Exam 2 Flashcards
(173 cards)
1
Q
A couple is seeking genetic counseling regarding their risk of having a child with cystic fibrosis. The nurse explains that cystic fibrosis is inherited in which of the following patterns?
A) X-linked recessive
B) Autosomal dominant
C) Autosomal recessive
D) Mitochondrial inheritance
A
C) Autosomal recessive
2
Q
A newborn is diagnosed with cystic fibrosis. The nurse understands that the genetic mutation responsible for this disease is located on which chromosome?
A) Chromosome 7
B) Chromosome 21
C) Chromosome 15
D) Chromosome X
A
A) Chromosome 7
3
Q
A nurse is providing education to parents of a child diagnosed with cystic fibrosis. Which statement made by the parents indicates a need for further teaching?
A) “Each of our children has a 50% chance of inheriting cystic fibrosis.”
B) “We should consider genetic testing if we plan to have more children.”
C) “Cystic fibrosis affects mucus production, causing thick secretions in the lungs and pancreas.”
D) “This condition is caused by a defect in chloride transport in cells.”
A
A) “Each of our children has a 50% chance of inheriting cystic fibrosis.”
Rationale: Cystic fibrosis follows an autosomal recessive inheritance pattern, meaning each child has a 25% chance of having the disease, a 50% chance of being a carrier, and a 25% chance of being unaffected if both parents are carriers.
4
Q
A patient presents with a persistent cough, unexplained weight loss, and hemoptysis. The nurse knows that the most common type of malignant lung cancer is:
A) Small cell carcinoma
B) Squamous cell carcinoma
C) Large cell carcinoma
D) Non-small-cell carcinoma
A
D) Non-small-cell carcinoma
5
Q
A nurse is teaching a group about lung cancer risk factors. Which statement made by a participant indicates the need for further education?
A) “Secondhand smoke can increase my risk of lung cancer.”
B) “Air pollution can contribute to lung cancer development.”
C) “Lung cancer only affects people who smoke.”
D) “Family history can be a risk factor for lung cancer.”
A
C) “Lung cancer only affects people who smoke.”
6
Q
A patient with advanced lung cancer asks the nurse about treatment options. The nurse explains that treatment is usually:
A) Focused solely on surgical removal of the tumor
B) Palliative, including chemotherapy and radiation
C) Limited to antibiotics and steroids
D) Completely curative with early diagnosis
A
B) Palliative, including chemotherapy and radiation
7
Q
A patient with HIV develops pneumonia caused by Pneumocystis jirovecii. The nurse understands that this type of pneumonia is classified as:
A) Community-acquired pneumonia
B) Nosocomial pneumonia
C) Opportunistic pneumonia
D) Aspiration pneumonia
A
C) Opportunistic pneumonia
8
Q
Which patient is at the highest risk for developing opportunistic pneumonia?
A) A 45-year-old smoker with chronic bronchitis
B) A 50-year-old patient undergoing chemotherapy for leukemia
C) A 30-year-old with seasonal allergies
D) A 60-year-old with a history of well-controlled asthma
A
B) A 50-year-old patient undergoing chemotherapy for leukemia
9
Q
The nurse is caring for a patient with Pneumocystis jirovecii pneumonia. Which intervention is the priority?
A) Encouraging increased oral fluid intake
B) Administering broad-spectrum antibiotics
C) Monitoring oxygen saturation levels closely
D) Providing postural drainage therapy
A
C) Monitoring oxygen saturation levels closely
10
Q
A nurse is explaining gas exchange to a nursing student. Which statement by the student indicates correct understanding?
A) “Oxygen and carbon dioxide exchange occurs in the bronchi.”
B) “Alveoli are the primary site of gas exchange in the lungs.”
C) “Hemoglobin does not play a role in oxygen transport.”
D) “Gas exchange is independent of ventilation and perfusion.”
A
B) “Alveoli are the primary site of gas exchange in the lungs.”
11
Q
The nurse is reviewing arterial blood gas (ABG) results for a patient with chronic obstructive pulmonary disease (COPD). Which ABG value suggests impaired gas exchange?
A) pH 7.40, PaCO₂ 40 mmHg, PaO₂ 90 mmHg
B) pH 7.30, PaCO₂ 55 mmHg, PaO₂ 60 mmHg
C) pH 7.45, PaCO₂ 38 mmHg, PaO₂ 95 mmHg
D) pH 7.38, PaCO₂ 42 mmHg, PaO₂ 92 mmHg
A
B) pH 7.30, PaCO₂ 55 mmHg, PaO₂ 60 mmHg
12
Q
A patient with pneumonia has an increased ventilation-perfusion (V/Q) mismatch. The nurse understands this means:
A) The lungs are not effectively perfused with blood
B) Oxygen and carbon dioxide exchange is occurring normally
C) The alveoli are overinflated, improving gas exchange
D) There is no effect on oxygen delivery to tissues
A
A) The lungs are not effectively perfused with blood
13
Q
The nurse is providing education to a group of older adults about the importance of the influenza vaccine. Which statement by a participant indicates a need for further teaching?
A) “The flu vaccine can help prevent complications like pneumonia.”
B) “As I get older, my immune system is not as strong, so the vaccine is beneficial.”
C) “I don’t need the flu vaccine because I’ve never had the flu before.”
D) “Older adults are at higher risk for severe flu-related complications.”
A
C) “I don’t need the flu vaccine because I’ve never had the flu before.”
14
Q
Which age-related change in the respiratory system makes older adults more susceptible to infections?
A) Increased lung elasticity
B) Enhanced immune system response
C) Decreased sensitivity of chemoreceptors
D) Stronger respiratory muscle function
A
C) Decreased sensitivity of chemoreceptors
15
Q
A nurse is educating a 70-year-old patient on ways to maintain respiratory health. Which recommendation is most appropriate?
A) “Avoid getting the flu vaccine to prevent unnecessary side effects.”
B) “Increase physical activity and perform deep breathing exercises regularly.”
C) “Reduce fluid intake to prevent excess lung secretions.”
D) “Ignore any mild cough or shortness of breath, as these are normal with aging.”
A
B) “Increase physical activity and perform deep breathing exercises regularly.”
16
Q
A newborn is diagnosed with neonatal respiratory distress syndrome (NRDS) due to insufficient surfactant. The nurse knows surfactant is essential because it:
A) Enhances mucus production to clear the lungs
B) Promotes alveolar collapse during exhalation
C) Reduces surface tension, preventing alveolar collapse
D) Increases airway resistance for better breathing control
A
C) Reduces surface tension, preventing alveolar collapse
17
Q
A preterm infant at 28 weeks’ gestation is at risk for respiratory complications due to a deficiency in surfactant. The nurse anticipates which treatment?
A) Administration of broad-spectrum antibiotics
B) Administration of exogenous surfactant therapy
C) Immediate lung transplantation
D) Restricting oxygen therapy to prevent lung damage
A
B) Administration of exogenous surfactant therapy
18
Q
The nurse is teaching a student nurse about surfactant production in the lungs. Which statement by the student indicates the need for further teaching?
A) “Surfactant helps keep alveoli open for gas exchange.”
B) “Surfactant is fully developed at 36 weeks of gestation.”
C) “Surfactant increases alveolar surface tension, making breathing easier.”
D) “Premature infants may need surfactant replacement therapy.”
A
C) “Surfactant increases alveolar surface tension, making breathing easier.”
19
Q
Which of the following is a common cause of croup in children?
A) Streptococcus pneumoniae
B) Parainfluenza virus
C) Mycoplasma pneumoniae
D) Pseudomonas aeruginosa
A
B) Parainfluenza virus
20
Q
A child presents to the emergency department with a barking cough, inspiratory stridor, and hoarseness. Which condition does the nurse suspect?
A) Epiglottitis
B) Asthma
C) Croup
D) Bronchiolitis
A
C) Croup
21
Q
Which of the following is a risk factor for developing croup?
