Download APEA 3P EXAM PREP- NEPHROLOGY|2025-2026|GU QUESTIONS WITH ANSWERS AND RATIONALE|RATED A+ and more Exams Nursing in PDF only on Docsity!
APEA 3P EXAM PREP- NEPHROLOGY|2025-2026|GU
QUESTIONS WITH ANSWERS AND RATIONALE
RATED A+
A 79 - year-old female patient with urinary frequency is found to have a UTI. Whatmedication 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 itwill 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 anotheretiology? Acute bacterial prostatitis
Chronic prostatitis Epididymitis Asymptomatic bacteriuria Chronic prostatitis can produce these symptoms. Sometimes this is accompanied byperineal 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 likelydiagnosis? 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 painis 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 left- sided 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.
patient with pyelonephritis. Ciprofloxacin is a quinolone antibiotic and is contraindicated in patients who are pregnant or younger than 18 years old because of potential problems with bone andcartilage formation. There is no contraindication in a patient with hypertension. A quinolone might be a good choice in a patient with pyelonephritis and would not be contraindicated. An example of a drug that targets the renin-angiotensin-aldosterone system is a(n): ACE inhibitor. beta blocker. calcium channel blocker. diuretic. Examples of drugs that target the renin-angiotensin-aldosterone system are angiotensin- converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These drugs are particularly beneficial to patients with diabetic nephropathybecause they may prevent and treat diabetic nephropathy. Additionally, these agents lower blood pressure, which has been shown to be renoprotective. Management of glucose levels and hypertension is especially important inpreventing diabetic nephropathy, but so is aggressive management of hyperlipidemia. Testicular torsion can produce: penile erythema. scrotal edema. scrotal erythema. penile edema. Testicular torsion is an emergency because the testicle is deprived of normal bloodsupply. If blood supply is not reestablished within 12 hours, irreversible damage is certain to occur. Ideally, ischemia is resolved within 4-6 hours. The penis is not affected during testicular torsion. Besides testicular torsion, epididymitis, trauma, and an inguinal hernia are other common causes of scrotal pain. How long should a female patient with an uncomplicated UTI be treated with an oral antibiotic? 3days 5 days
7 days Three days of treatment with an appropriate antibiotic is as efficacious as 7 - 10 days of treatment. Three-day treatment is associated with fewer side effects, better adherence, and fewer adverse reactions. A patient has a urinary tract infection. What findings on urine dipstick best describe a typical urinary tract infection? Positive leukocytes Positive nitrates Positive leukocytes, positive nitrites Positive nitrates and hematuria Classic findings in a urinary tract infection (UTI) are positive leukocytes and nitrites. Leukocytes indicate the presence of white cells in the urine. Nitrates are a normal finding in a urine specimen. Nitrites are not normal in the urine. Positive nitrites indicate that an organism in the urine is consuming nitrates for nutrition. Hematuriaindicates the presence of red blood cells in the urine. This is common in the presence of a UTI. Which medication should be avoided in a patient with a sulfa allergy?Sulfonylurea Sulfamethoxazole Naproxen Cefazolin Sulfamethoxazole is the sulfa component in Bactrim DS. It is contraindicated in patients with a sulfa allergy. There is no allergic potential with the antihyperglycemic agents known as the sulfonylureas. Naproxen and cefazolin haveno contraindications if a patient has a sulfa allergy. Some HIV protease inhibitors have the sulfonyl arylamine chemical group that is responsible for the allergic reaction. A female patient who is 45 years old states that she is having urinary frequency. She describes episodes of “having to go right now” and not being able to wait. Herurinalysis results are provided. What is part of the differential? Diabetes Lupus
