NURS 6531 Final Exam 3 2025/26 Questions and answers !% I !% I !% I !% I !% I !% I !% I !% I
With complete solution !% I !% I !% I
The daughter of an elderly confused patient reports that her parent is having urinary
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
incontinence several times each day. What will the provider do initially? a. Obtain a
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
urine sample for urinalysis (UA) and possible culture
!% I !% I !% I !% I !% I !% I !% I !% I
b. Order serum creatinine and blood urea nitrogen tests !% I !% I !% I !% I !% I !% I !% I
c. Perform a bladder scan to determine distention and retention !% I !% I !% I !% I !% I !% I !% I !% I
d. Tell the daughter that this is expected given her mother's age and confusion - ANS: A When
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
incontinence occurs, UA is performed initially to exclude hematuria, pyuria, glucosuria, or
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
proteinuria and possible infection. Serum creatinine and BUN may be performed if renal
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
disease is suspected. Bladder scans may be performed if the UA is normal to evaluate
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
physiologic causes. It is not correct to offer reassurance without ruling out other causes.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
The provider is evaluating a patient for potential causes of urinary incontinence and
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
performs a postvoid residual (PVR) test which yields 30 mL of urine. What is the
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
interpretation of this
!% I !% I !% I
result?
a. The patient may have overflow incontinence. !% I !% I !% I !% I !% I
b. The patient probably has a urinary tract infection (UTI).
!% I !% I !% I !% I !% I !% I !% I !% I
c. This is a normal result. !% I !% I !% I !% I
d. This represents incomplete emptying. - ANS: C !% I !% I !% I !% I !% I !% I
A PVR less than 50 mL is considered normal and this result does not indicate any
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
abnormality.
!% I
The provider is counseling a patient who has stress incontinence about ways to minimize
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
accidents. What will the provider suggest initially? a. Increasing fluid intake to dilute the
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
urine
!% I
b. Referral to a physical therapist !% I !% I !% I !% I
c. Taking pseudoephedrine daily !% I !% I
d. Voiding every 2 hours during the day - ANS: D !% I !% I !% I !% I !% I !% I !% I !% I !% I
Timed voiding is useful to help minimize stress incontinence and is used initially. Increasing
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
fluid intake will increase symptoms. PT referral may be done if other measures fail to help
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
with exercises to strengthen the pelvic floor muscles. Pseudoephedrine is useful, but not an
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
initial therapy.
!% I !% I
,An older male patient reports urinary frequency, back pain, and nocturia. A dipstick
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
urinalysis reveals hematuria. What will the provider do next to evaluate this condition? a.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Order a PSA and perform a digital rectal exam (DRE)
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Refer for a biopsy !% I !% I !% I
c. Refer the patient to a urologist !% I !% I !% I !% I !% I
d. Schedule a transurethral ultrasound (TRUS) - ANS: A !% I !% I !% I !% I !% I !% I !% I
Patients with symptoms of potential prostate cancer should be screened with PSA and DRE.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Referral to a urologist is the next step even with normal findings, since PSA is occasionally
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
normal. The urologist may order TRUS or biopsy.
!% I !% I !% I !% I !% I !% I !% I !% I
An older male patient has a screening prostate-specific antigen (PSA) which is 12 ng/mL.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
What does this value indicate? a. !% I !% I !% I !% I !% I
A normal result
!% I !% I !% I
b. Benign prostatic hypertrophy !% I !% I
c. Early prostate cancer !% I !% I
d. Prostate cancer - ANS: D !% I !% I !% I !% I
A PSA greater than 10 ng/mL suggests prostate cancer. A level between 4 and 10 ng/mL may
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
be early prostate cancer or a benign condition. A level less than 4 ng/mL is normal.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
A patient is diagnosed with prostate cancer and diagnostic testing reveals disease that has
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
gone past the prostatic capsule without evidence of metastasis. The patient does not wish to
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
undergo treatment. What will the provider tell this patient?
!% I !% I !% I !% I !% I !% I !% I !% I !% I
a. Chemotherapy is indicated to provide cure for this cancer. !% I !% I !% I !% I !% I !% I !% I !% I
b. Monitoring prostate-specific antigen (PSA) with regular digital rectal examination (DRE) !% I !% I !% I !% I !% I !% I !% I !% I !% I
is an acceptable option.
