Unit 3: End-of-Module Quizzes Flashcards
Provided by Dr. Knowlton
If someone has gallbladder issues, the pain should be present after eating which of the following food/drink items?
- salad and diet coke
- oatmeal and fruit
- bowl of ice cream
- egg white omelet and toast
Bowl of ice cream
A patient is admitted with choledocholithiasis. The nurse understands this to mean what is occurring in this patient.
There is a stone in the common bile duct.
Which of the following patients is most likely to develop cholecystitis?
- A 50-year-old woman who has type II diabetes and is overweight
- A 32-year-old male who is a weight lifter
- An 18-year-old female who uses oral birth control pills
- An 82-year-old female who has lost 10 lbs over the last 2 months.
A 50-year-old woman who has type II diabetes and is overweight
What can happen as a result of cholecystitis (select all that apply)?
- ischemia and possible necrosis of the gallbladder
- chronic cholecystitis
- cholecystectomy
- gallstone pancreatitis
- cholangitis
- hepatitis
- bowel obstruction
- ischemia and possible necrosis of the gallbladder
- chronic cholecystitis (if the GB is not removed, it can result in repeated episodes of inflammation)
- cholecystectomy (a removal of the GB can happen)
- gallstone pancreatitis (a gallstone can block the pancreatic duct)
- cholangitis (inflammation of the common bile duct can occur)
- hepatitis (inflammation of the liver can occur if the stones block the flow of bile and there is back up to the liver)
What causes the pain of pancreatitis?
The pancreas is being digested by the pancreatic enzymes and this causes pain.
Which of the following are possible complications from pancreatitis (gd select all that apply)?
- death
- shock
- systemic hypertension
- hemorrhage
- myocardial infarction
- ARDS
- death
- shock
- hemorrhage
- ARDS
What is one reason why pancreatic cancer have such a high mortality rate?
The cancer usually doesn’t have any symptoms until it has spread.
What is the underlying pathology to both Ulcerative Colitis and Crohn’s disease?
Inflammation
Which disease most commonly affects the small intestine and causes skip lesions in the bowel?
Crohn’s disease
Which of the following are symptoms of Crohn’s disease (heckin’ select all that apply)?
- loose stools with a lot of blood
- abdominal pain
- weight loss and malnutrition
- low grade fever
- tenesmus
- weight loss and malnutrition
- abdominal pain
- low grade fever
A patient develops a passage from their bowel that connects to the bladder. The nurse recognizes this as:
Fistula
A characteristic of ulcerative colitis is:
Confluent ulcers
What would you expect to see in a patient with Ulcerative colitis?
Many trips to the bathroom because of tenesmus
Which patients are at high risk for colon cancer? A patient with Chron’s disease; a patient with systemic IBD disease; a patient with a high amount of cobblestoning in the bowel; or a patient with ulcerative colitis.
A patient with ulcerative colitis.
What type of obstruction of the bowel occurs after surgery from anesthesia or drugs?
Paralytic ileus
What is scar tissue that causes areas of the intestines to adhere together called?
Adhesions
Which of the following is most serious?
- diverticulosis
- diverticulitis
- bowel perforation
- peritonitis
Peritonitis (The infection is in the peritoneal cavity and can easily cause the individual to become septic.)
If a patient has a bowel obstruction, which of the following should be a primary concern of the nurse?
- fluid and electrolyte imbalance
- pain management
- increasing abdominal size
- nausea and vomiting
- Fluid and electrolyte imbalance (This can lead to hypovolemic shock and fluids shift spaces. Massive loss of fluids can occur as well as acid-base imbalances.)
What contributes to the formation of diverticuli in the bowel?
Lack of fiber in diet
Which of the following GI situations would patients present with a symptom of low grade temperatures (MFing Select all that apply)?
- colon cancer
- diverticulosis
- appendicitis
- diverticulitis
- ulcerative colitis
- bowel obstruction
- appendicitis
- diverticulitis
- ulcerative colitis
If the liver is hard and small on ultrasound, the nurse understands the damage to the liver is at what stage?
Chronic inflammation (initial inflammation makes the liver large, long term inflammation leads to a small, hard liver for example in diseases like chronic hepatitis C)
Which patient is most likely to have typical symptoms of hepatitis?
- hepatitis C
- hepatitis B
- hepatitis A
- viral hepatitis
Hepatitis A (The types of hepatitis where the body is able to eradicate the infection are the ones that are most likely to have symptoms. The types of hepatitis that are chronic are less likely to have symptoms.)
If someone has hepatitis. What symptoms might they have (Ughhh Select all that apply)?
- elevated blood glucose levels
- right upper quadrant pain
- anorexia
- nausea
- fatigue
- jaundice
- constipation
- right upper quadrant pain
- anorexia
- nausea
- fatigue
- jaundice
What stage of hepatitis is the patient not having any jaundice?
Prodromal phase (this is the first stage and patients may be symptomatic but aren’t jaundiced yet)
What type of hepatitis causes the most liver cancer and liver cirrhosis?
Hepatitis C
Which of following have an immunization to prevent infection (Select all that apply :( )?
- hepatitis A
- hepatitis B
- hepatitis C
- hepatitis E
- hepatitis from alcohol
- hepatitis A
- hepatitis B
It is now recommended by the CDC to test baby boomers for which type of hepatitis?
Hepatitis C
Which of the following statements is true about nonalcoholic steatohepatitis?
- It happens normally as someone ages.
