Clinical 3 Review Final

1- Which HPV strains are oncogenic and cause the majority of cervical cancer cases?. A.HPV 6 and HPV 11. B.HPV 16 and HPV 18. C.HPV 2 and HPV 4. D.HPV 40 and HPV 51.

2- A 25-year-old woman with hirsutism, obesity, and oligomenorrhea is diagnosed with PCOS. A woman with PCOS is at higher risk for all of the following except?. A.Cervical cancer and atrophic vaginitis. B.Endometrial cancer and infertility. C.Type 2 diabetes and heart disease. D.Obesity and nonalcoholic fatty liver disease.

3- A 21-year-old woman complains of left-sided pelvic pain accompanied by dyspareunia. During the gynecologic exam, the nurse practitioner notices green cervical discharge. The patient mentions a new onset of a painful and swollen left knee and denies a history of trauma. This best describes: A.Septic arthritis. B.Reiter’s syndrome. C.Chondromalacia of the patella. D.Disseminated gonorrheal infection.

4- A male patient presents with reports of urethritis, migratory arthritis in the large joints, and ulcers on the glans penis secondary to a chlamydial infection. The nurse practitioner will implement all of the following interventions, except: A.Treat with nonsteroidal anti-inflammatory drugs (NSAIDs). B.Prescribe antibiotics to treat infection. C.Treat with alpha-linolenic acid (LNA). D.Recommend rest and comfort measures.

5- A 30-year-old male with a history of HIV infection has been on antiretroviral therapy (ART) since diagnosis at age 28 years. Which of the following indicates that the patient’s immune system is responding to ART?. A.The HIV viral load is higher compared with the previous test. B.The CD4 count is higher than the previous test. C.The CBC shows an increase in the leukocyte count. D.HIV genetic testing of the patient’s HIV strain shows that it is sensitive to current HIV regimen.

6- A middle-aged man who is homeless reports to the local public health clinic complaining of a painless and shallow ulcer on the penile shaft for the past 2 weeks. He is sexually active and had unprotected intercourse with two male partners over the past few months. The patient is tested for HIV, syphilis, gonorrhea, hepatitis B, and herpes types 1 and 2. The syphilis and HIV tests are both positive. The gonorrhea, hepatitis B, and herpes tests are negative. The nurse practitioner is aware of the nationally notifiable infectious conditions. Which of the following is true regarding the reporting of any of these sexually transmitted infections?. A.Healthcare providers must obtain the patient’s permission before reporting the positive HIV and syphilis test results to the local public health department. B.The nurse practitioner should obtain the patient’s and sexual partner’s permission before reporting the positive test results to the local health department. C.Healthcare providers are mandated by law to report certain types of diseases to the local health department even if the patient does not give permission. D.The nurse practitioner should consult with the supervising physician about this issue.

7- The Jarisch–Herxheimer reaction is a response to treatment of which of the following organisms?. A.Neisseria gonorrhoeae. B.Chlamydia trachomatis. C.Treponema pallidum. D.Rickettsia rickettsii.

8- A sexually active young adult is diagnosed with Chlamydia trachomatis and treated with doxycycline 100 mg BID 7 days. During a follow-up visit, the patient reports a new onset of right upper quadrant pain and tenderness on palpation. Alanine aminotransferase (ALT) is 43 U/L, and aspartate aminotransferase (AST) is 24 U/L. The nurse practitioner suspects: A.Jarisch–Herxheimer reaction. B.Reiter’s syndrome. C.Stevens–Johnson syndrome. D.Fitz-Hugh–Curtis syndrome.

9- A 21-year-old woman complains of left-sided pelvic pain accompanied by dyspareunia. During the gynecologic exam, the nurse practitioner notices green cervical discharge. The patient mentions a new onset of a painful and swollen left knee and denies a history of trauma. This best describes: A.Septic arthritis. B.Reiter’s syndrome. C.Chondromalacia of the patella. D.Disseminated gonorrheal infection.

10- A sexually active 16-year-old with cervicitis is tested for gonorrhea and chlamydia. The NAAT test result shows that the patient is positive for gonorrhea. Which of the following is appropriate treatment for this patient?. A.Cephalosporin. B.Cephalosporin and macrolide. C.Tetracycline. D.Tetracycline and sulfonamide.