!% I !% I !% I !% I
c. Palliative radiation therapy is necessary to improve quality of life. !% I !% I !% I !% I !% I !% I !% I !% I !% I
d. This level of disease requires intervention with hormonal therapy. - ANS: B This patient
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
has stage T2 prostate cancer which may be managed with watchful waiting which includes
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
PSA and DRE evaluation. Chemotherapy, palliative radiation therapy, and hormonal
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
therapy are not required.
!% I !% I !% I !% I
A male patient reports nocturia and daytime urinary frequency and urgency without
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
changes in the force of the urine stream. What is the likely cause of this? a. Bladder
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
outlet obstruction
!% I !% I
b. Lower urinary tract symptoms (LUTS) !% I !% I !% I !% I
c. Prostate cancer !% I
d. Urinary tract infection (UTI) - ANS: B !% I !% I !% I !% I !% I !% I
,Lower urinary tract symptoms (LUTS) result from irritative changes in the lower tract.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Bladder outlet obstruction causes hesitancy, decreased caliber and force of the urine stream,
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
and postvoid dribbling. Diagnosis of prostate cancer and UTI require further testing and are
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
less likely causes.
!% I !% I !% I
A 70-year-old male reports urinary hesitancy, postvoid dribbling, and a diminished urine
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
stream. A digital rectal exam (DRE) reveals an enlarged prostate gland that feels rubbery
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
and smooth. Which tests will the primary care provider order based on these findings? a.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Bladder scan for postvoid residual
!% I !% I !% I !% I !% I
b. Prostate-specific antigen (PSA) and bladder imaging !% I !% I !% I !% I !% I
c. Urinalysis and serum creatinine !% I !% I !% I
d. Urine culture and CBC with differential - ANS: C !% I !% I !% I !% I !% I !% I !% I !% I
The DRE reveals a prostate gland consistent with benign prostatic hyperplasia (BPH). The
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
primary provider should order a urinalysis and creatinine to evaluate possible infection and
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
renal function. A bladder scan is ordered at the discretion of the urologist. The prostate exam
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
isn't consistent with prostate cancer, so PSA and bladder imaging are not necessary.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Symptoms of prostatitis would indicate a need for evaluation of possible infection.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
A patient has been taking terazosin daily at bedtime to treat benign prostatic hyperplasia
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
(BPH) and reports persistent daytime dizziness. What will the provider do? a. Prescribe
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
finasteride instead of terazosin
!% I !% I !% I !% I
b. Recommend taking the medication in the morning !% I !% I !% I !% I !% I !% I
c. Suggest using herbal preparations !% I !% I !% I
d. Switch the prescription to doxazosin - ANS: A !% I !% I !% I !% I !% I !% I !% I
Patients who cannot tolerate the side effect of alpha-adrenergic antagonists, the provider may
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
initiate therapy with a 5a-reductase inhibitor such as finasteride. Terazosin should be given
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
at bedtime to minimize these adverse effects. Herbal preparations have not been proven to be
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
safe or effective. Doxazosin is in the same drug class as terazosin.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
A pregnant woman at 30 weeks gestation presents with proteinuria. What will the provider do
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
next?
!% I
a. Evaluate her blood pressure and discuss with OB/GYN !% I !% I !% I !% I !% I !% I !% I
b. Monitor serum glucose for gestational diabetes !% I !% I !% I !% I !% I
c. Perform a 24-hour urine collection !% I !% I !% I !% I
d. Reassure her that this normal at this stage of pregnancy - ANS: A !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Proteinuria after 24 weeks gestation is usually a sign of preeclampsia, so her blood pressure !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
should be evaluated and discussed with the OB/GYN. Serum glucose evaluation for
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
gestational diabetes is performed as part of routine screening but is not related to the finding
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
of proteinuria. A 24-hour urine collection is not indicated.
!% I !% I !% I !% I !% I !% I !% I !% I !% I
, An older male patient reports gross hematuria but denies flank pain and fever. What will
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
the provider do to manage this patient? a. Monitor blood pressure closely
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Obtain a urine culture !% I !% I !% I
c. Perform a 24-hour urine collection !% I !% I !% I !% I
d. Refer for cystoscopy and imaging - Gross hematuria in older men denotes a significant risk
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
of malignant disease, so cystoscopy and imaging are indicated. Proteinuria is concerning
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
for hypertension. The patient does not have flank pain or fever, so the likelihood of
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
infection is lower. A 24-hour urine collection is not indicated.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
A female patient reports hematuria and a urine dipstick and culture indicate a urinary tract
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
infection. After treatment for the urinary tract infection (UTI), what testing is indicated for
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
this patient?