A) Exposure to secondhand smoke
B) Genetic predisposition
C) Premature birth
D) Exposure to cold weather
A
A) Exposure to secondhand smoke
22
Q
Which condition is a primary risk factor for chronic bronchitis?
A) Allergies
B) Smoking
C) Viral infections
D) Air pollution
A
B) Smoking
23
Q
Which of the following is a hallmark manifestation of chronic bronchitis?
A) Dry, hacking cough
B) Non-productive cough
C) Persistent productive cough for at least 3 months in 2 consecutive years
D) Intermittent wheezing
A
C) Persistent productive cough for at least 3 months in 2 consecutive years
24
Q
Chronic bronchitis results in which of the following pathophysiological changes?
A) Loss of lung elasticity
B) Air trapping due to alveolar destruction
C) Hypersecretion of mucus and chronic inflammation of bronchi
D) Increased surfactant production
A
C) Hypersecretion of mucus and chronic inflammation of bronchi
25
What is the most common cause of bronchiolitis in infants?
A) Respiratory syncytial virus (RSV)
B) Influenza virus
C) Mycoplasma pneumoniae
D) Klebsiella pneumoniae
A) Respiratory syncytial virus (RSV)
26
A nurse is assessing a 6-month-old with bronchiolitis. Which of the following findings is expected?
A) Stridor and a barking cough
B) Wheezing and nasal flaring
C) Rales and a productive cough
D) Hemoptysis and clubbing
B) Wheezing and nasal flaring
27
Which of the following is a risk factor for developing bronchiolitis?
A) Prematurity
B) History of asthma
C) Seasonal allergies
D) Increased physical activity
A) Prematurity
28
Which of the following is the most common bacterial cause of community-acquired pneumonia?
A) Mycobacterium tuberculosis
B) Streptococcus pneumoniae
C) Legionella pneumophila
D) Pseudomonas aeruginosa
B) Streptococcus pneumoniae
29
Which symptom differentiates pneumonia from bronchitis?
A) Fever
B) Productive cough
C) Pleuritic chest pain
D) Wheezing
C) Pleuritic chest pain
30
30
A nurse is educating a patient on prevention of community-acquired pneumonia. Which statement indicates understanding?
A) "I should get the pneumococcal vaccine if I'm over 65."
B) "I only need to take antibiotics if I have a fever."
C) "Smoking does not increase my risk for pneumonia."
D) "Hand hygiene is not important in pneumonia prevention."
A) "I should get the pneumococcal vaccine if I'm over 65."
31
Which of the following is the primary mode of transmission for tuberculosis?
A) Fecal-oral
B) Direct skin contact
C) Airborne droplets
D) Bloodborne transmission
C) Airborne droplets
32
Which of the following is a hallmark symptom of active tuberculosis?
A) Productive cough with hemoptysis
B) Sudden-onset fever with chills
C) Painless jaundice
D) Severe chest pain with inspiration
A) Productive cough with hemoptysis
33
Which of the following increases the risk of developing tuberculosis?
A) High sodium diet
B) Immunosuppression
C) Regular aerobic exercise
D) Excessive water intake
B) Immunosuppression
34
Which of the following is a hallmark manifestation of COPD?
A) Increased lung compliance
B) Irreversible airflow limitation
C) Acute bronchoconstriction
D) Reduced lung surfactant
B) Irreversible airflow limitation
35
Which patient is at the highest risk for aspiration pneumonia?
A) A patient with a history of hypertension
B) A patient with a swallowing disorder post-stroke
C) A patient with well-controlled diabetes
D) A patient who exercises daily
B) A patient with a swallowing disorder post-stroke
36
Which condition is a common cause of ARDS?
A) Sepsis
B) Hypertension
C) Pulmonary embolism
D) Chronic sinusitis
A) Sepsis
37
Which assessment finding is most indicative of a tension pneumothorax?
A) Tracheal deviation to the unaffected side
B) Hyperresonance on percussion over the unaffected lung
C) Bilateral crackles on auscultation
D) Increased breath sounds over the affected side
A) Tracheal deviation to the unaffected side
38
Which environmental factor increases the risk of Legionnaires’ disease?
A) Contaminated water sources
B) High pollen count
C) Mold exposure
D) Pet dander
A) Contaminated water sources
39
A 3-year-old child presents to the emergency department with a seal-like barking cough, inspiratory stridor, and mild respiratory distress. What is the nurse's priority action?
A) Obtain a throat culture
B) Provide humidified oxygen
C) Lay the child flat to relax
D) Administer broad-spectrum antibiotics
B) Provide humidified oxygen
## Footnote
Rationale: Humidified oxygen helps reduce airway inflammation. Throat cultures can worsen swelling, and antibiotics are ineffective for viral croup.
40
A patient with chronic bronchitis reports increased sputum production and shortness of breath. Which assessment finding requires immediate intervention?
A) Increased work of breathing with use of accessory muscles
B) Barrel-shaped chest with clubbing of fingers
C) Occasional wheezing with minimal exertion
D) SpO₂ of 92% on room air
A) Increased work of breathing with use of accessory muscles
## Footnote
Rationale: Increased work of breathing indicates impending respiratory failure and requires immediate intervention.
41
A 5-month-old infant with bronchiolitis has nasal flaring, retractions, and oxygen saturation of 88%. Which intervention is the priority?
A) Administer an inhaled bronchodilator
B) Suction nasal secretions and apply humidified oxygen
C) Encourage oral fluids to thin secretions
D) Administer an antibiotic to prevent secondary infection
B) Suction nasal secretions and apply humidified oxygen
## Footnote
Rationale: Clearing secretions and providing oxygen support is the priority for bronchiolitis, which is usually caused by RSV.
42
A 72-year-old patient with CAP has a productive cough, fever of 101.3°F (38.5°C), and SpO₂ of 89% on room air. The nurse anticipates which order from the provider?
A) Encourage deep breathing and coughing, then reassess
B) Administer intravenous antibiotics and oxygen therapy
C) Obtain a sputum culture and delay antibiotics
D) Start oral antivirals and encourage fluids
B) Administer intravenous antibiotics and oxygen therapy
## Footnote
Rationale: Prompt antibiotic treatment and oxygen support are essential in bacterial pneumonia.
43
A nurse is caring for a patient with active TB. Which of the following isolation precautions should the nurse implement?
A) Contact precautions with a private room
B) Droplet precautions with a surgical mask
C) Airborne precautions with an N95 respirator
D) Standard precautions with gloves and gown
C) Airborne precautions with an N95 respirator
## Footnote
Rationale: TB is transmitted via airborne droplets and requires negative-pressure isolation and an N95 mask.
44
A patient with latent TB is prescribed isoniazid (INH). Which patient teaching is most important?
A) "Take the medication with antacids to prevent stomach upset."
B) "Limit alcohol intake while on this medication."
C) "Stop the medication if symptoms improve."
D) "Increase intake of vitamin K-rich foods."
B) "Limit alcohol intake while on this medication."
## Footnote
Rationale: INH can cause hepatotoxicity, and alcohol increases the risk of liver damage.
45
A COPD patient is on 2L of nasal cannula oxygen but still has an SpO₂ of 89%. The patient is anxious and asks the nurse to increase oxygen flow. What is the nurse's best response?
A) "I'll increase your oxygen to 4L to help your breathing."
B) "Let's practice pursed-lip breathing to help you exhale more CO₂."
C) "You need higher oxygen levels to prevent complications."
D) "Let's put you in a high-Fowler's position and see if that helps."
B) "Let's practice pursed-lip breathing to help you exhale more CO₂."
## Footnote
Rationale: Increasing oxygen in COPD can reduce the drive to breathe. Pursed-lip breathing helps improve CO₂ elimination.
46
A patient with a recent stroke is experiencing difficulty swallowing. Which intervention should the nurse implement to reduce the risk of aspiration pneumonia?
