Nokea
A patient calls the clinic for instructions before having a Papanicolaou (Pap) smear. The most appropriate instructions from the nurse are:
- A. If you are menstruating, please use pads to avoid placing anything into the vagina.
- B. Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your appointment.
- C. If you suspect that you have a vaginal infection, please gather a sample of the discharge to bring with you.
- D. We would like you to use a mild saline douche before your examination. You may pick this up in our office.
Correct Answer: B
Rationale: The correct answer is B because avoiding intercourse, inserting anything into the vagina, or douching within 24 hours of the appointment helps ensure an accurate Pap smear result. Intercourse, vaginal products, and douching can introduce foreign substances or disrupt the natural vaginal flora, potentially affecting the test results. Option A is incorrect because using pads during menstruation is a general recommendation and not specific to a Pap smear appointment. Option C is incorrect because bringing a sample of discharge is not necessary for a Pap smear. Option D is incorrect because douching is not recommended before a Pap smear as it can alter the vaginal environment.
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Thiazide diuretics may produce an increase in blood levels of uric acid and:
- A. Potassium
- B. BUN
- C. Urea
- D. Glucose
Correct Answer: D
Rationale: Thiazide diuretics can lead to hyperglycemia by reducing insulin sensitivity. This can result in increased blood glucose levels. Thiazides also elevate uric acid levels by reducing its excretion. Therefore, the correct answer is D (Glucose).
Incorrect choices:
A (Potassium) - Thiazides typically cause hypokalemia, not hyperkalemia.
B (BUN) and C (Urea) - Thiazides may cause a slight increase in BUN and serum creatinine levels due to reduced kidney function, but not as significantly as glucose levels.
A patient with adrenal tumor has symptoms of hypertension, edema, hypernatremia and hypokalemia. Which drug would be most likely to prescribe to antagonize the renal and systemic side effects of the hormone excess?
- A. Spironolactone
- B. Bumetanide
- C. Furosemide
- D. Acetazolamide
Correct Answer: A
Rationale: The correct answer is A: Spironolactone. Spironolactone is a potassium-sparing diuretic that works by antagonizing aldosterone, which is responsible for the symptoms of hypertension, edema, hypernatremia, and hypokalemia seen in adrenal tumor. By blocking aldosterone receptors, spironolactone helps to reduce sodium reabsorption and potassium excretion, thus counteracting the hormonal effects.
Bumetanide (choice B) and Furosemide (choice C) are loop diuretics that primarily work by inhibiting sodium reabsorption in the loop of Henle and are unlikely to be as effective in this scenario. Acetazolamide (choice D) is a carbonic anhydrase inhibitor that works in the proximal tubule and is not indicated for the specific hormonal effects seen in this case.
Acetazolamide is not frequently used as diuretic but the current indication is * in the treatment of:
- A. Liver cirrhosis
- B. CHF
- C. Glaucoma
- D. Kidney failure
Correct Answer: C
Rationale: Acetazolamide is a carbonic anhydrase inhibitor commonly used in treating glaucoma due to its ability to decrease intraocular pressure. The drug works by reducing the production of aqueous humor in the eye. This mechanism makes it an effective treatment for glaucoma. In contrast, liver cirrhosis (choice A) is typically managed with diuretics that act on the kidneys to reduce fluid accumulation. CHF (choice B) is commonly treated with loop diuretics to reduce fluid overload and improve cardiac function. Acetazolamide is not indicated for treating heart failure. Kidney failure (choice D) may require diuretics to manage fluid balance, but acetazolamide is not the first-line treatment in this condition. Therefore, the correct answer is C, as acetazolamide's current indication is in the treatment of glaucoma.
Superinfections are more common with: *
- A. Use of narrow spectrum antibiotics
- B. Short courses of antibiotics
- C. Use of antibiotics that are completely absorbed from the small intestines
- D. Use of antibiotic combinations covering both gram positive and gram negative bacteria
Correct Answer: D
Rationale: The correct answer is D because using antibiotic combinations covering both gram positive and gram negative bacteria can disrupt the balance of normal flora in the body, leading to superinfections. This is due to the broad spectrum of activity of these antibiotics, which can kill off a wider range of bacteria, including the beneficial ones.
Choice A is incorrect because narrow spectrum antibiotics target specific types of bacteria, reducing the likelihood of disrupting the normal flora and causing superinfections. Choice B is incorrect because longer courses of antibiotics increase the risk of superinfections as they continue to disrupt the normal flora over a longer period. Choice C is incorrect because antibiotics that are completely absorbed from the small intestines do not necessarily increase the risk of superinfections; it is more about the spectrum of activity and the impact on normal flora.
A woman states that 2 weeks ago she had a urinary tract infection that was treated with an antibiotic. As a part of the interview, the nurse should ask, 'Have you noticed any':
- A. Changes in your urination patterns?
- B. Excessive vaginal bleeding?
- C. Unusual vaginal discharge or itching?
- D. Changes in your desire for intercourse?
Correct Answer: C
Rationale: Rationale:
C is correct because UTI treatment can disrupt the vaginal microbiome, leading to yeast infection symptoms like unusual discharge or itching. A is relevant but focuses on only one aspect. B and D are unrelated to UTI treatment outcomes.