NR 511 Final EXAM 2024 AND PRACTICE QUESTIONS |ACCURATE ANSWERS| VERIFIED FOR GUARANTEED, Exams of Nursing

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NR 511 Final EXAM 2024 AND PRACTICE

QUESTIONS |ACCURATE ANSWERS|

VERIFIED FOR GUARANTEED PASS

|GRADED A |NEW VERSION 200

QUESTIONS

The examiner is providing a 20-year-old man with information on genital self- examination (GSE). For what reason should a man this age be taught how to do this? a. Testicular cancer is the most common type of cancer in young men. b. Self-examination can help determine when full development of the genitalia is completed. c. Self-examination can prevent acquiring a sexually transmitted infection. d. Routine examination can help detect prostate enlargement.

• ANSWER a. Testicular cancer is the most common type of cancer in young men. In which of the following situations is transillumination of the scrotum indicated? a. Presence of syphilis chancre is noted. b. Indirect hernia is palpated. c. The examiner suspects a mass.

d. The examiner palpates the testes.

• ANSWER c. The examiner suspects a mass. A 24-year-old man has scrotal pain and marked erythema. The examiner considers epididymitis. Which finding is consistent with this problem? a. The patient's scrotal size and shape are not symmetric. b. The patient has anorexia and nausea. c. The patient reports an acute onset of severe pain. d. Urinalysis shows elevated WBCs and bacteria.
• ANSWER d. Urinalysis shows elevated WBCs and bacteria. Hypospadias is a congenital defect in which the urethra meatus is located on the ventral surface of the glans penis. This is thought to occur embryologically during urethral development during which stage of gestation? a. 4 to 6 weeks b. 8 to 20 weeks c. 15 to 25 weeks d. 20 to 30 weeks
• ANSWER b. 8 to 20 weeks

You are examining a patient and note pearly gray, smooth, umbilicated lesions. The most common cause of these lesions is a. syphilis. b. condyloma acuminata. c. molluscum contagiosum. d. lymphogranuloma venereum.

• ANSWER molluscum contagiosum Feels boggy, enlarged, and tender to palpation
• ANSWER a. Prostatitis Feels hard, nodular; unable to palpate sulcus
• ANSWER Prostatic carcinoma PSA - ANSWER PSA ,4 ng/mL: normal PSA ,4 to 10 ng/mL: borderline PSA .10 ng/mL: high The higher the PSA level, the more likely cancer exists. However, men with prostate CA can have borderline to low results. PSA routine screening in conjunction with DRE in all men older than 50 years old and in men older than 40 years old with positive risk factors. Prostate enlargement is determined by the

a. diameter of the rectum near the bladder. b. circumference of the prostate. c. estimation of the depth of the sulcus. d. protrusion of the prostate into the rectum.

• ANSWER protrusion of the prostate into the rectum. Which of the following patients has a known risk factor for colorectal cancer? a. Marcus, a 21-year-old college student who is a vegetarian b. Jack, a 56-year-old man who eats a diet high in beef c. Susan, a 38-year-old woman with a 5-year history of gastric ulcers d. Helen, a 22-year-old mother with multiple hemorrhoids
• ANSWER b. Jack, a 56-year-old man who eats a diet high in beef The examiner palpates a prostate, noting that it is hard and irregular. The median sulcus is not palpable. These findings are consistent with a. prostate cancer. b. benign prostatic hypertrophy. c. prostatitis. d. rectal mass.
  • ANSWER prostate cancer.

Which statement about HIV postexposure prophylaxis (PEP) for health-care workers is the most accurate? a. PEP should be started within hours of exposure. b. PEP should be started within 72 hours of exposure. c. Renal and hepatic function tests should be done 6 weeks after beginning PEP. d. PEP will prevent potential hepatitis C infection if present.

