NR 507 Final
A 21-year-old patient reports to the primary care clinic complaining of urinary urgency,
frequency and burning. She also reports a small amount of vaginal discharge that contains
an odor. It is likely that the NP will perform a vaginal exam at this visit. - correct answer-true
A 25 year- old female presents to the primary care office with urinary burning and frequency
for the last 3 days. She denies any fever, chills, back pain. Her gynecological history is
negative and reports no vaginal discharge. The only new information reported is that she
recently had sexual intercourse with a new male partner.
The NP obtains a urinalysis and determines that the urine contains leukocytes, RBCs,
nitrites, and WBCs. No casts are identified. Based on symptom presentation and UA results,
the patient can be diagnosed with: - correct answer-cystitis
A 42-year-old female presents to the primary care clinic with a three- month history of
"feeling low", poor energy, inability to concentrate and irritability. She is concerned about her
loss of interest in her usual social activities of walking with her friends and participating in her
sewing group. She is especially concerned about her recent 15-pound weight gain. Other
reported symptoms are frequent headaches, difficulty getting out of bed in the morning, and
feeling worthless. She denies suicide ideation. She reports a family history of depression
(mother and sister) and denies any consumption of drugs and alcohol. She is divorced and
has a grown son who lives approximately one hour away but rarely sees because of his work
schedule. The patient is interested in knowing if her symptoms are related to depression.
Upon initial evaluation, the NP considers if the patient meets the criteria for MDD by
consulting the DS - correct answer-Depressed mood
Fatigue/loss of energy
Loss of interest/Anhedonia
Feeling worthless or having excessive guilt
Insomnia or hypersomnia
Poor concentration
Recurrent thoughts of death, suicide, a suicide plan or attempt
Psychomotor agitation or retardation
A 45-year-old male presents to the primary care office with right flank pain that he describes
as unremitting; he also reports nausea and vomiting. The NP performs an exam and
observes him writhing in pain on the exam table with the inability to find a comfortable
position. He is afebrile, BP 156/88 mmHg and HR 106/min. Right flank is mildly tender on
palpation. Abdominal exam is negative for any abnormality. A urinalysis was performed and
revealed 1+ blood. Urine microscopy also revealed 10-20 RBCs per high-power field (hpf). A
kidney stone is suspected. The patient reports no prior history of a kidney stone. After
providing the patient an analgesic, where the patient reported mild relief, the NP had the
patient transferred to the emergency room for intravenous fluids, pain management and
further work-up for the kidney stone. Upon follow-up in the office a week later, the patient
reported that he was diagnosed with - correct answer-adequate hydration
balanced diet
, A 54-year-old female reports to the primary care office with complaints of frequent urination.
She reports that she is "leaking" urine several times a day, especially when she coughs,
sneezes, or lifts a heavy object. She indicates that she has not experienced any dysuria or
any urgency. The NP looked at the patient's previous urine culture obtained approximately 1
month ago and determined that it was negative. Other than her urinary complaints, she is in
otherwise good health. BP 128/76; HR 78 bpm; T 98.6; Ht. 5'4"; Wt: 180lbs.; BMI 30.9. The
NP performs a physical exam and all findings are normal. The urinalysis obtained was
negative as well.
Based on patient's symptoms and negative physical exam, she has a typical
1. blank.
The leaking occurs when the abdominal pressure increases during coughing, sneezing, and
lifting. We can rule out urge incontinence because the denied urgency with her urination. We
could not - correct answer-1. stress incontinence
2. stress incontinence
A common organism that causes a urinary tract infection include: - correct
answer-Staphylococcus saprophyticus.
E coli
A mood disorder is a mental illness that causes the individual to have dramatic shifts in
emotions, mood and energy levels. - correct answer-true
A panic attack involves a very stressful situation where the individual develops an intense
fear that something bad will happen. - correct answer-true
A pre-renal cause of acute renal failure is: - correct answer-hypotension
A sphincter malfunction that prevents urine from flowing out of the bladder would most likely
result in: - correct answer-overflow incontinence
A strong social network has been proven to lead to a better outcome for individuals with
MDD. - correct answer-true
A symptom of a lower urinary tract infection includes: - correct answer-urgency
active phase - correct answer-more severe symptoms like delusions, hallucinations,
disorganized speech or behavior or catatonic behavior
Acute renal failure - correct answer-Oliguria (< 30ml/hr).
Increased blood urea nitrogen (BUN) and creatinine.
Fluid and electrolyte abnormalities.
Amitriptyline (Elavil) is an alpha-agonist that increases synaptic concentration of serotonin
and/or norepinephrine. - correct answer-false (Amitriptyline is a tricyclic anti-depressant)
Antiseizure medication can be used in severe panic attacks. - correct answer-true
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