MSN 611 FINAL EXAM () Questions and
Verified Answers, 100% Guarantee Pass
A 65-year-old man presents to the office with increased frequency, urgency, nocturia, and
hesitancy in micturition for the past week. He also complains of pain in ejaculation. He has
no flank pain, dysuria, hematuria, or fever. He is in a monogamous relationship and uses
condoms regularly. His temperature is 98.6 F (37 C), pulse rate is 77 beats/ minute,
respiration is 14 breaths/minute, and blood pressure is 130/80 mmHg. There is no
costovertebral angle tenderness or suprapubic tenderness, and external genitalia
examination is normal. Digital rectal examination shows normal sphincter tone and reflexes
with slightly enlarged and tender prostate. Urinalysis shows many WBCs with no RBCs or
casts. Urine culture grows E. coli. Serum prostate-specific antigen is 8ng/mL (reference
range of less than 3.5 ng/mL). Which of the following drug class can be used to treat the
patient's condition?
fluroquinolone
A 41-year-old G5P4004 at 38 weeks, 0 days pregnant presents for late prenatal testing. She
is found to have IgM-positive antibodies for HSV-2. The patient desires to deliver vaginally.
Which of the following statements is correct regarding the treatment of choice for this
patient's condition?
it is generally safe in pregnancy
A 25-year-old woman presents to the clinician with complaints of frequent burning
micturition and suprapubic discomfort from the past two days. The patient is sexually
active and has no significant past medical history. Urinalysis reveals the presence of
leukocyte esterase and a high level of nitrites. The clinician prescribes her a combination
antibiotic that inhibits two steps in the bacterial biosynthesis of tetrahydrofolate. Which of
the following is a contraindication to the use of this medication?
pregnancy
A 35-year-old woman comes to the office for pain and burning during urination for the past
few days. She denies fever, abdominal or flank pain, bloody urine, or passing any stones
while urinating. She has a medical history of gastroesophageal reflux disease, diabetes
mellitus type 2, and hyperlipidemia. She takes over-the-counter antacids, pantoprazole,
metformin, and atorvastatin. She is para 2 with both normal vaginal delivery and her last
menstrual period was three weeks ago. She uses oral contraceptive pills for contraception.
Her temperature is 37.2 C, her pulse is 70 beats/min, her respiratory rate is 12 breaths/min,
and her blood pressure is 130/80 mmHg. On examination, she denies suprapubic pain or
,costovertebral angle tenderness. Urinalysis reveals white blood cells of 20-25/hpf and red
blood cells of 5-10/hpf with no casts. Urinary nitrites and leukocyte esterase are positive,
and glucose and ketone are absent. White blood cell count is 7800/mm3. Serum creatinine
is 1.1 mg/dL and blood urea nitrogen is 17 mg/dL. Urine culture grows Escherichia coli.
The patient is started on a drug that inhibits an enzyme required in bacterial DNA
replication. The patient is counseled about adherence and the adverse effect of this drug.
About which of her other medications should she be counseled?
antacid
A 27-year-old male with a past medical history of tuberculosis presents to the outpatient
clinic with complaints of diarrhea and crampy abdominal pain. The patient was diagnosed
with tuberculosis 16 weeks ago and is currently on treatment with isoniazid and rifampicin.
Complete blood count shows an elevated WBC count. Blood testing shows that liver
function tests are normal. Which of the following is the best next step in the management of
this patient?
testing for clostridium difficle
A 5-year-old boy presents with a worsening cough and thick yellow-green nasal discharge
for the past two weeks. He has no chronic medical conditions and is not taking any
medication. His immunizations are up to date. Vital signs show a temperature of 39.2 C
(102.6 F), blood pressure of 120/80 mmHg, pulse of 92/min, and respiratory rate of 20/min.
On examination, nasal turbinates are swollen and erythematous, and there is a thick
purulent discharge from the nares. Lungs are clear on auscultation. Amoxicillin-
clavulanate is prescribed for acute bacterial sinusitis. What is the role of the clavulanate
component in amoxicillin-clavulanate?
Clavulanate inhibits beta-lactamase produced by bacteria to prevent the inactivation of
amoxicillin
A 65-year-old man starts treatment with linezolid for methicillin-resistant Staphylococcus
aureus (MRSA) infection. Two days later, he complains of fever, sweating, confusion, and
agitation. His blood pressure is 150/91 mmHg, and his heart rate is 110/minute. A physical
exam reveals diaphoresis, shivering, and hyperreflexia. The patient has a history of allergic
rhinitis, hypercholesterolemia, depression, and peptic ulcer disease. His usual medications
include lovastatin, astemizole, phenelzine, and famotidine. Which of the following most
likely caused a drug interaction with linezolid?