• ANSWER a. PEP should be started within hours of exposure. Which household solution should be used to clean a bathroom if sharing with a friend who has HIV? a. 100% bleach b. 50% bleach and 50% vinegar c. Nine parts H2O to one part bleach d. The friend must have his or her own bathroom.
• ANSWER c. Nine parts H2O to one part bleach Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate? a. A favorable prognostic trend b. Disease progression c. The need to be more aggressive with Reuben's medications d. The eradication of the HIV
• ANSWER a. A favorable prognostic trend

The most cost-effective screening test for determining HIV status is which of the following? a. Western blot b. Enzyme-linked immunosorbent assay c. Venereal Disease Research Laboratory test d. Viral load

• ANSWER b. Enzyme-linked immunosorbent assay The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety?
  • ANSWER Gamma-aminobutyric acid (GABA) The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least?
  • ANSWER 6 months A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? a. Ceftriaxone b. Doxycycline c. Acyclovir d. Metronidazole
  • ANSWER Ceftriaxone

A patient is seen in the clinic with a chief complaint of hematuria. To make a differential diagnosis, which of the following questions should be asked? a. "Do you have a history of liver disease?" b. "What medications are you currently taking?" c. "Have you noticed swelling in your ankles?" d. All of the above

• ANSWER "What medications are you currently taking" A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might be the cause of hematuria? a. NSAIDs b. Beets c. Vitamin A d. Red meat
• ANSWER NSAIDS A 27-year-old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tract infection (UTI). What are some additional symptoms consistent with a diagnosis of lower UTI? a. Back and abdominal pain b. Fever, chills, costovertebral angle (CVA) tenderness c. Blood in urine and frequency d. Foul-smelling discharge, perineal itch
  • ANSWER Blood in urine ad frequency

A 30-year-old patient presents with pain on urination. The urine microscopy of unspun urine shows greater than 10 leukocytes/mL, and a dipstick is positive for nitrites. What is the probable diagnosis? a. Lower urinary tract infection b. Chlamydia infection c. Candidiasis d. Pyelonephritis

• ANSWER Lower urinary tract infection A patient presents with CVA tenderness and a several-day history of high fever, chills, and dysuria. Which of the following diagnoses is most likely given the above information? a. Pyelonephritis b. Cystitis c. Renal calculi d. Bladder tumor
• ANSWER Pyelonephritis A patient is diagnosed with urge incontinence. Before prescribing Detrol XL, the provider should question the patient about which of these contraindications to this medication? a. Diarrhea b. Parkinson's disease c. Closed-angle glaucoma d. Breast cancer

• ANSWER Closed-angle glaucoma A patient is seen in the office complaining of severe flank pain. The clinician should assess this patient for which risk factor for kidney stones? a. Hypertension b. Constipation c. Tubal ligation d. Diabetes
• ANSWER Hypertension A patient is diagnosed with overactive bladder. Which of the following instructions should be given to this woman? a. "Limit the amount of water that you drink." b. "Eliminate caffeine from your diet." c. "Wear panty liners." d. All of the above
• ANSWER Eliminate caffeine from your diet A 34-year-old patient was treated for a UTI and has not responded to antibiotic therapy. Which of the following actions should be taken next? a. Send a urine specimen for microscopy and evaluate for fungal colonies. b. Increase the dose of antibiotic. c. Order a cytoscopy. d. Order a different antibiotic.
• ANSWER Send a urine specimen for microscopy and evaluate for fungal colonies

Which of the following are predisposing factors for pyelonephritis? a. Pregnancy b. Dehydration c. Smoking d. Alkaline urine - ANSWER Pregnancy A 42-year-old woman is seen in the clinic with fever, chills, vomiting, and severe dysuria. She is diagnosed with acute pyelonephritis. How should this patient be managed? a. 3-day course of oral antibiotics b. Hospitalization c. Encourage cranberry juice intake. d. 6-week course of antibiotics - ANSWER Hospitalization Oral antibiotics may be prescribed in mild cases of acute pyelonephritis, characterized by the absence of nausea and vomiting or signs of sepsis. First-line therapy includes ciprofloxacin (Cipro) 500 mg two times daily for 7 days, or ciprofloxacin extended-release (Cipro XR) 1,000 mg daily for 7 days, or levofloxacin (Levaquin) 750 mg daily for 5 days. Hospitalization may be indicated, depending on the patient's ability to maintain adequate fluid intake and to tolerate oral antibiotics, along with the severity of the symptoms and evidence of bacteremia. Hospitalization of patients who are pregnant, vomiting, or dehydrated should be strongly considered. Likewise, the patient's degree of systemic illness (bacteremia or urosepsis), age, history of chronic disease, or nonadherence to therapy may lead to the assessment that

hospitalization is necessary. Ninety- five percent of patients demonstrate a good response within 48 hours to IV antibiotic treatment and may be discharged on appropriate oral medication, once urine culture and antibiotic sensitivity results are available and subsequent antimicrobial therapy may be narrowed in spectrum. A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses? a. Pancreatitis b. Peptic ulcer disease c. Diverticulitis d. All of the above - ANSWER All of the above Which of the following instructions should be given to the patient with nephrolithiasis? a. Take ibuprofen, 600 mg every 8 hours. b. Take Tums® for stomach upset. c. Drink more black tea. d. Increase intake of vegetables, like spinach. - ANSWER Take ibuprofen, 600 mg every 8 hours Which of the following patients is at risk for developing urinary tract cancer? a. The 45-year-old woman who is 100 lbs overweight b. The 78-year-old man who smokes three packs of cigarettes a day c. The 84-year-old man who worked in the asbestos mines d. All of the above - ANSWER All of the above