A) Encourage drinking fluids through a straw
B) Place the patient in a high-Fowler’s position during meals
C) Offer large bites of food for easier swallowing
D) Provide thin liquids for hydration
B) Place the patient in a high-Fowler’s position during meals
## Footnote
Rationale: High-Fowler’s position helps prevent aspiration in patients with dysphagia.
47
A patient with sepsis is at risk for ARDS. The nurse should monitor for which early sign?
A) Pink, frothy sputum
B) Increased work of breathing and dyspnea
C) Hypertension and bradycardia
D) Sudden absence of lung sounds
B) Increased work of breathing and dyspnea
## Footnote
Rationale: Early ARDS presents as increased respiratory effort and refractory hypoxia.
48
Which ventilator setting is most beneficial for a patient with ARDS?
A) High tidal volume to maximize oxygenation
B) Low tidal volume with positive end-expiratory pressure (PEEP)
C) Continuous mandatory ventilation with no PEEP
D) Low oxygen concentration to prevent hyperoxia
B) Low tidal volume with positive end-expiratory pressure (PEEP)
## Footnote
Rationale: Low tidal volume prevents lung injury, and PEEP helps keep alveoli open in ARDS.
49
A patient presents with sudden chest pain, dyspnea, and tracheal deviation. What is the priority intervention?
A) Prepare for chest tube insertion
B) Administer bronchodilators
C) Obtain a chest X-ray
D) Encourage deep breathing exercises
A) Prepare for chest tube insertion
## Footnote
Rationale: A chest tube is needed to relieve pressure and prevent further lung collapse.
50
A patient diagnosed with Legionnaires’ disease asks how they got infected. The nurse's best response is:
A) "It spreads from person to person through coughing."
B) "You may have inhaled contaminated water droplets."
C) "It’s a virus that spreads through direct contact."
D) "It spreads through mosquito bites in warm climates."
B) "You may have inhaled contaminated water droplets."
## Footnote
Rationale: Legionella pneumophila is transmitted via contaminated water sources like air conditioning and hot tubs.
51
A nurse is assessing a patient suspected of having hypocalcemia. Which physical assessment finding would confirm the diagnosis?
A) Positive Babinski sign
B) Hypoactive deep tendon reflexes
C) Positive Trousseau’s and Chvostek’s signs
D) Bradycardia and widened pulse pressure
C) Positive Trousseau’s and Chvostek’s signs
## Footnote
Trousseau’s sign is elicited by inflating a blood pressure cuff above systolic pressure for 3 minutes, causing carpal spasm. Chvostek’s sign is positive when tapping the facial nerve triggers facial twitching. These indicate neuromuscular excitability, a hallmark of hypocalcemia.
52
A patient with hypocalcemia is experiencing laryngeal spasms and muscle twitching. The nurse should prepare to administer which of the following?
A) Sodium bicarbonate
B) IV calcium gluconate
C) Potassium chloride
D) IV magnesium sulfate
B) IV calcium gluconate
## Footnote
Rationale: Calcium gluconate is the first-line treatment for acute symptomatic hypocalcemia, particularly in cases of laryngeal spasms, which can compromise the airway.
Magnesium sulfate is used for hypomagnesemia, while potassium chloride is used for hypokalemia.
53
A nurse is reviewing laboratory results for a patient with hypocalcemia. Which coexisting electrolyte imbalance should the nurse anticipate?
A) Hyperkalemia
B) Hypophosphatemia
C) Hyperphosphatemia
D) Hypermagnesemia
C) Hyperphosphatemia
## Footnote
Rationale: Calcium and phosphorus have an inverse relationship—when calcium levels decrease, phosphorus levels typically increase. This occurs because calcium is bound in bone and is regulated in part by parathyroid hormone (PTH).
54
A patient with anasarca is admitted to the hospital. Which of the following conditions is the most likely cause of this finding?
A) Acute otitis media
B) Nephrotic syndrome
C) Mild dehydration
D) Chronic sinusitis
B) Nephrotic syndrome
## Footnote
Rationale: Anasarca is generalized severe edema affecting the entire body, often due to low albumin levels, as seen in nephrotic syndrome. Nephrotic syndrome leads to protein loss in urine (proteinuria), causing hypoalbuminemia and fluid shifts into interstitial spaces.
55
A patient with liver cirrhosis presents with severe anasarca. Which laboratory finding is most consistent with this condition?
A) Increased serum albumin
B) Decreased serum albumin
C) Increased serum sodium
D) Decreased blood urea nitrogen (BUN)
B) Decreased serum albumin
## Footnote
Rationale: Albumin is a major plasma protein that maintains oncotic pressure—low levels lead to fluid leakage into tissues, causing anasarca. Liver disease impairs albumin production, exacerbating severe edema.
56
A nurse is assessing a patient with lower extremity edema. Which of the following findings would indicate pitting edema rather than non-pitting edema?
A) Skin remains firm and does not indent when pressed
B) A depression remains in the skin after applying pressure
C) The area appears thickened and does not retain an indentation
D) The edema is localized only around the ankles
B) A depression remains in the skin after applying pressure
## Footnote
Rationale: Pitting edema is characterized by an indentation remaining in the skin after pressure is applied for several seconds. Non-pitting edema is often associated with lymphatic obstruction (e.g., lymphedema) and does not leave an indentation.
57
A patient with diabetic ketoacidosis (DKA) has arterial blood gas (ABG) results showing pH 7.25, PaCO₂ 30 mmHg, and HCO₃ 15 mEq/L. Which compensatory mechanism is occurring?
A) The kidneys retain hydrogen ions
B) The lungs increase respiratory rate and depth
C) The kidneys decrease bicarbonate excretion
D) The lungs retain carbon dioxide by slowing respirations
B) The lungs increase respiratory rate and depth
## Footnote
Rationale: The body compensates for metabolic acidosis through respiratory compensation. Kussmaul respirations (deep, rapid breathing) help blow off CO₂, reducing acidity.
58
A nurse is caring for a patient in shock with lactic acidosis. Which ABG result indicates the body's compensatory response?
A) pH 7.31, PaCO₂ 28 mmHg, HCO₃ 17 mEq/L
B) pH 7.48, PaCO₂ 48 mmHg, HCO₃ 32 mEq/L
C) pH 7.35, PaCO₂ 42 mmHg, HCO₃ 24 mEq/L
D) pH 7.28, PaCO₂ 50 mmHg, HCO₃ 22 mEq/L
A) pH 7.31, PaCO₂ 28 mmHg, HCO₃ 17 mEq/L
## Footnote
Rationale: Decreased PaCO₂ indicates respiratory compensation via hyperventilation. Low bicarbonate confirms metabolic acidosis.
59
A patient with renal failure develops metabolic acidosis. How will the kidneys attempt to compensate?
A) Excreting more hydrogen ions
B) Retaining carbon dioxide
C) Increasing ammonia excretion
D) Decreasing bicarbonate retention
A) Excreting more hydrogen ions
## Footnote
Rationale: The renal system compensates by increasing hydrogen ion excretion and bicarbonate reabsorption to correct acidosis.
60
A patient with severe vomiting has ABG results of pH 7.50, PaCO₂ 48 mmHg, and HCO₃ 32 mEq/L. Which compensatory mechanism is the body using?
A) The kidneys are excreting more hydrogen ions
B) The lungs are slowing respirations to retain CO₂
C) The kidneys are increasing bicarbonate reabsorption
D) The lungs are increasing the depth of respirations
B) The lungs are slowing respirations to retain CO₂
## Footnote
Rationale: Respiratory compensation occurs by hypoventilation, allowing CO₂ retention to increase acidity.
61
Which intervention helps the kidneys compensate for metabolic alkalosis?
