Download NR507 / NR 507 Final Exam (Latest 2024 / 2025): Advanced Pathophysiology - Chamberlain and more Exams Nursing in PDF only on Docsity!
NR507 / NR 507 Final Exam
A 21-year-old patient reports to the primary care clinic complaining of urinary urgency, frequency and burning. She also reports a small amount of vaginal discharge that contains an odor. It is likely that the NP will perform a vaginal exam at this visit. - ANSWER: true A 25 year- old female presents to the primary care office with urinary burning and frequency for the last 3 days. She denies any fever, chills, back pain. Her gynecological history is negative and reports no vaginal discharge. The only new information reported is that she recently had sexual intercourse with a new male partner. The NP obtains a urinalysis and determines that the urine contains leukocytes, RBCs, nitrites, and WBCs. No casts are identified. Based on symptom presentation and UA results, the patient can be diagnosed with: - ANSWER: cystitis A 42-year-old female presents to the primary care clinic with a three- month history of "feeling low", poor energy, inability to concentrate and irritability. She is concerned about her loss of interest in her usual social activities of walking with her friends and participating in her sewing group. She is especially concerned about her recent 15-pound weight gain. Other reported symptoms are frequent headaches, difficulty getting out of bed in the morning, and feeling worthless. She denies suicide ideation. She reports a family history of depression (mother and sister) and denies any consumption of drugs and alcohol. She is divorced and has a grown son who lives approximately one hour away but rarely sees because of his work schedule. The patient is interested in knowing if her symptoms are related to depression. Upon initial evaluation, the NP considers if the patient meets the criteria for MDD by consulting the DS - ANSWER: Depressed mood Fatigue/loss of energy Loss of interest/Anhedonia Feeling worthless or having excessive guilt Insomnia or hypersomnia Poor concentration Recurrent thoughts of death, suicide, a suicide plan or attempt Psychomotor agitation or retardation A 45-year-old male presents to the primary care office with right flank pain that he describes as unremitting; he also reports nausea and vomiting. The NP performs an exam
and observes him writhing in pain on the exam table with the inability to find a comfortable position. He is afebrile, BP 156/88 mmHg and HR 106/min. Right flank is mildly tender on palpation. Abdominal exam is negative for any abnormality. A urinalysis was performed and revealed 1+ blood. Urine microscopy also revealed 10-20 RBCs per high-power field (hpf). A kidney stone is suspected. The patient reports no prior history of a kidney stone. After providing the patient an analgesic, where the patient reported mild relief, the NP had the patient transferred to the emergency room for intravenous fluids, pain management and further work-up for the kidney stone. Upon follow-up in the office a week later, the patient reported that he was diagnosed with - ANSWER: adequate hydration balanced diet A 54-year-old female reports to the primary care office with complaints of frequent urination. She reports that she is "leaking" urine several times a day, especially when she coughs, sneezes, or lifts a heavy object. She indicates that she has not experienced any dysuria or any urgency. The NP looked at the patient's previous urine culture obtained approximately 1 month ago and determined that it was negative. Other than her urinary complaints, she is in otherwise good health. BP 128/76; HR 78 bpm; T 98.6; Ht. 5'4"; Wt: 180lbs.; BMI 30.9. The NP performs a physical exam and all findings are normal. The urinalysis obtained was negative as well. Based on patient's symptoms and negative physical exam, she has a typical
- blank. The leaking occurs when the abdominal pressure increases during coughing, sneezing, and lifting. We can rule out urge incontinence because the denied urgency with her urination. We could not - ANSWER: 1. stress incontinence
- stress incontinence A common organism that causes a urinary tract infection include: - ANSWER: Staphylococcus saprophyticus. E coli A mood disorder is a mental illness that causes the individual to have dramatic shifts in emotions, mood and energy levels. - ANSWER: true A panic attack involves a very stressful situation where the individual develops an intense fear that something bad will happen. - ANSWER: true