Phenelzine
A 65-year-old female comes to the clinician with pain behind her left heel for a day. The
pain is aggravated by dorsiflexion of the feet. She denies stiffness, weakness, numbness,
tingling, or redness of her feet and toes. She has diabetes managed with Insulin and
,osteoarthritis of the knee managed with painkillers. She was recently treated for an episode
of urinary tract infection. She eats a balanced diet and walks for 30 minutes every day. Her
vital signs are normal. On examination, there is no warmth, redness, or swelling on her
feet, but there is tenderness 3 centimeters above the posterior calcaneus on the left side.
Bilateral motor strength, reflexes, and sensation are normal. Which of the following is the
most likely cause of the condition?
use of prescription medication
A 54-year-old female with no significant past medical history presents with a 6-month
history of recurring "cold sores on my mouth." On exam, there are several vesicular lesions
on her lips. A 5% concentration of the antiviral ointment is administered. Regarding this
antiviral ointment, it is important to teach the patient which one of the following?
lesions may occur again at a later date despite treatment
A 25-year-old sexually active female comes to the clinician with complaints of frequent
urination, burning micturition, and mild supra-pubic pain for two days. She gives no
history of fever, nausea, flank pain, or vomiting. After an appropriate workup, the clinician
prescribes her a medication taken up by bacterial intracellular nitroreductases to produce
the active form of the drug to treat her condition. Which of the following is a well-known
severe adverse effect of the drug most likely given in this case?
pulmonary toxicity
A 25-year-old female patient comes to you for urinary discomfort and frequency. Urine
culture shows that her infection is susceptible to sulfamethoxazole/trimethoprim. What is
the benefit of using these drugs together?
the drugs inhibit sequential steps of the folate synthesis pathway
A 45-year-old woman develops pruritis, erythematous rash on the face and neck, and
hypotension during initial intravenous antimicrobial treatment. Which of the following
most likely caused this patients presentation?
vancomycin
A 41-year-old woman is involved in a serious skiing accident, requiring surgery for a
fractured femur. Postoperatively she develops methicillin-resistant Staphylococcus aureus
(MRSA) bacteremia. Infusion of a synthetic oxazolidinone antimicrobial drug is initiated.
Which of the following is one of the most common adverse effects of this drug?
headache
An 8-month-old boy presents with a new onset of fever, urinary hesitancy, and frequency
for three days. This is his second episode of similar complaints in the same month. He has a
, history of recurrent urinary tract infections since his birth. He has a 4-year-old sibling who
is healthy. He has normal growth and development and achieved his milestones on time.
The urine culture of catheterized specimens grew >100,000 colony-forming units of
Escherichia coli. The renal ultrasound shows mild hydronephrosis of the left kidney, and
the voiding cystourethrogram shows moderate dilatation of the left ureter and pelvis. The
patient is managed with nitrofurantoin and paracetamol. The patient is discharged on a
prophylactic antibiotic for his condition. Which of the following antimicrobial agents is
contraindicated in this patient?
ciprofloxacin
A 16-year-old female is being treated for insulin dependent diabetes mellitus and develops a
perineal abscess. It is foul smelling and you suspect an anaerobic infection. Which of the
following antibiotics has anaerobic activity?
metronidazole
An otherwise healthy 12-year-old boy is brought to the clinic by his mother with fever's
chief complaint for three days. His mother notes he has had a dry cough, congestion, and
fevers as high as 103 F at home. Starting two days ago, he began complaining about pain in
his right ear. The patient's immunizations are up to date, and no one else is currently sick
at home. Vital signs include blood pressure 112/76 mmHg, pulse 107/min, respiratory rate
18/min, temperature 39 C (102.2 F), SaO2 of 99% on room air. On examination, an
erythematous and moderately bulging right tympanic membrane with a fluid level is
observed behind the membrane. Visual inspection of the left ear reveals a normal-
appearing tympanic membrane. The remainder of the child's exam is unremarkable. What
is the mechanism of action of the medication that would be prescribed to him?
cell wall synthesis inhibitor
A 55-year-old man presents with septicemia after recovering from a motorcycle accident in
the hospital. The clinician suspects that the septicemia is caused by methicillin-resistant
Staphylococcus aureus (MRSA). Which of the following would provide the best antibiotic
coverage for this patient?
vancomycin
A 17-year-old patient presents to the clinic after experiencing significant dysphagia and
retrosternal heartburn. He was recently prescribed medication to treat a genital chlamydial
infection. Which of the following medications could have caused this patient's presenting
symptoms while treating the genital chlamydial infection?
