APEA 3P Exam PrepNephrology/GU Questions with Correct Answers and Explanations

A 79-year-old female patient with urinary frequency is found to have a UTI. What medication could produce arrhythmias in her? Doxycycline Amoxicillin Ciprofloxacin Macrodantin Ciprofloxacin is a quinolone antibiotic. All quinolones have the potential to produce prolongation of the QT interval. It should be prescribed with caution in older adults. Mrs. Jackson complains of urinary incontinence when she laughs or sneezes. What should be used first line to treat her symptoms? Kegel exercises Prescribe oxybutynin Avoid caffeine and alcohol Minimize fluids at nighttime This patient has stress incontinence. The first-line approach with these patients is to attempt to strengthen the pelvic floor muscles. Appropriate performance of Kegel exercises is key. Prescribing an anticholinergic might worsen incontinence because it will cause urinary retention. Avoiding caffeine and alcohol is especially helpful for people with urge incontinence, but could have a minimal benefit for this patient. However, this does not address the underlying problem, weak pelvic muscles. Minimizing fluids at nighttime will help if nocturia is a problem. A 76-year-old male presents with urethral irritation after voiding. If sexually transmitted diseases and urinary tract infection are ruled out, what is another etiology? Acute bacterial prostatitis Chronic prostatitis Epididymitis Asymptomatic bacteriuria Chronic prostatitis can produce these symptoms. Sometimes this is accompanied by perineal pain, but the patient may have a normal prostate exam. Acute bacterial prostatitis patients will present with fever, chills. Examination of the prostate gland reveals a tender, boggy prostate gland. Epididymitis can produce scrotal pain, not dysuria or irritation with voiding. Asymptomatic bacteriuria is asymptomatic. These patients don’t know they have this because they have no symptoms. A healthy 32-year-old female has left flank pain and nausea. What is the most likely diagnosis? Urinary tract infection Renal stone Cholecystitis Pyelonephritis The most common presentation of acute uncomplicated pyelonephritis includes fever, flank pain, and nausea and vomiting. Sometimes patients present with symptoms of pelvic inflammatory disease (PID). In this presentation, abdominal pain is common too. Fever is so strongly correlated with acute pyelonephritis that it is unusual not to have fever. Renal stone patients may have this presentation, but fever is usually NOT present. It is unlikely that cholecystitis would present with leftsided flank pain. The gall bladder is on the right side of the body. The incidence of pyelonephritis is: least common in young adults. less common than urinary tract infections. always associated with urinary tract infections. more likely in elderly males. The incidence of pyelonephritis in the US is much less common than urinary tract infections (UTIs). It is less likely in males, but is most common in females aged 15- 29 years; and even more common during pregnancy. Factors associated with pyelonephritis are frequent sexual intercourse, UTI within the last year, presence of diabetes, and presence of stress incontinence within the previous 30 days. A 25-year-old male patient with subacute bacterial epididymitis should be treated initially with an oral quinolone doxycycline. NSAIDs only. ice and scrotal support. In a 25-year-old male with subacute bacterial epididymitis, the most likely organism is Chlamydia. Therefore, until cultures are back, he should be treated empirically with doxycycline 100 mg BID for 10 days. Quinolones should specifically be avoided if the suspected agent is gonorrhea because of rising resistance. NSAIDs, ice, and scrotal support will help the patient’s symptoms but not treat the underlying cause. A 73-year-old male patient reports that he is experiencing a weakened urinary stream, urinary frequency, and urgency. He is waking up once or twice nightly to urinate. How should the nurse practitioner proceed? Digital rectal exam (DRE) only DRE, urinalysis, PSA PSA only PSA, DRE, BUN