Anyone who consumes multiple carbonated beverages daily 70 - year-old nursing home resident Young sexually active women are at much higher risk (some studies indicate 2.6 times higher risk) of UTI than nonsexually active females. Presumably, this occurs because the vaginal introitus becomes colonized with bacteria. UTI in males is unusual compared to females. E. coli is the most common urinary tract pathogen causing disease. Nursing home residents are more likely to develop asymptomaticbacteriuria. A male patient with lower urinary tract symptoms has the following urinalysis. Whatmedication should be given and for how many days? Doxycycline for 7 days Trimethoprim-sulfamethoxazole (TMPS) for 7 - 10 days Ciprofloxacin for 3 days Nitrofurantoin for 14 days Trimethoprim-sulfamethoxazole (TMPS) is usually an appropriate medication to treaturinary tract infections (UTIs) in most patients. In the case of community resistance to TMPS > 20%, another medication should be substituted. In men, the appropriate length of time is 7 - 10 days. Women may be treated for 3 days for uncomplicated UTIs. A 31-year-old female patient present with fatigue, fever (101° F), and worsening unilateral low back pain for the past 5 days. Her pain is 5/10 on the pain scale and has been unresponsive to ibuprofen. She denies abdominal pain, but is anorexic andnauseous. She denies vaginal discharge. What should be included in the differential diagnosis? Pelvic inflammatory disease Renal stone Pyelonephritis Urinary tract infection
This patient's complaint of unilateral low back pain is likely secondary to pyelonephritis. Costovertebral angle (CVA) tenderness is typical in patients who have pyelonephritis. Additionally, the most common symptom associated with pyelonephritis is fever. The presence of WBC casts in the urine strongly suggests a renal origin for pyuria in this patient's urine. A patient who presents with this scenario has to be considered to have pyelonephritis until proven otherwise. Most women with pelvic inflammatory disease (PID) have bilateral abdominal tenderness,usually in the lower quadrants. Purulent vaginal discharge and fever are also common. A 70 - year-old male patient is diagnosed with renal disease. Which activity will helppreserve kidney function? 20 minutes of daily exercise Daily increase in water consumption Daily weights Avoidance of red meat Volume depletion decreases renal perfusion. Decreased renal perfusion secondary to volume depletion is potentially correctable by increasing fluids. As glomerular filtration rates improve, renal function improves. Water is critical for the proper functioning of the kidneys. The most common pathogen found in patients with pyelonephritis is:Pseudomonas. Streptococcus. E. coli. Klebsiella. The most common pathogen in upper and lower urinary tract infections is E. coli. Approximately 70 - 95% of infection can be attributed to E. coli. As patients age, theincidence of E. coli declines (though it is still the most common pathogen), the incidence of Klebsiella increases.
daytime and nighttime symptoms related to urinary retention. Stool softeners andNSAIDs have no effect on BPH symptoms. The most appropriate time to begin screening for renal nephropathy in a patientwith Type 2 diabetes is: at diagnosis. once year after diagnosis. 2 - 3 years after diagnosis. 5 years after diagnosis. Patients with Type 2 diabetes should be screened for renal nephropathy at diagnosis. Nephropathy takes several years to develop but develops in about 30% of patients with diabetes. Diabetic nephropathy is defined as the presence of diabetes and more than 300 mg/d of albuminuria on at least two occasions separated by 3 - 6 months. Screening should take place annually. A 50 - year-old male patient reports that he has a sensation of scrotal heaviness. He reports that the sensation is worse at the end of the day. He denies pain. What is the likely etiology of these symptoms? Strangulated hernia Inguinal hernia Epididymitis Hydrocele Inguinal hernias are common in males. A typical symptom reported by men with an inguinal hernia is scrotal heaviness, especially at the end of the day. These symptoms are often experienced with heavy lifting, prolonged standing, or straining to have a bowel movement. If pain is present (which is unusual), it can usually be relieved by lying down or ceasing the activity that produced the symptoms. If this does not relieve the pain, or if the pain is severe, the hernia may have become strangulated. This requires immediate referral. Epididymitis can produce scrotal pain, not usually “heaviness.” Hydrocele results in fluid in the scrotum. An adolescent has suspected varicocele. He has dull scrotal pain that is relieved by:standing. recumbency. having a bowel movement.
