NR574/ NR 574 Midterm Exam (2026/2027 New Update) Acute Care Practicum Review | Week 1-4 | Verified Questions and Answers| 100% Correct- Chamberlain

NR574/ NR 574 Midterm Exam (2026/2027 New Update) Acute Care Practicum Review | Week 1-4 | Verified Questions and Answers| 100% Correct- Chamberlain Q. A nurse obtains a clients health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client? a. I drink two glasses of red wine each week. b. I take a lot of Tylenol for my arthritis pain. c. I have a cousin who died of liver cancer. d. I got a hepatitis vaccine before traveling. ANSWER B Q. A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the client daily. ANSWER B Q. A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 18 to 14 breaths/min d. A decrease in the clients weight by 6 kg ANSWER A Q. A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a. Sedate the client to prevent tube dislodgement. b. Maintain balloon pressure at 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Assess the client for airway patency. ANSWER D Q. A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices. Which clinical manifestation should alert the nurse to a serious adverse effect? a. Nausea and vomiting b. Frontal headache c. Vertigo and syncope d. Mid-sternal chest pain ANSWER D Q. A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond? a. A low-protein diet will help the liver rest and will restore liver function. b. Less protein in the diet will help prevent confusion associated with liver failure. c. Increasing dietary protein will help the client gain weight and muscle mass. d. Low dietary protein is needed to prevent fluid from leaking into the abdomen. ANSWER B Q. A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, I do not want to take this medication because it causes diarrhea. How should the nurse respond? a. Diarrhea is expected; thats how your body gets rid of ammonia. b. You may take Kaopectate liquid daily for loose stools. c. Do not take any more of the medication until your stools firm up. d. We will need to send a stool specimen to the laboratory. ANSWER A Q. After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. Some medications have been known to cause hepatitis A. b. I may have been exposed when we ate shrimp last weekend. c. I was infected with hepatitis A through a recent blood transfusion. d. My infection with Epstein-Barr virus can co-infect me with hepatitis A. ANSWER B Q. A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner ANSWER A Q. A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this clients discharge education? a. Use a pill organizer to ensure you take this medication as prescribed. b. Transient muscle aching is a common side effect of this medication. c. Follow up with your provider in 1 week to test your blood for toxicity. d. Take your radial pulse for 1 minute prior to taking this medication. ANSWER A Q. After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the clients understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching? a. I should drink bottled water during my travels. b. I will not eat off anothers plate or share utensils. c. I should eat plenty of fresh fruits and vegetables. d. I will wash my hands frequently and thoroughly. ANSWER C Q. An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel mark across the clients chest. Which action should the nurse take? a. Ask the client where in the car he or she was sitting during the crash. b. Assess the client by gently palpating the abdomen for tenderness. c. Notify the laboratory to draw blood for blood type and crossmatch. d. Place the client on the stretcher in reverse Trendelenburg position. ANSWER B Q. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver? a. A 22-year-old with a history of blunt liver trauma b. A 48-year-old with a history of diabetes mellitus c. A 66-year-old who has a history of cirrhosis d. An 82-year-old who has chronic malnutrition ANSWER C Q. A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, I am experiencing right flank pain and have a temperature of 101 F. How should the nurse respond? a. The anti-rejection drugs you are taking make you susceptible to infection. b. You should go to the hospital immediately to have your new liver checked out. c. You should take an additional dose of cyclosporine today. d. Take acetaminophen (Tylenol) every 4 hours until you feel better. ANSWER B Q. After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I cannot drink any alcohol at all anymore. b. I need to avoid protein in my diet. c. I should not take over-the-counter medications. d. I should eat small, frequent, balanced meals. ANSWER B Q. A nurse cares for a client with hepatopulmonary syndrome who is experiencing dyspnea with oxygen saturations at 92%. The client states, I do not want to wear the oxygen because it causes my nose to bleed. Get out of my room and leave me alone! Which action should the nurse take? a. Instruct the client to sit in as upright a position as possible. b. Add humidity to the oxygen and encourage the client to wear it. c. Document the clients refusal, and call the health care provider. d. Contact the provider to request an extra dose of the clients diuretic. ANSWER A Q. A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)? a. Have the client sign the informed consent form. b. Assist the client to void before the procedure. c. Help the client lie flat in bed on the right side. d. Get the client into a chair after the procedure. ANSWER B Q. A nurse cares for a client who has chronic cirrhosis from substance abuse. The client states, All of my family hates me. How should the nurse respond? a. You should make peace with your family. b. This is not unusual. My family hates me too. c. I will help you identify a support system. d. You must attend Alcoholics Anonymous. ANSWER C Q. A nurse cares for a client with hepatitis C. The clients brother states, I do not want to contract this infection, so I will not go into his hospital room. How should the nurse respond? a. If you wear a gown and gloves, you will not get this virus. b. Viral hepatitis is not spread through casual contact. c. This virus is only transmitted through a fecal specimen. d. I can give you an update on your brothers status from here. ANSWER B An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.) a. Policies related to consistent use of Standard Precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner a,c,d,e A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT) b,e,f A nurse delegates hygiene care for a client who has advanced cirrhosis to an unlicensed nursing personnel (UAP). Which statements should the nurse include when delegating this task to the UAP? (Select all that apply.) a. Apply lotion to the clients dry skin areas. b. Use a basin with warm water to bathe the client. c. For the clients oral care, use a soft toothbrush. d. Provide clippers so the client can trim the fingernails. e. Bathe with antibacterial and water-based soaps. a,c,d A nurse assesses a male client who has symptoms of cirrhosis. Which questions should the nurse ask to identify potential factors contributing to this laboratory result? (Select all that apply.) a. How frequently do you drink alcohol? b. Have you ever had sex with a man? c. Do you have a family history of cancer? d. Have you ever worked as a plumber? e. Were you previously incarcerated? A,B,E A nurse plans care for a client who has hepatopulmonary syndrome. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Oxygen therapy b. Prone position c. Feet elevated on pillows d. Daily weights e. Physical therapy A,C,D An emergency room nurse assesses a client with potential liver trauma. Which clinical manifestations should alert the nurse to internal bleeding and hypovolemic shock? (Select all that apply.) a. Hypertension b. Tachycardia c. Flushed skin d. Confusion e. Shallow respirations B,D The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA view shows a left lower chest area of consolidation adjacent to the left border of the heart approximately 2 rib spaces above the costophrenic angle. The lateral x-ray view shows this lesion absent of the window posterior to the cardiac silhouette. Which is the most likely location of this area of focal consolidation? *Left upper lobe apex *Right middle lobe *Left upper lobe lingula *Left lower lobe Left upper lobe lingula Ratonale: Lingular consolidation is described in this question precisely. If the cardiac margin/silhouette is obliterated by the mass, the lesion is either right middle lobe or left upper lobe lingula. The inability to fully relax the myocardium during relaxation is a trademark of which of the following diagnoses? Diastolic dysfunction Rationale: The inability for the heart to relax is a trademark of the diagnosis of diastolic dysfunction and is common in patients with thickened hypertrophic myocardium. An otherwise healthy African American adult male has been diagnosed with hypertension. He has been restricting his salt intake, eating a DASH (Dietary Approaches to Stop Hypertension) diet, and exercising more, but his blood pressure is still elevated. Which is the BEST medication to prescribe him? Calcium channel blocker Rationale: African American patients per JNC8 Hypertension Guidelines should be managed with a dihydropyridine calcium channel blocker such as amlodipine (Norvasc) as first line management therapy for hypertension not at goal with DASH and lifestyle modifications. Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which medical imaging is considered standard of care for serial surveillance? CT angiography of the chest Rationale: CT angiography is considered the standard of care for measuring vascular luminal dimensions with contrast. CT PE protocol is not timed properly for the aorta (it's timed for the pulmonary artery). Although a plain film is able to catch large aneurysms at times, they are not able to provide multi-axis reconstruction needed to accurately measure the size. Transesophageal echo is not needed to accurately measure the aorta and requires the patient to undergo sedation which is unnecessary. Which of the following medications does not cause beta 1 stimulation? phenylephrine Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta receptor activity. A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and orthopnea. On examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is the most likely diagnosis? Congestive heart failure Rationale: Of the available options, the most accurate response is congestive heart failure as it is signifying both a right ventricular back up with jugular venous extension and crackles on lung assault, which are suggestive of left ventricular back up. it is possible the patient may have an acute myocardial infarction that precipitated this, however, a patient has not described that, rather is only describing dyspnea on exertion and orthopnea, which both speak to a state of fluid overload. The only appropriate response of these available is congestive heart failure. Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with an ejection fraction of 40% who is also not on optimal medical therapy has been diagnosed with a myocardial infarction this admission and received emergent placement of a drug-eluting stent to the left anterior descending artery. As the medical home who will manage this patient after discharge, which medication strategy would you expect to be a priority in the patient's care? Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35% Rationale: The patient should have a protective mechanism such as an implantable automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35% due to the increased risk of sudden cardiac death with low EF states. Since most patients are not eligible for 90 days for an AICD in this state, optimizing their medication regimen and repeating an echo in 2-3 months to re-evaluate for improvement in their EF is required by most insurance companies. A baseline echo is needed at discharge to provide a baseline for improvement vs their repeat echo in 2-3 months. Dual anti-platelet therapy is required for 12 months minimum post-MI. A Holter monitor does not provide any conceivable benefit for this patient as presented. Which of the following people groups represent the least risk of cardiac disease? Caucasians Rationale: Statistically African Americans, Native Hawaiians, and American Indians are at at increased risk of cardiac disease due to higher rates of hypertension, diabetes, and obesity than Caucasians. A 65-year-old woman presents for a follow-up examination. She is a smoker, and her hypertension is now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting therapeutic lifestyle changes, the nurse practitioner should start the patient on: a statin drug. Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be useful in reducing ASVD risk, but for a patient who is an active smoker with premature coronary disease history (less than age 65 for women), has hypertension and is far from an LDL goal, this patient is most certainly a candidate for statin therapy, which represents the most aggressive therapy option of these four listed. Which of the following end-organ sequelae is not directly caused by uncontrolled hypertension? Peripheral neuropathy Ratioanle: Although patients with hypertension frequently have peripheral neuropathy, it is only directly attributed to patients who are also diabetic and is commonly found in non-hypertensive diabetic patients. Proteinuria, AV nicking, and hemorrhagic stroke are all caused by uncontrolled hypertension. Preventive cardiac care should focus primarily on addressing all the following except? Genetic predisposition Rationale: Smoking cessation, exercise, and medication compliance all represent modifiable risk factors and should be the focus of preventive care. Non-modifiable risk factors such as age, gender, genetic/family history should not be the primary focus of prevention. A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and obesity. Laboratory tests reveal elevated serum testosterone and LH ratio 2:1. What is the most appropriate initial treatment? Oral contraceptives Rationale: These are classic symptoms of polycystic ovarian syndrome and the patient should be treated with oral contraceptives to help stabilize their estrogen and progesterone. Additionally, they may be managed on metformin and/or spironolactone for their PCOS. Oral contraceptive pills (OCPs) are often the first pharmacological treatment for polycystic ovary syndrome (PCOS) because they help manage in several ways: Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods lighter and more regular. This is important because irregular ovulation can lead to endometrial hyperplasia, which is a buildup of uterine tissue that can increase the risk of uterine cancer. Androgen excess: OCPs can reduce androgen production and increase sex hormone-binding globulin (SHBG), which binds androgens. This can help reduce symptoms like acne, hirsutism (unwanted body and facial hair), and androgenic alopecia (male pattern baldness). Endometrium protection: OCPs can protect the