- It is caused by too much alcohol intake
- Normal liver function tests but the liver is enlarged.
- It is just as detrimental as cirrhosis and is related to poor dietary intake
- It is just as detrimental as cirrhosis and is related to poor dietary intake
Albumin is made in the liver, therefore patients with cirrhosis will have what symptoms?
Edema, ascites, and low blood pressure
Why are cirrhosis patients at risk for bleeding? (This is one of the reasons)
Low levels of vitamin K due to difficulty absorbing fat
What type of patient would have an intrahepatic jaundice?
- sickle cell disease
- blood transfusion reaction
- cirrhosis
- stone in the common bile duct
Cirrhosis
If bile is not able to be conjugated and reach the small intestine, the stool will be what color?
Clay
Dark colored urine in a patient with jaundice indicates what?
Bilirubin is causing the urine to be dark in color
If a patient has a dysfunctional liver and portal hypertension has developed, what are other possible problems from portal hypertension? (Select all that apply)
- gynecomastia
- ascites
- esophageal varices
- high blood pressure
- peritonitis
- hemorrhoids
- caput medusae
- ascites
- esophageal varices
- peritonitis
- hemorrhoids
- caput medusae
What might cause a patient to develop hepatic encephalopathy (Ehhhh Select all that apply)?
- a diet high in protein
- high blood sugar levels
- GI bleed
- leukopenia
- anemia
- infection
- A diet high in protein
- GI bleed
- Infection
What impact can cirrhosis have on the kidneys?
Pre-renal failure
A chart reveals the patient has GERD. The nurse knows this to mean:
The lower esophageal sphincter is allowing acid to reflux into the esophagus.
A patient reports stomach irritation from drinking too much alcohol last night. The patient is diagnosed with?
Gastritis
A neighbor is telling you his stomach protrudes above his diaphragm and causes indigestion symptoms. He plans to have surgery soon. The nurse recognizes this as:
Hiatal hernia
Gallstone pancreatitis occurs because there is a stone located in the:
Pancreatic duct (the number one cause of acute pancreatitis is gallstones. The gallstone gets lodged into the pancreatic duct blocking the drainage of pancreatic enzymes from the pancreas.)
Which of the following individuals has the highest risk of developing gallstones?
- A 50-year-old Caucasian female who is overweight.
- An 80-year-old overweight woman.
- A Native American man with kidney stones.
- An 18-year-old male with Type II Diabetes.
A 50-year-old Caucasian female who is overweight.
Which of the following statements is true about pancreatitis?
- Stimulates the exocrine function of the pancreas leading to overproduction of pancreatic enzymes.
- Can result in the release of pancreatic enzymes into the peritoneal cavity or into the general circulation.
- It is a common disorder that is easily treated with bowel rest, fluids and pain medication.
- It causes right upper quadrant pain associated with meals high in fat.
Can result in the release of pancreatic enzymes into the peritoneal cavity or into the general circulation (Acute pancreatitis has a high mortality rate (10-30 %) so it should be taken seriously. Patients can quickly become very ill if the pancreatic enzymes spread into the peritoneal cavity or into the general circulation.)
Which of the following statements is true about pancreatic cancer?
- It is typically diagnosed early when patients present with jaundice.
- It is the head of the pancreas that is most often involved.
- Incidence of pancreatic cancer has been on the decline.
- It has great cure rates.
It is the head of the pancreas that is most often involved (The head of the pancreas is involved in 60% of cases. Because of it’s proximity to the CBD, patients often don’t present until they are jaundiced. It is often too late by that time and it has metastasized by then. The incidence of pancreatic cancer has tripled. 5% survival rate at 5 years.)
T/F: Patients with cholecystitis always have gallstones.
False (Cholecystitis can be caused by gallstone or by “acalculous” where no stones are found. Acalculous cholecystits can be caused by trauma, DM, fasting, dehydration, opioid use, or hormone replacement therapy.)
Which of the following has a “chronic state” (Gahhhh select all that apply)?
- chronic gastritis
- chronic pancreatitis
- chronic cholecystitis
- chronic pancreatic cancer
- chronic gastritis
- chronic pancreatitis
- chronic cholecystitis
T/F: Many believe that inflammatory bowel disease (IBD) has an autoimmune etiology.
True (There is a belief that IBD has an autoimmune cause. If you look at the drug therapy for IBD, many of the drugs (biologics) that are used now are targeting the immune system trying to calm it down.)
Which of the following are complications of Chron’s disease that were discussed in lecture (Crappy select all that apply)?
- fistula formation
- bowel perforations
- strictures
- colon cancer
- abscess formation
- fistula formation
- bowel perforations
- strictures
- abscess formation
Patients who have appendicitis have a particular pattern of pain. What location is the pain typically found last and the patient can point one finger to identify?
Right lower quadrant (The pain usually starts midline (epigastric, periumbilical or pelvic) and eventually moves to the right lower quadrant of the abdomen.)
T/F: If a patient with appendicitis tells you that his pain is gone, that is a good sign and he probably will not need surgery.
False (When the pain disappears in an appendicitis patient, it usually means that the appendix ruptured. A patient with a ruptured appendix needs surgery with the peritoneal cavity washed out and antibiotics for a couple of days.)
Which of the following statements is true about diverticular disease?
- Diverticulosis causes symptoms of bloody stool, constipation, nausea/vomiting and LLQ pain.
- Diverticulitis is a serious inflammation of a diverticuli and may require hospitalization.