A) Administration of IV sodium bicarbonate
B) Administration of potassium chloride
C) Encouraging hyperventilation
D) Giving diuretics to enhance bicarbonate loss
B) Administration of potassium chloride
## Footnote
Rationale: Hypokalemia often accompanies metabolic alkalosis. Correcting potassium enhances renal excretion of bicarbonate, reducing alkalosis.
62
Which ABG result indicates complete compensation for metabolic alkalosis?
A) pH 7.50, PaCO₂ 50 mmHg, HCO₃ 30 mEq/L
B) pH 7.35, PaCO₂ 50 mmHg, HCO₃ 30 mEq/L
C) pH 7.45, PaCO₂ 48 mmHg, HCO₃ 30 mEq/L
D) pH 7.30, PaCO₂ 35 mmHg, HCO₃ 18 mEq/L
C) pH 7.45, PaCO₂ 48 mmHg, HCO₃ 30 mEq/L
## Footnote
Rationale: The pH is normalized, meaning full compensation has occurred. Elevated CO₂ indicates respiratory compensation through hypoventilation.
63
A patient with chronic obstructive pulmonary disease (COPD) has an ABG showing pH 7.33, PaCO₂ 58 mmHg, and HCO₃ 30 mEq/L. What does this indicate?
A) Uncompensated respiratory acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Metabolic acidosis
B) Partially compensated respiratory acidosis
## Footnote
Rationale: HCO₃ is elevated, showing renal compensation. pH is still below normal, meaning compensation is incomplete.
64
Which renal response compensates for chronic respiratory acidosis?
A) Increasing bicarbonate reabsorption
B) Decreasing bicarbonate retention
C) Excreting sodium
D) Retaining carbon dioxide
A) Increasing bicarbonate reabsorption
## Footnote
Rationale: The kidneys retain bicarbonate to buffer the excess CO₂ and increase pH.
65
A nurse is caring for a patient with respiratory acidosis. Which clinical sign indicates the body's attempt to compensate?
A) Kussmaul respirations
B) Decreased urine output
C) Increased bicarbonate on ABGs
D) Increased respiratory rate
C) Increased bicarbonate on ABGs
## Footnote
Rationale: The kidneys retain bicarbonate as compensation for chronic CO₂ retention.
66
A patient with anxiety-induced hyperventilation has ABGs showing pH 7.48, PaCO₂ 30 mmHg, and HCO₃ 22 mEq/L. What compensatory mechanism should the nurse expect?
A) The kidneys will excrete more bicarbonate
B) The lungs will increase CO₂ retention
C) The kidneys will reabsorb more bicarbonate
D) The patient will develop metabolic acidosis
A) The kidneys will excrete more bicarbonate
## Footnote
Rationale: To compensate for respiratory alkalosis, the kidneys excrete bicarbonate, reducing alkalinity.
67
Which ABG result suggests full compensation for respiratory alkalosis?
A) pH 7.48, PaCO₂ 30 mmHg, HCO₃ 20 mEq/L
B) pH 7.44, PaCO₂ 30 mmHg, HCO₃ 20 mEq/L
C) pH 7.35, PaCO₂ 30 mmHg, HCO₃ 20 mEq/L
D) pH 7.28, PaCO₂ 50 mmHg, HCO₃ 30 mEq/L
C) pH 7.35, PaCO₂ 30 mmHg, HCO₃ 20 mEq/L
## Footnote
Rationale: The pH is normal but on the lower end, meaning compensation is complete.
68
A patient with respiratory alkalosis due to a panic attack continues to hyperventilate. Which intervention helps promote compensation?
A) Encourage deep, slow breathing into a paper bag
B) Administer sodium bicarbonate IV
C) Place the patient in high Fowler’s position
D) Increase oxygen flow rate
A) Encourage deep, slow breathing into a paper bag
## Footnote
Rationale: Breathing into a paper bag increases CO₂ retention, correcting alkalosis.
69
A nurse is caring for a patient with hypokalemia. Which of the following conditions is the most likely cause of the electrolyte imbalance?
A) Acute kidney injury
B) Excessive loop diuretic use
C) Addison’s disease
D) Uncontrolled diabetes mellitus
B) Excessive loop diuretic use
## Footnote
Rationale: Loop diuretics (e.g., furosemide) promote potassium excretion, leading to hypokalemia. Addison’s disease causes hyperkalemia, not hypokalemia. Diabetes mellitus can lead to hyperkalemia due to acidosis.
70
A patient with severe hypokalemia is at greatest risk for which of the following complications?
A) Increased deep tendon reflexes
B) Hypertension
C) Respiratory muscle weakness
D) Hyperactive bowel sounds
C) Respiratory muscle weakness
## Footnote
Rationale: Hypokalemia affects skeletal and respiratory muscles, leading to shallow respirations and potential respiratory failure.
71
A nurse is reviewing ECG findings for a patient with hypokalemia. Which of the following abnormalities is most commonly associated with this condition?
A) Peaked T waves
B) Widened QRS complex
C) Presence of U waves
D) ST elevation
C) Presence of U waves
## Footnote
Rationale: U waves are a hallmark ECG finding in hypokalemia. Peaked T waves are seen in hyperkalemia.
72
A patient with end-stage renal disease (ESRD) is at risk for hyperkalemia. The nurse expects which laboratory finding to confirm the condition?
A) Potassium 3.2 mEq/L
B) Potassium 5.9 mEq/L
C) Sodium 135 mEq/L
D) Calcium 10.2 mg/dL
B) Potassium 5.9 mEq/L
## Footnote
Rationale: Normal potassium levels are 3.5–5.0 mEq/L. ESRD leads to impaired potassium excretion, causing hyperkalemia.
73
A patient with hyperkalemia reports muscle weakness and palpitations. The nurse assesses the ECG and expects to find which abnormality?
A) Prolonged PR interval
B) Peaked T waves
C) Depressed ST segment
D) Widened QRS with a U wave
B) Peaked T waves
## Footnote
Rationale: Peaked T waves are a hallmark ECG change in hyperkalemia due to increased excitability of cardiac cells.
74
A patient receiving spironolactone therapy presents with muscle weakness and decreased urine output. The nurse suspects hyperkalemia. Which of the following interventions should be anticipated?
A) Administration of IV potassium chloride
B) IV calcium gluconate and insulin with glucose
C) Sodium bicarbonate infusion
D) Encouraging the patient to increase potassium-rich foods
B) IV calcium gluconate and insulin with glucose
## Footnote
Rationale: Calcium gluconate stabilizes cardiac membranes, preventing fatal arrhythmias. Insulin shifts potassium into cells, reducing serum levels.
75
A patient with severe hyponatremia presents with confusion, seizures, and lethargy. The nurse understands that these symptoms are primarily caused by:
A) Increased intracellular sodium levels
B) Cerebral edema due to water shifting into brain cells
C) Increased excitability of neurons
D) Fluid retention in the intravascular space
B) Cerebral edema due to water shifting into brain cells
## Footnote
Rationale: Hyponatremia causes water to shift into brain cells, leading to cerebral edema, which can result in seizures and coma.
76
A nurse is caring for a patient with hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone (SIADH). Which finding is most concerning?
A) Serum sodium of 126 mEq/L
B) Muscle cramps and fatigue
C) Decreased deep tendon reflexes
D) Seizure activity and decreased level of consciousness
D) Seizure activity and decreased level of consciousness
## Footnote
Rationale: Seizures and altered mental status indicate severe cerebral edema, requiring urgent intervention.
77
A nurse is preparing to administer IV fluids to a patient with symptomatic hyponatremia (Na+ 120 mEq/L). Which IV fluid order should the nurse question?
A) 3% hypertonic saline
B) 0.9% normal saline
C) 0.45% half-normal saline
D) Lactated Ringer’s
C) 0.45% half-normal saline
## Footnote
Rationale: Hypotonic solutions (like 0.45% NS) worsen hyponatremia by further diluting sodium levels. 3% hypertonic saline is used cautiously for severe hyponatremia.