endometrium by ensuring regular ovulation A 50-year-old woman with hypertension and diabetes comes in for a routine check-up. What screening test should be regularly performed to monitor for early signs of diabetic nephropathy? Urine dipstick for protein Rationale: The most sensitive indicator of diabetic nephropathy would be the evidence of small proteins in the urine (proteinuria) as found on urinalysis. The other options might describe macro-organ function (such as BUN/Creat from a BMP, a renal biopsy which is not indicated for routine diabetic nephropathy testing, and a Abd CT, which is more akin to evaluation of less subtle findings), but at the functional level of the nephron, namely the glomerulus, evidence of glucose-related damage is easily identified with proteinuria from a UA. Which of the following is at highest risk for DMII? An adult woman with a BMI of 27 who just delivered a baby weighing 9 1/2 lbs Rationale: Of these options, an adult woman with a BMI of 27 who just delivered a baby weighing 9 1/2 lbs is the most likely due to their increased BMI and the large size of the baby. giving birth to a large baby, also known as a large-for-gestational-age (LGA) baby, can increase the risk of developing type 2 diabetes later in life. Women who give birth to a LGA baby are 10% more likely to develop DMII 10-14 years after pregnancy compared to women who give birth to babies of average gestational age (AGA). This increased risk is even after adjusting for other risk factors, such as age, obesity, high blood pressure, and family history of diabetes. A starting dose for a elderly adult patient with a BMI of 20 needing levothryoxine 25 mcg Rationale: The widely considered best practice for treatment of hypothyroidism in the elderly is to "go slow and start low". 25 mcg is the most appropriate low dose to start with of these options. It is possible that over time the dose will be increased until therapeutic levels are obtained, but the risk of over-dosing the patient outweighs the desire to quickly achieve this state. An adult female who recently returned for a recheck appointment. The only remarkable laboratory result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal = 0.4-6 microunits/mL). The patient reports that her neck hurts; examination reveals thyroid tenderness. Which of the following laboratory tests should the nurse practitioner order now? Triiodothyronine (T3) and free thyroxine (FT4) Rationale: Remember that a patient with low TSH is suspicious of hyperthyroidism with a corresponding finding of elevated T3/T4 and clinical symptoms of a goiter, tremulousness, anxiety, palpitations, weight loss, insomnia, diarrhea, etc. This patient is describing a sore neck as well, which is suggestive of Graves disease (hyperthyroid state). All the following are symptoms of hypocalcemia except: Visual field deficits Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other are symptoms related to hypocalcemia. An adult patient diagnosed with type 2 diabetes mellitus presents for a recheck. The patient follows a carbohydrate counting diet and walks 30 minutes 5 times weekly. Current fasting blood glucose = 116 mg/dL [normal = less than 99 mg/dL] and A1c = 6.3% [normal = less than 7.0%]. In accordance with the American Diabetes Association, the nurse practitioner would recommend that the next follow-up appointment be scheduled for: 6 months. Rationale: Based off of the ADA recommendation, this patient should be evaluated in six months. They are actually showing good control and excellent compliance with diet and exercise management strategies. If there compliance was worse or they were not controlled with their A1c, this would likely be a three month follow up. Your patient has a diagnosis of Hashimoto's and is on Levothyroxine 75 mcg daily. Her recent TSH was elevated at 15 uU/mL. Your next best action is to: Increase Levothyroxine to 100 mcg daily Rationale: When the TSH is elevated the patient needs more thyroid hormone. Once diagnosed with Hashimoto's there is no clinical need/benefit to repeating anti bodies. A patient has a 3 cm pituitary mass noted on CT. What is your next step in evaluating the patient? Screen for hormone deficiencies Rationale: Initial work up includes hormone testing. Cabergoline is the treatment for prolactinoma. Surgery consult is indicated when there are VF deficits and/or abutment/compression on optic nerves or chiasm or if adenoma is hyperfunctioning. Adenomas 1 cm with no VF deficit or abutment/compression of optic nerves or chiasm require a follow up MRI at 6 months. An adult female presents with a chief complaint of fatigue and weight gain. She states that she doesn't feel like herself. A diagnosis of hypothyroidism is suspected. Which of the following physical findings would support this diagnosis? Dry skin, bradycardia, and hypoactive deep tendon reflexes Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly classic signs of hypothyroidism. To further substantiate these concerns, the patient should have their TSH and T3 and Free T4 checked, and it is likely their TSH would be elevated, T3/T4 low. An older adult patient with new onset GERD, cough, heartburn. Initial tx Antacid and lifestyle modification/weight loss Rationale: Before initiating a PPI or H2RA, it would always be wise to initiate diet/exercise and symptom management when present with an antacid. Loss of weight/dieting is most likely to deal with obesity as the most common underlying cause of GERD. A 59-year-old male presents with symptoms of abdominal pain, jaundice, and weight loss which he has not been trying to lose weight. What would be a malignancy associated with these symptoms? Pancreatic cancer Raionale: Pancreatic cancer, the most typically presentation includes abdominal pain, jaundice, and weight loss. Although weight loss and abdominal pain may be present with adenocarcinoma it is unlikely to present with jaundice, and you're unlikely to have abdominal pain or jaundice with any esophageal malignancy. A 63-year-old male presents with a suspected lower GI bleed. He reports passing frank small amounts of blood several times today. He denies any use of NSAID's or blood thinners. What must be taken into consideration before performing a colonoscopy on this patient? All are reasonable options Rationale: This patient has had blood loss and should first be hemodynamically stable, and fluid/blood product resuscitated. In all cases of GI bleed risk factors for an upper GI bleed must be taken into consideration first, we must always discuss with the patient all risks and benefits associated with the procedure to provide an informed consent. A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4 loose stools a day. She also reports mild cramping. Which labs would be helpful in further workup of a diagnosis? ESR, fecal occult, Stool culture Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to determine the potential cause of her symptoms. An adult female presents with a 1-week history of left lower quadrant abdominal pain. T=101.2 degrees F. (38.4 degrees C) and an elevated WBC count. This is the patient's first episode of severe abdominal pain. The nurse practitioner suspects diverticulitis. Which of the following diagnostic tests would confirm the diagnosis? CT scan of the abdomen Rationale: For patients with acute diverticulitis, CT of the abdomen will provide evidence of the pathophysiology. Evidence of diverticula will be present on a flat plate KUB x-ray, but there is not enough specificity to show that it is inflamed as with a CT scan. A 