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.
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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.
Which of the following diuretics is the most potent and cause hypotension * due to hypovolemia from excessive diuresis?
- A. Acetazolamide
- B. Furosemide
- C. Spironolactone
- D. Hydrocholorpthiazide
Correct Answer: B
Rationale: Step 1: Furosemide is a loop diuretic, known for its high potency in inhibiting the reabsorption of sodium and chloride in the loop of Henle.
Step 2: This leads to significant diuresis, causing hypovolemia and subsequent hypotension.
Step 3: Acetazolamide is a carbonic anhydrase inhibitor diuretic, not as potent as loop diuretics.
Step 4: Spironolactone is a potassium-sparing diuretic, less likely to cause hypotension due to its mechanism of action.
Step 5: Hydrochlorothiazide is a thiazide diuretic, less potent than loop diuretics like furosemide in causing hypovolemia and hypotension.
A 45-year-old mother of two children is seen at the clinic for complaints of “losing my urine when I sneeze.†The nurse documents that she is experiencing:
- A. Urinary frequency.
- B. Enuresis.
- C. Stress incontinence.
- D. Urge incontinence.
Correct Answer: C
Rationale: The correct answer is C: Stress incontinence. This type of incontinence is characterized by leakage of urine during activities that increase intra-abdominal pressure, such as sneezing, coughing, or laughing. In this case, the woman is experiencing urine loss specifically when she sneezes, which aligns with the definition of stress incontinence. Other choices are incorrect because urinary frequency (choice A) refers to a frequent need to urinate, enuresis (choice B) is involuntary urination during sleep, and urge incontinence (choice D) is the sudden, strong need to urinate followed by involuntary leakage.
On assessment of the patient with a renal calculus passing down the ureter, what should the nurse expect the patient to report?
- A. A history of chronic UTIs
- B. Dull, costovertebral flank pain
- C. Severe, colicky back pain radiating to the groin
- D. A feeling of bladder fullness with urgency and frequency
Correct Answer: C
Rationale: The correct answer is C: Severe, colicky back pain radiating to the groin. This type of pain is characteristic of renal colic caused by a renal calculus passing down the ureter. The sharp, severe pain originates in the flank and radiates to the groin as the stone moves. Choices A and D are incorrect because they do not describe the typical pain associated with renal colic. Choice B describes dull, costovertebral flank pain, which is not characteristic of the sharp, severe colicky pain seen in renal colic. Therefore, option C is the most appropriate response based on the typical presentation of a patient with a renal calculus passing down the ureter.
The first step in urine production
- A. is called reabsorption.
- B. moves water and solutes from the renal tubules into the peritubular capillaries.
- C. is called secretion.
- D. occurs as water and solutes move from the glomerulus to the glomerular capsul
Correct Answer: D
Rationale: The correct answer is D because the first step in urine production occurs as water and solutes move from the glomerulus to the glomerular capsule during the process of filtration. This initial step involves the passive movement of water and small solutes through the filtration membrane in the glomerulus. Reabsorption (choice A) occurs later in the process when useful substances are reclaimed from the filtrate. Choice B is incorrect as it describes the process of reabsorption, not the initial step. Choice C is also incorrect as secretion is the process of actively transporting substances from the blood into the renal tubules, not the first step in urine production.