elevation of the testicle. Varicocele may be asymptomatic but more commonly is accompanied by scrotal pain described as a dull ache. It becomes more noticeable with standing and is relieved by lying down. This occurs because lying down relieves dilation of the spermatic veins. This is present in about 15 - 20% of postpubertal males and may bereferred to as “a bag of worms” because of the scrotum’s appearance. Wearing a scrotal supporter may also provide relief. A female patient with a complaint of dysuria has the following urinalysis results. The most appropriate diagnosis is: urinary tract infection. asymptomatic bacteriuria. UTI with hematuria. UTI or chlamydia. UTI is a common abbreviation for urinary tract infection. The presence of leukocytes and nitrites in the urine indicates a likely infection in the bladder. The presence of blood is common when a patient has a urinary tract infection. This is termed hematuria. A diagnosis of chlamydia cannot be made based on symptoms or these urinalysis results. Asymptomatic bacteriuria is the diagnosis given to patients who are found to have bacteria in the urine and who are asymptomatic. This patient has complaints of dysuria. A patient with urolithiasis is more likely to: have frequent urinary tract infections. be of the male gender. have chills and fever. demonstrate RBC casts. Males are more likely (4:1) than females to have urolithiasis. The overall incidence isabout 2 - 5% in a lifetime. There is no increased incidence of stone formation among patients with frequent UTIs. Patients with urolithiasis may exhibit fever and chills if the infection is associated with a very large stone, but this is not the usual case.
CVA (costovertebral angle) tenderness is a classic finding in patients with pyelonephritis, an infection of the upper renal tract. A positive Murphy’s sign (inspiratory arrest with deep palpation of the upper right quadrant) is demonstratedin a patient with cholecystitis. Pain that waxes and wanes usually describes a patient with a kidney stone. Burning with urination is often seen in patient with urinary tract infection. A patient comes to clinic today with a complaint of green urine for the past 6 hours. She feels well otherwise. The most likely reason for this is: something she has consumed. a urinary tract infection. Incorrect a stone in the upper urinary tract. a psychiatric illness. An unusual color imparted to the urine is nearly always due to something the patient has had to eat or drink in the last 24 hours. A urine specimen should be obtained for analysis to rule out blood, but blood in the urine is usually bright red orbrown in color. A green hue should compel the examiner to consider a food dye. A patient with dysuria has a urine specimen that reveals < 10,000 bacteria andnumerous trichomonas. How should this patient be managed? Increased fluids and a urinary tract analgesic Ciprofloxacin for 3 days Metronidazole for 7 days Ciprofloxacin and metronidazole This patient has trichomoniasis. This is the likely cause of her dysuria. She could be treated with metronidazole initially. This should eradicate the infection. Her partner will need treatment too. She has an inconsequential number of bacteria in her urine. She does not need treatment for the bacteria in her urine. A sexually active male patient presents with epididymitis. What finding is likely?Hematuria Dysuria Recent history of heavy physical exercise Scrotal edema
The typical presentation of an adult male with epididymitis is the gradual development of scrotal pain. There is no scrotal edema. This is more typical in hydrocele. Common precipitants are sexual activity, heavy physical exertion as described in the question, and bicycle or motorcycle riding. In sexually active malesunder age 35 years, a common cause is an STD. A 44-year-old female patient is diagnosed with a urinary tract infection (UTI). Which bacteria count collected via midstream, clean catch supports a diagnosis of UTI?
10,000 bacteria 25,000 bacteria 50,000 bacteria 100,000 bacteria Urine in the bladder should be sterile unless there is an infection or when asymptomatic bacteriuria is present. When bacteria are present in a urine specimen, consideration must be given to how the specimen was collected. When the specimen is collected via midstream, clean catch, the tolerance for organisms isless than 100,000. It is expected that the urine collected in this manner will include bacteria from external genitalia as urine exits the body. If the number of bacteria are greater than 100,000, a urinary tract infection is correctly diagnosed.