B. R. is a 20-year-old college student who reports feeling anxious "about everything", restlessness and irritability. She reports no significant past medical or mental health history. She states that her anxiety started about 6 months ago when she decided to change her major to pre-med and complete an application to participate in a summer pre- med preparation program. During an open house meeting with the medical school academic advisors attended by all students applying for the summer program, she learned that only 50 students would be selected out of 450 applications to participate in the summer program. Despite wanting to enter the summer program, she felt that she would be unable to cope with the pressure associated with a short summer program or the rejection if she was not selected. She told the NP that she did not feel "good enough" to be selected as she compared herself to the other applicants. She said that - ANSWER: Generalized anxiety disorder Benzodiazepines are drugs that reduce depression associated with the individual's anxiety. - ANSWER: false (psychoactive drugs that reduce anxiety by providing calming effect on individual) Bipolar 1 - ANSWER: More severe One or more manic or mixed episodes leading to: Serious problems Hospitalization Psychotic features Bipolar 2 - ANSWER: One or more hypomanic episodes (4 days or more), and no maniaOne or more major depressive episodes (2 weeks or more) Catatonic behavior involves bizarre movements, posture, and responsiveness. - ANSWER: true Cognitive behavioral therapy has major advantages over medications in the long-term treatment of anxiety - ANSWER: true cognitive symptoms - ANSWER: Memory Ability to learn new things Understanding
Symptoms are subtle and may only be detected when specific tests are performed. For example, the individual may not be able to keep up with several tasks at once. Complicated UTI - ANSWER: UTI extends beyond the bladder Caused by structural or functional urinary tract abnormalities or untreated UTI Infants and older adults affected Associated with: indwelling catheters, renal calculi, diabetes, pregnancy Cyclothymia - ANSWER: Alternating between hypomanic symptoms, and mild or moderate depressive moods, like Bipolar II Less severe, higher functioning Despite the different classifications, all antidepressant medications are equally effective in reducing the major symptoms of major depressive disorder. - ANSWER: true Dietary management of a patient with CKD includes: - ANSWER: low potassium, low sodium, and low phosphate Diuretic therapy is used in Stage IV kidney failures to stimulate kidney function. - ANSWER: false (diuretics used for stages 1-111 and dialysis for 4 and 5) During a manic phase, the individual will experience a low self-esteem. - ANSWER: false (high self-esteem) Dysthymia is a persistent depressive disorder used to describe milder symptoms of depression that happen over longer periods of time. - ANSWER: true E.M. is a 21-year-old man that presents to the primary clinic accompanied by his mother. He is a freshman in college but came home last week telling his mother that he 1. blank because 2. blank. His mother called her son's roommate to obtain further information about her son's behavior. The roommate reports that E.M. has 3. blank over the last week because he 4. blank. He also insists that the rival fraternity's president has had his dorm room bugged and that his 5. blank. At the primary care office, E.M. just 6. blank and 7. blank. - ANSWER: 1. dropped out
- everyone is out to get me
In intrinsic renal failure, sodium and water excretion is increased which leads to a dilute urine. - ANSWER: true In post-renal failure, the damage occurs in the collecting duct. - ANSWER: truen In rapid cycling, the individual has 4 or more episodes of depression and mania within one year. - ANSWER: true In the active phase of schizophrenia, the individual experiences more severe delusions, hallucinations and disorganized behavior. - ANSWER: true In the prodromal phase of schizophrenia, Individuals become hyperactive and outgoing. - ANSWER: false (become withdrawn) In the residual phase of schizophrenia, the individual may exhibit cognitive symptoms of not being able to concentrate or becoming withdrawn. - ANSWER: true Individuals with family members who have bipolar disorder are ten times more likely to also have it. - ANSWER: true Intra-renal - ANSWER: direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply Involuntary loss of urine caused by dementia or immobility is known as: - ANSWER: functional incontinence Irritative symptoms - ANSWER: urinary frequency nocturia urgency that results from bladder hypertrophy and dysfunction J.J. is a 44-year-old male who works as a department head for a Fortune-500 company that is down-sizing due to economic reasons. Top level management has announced that