- Diverticulosis occurs in mostly women and the onset is during puberty.
- Patients who eat a large amount of fruits and vegetables are more likely to develop diverticulosis.
Diverticulitis is a serious inflammation of a diverticuli and may require hospitalization (Diverticulosis is the outpouchings and is usually asymptomatic in most individuals. Most common as we age and due to our “American diet” which is low in fiber. When inflammed the diverticulosis becomes diverticulitis.).
T/F: A patient is diagnosed with colon cancer in the descending colon, which is the most common site for colon cancer
False. The most common site is the rectum (30%) and the sigmoid colon (25%). Between the two, over 50% of all colon cancer is found in those two locations.
The screening test for colon cancer that should be performed every 10 years after the age of 50 is:
Colonoscopy (There have been some recent changes. Now colon cancer screenings are recommended at the age of 45 instead of age 50. Additionally, colonoscopy is only reserved for those with a higher risk of colon cancer. Individuals with a low risk of colon cancer can be given Cologaurd, a home test whereby stool is mailed in to check the DNA found in the stool for cancer. Higher risk individuals are still given a colonoscopy and any positive results from Cologaurd have a colonoscopy follow up. )
Which hepatitis only exists with hepatitis B?
Hepatitis D
Which hepatitis is spread through fecal-oral transmission?
Hepatitis A
Which hepatitis is leading cause of liver transplants?
Hepatitis C
Which hepatitis is most common blood/body fluid transmission?
Hepatitis B
Which types of viral hepatitis causes a carrier state (Select all that apply!!!)?
- hepatitis G
- hepatitis C
- hepatitis B
- hepatitis D
- hepatitis E
- hepatitis A
- hepatitis G
- hepatitis C
- hepatitis B
- hepatitis D
T/F: If a patient is very symptomatic from hepatitis, then he or she is more likely to develop chronic hepatitis.
False: Pts with no symptoms and little immune response tend to be the ones who develop into a chronic hepatitis.
A patient has jaundice, therefore is most likely in which phase of the 3 phases of hepatitis?
A patient has jaundice, therefore is most likely in the icteric phase of the 3 phases of hepatitis.
Which of the following patients is most likely to develop NASH?
- A 28-year-old person with alcohol use disorder.
- An 80-year-old male with cancer of the liver.
- A 15-year-old who has substance use disorder (heroin).
- A 40-year-old male who is obese.
A 40-year-old male who is obese (NASH is nonalcoholic steatohepatitis and is related to excess energy intake that leads to fatty deposits on the liver. Caused by overeating.)
What is the cause of jaundice in this patient?
Patient has increased unconjugated (indirect) and conjugated (direct) bilirubin. Urine dark and stool clay colored.
- newborn jaundice
- prehepatic jaundice
- posthepatic jaundice
- intrahepatic jaundice
Intrahepatic jaundice. Intrahepatic jaundice causes difficulty with conjugating bilirubin as well as excreting conjugated bilirubin from the liver. Both are high. When conjugated bili is involved, then both urine and stool change colors. This would be common with cirrhosis or some other intrahepatic injury.
A patient with liver cirrhosis is asking the nurse why his stool floats. What is the best response by the nurse?
- more amylase and lipase is release into the stool
- high amounts of bilirubin in the stool
- high amounts of fat in the stool
- liver damage leads to increased fluid in the colon
High amounts of fat in the stool (Fat in the stool makes the stool float. Bile is needed to absorb fat in the GI tract. Bile is not being made or excreted properly in cirrhosis.)
Describe the cause of the symptom below:
The patient cannot breathe well when he lies down, he is taking diuretics (water pill) and has had a number of paracentesis treatments.
He can’t breathe because of the ascites in his abdomen is limiting the expansion of his lungs.
__________ is the flapping tremor that patients develop when they have hepatic encephalopathy.
Asterixis
Emily is 27 years old and has endometriosis. ‘Select all that apply’ that are correlated with the occurrence of endometriosis.
- She complains of constant pelvic pain throughout the month without variation.
- She started having menstrual periods at the age of 16.
- Her mother and older sister both have endometriosis.
- She has not been able to become pregnant after trying for 5 years to conceive
- Her periods have been heavy with intense cramping.
- Her mother and older sister both have endometriosis.
- She has not been able to become pregnant after trying for 5 years to conceive
- Her periods have been heavy with intense cramping.
T/F One theory is that endometriosis is caused by dormant embryonic cellular components are evolving into endometrial tissue outside of the uterus.
True. This is one of many theories. Other theories include: retrograde menstruation, spread through lymph and vascular as well as genetics, immunity or environmental.
What are the classic triad symptoms of endometriosis? (another damn select all that apply)?
- dysmenorrhea
- menorrhagia
- dyschezia
- infertility
- dsypareunia
- dysmenorrhea
- infertility
- dsypareunia
The others listed are symptoms of endometriosis, but not the classic triad.
A patient is asking the nurse about her symptoms of endometriosis. She asks for further clarification. What is the best response by the nurse?
“There is uterus tissue that changes from squamous epithelium to columnar epithelium and that causes the pain.”
“The best way to diagnose endometriosis in patients it through a vaginal ultrasound guided biopsy.”
“Endometriosis is a risk factor for cervical cancer and therefore yearly pap smear screenings are recommended.”
“When the endometrial tissue bleeds outside of the uterus, it causes inflammation and scarring which leads to a lot of the pain and chronic complications.”