!% I !% I
a. 24-hour urine collection to evaluate for glomerulonephritis !% I !% I !% I !% I !% I !% I
b. Bladder scan !% I
c. Repeat urinalysis !% I
d. Voiding cystourethrogram - ANS: C !% I !% I !% I !% I
After treatment has been completed, repeated urinalysis is necessary to ensure that the
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
hematuria has resolved. Failure to follow hematuria to resolution may result in failure to
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
diagnose a serious condition.
!% I !% I !% I !% I
Which is a prerenal cause of acute kidney injury (AKI)? a. !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Hemorrhagic shock
!% I !% I
b. Hydronephrosis
c. Hypertension
d. Renal calculi - ANS: A !% I !% I !% I !% I
Hemorrhagic shock interferes with perfusion of the kidney, which is a prerenal cause of AKI. !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Hydronephrosis and renal calculi are postrenal causes leading to obstruction to renal pelvis,
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
ureters, bladder, or urethra. Hypertension is an intrinsic cause.
!% I !% I !% I !% I !% I !% I !% I !% I !% I
A primary care provider sees a new patient who reports having a diagnosis of chronic kidney
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
disease for several years. The patient is taking one medication for hypertension which has
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
been prescribed since the diagnosis was made. The provider orders laboratory tests to
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
evaluate the status of this patient. Which laboratory finding indicates a need to refer the
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
patient to a nephrologist?
!% I !% I !% I !% I
a. Albumin/creatinine ratio (ACR) of 325 mg/g !% I !% I !% I !% I !% I
b. Blood pressure of 145/85 mm Hg !% I !% I !% I !% I !% I
c. Glomerular filtration rate (eGFR) of 35 !% I !% I !% I !% I !% I
d. Urine red blood cell (RBC) count of 15/hpf - ANS: A !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
With complete solution !% I !% I !% I
The daughter of an elderly confused patient reports that her parent is having urinary
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
incontinence several times each day. What will the provider do initially? a. Obtain a
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
urine sample for urinalysis (UA) and possible culture
!% I !% I !% I !% I !% I !% I !% I !% I
b. Order serum creatinine and blood urea nitrogen tests !% I !% I !% I !% I !% I !% I !% I
c. Perform a bladder scan to determine distention and retention !% I !% I !% I !% I !% I !% I !% I !% I
d. Tell the daughter that this is expected given her mother's age and confusion - ANS: A When
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
incontinence occurs, UA is performed initially to exclude hematuria, pyuria, glucosuria, or
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
proteinuria and possible infection. Serum creatinine and BUN may be performed if renal
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
disease is suspected. Bladder scans may be performed if the UA is normal to evaluate
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
physiologic causes. It is not correct to offer reassurance without ruling out other causes.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
The provider is evaluating a patient for potential causes of urinary incontinence and
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
performs a postvoid residual (PVR) test which yields 30 mL of urine. What is the
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
interpretation of this
!% I !% I !% I
result?
a. The patient may have overflow incontinence. !% I !% I !% I !% I !% I
b. The patient probably has a urinary tract infection (UTI).
!% I !% I !% I !% I !% I !% I !% I !% I
c. This is a normal result. !% I !% I !% I !% I
d. This represents incomplete emptying. - ANS: C !% I !% I !% I !% I !% I !% I
A PVR less than 50 mL is considered normal and this result does not indicate any
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
abnormality.
!% I
The provider is counseling a patient who has stress incontinence about ways to minimize
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
accidents. What will the provider suggest initially? a. Increasing fluid intake to dilute the
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
urine
!% I
b. Referral to a physical therapist !% I !% I !% I !% I
c. Taking pseudoephedrine daily !% I !% I
d. Voiding every 2 hours during the day - ANS: D !% I !% I !% I !% I !% I !% I !% I !% I !% I
Timed voiding is useful to help minimize stress incontinence and is used initially. Increasing
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
fluid intake will increase symptoms. PT referral may be done if other measures fail to help
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
with exercises to strengthen the pelvic floor muscles. Pseudoephedrine is useful, but not an
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
initial therapy.
