Nokea
Number the following physiologic occurrences in the order they occur in the formation of urine.
- A. Blood is filtered in the glomerulus.
- B. Reabsorption of water in the loop of Henle.
- C. Reabsorption of electrolytes, glucose, amino acids, and small proteins in the tubules.
- D. Acid-base regulation with conservation of bicarbonate (HCO–) and secretion of excess H+ in the distal tubule.
Correct Answer: A
Rationale: Rationale: The correct order of physiologic occurrences in urine formation is as follows: A) Blood is filtered in the glomerulus. This is the initial step where blood enters the nephron for filtration. The other choices are incorrect because B) Reabsorption of water in the loop of Henle occurs after filtration, C) Reabsorption of electrolytes, glucose, amino acids, and small proteins in the tubules happens after the initial filtration, and D) Acid-base regulation in the distal tubule occurs after other processes such as reabsorption and secretion have taken place.
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The nurse is palpating a female patient's adnexa. The findings include a firm, smooth uterine wall; the ovaries are palpable and feel smooth and firm. The fallopian tube is firm and pulsating. The nurse's most appropriate course of action would be to:
- A. Tell the patient that her examination is normal.
- B. Give her an immediate referral to a gynecologist.
- C. Suggest that she return in a month for a recheck to verify the findings.
- D. Tell the patient that she may have an ovarian cyst that should be evaluated further.
Correct Answer: B
Rationale: The correct answer is B because the findings of a firm, smooth uterine wall, palpable ovaries, and a firm, pulsating fallopian tube are concerning for possible gynecological issues such as ovarian cancer or pelvic inflammatory disease. A prompt referral to a gynecologist is necessary for further evaluation, which may include imaging studies or biopsies to rule out serious conditions. Choice A is incorrect as the findings are not normal. Choice C delays necessary evaluation, potentially leading to a progression of any underlying condition. Choice D assumes the presence of an ovarian cyst without further investigation, which is not appropriate given the pulsating fallopian tube and the need for a comprehensive assessment by a specialist.
During a physical examination, the nurse finds that a male patient’s foreskin is fixed and tight and will not retract over the glans. The nurse recognizes that this condition is:
- A. Phimosis.
- B. Epispadias.
- C. Urethral stricture.
- D. Peyronie disease.
Correct Answer: A
Rationale: The correct answer is A: Phimosis. Phimosis is a condition where the foreskin is tight and cannot be retracted over the glans. This can lead to problems with hygiene and urination. Epispadias (B) is a congenital malformation where the urethra opens on the dorsal side of the penis. Urethral stricture (C) is a narrowing of the urethra, causing difficulty with urination. Peyronie disease (D) is the development of fibrous scar tissue inside the penis, leading to curvature during erection. In this case, the fixed and tight foreskin indicates phimosis.
Which antibiotic is primarily bacteriostatic but becomes bactericidal at higher concentrations?:
- A. Erythromycin
- B. Tetracycline
- C. Chloramphenicol
- D. Ampicillin
Correct Answer: A
Rationale: Erythromycin is primarily bacteriostatic by inhibiting protein synthesis in bacteria. At higher concentrations, it can disrupt bacterial cell membranes, making it bactericidal. Tetracycline inhibits protein synthesis, Chloramphenicol blocks peptide bond formation, and Ampicillin disrupts bacterial cell wall synthesis. Therefore, A is correct because of its dual mechanism of action.
A nurse is caring for a patient with impaired renal which the nurse should monitor the patient?
- A. Accumulation of wastes
- B. The nurse should facilitate collection of what
- C. Retention of potassium
- D. Depletion of calcium
Correct Answer: A
Rationale: The correct answer is A because impaired renal function can lead to the accumulation of wastes in the body, causing toxicity. Monitoring this is crucial for the patient's overall health. Choice B is incorrect as it does not directly relate to the consequences of impaired renal function. Choice C, retention of potassium, is also incorrect as it is a specific outcome of impaired renal function and not the primary focus of monitoring. Choice D, depletion of calcium, is incorrect as impaired renal function is more likely to lead to hypercalcemia rather than hypocalcemia. Therefore, the nurse should prioritize monitoring the accumulation of wastes in a patient with impaired renal function.
What causes the gastrointestinal (GI) manifestation of stomatitis in the patient with CKD?
- A. High serum sodium levels
- B. Irritation of the GI tract from creatinine
- C. Increased ammonia from bacterial breakdown of urea
- D. Iron salts, calcium-containing phosphate binders, and limited fluid intake
Correct Answer: D
Rationale: The correct answer is D. Stomatitis in CKD patients is often caused by iron salts, calcium-containing phosphate binders, and limited fluid intake. Iron salts and calcium binders can lead to mucosal irritation in the GI tract, exacerbating stomatitis. Limited fluid intake can cause dehydration, leading to oral mucosal dryness and vulnerability to stomatitis.
A: High serum sodium levels do not directly cause stomatitis in CKD patients.
B: Irritation of the GI tract from creatinine is not a common cause of stomatitis in CKD patients.
C: Increased ammonia from bacterial breakdown of urea is more related to hepatic encephalopathy rather than stomatitis in CKD patients.