“When the endometrial tissue bleeds outside of the uterus, it causes inflammation and scarring which leads to a lot of the pain and chronic complications.”
The scarring (also called adhesions) causes a lot of the chronic problems with pain and infertility.
The age group that is most commonly diagnosed with endometriosis is:
25-35 years old. Most women are diagnosed with endometriosis during the time that women are typically trying to become pregnant (25-35) and it can lead to infertility. Often interventions are aimed at helping women become pregnant during this time frame if they have endometriosis and what to have children in case they become infertile.
The cervix is normally lined with __________ epithelium, whereas the vagina is lined with __________. The area where the two types of tissues come together is called the ___________ zone.
Simple columnar, stratified squamous, transformation
T/F Cervical cancer is a sexually transmitted disease.
True
This may be debated, but what I want you to walk away knowing is that 80% of all cervical cancer is caused by the human papilloma virus, which is transmitted sexually.
Which two types of HPV are associated with cervical cancer?
HPV type 16 & 18 cause 80% of all cervical cancer cases.
HPV has been associated with other cancers in addition to cervical cancer. SELECT ALL THAT APPLY to indicate what other types of cancers have been associated with HPV.
- rectal
- oral
- breast
- penile
- vaginal
- rectal
- oral
- penile
- vaginal
Which of the following pathology descriptions is describing a case of cervical cancer?
- ASC-US
- LSIL
- CIN3
- HSIL
CIN3
ASC-US: atypical squamous cell of undetermined significance.
CIN 1= mild dysplasia (LSIL) low grade squamous intraepithelial lesion
CIN2= moderate (HSIL) high grade squamous intraepithelial lesion
CIN3=severe dysplasia and carcinoma in situ **This one is cancer that has been contained to the cervix only. It has not crossed the basement membrane.
How does the body normally respond to HPV? This helps explain the change in the guidelines for Pap smears.
The body normally eradicates the virus on its own.
The screening guidelines changed to first pap at the age of 21 or 3 years after first intercourse due to many positive responses. The body normally clears HPV on its own. Delaying screening gives the body the chance to do this.
What are some risk factors for prostate cancer? SATA:
- African American background
- diet high in meat and fat
- multiparity (fathered many kids)
- increasing age (Ex. over the age of 65)
- family history
- African American background
- diet high in meat and fat
- increasing age (Ex. over the age of 65)
- family history
T/F: The symptoms of prostate cancer can look like the symptoms of benign prostatic hyperplasia.
True
Prostate cancer is usually asymptomatic in the early stages and then as it advances the symptoms are similar to BPH. Advanced disease can have symptoms from the metastasis.
Which of the following statements is characteristic of prostate cancer?
- I was screened for prostate cancer by having a trans-rectal ultrasound completed.
- Prostate cancer is a very fast growing cancer.
- The most common type of prostate cancer is adenocarcinoma.
- Prostate specific antigen levels are considered abnormal if it is elevated more than 2 ng/mL.
The most common type of prostate cancer is adenocarcinoma.
Which statement is characteristic of testicular cancer?
- Men at highest risk for testicular cancer are men over 50 years of age.
- Men are taught to do monthly testicular exams as a screening method.
- Testicular cancer masses should transilluminate when examined.
- Most patients seek treatment due to a painful mass in the testicle.
Men are taught to do monthly testicular exams as a screening method.
TSE is encouraged to young men (15-35), as they are most at risk. The mass is painless and does not trans-illuminate (like a fluid fill cyst would).
T/F: Women with triple negative breast cancer are lucky since there is receptor targeted therapy that is quite effective.
False. No one with cancer is “lucky.” AND Triple negative means Estrogen receptor, progesterone and HER2 receptor negative. This type of cancer is usually receptive to chemo, but not therapy targeted at receptors. It tends to be a more aggressive cancer with a high relapse rate.
What are the symptoms of breast cancer? Select all that apply
- breast pain before menstruation
- discharge from the nipple
- inversion of nipples
- change in size of one breast
- palpable mass that comes and goes
- discharge from the nipple
- inversion of nipples
- change in size of one breast
Symptoms include: hard, uneven, painless mass; change in shape, size or feel or breast or nipple, orange peel appearance, and nipple drainage.
Painful breasts before menstruation is associated with premenstrual syndrome. Breast cancer masses don’t “come and go”.
Which STI am I?
Most characteristic symptom is a thick creamy yellow discharge, most commonly occurring in men.
Gonorrhea
Which STI am I?
The most common sexually transmitted infection.
Chlamydia
Which STI am I?
Very painful or itching sensation occurs prior to the presence of lesions.
HSV
Which STI am I?
Painless chancre lesion
Syphilis
Candidiasis infections are caused by:
Imbalance in the normal vaginal flora
Candidiasis infections occur when the normal balance is off: normal flora disturbed; pH changes, decreased immune response or increased glucose levels.
T/F: Herpes simplex virus infections can’t be spread unless there are lesions present.
False. Asymptomatic shedding of the virus still occurs even when lesions are not present. Additionally, people are always contagious when lesions are present.
In which stage of syphilis is this symptom found?
Gummas are present in various parts of the body
Tertiary
In which stage of syphilis is this symptom found?
Painless chancre is present at site of exposure
Primary
In which stage of syphilis is this symptom found?
CNS effects like dementia
Tertiary
In which stage of syphilis is this symptom found?
Maculopapular rash on chest, palms of hands and feet present
Secondary
Which of the following women would be most likely (highest risk) of having endometriosis?
