NR601 WEEK 6 QUIZ – AUG 2019

<span itemprop="name">NR601 WEEK 6 QUIZ – AUG 2019</span>

Question 1

Urinary inconsistency is defined as:

· Urinary occurs more frequently during the day than would be considered normal.

· Sudden compelling desire to pass urine that is difficult to prevent.

· Unintentional voiding, loss or leakage of urine.

· Continuous loss of urine or leakage of urine.

Question 2

A 76 year old man is seen in the office for complaints of urinary inconsistency. The clinician should explore which of these causes of inconsistency in men?

· All the above

· Sildenafil

· Urethral polyps

· Urinary tract infection (UTI)

Question 3

How does women’s anatomy make them more susceptible to UTIs?

· Their urethra is shorter.

· Women tend to get UTIs when they are pregnant

· Asymptomatic UTIs do not resolve themselves without treatment

· There is a longer distance between the urethra and anus

Question 4

A 63-year-old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis?

· Benign prostatic hypertrophy

· Urethral polyp

· Psychogenic nocturia

· Irritative posterior urethral lesion

Question 5

Acanthosis nigrans is associated with all the following conditions except?

· Colon cancer

· Obesity

· Tinea versicolor

· Diabetes

Question 6

Mrs. Smith, a 65-year old woman presents to the clinic for the first time and complaints of urinary incontinence and dyspareunia. She went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at the age of 82. The patient’s most recent mammogram was 5 years ago and no known family history of breast cancer. She is not taking any medications. Her physical examination is unremarkable except for findings consistent with atrophic vaginitis. You decide to begin topical hormone replacement therapy. Which of the following evaluations would be necessary prior to initiative hormone replacement therapy?

· Endometrial biopsy

· Bone mineral density measurement

· Papanicolaou smear

· Mammogram

Question 7

Which of the following screening tests for type 2 diabetes mellitus?

· Fasting plasma glucose

· Hemoglobin A1C

· To-hour OGTT

· All the above

Question 8

A 55-year-old woman has Type 2 diabetes mellitus. She has had three urinary tract infections in the last 9 months and she is concerned about her kidneys. She has no reports of dysuria, frequency or urgency at this time. Which of the following is the best action to follow?

· Evaluate for kidney infection

· Refer patient to urologist

· Order an intravenous pyelogram (IVP)

· Recheck UA dipstick today

Question 9

A 65 year old Hispanic woman presents to the office for routine follow up of her Type 2 diabetes mellitus. Her routine UA results are as follows:

Few epithelial cells, negative leukocytes, negative nitrites, negative protein, no ketones

Which test would you order next?

· Result is normal, no further tests are necessary

· Recommend a screening intravenous pyelogram (IVP)

· Urine for culture and sensitivity

· 24 hour urine Microalbumin

Question 10

An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses?

· Parkinson’s disease

· Benign prostatic hyperplasia (BPH)

· Prostate cancer

· All the above

Question 11

A patient has been prescribed metformin (Glucophage). One week later she returns with lowered blood sugar but complaints of some loose stools during the week. How should the nurse practitioner respond?

· Order a chem. 7 to check for lactic acidosis

· Double the dosage of medication and have a patient return in 1 week

· Discontinue the medication immediately

· Reassure the patient that this is an anticipated side effect

Question 12

Which of the following medications can blunt the signs of hypoglycemia in diabetics?

· Calcium channel blockers

· Diuretics

· Angiotensin receptor blockers (ARBs)

· Beta blockers

Question 13

According to genitourinary presentation, the number 1 risk factor for urinary incontinence is?

· Obesity

· Uncontrolled diabetes

· Aging

· Smoking and caffeine intake

Question 14

Lifestyle approaches to postmenopausal symptom management include:

· More than 1000 international units/day of vitamin E

· Avoiding sugar, coffee, chocolate and alcohol

· Sleeping more than 8 hours a night

· Decreasing levels of physical activity

Question 15

The patient with BPH is seen for follow up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects?

· Glaucoma

· Headache

· Hypotension

· Impotence

Question 16

Which of the following would you recommend annually for the elderly type 2 diabetic?

