe assay B. Wet mount C. KOH prep D. Rapid plasma reagin test

D. Rapid plasma reagin test The key finding in this question is the presence of a painless sore. This is indicative of a possible diagnosis of syphilis. The preferred method to screen for syphilis is the RPR, also known as the rapid plasma reagin test.

A 19 year old male patient presents to the clinic with concerns about a new "heaviness" on the right side of his scrotum. An in-office ultrasound reveals a solid mass present on the right testicle. Which of the following is the most appropriate plan of care for this patient? A. Instruct the patient to follow up in 4 weeks if this does not resolve spontaneously on its own B. Perform transillumination of the testicle for further evaluation C. Educate the patient that this is a hydrocele and will likely need surgical intervention D. Refer the patient as this is likely testicular cancer and a testicular biopsy will need to be performed

D. Refer the patient as this is likely testicular cancer and a testicular biopsy will need to be performed The solid mass noted on the patient's ultrasound in conjunction with his symptoms is highly suspicious of possible testicular cancer. This type of cancer commonly occurs in males 15-35 years old, and classically presents as a singular sided "heaviness." Transillumination is not needed as the ultrasound confirmed the possible suspicion and need for referral.

A woman at 18 weeks gestation obtains a urine sample as part of a routine prenatal visit. She denies any pain or burning with urination, but there are positive leukocytes and nitrites present on the urinalysis. Which of the following is true regarding treatment? A. Since she does not have any active symptoms, she does not require treatment. B. She should get a 3 day course of Ciprofloxacin (Cipro) for her urinary tract infection C. She should be sent to the hospital for treatment as there is concern for pyelonephritis D. She can be treated with Amoxicillin (Amoxil) for her urinary tract infection

D. She can be treated with Amoxicillin (Amoxil) for her urinary tract infection Pregnant patients with urinary tract infections are more likely to develop complications such as pyelonephritis which can lead to preterm delivery and low birth weight infants. Because of this, it is recommended to treat asymptomatic bacteriuria in pregnant women with antibiotics. Amoxicillin is safe throughout all trimesters of pregnancy and can be used for urinary tract infections as long as the bacteria is susceptible. Antibiotics such as Keflex (Cephalexin) and Macrobid (Nitrofurantoin) can also be used during particular trimesters, but fluoroquinolones like Ciprofloxacin should be avoided in pregnant women.

A retrograde pyelogram is a non-invasive procedure. True or False

False

Is it common to have bright red bleeding after a cystoscope? True or False

False

Transurethral resection of the prostate usually involves complete removal of the entire gland. True or False

False

Lower tract UTI's generally do not involve systemic symptoms. True or False

True