- Woman who started her menstrual cycle at age 8.
- Woman who had her first child at the age of 14.
- Woman who has had 5 pregnancies.
- Woman who has had HPV infection.
Woman who started her menstrual cycle at age 8.
The nurse understands endometriosis to be:
- A condition that is very painful and is worse with constipation.
- Tissue that should be in the uterus is found in other areas and goes through changes with the menstrual cycle.
- A benign growth of ovarian tissue that responds to hormone stimulation.
- An inflammatory condition that is aggravated by hormonal changes with menses.
Tissue that should be in the uterus is found in other areas and goes through changes with the menstrual cycle.
A patient tells the nurse that she has adhesions from endometriosis. The nurse understands this to be:
Scar tissue
Women who have endometriosis complain of:
- dsymenorrhea
- amenorrhea
- high risk of pregnancy
- lower back pain
Dsymenorrhea
A woman is having a speculum exam with a specimen taken for a pap smear. The goal is to take a sample of which cervical cells for evaluation under a microscope to look for cervical cancer changes?
- outer ring of the cervix
- squamous epithelial cells
- columnar epithelium cells
- cells in the transformation zone
Cells in the transformation zone
A woman needs to be tested for human papilloma virus. What test should be done?
A cell sample from the cervix and tested for HPV *. Remember HPV testing is not the same as a pap smear, but is an additional sample that is taken from the cervix.
A 16-year old female starts to become sexually active for the first time and contracts HPV infection. What does the nurse expect to happen?
The patient’s body will most likely eradicate the virus on its own.
Which of the following are caused by the HPV virus?
- psoriasis
- impetigo
- plantar warts
- cold sores
- some rectal cancers
- genital warts
- plantar warts
- some rectal cancers
- genital warts
Which of the following pathology reports is the most dysplastic changes?
- ASC-US
- LSIL or CIN1
- HSIL or CIN2
- CIN3
CIN3
Which of the following men are at greatest risk of prostate cancer?
- 40-year-old African American male
- 85-year-old male
- 50-year-old male with cardiovascular and kidney disease
- 60-year-old male with poor dietary habits
85-year-old male
Age alone is one of the strongest risk factors for cancer. We know that 1 in 6 men have prostate cancer by the age of 85.
Which of the following has been identified as a dietary addition that is protective against prostate cancer?
- Red meat
- Eating foods higher in fat like avocados and nuts
- Drinking green tea
- Diet high in supplements
Drinking green tea
A patient is diagnosed with advanced prostate cancer that has metastasized. What is the most likely presentation for this type of patient?
- asymptomatic
- complaints of incontinence
- complaints of BPH-like symptoms as well as pain in the lower back and pelvis
- shortness of breath
Complaints of BPH-like symptoms as well as pain in the lower back and pelvis
Once advanced, BPH symptoms are common as well as signs of mets. Mets to the bones is common and may present as lower back or pelvic pain.
A patient had a PSA done 1 year ago and it was 1.5 ng/mL. A repeat test this year resulted in 25 ng/mL. How would the nurse interpret this information?
- That is a normal change in results.
- Was a digital rectal exam done prior to drawing the blood?
- This is a sign of prostate cancer.
- The man most likely has prostatitis.
Was a digital rectal exam done prior to drawing the blood?
This result is concerning and is a significant increase in a 1-year time period. This could be related to doing a digital rectal exam right before drawing the blood. It could also be prostate cancer, prostatitis or BPH. The nurse should recognize that this is a significant increase and should be further investigated.
Which of the following men is most suspicious of testicular cancer?
- An 88-year-old male with bilateral enlarged testicles.
- An 18-year-old with one large, painful testicle after trauma.
- A 22-year-old male with a painless mass found incidentally during self-exam.
- A 50-year-old male with urinary symptoms and swelling in his testicles.
A 22-year-old male with a painless mass found incidentally during self-exam.
Which woman would be at highest risk of breast cancer due to estrogen exposure risk?
- A woman who was on birth control pills for 40 years from the age of 15 to 55.
- A woman whose husband had a vasectomy.
- A woman who had menarche at the age of 18 and menopause at the age of 40.
A woman who was on birth control pills for 40 years from the age of 15 to 55.
A woman has been diagnosed with ER positive breast cancer. What does this mean?
- Only chemotherapy can work for this patient.
- The cancer is very aggressive.
- The cancer will respond to targeted hormone therapy that targets estrogen receptors.
The cancer will respond to targeted hormone therapy that targets estrogen receptors.
A nurse is teaching a woman to do monthly self-exams of the breast to look for signs of breast cancer. What should the nurse teach the woman to watch for? Select all that apply.
- asymmetry in the breasts
- breasts that are atrophied
- discharge from the nipple
- skin that has the appearance of an orange peel
- painful lumps in the breast
- asymmetry in the breasts
- painful lumps in the breast
- discharge from the nipple
- skin that has the appearance of an orange peel
A patient comes into the clinic with suspected cold sores on his mouth. What action should the nurse take?
- Tell the patient he has herpes simplex virus infection.
- Put a surgical mask on the patient.
- Tell the patient that antibiotic therapy will cure his cold sores.
- Wear gloves when assessing the patient.
Wear gloves when assessing the patient.
A patient has genital herpes. What clinical presentation does the nurse expect when examining the patient?
There is itching and painful sensations that occurred prior to the outbreak of lesions.
What is the most typical scenario for a patient with Chlamydia?
