APEA 3P EXAM PREP3 –NEPHROLOGY WITH RATIONALE
A hea l thy 32-year-o l d female has le f t f l ank pa in and nausea. What is the most
l i ke ly d iag... [Show More] nos is?
Ur inary t rac t in fec t i on
Rena l s tone
Cholecys t i t i s
Pye lonephr i t i s
The most common presenta t ion o f acu te uncompl ica ted pye lonephr i t i s inc ludes
fever , f lank pa in , and nausea and vomi t i ng. Somet imes pat ient s p resent w i th
symptoms o f pe lv ic i nf lammatory d isease (PID) . In th is p resenta t ion , abdomina l
pa in is common too . Fever is so s t rong ly cor re la ted wi th acute pye lonephr i t i s
tha t i t i s unusua l not to have fever . Rena l s tone pa t ien ts may have th is
presenta t ion , bu t fever is usua l ly NOT present . I t i s un l ikel y tha t
cho lecys t i t i s wou ld present w i th le f t -s i ded f lank pa in . The ga l l b ladder is on
the r igh t s ide o f the body.
The inc idence o f pyel onephr i t i s i s :
l eas t common in young adu l ts .
l ess common than ur i nary t rac t in fec t ions .
a lways assoc ia ted wi th u r inary t rac t in f ect ions .
more l i ke ly in e lderl y ma les .
The inc idence o f pyel onephr i t i s in the US is much less common than ur inary
t rac t in fec t ions (UTI s ) . I t i s less l i kel y in males , bu t i s most common in
females aged 15-29 years ; and even more common dur ing pregnancy. Fac tors
assoc ia ted wi th pye l onephr i t i s a re f requent sexua l in te rcourse, UTI w i th in the
l as t year , p resence of d iabetes , and presence o f s t ress incont inence wi th in the
prev ious 30 days .
A 79-year-o ld female pa t ien t w i th u r inary f requency is found to have a UTI .
What med ica t ion cou l d produce ar rhy thmias in her?
Doxycyc l ine
Amoxic i l l in
Cipro f loxac in
Macrodant in
Cipro f loxac in is a qu ino lone ant ib io t ic . A l l qu ino lones have the po ten t ia l to
produce pro longat ion o f the QT in te rva l . I t shou ld be prescri bed wi th caut ion
i n o lder adu l ts .
Mrs. Jackson compla i ns o f u r inary inconti nence when she laughs or sneezes. What
shou ld be used f i rs t l ine to t rea t her symptoms?
Kege l exerc ises
Prescr ibe oxybutyn in
Avo id ca f fe ine and al coho l
Min imize f lu ids a t nigh t t ime
This pa t ien t has s t r ess incont inence. The f i rs t - l ine approach wi th these
pat ien ts is to a t tempt to s t reng then the pe lv ic f loor musc les . Appropr ia te
per formance o f Kege l exerc ises is key . Prescr ib ing an an t icho l inerg ic might
worsen incont inence because i t w i l l cause ur inary re ten t ion . Avo id ing ca f fe ine
and a lcoho l i s especi a l l y he lp fu l fo r peop le wi th u rge incont inence, bu t cou ld
have a min imal benefi t fo r th is pa t ien t . However , th is does not address the
under ly ing prob lem, weak pe lv ic musc les . Min imiz ing f lu ids at n igh t t ime wi l l
he lp i f noc tur ia is a prob lem.
A 76-year-o ld male presents w i th u re thral i r r i ta t i on a f te r vo id ing . I f sexua l ly
t ransmi t ted d iseases and ur inary t rac t i nfec t ion are ru led out , what is another
et io logy?
Acute bac ter ia l p rosta t i t i s
Chron ic p ros ta t i t i s
Epid idymi t is
Asymptomat ic bac ter i ur ia
Chron ic p ros ta t i t i s can produce these symptoms. Somet imes thi s i s accompanied
by per inea l pa in , but the pa t ien t may have a normal p ros ta te exam. Acute
bacter ia l p ros ta t i t i s pa t ien ts w i l l p resent w i th fever , ch i l l s . Examinat ion o f
the pros ta te g land r evea ls a tender , boggy pros ta te g land. Ep id idymi t is can
produce scro ta l pa in, no t dysur ia o r i r r i ta t ion wi th vo id ing. Asymptomat ic
bacter iu r ia is asymptomat ic . These pa t ients don ’ t know they have th is because
they have no symptoms .