70-year-old patient presents to the clinic with dyspnea, palpitations, and fatigue. The patient reports a 2-week history of blackened stools, which the patient attributes to drinking berry juice. Assessment reveals vital signs of BP = 110/60, P = 100, R = 24; Hgb = 4.5 g/dL; Hct = 16%. What is the most appropriate immediate intervention? Send to the emergency room. Rationale: This patient is experiencing a GI bleed and is in need of emergency treatment due to their considerably low hemoglobin. An older adult has a follow-up fasting lipid panel 6 months after making therapeutic lifestyle changes. LDL=205mg/dL (Normal=100mg/dL), HDL=44mg/dL, and triglycerides=180mg/dL (Normal-150mg/dL). The patient is placed on statin therapy. Two months later, the patient presents for follow-up and complains of body aches. In addition to creatine phosphokinase (CPK), which of the following tests should the nurse practitioner order? Liver transaminase (AST and ALT) levels Rationale: Due to the potential liver function test elevation found with statin use, LFTs of AST/ALT should be checked routinely after initiation of therapy A 56-year-old male on your service has been diagnosed with colon cancer which is localized. What is the primary management that you should expect to prepare your patient for? Surgery Rationale: Surgery is the only curative modality for localized colon cancers. Patients with progressive/metastatic disease may require chemotherapy/radiation. A 28-year-old woman presents with abdominal pain, diarrhea, and weight loss. She also reports occasional bloody stools. Colonoscopy reveals continuous inflammation from the rectum extending proximally. What is the most likely diagnosis? Ulcerative colitis Rationale: The presence of inflammatory bowel disease which is present in the patient with bloody stool suggests ulcerative colitis. This patient should be acutely managed with steroids and chronically with auto-immune therapy such as biologics and/or DMARDs. A 63-year-old male presents with a suspected lower GI bleed. He reports passing frank small amounts of blood several times today. He denies use of NSAID's or blood thinners. What questions would be important to ask to further differentiate your diagnosis? All these questions would help determine if this bleed was associated with a potential diverticular bleed (typically painless), painful bowel movement associated with IBD (UC/Crohn's), and changes in bowel habit/colonoscopy risk for malignancy. Which is best performed to assess the risk for fall in an 88-year old adult? Get up and go test Rationale: This question is asking you if you understand the different screening to available for Mobility and fall risk. The global screening assessment, PHQ-2 questionnaire, and clock drawing test have no clinical significance to mobility. The "get up and go" test is the only option that is a mobility test of these four. A frail elderly patient presents with constipation. Which of the following normal physiologic changes seen with aging is the most likely cause? Decreased bowel muscle tone Rationale: The frail, elderly patient will typically have their GI track decrease bile secretion and decrease absorption of calcium. A decrease in pancreas secretions is not related to presence of constipation, however, decreased bowel muscle tone certainly does reduce the GI motility and increase the transit time, thereby increasing the drying of stool in the large intestine which leads to constipation An elderly patient diagnosed with end-stage lung cancer has been refusing meals, opting instead for ice cream only. The family is concerned about the patient not getting enough nutrition. The NP: explains loss of appetite is common at the end of life Rationale: Death is an uncomfortable topic, and must be handled tactfully. Factual re-orientation to the terminal state of a patient's condition may be appropriate when unrealistic expectations for their longevity have been voiced. The reasonable choice in this case is to describe the normalcy of what the patient is experiencing with their loss of appetite and their terminal state. Testing the patient for depression has really no clinical bearing on this particular time nor does prescribing methylphenidate. Ordering a UA and CBC would suggest a concern of a urinary tract infection, and that is not a likely scenario to describe the patient's existing condition. Support the patient as his advocate by helping the man enjoy the ice cream he requested. An elderly patient is being admitted to the skilled nursing facility and is being screened for the risk of falling. Which of the following information would trigger a complete falls assessment? A history of two or more falls in the prior year Rationale: Of these options, the only two that have any clinical bearing on falls are a patient who has a demonstrated incident of two or more falls in a year and a patient who has a altered cognition, such as the patient who is living alone and has mild dementia. Of the two options, the clear winner is the patient who has already demonstrated to fall in the last year and they should certainly be a valuated more thoroughly with a complete fall assessment. The management of COPD in the elderly is best guided by: symptomatology. Rationale: Symptomatology is what guides COPD management since the severity and frequency of symptoms will warrant changes and additions to medications as exacerbations present. Although very useful tool for chronic management and baseline status, spirometry does not typically dictate therapy, rather diagnose the disease state itself. Our blood gases may be used for clinically correlate severity during an exacerbation, and radiologic imaging may showcase severity of stable chronic finding such as somatic, lung tissue or bullae. Which of the following is an example of implied consent? The patient collapses while having a myocardial infarction in the hospital cafeteria. Bystanders witnessed the patient clutch his chest, say "my chest", then collapse. They start CPR and initiate the emergency care system to transport the patient for care in the emergency department. Rationale: Surgical consent is by definition "informed" when the risks and benefits are discussed as with the patients undergoing surgery and a chest tube, and 2 person emergency consent is described with the patient with altered mental status. The collapsed patient reflects a clear inability to care for oneself and care is being performed under the assumption of what is implied as what any reasonable person would want. Which of the following refers to the primary access point of medical care patients are encouraged to use to aid in providing continuity and reduction of cost per the Affordable Care Act? The Medical Home Rationale: The medical home reduces cost by providing continuity of care, reducing overtesting, duplicate testing, and aids with longitudinal management of the patient. The other options all increase these cost-burdening elements and should be avoided unless care through the medical home is not a reasonable or appropriate option. A patient states they do not want to have any further medical care and wishes to leave against medical advice. Unknown to you, the healthcare tech then held their arm down to get an IV catheter placed against their will. The healthcare tech is at risk of being charged with which of the following: Battery Rationale: Assault refers to the risk of a harm to others, whereas battery refers to the actual act of that harm. Which act formed in 1996 was created to protect patient health information from