doxycycline
Verified Answers, 100% Guarantee Pass
A 65-year-old man presents to the office with increased frequency, urgency, nocturia, and
hesitancy in micturition for the past week. He also complains of pain in ejaculation. He has
no flank pain, dysuria, hematuria, or fever. He is in a monogamous relationship and uses
condoms regularly. His temperature is 98.6 F (37 C), pulse rate is 77 beats/ minute,
respiration is 14 breaths/minute, and blood pressure is 130/80 mmHg. There is no
costovertebral angle tenderness or suprapubic tenderness, and external genitalia
examination is normal. Digital rectal examination shows normal sphincter tone and reflexes
with slightly enlarged and tender prostate. Urinalysis shows many WBCs with no RBCs or
casts. Urine culture grows E. coli. Serum prostate-specific antigen is 8ng/mL (reference
range of less than 3.5 ng/mL). Which of the following drug class can be used to treat the
patient's condition?
fluroquinolone
A 41-year-old G5P4004 at 38 weeks, 0 days pregnant presents for late prenatal testing. She
is found to have IgM-positive antibodies for HSV-2. The patient desires to deliver vaginally.
Which of the following statements is correct regarding the treatment of choice for this
patient's condition?
it is generally safe in pregnancy
A 25-year-old woman presents to the clinician with complaints of frequent burning
micturition and suprapubic discomfort from the past two days. The patient is sexually
active and has no significant past medical history. Urinalysis reveals the presence of
leukocyte esterase and a high level of nitrites. The clinician prescribes her a combination
antibiotic that inhibits two steps in the bacterial biosynthesis of tetrahydrofolate. Which of
the following is a contraindication to the use of this medication?
pregnancy
A 35-year-old woman comes to the office for pain and burning during urination for the past
few days. She denies fever, abdominal or flank pain, bloody urine, or passing any stones
while urinating. She has a medical history of gastroesophageal reflux disease, diabetes
mellitus type 2, and hyperlipidemia. She takes over-the-counter antacids, pantoprazole,
metformin, and atorvastatin. She is para 2 with both normal vaginal delivery and her last
menstrual period was three weeks ago. She uses oral contraceptive pills for contraception.
Her temperature is 37.2 C, her pulse is 70 beats/min, her respiratory rate is 12 breaths/min,
and her blood pressure is 130/80 mmHg. On examination, she denies suprapubic pain or
,costovertebral angle tenderness. Urinalysis reveals white blood cells of 20-25/hpf and red
blood cells of 5-10/hpf with no casts. Urinary nitrites and leukocyte esterase are positive,
and glucose and ketone are absent. White blood cell count is 7800/mm3. Serum creatinine
is 1.1 mg/dL and blood urea nitrogen is 17 mg/dL. Urine culture grows Escherichia coli.
The patient is started on a drug that inhibits an enzyme required in bacterial DNA
replication. The patient is counseled about adherence and the adverse effect of this drug.
About which of her other medications should she be counseled?
antacid
A 27-year-old male with a past medical history of tuberculosis presents to the outpatient
clinic with complaints of diarrhea and crampy abdominal pain. The patient was diagnosed
with tuberculosis 16 weeks ago and is currently on treatment with isoniazid and rifampicin.
Complete blood count shows an elevated WBC count. Blood testing shows that liver
function tests are normal. Which of the following is the best next step in the management of
this patient?
testing for clostridium difficle
A 5-year-old boy presents with a worsening cough and thick yellow-green nasal discharge
for the past two weeks. He has no chronic medical conditions and is not taking any
medication. His immunizations are up to date. Vital signs show a temperature of 39.2 C
(102.6 F), blood pressure of 120/80 mmHg, pulse of 92/min, and respiratory rate of 20/min.
On examination, nasal turbinates are swollen and erythematous, and there is a thick
purulent discharge from the nares. Lungs are clear on auscultation. Amoxicillin-
clavulanate is prescribed for acute bacterial sinusitis. What is the role of the clavulanate
component in amoxicillin-clavulanate?
Clavulanate inhibits beta-lactamase produced by bacteria to prevent the inactivation of
amoxicillin
A 65-year-old man starts treatment with linezolid for methicillin-resistant Staphylococcus
aureus (MRSA) infection. Two days later, he complains of fever, sweating, confusion, and
agitation. His blood pressure is 150/91 mmHg, and his heart rate is 110/minute. A physical
exam reveals diaphoresis, shivering, and hyperreflexia. The patient has a history of allergic
rhinitis, hypercholesterolemia, depression, and peptic ulcer disease. His usual medications
include lovastatin, astemizole, phenelzine, and famotidine. Which of the following most
likely caused a drug interaction with linezolid?