!% I !% I
,An older male patient reports urinary frequency, back pain, and nocturia. A dipstick
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
urinalysis reveals hematuria. What will the provider do next to evaluate this condition? a.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Order a PSA and perform a digital rectal exam (DRE)
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Refer for a biopsy !% I !% I !% I
c. Refer the patient to a urologist !% I !% I !% I !% I !% I
d. Schedule a transurethral ultrasound (TRUS) - ANS: A !% I !% I !% I !% I !% I !% I !% I
Patients with symptoms of potential prostate cancer should be screened with PSA and DRE.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Referral to a urologist is the next step even with normal findings, since PSA is occasionally
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
normal. The urologist may order TRUS or biopsy.
!% I !% I !% I !% I !% I !% I !% I !% I
An older male patient has a screening prostate-specific antigen (PSA) which is 12 ng/mL.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
What does this value indicate? a. !% I !% I !% I !% I !% I
A normal result
!% I !% I !% I
b. Benign prostatic hypertrophy !% I !% I
c. Early prostate cancer !% I !% I
d. Prostate cancer - ANS: D !% I !% I !% I !% I
A PSA greater than 10 ng/mL suggests prostate cancer. A level between 4 and 10 ng/mL may
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
be early prostate cancer or a benign condition. A level less than 4 ng/mL is normal.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
A patient is diagnosed with prostate cancer and diagnostic testing reveals disease that has
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
gone past the prostatic capsule without evidence of metastasis. The patient does not wish to
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
undergo treatment. What will the provider tell this patient?
!% I !% I !% I !% I !% I !% I !% I !% I !% I
a. Chemotherapy is indicated to provide cure for this cancer. !% I !% I !% I !% I !% I !% I !% I !% I
b. Monitoring prostate-specific antigen (PSA) with regular digital rectal examination (DRE) !% I !% I !% I !% I !% I !% I !% I !% I !% I
is an acceptable option.
!% I !% I !% I !% I
c. Palliative radiation therapy is necessary to improve quality of life. !% I !% I !% I !% I !% I !% I !% I !% I !% I
d. This level of disease requires intervention with hormonal therapy. - ANS: B This patient
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
has stage T2 prostate cancer which may be managed with watchful waiting which includes
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
PSA and DRE evaluation. Chemotherapy, palliative radiation therapy, and hormonal
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
therapy are not required.
!% I !% I !% I !% I
A male patient reports nocturia and daytime urinary frequency and urgency without
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
changes in the force of the urine stream. What is the likely cause of this? a. Bladder
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
outlet obstruction
!% I !% I
b. Lower urinary tract symptoms (LUTS) !% I !% I !% I !% I
c. Prostate cancer !% I
d. Urinary tract infection (UTI) - ANS: B !% I !% I !% I !% I !% I !% I
,Lower urinary tract symptoms (LUTS) result from irritative changes in the lower tract.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Bladder outlet obstruction causes hesitancy, decreased caliber and force of the urine stream,
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
and postvoid dribbling. Diagnosis of prostate cancer and UTI require further testing and are
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
less likely causes.
!% I !% I !% I
A 70-year-old male reports urinary hesitancy, postvoid dribbling, and a diminished urine
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
stream. A digital rectal exam (DRE) reveals an enlarged prostate gland that feels rubbery
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
and smooth. Which tests will the primary care provider order based on these findings? a.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Bladder scan for postvoid residual
!% I !% I !% I !% I !% I
b. Prostate-specific antigen (PSA) and bladder imaging !% I !% I !% I !% I !% I
c. Urinalysis and serum creatinine !% I !% I !% I
d. Urine culture and CBC with differential - ANS: C !% I !% I !% I !% I !% I !% I !% I !% I
The DRE reveals a prostate gland consistent with benign prostatic hyperplasia (BPH). The
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
primary provider should order a urinalysis and creatinine to evaluate possible infection and
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
renal function. A bladder scan is ordered at the discretion of the urologist. The prostate exam
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
isn't consistent with prostate cancer, so PSA and bladder imaging are not necessary.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Symptoms of prostatitis would indicate a need for evaluation of possible infection.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
A patient has been taking terazosin daily at bedtime to treat benign prostatic hyperplasia
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
(BPH) and reports persistent daytime dizziness. What will the provider do? a. Prescribe
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
finasteride instead of terazosin
!% I !% I !% I !% I
b. Recommend taking the medication in the morning !% I !% I !% I !% I !% I !% I
c. Suggest using herbal preparations !% I !% I !% I
d. Switch the prescription to doxazosin - ANS: A !% I !% I !% I !% I !% I !% I !% I
Patients who cannot tolerate the side effect of alpha-adrenergic antagonists, the provider may
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
initiate therapy with a 5a-reductase inhibitor such as finasteride. Terazosin should be given
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
at bedtime to minimize these adverse effects. Herbal preparations have not been proven to be
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
safe or effective. Doxazosin is in the same drug class as terazosin.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
A pregnant woman at 30 weeks gestation presents with proteinuria. What will the provider do
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
next?