being disclosed without the patient's consent or knowledge? Health Insurance Portability and Acountability Act (HIPAA) Rationale: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. FERPA was aimed at educational protections similar to HIPAA but for education. COBRA is for continuing insurance benefits after separation from employment. EMTALA is to guarantee provision of emergency treatment for stabilization or for those in active labor. An 87-year-old female has a history of ovarian cancer. She recently completed the tenth of 26 chemotherapy treatments. She informs the nurse practitioner that she plans to stop chemotherapy; she has lived a good life and is ready to die. She is alert and very active, and lives with her son. The family is determined that the patient will complete the chemotherapy. The nurse practitioner's most appropriate action is to: support the patient's decision. Rationale: Good nursing practice supports advocacy at all times for the patient, even when the patient's family disagrees. Supporting their decision to self-direct their care is your primary obligation. Your patient presents with complaint of a persistent itch in one eye and says it feels like gravel is in their eye. On brief inspection, there is no obvious trauma. What can the prudent nurse practitioner use to aid in diagnosis of this patient's chief complaint? Fluorescein sodium Rationale: Fluorescein stain is the best way to evaluate the surface of the cornea for abrasion or trauma. Magnesium salt is not used on the eye. Tetracaine is an anesthetic for the eye, but it does not aid in diagnosis, rather symptom management. Ophthalmoscope use should be tangentially to the cornea and sclera, not directly of the fundus. A patient presents with blood present in the anterior portion of their eye covering the lower half of their iris. With which of the following diagnoses is this most consistent? Hyphema Rationale: Hyphema is defined as red blood cells in the anterior portion of the eye between the cornea and iris. Subconjunctival hemorrhage is commonly mistaken for this and is a hemorrhage lateral to the iris in the conjunctiva of the eye. Globe rupture does not present with such specific findings unless hyphema is also included in the trauma, and acute angle glaucoma is not associated with blood in the anterior vitreous; however, hyphema may lead to this if the trabecular network were to get clogged. For this reason, close follow up is required for these patients. An elderly patient has throbbing pain in the left eye, blurred vision, marked photophobia, and redness around the iris. What is the nurse practitioner's initial diagnosis? Iritis Rationale: Redness around the iris is a classic descriptor of iritis, whereas conjunctival erythema and injection is suggestive of conjunctivitis. Sjogren syndrome is characterized by dry eyes, and glaucoma typically shares the symptoms noted above but does not have circular redness around the iris. An older adult female reports nasal congestion, clear nasal secretions, and a post-nasal drip since going through menopause. After a thorough examination reveals no significant abnormalities, the nurse practitioner diagnoses the patient with: Vasomotor rhinitis Rationale: Hormones can affect how the body reacts to environmental changes, like humidity and temperature. Menopause can trigger vasomotor rhinitis (VMR), also known as non-allergic rhinitis. A 51-year-old male patient presents to the urgent care with a unilateral injected cornea and nausea. He reports visual acuity changes and light sensitivity. Which of the following is not included in your differential? Chalazion Rationale: Chalazion is a blocked meibomian gland that is not associated with visual acuity changes, light sensitivity, or an injected cornea. Digoxin toxicity is commonly associated with halos around eyes with nausea but does not have any mechanism to explain the injected cornea. Cluster headaches also share the erythema, unilateral pain/pathology. A 35-year-old woman presents with allergic rhinitis, experiencing significant nasal congestion, sneezing, and itchy eyes. She has tried over-the-counter antihistamines with limited relief. What is the most appropriate next step in management? Intranasal corticosteroids Which of the following best characterizes presbycusis in the older adult? Bilateral high-frequency sensorineural hearing loss Your 24-year-old male patient has been admitted post-motor vehicle collision at a high rate of speed. A CT head is performed revealing a pyramidal fracture involving the lateral walls of the maxillary sinuses and inferior orbital rim. Which classification of fracture is this? Le Fort II Rationale: Le Fort II fracture lines pass through the posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim, and nasal bones Le Fort type I, the plane of injury is horizontal and typically results in a separation of the teeth from the upper face. The horizontal fracture line generally passes through the alveolar ridge which is the bony socket that holds the teeth, the lateral nose, and the inferior part of the maxillary sinus, one of the four nasal sinuses that resides near the nose. Le Fort type II presents with a pyramidal-shaped fracture. The upper teeth make up the base and the nasofrontal suture— a band of tissue connecting the frontal bone and the nasal bones—makes up the point or apex of the pyramidal fracture. The pyramidal plane of fracture can again occur through the alveolar ridge (an extension of the upper jaw) and maxillary sinuses, but typically also extends through the orbital rim (eye socket) and nasal bones. Le Fort type III, the plane of injury is transverse, or horizontal, similar to type I; however, in type III, injury typically begins at the nasofrontal area and extends across the orbital walls, zygomatic arch (cheek bone), and pterygoid plates. A type III Le Fort fracture is the most extensive as it can result in a complete dislocation of the midface from the base of the skull, known as a craniofacial dislocation. Which of the following is not a common symptom of Meniere's disease? Photophobia Rationale: The classic triad of Meniere's disease is vertigo, tinnitus, and hearing loss. The medical term for nosebleed is which of the following? Epistaxis Rationale: Epistaxis is the medical term for nosebleed. A 73 y.o. M presents to the ED with complaints of large output hematemesis since early this morning. He is a endorses chronic alcohol use and his PMH is positive for peptic ulcer. Which of the following symptoms indicate a potentially severe GI bleed and likely need for immediate PRBC transfusion? Orthostatic dizziness, confusion, angina, severe palpitations, and cold/clammy extremities Rationale: Symptoms of severe blood loss include Orthostatic dizziness, confusion, angina, severe palpitations, and cold/clammy extremities. A 35-year-old man presents with recurrent episodes of severe pain in his back, chest, and extremities. He has a history of sickle cell disease. What is the most appropriate initial management during a pain crisis? Hospitalization for intravenous fluids and opioids Rationale: Patients experiencing acute sickle cell crisis should be transported to the hospital for IV hydration therapy and pain management. A 14-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents for a follow-up examination after a recent hospitalization. It is most important to continue monitoring growth, development, and: hemoglobin levels. Rationale: Chronic monitoring for patients with sickle cell disease includes monitoring of hemoglobin and