Phenelzine
A 65-year-old female comes to the clinician with pain behind her left heel for a day. The
pain is aggravated by dorsiflexion of the feet. She denies stiffness, weakness, numbness,
tingling, or redness of her feet and toes. She has diabetes managed with Insulin and
,osteoarthritis of the knee managed with painkillers. She was recently treated for an episode
of urinary tract infection. She eats a balanced diet and walks for 30 minutes every day. Her
vital signs are normal. On examination, there is no warmth, redness, or swelling on her
feet, but there is tenderness 3 centimeters above the posterior calcaneus on the left side.
Bilateral motor strength, reflexes, and sensation are normal. Which of the following is the
most likely cause of the condition?
use of prescription medication
A 54-year-old female with no significant past medical history presents with a 6-month
history of recurring "cold sores on my mouth." On exam, there are several vesicular lesions
on her lips. A 5% concentration of the antiviral ointment is administered. Regarding this
antiviral ointment, it is important to teach the patient which one of the following?
lesions may occur again at a later date despite treatment
A 25-year-old sexually active female comes to the clinician with complaints of frequent
urination, burning micturition, and mild supra-pubic pain for two days. She gives no
history of fever, nausea, flank pain, or vomiting. After an appropriate workup, the clinician
prescribes her a medication taken up by bacterial intracellular nitroreductases to produce
the active form of the drug to treat her condition. Which of the following is a well-known
severe adverse effect of the drug most likely given in this case?
pulmonary toxicity
A 25-year-old female patient comes to you for urinary discomfort and frequency. Urine
culture shows that her infection is susceptible to sulfamethoxazole/trimethoprim. What is
the benefit of using these drugs together?
the drugs inhibit sequential steps of the folate synthesis pathway
A 45-year-old woman develops pruritis, erythematous rash on the face and neck, and
hypotension during initial intravenous antimicrobial treatment. Which of the following
most likely caused this patients presentation?
vancomycin
A 41-year-old woman is involved in a serious skiing accident, requiring surgery for a
fractured femur. Postoperatively she develops methicillin-resistant Staphylococcus aureus
(MRSA) bacteremia. Infusion of a synthetic oxazolidinone antimicrobial drug is initiated.
Which of the following is one of the most common adverse effects of this drug?
headache
An 8-month-old boy presents with a new onset of fever, urinary hesitancy, and frequency
for three days. This is his second episode of similar complaints in the same month. He has a
, history of recurrent urinary tract infections since his birth. He has a 4-year-old sibling who
is healthy. He has normal growth and development and achieved his milestones on time.
The urine culture of catheterized specimens grew >100,000 colony-forming units of
Escherichia coli. The renal ultrasound shows mild hydronephrosis of the left kidney, and
the voiding cystourethrogram shows moderate dilatation of the left ureter and pelvis. The
patient is managed with nitrofurantoin and paracetamol. The patient is discharged on a
prophylactic antibiotic for his condition. Which of the following antimicrobial agents is
contraindicated in this patient?
ciprofloxacin
A 16-year-old female is being treated for insulin dependent diabetes mellitus and develops a
perineal abscess. It is foul smelling and you suspect an anaerobic infection. Which of the
following antibiotics has anaerobic activity?
metronidazole
An otherwise healthy 12-year-old boy is brought to the clinic by his mother with fever's
chief complaint for three days. His mother notes he has had a dry cough, congestion, and
fevers as high as 103 F at home. Starting two days ago, he began complaining about pain in
his right ear. The patient's immunizations are up to date, and no one else is currently sick
at home. Vital signs include blood pressure 112/76 mmHg, pulse 107/min, respiratory rate
18/min, temperature 39 C (102.2 F), SaO2 of 99% on room air. On examination, an
erythematous and moderately bulging right tympanic membrane with a fluid level is
observed behind the membrane. Visual inspection of the left ear reveals a normal-
appearing tympanic membrane. The remainder of the child's exam is unremarkable. What
is the mechanism of action of the medication that would be prescribed to him?
cell wall synthesis inhibitor
A 55-year-old man presents with septicemia after recovering from a motorcycle accident in
the hospital. The clinician suspects that the septicemia is caused by methicillin-resistant
Staphylococcus aureus (MRSA). Which of the following would provide the best antibiotic
coverage for this patient?
vancomycin
A 17-year-old patient presents to the clinic after experiencing significant dysphagia and
retrosternal heartburn. He was recently prescribed medication to treat a genital chlamydial
infection. Which of the following medications could have caused this patient's presenting
symptoms while treating the genital chlamydial infection?
doxycycline
