NUR 524 EXAM 3 LATEST UPDATED 180
QUESTIONS AND ANSWERS WELL
EXPLAINED 2024. A+ ULTIMATE GUIDE
1. A 14-year-old boy presents with symptoms of fatigue and oliguria
with cola-colored urine, following streptococcal pharyngitis two weeks
ago. Physical examination reveals elevated blood pressure and
swelling in the hands and feet. Urinalysis shows proteinuria and
hematuria with red blood cell casts. What is the most likely diagnosis?
Acute glomerulonephritis
Acute pyelonephritis
Acute tubular necrosis
Initial onset of diabetes mellitus: Acute glomerulonephritis
Acute glomerulonephritis can occur 1-3 weeks after a streptococcal
infection. The reaction that occurs as a result of streptococcal infection is
the result of an abnormal immunologic response, resulting in damage to
the glomeruli. Symptoms include hematuria, cola-colored urine, oliguria,
hypertension, and edema of the face and extremities. Urinalysis reveals
red blood cells, mild proteinuria, and red blood cell casts. Pediatric
,patients usually have depressed C3 complement levels. In adults,
elevation of creatinine levels is more common. Management of
postinfectious glomerulonephritis is supportive, with water and salt
restriction. Calcium channel blockers or ACE inhibitors may be used in
cases of severe hypertension. More than 90% of children achieve full
recovery; complete remission in adults is 26-56%, depending on age and
other comorbidities.
2. A 23-year-old woman presents to the clinic with a history of
debilitating, unilateral headaches that only occur shortly before her
period and take her several days to recover. Which one of the
following triptans has been found to be effective in preventing these
kinds of headaches?
Almotriptan
Frovatriptan
Rizatriptan
Sumatriptan: Frovatriptan
Frovatriptan and naratriptan are two long-acting triptans that have been
found to be effective in preventing menstrual migraine if taken around-
the-clock starting two days before menses and continuing for a total of
five to six days. Menstrual migraines are migraine headaches that occur
,exclusively near the time of menses. Triptans are drugs specific to
migraine treatment and bind to serotonergic receptors. They are
considered first-line treatment for moderate to severe migraines or for
mild-to-moderate migraine headaches that have failed other analgesics.
Triptans have vasoconstrictive properties so their use is contraindicated
in those with ischemic heart disease, stroke, uncontrolled hypertension,
or basilar migraine
3. A 55-year-old woman with restless legs syndrome presents with
worsening leg symptoms described as crawling and fidgeting over the
past 4 weeks. Her symptoms have been interfering with her quality of
sleep. When asked about medications, she reports only taking
pramipexole 0.5 mg (normal dose range: 0.125-0.5 mg) in the evenings.
Which of the following is the most appropriate next step in
management?
Discontinue pramipexole and start gabapentin
Offer reassurance and recommend a melatonin supplement at bedtime
Order a CBC
Refer to neurology: Order a CBC
Restless legs syndrome is a condition characterized by sensory
disturbances and an irresistible urge to move the legs during periods of
, rest. Patients will often report disturbed sleep patterns and daytime
sleepiness. Certain conditions can predispose individuals to developing
the syndrome, such as family history of restless legs syndrome,
Parkinson disease, pregnancy, iron deficiency anemia, or diabetic
peripheral neuropathy
4. A 42-year-old woman presents to the office with double vision
and eye pain. She reports these symptoms started 4 days ago, and she
experienced a similar episode around 3 months ago. She reports pain
and blurring of vision in her left eye. She has no significant past
medical history and takes no medications. On physical examination,
her vital signs are normal. A focused neurologic examination reveals
that the patient cannot fully adduct her left eye while at the same time
you notice nystagmus on abduction of the right eye. There is dysmetria
with finger-nose testing in the right arm. What would be the first test
to order on this patient based on the suspected diagnosis?