33. The Jarisch-Herxheimer reaction is a response to treatment of which of the following organisms?. A. Neisseria gonorrhoea. B. Chlamydia trachomatis. C. Treponema pallidum. D. Rickettsia rickettsii.

Signs of primary Syphilis. A- Painless chancre (heals in 6–9 weeks if not treated). B- Condyloma lata (infectious white papules [that look like white warts] in moist areas). C- Asymptomatic but will have positive titers. D- Neurosyphilis, gumma (soft tissue tumors), aneurysms, valvular damage.

Recommendations for Cytology 30-65 years old. No screening. Cytology alone every 3 years. No screening in history on individuals with a prior history of precancerous cancer. No screening after prior negative results. Cytology alone every 3 years, or hrHPV testing every 5 years, or both.

12- All of the following vaccines are contraindicated in pregnant women except: A) Influenza. B) Mumps. C) Varicella. D) Rubella.

13- Hegar’s sign is considered a: A) Positive sign of pregnancy. B) Probable sign of pregnancy. C) Presumptive sign of pregnancy. D) Problem in pregnancy.

14- Treatment for mild preeclampsia includes all of the following, except: A) Bed rest except for bathroom privileges. B) Close monitoring of weight and blood pressure. C) Close follow-up of urinary protein, serum creatinine, and platelet count. D) A prescription of methyldopa (Aldomet) to control blood pressure.

15- Treatment for mild preeclampsia includes all of the following, except: A. Bed rest with bathroom privileges. B. Close monitoring of weight and blood pressure. C. Close follow-up of urinary protein, serum creatinine, and platelet count. D. A prescription of methyldopa (Aldomet) to control blood pressure.

16- You note the following result on a routine urinalysis of a 37-year-old primigravida who is at 30 weeks’ gestation: leukocyte = trace, nitrite = negative, protein = 2+, blood = negative. Her weight has increased by 5 lb during the past week. Which of the following is most likely?. A. HELLP syndrome. B. Pregnancy-induced hypertension (preeclampsia). C. Eclampsia of pregnancy. D. Primary hypertension.

17- A 38-year-old patient who is 3 weeks postpartum presents for follow-up and reports frequent headaches and intermittent blurred vision when arising in the morning. Her blood pressure is 128/86 mmHg in the left arm and 122/78 mmHg in the right arm. The next day, the patient returns with worsening headaches and a 2-pound weight gain in 3 days. Her blood pressure is now 156/92 mmHg in the left arm and 148/94 mmHg in the right arm. Which diagnosis is most likely?. A. Pregnancy-induced hypertension. B. Preexisting chronic hypertension. C. Eclampsia. D. Migraine headaches.

18- Among patients with nephrolithiasis, what is the most common type of kidney stone?. A. Struvite. B. Cystine. C. Calcium oxalate. D. Uric acid.

19- A patient presents with acute renal colic pain and hematuria. The patient denies nausea, vomiting, and dysuria. Serum creatinine level is 0.8 mg/dL. The patient is afebrile, and urinalysis is unremarkable. Imaging indicates a stone of 5 mm. What is the priority intervention for management of this patient?. A. Analgesia and hydration. B. Urologic consultation. C. Administration of tamsulosin 0.4 mg once daily. D. Initiation of antibiotics.

20- Which of the following presentations warrants a nephrology consultation in a patient with newly identified chronic kidney disease (CKD)?. A. Pregnant adult female patient with no comorbidities. B. Patient with hypertension that is reactive to treatment therapy. C. Patient with diabetes mellitus and hemoglobin A1C of 6%. D. Patient with family history of systemic autoimmune disease.

21- What sign or symptom suggests the possibility of an uncomplicated urinary tract infection (UTI)?. A. Fever. B. Flank pain. C. Costovertebral angle tenderness. D. Dysuria.

22- A new patient, a 54-year-old male athlete with a history of hyperlipidemia, is seen for new onset of generalized myalgia, muscle weakness, oliguria, and tea-colored urine for the past 24 hours. He recently completed running a marathon. He is on a statin and reports taking ibuprofen several times to treat the muscle pain. Which diagnosis is most likely?. A. Hyperthyroidism. B. Rhabdomyolysis. C. Pyelonephritis. D. Viral influenza.