- Patient comes to the clinic with complaints of profound vaginal itching.
- The infection was found incidentally during a vaginal swab exam.
- Patient comes to the clinic with complaints of profound vaginal itching.
- The patient reports having frequent outbreaks of this infection over the last 5 years.
The infection was found incidentally during a vaginal swab exam.
A patient tells the nurse that he has noticed a lesion on his penis that is moist and does not hurt. The nurse is suspicious that this is might be which STI?
Syphilis
A patient has a rash on the soles of his feet. The nurse recognizes this can occur with which stage of syphilis?
Secondary
A hospitalized patient who has been treated for a major systemic infection (sepsis) with multiple antibiotic drugs is at risk of developing which infection?
Candidiasis
The nurse recognizes that a patient with creamy yellowish-white discharge from his penis may have which STI?
Gonorrhea
Incontinence is a normal part of aging.
False. Incontinence is NOT a normal part of aging. Increasing age is a risk factor for incontinence due to weakening of pelvic floor muscles but should not be accepted as a normal part of aging and should be investigated as to the cause.
The type of incontinence that occurs when the bladder becomes overdistended and urine leaks out is called?
Overflow incontinence
Overflow incontinence is related to the over distension of the bladder. The bladder is full of urine and is not emptying correctly. Typical causes of this situation include chronic distension, bladder damage, or an enlarged prostate (BPH).
A patient is telling the nurse that she better put a commode right next to the bed, because when she has urinate, the urge comes on suddenly and if she doesn’t get there quick enough, she will have an “accident”. This is called [x] incontinence.
Urge incontinence
Urge incontinence is sometimes called overactive bladder. There is a strong urgency to go urinate. May be an sympathetic nervous system cause as it is common in neurological conditions.
In [x] incontinence, there is increased pressure on the external bladder (such as increased intra-abdominal pressure from coughing) that causes the weakened urinary sphincter to not be able to hold the urine leading to leaking of urine.
Stress incontinence
Stress incontinence is very common as risk factors include pregnancy, childbirth, and obesity. Urinary leaking occurs due to pressure on the bladder and a weakened urinary sphincter.
Patient brought to the emergency room after having a seizure was found to be incontinent of urine. This type of incontinence is called [x].
Transient incontinence.
Transient incontinence occurs as a result of a temporary condition, such as a seizure of diuretic use.
The nurse recognizes that many things can cause incontinence. Mark all that apply from the list below that are causes of incontinence using the DIAPPERS pneumonic.
- delirium
- old age
- hypertension
- urinary tract infections
- medications such as diuretics
- fecal impaction
- delirium
- medications such as diuretics
- fecal impaction
- urinary tract infections
D- dementia/ delirium
I-infection (UTI)
A-atrophic vaginitis
P-pharmacological (diuretics)
P=psychological
E-endocrine (DM)
R-restricted mobility
S=stool impaction
The most common pathological agent that causes urinary tract infections is [x], an organism that normally inhabits the gastrointestinal system.
Escherichia coli
There are normal host defenses that try to prevent urinary tract infections.
Select all that apply
- lactobacillus in the periurethral area
- low levels of estrogen
- increased blood supply to the bladder
- mucin layer
- prostatic fluid has anti-microbial properties
- lactobacillus in the periurethral area
- mucin layer
- prostatic fluid has anti-microbial properties
Normal host defenses include: mucin layer, IgA, lactobacillis, prostatic fluid.
There is a universal push to decrease urinary catheter use in hospitalized patients to decrease the incidence of urinary tract infections. What is one factor about urinary catheters that increases the risk of urinary tract infections?
Formation of a biofilm on the catheter surface
Bacteria adhere to the surface of the catheter and initiate growth of a biofilm that covers the surface of the catheter. The biofilm protects bacteria from the action of antibiotics and makes treatment difficult.
A 24-year-old female patient presents with a urinary tract infection. What symptoms would the nurse expect to find?
Select all frikkin’ that apply.
- foul smelling urine
- gross hematuria
- dysuria
- acute confusion
- vaginal itching
- foul smelling urine
- dysuria
I made this one a little tricky. Yes, hematuria can occur with a UTI, but it should not be gross hematuria (meaning a lot). See the minor topic area on bladder and renal cancer that talk about gross hematuria.
Acute confusion IS a common symptom in elderly patients. I didn’t talk about that in the lecture, but a good piece of information to know. We always joke about the brain-bladder connection in the elderly.
Normal symptoms: frequency, dysuria, cloudy and foul smelling urine, urgency, some hematuria. Fever, chills and fatigue are possible, but are more likely to occur with an upper UTI (pyelonephritis) than a lower UTI (cystitis).
The nurse is reviewing the urinalysis results of a patient with a suspected urinary tract infection. The nurse recognizes which of the following findings is only present when there are white blood cells in the urine?
- negative for nitrites
- positive for leukocyte esterase
- clarity of urine: cloudy
- positive for RBC
Positive for leukocyte esterase
Leukocyte esterase is an enzyme that is only present when white blood cells are in the urine. It is a strong indicator of a urinary tract infection.
An 85-year-old man is telling the nurse that he is having urinary problems. He shares that he had difficulty getting his urinary stream started and often has to push really hard for the urine to come out. He has to get up 5 times at night to go to the bathroom. He often experiences this sudden need to urinate and has to quickly find a bathroom.
What symptoms of BPH is this patient experiencing?
Select all that apply!