!% I
a. Evaluate her blood pressure and discuss with OB/GYN !% I !% I !% I !% I !% I !% I !% I
b. Monitor serum glucose for gestational diabetes !% I !% I !% I !% I !% I
c. Perform a 24-hour urine collection !% I !% I !% I !% I
d. Reassure her that this normal at this stage of pregnancy - ANS: A !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Proteinuria after 24 weeks gestation is usually a sign of preeclampsia, so her blood pressure !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
should be evaluated and discussed with the OB/GYN. Serum glucose evaluation for
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
gestational diabetes is performed as part of routine screening but is not related to the finding
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
of proteinuria. A 24-hour urine collection is not indicated.
!% I !% I !% I !% I !% I !% I !% I !% I !% I
, An older male patient reports gross hematuria but denies flank pain and fever. What will
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
the provider do to manage this patient? a. Monitor blood pressure closely
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Obtain a urine culture !% I !% I !% I
c. Perform a 24-hour urine collection !% I !% I !% I !% I
d. Refer for cystoscopy and imaging - Gross hematuria in older men denotes a significant risk
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
of malignant disease, so cystoscopy and imaging are indicated. Proteinuria is concerning
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
for hypertension. The patient does not have flank pain or fever, so the likelihood of
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
infection is lower. A 24-hour urine collection is not indicated.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
A female patient reports hematuria and a urine dipstick and culture indicate a urinary tract
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
infection. After treatment for the urinary tract infection (UTI), what testing is indicated for
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
this patient?
!% I !% I
a. 24-hour urine collection to evaluate for glomerulonephritis !% I !% I !% I !% I !% I !% I
b. Bladder scan !% I
c. Repeat urinalysis !% I
d. Voiding cystourethrogram - ANS: C !% I !% I !% I !% I
After treatment has been completed, repeated urinalysis is necessary to ensure that the
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
hematuria has resolved. Failure to follow hematuria to resolution may result in failure to
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
diagnose a serious condition.
!% I !% I !% I !% I
Which is a prerenal cause of acute kidney injury (AKI)? a. !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Hemorrhagic shock
!% I !% I
b. Hydronephrosis
c. Hypertension
d. Renal calculi - ANS: A !% I !% I !% I !% I
Hemorrhagic shock interferes with perfusion of the kidney, which is a prerenal cause of AKI. !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Hydronephrosis and renal calculi are postrenal causes leading to obstruction to renal pelvis,
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
ureters, bladder, or urethra. Hypertension is an intrinsic cause.
!% I !% I !% I !% I !% I !% I !% I !% I !% I
A primary care provider sees a new patient who reports having a diagnosis of chronic kidney
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
disease for several years. The patient is taking one medication for hypertension which has
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
been prescribed since the diagnosis was made. The provider orders laboratory tests to
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
evaluate the status of this patient. Which laboratory finding indicates a need to refer the
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
patient to a nephrologist?
!% I !% I !% I !% I
a. Albumin/creatinine ratio (ACR) of 325 mg/g !% I !% I !% I !% I !% I
b. Blood pressure of 145/85 mm Hg !% I !% I !% I !% I !% I
c. Glomerular filtration rate (eGFR) of 35 !% I !% I !% I !% I !% I
d. Urine red blood cell (RBC) count of 15/hpf - ANS: A !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
