Nokea
During the interview, a patient reveals that she has some vaginal discharge. She is worried that it may be a sexually transmitted infection. The nurse's most appropriate response to this would be:
- A. Oh, don't worry. Some cyclic vaginal discharge is normal.
- B. Have you been engaging in unprotected sexual intercourse?
- C. I'd like some information about the discharge. What color is it?
- D. Have you had any urinary incontinence associated with the discharge?
Correct Answer: C
Rationale: The correct answer is C because it focuses on gathering more information about the vaginal discharge, which is essential in assessing the patient's condition. By asking about the color of the discharge, the nurse can gather valuable information to help determine if it might be related to a sexually transmitted infection or another issue. This approach shows a patient-centered and thorough assessment.
Choice A is incorrect as it dismisses the patient's concerns without obtaining further information. Choice B jumps to conclusions about unprotected sexual intercourse without first assessing the situation. Choice D is unrelated to the patient's primary concern about vaginal discharge and urinary incontinence.
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The drug of choice for treatment and secondary prophylaxis against cryptococcal meningitis among AIDS patients is:
- A. Amphotericin B
- B. Flucytosine
- C. Fluconazole
- D. Ketoconazole
Correct Answer: C
Rationale: Step-by-step rationale:
1. Fluconazole is preferred due to its efficacy, safety, and tolerability in Cryptococcal meningitis.
2. It has better CNS penetration compared to other azoles.
3. It is less toxic than Amphotericin B and Flucytosine.
4. Ketoconazole is less effective and not recommended for this indication.
Summary:
- A: Amphotericin B is reserved for severe cases due to its toxicity.
- B: Flucytosine is used in combination therapy but not as the primary drug of choice.
- D: Ketoconazole is less effective and not preferred for Cryptococcal meningitis in AIDS patients.
Which classification of urinary tract infection (UTI) is described as infection of the renal parenchyma, renal pelvis, and ureters?
- A. Upper UTI
- B. Lower UTI
- C. Complicated UTI
- D. Uncomplicated UTI
Correct Answer: A
Rationale: The correct answer is A: Upper UTI. This classification describes infection of the renal parenchyma, renal pelvis, and ureters, which are part of the upper urinary tract. In upper UTIs, the infection involves the kidneys (renal parenchyma), renal pelvis, and ureters, whereas lower UTIs typically involve the bladder (cystitis) and urethra. Complicated UTIs involve structural or functional abnormalities of the urinary tract, making treatment more challenging. Uncomplicated UTIs refer to infections in otherwise healthy individuals with normal urinary tracts. Therefore, the description provided aligns with the characteristics of an upper UTI, making it the correct choice.
The drug of choice for treatment and secondary prophylaxis against * cryptococcal meningitis among AIDS patients is:
- A. Amphotericin B
- B. Flucytosine
- C. Fluconazole
- D. Ketoconazole
Correct Answer: C
Rationale: The correct answer is C: Fluconazole. Fluconazole is the drug of choice for treating and preventing *cryptococcal meningitis in AIDS patients due to its excellent CNS penetration and efficacy. It is preferred over Amphotericin B due to its better safety profile and tolerability. Flucytosine is not used as monotherapy and is often combined with other antifungals. Ketoconazole is not recommended for cryptococcal meningitis due to poor CNS penetration.
A patient with suprapubic pain and symptoms of urinary frequency and urgency has two negative urine cultures. What is one assessment finding that would indicate interstitial cystitis?
- A. Residual urine greater than 200 mL
- B. A large, atonic bladder on urodynamic testing
- C. A voiding pattern that indicates psychogenic urinary retention
- D. Pain with bladder filling that is transiently relieved by urination
Correct Answer: D
Rationale: The correct answer is D. Pain with bladder filling that is transiently relieved by urination is a classic symptom of interstitial cystitis. This pattern of pain is due to inflammation of the bladder lining, which worsens as the bladder fills with urine and improves temporarily after urination. This finding is specific to interstitial cystitis and not typically seen in other conditions.
Choices A, B, and C are incorrect:
A: Residual urine greater than 200 mL is more indicative of bladder outlet obstruction or neurogenic bladder dysfunction, not specifically interstitial cystitis.
B: A large, atonic bladder on urodynamic testing is suggestive of neurogenic bladder or bladder outlet obstruction, not interstitial cystitis.
C: A voiding pattern indicating psychogenic urinary retention is more likely related to psychological factors affecting bladder function, not interstitial cystitis.
During a vaginal examination of a 38-year-old woman, the nurse notices that the vulva and vagina are erythematous and edematous with thick, white, curdlike discharge adhering to the vaginal walls. The woman reports intense pruritus and thick white discharge from her vagina. The nurse knows that these history and physical examination findings are most consistent with which condition?
- A. Candidiasis
- B. Trichomoniasis
- C. Atrophic vaginitis
- D. Bacterial vaginosis
Correct Answer: A
Rationale: Step 1: The key clues in the question are thick, white, curdlike discharge, intense pruritus, erythematous, and edematous vulva and vagina.
Step 2: These symptoms are classic for candidiasis, a fungal infection caused by Candida species.
Step 3: Candidiasis commonly presents with thick, white discharge, itching, and inflamed vaginal tissues.
Step 4: Trichomoniasis (choice B) typically presents with frothy, greenish-yellow discharge and vaginal itching.
Step 5: Atrophic vaginitis (choice C) is more common in postmenopausal women and presents with thin, watery discharge and vaginal dryness.
Step 6: Bacterial vaginosis (choice D) presents with thin, grayish-white discharge and a fishy odor.
Step 7: Therefore, based on the symptoms described in the question, the correct answer is A: Candidiasis.