Obesity; exposure to asbestos, cadmium, and/or gasoline; the use of phenacetin- and aspirin-containing analgesics; and chronic hemodialysis for acquired polycystic kidney disease are all risk factors for renal cell carcinoma. Cigarette smoking has a 25% to 30% correlation with the development of renal cell carcinoma. An 86-year-old woman is seen in the clinic for recurrent hematuria. The provider suspects bladder cancer. Which of the following data from the history is considered a risk factor for this type of cancer? a. History of alcoholism b. Sedentary lifestyle c. Obesity d. 65-year smoking history - ANSWER 65-year smoking history Which of the following diagnostic tests should be ordered for a patient suspected of having bladder cancer? a. Kidneys, ureter, bladder x-ray b. Cystoscopy with biopsy c. Magnetic resonance imaging d. Urine tumor marker (NMP22) - ANSWER Cystoscopy with biopsy A 78-year-old man is diagnosed with Stage D bladder cancer and asks the provider what that means. Which is the best response? a. "There is no such thing as Stage D cancer." b. "You have cancer that has spread to the surrounding tissue."

c. "Your cancer has spread to other organs." d."Your cancer can be cured by removing your bladder." - ANSWER "Your cancer has spread to other organs" In general, TRANSITIONAL CELL CARCINOMAS are staged from A to D, according to level of invasion: stage 0 tumors are confined to the mucosa; stage A tumors invade the lamina propria; stage B tumors invade the muscular layer; stage C tumors extend to the peripelvic fat or renal parenchyma; and stage D indicates metastatic disease. The tumor-node-metastasis (TNM) system of the American Joint Committee on Cancer may also be used, with nodal metastases reflecting stage IV cancer. When transitional cell carcinomas are looked at as a whole, in situ disease has a 5 - year survival rate of 95%, localized disease nearly 90%, regional disease just over 60%, and distant disease only 17% Hematuria differential diagnosis include? - ANSWER UTI, pylyonephritis, cancer, BPH Hematuria physical exam should include? - ANSWER Abdominal exam, tenderness, massess, CVA tenderness, pelvic/prostate exam

Diagnostic tests needed in evaluation of hematuria? - ANSWER UA, C&S, CMP, BMP, IVP intravenous pyelogram, cystoscopy, US, CT scan Hematuria management and follow-up - ANSWER If bacterial such as UTI- antibiotic therapy **if not further evaluation refer to urology or nephrology Lower UTI occurs where? - ANSWER urethra, bladder, prostate Most common pathogen of UTI includes? - ANSWER E.coli Clinical presentation of UTI S/S? - ANSWER dysuria, urinary frequency/urgency, nocturia, hematuria, low back or suprapubic pain, urinary incontinence, foul smelling urine **elderly alterned mental status may be only manifestation! What diagnostic tests would one use for UTI? - ANSWER Clean catch urine sample showing presence of bacteria **>100 organisms/ml with presence of clinical symptoms *Urine culture may be indicated if complicated infection is suspected, if atypical symptoms are present or if symtpoms persist or recur within a month of pt recieving empiric course of antibiotics.

What antibiotics would be prescribed for an uncomplicated UTI? - ANSWER Bactrim (TMP-SMP) 160/800 mg BID for 3 days **for pts with no drug allergies, previous hospitalization or antibioitc use in 3 months Macrobid (Nitrofurantoin) 100 mg BID x 7 days used as an alternative for pts with sulfa allergies or those with previous antibiotics within last 3 months Fluoroquinolones such as Cipro 250 mg BID x 3 days or levaquin 250 mg daily x 3 days What would you treat a patient with a fungal UTI? What is usually the cause? - ANSWER Diflucan (Fluconazole) 200 mg PO daily for 7 - 14 days. **usuallyis associated with indwelling catheter ALMOST HALF CASES RESOLVE ON THEIR OWN WHEN CATHETER IS REMOVED AND does not need treatment. What is pyelonephritis? - ANSWER infection of the kidney that is characterized by infection within renal pelvis, tubules, or interstial tissue that may be unilateral or bilateral What are the pre-disposing risk factors for pyelonephritis? a. Pregnancy b. Dehydration c. Smoking