- weak urine stream
- urgent urination
- increased force needed to urinate
- feeling of a full bladder that doesn’t empty all the way
- decreased libido (sex drive)
- frequent urination at night
- weak urine stream
- urgent urination
- increased force needed to urinate
- frequent urination at night
All of the options listed are common symptoms of BPH. In the scenario given, the patient is only experiencing three of the symptoms (weak stream, nighttime voiding and urgency).
Which of the following patients is at greatest risk for having BPH?
- A 48-year-old male with a mildly elevated PSA.
Correct!
- An 80-year-old African American male
- A 30-year-old with a family history of BPH.
- A 62-year-old man with a history of prostate cancer.
An 80-year-old African American male
Risk factors for BPH include *age, family history, dietary (high fat and meat intake), hormonal, and African American race. In the example, the patient has both age and race.
Remember there is not a connection in incidence between BPH and prostate cancer risks. I want you to know that PSA is more associated with screening for prostate cancer.
Based on your understanding of the patho of BPH, what type of drug therapy would be recommended for the patient (this directly relates to patho)?
Administer drugs that block the conversion of testosterone to DHT.
There are already increasing estrogen levels in men as they age. This promotes prostate cell growth. More testosterone would result in more DHT, which the man does not need. He needs less DHT—so give drugs to block the conversion of testosterone into DHT. We want to detrusor muscle to contract properly, so we wouldn’t want to give any drugs that make it NOT contract.
Identify the following situation as either a pre-renal, intra-renal or post-renal type of acute renal failure.
Benign prostatic hyperplasia
Post-renal
Identify the following situation as either a pre-renal, intra-renal or post-renal type of acute renal failure.
Hemorrhage
Pre-renal
Identify the following situation as either a pre-renal, intra-renal or post-renal type of acute renal failure.
Heart failure
Pre-renal
Identify the following situation as either a pre-renal, intra-renal or post-renal type of acute renal failure.
Nephrotoxic drugs (Ex. Amphotericin, Vancomycin)
Intra-renal
Identify the following situation as either a pre-renal, intra-renal or post-renal type of acute renal failure.
Acute glomerulonephritis
Intra-renal
Identify the following situation as either a pre-renal, intra-renal or post-renal type of acute renal failure.
Severe dehydration
Pre-renal
Identify the following situation as either a pre-renal, intra-renal or post-renal type of acute renal failure.
Shock
Pre-renal
Identify the following situation as either a pre-renal, intra-renal or post-renal type of acute renal failure.
Bladder tumor
Post-renal
Identify the following situation as either a pre-renal, intra-renal or post-renal type of acute renal failure.
Acute tubular necrosis
Intra-renal
Review the following list of lab values and clinical findings. Mark all items that will go “up” when a patient has end stage renal disease (CKD 5) and is at the point of needing dialysis.
- phosphate
- calcium
- pH
- creatinine (Cr)
- potassium
- hemoglobin and hematocrit (H/H)
- blood urea nitrogen (BUN)
- blood pressure
- phosphate
- creatinine (Cr)
- blood urea nitrogen (BUN)
- potassium
- blood pressure
Potassium and phosphorus: normally excreted by the kidneys. Can’t be excreted.
BUN and Creatinine are waste product and can’t be excreted.
Blood pressure goes up because the patient is fluid overloaded.
(calcium is always inverse to phosphorus, so remember calcium is low and phosphorus is high, pH goes down meaning that the patient becomes acidotic, and Hgb/Hct are down-anemia because the kidney doesn’t make as much erythropoieten).
What Chronic kidney disease stage is the patient in if his/her GFR is 50?
CKD stage 3
CKD Stage 3, patients have a GFR between 30-59. MOST people with CKD are in stage 3 and many stay there and don’t necessarily advance.
A patient will be starting dialysis next week because of chronic kidney disease. The nurse correctly assumes that the patient is in what CKD stage?
CKD stage 5
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Reversible
Acute kidney disease
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Irreversible
Chronic kidney disease
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Onset over weeks
Acute kidney disease
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Onset over years
Chronic kidney disease
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Treat with dialysis
Both
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Has 4 phases
Acute kidney disease
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Elevation of BUN/creatinine in the same ratio
Chronic kidney disease
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Elevation of BUN/creatinine in 15:1 ratio
Acute kidney disease
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Could be caused by hypovolemic shock
Acute kidney disease
Look at the following term and determine if it applies to acute kidney disease, chronic kidney disease or both.
Could be caused by diabetes mellitus or hypertension
Chronic kidney disease
T/F: It is possible for a patient to have acute and chronic kidney disease at the same time.
True.
Yes, you will see this written in a chart as “acute on chronic kidney disease” For example, a patient has decreased renal function, maybe is CKD Stage 3, then the person has an acute insult on their kidneys (ex: too much ibuprofen, nephrotoxic drug intake, dehydration) and can develop an “acute kidney disease” problem on top of the already poor kidney condition that they have. Once we “fix” the acute problem, they will still remain with their chronic kidney condition.
Why might a patient with CKD Stage 5 be experiencing nausea/vomiting/ metallic taste in the mouth?
Uremia–the build up of wastes in the body, makes people feel nauseated and sick to the stomach.
A patient just had a dialysis catheter placed and the surgical site keeps oozing blood and won’t stop bleeding. Why is this happening?
Uremia effect on platelets
Uremia causes platelets to dysfunction. The actual number of platelets remains the same, but the platelets don’t work as well.
Which blood pressure reading is expected in a patient with chronic kidney disease stage 5?