· Follow up with a urologist

· Neurology visit

· Eye exam with an ophthalmologist

· Colonoscopy

Question 17

Mrs. L a 55-year-old woman with a BMI of 28 has a 20 year history of primary hypertension and has been on hydrochlorothiazide 35mg daily for year with excellent response. During this follow up visit, Mrs. L reports that the last 6 months she has felt thirsty all of the time though she drinks at least 10 glasses of water a day. Upon chart review the N notes that the last two fasting blood glucose levels have been 136 mg/dl and 165 mg/dl. The NP checks a random blood glucose which is 210 mg/dl. Which is the next appropriate step?

· Order a Hgb A1C

· Order a 3 hour GTT

· Prescribe Metformin 500mg po BID

· Order another random blood glucose in 2 weeks

Question 18

A 55 year old Caucasian man with type 2 diabetes mellitus presents to the clinic a new patient. He takes Metformin 500mg twice a day. His last Hgb A1C was 7%. He is up to date on eye and foot examinations. His BP today is 142/96. According to JNC 8, hat is the most appropriate medication?

· Clonidine

· Amlodipine

· Lisinopril

· Furosemide

Question 19

Which of the following would be an appropriate treatment for a patient with minimal symptoms of BPH?

· Prescribe a trial tamsulosin

· Recommend cranberry supplements

· Refer to a urologist for surgery

· Watchful waiting

Question 20

Mrs. N a 65 year old woman with a BMI of 29 on Medicare has a 20 year history of primary hypertension and has been on hydrochlorothiazide 25 mg daily for years with excellent response. During this follow up visit Mrs. N reports that the last 6 months she has felt thirsty all the time even though she drinks at least 10 glasses of water a day. Upon chart review the N notes that the lasting two fasting blood glucose levels has been 136 mg/dl and 165 mg/dl. What action should the NP perform next?

· Plan to recheck glucose as schedule at the yearly physical

· Check a POC glucose now, she has just eaten breakfast

· Order a fasting blood glucose

· Educate that the diuretic is causing the increased thirst

Question 21

A male patient with a BMI of 33 presents to the office with complaints of fatigue, excessive hunger and excessive thirst You suspect Type 2 diabetes mellitus. Initial testing to confirm diagnosis include:

· Glucose tolerance testing

· Hemoglobin A1C

· All the above

· Fasting plasma glucose

Question 22

Which of the following patients should be screened for diabetes?

· A 42 year old female on disability from back injury who is unable to exercise

· A 44 year old Caucasian male with hypertension

· An obese Hispanic man

· An overweight middle age African American woman with a family history of Type 2 diabetes mellitus

· All patients are appropriate for screening

Question 23

Age related changes in the bladder, urethra and ureters include all of the following in older women except?

· Decline in ureter resistance pressure

· Decline in bladder outlet function

· Increased estrogen production’s influence on the bladder and ureter

· Laxity of the pelvic muscle

Question 24

A 78 year old female comes to the office because she has pain when she urinates. She has been seen 3 times for this problem in the last 3 months. Each time she was told she had a UTI and was given antibiotics. She carefully followed the instructions but has had no relief of symptoms. Last UA:

WBCs: 2-3/ high-power field

RBCs: 0-2/high-power field

Epithelial cells: Few

Nitrite: Negative

Leukocyte esterase: Negative

Which of the following should be done next?

· Perform a pelvic examination

· Obtain a clean catch urine from UA and urine for C&S

· Order a pelvic ultrasound

· Reassure the patient that she has asymptomatic bacteriuria and does not need antibiotics

Question 25

A 60 year old obsess male client has type 2 diabetes mellitus and a lipid panel of TC=250, HDL=32, LDL=165. The NP teaches the patient about his modifiable cardiac risk factors which include:

· Diabetes, obesity and hyperlipidemia

· Male with age> 45, diabetes mellitus and hyperlipidemia

· Hyperlipidemia, smoking and family history of heart disease

· Advancing age, diabetes, hyperlipidemia and male gender