NURS317 Finals Flashcards
Which of the following individuals is at the highest risk of developing a urinary tract
infection (UTI)?
A) A 60-year-old man with a history of cardiovascular disease who is recovering in
hospital from a coronary artery bypass graft
B) A 66-year-old man undergoing dialysis for the treatment of chronic renal failure
secondary to hypertension
C) A 38-year-old man with high urine output due to antidiuretic hormone
insufficiency
D) A 30-year-old woman with poorly controlled diabetes mellitus
Ans: D
Feedback:
Young women as well as persons with diabetes are at high risk of UTIs. Neither
postsurgical recovery nor renal failure is necessarily a direct risk for UTI development,
and high urine output would prevent decrease rather than increase in UTI risk.
Because the associated nephropathy is an important cause of end-stage renal failure in
children and adolescents, a toddler who has had an uncomplicated bout of urinary tract
infection (UTI) should still be evaluated for:
A) urethrovesical reflux.
B) vesicoureteral reflux.
C) neurogenic bladder.
D) detrusor muscle instability.
Ans: B
Feedback:
Urethrovesical reflux occurs when urine from the urethra moves into the bladder.
Vesicoureteral reflux occurs when urine moves from the bladder into the ureter.
Vesicoureteral reflux is the most commonly associated abnormality in UTIs. Reflux
nephropathy is an important cause of end-stage renal disease in children and
adolescents; children with a relatively uncomplicated first UTI may turn out to have
significant reflux. Therefore, even a single documented UTI in a child requires careful
diagnosis. Functional obstructions include neurogenic bladder, infrequent voiding,
detrusor (bladder) muscle instability, and constipation.
During male ejaculation, which of the following statements addresses why sperm is not
normally seen inside the bladder?
A) The parasympathetic nervous system keeps the seminal fluid inside the urethra.
B) The musculature of the trigone area, bladder neck, and prostatic urethra contract at
the same time.
C) With ejaculation, the male expels some urine along with the seminal fluid to wash
any extra sperm out of the bladder.
D) The detrusor muscle relaxes allowing for the closing of the sphincter at the base of the bladder.
Ans: B
Feedback:
During male ejaculation, which is mediated by the SNS, the musculature of the trigone
area and that of the bladder neck and prostatic urethra contracts and prevents the
backflow of seminal fluid into the bladder.
The clinic nurse is providing care for a patient with a urinary tract infection (UTI). Which drug would
the nurse expect to administer to this patient?
A) Solifenacin
B) Pentosan polysulfate sodium
C) Norfloxacin
D) Alfuzosin
Ans: C
Feedback:
Norfloxacin is a urinary anti-infective that is used in the treatment of adults with UTIs caused by
susceptible strains of bacteria, uncomplicated urethral and cervical gonorrhea, and prostatitis caused by
Escherichia coli. Solifenacin is an antispasmodic, pentosan polysulfate sodium is a bladder protectant,
and alfuzosin is used in the treatment of benign prostatic hyperplasia (BPH).
Which of the following statements best captures the essence of a second messenger in
the mechanisms of the endocrine system?
A) Second messengers act as the intracellular signal that responds to the presence of
a hormone.
B) Endocrine-producing cells must release both a hormone and a second messenger
in order to exert a distant effect.
C) Second messengers act to supplement hormone effects on cell receptors when the
desired hormonal effect must be either increased.
D) Second messengers provide an alternative pathway for endocrine effects on a cell
that bypass the normal receptor pathways.
Ans: A
Feedback:
Second messengers interact with hormones that cannot cross the cell membrane, and
they mediate the ultimate effect on the cell. They are not produced by the
hormone-producing cell, and they are necessary to bring about hormonal effects, not
simply for increasing the intensity of the effect. They are not an alternative mechanism
of effect but rather a prerequisite for certain hormonal effects on body cells.
Which of these patients would the nurse expect to be the best candidate for misoprostol (Cytotec)?
A) A 12-year-old with obsessive-compulsive disorder
B) A 22-year-old pregnant patient
C) A 46-year-old trial lawyer with hypertension
D) An 83-year-old man with rheumatoid arthritis
Ans: D
Feedback:
The 83-year-old man with rheumatoid arthritis is most likely to be taking nonsteroidal antiinflammatory
drugs (NSAIDs). Misoprostol is indicated for prevention of NSAID induced ulcers in
adults at high risk for development of gastric ulcers. The other three patients would not be candidates
for this drug.
A patient has been prescribed esomeprazole (Nexium). What statement by the patient does the nurse
evaluate as indicating that he or she has a good understanding of his newly prescribed drug?
A) I should open the capsules and crush the drug into applesauce.
B) It is important that I take the drug after each meal.
C) I need to swallow the drug whole and not chew the capsules.
D) I should always take the drug with an antacid.
Ans: C
Feedback:
Esomeprazole must be swallowed whole, not cut, crushed, or chewed, which would interfere with its effectiveness. The drug should not be taken with an antacid, which could interfere with absorption. The
drug is taken once a day, not with each meal.
A client with a new diagnosis of an endocrine disorder is unclear how the body can
control the levels of different hormones over time. Which of the following statements
most accurately underlies the dominant regulation process of hormone levels in the
body?
A) A positive feedback cycle ensures that stable levels of hormones exist in the body
over time.
B) With input from various sensors, hormone production and release are adjusted
based on existing hormone levels.
C) The hypothalamus ensures that hormone levels correspond accurately to the
diurnal cycle.
D) The pituitary gland is genetically programmed to stimulate and inhibit hormone
production and/or release based on the needs at different points in the life cycle.