hematocrit. A patient with a known intrinsic factor autoantibody is at risk for developing which of the following conditions? B12 deficiency and pernicious anemia Rationale: Causes of B12 deficiency include malabsorption and intrinsic factor deficiency. Intrinsic factor deficiency is a result of gastric resection or IF autoantibody. A patient with rheumatoid arthritis is admitted to the rehab unit you oversee for management of pain due to pelvic fracture after motor vehicle collision. Admission labs show ANC of 1.4. The patient is asymptomatic and denies history of repeated infection. What is the most appropriate level of intervention for his patient? Observation until patient becomes symptomatic Rationale: Treatment of neutropenia in asymptomatic patients is observation. Overactivation of coagulation and fibrinolysis resulting in thrombosis and hemorrhage is a trademark of which of the following? Disseminated intravascular coagulation Rationale: DIC is a systemic process that has potential to result in thrombosis and hemorrhage often due to overactivation of coagulation and fibrinolysis. A patient diagnosed with iron deficiency anemia requires iron supplementation. Which of the following treatments would likely be ineffective? Ferrous sulfate 325 mg PO BID for a 43 y.o. F s/p gastric bypass 2 years ago Rationale: Patients who have undergone bariatric surgery have a permanent loss and/or alteration of gastric space and subsequent decrease in the production of HCL and/or enterocytes. This loss decreases the conversion/absorption of ferric iron (present in food) into the usable ferrous form. Any PO administration of either ferrous or ferric iron is less likely to be absorbed in adequate amounts after gastric bypass or other gastric procedures. All the following thrombocytopenic emergencies require immediate action except: Scheduled surgical procedure with mild thrombocytopenia Rationale: Mild thrombocytopenia is not an emergency, but should involve evaluation by a hematologist or oncologist if no etiology is known prior to surgical stress. In which of the following patients is PRBC transfusion recommended? 73 y.o. M with acute GI bleed and Hgb 6.2 Rationale: PRBC is indicated to provide enough RBCs to maximize clinical outcomes while avoiding unnecessary transfusions. For most hemodynamically stable medical and surgical patients, transfusion is recommended/considered at a hemoglobin of 7 to 8 g/dL. A 78 y.o. M patient reports chronic infections, bruising, fatigue, SOB, and fevers. He has a history of rectal adenocarcinoma and completed concurrent chemotherapy/radiation earlier this year. His CBC shows Hgb 7.5, PLT 88, WBC 1.2, ANC 0.8, and peripheral smear shows dysplasia. What additional work-up would you anticipate for this patient? Bone marrow biopsy and flow cytometry Rationale: Diagnosis of MDS involves H&P, CBC, peripheral smear, bone marrow biopsy (immunocytochemistry and flow cytometry). Diagnosis is dependent on cytopenias, dysplasia, and cytogenic abnormalities. IPSS is used to identify risk. Patients with a diagnosis of myasthenia gravis are more likely to have the presence of which tissue in greater quantities? Thymic tissue Rationale: Thymic tissue is routinely found in larger quantity on patients with MG and given this correlation, patients with MG routinely will undergo thymectomy. Which of the following treatments is not recommended for a patient with a new diagnosis of rheumatoid arthritis? Oxycontin PRN for mild pain Rationale: Patients with RA may be controlled with any of the above regimens except use of opioids for a new diagnosis with a high abuse potential, as this does not safely balance the risk and benefit of treatment. Which of the following categories of medication are not likely to be included in the medication regimen for a patient with HIV? Protease antagonists Rationle: NRTIs, NNRTIs, and protease inhibitors represent the three-drug regimen for HAART therapy. A 35-year-old woman presents with fatigue, joint pain, and a butterfly-shaped rash on her face. What is the most appropriate initial management in primary care? Referral to rheumatology Rationale: As this represents a likely diagnosis of systemic lupus erythematosus (SLE), this should be managed by rheumatology to evaluate and initiate therapy when possible. Which of the following symptoms best describes a classic case of systemic lupus erythematosus? Butterfly rash on the face Rationale: Rash on the back is more common with pityriasis rosea. A large collection of urate crystals in the joint is likely gout. Painful ambulation with joint laxity and ecchymosis suggests ligamentum injury. Butterfly rash on the face is classic SLE. Patients with Stevens-Johnson syndrome should be managed by which of the following mechanisms? Similarly to burn patients due to loss of fluid volume Rationale: Due to the loss of the protective skin barrier where sloughing occurs, infection risk is high and substantial insensible fluid loss means these patients need to be treated as burn victims would be. Hypervolemia is not a typical concern for the same reason, as they tend to be underfilled. Off floor privileges would not be wise since the infection risk and pain requires close monitoring, fall risk, and analgesic requirements. A patient who has active herpes zoster is at risk of shedding which contagious virus? Varicella zoster Rationale: Patients with herpes zoster (shingles) are at risk of transmitting varicella zoster (chicken pox) to those who have not yet had varicella or been vaccinated. Your patient presented yesterday to urgent care with symptoms of lower extremity weakness and then went home for observation with family. They have returned to urgent care and it now appears to be affecting the patient's abdomen in just the past few hours. What is your priority intervention? Immediate transportation to the hospital and monitor for airway involvement (This patient appears to have ascending GB and is at risk of airway compromise based on the rapid succession of symptoms towards the airway.) Rationale: With Guillain-Barre syndrome as the leading diagnosis, there are two types (ascending and descending). Ascending, which is being described in this scenario, will require hospitalization as it is next likely to affect the thorax/lungs and may require airway management with an advanced airway to support if the patient's muscle loses neurologic control due to demyelination. Your patient has been noticing bilateral joint pain in the knees and feet for about 6 months and has been started on methotrexate. Which of the following diagnoses correlate to this treatment plan? Rheumatoid arthritis Rationale: This is a classic diagnosis and treatment of RA. OA is the same as DJD, and PMR is typically located in the upper chest and shoulder girdle. A patient is newly diagnosed with multiple sclerosis. Treatment includes prednisone with physical therapy. The nurse practitioner advises the patient to begin disease-modifying therapy: as soon as possible. Rationale: To limit disease progression, disease modifying therapy (DMARDs) should be initiated as soon as possible. This is also to limit the exposure and duration of steroid therapy as this does not treat the underlying cause and it may take some time for DMARD therapy to become fully therapeutic for the patient. Your patient is being treated with disease modifying anti-rheumatic drugs for a plaque-like skin condition located on the extensor surfaces of joints. Which condition is this likely describing? Plaque psoriasis Rationale: Plaque psoriasis is