78
A nurse is assessing a patient with hypokalemia. Which manifestation should the nurse expect?
A) Increased deep tendon reflexes and muscle spasms
B) Muscle weakness and irregular heart rate
C) Severe hypertension and bradycardia
D) Facial twitching and tetany
B) Muscle weakness and irregular heart rate
## Footnote
Rationale: Hypokalemia leads to muscle weakness, cramps, and arrhythmias due to impaired nerve conduction and muscle contraction.
79
A patient with a history of heart failure is receiving furosemide (Lasix) therapy. The nurse should monitor for which potential cause of hypokalemia?
A) Increased potassium retention in the kidneys
B) Excessive gastrointestinal absorption of potassium
C) Increased potassium excretion due to diuretic use
D) Reduced sodium excretion, leading to potassium retention
C) Increased potassium excretion due to diuretic use
## Footnote
Rationale: Loop diuretics like furosemide promote potassium excretion, leading to hypokalemia.
80
A patient with hypokalemia presents with an abnormal ECG. Which finding is most indicative of this condition?
A) Peaked T waves
B) Widened QRS complex
C) Presence of U waves
D) ST segment elevation
C) Presence of U waves
## Footnote
Rationale: U waves are a hallmark ECG finding in hypokalemia. Peaked T waves are seen in hyperkalemia.
81
A patient with acute kidney injury has a potassium level of 6.2 mEq/L. Which manifestation should the nurse expect?
A) Bradycardia and peaked T waves
B) Hyperactive bowel sounds and diarrhea
C) Muscle cramping and tetany
D) Increased deep tendon reflexes and tremors
A) Bradycardia and peaked T waves
## Footnote
Rationale: Hyperkalemia slows cardiac conduction, leading to bradycardia and peaked T waves on ECG.
82
A nurse is caring for a patient with severe hyperkalemia. Which of the following conditions is the most likely cause?
A) Chronic diuretic use
B) Addison’s disease
C) Increased insulin levels
D) Prolonged vomiting
B) Addison’s disease
## Footnote
Rationale: Addison’s disease (adrenal insufficiency) causes reduced aldosterone levels, leading to potassium retention and hyperkalemia.
83
A patient with hyperkalemia is at risk for life-threatening complications. Which intervention should the nurse anticipate?
A) Administration of IV potassium chloride
B) IV insulin with dextrose and calcium gluconate
C) Encouraging a high-potassium diet
D) Administration of sodium bicarbonate for alkalosis
B) IV insulin with dextrose and calcium gluconate
## Footnote
Rationale: Insulin shifts potassium into cells, reducing serum levels. Calcium gluconate stabilizes cardiac membranes.
84
A patient with severe hyponatremia presents with confusion, headache, and seizures. The nurse understands that these symptoms result from:
A) Increased intracellular sodium levels
B) Cerebral edema due to fluid shifting into brain cells
C) Decreased excitability of neurons
D) Dehydration of brain cells due to hypertonic fluid shifts
B) Cerebral edema due to fluid shifting into brain cells
## Footnote
Rationale: Hyponatremia causes water to move into brain cells, leading to swelling and neurological symptoms.
85
Which of the following patients is at the highest risk for developing hyponatremia?
A) A patient receiving excessive intravenous normal saline
B) A patient with syndrome of inappropriate antidiuretic hormone (SIADH)
C) A patient on corticosteroid therapy
D) A patient experiencing prolonged diarrhea
B) A patient with syndrome of inappropriate antidiuretic hormone (SIADH)
## Footnote
Rationale: SIADH causes water retention, diluting sodium levels and leading to hyponatremia.
86
A patient with a sodium level of 120 mEq/L is receiving IV fluids. Which order should the nurse question?
A) Administer 3% hypertonic saline
B) Restrict free water intake
C) Administer 0.45% normal saline
D) Monitor for signs of neurological deterioration
C) Administer 0.45% normal saline
## Footnote
Rationale: Hypotonic solutions (0.45% NS) worsen hyponatremia by further diluting sodium levels.
Hypertonic saline (3%) is used cautiously for severe hyponatremia.
87
A patient’s ABG results are: pH 7.30, PaCO₂ 50 mmHg, HCO₃ 26 mEq/L. How should the nurse interpret these findings?
A) Metabolic acidosis, uncompensated
B) Respiratory acidosis, uncompensated
C) Metabolic alkalosis, partially compensated
D) Respiratory alkalosis, fully compensated
B) Respiratory acidosis, uncompensated
## Footnote
Rationale:
pH is low (acidic) → Acidosis
PaCO₂ is high (retained CO₂) → Respiratory cause
HCO₃ is normal → No metabolic compensation
Conclusion: Uncompensated respiratory acidosis
88
A patient’s ABG results are: pH 7.38, PaCO₂ 48 mmHg, HCO₃ 30 mEq/L. What is the correct interpretation?
A) Fully compensated metabolic alkalosis
B) Fully compensated respiratory acidosis
C) Uncompensated metabolic acidosis
D) Partially compensated respiratory alkalosis
B) Fully compensated respiratory acidosis
## Footnote
Rationale:
pH is normal but slightly acidic (7.35–7.45 range but closer to acidosis)
PaCO₂ is high → Indicates respiratory acidosis
HCO₃ is high → Indicates metabolic compensation
Since the pH is normal, full compensation has occurred.
89
A nurse is interpreting ABGs for a patient with metabolic alkalosis. Which of the following ABG values would confirm this condition?
A) pH 7.50, PaCO₂ 40 mmHg, HCO₃ 32 mEq/L
B) pH 7.30, PaCO₂ 50 mmHg, HCO₃ 24 mEq/L
C) pH 7.48, PaCO₂ 30 mmHg, HCO₃ 22 mEq/L
D) pH 7.25, PaCO₂ 40 mmHg, HCO₃ 17 mEq/L
A) pH 7.50, PaCO₂ 40 mmHg, HCO₃ 32 mEq/L
## Footnote
Rationale:
pH is high → Alkalosis
HCO₃ is elevated → Metabolic cause
PaCO₂ is normal, meaning no respiratory compensation yet
90
A patient with diabetic ketoacidosis (DKA) has the following ABG results: pH 7.28, PaCO₂ 30 mmHg, HCO₃ 15 mEq/L. How is the body attempting to compensate?
A) The kidneys are retaining bicarbonate
B) The lungs are increasing the respiratory rate
C) The kidneys are retaining hydrogen ions
D) The lungs are decreasing the respiratory rate
B) The lungs are increasing the respiratory rate
## Footnote
Rationale:
pH is low → Acidosis
HCO₃ is low → Metabolic acidosis
PaCO₂ is also low, indicating respiratory compensation (hyperventilation to blow off CO₂).
91
A nurse is analyzing a patient’s ABGs: pH 7.51, PaCO₂ 28 mmHg, HCO₃ 24 mEq/L. What condition does this indicate?
A) Metabolic acidosis, partially compensated
B) Respiratory alkalosis, uncompensated
C) Metabolic alkalosis, fully compensated
D) Respiratory acidosis, partially compensated
B) Respiratory alkalosis, uncompensated
## Footnote
Rationale:
pH is high → Alkalosis
PaCO₂ is low → Respiratory cause (hyperventilation)
HCO₃ is normal → No metabolic compensation
92
A patient is diagnosed with prerenal acute kidney injury (AKI). Which of the following is the most likely cause?
A) Kidney stones causing urinary obstruction
B) Acute glomerulonephritis
C) Severe dehydration and hypovolemia
D) Acute tubular necrosis due to nephrotoxic drugs
C) Severe dehydration and hypovolemia
## Footnote
Rationale: Prerenal AKI occurs due to decreased renal perfusion, often caused by hypovolemia, heart failure, or hypotension.
93
A patient with postrenal AKI is most likely to have which underlying condition?