23- Which of the following conditions would most likely contribute to acute tubular necrosis (ATN)?. A. Neurogenic bladder from spinal cord injury. B. Urethral stricture. C. Benign prostatic hyperplasia. D. Sepsis.

24- The nurse practitioner is providing education to a female patient on avoiding urinary tract infection (UTI). The patient requires additional education if they identify what factor as a risk factor for UTI?. A. Recent sexual intercourse. B. Previous pregnancy. C. Low fluid intake. D. Spermicide use.

25- Which of the following symptoms prompts further evaluation in a patient with chronic kidney disease?. A. Edema. B. Hypertension. C. Weakness/fatigue. D. New-onset oliguria.

27- The most frequent cause of acute complicated urinary tract infection (UTI) is: A. Escherichia coli. B. Klebsiella. C. Methicillin-sensitive Staphylococcus aureus (MSSA). D. Methicillin-resistant Staphylococcus aureus (MRSA).

26- A patient presents complaining of edema and decreased urine output after taking a prescribed aminoglycoside as an antibacterial agent for a complicated urinary tract infection (UTI) for the past 3 weeks. The nurse practitioner is concerned for which type of kidney injury?. A. Prerenal. B. Chronic kidney disease stage 1. C. Postrenal. D. Acute tubular necrosis.

27- A patient presents with acute renal colic pain, hematuria, nausea, and vomiting. Based on these symptoms, which of the following tests is the preferred imaging to confirm the diagnosis?. A. Ultrasound of the kidneys and bladder. B. Abdominal radiography. C. CT of the abdomen and pelvis without contrast. D. Intravenous pyelography.

29- Which of the following is a cause of prerenal disease in acute kidney injury?. A. Nephrotoxic agents. B. Dehydration. C. Renal calculi. D. Benign prostatic hypertrophy.

30- Which of the following is considered the best overall measure of kidney function and is used to stage chronic kidney disease?. A. Creatinine clearance. B. Glomerular filtration rate (GFR). C. Blood urea nitrogen (BUN). D. Serum creatinine.

31- A 55-year-old female patient presents with symptoms of a urinary tract infection (UTI). A clean catch midstream urine specimen is obtained and sent to the laboratory for culture and sensitivity (C&S) testing. Which of the following results is indicative of an uncomplicated UTI?. A. 105 CFU/mL of one organism. B. 105 CFU/mL of one or more organisms. C. 103 CFU/mL of Enterobacteriaceae. D. 103 CFU/mL of gram-negative Enterobacteriaceae.

33- A new patient, a 54-year-old male athlete with a history of hyperlipidemia, is seen for new onset of generalized myalgia, muscle weakness, oliguria, and tea-colored urine for the past 24 hours. He recently completed running a marathon. He is on a statin and reports taking ibuprofen several times to treat the muscle pain. Which diagnosis is most likely?. A. Hyperthyroidism. B. Rhabdomyolysis. C. Pyelonephritis. D. Viral influenza.

34- Which of the following conditions would most likely contribute to acute tubular necrosis (ATN)?. A. Neurogenic bladder from spinal cord injury. B. Urethral stricture. C. Benign prostatic hyperplasia. D. Sepsis.

36- A sexually active 16-year-old with cervicitis is tested for gonorrhea and chlamydia. The NAAT test result shows that the patient is positive for gonorrhea. Which of the following is appropriate treatment for this patient?. A. Cephalosporin. B. Cephalosporin and macrolide. C. Tetracycline. D. Tetracycline and sulfonamide.

37- A sexually active adult female presents to the clinic complaining of genital ulcers. Upon examination, white wartlike papules are found in the inguinal area and a maculopapular rash is noted on the palms and soles of the feet. The nurse practitioner will order: A. Gram stain. B. Rapid plasma reagin test. C. Nucleic acid amplification test (NAAT). D. HIV-1/HIV-2 antibody and P24 antigen test.

38- A 32-year-old sexually active female is diagnosed with bacterial vaginosis based on findings of copious milklike vaginal discharge. Speculum exam reveals gray/white discharge on the vaginal walls and fishlike odor based on the whiff test. The patient will be treated with a 5-day course of metronidazole vaginal gel, one application at bedtime, and advised to do which of the following?. A. Douche after intercourse. B. Ensure that sexual partner is seen and treated. C. Abstain from sexual intercourse during treatment. D. Use a condom during sexual intercourse.