Nokea
During an examination, the nurse observes a female patient's vestibule and expects to see the:
- A. Urethral meatus and vaginal orifice.
- B. Vaginal orifice and vestibular (Bartholin) glands.
- C. Urethral meatus and paraurethral (Skene) glands.
- D. Paraurethral (Skene) and vestibular (Bartholin) glands.
Correct Answer: A
Rationale: The correct answer is A: Urethral meatus and vaginal orifice. The vestibule is the area between the labia minora where the urethral meatus and vaginal orifice are located. This is important for the nurse to observe during an examination to assess the patient's genital health.
Choice B is incorrect because the vestibular (Bartholin) glands are not typically visible in the vestibule during an examination. Choice C is incorrect because the paraurethral (Skene) glands are not typically visible in the vestibule either. Choice D is incorrect because it combines the paraurethral (Skene) and vestibular (Bartholin) glands, which are not typically visible in the vestibule during examination.
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The nurse is performing a genital examination on a male patient and notices urethral drainage. When collecting urethral discharge for microscopic examination and culture, the nurse should:
- A. Ask the patient to urinate into a sterile cup.
- B. Ask the patient to obtain a specimen of semen.
- C. Insert a cotton-tipped applicator into the urethra.
- D. Compress the glans between the examiner’s thumb and forefinger, and collect any discharge.
Correct Answer: D
Rationale: The correct answer is D because gently compressing the glans between the thumb and forefinger can help express the urethral discharge for collection. This method minimizes contamination and ensures a proper sample for microscopic examination and culture.
A: Asking the patient to urinate into a cup would not capture the discharge.
B: Semen is not relevant for urethral discharge testing.
C: Inserting a cotton-tipped applicator into the urethra may cause trauma and is not recommended for collecting urethral discharge.
Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur?
- A. The only treatment modalities for the disease are palliative.
- B. Diagnostic tests are not available to detect tumors before they metastasize.
- C. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced.
- D. Early metastasis to the brain impairs the patient’s ability to recognize the seriousness of symptoms.
Correct Answer: D
Rationale: The correct answer is D because early metastasis to the brain can impair the patient's ability to recognize the seriousness of symptoms. This can delay diagnosis and treatment, leading to a higher percentage of patients having metastasis at the time of diagnosis.
A is incorrect because there are treatment modalities for kidney cancer beyond palliative care. B is incorrect as diagnostic tests like imaging studies can detect tumors before they metastasize. C is incorrect because while classic symptoms may not always be present, other symptoms and diagnostic tests can still lead to an earlier diagnosis.
In which segment of the nephron is glucose reabsorbed?
- A. Loop of henle
- B. Collecting duct
- C. Distal convoluted tubule
- D. Proximal convoluted tubule
Correct Answer: D
Rationale: The correct answer is D: Proximal convoluted tubule. Glucose reabsorption primarily occurs in the proximal convoluted tubule due to the presence of specialized glucose transporters. Step-by-step rationale: 1. Glucose is filtered in the glomerulus and enters the renal tubules. 2. In the proximal convoluted tubule, glucose is reabsorbed through sodium-glucose cotransporters (SGLT) and facilitated diffusion via glucose transporters (GLUT). 3. The loop of Henle is primarily responsible for water and electrolyte reabsorption, not glucose. 4. The collecting duct mainly concentrates urine by reabsorbing water and electrolytes, not glucose. 5. The distal convoluted tubule is involved in fine-tuning electrolyte balance and regulating acid-base balance, not glucose reabsorption.
During a pelvic examination, the nurse notes that the patient's cervix is irregular and hard to the touch. The nurse's next best action would be to:
- A. Perform a Pap smear test to confirm the diagnosis.
- B. Referral to a gynecologist for further examination.
- C. Complete a cervical cancer screening.
- D. Complete an endometrial biopsy to assess for malignancy.
Correct Answer: B
Rationale: The correct answer is B: Referral to a gynecologist for further examination. This is the best course of action because an irregular and hard cervix can indicate various underlying issues such as cervical dysplasia, fibroids, or cervical stenosis. A gynecologist can conduct a more thorough evaluation including additional tests like colposcopy or ultrasound to determine the cause and appropriate treatment.
A: Performing a Pap smear test may not provide sufficient information about the specific condition causing the irregularity.
C: Completing a cervical cancer screening may not address the immediate concern of the irregular and hard cervix.
D: Completing an endometrial biopsy is not indicated for assessing cervical abnormalities, as it focuses on the endometrium rather than the cervix.
Which of these statements is most appropriate when the nurse is obtaining a genitourinary history from an older man?
- A. Do you need to get up at night to urinate?
- B. Do you experience nocturnal emissions, or wet dreams?
- C. Do you know how to perform a testicular self-examination?
- D. Has anyone ever touched your genitals when you did not want them to?
Correct Answer: A
Rationale: The correct answer is A because it pertains to a common genitourinary issue in older men, nocturia. Nocturnal emissions (choice B) are not typically relevant in this context. Testicular self-examination (choice C) is more appropriate for younger men, and asking about unwanted touching (choice D) is not relevant to obtaining a genitourinary history. Asking about nocturia can provide valuable information about potential prostate issues, urinary tract infections, or other conditions commonly affecting older men.