A 25-year-o ld male pat ien t w i th subacute bac ter ia l ep id idymit i s shou ld be
t rea ted in i t ia l l y w i th
an ora l qu ino lone
doxycyc l ine .
NSAIDs on ly .
i ce and scro ta l suppor t .
In a 25-year-o ld male wi th subacute bac t er ia l ep id idymi t is , the most l i ke ly
organ ism is Ch lamyd ia. There fore , un t i l cu l tu res are back , he shou ld be t reated
empi r ica l l y w i th doxycyc l ine 100 mg BID fo r 10 days . Qu ino lones shou ld
spec i f i ca l l y be avo i ded i f the suspec ted agent is gonor rhea because o f r i s ing
res is tance. NSAIDs, i ce , and scro ta l suppor t w i l l he lp the pat ien t ’s symptoms
but no t t rea t the under ly ing cause.
A 73-year-o ld male pat ien t repor ts tha t he is exper ienc ing a weakened ur inary
s t ream, u r inary f requency, and urgency. He is wak ing up once o r tw ice n igh t ly
to u r ina te . How shoul d the nurse prac t i t i oner p roceed?
Dig i ta l rec ta l exam (DRE) on ly
DRE, ur ina lys is , PSA
PSA on ly
PSA, DRE, BUN, Cr
Many tes ts can be used to eva lua te an o l der pa t ien t w i th suspected ben ign
pros ta t ic hyper t rophy (BPH) . The va lue of d ig i ta l rec ta l exam (DRE) is to
eva lua te the s ize , cons is tency and assess fo r ma l ignancy o f the pros ta te g land.
Ur ina lys is is done t o de tec t b lood or infec t ion , bu t hematuri a i s common in
pat ien ts w i th BPH. The pros ta te spec i f i c an t igen (PSA) is done as a screen ing
tes t fo r p ros ta te cancer in symptomat ic men. Th is pa t ien t has mul t ip le symptoms
which cou ld ind ica te pa tho logy in the prosta te g land as the et io logy o f h is
symptoms (weakened ur inary s t ream, ur inary f requency and urgency, and
noctur ia ) . A serum crea t in ine can be part o f the in i t ia l sc r een ing . Th is wou ld
he lp iden t i f y b ladder ou t le t obs t ruc t ion, rena l , o r p re - renal d isease. A b lood
urea n i t rogen (BUN) i s no t necessary to eva lua te th is pa t ient ' s symptoms.
Cipro f loxac in g iven to t rea t a u r inary t rac t in fec t ion wou ld be cont ra ind ica ted
i n a :
pregnant pa t ien t .
19-year-o ld female .
pat ien t w i th hyper tens ion .
pat ien t w i th pye lonephr i t i s .
Cipro f loxac in is a qu ino lone ant ib io t ic and is cont ra ind ica t ed in pa t ien ts who
are pregnant o r younger than 18 years o l d because o f po ten t i a l p rob lems wi th
bone and car t i lage f ormat ion . There is no cont ra ind ica t ion i n a pa t ien t w i th
hyper tens ion . A qu ino lone might be a good cho ice in a pa t ient w i th
pye lonephr i t i s and wou ld no t be cont ra ind ica ted .
An example o f a d rug tha t ta rgets the ren in -ang io tens in -a ldos terone sys tem is
a(n) :
ACE inh ib i to r .
beta b locker .
ca lc ium channe l b locker .
d iure t ic .
Examples o f d rugs that ta rget the ren in - ang io tens in -a ldos terone sys tem are
ang io tens in -conver t i ng enzyme (ACE) inh i b i to rs and ang io tensi n receptor
b lockers (ARBs) . These drugs are par t icul a r l y benef ic ia l to pat ien ts w i th
d iabet ic nephropathy because they may prevent and t rea t d iabet ic nephropathy .
