FINAL EXAM NR509 CERTIFICATION TEST 2026
COMPREHENSIVE STUDY GUIDE
◉ Hepatitis B high risk. Answer: -Sexual contact: w/ partners
infected, more than one parter in prior 6 mos, people seeing eval of
treatment for STD, men with men
-Perc and Mucosal exposure to blod: drugs, household contacts,
residents and staff of facilties of DD, Health care, dialysis
-Others: Travel to endemic areas, chronic liver disease and HIV,
people seeking protection from Hep B.
--All adults in high risk-settings: STD clinics, HIV programs, Drug
programs, correctional facilities, programs for gay men, chronic
hemodialysis facilities, facilities for people with Developmental
Delays.
◉ IBS patterns. Answer: 1. diarrhea—predominant
2. constipation—predominant
3. mixed.
--Symptoms present ≥6 mo and abdominal pain for ≥3 mo plus at
least 2 of 3 features (improvement with defecation; onset with
change in stool frequency; onset with change in stool form and
appearance)
,◉ IBS: process. Answer: Altered motility or secretion from luminal
and mucosal irritants that change mucosal permeability, immune
activation, and colonic transit, including maldigested carbohydrates,
fats, excess bile acids, gluten intolerance, entero-endocrine signaling,
and changes in microbiomes
◉ IBS characteristics of stool. Answer: Loose; ∼50% with mucus;
small to mod-erate volume. Small, hard stools with constipation.
May be mixed pattern.
◉ IBS timing. Answer: Worse in the morning; rarely at night.
◉ IBS associated symptoms. Answer: Crampy lower ab-dominal
pain, ab-dominal disten-tion, flatulence, nausea; urgency, pain
relieved with defecation
◉ IBS setting, persons at risk. Answer: Young and middle-aged
adults, especially women
◉ Stress Incontinence problem. Answer: The urethral sphincter is
weakened so that transient increases in intra-abdominal pressure
raise the bladder pressure to levels that exceed urethral resistance.
◉ Stress Incontinence mechanisms. Answer: In women, pelvic floor
weakness and inadequate muscular and ligamentous support of the
,bladder neck and proximal urethra change the angle between the
bladder and the urethra (see Chapter 14, pp. 592-593). Causes
include childbirth and surgery. Local conditions affecting the
internal urethral sphincter, such as postmenopausal atrophy of the
mucosa and urethral infection, may also contribute.
In men, stress incontinence may follow prostate surgery.
◉ Stress Incontinence symptoms. Answer: Momentary leakage of
small amounts of urine with
coughing, laughing, and sneezing while the person is in an upright
position. Urine loss is unrelated to a conscious urge to urinate.
◉ Stress Incontinence Physical signs. Answer: Stress incontinence
may be demonstrable, especially if the patient is examined before
voiding and in a standing position. Atrophic vaginitis may be
evident. Bladder distention is absent.
◉ Urge incontinence problem. Answer: Detrusor contractions are
stronger than normal and overcome the normal urethral resistance.
The bladder is typically small.
◉ Urge incontinence mechanism. Answer: Decreased cortical
inhibition of detrusor contractions from stroke, brain tumor,
dementia, and lesions of the spinal cord above the sacral level.
, Hyperexcitability of sensory pathways, as in bladder infections,
tumors, and fecal impaction.
Deconditioning of voiding reflexes, as in frequent voluntary voiding
at low bladder volumes.
◉ Urge incontinence symptoms. Answer: Involuntary urine loss
preceded by an urge to void. The volume tends to be moderate.
Urgency, frequency, and nocturia with small to moderate volumes. If
acute inflammation is present, pain on urination.
Possibly "pseudo-stress incontinence"—voiding 10-20 sec after
stresses such as a change of position, going up-or downstairs, and
possibly coughing, laughing, or sneezing.
◉ Urge incontinence physical signs. Answer: The small bladder is
not detectable on abdominal examination.
When cortical inhibition is decreased, mental deficits or motor signs
of central nervous system disease are often present.
When sensory pathways are hyperexcitable, signs of local pelvic
problems or a fecal impaction may be present.
◉ Overflow incontinence problem. Answer: Detrusor contractions
are insufficient to overcome urethral resistance, causing urinary
retention. The bladder is typically flaccid and large, even after an
effort to void.