trademarked by these findings. Eczema tends to be on the flexor surfaces and is not treated with DMARDs. Contact dermatitis is due to exposure to an irritant and is typically self-limiting without the use of DMARDs. What is the most likely diagnosis for an elderly patient with GI cancer who presents with skin pallor, conjunctival pallor, palpitations, and weakness? Iron deficiency anemia Rationale: Iron deficiency anemia due to GI cancer may present with symptoms such as fatigue, weakness, pale skin, shortness of breath, and dizziness. These symptoms occur because of reduced oxygen-carrying capacity in the blood due to low hemoglobin levels. An 18-year-old presents with acne. He notes that he washes his face with a mild skin cleanser 3 to 4 times daily, however the acne persists and has worsened. The nurse practitioner explains that: frequent facial scrubs can worsen acne. Rationale: Over-washing the face can contribute to acne or exacerbate existing acne symptoms. Over-washing can irritate the skin, causing redness, inflammation, and sensitivity. This can worsen existing acne lesions and delay healing. What is the definitive treatment for uncomplicated skin abscess on the arm? Incision and drainage Rationale: The definitive treatment for an uncomplicated skin abscess is to open and drain the contents. The body will then re-approximate by secondary intention once the contents has been evacuated. Gram negative coverage is not recommended for an area typically associated with gram-positive flora. Which of the following is a true statement about squamous cell carcinoma? Squamous cell carcinoma is more likely to have metastasis than basal cell carcinoma Rationale: Squamous cell carcinoma is more common to have metastasis than basal cell carcinoma. Basal cell carcinoma is more common than squamous cell carcinoma. A frail elderly male with a history of sun exposure and rough, scaly, brownish lesions on the face, ears, and hands presents with a firm erythematous, ulcerated nodule on the dorsal surface of the hand. The most likely diagnosis is: Squamous cell carcinoma Rationale: Squamous cell carcinoma (SCC) is a type of skin cancer that can also occur in other areas of the body, including the lining of the respiratory and digestive tracts. The symptoms of SCC can vary depending on the location of the cancer. SCC typically appears as a firm, red nodule or a flat sore with a scaly crust. It may also present as a rough, scaly patch that may bleed or crust over. A pediatric male is present with his mother, who states that he is extremely restless at night and constantly scratches his anal area. Which diagnostic procedure would confirm a diagnosis of pinworm infestation? Examination of transparent tape sample from perianal skin Rationale: Scotch Tape Test (Cellophane Tape Test): This is a common diagnostic method where a piece of transparent adhesive tape (such as Scotch tape) is pressed against the perianal skin in the morning before bathing or using the toilet. The tape is then carefully placed on a glass slide or slide labeled with the patient's name and date of collection and submitted to a laboratory for examination under a microscope. The presence of pinworm eggs or occasionally adult worms clinging to the tape can confirm the diagnosis. A Caucasian male patient with fair skin and green eyes is at a particularly high risk for which of the following serious skin conditions? Skin cancer Rationale: Although wrinkles, sunburn, and keratoacanthoma are skin conditions, none of them are serious nor predisposed from this patient's profile. Skin cancer risk is very high for this patient. During the preadmission history and physical, you examine your patient and find a new multicolored mole measuring 9mm with irregular borders. What is the most likely diagnosis? Melanoma Rationale: These are all classic findings for melanoma: irregular borders, diameter over 6mm, multicolor, and new or rapidly evolved. Your patient presents with darkened, velvety creases of the groin, neck, and axilla with skin tags present. What does this possibly indicate? Evidence of insulin resistance Rationale: Acanthosis nigricans is described as the presence of darkened, velvety creases of the groin, neck, and axilla with skin tags present. This is suggestive of increased insulin resistance and metabolic syndrome. An adult male presents complaining of a left ankle injury that occurred 2 days ago while he was playing basketball. The patient cannot bear weight and ROM is limited by pain. What acute injuries would be included in the differential diagnosis for this patient? Ankle sprain, ankle fracture Rationale: An ankle fracture results in severe pain, swelling, and bruising around the ankle, often with visible deformity or misalignment of the joint. It can lead to an inability to bear weight on the affected leg and severe tenderness at the fracture site. Immediate medical evaluation is crucial for accurate diagnosis and appropriate treatment. An ankle sprain typically causes sudden pain and swelling around the ankle joint, often accompanied by bruising and tenderness, especially along the outer ankle. There may be a feeling of instability and difficulty moving the ankle due to pain and swelling. An adolescent football player presents to the urgent care with an acute knee injury. He heard a pop when his knee buckled. The nurse practitioner notes a positive anterior drawer test. The most likely diagnosis is injury to the: anterior cruciate ligament. Rationale: A positive anterior drawer test is commonly associated with the diagnosis of an anterior cruciate ligament (ACL) injury in the knee. The ACL is one of the major ligaments that provides stability to the knee joint, and injury to this ligament is common, especially in sports-related activities or trauma. Which of the following distinguishes plantar fasciitis from other common foot problems? Pain with initial step after rising in the morning Rationale: A hallmark of plantar fasciitis is severe pain upon waking or after periods of rest, which tends to improve with movement as the fascia stretches out. Which of the following is a urate lowering drug that may be used in conjunction with NSAIDs in treating gouty arthritis? Allopurinol (Zyloprim) Rationale: Allopurinol is a xanthine oxidase inhibitor that reduces the production of uric acid in the body. It inhibits the enzyme xanthine oxidase, which is involved in the metabolism of purines (substances that contribute to uric acid formation). Allopurinol is commonly used as a long-term maintenance therapy to prevent recurrent gout attacks and to reduce the risk of complications associated with chronic hyperuricemia, such as tophi (deposits of urate crystals in joints and other tissues). For primary prevention of osteoporosis in females, the US Preventative Task Force recommends bone density screening: At least once after age 65 Rationale: Women at higher risk of osteoporosis, such as those with a family history, early menopause, or certain medical conditions, should discuss bone density screening (DEXA scan) with their healthcare provider. Your patient has presented with an acute GI bleed. In working up potential causes, which of the following scenarios is most probable as a reason for the bleed? Four days of high dose of naproxen sodium for joint pain after a long hike Rationale: Acute high dose use of NSAID is a risk of developing a stomach ulcer and subsequent GI bleeding. Topical use of NSAID is not associated with systemic absorption over 1-2% and accordingly does not carry the prostaglandin inhibition