NCLEX : Other Conditions
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Example Question #11 : Identifying Other Conditions
Which of the following physical exam findings would you expect to find in a patient who overdosed on heroin?
Shallow breathing, normal respiratory rate, dilated pupils
Shallow breathing, fast respiratory rate, pin-point pupils
Shallow breathing, low respiratory rate, pin-point pupils
Deep breathing, low respiratory rate, dilated pupils
Deep breathing, fast respiratory rate, dilated pupils
Shallow breathing, low respiratory rate, pin-point pupils
Opioid (heroin) overdose is marked by a decreased respiratory drive, shallow breathing, and pin-point pupils. Treatment is with naloxone and reverses overdose quickly. Heroin overdoses can be fatal if untreated because of the respiratory depression.
Example Question #12 : Identifying Other Conditions
A patient arrives to the ER in a comatose state. He is shallowly breathing, appears disheveled, and has pin-point pupils. There are track marks on his right arm and it appears swollen. Which of the following conditions does this patient likely have?
Benzodiazepene overdose
Aspirin overdose
Anticholinergic overdose
Alcohol overdose
Opioid overdose
Opioid overdose
This patient likely has opioid (heroin) overdose. Common signs of overdose include: altered mental states, decreased respiratory rate and effort, and pin-point pupils. Treatment includes inhalation of naltrexone to remove the opioids off their receptors in the body. Additionally, track marks are a sign that the patient injects heroin.
Example Question #11 : Other Conditions
A 23 year old female comes in for urinary frequency and dysuria. This morning she noticed that her urine seemed slightly "tea" colored. On UA the nurse sees a large amount of leukocyte esterase, moderate red blood cells, and a pH of 9.5. On lab analysis a Gram-negative anaerobic bacteria with swarming motility is cultured out of her urine sample.
If the organism identified in this patient's urine sample is Proteus mirabilis, which of the following would be the appropriate treatment?
A 3 day course of either oral quinolone or trimethoprim/sulfamethoxazole (TMP/SMZ)
A 14 day course of ampicillin or cefalexin
A 10- to 21-day course of oral quinolone or trimethoprim/sulfamethoxazole (TMP/SMZ)
A 21 day course of ampicillin or cefalexin
A 3 day course of either oral quinolone or trimethoprim/sulfamethoxazole (TMP/SMZ)
The first-line treatment for uncomplicated urinary tract infection with Proteus mirabilis is a 3 day course of either oral quinolone or trimethoprim/sulfamethoxazole (TMP/SMZ). 10-21 day courses are only appropriate in patients with complicated UTI or co-infections. Ampicillin and cefalexin are poor choices for initial treatment due to a 10-20% rate of resistance in Proteus species.
Example Question #12 : Other Conditions
A 23 year old female comes in for urinary frequency and dysuria. This morning she noticed that her urine seemed slightly "tea" colored. On urinalysis the nurse sees a large amount of leukocyte esterase, moderate red blood cells, and a pH of 9.5. On lab analysis a Gram-negative anaerobic bacteria with swarming motility is cultured out of her urine sample.
This individual is most likely experiencing a urinary tract infection (UTI) due to which of the following organisms?
Staphylococcus saprophyticus
Escherichia coli
Staphylococcus aureus
Proteus mirabillis
Proteus mirabillis
While all of the organisms listed are capable of causing UTI's, Staphylococcus species are all Gram-positive. Escherichia coli, while responsible for 75-95% of all UTI's, would not result in a urinary pH of 9.5. The high alkalinity of this patient's urine suggest a urea-splitting bacteria such as Proteus.
Example Question #15 : Identifying Other Conditions
A 23 year old female comes in for urinary frequency and dysuria. This morning she noticed that her urine seemed slightly "tea" colored. On UA the nurse sees a large amount of leukocyte esterase, moderate red blood cells, and a pH of 9.5. On lab analysis a Gram-negative anaerobic bacteria with swarming motility is cultured out of her urine sample.
In the case of chronic Proteus mirabilis infection, which of the following is a common sequelae?
Infertility
Pelvic inflammatory disease (PID)
Renal calculi
Bladder cancer
Renal calculi
Due to its production of urease, Proteus mirabilis infection results in alkalinization of urine (as urease hydrolyzes urea to produce ammonia). This can cause the formation of calcium, struvite, or apatite crystals in the urine, which may form renal calculi.
P. mirabilis is not associated with increased risk for infertility, PID, or bladder cancer.
Example Question #16 : Other Conditions
You are the nurse taking care of a 21-year old female who complains of two days dysuria, that over the last 24 hours has been accompanied by fever, chills, and lower back pain. Her physical exam is remarkable for right-sided costovertebral angle tenderness. Which of the following is the most likely diagnosis?
Pneumothorax
Spinal stenosis
Genital herpes
Pyelonephritis
Primary syphilis
Pyelonephritis
The correct answer is "pyelonephritis." This is the correct answer because the patient's presentation with dysuria that progresses to include fever, chills, and lower back pain, is a very classic presentation of pyelonephritis. Pyelonephritis is an infection of the renal parenchyma, most commonly due to an ascending urinary tract infection. In this patient, who is a female (which places her at a greater risk for UTI's as compared to males due to females having shorter urethras than males) who initially has dysuria, this is a convincing story for a UTI. Further, the fact that the symptoms of fever, chills, and lower back pain are not present initially with the dysuria, but develop over the next day, is further evidence that pyelonephritis is the likely diagnosis. The physical exam finding of unilateral costovertebral angle tenderness also is highly suggestive of pyelonephritis.
The other choices are incorrect. Spinal stenosis is not a common diagnosis in young, otherwise healthy patients, and would not account for dysuria and unilteral costovertebral angle tenderness. A pneumothorax would not cause dysuria and would likely present with shortness of breath. Primary syphilis and genital herpes would not account for dysuria, lower back pain, or costovertebral angle tenderness.
Example Question #941 : Nclex
A 32-year old male presents to his primary care physician's office complaining of a 2-cm painless chancre on the glans of his penis. He denies any other bodily aches or pains, any penile discharge, dysuria, fevers, chills, or other skin rashes. Which of the following is the most likely diagnosis?
Chlamydia
Urinary tract infection
Gonorrhea
Genital herpes
Primary syphilis
Primary syphilis
The correct answer is "primary syphilis." This is the correct answer as the classic presentation of primary syphilis is a painless chancre found on the base, shaft, or glans of the penis. The other choices are incorrect. A urinary tract infection would not present with a chancre, and would typically present with dysuria. Chlamydia or gonorrhea would typically present with penile discharge in males, not a painless chancre. Genital herpes would typically present with one or multiple painful ulcers on the penis, not a single painless chancre.
Example Question #13 : Other Conditions
Example Question #14 : Other Conditions
Example Question #1 : Causes And Treatments Of Other Conditions
Which of the following is considered to be a normal age-related ocular degeneration?
Glaucoma
Presbyopia
Blepharitis
Cataracts
Presbyopia
Presbyopia, or farsightedness, is caused by a loss of elasticity in the lens of the eye, and is considered a normal change with aging.
Glaucoma, blepharitis, and cataracts all carry increased risk with advanced age, but are considered to be abnormal and/or pathological changes.
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