there will be restructuring of the company where many of the management roles will be consolidated. Some department head positions will be eliminated altogether. Each department head has been given the task of developing a presentation to provide an overview of their department specifically sharing data to demonstrate productivity and the meeting of company initiatives. From the moment J.J. read the email outlining the presentation requirements, he started to feel fearful of the possibility of losing his job. On the day of delivering the presentation, all department heads were present with top-level management. As he listened to the other department heads deliver their presentations, he began to feel nausea. He even noticed his heart pounding. When it - ANSWER: Panic attack J.S. is an 80 - year-old patient who resides in a local nursing home. He recently became confused and then fell while ambulating to the bathroom three days ago. Because of his confusion and fall, he was transferred to the acute care facility for evaluation and treatment. Lab work revealed that the patient was very dehydrated with hypernatremia identified and appropriate intravenous fluids started. Cystitis was also identified from the urinalysis. He was also noted to have red and excoriated skin between the buttocks and inner thighs due to urinary frequency and dribbling. To help with skin healing and to prevent further urine leakage, an indwelling catheter was inserted. Two days after the catheter was placed, the patient spiked a fever of 102 degrees Fahrenheit associated with shaking chills. An intense, foul odor was noted in the urine. On examination of the flank area, the patient yelled out when touched. A urine c - ANSWER: pyelonephritis Lithium is best at treating both manic and depressive episodes. - ANSWER: false (only manic) Lithotripsy is an invasive procedure used to break up the stone - ANSWER: false Major depression is required to be present in order to diagnose Bipolar 1 and Bipolar 2 disorder. - ANSWER: false (Major depression may be present in both but not required for diagnosis) Men who have BPH are prone to developing a UTI because: - ANSWER: Stagnated urine in the bladder promotes bacterial growth.
One of the issues that requires management of a patient with acute renal failure is hypokalemia - ANSWER: false (Hyperkalemia) One of the major markers for glomerular filtration rate is creatinine. - ANSWER: true overflow incontinence - ANSWER: leakage of urine is associated with urgency, frequency, dribbling, and hesitancy Leakage is due to retained urine in the bladder that leads to over-distention Physical manifestations can also be associated with Generalized Anxiety Disorder - ANSWER: true Post-partum depression - ANSWER: after childbirth, a mother's depressed mood (hormonal change accompanies) Post-renal - ANSWER: sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury postitive symptoms - ANSWER: Delusions: are thing that the individual feels strong about that they refuse to change their mind even if there is evidence against their stance: delusion of control-some outside force is controlling their actions Delusion of reference: insignificant remarks are directed at them Hallucinations: any type of sensation that is not actually there (visual) of auditory-hearing things that are not there. Disorganized speech: word salad- a random juggling of words or phrases. Disorganized behavior: bizarre behavior that is out of context to the situation with no purpose (wearing a heavy coat in the summer). Catatonic behavior: bizarre movements, posture, and responsiveness; stupor and unresponsive to moving. Pre-renal - ANSWER: sudden and severe drop in blood pressure or interruption of blood flow to the kidneys from severe injury or illness
Pre-renal is the most common cause of acute renal failure. The most common cause of acute renal failure is due to a pre-renal failure. - ANSWER: true Prodromal phase - ANSWER: become withdrawn and spend most time alone Psychotherapy helps the individual to think and act in different ways to deal with stressful situation - ANSWER: true R.D. is a 34-year-old female who is engaged to be married in one month. This will be her second marriage. She has been divorced for three years. Her fiancé, who has never been married, has invited his parents to town to meet their soon- to - be daughter-in-law. R.D. learns that her future in-laws have very traditional thoughts on marriage, specifically, unfavorable thoughts about divorce. On the day of the parent's arrival, R.D.'s fiancé asks her to pick them up from the airport. R.D. agrees, but starts to feel uneasy about it. She is concerned that they will not accept her because of her previous divorce, although she has spoken to them on the phone and they were very gracious and accepting of their son's relationship with her. The closer she got to the airport, the more uneasy she felt to the point of disorientation. Just before entering the airport terminal, she turned around and called her fiancé to inform him - ANSWER: social anxiety Renal calculi are typically confined to the bladder. - ANSWER: false Renal colic is caused by the passing of the stone through the ureter. - ANSWER: true Renal stones are formed when calcium and oxalate in the urine combine. - ANSWER: true residual phase - ANSWER: cognitive symptoms not being able to concentrate or becoming withdrawn Selective Serotonin Reuptake Inhibitors (SSRIs) block the reabsorption or inhibits the reuptake of serotonin that allows for more of it in the synaptic cleft. - ANSWER: true