d. Alkaline urine - ANSWER Pregnancy increased in patients with predisposing factors including anatomical abnormalities such as ureterovesical reflux, urinary obstruction, stress incontinence, multiple or recurrent urinary tract infections (UTIs), renal disease, kidney trauma, pregnancy, and metabolic disorders such as diabetes mellitus. What are the signs and symptoms of acute pylonephritis - ANSWER sudden onset of fever, shaking, chills, n/v, unilateral or localized flank pain, fatigue, diarrhea **largely asymptomatic **elderly pts with altered mentation What can be seen on physical exam for pylonephritis? - ANSWER marked tenderness on deep abdominal palpation **may be hypertensive. Diagnostics needed for pylonephritis? - ANSWER dx confirmed through UA (positive for bacteria, proteinuria, leukocytes esterase, urinary nitrates,

hematuria, pyuria, WBC CASTS (passage through nuetrophils thorugh renal tubules) **Urine culture >100,000 cfu/ml (allowing for identification of causitive organism) **MOST IMPORTANT is WBC CASTS *cystoscopy with ureteral catheterization, renal ultrasound, intravenous pyelogram What assessment is performed to try and diagnose pylonephritis? - ANSWER physical exam: Tenderness on deep palpation/percussion of CVA tenderness (back) ** pts may be hypertensive What antibiotics should be used for pyleonephritis? - ANSWER Cipro 500 mg BID for 7 days Cipro XR 1000mg daily for 7 days Levaquin 750 mg daily for 5 days TX for kidney stones include? - ANSWER pain relief (oral NSAIDS, opiates, antispasmodics, warm compresses, focused breathing diversional therapy) *thiazide diuretics (calcium) Allopurinol (uric acid) D penicillamine (cystine)

increase water intake noninvasive and invasive surgical interventions AVOID TUMS, loop diuretics, vitamin supplements Stress incontinence can be brought on easily by? - ANSWER coughing sneezing, straining Management of stress incontinence includes? - ANSWER kegals 40- 60 contractions daily (slow tighten 10 seconds, hold 10 seconds, release over 10 seconds) Pelvic floor muscle training Vaginal cones or pessaries lose wt limit fluids in evening MEDS: vaginal estrogen Surgical intervention Over Active Bladder medications include? - ANSWER Anticholinergic/Antimuscarinic medications

Oxybutynin- Ditropan and XL PO or patch Tolterodine (Detrol and Detrol LA) Side effects: dry mouth, constipation, blurred vision The result of the patient's 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions? a. Repeat the test. b. Refer to a nephrologist. c. Measure the serum protein. d. Obtain a blood urea nitrogen (BUN) and creatinine. - ANSWER Refer to a nephrologist. If the excretion rate is above 3.0 to 3.5 g/day, the patient, by definition, has nephrotic syndrome and must be referred to a nephrologist. Can lead to AKI, End stage renal failure and hypertension A patient is seen complaining of "leaking urine when I sneeze." Which of the following actions should the clinician take first? a. Order a cystometrogram. b. Obtain a computed tomography scan.

c. Instruct the patient on Kegel exercises. d. Prescribe imipramine. - ANSWER Instruct the patient on Kegel exercises. Which of the following information is essential before prescribing Bactrim DS to a 24-year-old woman with a UTI? a. Last menstrual period b. Method of birth control c. Last unprotected sexual contact d. All of the above - ANSWER All of the above Certain patterns of pain, numbness, and tingling are associated with carpal tunnel syndrome. - ANSWER Katz hand diagram Tinel sign - ANSWER Median nerve integrity Tinel sign is tested by striking the patient's wrist with your index or middle finger where the median nerve passes under the flexor retinaculum and volar carpal ligament. A tingling sensation radiating from the wrist to the hand in the distribution of the median nerve is a positive Tinel sign and is suggestive of carpal tunnel syndrome. Median Nerve Integrity/ Carpal Tunnel testing - ANSWER Tinel sign, Phalen, Thumb abduction