A) Hypotension from hemorrhage
B) Bilateral ureteral obstruction
C) Acute tubular necrosis
D) Acute interstitial nephritis
B) Bilateral ureteral obstruction
## Footnote
Rationale: Postrenal AKI occurs due to obstruction of urine flow, often caused by kidney stones, tumors, or enlarged prostate.
94
The nurse is reviewing a patient's chart and notes that the patient has intrinsic (intrarenal) AKI. Which of the following is the most likely cause?
A) Sepsis and nephrotoxic medications
B) Severe blood loss and dehydration
C) Bladder outlet obstruction
D) Chronic hypertension and diabetes
A) Sepsis and nephrotoxic medications
## Footnote
Rationale: Intrinsic AKI results from direct kidney damage, often due to acute tubular necrosis (ATN), nephrotoxic drugs (NSAIDs, aminoglycosides), ischemia, or infections (sepsis).
95
A patient in the oliguric phase of AKI is most at risk for developing which complication?
A) Hypokalemia and metabolic alkalosis
B) Fluid overload and hyperkalemia
C) Increased urine output and dehydration
D) Hypernatremia and hypovolemia
B) Fluid overload and hyperkalemia
## Footnote
Rationale: The oliguric phase is marked by decreased urine output (<400 mL/day), fluid retention, hyperkalemia, metabolic acidosis, and uremia.
96
A patient is recovering from AKI and is in the diuretic phase. Which finding should the nurse anticipate?
A) Decreased urine output and fluid retention
B) Increased risk of dehydration and electrolyte imbalances
C) Severe hyperkalemia and metabolic acidosis
D) Progressive worsening of kidney function
B) Increased risk of dehydration and electrolyte imbalances
## Footnote
Rationale: In the diuretic phase, urine output increases significantly, but the kidneys still have difficulty concentrating urine, leading to dehydration, hypokalemia, and hyponatremia.
97
A nurse is monitoring a patient in the recovery phase of AKI. What is the expected outcome during this phase?
A) Permanent kidney damage with chronic renal failure
B) A slow return of GFR, electrolyte balance, and normal urine output
C) Continued oliguria with worsening metabolic acidosis
D) Increased serum creatinine and blood urea nitrogen (BUN) levels
B) A slow return of GFR, electrolyte balance, and normal urine output
## Footnote
Rationale: The recovery phase is characterized by a gradual improvement in kidney function, where glomerular filtration rate (GFR) increases, electrolyte levels stabilize, and urine output normalizes.
98
Which of the following is the most common causative organism of a urinary tract infection (UTI)?
A) Streptococcus pneumoniae
B) Staphylococcus aureus
C) Escherichia coli
D) Pseudomonas aeruginosa
C) Escherichia coli
99
A female patient is diagnosed with a UTI. Which factor increases the risk of developing a UTI?
A) High-protein diet
B) Shorter urethra
C) Excessive hydration
D) Increased testosterone levels
B) Shorter urethra
100
Which symptom is most commonly associated with a lower UTI?
A) Flank pain
B) Cloudy, foul-smelling urine
C) Peripheral edema
D) Hypertension
B) Cloudy, foul-smelling urine
101
A patient with an untreated UTI is at risk for developing which complication?
A) Pyelonephritis
B) Glomerulonephritis
C) Nephrotic syndrome
D) Polycystic kidney disease
A) Pyelonephritis
102
A patient presents with severe flank pain radiating to the groin. The nurse suspects renal calculi. What is the priority nursing intervention?
A) Increase oral fluid intake
B) Administer pain medication
C) Obtain a urine specimen
D) Prepare for immediate surgery
B) Administer pain medication
102
Which of the following is a major risk factor for developing renal calculi?
A) High fluid intake
B) Hypocalcemia
C) Urinary stasis
D) Low-protein diet
C) Urinary stasis
103
What is the most common type of kidney stone?
A) Struvite
B) Calcium oxalate
C) Uric acid
D) Cystine
B) Calcium oxalate
104
What is a hallmark characteristic of nephrotic syndrome?
A) Hematuria
B) Proteinuria >3.5 g/day
C) Oliguria
D) Fever
B) Proteinuria >3.5 g/day
105
Which clinical manifestation differentiates nephritic syndrome from nephrotic syndrome?
A) Edema
B) Hypoalbuminemia
C) Hematuria
D) Hyperlipidemia
C) Hematuria
106
A patient with nephrotic syndrome is at increased risk for which complication?
A) Deep vein thrombosis (DVT)
B) Hypotension
C) Pulmonary fibrosis
D) Hypoglycemia
A) Deep vein thrombosis (DVT)
107
A patient with pyelonephritis will most likely present with which symptom?
A) Costovertebral angle (CVA) tenderness
B) Polyuria
C) Bradycardia
D) Weight gain
A) Costovertebral angle (CVA) tenderness
108
Which of the following is a potential complication of chronic pyelonephritis?
A) Kidney scarring and dysfunction
B) Dehydration
C) Bladder rupture
D) Hypercalcemia
A) Kidney scarring and dysfunction
109
Hydronephrosis occurs due to:
A) Increased urine production
B) Urinary tract obstruction
C) Excessive fluid intake
D) Renal artery stenosis
B) Urinary tract obstruction
110
A nurse is assessing a patient with hydronephrosis. Which finding is expected?
A) Polyuria
B) Hypertension
C) Hypotension
D) Hyperkalemia
B) Hypertension
111
Which is the most common early symptom of bladder cancer?
A) Hematuria
B) Dysuria
C) Flank pain
D) Urinary retention
A) Hematuria
112
Which factor increases the risk of bladder cancer?
A) Low-sodium diet
B) Occupational exposure to chemicals
C) Frequent UTIs
D) Family history of hypertension
B) Occupational exposure to chemicals
113
Which statement about autosomal dominant polycystic kidney disease (ADPKD) is correct?
A) It is usually diagnosed in infancy
B) It leads to cyst formation in the kidneys
C) It is caused by a bacterial infection
D) It does not affect renal function
B) It leads to cyst formation in the kidneys
114
A patient with PKD is at risk for which complication?
A) Chronic kidney disease (CKD)
B) Dehydration
C) Hyperthyroidism
D) Polyuria
A) Chronic kidney disease (CKD)
115
What symptom is most common in patients with PKD?
A) Flank pain
B) Hypotension
C) Weight loss
D) Seizures
A) Flank pain
116
What is a characteristic symptom of interstitial cystitis?
A) Pain that worsens with bladder filling and improves after urination
B) Fever and chills
C) Hematuria with blood clots
D) Hypertension
A) Pain that worsens with bladder filling and improves after urination
117
Which factor is associated with interstitial cystitis?
A) Bacterial infection
B) Autoimmune response
C) Renal artery stenosis
D) High protein intake
B) Autoimmune response
118
A patient with a history of recurrent kidney stones should be advised to:
A) Increase fluid intake
B) Decrease calcium intake
C) Increase sodium intake
D) Restrict potassium
A) Increase fluid intake
119
What electrolyte imbalance is common in nephrotic syndrome?
A) Hyperkalemia
B) Hypocalcemia
C) Hypernatremia
D) Hypermagnesemia
B) Hypocalcemia
120
Which imaging study is most useful in diagnosing hydronephrosis?
A) CT scan
B) X-ray
C) ECG
D) Colonoscopy
A) CT scan
121
A patient with chronic kidney disease (CKD) is expected to have which of the following laboratory findings?
A) Increased glomerular filtration rate (GFR)
B) Decreased serum creatinine
C) Increased blood urea nitrogen (BUN)
D) Decreased serum potassium
C) Increased blood urea nitrogen (BUN)
## Footnote
Rationale: In CKD, the kidneys lose the ability to excrete waste, leading to an elevation in BUN and creatinine.
122
A nurse is reviewing lab results for a patient with CKD. Which electrolyte imbalance is most commonly associated with CKD?