Ans: B
Feedback:
Most hormone levels are controlled by way of a negative feedback cycle, in which low
levels stimulate production and/or release. A positive feedback cycle would not achieve
this effect. While some hormones are released on a diurnal schedule, the dominant form
of hormone regulation in the body is that of negative feedback. Hormone release is not
predetermined by the pituitary gland.
A nurse on a medical unit is providing care for a 37-year-old female patient who has a
diagnosis of Graves disease. Which of the following treatments would the nurse most
likely anticipate providing for the client?
A) -Adrenergic–blocking medication to reduce sympathetic nervous stimulation
B) Administration of levothyroxine to supplement thyroid function
C) Calcium channel blocking medications to reduce heart rate and cardiac risks
D) Administration of somatostatin analogs to inhibit GH production
Ans: A
Feedback:
The hyperthyroidism that constitutes Graves disease can often be mitigated by the
administration of -adrenergic–blocking medications. Levothyroxine would be used to
address hypothyroidism, and calcium channel blockers are not an identified treatment
modality for Graves disease. Somatostatin analogs are used to treat GH excess.
When doing a shift assessment on the patient, the nurse would report what symptoms as a possible adverse effect of intranasal methylprednisolone? (Select all that apply.) A) Headache B) Impaired wound healing C) Epistaxis D) Hypotension E) Nasal irritation
Ans: A, B, C, D, E
Feedback:
Intranasal administration of hydrocortisone can result in headache, nausea, nasal irritation, fungal
infections, epistaxis, rebound congestion, perforation of the nasal septum, anosmia, and urticaria.
Systemically administered hydrocortisone has many possible adverse effects including impaired wound
healing and hypotension, but these would not be likely to be associated with intranasal administration
of hydrocortisone.
A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on
urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual
activity during the last 6 months. Her records show that she has diabetes mellitus and
uses oral contraceptives. Which category of antimicrobial medication is most likely to
clear her symptoms?
A) Clotrimazole, an antifungal agent
B) Penicillin V potassium, a broad-spectrum antibiotic
C) Ciprofloxacin, a fluoroquinolone antibiotic
D) Tenofovir, an antiviral agent
Ans: A
Feedback:
The character of the discharge and the lack of recent sexual activity suggest infection
with Candida, which can exist asymptomatically and flare up only if conditions such as
an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or
oral contraceptive use enable the fungus to proliferate. Candidiasis responds well to
treatment with azole antifungal agents.
Which of the following is the best example of a diarthrodial joint?
A) The interface between the body of the femur and the epiphyseal plates at the ends
of the bone
B) The interphalangeal joint between the proximal and middle phalanges of the
fingers
C) The suture between the frontal and parietal bones of the skull
D) The syndesmoses between the two sides of the pelvis
Ans: B
Feedback:
Interphalangeal joints are exaNmUpRleSs oIfNdGiaTrtBhr.oCdiOalM, or synovial joints, which are
characterized by free movement. The joints at epiphyseal plates, between skull bones,
and at the symphysis pubis do not meet this criterion.
In which of the following locations would a clinician expect to find a ligament?
A) At the attachment points between ribs and the sternum
B) Between the radius bone of the arm and the biceps brachii muscle
C) Around the capsule that forms the knee joint
D) Between the individual plates of the skull
Ans: C
Feedback:
Ligaments exist where a bone connects to its articulating mate, as in the case of the
synovial joint between the tibia and femur that constitutes the knee. Ligaments do not
connect the ribs to the sternum, and the radius and biceps are connected by a tendon.
The interfaces between the skull plates are considered joints, but these are not
ligaments.
A patient has been admitted with a fractured pelvis that occurred in an auto accident just
a few hours ago. The nurse notices a slight change in behavior. Which of the following
clinical manifestations would lead the nurse to suspect that the patient has fat emboli
that has migrated? Select all that apply.
A) Complaints of substernal chest pain
B) Complaints of pain in the lower abdomen and back
C) Pulse rate 120 with temperature of 99.7°F
D) Profuse diaphoresis with pallor noted
E) Urine output of 30 mL/hour
Ans: A, C, D
Feedback:
Initial symptoms of FES are a subtle change in behavior and signs of disorientation
resulting from emboli in the cerebral circulation combined with respiratory depression.
There may be complaints of substernal chest pain and dyspnea accompanied by
tachycardia and low-grade fever. Diaphoresis, pallor, and cyanosis become evident as
respiratory function deteriorates. It would be expected that the patient have lower
abdominal and back pain since they have a pelvic fracture. The normal urine output is a
minimum of 30 mL/hour.
A 56-year-old male is obese and has poorly controlled type 2 diabetes mellitus. The
home care nurse who changes the dressing on his chronic foot ulcer three times weekly
has noted that the client’s bone is now visible in the wound bed. The client has a fever
and has not complained of any notable increased of pain to his foot. Which of the
following statements best captures what is likely occurring?
A) The client is possibly experiencing direct penetration osteomyelitis in which
microorganisms have entered through his foot wound.
B) Infectious microorganisms in his blood supply have proliferated in the distal
portions of his skeletal system.
C) Vascular insufficiency has contributed to infection in both soft tissue and now his
bone.
D) His immunocompromised status associated with diabetes has allowed skin flora to
penetrate his foot bone via the surface wound.
Ans: C
Feedback:
Diabetes is strongly associated with vascular insufficiency; this process is more likely
than infection from the bloodstream, and his situation is not indicative of direct
penetration osteomyelitis. Decreased immune status is not directly responsible for his
problem