COMPREHENSIVE STUDY GUIDE
◉ Hepatitis B high risk. Answer: -Sexual contact: w/ partners
infected, more than one parter in prior 6 mos, people seeing eval of
treatment for STD, men with men
-Perc and Mucosal exposure to blod: drugs, household contacts,
residents and staff of facilties of DD, Health care, dialysis
-Others: Travel to endemic areas, chronic liver disease and HIV,
people seeking protection from Hep B.
--All adults in high risk-settings: STD clinics, HIV programs, Drug
programs, correctional facilities, programs for gay men, chronic
hemodialysis facilities, facilities for people with Developmental
Delays.
◉ IBS patterns. Answer: 1. diarrhea—predominant
2. constipation—predominant
3. mixed.
--Symptoms present ≥6 mo and abdominal pain for ≥3 mo plus at
least 2 of 3 features (improvement with defecation; onset with
change in stool frequency; onset with change in stool form and
appearance)
,◉ IBS: process. Answer: Altered motility or secretion from luminal
and mucosal irritants that change mucosal permeability, immune
activation, and colonic transit, including maldigested carbohydrates,
fats, excess bile acids, gluten intolerance, entero-endocrine signaling,
and changes in microbiomes
◉ IBS characteristics of stool. Answer: Loose; ∼50% with mucus;
small to mod-erate volume. Small, hard stools with constipation.
May be mixed pattern.
◉ IBS timing. Answer: Worse in the morning; rarely at night.
◉ IBS associated symptoms. Answer: Crampy lower ab-dominal
pain, ab-dominal disten-tion, flatulence, nausea; urgency, pain
relieved with defecation
◉ IBS setting, persons at risk. Answer: Young and middle-aged
adults, especially women
◉ Stress Incontinence problem. Answer: The urethral sphincter is
weakened so that transient increases in intra-abdominal pressure
raise the bladder pressure to levels that exceed urethral resistance.
◉ Stress Incontinence mechanisms. Answer: In women, pelvic floor
weakness and inadequate muscular and ligamentous support of the
,bladder neck and proximal urethra change the angle between the
bladder and the urethra (see Chapter 14, pp. 592-593). Causes
include childbirth and surgery. Local conditions affecting the
internal urethral sphincter, such as postmenopausal atrophy of the
mucosa and urethral infection, may also contribute.
In men, stress incontinence may follow prostate surgery.
◉ Stress Incontinence symptoms. Answer: Momentary leakage of
small amounts of urine with
coughing, laughing, and sneezing while the person is in an upright
position. Urine loss is unrelated to a conscious urge to urinate.
◉ Stress Incontinence Physical signs. Answer: Stress incontinence
may be demonstrable, especially if the patient is examined before
voiding and in a standing position. Atrophic vaginitis may be
evident. Bladder distention is absent.
◉ Urge incontinence problem. Answer: Detrusor contractions are
stronger than normal and overcome the normal urethral resistance.
The bladder is typically small.
◉ Urge incontinence mechanism. Answer: Decreased cortical
inhibition of detrusor contractions from stroke, brain tumor,
dementia, and lesions of the spinal cord above the sacral level.
, Hyperexcitability of sensory pathways, as in bladder infections,
tumors, and fecal impaction.
Deconditioning of voiding reflexes, as in frequent voluntary voiding
at low bladder volumes.
◉ Urge incontinence symptoms. Answer: Involuntary urine loss
preceded by an urge to void. The volume tends to be moderate.
Urgency, frequency, and nocturia with small to moderate volumes. If
acute inflammation is present, pain on urination.
Possibly "pseudo-stress incontinence"—voiding 10-20 sec after
stresses such as a change of position, going up-or downstairs, and
possibly coughing, laughing, or sneezing.
◉ Urge incontinence physical signs. Answer: The small bladder is
not detectable on abdominal examination.
When cortical inhibition is decreased, mental deficits or motor signs
of central nervous system disease are often present.
When sensory pathways are hyperexcitable, signs of local pelvic
problems or a fecal impaction may be present.
◉ Overflow incontinence problem. Answer: Detrusor contractions
are insufficient to overcome urethral resistance, causing urinary
retention. The bladder is typically flaccid and large, even after an
effort to void.