Cerebrospinal fluid analysis for oligoclonal bands
Computed tomography of the brain with and without contrast
Magnetic resonance imaging of the brain with and without contrast
Visual evoked potentials: Magnetic resonance imaging of the brain
with and without contrast
QUESTIONS AND ANSWERS WELL
EXPLAINED 2024. A+ ULTIMATE GUIDE
1. A 14-year-old boy presents with symptoms of fatigue and oliguria
with cola-colored urine, following streptococcal pharyngitis two weeks
ago. Physical examination reveals elevated blood pressure and
swelling in the hands and feet. Urinalysis shows proteinuria and
hematuria with red blood cell casts. What is the most likely diagnosis?
Acute glomerulonephritis
Acute pyelonephritis
Acute tubular necrosis
Initial onset of diabetes mellitus: Acute glomerulonephritis
Acute glomerulonephritis can occur 1-3 weeks after a streptococcal
infection. The reaction that occurs as a result of streptococcal infection is
the result of an abnormal immunologic response, resulting in damage to
the glomeruli. Symptoms include hematuria, cola-colored urine, oliguria,
hypertension, and edema of the face and extremities. Urinalysis reveals
red blood cells, mild proteinuria, and red blood cell casts. Pediatric
,patients usually have depressed C3 complement levels. In adults,
elevation of creatinine levels is more common. Management of
postinfectious glomerulonephritis is supportive, with water and salt
restriction. Calcium channel blockers or ACE inhibitors may be used in
cases of severe hypertension. More than 90% of children achieve full
recovery; complete remission in adults is 26-56%, depending on age and
other comorbidities.
2. A 23-year-old woman presents to the clinic with a history of
debilitating, unilateral headaches that only occur shortly before her
period and take her several days to recover. Which one of the
following triptans has been found to be effective in preventing these
kinds of headaches?
Almotriptan
Frovatriptan
Rizatriptan
Sumatriptan: Frovatriptan
Frovatriptan and naratriptan are two long-acting triptans that have been
found to be effective in preventing menstrual migraine if taken around-
the-clock starting two days before menses and continuing for a total of
five to six days. Menstrual migraines are migraine headaches that occur
,exclusively near the time of menses. Triptans are drugs specific to
migraine treatment and bind to serotonergic receptors. They are
considered first-line treatment for moderate to severe migraines or for
mild-to-moderate migraine headaches that have failed other analgesics.
Triptans have vasoconstrictive properties so their use is contraindicated
in those with ischemic heart disease, stroke, uncontrolled hypertension,
or basilar migraine
3. A 55-year-old woman with restless legs syndrome presents with
worsening leg symptoms described as crawling and fidgeting over the
past 4 weeks. Her symptoms have been interfering with her quality of
sleep. When asked about medications, she reports only taking
pramipexole 0.5 mg (normal dose range: 0.125-0.5 mg) in the evenings.
Which of the following is the most appropriate next step in
management?
Discontinue pramipexole and start gabapentin
Offer reassurance and recommend a melatonin supplement at bedtime
Order a CBC
Refer to neurology: Order a CBC
Restless legs syndrome is a condition characterized by sensory
disturbances and an irresistible urge to move the legs during periods of
, rest. Patients will often report disturbed sleep patterns and daytime
sleepiness. Certain conditions can predispose individuals to developing
the syndrome, such as family history of restless legs syndrome,
Parkinson disease, pregnancy, iron deficiency anemia, or diabetic
peripheral neuropathy
4. A 42-year-old woman presents to the office with double vision
and eye pain. She reports these symptoms started 4 days ago, and she
experienced a similar episode around 3 months ago. She reports pain
and blurring of vision in her left eye. She has no significant past
medical history and takes no medications. On physical examination,
her vital signs are normal. A focused neurologic examination reveals
that the patient cannot fully adduct her left eye while at the same time
you notice nystagmus on abduction of the right eye. There is dysmetria
with finger-nose testing in the right arm. What would be the first test
to order on this patient based on the suspected diagnosis?
Cerebrospinal fluid analysis for oligoclonal bands
Computed tomography of the brain with and without contrast
Magnetic resonance imaging of the brain with and without contrast
Visual evoked potentials: Magnetic resonance imaging of the brain
with and without contrast