The action of a 5-Alpha-reductase inhibitor causes: - ANSWER: Shrinkage of the prostate gland. The anemia seen in renal failure is due to the lack or iron. - ANSWER: false (Anemia occurs because there is a reduced production of erythropoietin which is responsible for triggering the production of RBCs rather than the lack of iron or a decrease in the RBCs) The cognitive symptoms of schizophrenia are subtle and may only be detected when specific tests are performed. - ANSWER: true The decision to begin dialysis is guided by the patient's symptoms rather than GFR. - ANSWER: true The gold standard for diagnosing a renal stone is a urinalysis. - ANSWER: false (ct scan) The levator ani muscle plays a major role in constriction of the external sphincter. - ANSWER: true The location of the characteristic hyperplastic nodules of BPH is: - ANSWER: In the periurethral zone. The location of the internal sphincter is under the urogenital diaphragm. - ANSWER: false (located in the bladder) The major acid/base disturbance in renal failure is: - ANSWER: metabolic acidosis The major cause of stress incontinence in women is hypermobility of the external sphincter. - ANSWER: true The Monoamine Deficiency Theory states that the underlying basis of depression is low levels of serotonin, norepinephrine and dopamine. - ANSWER: true The most common stone found in the patient with gout is: - ANSWER: uric acid stone
The most common type of stone is: - ANSWER: calcium stone The NP would know that the patient most likely has an uncomplicated UTI because: - ANSWER: The UTI responds well to a short course of antibiotic therapy. The number one cause of end-stage renal disease is diabetes mellitus and hypertension combined. - ANSWER: true The pathophysiology of neurogenic bladder is: - ANSWER: Lesions alter nervous system impulses that innervate the detrusor muscle to decrease bladder compliance and decreased sphincter tone. The patient most often develops symptoms of BPH when: - ANSWER: The prostatic urethra becomes obstructed. The peripheral zone of the prostate is the largest zone. - ANSWER: true The prostate specific antigen (PSA) helps to liquefy semen post-ejaculation. - ANSWER: true The purpose of straining in BPH is to overcome the obstruction encountered during urination. - ANSWER: true The relay station in the brain that plays a major role in regulating micturition is: - ANSWER: Pontine micturition center. The result of vitamin D deficiency results in: - ANSWER: hypocalcemia The type of stone that forms due to a urinary tract infection is: - ANSWER: Struvite stone. The underlying cause of BPH is that normal prostate cells respond to increases in dihydrotestosterone that causes them to live longer and multiply. - ANSWER: true
Which of the following cognitive symptoms are seen in schizophrenia? - ANSWER: Memory. Ability to learn new things. Understanding. Which of the following is a complication of decreased GFR? - ANSWER: anemia Which of the following is a risk factor for the development of a urinary tract infection (UTI)? - ANSWER: Pregnancy Which of the following is a situation where the individual may experience social anxiety?
- ANSWER: Making small talk (think of adult interaction) Which of the following is considered be a transient cause of urinary incontinence? - ANSWER: UTI Which of the following is the best indicator of a good prognosis for recovery from acute renal failure? - ANSWER: The kidney responds to furosemide Which of the following is true regarding a complicated urinary tract infection? - ANSWER: Can be caused by a structural urinary tract disorder Which of the following is true regarding creatinine? - ANSWER: Creatinine gets freely filtered from the glomerulus. Which of the following symptoms together would be used in the diagnosis of schizophrenia? - ANSWER: Delusions and hallucinations Which of the following symptoms would prompt the NP to refer the patient to a psychiatrist? - ANSWER: Psychotic symptoms. Suicide ideation. Patient's request.
Which of the following would be considered a negative symptom of schizophrenia? - ANSWER: flat affect Women are at a higher risk for the development of a UTI because of having a shorter urethra. - ANSWER: true