- 150/94
- 90/50
- 126/90
- 100/62
150/94
HTN is expected in CKD 5 due to the fluid overload problem that they have. They have increased intravascular volume.
A patient with end stage renal failure had an arterial blood gas done. What result does the nurse anticipate?
Metabolic acidosis.
Metabolic acidosis is expected because when the kidneys don’t function, they can’t excrete H ions. The accumulation of H ions leads to metabolic acidosis.
Which description best describes the pathophysiology that occurs with chronic kidney disease?
- Slow progressive loss of nephrons due to hyperactivity of the immune system causing scaring and fibrosis and loss of function.
- Hyperfiltration of the glomerulus which stunts the action of the RAAS system.
- Lack of perfusion that leads to ischemia of the tubules within the nephron.
- A series of events that include increased the passing of albumin through the glomerulus, activation of the RAAS system that leads to scarring and fibrosis.
A series of events that include increased the passing of albumin through the glomerulus, activation of the RAAS system that leads to scarring and fibrosis.
What name would be given to a patient who has an involuntary release of urine due to intoxication?
Transient incontinence
If there is an increase in intra-abdominal pressure from pregnancy, this type of incontinence is:
Stress incontinence
The bladder involuntary contracts when a patient has _____________incontinence.
Urge incontinence
Patients with neurological disorders such as multiple sclerosis are most at risk for what type of incontinence?
Urge incontinence
Patients who have no control or no knowledge of urinary function have ________incontinence
Gross total incontinence
Patient’s with benign prostatic hypertrophy have difficulty emptying the bladder and it results in _____________incontinence.
Overflow incontinence
Who is at risk for incontinence? Select all that apply
- pregnant women
- obese individuals
- 80-year-old female
- 65-year-old patient with COPD
- 62-year-old with cardiovascular disorder
- 50-year-old female with urinary tract infection
- pregnant women
- obese individuals
- 80-year-old female
- 65-year-old patient with COPD
- 50-year-old female with urinary tract infection
A patient is diagnosed with pyelonephritis. The nurse understands this to mean:
The patient has an infection in the kidneys. This is also known as an upper urinary tract infection.
Which of the following is a way that the body helps to protect the body against bacterial invasion in the bladder?
- mucin layer
- Immunoglobulin E
- E. Coli
- testosterone
Mucin layer
Who is most likely to get a UTI (select all that applyyyyy)?
- Male with BPH
- postmenopausal woman
- immunocompromised individual
- 30-year-old male
- bed-bound patient
- individual with a urinary catheter
- hospitalized patient who has pneumonia
- 20-year-old woman with frequent sexual partners
- Male with BPH
- postmenopausal woman
- immunocompromised individual
- bed-bound patient
- individual with a urinary catheter
- 20-year-old woman with frequent sexual partners
Why are patients with a urinary catheter more at risk of getting a UTI?
Biofilm formation on the catheter surface
A patient complains of dysuria. What does this mean?
It is painful to urinate
T/F: BPH increases a man’s risk of prostate cancer.
False
T/F: BPH is a normal finding in men as they age.
True
The nurse is planning a community health screening for BPH, which population of men should the nurse target for this health screening?
- Men from a Mediterranean decent
- Men who are Ashkenzi Jewish decent
- Men from the South
- African American Men
African American Men
What hormones are involved in prostate proliferation in BPH?
Estrogen and dihydrotestosterone (DHT)
Which of the following are symptoms of BPH (Won’t you select all that apply)?
- dysuria
- urgency
- frequency
- difficulty starting a urine stream
- hematuria
- urgency
- frequency
- difficulty starting a urine stream
Which of the following patients is exhibiting symptoms of BPH?
- Voids five times at night
- Increased libido
- Voiding large amount of urine at one time
- Frequent kidney stones
Voids five times at night
What type of renal failure would the nurse expect in a patient with a history of BPH?
Post-renal failure
What does a normal prostate feel like?
Smooth and equal
A patient develops acute renal injury (aka acute renal failure) as a result of taking too much NSAIDS like ibuprofen. Why did this happen?
NSAIDS block prostaglandin synthesis resulting in decreased blood flow to the kidney
A patient has 150 mL (mL is the same as cc) of output in an 8-hour period. What is this called?
Oliguria
Which of the following patient with acute renal injury (acute renal failure) would most likely have an intra-renal problem?
- Sustained hypertension leading to narrowed afferent arterials
- Nephrotoxic drug ingestion
- Large bladder tumor
Nephrotoxic drug ingestion
Which of the following is a normal GFR? 30 ml/min 60 ml/min 90 ml/min 120 ml/min
120 ml/min
A patient is in CKD Stage 3. What does the nurse expect?
- no symptoms
- Alterations in BUN and creatinine levels and GFR decreased
- Increased urine output and GFR over 100
- The initiation of dialysis
Alterations in BUN and creatinine levels and GFR decreased
Which of the following patient’s would the nurse expect to be on dialysis?
CKD stage 1 CKD stage 2 CKD stage 3 CKD stage 4 CKD stage 5
CKD stage 5
If a patient has protein (albumin) in their urine, what does that tell us?
There is damage to the glomerulus
What potassium value would you expect in a stage 5 CKD patient (GFR of 5) who has missed dialysis for 3 days?
- 5 mEq/L
- 5 mEq/L
- 0 mEq/L
- 0 mEq/L
6.0 mEq/L
Normal 3.6-5.2
