NRNP 6531 Final Exam part two (180 Questions) and Answers with Rationale 2022/2023

NRNP 6531 Final Exam part two Questions and Answers The daughter of an elderly confused patient reports that her parent is having urinary incontinence several times each day. What will the provider do initially? a. Obtain a urine sample for urinalysis (UA) and possible culture b. Order serum creatinine and blood urea nitrogen tests c. Perform a bladder scan to determine distention and retention d. Tell the daughter that this is expected given her mother's age and confusion - ANS: A When incontinence occurs, UA is performed initially to exclude hematuria, pyu ria, glucosuria, or proteinuria and possible infection. Serum creatinine and BUN may be performed if renal disease is suspected. Bladder scans may be performed if the UA is normal to evaluate physiologic causes. It is not correct to offer reassurance witho ut ruling out other causes. The provider is evaluating a patient for potential causes of urinary incontinence and performs a postvoid residual (PVR) test which yields 30 mL of urine. What is the interpretation of this result? a. The patient may have overflow incontinence. b. The patient probably has a urinary tract infection (UTI). c. This is a normal result. d. This represents incomplete emptying. - ANS: C A PVR less than 50 mL is considered normal and this result does not ind icate any abnormality. The provider is counseling a patient who has stress incontinence about ways to minimize accidents. What will the provider suggest initially? a. Increasing fluid intake to dilute the urine b. Referral to a physical therapist c. Takin g pseudoephedrine daily d. Voiding every 2 hours during the day - ANS: D Timed voiding is useful to help minimize stress incontinence and is used initially. Increasing fluid intake will increase symptoms. PT referral may be done if other measures fail to h elp with exercises to strengthen the pelvic floor muscles. Pseudoephedrine is useful, but not an initial therapy. An older male patient reports urinary frequency, back pain, and nocturia. A dipstick urinalysis reveals hematuria. What will the provider do next to evaluate this condition? a. Order a PSA and perform a digital rectal exam (DRE) b. Refer for a biopsy c. Refer the patient to a urologist d. Schedule a transurethral ultrasound (TRUS) - ANS: A Patients with symptoms of potential prostate cancer sho uld be screened with PSA and DRE. Referral to a urologist is the next step even with normal findings, since PSA is occasionally normal. The urologist may order TRUS or biopsy. An older male patient has a screening prostate -specific antigen (PSA) which is 12 ng/mL. What does this value indicate? a. A normal result b. Benign prostatic hypertrophy c. Early prostate cancer d. Prostate cancer - ANS: D A PSA greater than 10 ng/mL suggests prostate cancer. A level between 4 and 10 ng/mL may be early prostate canc er or a benign condition. A level less than 4 ng/mL is normal. A patient is diagnosed with prostate cancer and diagnostic testing reveals disease that has gone past the prostatic capsule without evidence of metastasis. The patient does not wish to undergo treatment. What will the provider tell this patient? a. Chemotherapy is indicated to provide cure for this cancer. b. Monitoring prostate -specific antigen (PSA) with regular digital rectal examination (DRE) is an acceptable option. c. Palliative radiation therapy is necessary to improve quality of life. d. This level of disease requires intervention with hormonal therapy. - ANS: B This patient has stage T2 prostate cancer which may be managed with watchful waiting which includes PSA and DRE evaluation. Chemotherapy, palliative radiation therapy, and hormonal therapy are not required. A male patient reports nocturia and daytime urinary frequency and urgency without changes in the force of the urine stream. What is the likely cause of this? a. Bladder outlet obstruction b. Lower urinary tract symptoms (LUTS) c. Prostate cancer d. Urinary tract infection (UTI) - ANS: B Lower urinary tract symptoms (LUTS) result from irritative changes in the lower tract. Bladder outlet obstruction causes hesitancy, decreased caliber and force of the urine stream, and postvoid dribbling. Diagnosis of prostate cancer and UTI require further testing and are less likely causes. A 70 -year -old male reports urinary hesitancy, postvoid dribbling, and a diminishe d urine stream. A digital rectal exam (DRE) reveals an enlarged prostate gland that feels rubbery and smooth. Which tests will the primary care provider order based on these findings? a. Bladder scan for postvoid residual b. Prostate -specific antigen (PSA) and bladder imaging c. Urinalysis and serum creatinine d. Urine culture and CBC with differential - ANS: C The DRE reveals a prostate gland consistent with benign prostatic hyperplasia (BPH). The primary provider should order a urinalysis and creatinine t o evaluate possible infection and renal function. A bladder scan is ordered at the discretion of the urologist. The prostate exam isn't consistent with prostate cancer, so PSA and bladder imaging are not necessary. Symptoms of prostatitis would indicate a need for evaluation of possible infection. A patient has been taking terazosin daily at bedtime to treat benign prostatic hyperplasia (BPH) and reports persistent daytime dizziness. What will the provider do? a. Prescribe finasteride instead of terazosin b. Recommend taking the medication in the morning c. Suggest using herbal preparations d. Switch the prescription to doxazosin - ANS: A Patients who cannot tolerate the side effect of alpha -adrenergic antagonists, the provider may initiate therapy with a 5 a-reductase inhibitor such as finasteride. Terazosin should be given at bedtime to minimize these adverse effects. Herbal preparations have not been proven to be safe or effective. Doxazosin is in the same drug class as terazosin. A pregnant woman at 30 w eeks gestation presents with proteinuria. What will the provider do next? a. Evaluate her blood pressure and discuss with OB/GYN b. Monitor serum glucose for gestational diabetes c. Perform a 24 -hour urine collection d. Reassure her that this normal at this stage of pregnancy - ANS: A Proteinuria after 24 weeks gestation is usually a sign of preeclampsia, so her blood pressure should be evaluated and discussed with the OB/GYN. Serum glucose evaluation for gestational d iabetes is performed as part of routine screening but is not related to the finding of proteinuria. A 24 -hour urine collection is not indicated. An older male patient reports gross hematuria but denies flank pain and fever. What will the provider do to ma nage this patient? a. Monitor blood pressure closely b. Obtain a urine culture c. Perform a 24 -hour urine collection d. Refer for cystoscopy and imaging –