risks to the gut lining. Use of prednisone does not predispose to bleeding, nor does acetaminophen use. A 25-year-old athlete presents with shoulder pain and difficulty with overhead activities. Physical examination suggests impingement syndrome. What is the most appropriate initial treatment? Physical therapy focusing on rotator cuff strengthening Rationale: Exercises to improve shoulder strength and flexibility, focusing on the rotator cuff and scapular stabilizers is an important initial treatment. Physical therapy may include stretching and strengthening exercises, as well as techniques to improve shoulder mechanics. A 75-year-old presents with depression. The patient also has osteoarthritis of both knees that interferes with mobility. Which antidepressant may also benefit osteoarthritis? Duloxetine (Cymbalta) Rationale: For individuals with both osteoarthritis and depression, duloxetine offers the advantage of addressing both conditions simultaneously, potentially improving overall quality of life. Its dual action can also be beneficial in managing chronic pain and associated emotional distress often experienced by patients with osteoarthritis. Which of the following treatments is most successful for patients with chronic fatigue syndrome? Graded exercise program Rationale: A graded exercise program (GEP) for chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a structured approach to physical activity aimed at gradually increasing exercise tolerance and improving overall function. Here are key components and considerations for implementing a GEP: Individualized Assessment: Before starting a GEP, it's crucial to conduct a thorough assessment of the individual's current physical capabilities, symptom severity, and any specific limitations or concerns related to CFS. Goal Setting: Establish clear and realistic goals with the patient, focusing on improving function, reducing symptom severity, and enhancing quality of life rather than aiming for rapid fitness gains. Structured Program: Develop a structured exercise plan tailored to the individual's baseline fitness level and tolerance. The program typically involves incremental increases in exercise intensity, duration, or frequency over time. Pacing: Emphasize the importance of pacing activities to avoid overexertion and exacerbation of symptoms. Encourage regular breaks during activity and gradual progression based on symptom response. A 25-year-old woman presents with dysuria, frequency, and urgency. Urinalysis shows pyuria and bacteriuria. What is the most likely diagnosis? Cystitis Rationale: Symptoms of cystitis include frequent urges to urinate, which may be accompanied by pain or burning during urination. The urine may appear bloody or cloudy, and there can be discomfort or pressure in the lower abdomen or pelvic area. Additionally, individuals may feel generally unwell, fatigued, or experience a mild fever. Inability to reach the bathroom before urinating is a feature consistent with which of the following diagnoses? urge-type incontinence Rationale: Urge-type incontinence, also known as overactive bladder (OAB) or urgency incontinence, is a condition characterized by a sudden and strong need to urinate, often followed by involuntary leakage of urine. This type of incontinence occurs when the bladder muscle (detrusor) contracts involuntarily, leading to urgency and sometimes an inability to reach the toilet in time. An older adult with diabetes mellitus, COPD, hypertension, and osteoarthritis develops chronic kidney disease. The most likely cause is: Diabetes Rationale: Diabetes is a leading cause of kidney failure, medically known as end-stage renal disease (ESRD), and it is often referred to as diabetic nephropathy when discussing kidney damage specifically caused by diabetes. An older adult female presents with a 2-month history of incontinence. She specifically complains of an inability to make it to the bathroom without the loss of some urine most of the time, and denies incontinence due to laughing, coughing, or sneezing; she denies dysuria. Her medications include an angiotensin-converting enzyme (ACE) inhibitor. The initial plan of action for this patient would be: Obtaining a urinalysis for pyuria, hematuria, and glucosuria Rationale: Obtaining a urinalysis for pyuria (pus in the urine), hematuria (blood in the urine), and glucosuria (glucose in the urine) is typically done to assess and diagnose various medical conditions affecting the urinary tract and overall health. A 50-year-old man presents for a routine check-up and expresses concerns about prostate health. What is the most appropriate screening recommendation for prostate cancer? Prostate-specific antigen (PSA) test every year starting at age 50 Rationale: PSA testing is used as a screening tool to detect prostate cancer early, before symptoms develop. Prostate cancer is one of the most common cancers in men, and early detection can improve treatment outcomes. A 24-year-old female reports urinary urgency with suprapubic tenderness relieved by bladder emptying. The patient has been evaluated by urology and urogynecology. Review of laboratory reports reveal negative urinalysis and cultures, negative results for sexually transmitted infections, and an unremarkable cystoscopy. Which of the following is an appropriate plan of care? Amitriptyline (Elavil) 25 mg oral once daily Rationale: Amitriptyline (Elavil) is a tricyclic antidepressant medication that is sometimes used off-label for various conditions, including the management of urinary urgency and overactive bladder symptoms. Patients with an elevated creatinine after receiving contrast from an angiogram are exhibiting which classification of renal dysfunction? Intrarenal Rationale: This is a classic example of intrarenal failure due to contrast induced nephropathy (CIN). In the case of otherwise healthy kindeys, CIN is a transient finding and resolves without intervention other than time and hydration. If the kidney is in a chronically damaged state, CIN can exacerbate permanent damage. Which of the following states represents an example of postrenal failure? Blood clot obstructing a foley catheter after a transurethral prostatectomy Rationale: Obstruction to flow is an example of post-renal failure. CIN and furosemide use are examples of intrarenal failure, and hypotension represents prerenal failure. Which portion of the renin-angiotensin-aldosterone mechanism is inhibited by lisinopril? Conversion of angiotensin I to angiotensin II Rationale: ACE inhibitors key mechanism of action is to inhibit the conversion of angiotensin I to angiotensin II. Aldosterone secretion is a later process of these drugs. JGA cell stimulation occurs regardless of this drug. Efferent arteriole dilation is specifically not inhibited by ACE inhibitors; rather it is promoted. The hospitalized patient you are caring for has experienced a low blood pressure for a period of 2 hours before treatment with a fluid bolus. Which type acute renal dysfunction is being described in this scenario? Prerenal Rationale: Inability to provide driving pressure to the glomerulus of the kidney such as hypotension is an example of prerenal source of renal dysfunction. Patients who take chronic anti-seizure medication should be notified of which risk of abrupt change or discontinuation of these medications? Decreased seizure threshold Rationale: Seizure threshold will decrease when medications used as prophylaxis for seizures are reduced or abruptly halted. Therefore, more seizure activity will get through the "threshol