A) Hypokalemia
B) Hypercalcemia
C) Hyperkalemia
D) Hypophosphatemia
C) Hyperkalemia
## Footnote
Rationale: The kidneys play a crucial role in potassium excretion. In CKD, potassium builds up, increasing the risk of life-threatening arrhythmias.
123
A patient with stage 4 CKD is likely to have which acid-base imbalance?
A) Metabolic alkalosis
B) Respiratory acidosis
C) Metabolic acidosis
D) Respiratory alkalosis
C) Metabolic acidosis
## Footnote
Rationale: Impaired kidney function reduces the ability to excrete hydrogen ions and reabsorb bicarbonate, leading to metabolic acidosis.
124
A patient with CKD has a low hemoglobin and hematocrit. Which lab value is most likely contributing to this finding?
A) Increased calcium
B) Decreased erythropoietin
C) Increased albumin
D) Decreased potassium
B) Decreased erythropoietin
## Footnote
Rationale: The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. In CKD, erythropoietin levels drop, leading to anemia.
125
Which phosphorus and calcium lab values are expected in a patient with CKD?
A) Low phosphorus, high calcium
B) High phosphorus, low calcium
C) Low phosphorus, low calcium
D) High phosphorus, high calcium
B) High phosphorus, low calcium
## Footnote
Rationale: In CKD, phosphorus is retained due to poor excretion, while calcium decreases due to impaired vitamin D activation and secondary hyperparathyroidism.
126
A patient reports urine leakage when sneezing, laughing, or exercising. Which type of incontinence does the nurse suspect?
A) Urge incontinence
B) Overflow incontinence
C) Stress incontinence
D) Functional incontinence
C) Stress incontinence
## Footnote
Rationale: Stress incontinence occurs when increased intra-abdominal pressure (e.g., from laughing, coughing, or sneezing) leads to urine leakage due to weakened pelvic floor muscles.
127
A patient with diabetes mellitus reports frequent, sudden, strong urges to urinate and occasional involuntary loss of urine before reaching the bathroom. The nurse recognizes this as which type of incontinence?
A) Overflow incontinence
B) Urge incontinence
C) Functional incontinence
D) Stress incontinence
B) Urge incontinence
## Footnote
Rationale: Urge incontinence (also called overactive bladder) is caused by involuntary bladder contractions, leading to a sudden, intense urge to urinate. It is common in neurologic conditions such as diabetes, stroke, or multiple sclerosis.
128
A nurse is caring for a patient with Parkinson’s disease who is unable to reach the bathroom in time due to mobility issues. Which type of incontinence does this represent?
A) Functional incontinence
B) Urge incontinence
C) Stress incontinence
D) Overflow incontinence
A) Functional incontinence
## Footnote
Rationale: Functional incontinence occurs when a physical or cognitive impairment (e.g., Parkinson’s disease, arthritis, dementia) prevents a patient from reaching the bathroom in time, even though bladder control may be intact.
129
A nurse is caring for a male patient with an enlarged prostate who reports frequent dribbling of urine and difficulty initiating a urine stream. The nurse suspects which type of incontinence?
A) Urge incontinence
B) Functional incontinence
C) Overflow incontinence
D) Stress incontinence
C) Overflow incontinence
## Footnote
Rationale: Overflow incontinence occurs when the bladder cannot fully empty, leading to frequent dribbling and urinary retention. It is often seen in conditions like benign prostatic hyperplasia (BPH), neurogenic bladder, or spinal cord injuries.
130
A nurse is providing education to a caregiver of a patient with advanced dementia who has no awareness of their need to urinate and experiences involuntary loss of urine. The nurse explains that this describes which type of incontinence?
A) Functional incontinence
B) Reflex incontinence
C) Overflow incontinence
D) Urge incontinence
B) Reflex incontinence
## Footnote
Rationale: Reflex incontinence occurs when there is an absence of the sensation to urinate, leading to involuntary urine loss at predictable intervals. It is often seen in patients with spinal cord injuries, neurological disorders, or advanced dementia.
131
A patient recovering from a spinal cord injury at T6 experiences unpredictable loss of urine without the urge to void. Which type of incontinence does the nurse suspect?
A) Overflow incontinence
B) Reflex incontinence
C) Functional incontinence
D) Stress incontinence
B) Reflex incontinence
## Footnote
Rationale: Reflex incontinence occurs when the bladder empties involuntarily due to disrupted nerve signals between the brain and bladder, commonly seen in spinal cord injuries above T12.
132
A 68-year-old female presents with urinary incontinence and a sensation of pelvic pressure. Which factor most likely contributed to her condition?
A. Nulliparity
B. Obesity
C. Endometriosis
D. Decreased estrogen levels
D. Decreased estrogen levels
133
Which of the following is the most appropriate intervention for a patient with mild pelvic organ prolapse?
A. Immediate surgical repair
B. Kegel exercises
C. Long-term catheterization
D. Antibiotic therapy
B. Kegel exercises
134
A 22-year-old woman presents with severe menstrual cramps that began 6 months ago. Which underlying condition is most likely responsible?
A. Primary dysmenorrhea
B. Secondary dysmenorrhea due to endometriosis
C. Polycystic ovarian syndrome
D. Uterine fibroids
B. Secondary dysmenorrhea due to endometriosis
135
Which medication is most effective for managing primary dysmenorrhea?
A. Acetaminophen
B. Nonsteroidal anti-inflammatory drugs (NSAIDs)
C. Antibiotics
D. Antidepressants
B. NSAIDs
136
Cryptorchidism increases the risk of which condition later in life?
A. Testicular cancer
B. Prostate cancer
C. Erectile dysfunction
D. Infertility
A. Testicular cancer
137
What is the recommended age for surgical correction of cryptorchidism?
A. Before 6 months
B. By 12 months
C. Before 3 years
D. By puberty
B. By 12 months
138
A patient with sickle cell disease presents with a painful, prolonged erection lasting more than 6 hours. What is the first-line treatment?
A. Ice packs
B. Oral analgesics
C. Aspiration of blood from the corpus cavernosum
D. Antibiotic therapy
C. Aspiration of blood from the corpus cavernosum
139
Which medication is most commonly associated with priapism?
A. Sildenafil (Viagra)
B. Acetaminophen
C. Metformin
D. Insulin
A. Sildenafil (Viagra)
140
Which statement best describes hydrocele?
A. It is a non-cancerous fluid collection around the testicle.
B. It is a solid mass that requires biopsy.
C. It is a painful testicular condition requiring emergency surgery.
D. It is caused by an untreated bacterial infection.
A. It is a non-cancerous fluid collection around the testicle.
141
What is the recommended treatment for an asymptomatic hydrocele in an adult?
A. Surgical repair
B. Aspiration of fluid
C. Watchful waiting
D. Radiation therapy
C. Watchful waiting
142
Which symptom is commonly associated with ovarian cancer?
A. Abnormal vaginal bleeding
B. Bloating and abdominal distension
C. Breast tenderness
D. Painful urination
B. Bloating and abdominal distension
143
What is a significant risk factor for ovarian cancer?
A. Early menopause
B. Oral contraceptive use
C. BRCA gene mutation
D. Low-fat diet
C. BRCA gene mutation
144
What is the most common cause of epididymitis in young, sexually active males?
A. E. coli infection
B. Chlamydia or gonorrhea
C. Fungal infections
D. Viral mumps
B. Chlamydia or gonorrhea
145
Which is the most common type of testicular cancer?
A. Seminoma
B. Teratoma
C. Lymphoma
D. Sarcoma
A. Seminoma
146
What is a common psychological symptom of premenstrual syndrome (PMS)?
A. Euphoria
B. Increased energy
C. Irritability
D. Hypersomnia
C. Irritability
147
What is the best initial treatment for mild PMS symptoms?
