pg. 1 NURS 6531 Final Newest 2024 Test Bank Complete 200+ Exam Questions with Correct Detailed Answers (Verified Answers) Graded A+
A primary care provider sees a new patient who reports having a diagnosis of chronic kidney disease for several years. The patient is taking one medication for hypertension which has been prescribed since the diagnosis was made. The provider orders laboratory tests to evaluate the status of this patient. Which laboratory finding indicates a need to refer the patient to a nephrologist?
- Albumin/creatinine ratio (ACR) of 325 mg/g
- Blood pressure of 145/85 mm Hg
- Glomerular filtration rate (eGFR) of 35
d. Urine red blood cell (RBC) count of 15/hpf - ANS: A
An albumin/creatinine ratio greater than 300 mg/g warrants referral. A specialist is necessary for persistent hypertension refractory to treatment with four or more agents, a GFR of less than 30, and urine RBC greater than 20/hpf.
Which tests should be monitored regularly to monitor for complications of chronic renal disease (CRD)? (Select all that apply.)
- Liver enzymes
- Parathyroid hormone levels
- Serum glucose
- Serum lipids
e. Vitamin D levels - ANS: B, D, E
CKD can cause hyperparathyroidism, hyperlipidemia, and alterations in vitamin D, calcium, and phosphorus metabolism, so these should be monitored. Liver function and serum glucose are not affected by CKD.
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pg. 2 Which is true about hypoactive sexual desire in older men?
- Hypoactive sexual desire in older men is related to sexual aversion.
- Hypoactive sexual desire is a conscious choice to avoid sexual relations.
- Men with hypoactive sexual desire may have normal excitement and orgasm.
- The most common type of sexual dysfunction is hypoactive sexual desire. - ANS: C
Men with hypoactive sexual desire have diminished response in the desire phase of the sexual response cycle but may still experience normal excitement and orgasm. Sexual aversion and hypoactive desire are not related. Many people with normal sexual desires choose not to have sexual relations; hypoactive desire is a physiological condition. Only 16% of men have hypoactive desire.
A patient with chronic hip pain cannot take nonsteroidal anti-inflammatory drugs (NSAIDs) and tells the provider that acetaminophen is minimally helpful. What might the provider recommend initially to improve pain relief?
- A fentanyl patch
- Capsaicin
- Glucosamine
d. Lidocaine patches - ANS: B
Topical capsaicin has been shown to provide short-term pain relief and has fewer side effects than oral agents. It is an appropriate initial therapy. Fentanyl is a narcotic analgesic and should be reserved for more severe pain. Glucosamine and lidocaine may be helpful for some patients.
A high school soccer player sustains a knee injury when kicked on the lateral side of the knee by another player. The provider notes significant swelling of the knee, with pain at the joint line on the medial aspect of the knee. What will the provider do to treat this injury?
- Instruct about RICE management and follow up in 1 week
- Refer for a same-day orthopedic consultation
- Schedule a magnetic resonance imaging (MRI) exam
- Splint the knee and refer for orthopedic consultation in 1 to 2 weeks - ANS: B 2 / 4
pg. 3 This patient has an injury caused by a traumatic event associated with swelling and should have a same-day orthopedic consultation. Simple sprains may be managed with RICE. MRI may be ordered by the orthopedist.
Which maneuver during a physical examination is used to assess the anterior cruciate ligament (ACL)?
- Anterior drawer test
- Posterior drawer test
- Valgus stress on knee joint
d. Varus stress on knee joint - ANS: A
The anterior drawer test, in which the examiner pulls the tibia forward while the knee is flexed, is used to assess anterior cruciate ligament laxity. The posterior drawer test is used to determine posterior cruciate ligament laxity. The valgus stress test assesses the medial collateral ligament (MCL) laxity and the varus stress test assesses the lateral collateral ligament (LCL) laxity.
A previously healthy patient reports a sensation of one knee locking or feeling like it will give way when descending stairs. The patient has no recollection of injury to the knee and denies pain. What is the most likely treatment for this disorder?
- Conservative management with RICE and activity modification
- Immediate referral to an orthopedic surgeon for possible repair
- Intraarticular injections of corticosteroids three times yearly
- Restricting participation in sports and strenuous workouts indefinitely - ANS: A
This patient has symptoms consistent with chronic degenerative meniscal injury and is without pain or significant disability. Conservative management is indicated. Immediate referral is indicated for severe pain or disability. Intra-articular injections of corticosteroids are used for patients with concomitant osteoarthritis. Patients should be encouraged to continue sports and exercise to improve overall muscle tone and minimize disability.
A 50-year-old man reports having erectile dysfunction (ED). What is an important response by the provider when developing a plan of care for this patient?
- Considering testosterone hormone replacement therapy 3 / 4
pg. 4
- Evaluating the patient for cardiovascular disease
- Prescribing an oral phosphodiesterase type 5 inhibitor
d. Referring the patient for psychotherapy and counseling - ANS: B
Men under age 60 years with ED are at higher risk for cardiovascular disease, so this patient should be evaluated for this condition. Until the underlying cause is found, prescribing medications or hormones is not indicated. Psychotherapy and counseling are used when psychogenic ED is present.
The provider prescribes the oral phosphodiesterase type 5 inhibitor sildenafil to treat erectile dysfunction (ED) in a 65-year-old male patient. What will be included when teaching this patient about taking this medication? (Select all that apply.)
- The medication is best taken on an empty stomach.
- The medication should be taken with a fatty food or meal.
- The medication's effects may last for 24 to 36 hours.
- This medication has a rapid onset and short duration of action.
e. This medication may be taken once daily. - ANS: A, D
Sildenafil has a rapid onset and short duration of action and should be taken on an empty stomach. Fatty foods may delay or interfere with absorption. This medication is given when sexual activity is desired and not once daily.
A young adult male reports a dull pain in the right scrotum and the provider notes a bluish color showing through the skin on the affected side. Palpation reveals a bag of worms on the proximal spermatic cord. What is an important next step in managing this patient?
- Anti-infective therapy with ceftriaxone or doxycycline
- Consideration of underlying causes of this finding
- Reassurance that this is benign and may resolve spontaneously
d. Referral to an emergency department for surgical consultation - ANS: B
This patient has symptoms of varicocele. Because varicocele is rare on the right side, the provider should look for underlying causes of these findings. Anti infective therapy is indicated for epididymitis. Varicocele requires surgical intervention or ablation to resolve. Testicular torsion is an emergency.
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