Addi t iona l ly , these agents lower b lood pressure , wh ich has been shown to be
renopro tec t ive . Management o f g lucose leve ls and hyper tens ion is espec ia l l y
impor tan t in p reventi ng d iabet ic nephropathy , bu t so is aggress ive management
of hyper l ip idemia .
Test icu la r to rs ion can produce:
pen i le e ry thema.
scro ta l edema.
scro ta l e ry thema.
pen i le edema.
Test icu la r to rs ion i s an emergency because the tes t ic le is depr ived o f normal
b lood supp ly . I f b lood supp ly is no t rees tab l ished wi th in 12 hours ,
i r revers ib le damage i s cer ta in to occur . Idea l ly , i schemia i s reso lved wi th in
4-6 hours . The pen is i s no t a f fec ted duri ng tes t icu la r to rs i on. Bes ides
tes t icu la r to rs ion , ep id idymi t is , t rauma, and an ingu ina l hern ia a re o ther
common causes o f sc r ota l pa in .
How long shou ld a female pa t ien t w i th an uncompl ica ted UTI be t rea ted wi th an
ora l an t ib io t ic?
3days
5 days
7 days
Three days o f t rea tment w i th an appropr i ate an t ib io t ic is as e f f i cac ious as 7 -
10 days o f t rea tment. Three-day t rea tment i s assoc ia ted wi th fewer s ide
ef fec ts , be t te r adherence, and fewer adverse reac t ions .
A pat ien t has a u r inary t rac t in fec t ion . What f ind ings on uri ne d ips t ick bes t
descr ibe a typ ica l ur inary t rac t in f ec t i on?
Pos i t i ve leukocytes
Pos i t i ve n i t ra tes
Pos i t i ve leukocytes , pos i t i ve n i t r i tes
Pos i t i ve n i t ra tes and hematur ia
Class ic f ind ings in a ur inary t rac t in fec t ion (UTI ) a re pos i t i ve leukocytes and
n i t r i tes . Leukocytes ind ica te the presence o f wh i te ce l ls in the u r ine .
Ni t ra tes are a normal f ind ing in a u r ine spec imen. N i t r i tes are no t normal in
the ur ine . Pos i t i ve n i t r i tes ind ica te that an organ ism in the ur ine is
consuming n i t ra tes f or nu t r i t ion . Hematur ia ind ica tes the presence o f red b lood
ce l ls in the ur ine . This is common in the presence o f a UTI .
Which med ica t ion shou ld be avo ided in a pat ien t w i th a su l fa a l le rgy?
Sul fony lu rea
Sul famethoxazo le
Naproxen
Cefazo l in
Sul famethoxazo le is the su l fa component i n Bac t r im DS. I t i s con t ra ind ica ted in
pat ien ts w i th a su l f a a l le rgy . There is no a l le rg ic po ten t ial w i th the
ant ihyperg lycemic agents known as the sul f ony lu reas . Naproxen and cefazo l in
have no cont ra ind icat ions i f a pa t ien t has a su l fa a l le rgy . Some HIV pro tease
i nh ib i to rs have the su l fony l a ry lamine chemica l g roup tha t i s respons ib le fo r
the a l le rg ic reac t ion.
A female pa t ien t who i s 45 years o ld s tates tha t she is hav i ng ur inary
f requency. She descri bes ep isodes o f “ h av ing to go r igh t now ” and no t be ing
ab le to wa i t . Her u r i na lys is resu l ts a re p rov ided. What is par t o f the
d i f fe ren t ia l?
Diabetes
Lupus
Stress incont inence
Asymptomat ic bac ter i ur ia
Pat ien ts w i th d iabetes can present w i th po lyur ia . An assessment o f the
pat ien t ’s r i sk fac tors shou ld be done wi th s t rong cons idera t i on g iven to
check ing g lucose leve ls . I f th is is norma l , o ther d iagnoses to cons ider a re
urge incont inence and vag in i t i s . The pat i en t ’s med ica t ions shou ld be reviewed
fo r med ica t ions produc ing urgency, l i ke d iure t ics or herba l supp lements . [Show Less]