Thumb abduction - ANSWER Have the patient place the hand palm up and raise the thumb perpendicular to it. Apply downward pressure on the thumb to test muscle strength. Full resistance to pressure is expected. Weakness is associated with carpal tunnel syndrome. Phalen test - ANSWER To perform the Phalen test, ask the patient to hold both wrists in a fully palmar-flexed position with the dorsal surfaces pressed together for 1 minute Numbness and paresthesia in the distribution of the median nerve are suggestive of carpal tunnel syndrome. Hawkins test - ANSWER Shoulder rotator cuff impingement of tear The Hawkins test is performed by abducting the shoulder to 90 degrees, flexing the elbow to 90 degrees, and then internally rotating the arm to its limit. Increased shoulder pain is associated with rotator cuff inflammation or a tear McMurray test - ANSWER Torn meniscus in the knee The McMurray test is used to detect a torn medial or lateral meniscus. McMurray test - ANSWER Have the patient lie supine and flex one knee. Position your thumb and fingers on either side of the joint space. Hold the heel with your other hand, fully flexing the knee, and rotate the foot and knee outward (VALGUS stress) to a lateral position. Extend and then flex the patient's knee.

Any palpable or audible click, grinding, pain, or limited extension of the knee is a positive sign of a torn medial meniscus. Valgus-varus stress test - ANSWER Medial or lateral collateral ligament instability in knee The varus (abduction) and valgus (adduction) Have the patient lie supine and extend the knee. Stabilize the femur with one hand and hold the ankle with your other hand. Apply varus force against the ankle (toward the midline) and internal rotation. Excessive laxity is felt as joint opening. Laxity in this position indicates injury to the lateral collateral ligament. Then apply valgus force against the ankle (away from the midline) and external rotation. Laxity in this position indicates injury to the medial collateral ligament. Repeat the movements with the patient's knee flexed to 30 degrees. No excessive medial or lateral movement of the knee is expected. Acute knee injury diagnostic - ANSWER Acute Knee Injury In cases of acute knee injury, the Ottawa Knee Rules identify the characteristics of patients who should have a radiograph of the knee.

The rules include any of the following findings: •Age older than 55 years •Tenderness at head of fibula •Isolated tenderness of the patella •Inability to flex the knee to 90 degrees Straight leg test - ANSWER L4, L5, S1 nerve root irritation Have the patient lie supine with the neck slightly flexed. Ask the patient to raise the leg, keeping the knee extended. No pain should be felt below the knee with leg raising. Radicular pain below the knee may be associated with disk herniation. Flexion of the knee often eliminates the pain with leg raising. Repeat the procedure on the unaffected leg. Crossover pain in the affected leg with this maneuver is more indicative of sciatic nerve impingements. Femoral stretch/hip extension test - ANSWER L1, L2, L3, L4 nerve root irritation The femoral stretch test or hip extension test is used to detect inflammation of the nerve root at the L1, L2, L3, and sometimes L4 level. Have the patient lie prone and extend the hip.

No pain is expected. The presence of pain on extension is a positive sign of nerve root irritation. Bulge sign - ANSWER Effusion in the knee With the patients knee extended, milk the medial aspect of the knee upward two or three times, and then milk the lateral side of the patella. Observe for a bulge of returning fluid to the hollow area medial to the patella ROM for upper and lower extremities in degrees - ANSWER Elbow extension 180 Flexion 160 Supination/pronation 90 Shoulder Flexion 180 Hyperextension up to 50 Abduction 180 Adduction 50 Internal/external rotation 90 Cervical spine Extension up to 55

Flexion 45 Lateral 40 Rotation 70 Ankylosing spondylitis - ANSWER a hereditary chronic inflammatory disease; may affect the cervical, thoracic, and lumbar sign and also involves the sacroiliac joints; leads to eventual fusion and severe deformity of the vertebral column. Bursitis - ANSWER inflammation of the bursa caused by repetitive movement and excessive pressure on the bursa. Carpal tunnel syndrome - ANSWER compression on the median nerve at the wrist within its flexor tendon sheath caused by microtrauma, local edema, repetitive motion, or vibration of the hands Rotator cuff tear - ANSWER microtrauma and tearing of the rotator cuff muscles, most often the supraspinatus; usually caused by degeneration of the muscle and tendon from repeated overhead lifting. Lumbar disk herniation - ANSWER Low back pain that radiates to the buttocks and posterior thigh, with tenderness over the spine Which of the following tests would detect a torn meniscus? a. Ballottement