A. Antidepressants
B. Hormone replacement therapy
C. Lifestyle modifications, including diet and exercise
D. NSAIDs
C. Lifestyle modifications, including diet and exercise
148
A 15-year-old male presents with sudden-onset scrotal pain and absent cremasteric reflex. What is the likely diagnosis?
A. Epididymitis
B. Hydrocele
C. Testicular torsion
D. Inguinal hernia
C. Testicular torsion
149
What is the most appropriate intervention for testicular torsion?
A. Immediate ultrasound and observation
B. Manual detorsion in the emergency room
C. Emergent surgical intervention within 6 hours
D. Antibiotic therapy
C. Emergent surgical intervention within 6 hours
150
Which symptom is most characteristic of endometriosis?
A. Painless vaginal bleeding
B. Severe dysmenorrhea and pelvic pain
C. Urinary incontinence
D. Chronic diarrhea
B. Severe dysmenorrhea and pelvic pain
151
Which diagnostic test is definitive for endometriosis?
A. Transvaginal ultrasound
B. Laparoscopy with biopsy
C. CT scan
D. MRI
B. Laparoscopy with biopsy
152
Which virus is most commonly associated with cervical cancer?
A. Hepatitis B
B. Epstein-Barr virus
C. Human papillomavirus (HPV)
D. Cytomegalovirus
C. Human papillomavirus (HPV)
153
Which screening test is used to detect cervical cancer?
A. Mammogram
B. Pap smear
C. CA-125 blood test
D. Colonoscopy
B. Pap smear
154
A patient with genital herpes presents with painful vesicular lesions. What is the recommended treatment?
A. Antibiotics
B. Antiviral medications
C. Steroid therapy
D. Surgical removal of lesions
B. Antiviral medications
155
Which statement about herpes is true?
A. It is curable with antivirals.
B. It is only spread through symptomatic lesions.
C. It can be transmitted even when asymptomatic.
D. It is a bacterial infection.
C. It can be transmitted even when asymptomatic.
156
What is the characteristic lesion of primary syphilis?
A. Painless chancre
B. Genital warts
C. Painful ulcer
D. Purulent discharge
A. Painless chancre
157
What is the treatment of choice for syphilis?
A. Acyclovir
B. Penicillin G
C. Doxycycline
D. Metronidazole
B. Penicillin G
158
A patient is diagnosed with a rectocele. Which symptom is most commonly associated with this condition?
A. Difficulty urinating
B. Constipation and difficulty with bowel movements
C. Urinary urgency
D. Painful intercourse
B. Constipation and difficulty with bowel movements
159
A 19-year-old female presents with painful menstruation that occurs every cycle without any underlying reproductive disorder. What is the most likely diagnosis?
A. Primary dysmenorrhea
B. Secondary dysmenorrhea
C. Endometriosis
D. Polycystic ovarian syndrome
A. Primary dysmenorrhea
160
A newborn male is diagnosed with cryptorchidism. What is the primary reason for recommending surgical correction?
A. Prevent future infertility and reduce cancer risk
B. Improve testosterone production
C. Enhance cosmetic appearance
D. Improve urinary function
A. Prevent future infertility and reduce cancer risk
## Footnote
Rationale: Cryptorchidism increases the risk of testicular cancer and infertility due to prolonged exposure of the testes to higher abdominal temperatures. Early surgical correction (orchiopexy) improves fertility outcomes and reduces cancer risk.
161
Which of the following patients is at the highest risk of developing priapism?
A. A 52-year-old male taking antihypertensives
B. A 30-year-old male with a history of sickle cell disease
C. A 45-year-old male with a history of testicular torsion
D. A 28-year-old male with a urinary tract infection
B. A 30-year-old male with a history of sickle cell disease
## Footnote
Rationale: Sickle cell disease is a common cause of ischemic priapism, where sickled red blood cells block venous outflow, leading to prolonged and painful erections.
162
What is the best diagnostic test for confirming hydrocele?
A. Urinalysis
B. Doppler ultrasound
C. Transillumination
D. Testicular biopsy
C. Transillumination
163
A patient with ovarian cancer is scheduled for a CA-125 blood test. What is the primary purpose of this test?
A. To confirm the presence of ovarian cancer
B. To evaluate response to treatment and monitor recurrence
C. To determine the exact stage of the cancer
D. To differentiate ovarian cancer from endometrial cancer
B. To evaluate response to treatment and monitor recurrence
## Footnote
Rationale: CA-125 is a tumor marker that is not specific for diagnosis, but it is useful in monitoring treatment response and detecting recurrence in ovarian cancer patients.
164
A male patient presents with gradual-onset scrotal pain, dysuria, and scrotal swelling. Which condition is most likely?
A. Epididymitis
B. Testicular torsion
C. Hydrocele
D. Prostatitis
A. Epididymitis
165
A patient reports severe PMS symptoms that significantly impact daily functioning. What is the best first-line pharmacologic treatment?
A. Selective serotonin reuptake inhibitors (SSRIs)
B. NSAIDs
C. Oral contraceptives
D. Diuretics
A. Selective serotonin reuptake inhibitors (SSRIs)
## Footnote
Rationale: SSRIs (such as fluoxetine) are the first-line treatment for severe PMS or PMDD due to their ability to stabilize mood and reduce irritability, depression, and anxiety.
166
A patient with endometriosis is prescribed a GnRH agonist (e.g., leuprolide). What is the expected effect of this medication?
A. Increased ovulation
B. Induction of menopause-like state
C. Reduction in blood clotting
D. Promotion of endometrial growth
B. Induction of menopause-like state
## Footnote
Rationale: GnRH agonists suppress estrogen production, leading to temporary menopause-like effects (e.g., hot flashes, bone loss), which help reduce endometrial tissue growth and pain.
166
A 16-year-old male presents with sudden-onset severe testicular pain and an absent cremasteric reflex. What is the priority nursing intervention?
A. Apply cold packs
B. Administer IV antibiotics
C. Prepare the patient for emergency surgery
D. Perform manual detorsion
C. Prepare the patient for emergency surgery
## Footnote
Rationale: Testicular torsion requires emergency surgery within 6 hours to prevent ischemia and testicular loss. The absent cremasteric reflex is a key diagnostic finding.
167
Which patient is at the highest risk for developing cervical cancer?
A. A 45-year-old with a history of uterine fibroids
B. A 30-year-old with multiple sexual partners and a history of HPV
C. A 50-year-old postmenopausal woman with no Pap smear history
D. A 35-year-old woman using oral contraceptives
B. A 30-year-old with multiple sexual partners and a history of HPV
## Footnote
Rationale: Almost all cases of cervical cancer are caused by HPV infection, particularly high-risk strains (HPV-16, HPV-18).
168
A patient with recurrent genital herpes asks how to reduce the risk of transmission to a sexual partner. What is the best response?
A. "You are only contagious when you have active lesions."
B. "Using condoms will fully prevent transmission."
C. "Daily antiviral therapy can reduce the frequency of outbreaks and transmission risk."
D. "Avoiding sex completely is the only way to prevent transmission."
C. "Daily antiviral therapy can reduce the frequency of outbreaks and transmission risk."
## Footnote
Rationale: Suppressive therapy with valacyclovir or acyclovir reduces viral shedding and decreases transmission risk, but does not completely eliminate it.
169
A patient presents with a painless genital ulcer (chancre). The nurse knows this lesion is associated with which stage of syphilis?
A. Primary
B. Secondary
C. Tertiary
D. Latent
A. Primary
## Footnote
Rationale: A painless chancre is the hallmark of primary syphilis and resolves spontaneously if untreated.
170
Which STI is known as the "silent infection" because it is often asymptomatic?
A. Gonorrhea
B. Chlamydia
C. Trichomoniasis
D. Syphilis
B. Chlamydia
## Footnote
Rationale: Chlamydia is often asymptomatic in both men and women, which increases the risk of untreated transmission and complications like pelvic inflammatory disease (PID).
