Nokea
A patient has very high plasma uric acid and has high risk of developing acute * uric acid nephropathy. Which of the following agent should be avoided?
- A. Ethacrynic acid
- B. Acetazolamide
- C. Hydrochlorothiazide
- D. Furosemide
Correct Answer: B
Rationale: The correct answer is B: Acetazolamide. Acetazolamide is a carbonic anhydrase inhibitor that can worsen hyperuricemia by increasing renal uric acid reabsorption. This can further exacerbate the risk of acute uric acid nephropathy. Ethacrynic acid (A), Hydrochlorothiazide (C), and Furosemide (D) are loop diuretics that can actually help in reducing uric acid levels by increasing its excretion through the urine. Therefore, they would not be contraindicated in this scenario.
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A 70 year old man has severe urinary hesitancy associated with bPH. He has * tried alpha blockers with little effect. His physician recommends a drug that blocks 5α-reductase in the prostate which is:
- A. Leuprolide
- B. Finasteride
- C. Flutamide
- D. Ketoconazole
Correct Answer: B
Rationale: The correct answer is B: Finasteride. Finasteride inhibits 5-alpha reductase, reducing conversion of testosterone to dihydrotestosterone (DHT) in the prostate. This helps shrink the prostate gland, relieving urinary symptoms in BPH. Leuprolide (A) is a GnRH agonist used for prostate cancer. Flutamide (C) is an antiandrogen for prostate cancer. Ketoconazole (D) is an antifungal, not for BPH. Finasteride is the most appropriate choice for this patient based on mechanism of action and indication.
A 52-year-old patient states that when she sneezes or coughs she wets herself a little. She is very concerned that something may be wrong with her. The nurse suspects that the problem is:
- A. Dysuria.
- B. Stress incontinence.
- C. Hematuria.
- D. Urge incontinence.
Correct Answer: B
Rationale: The correct answer is B: Stress incontinence. This is the most likely issue because the patient leaks urine during activities that increase intra-abdominal pressure, such as sneezing or coughing. Stress incontinence is due to weakened pelvic floor muscles and sphincter, leading to leakage with exertion. Dysuria (choice A) is painful urination, not related to leakage. Hematuria (choice C) is blood in urine, not related to leakage. Urge incontinence (choice D) involves a sudden, strong urge to urinate and is not triggered by sneezing or coughing.
When performing a genitourinary assessment on a 16-year-old male adolescent, the nurse notices a swelling in the scrotum that increases with increased intra-abdominal pressure and decreases when he is lying down. The patient complains of pain when straining. The nurse knows that this description is most consistent with a(n) ______ hernia.
- A. Femoral.
- B. Incisional.
- C. Direct inguinal.
- D. Indirect inguinal.
Correct Answer: D
Rationale: The correct answer is D: Indirect inguinal hernia. In an indirect inguinal hernia, the swelling in the scrotum increases with increased intra-abdominal pressure due to the herniation of abdominal contents through the internal inguinal ring. The swelling decreases when lying down because the contents reduce back into the abdominal cavity. Pain with straining is also characteristic of an indirect inguinal hernia.
A: Femoral hernia presents as a bulge in the upper thigh and is more common in females.
B: Incisional hernia occurs at the site of a previous surgical incision and is not typically affected by intra-abdominal pressure.
C: Direct inguinal hernia protrudes directly through the abdominal wall and is typically not palpable in the scrotum.
A married couple has come to the clinic seeking advice on pregnancy. They have been trying to conceive for 4 months and have not been successful. What should the nurse do first?
- A. Ascertain whether either of them has been using broad-spectrum antibiotics.
- B. Explain that couples are considered infertile after 1 year of unprotected intercourse.
- C. Immediately refer the woman to an expert in pelvic inflammatory disease – the most common cause of infertility.
- D. Explain that couples are considered infertile after 3 months of engaging in unprotected intercourse and that they will need a referral to a fertility expert.
Correct Answer: B
Rationale: The correct answer is B because it aligns with standard medical guidelines. Couples are typically considered infertile after 1 year of trying to conceive without success. This timeframe allows for natural variations in fertility and is when medical intervention is usually recommended.
A: Ascertain antibiotic use is not the first step as it may not be directly related to infertility.
C: Referring to pelvic inflammatory disease assumes a diagnosis without proper evaluation.
D: Incorrect timeline of 3 months and immediate referral to a fertility expert is premature without giving time for natural conception.
Due to its potential for severe hepatoxicity, Nevirapine should NOT be * initiated in:
- A. Women with CD4 cell counts >150 cells/mm3 or in men with CD4 cell count >400 cells/mm3
- B. Women with CD4 cell counts >250 cells/mm3 or in men with CD4 cell count >400 cells/mm3
- C. Women with CD4 cell counts >250 cells/mm3 or in men with CD4 cell count >500 cells/mm3
- D. Women with CD4 cell counts >250 cells/mm3 or in men with CD4 cell count >450 cells/mm3
Correct Answer: D
Rationale: The correct answer is D because Nevirapine is associated with an increased risk of severe hepatoxicity, especially within the first few weeks of treatment initiation. The recommended CD4 cell count thresholds for starting Nevirapine are lower in women compared to men to minimize this risk. In this case, women with CD4 cell counts >250 cells/mm3 and men with CD4 cell counts >450 cells/mm3 should not initiate Nevirapine due to the higher likelihood of developing hepatoxicity.
A is incorrect because the CD4 cell count thresholds are too high for both women and men. B is incorrect as it sets the threshold for women too high. C is incorrect because the threshold for men is too high. Thus, D is the most appropriate choice based on the recommended guidelines to minimize the risk of severe hepatoxicity.