Getting the Information
A 24-year-old patient reports lower abdominal pain, fever, and new purulent vaginal discharge. Which additional finding most strongly supports pelvic inflammatory disease (PID)?
A. Painless genital lesion
B. Cervical motion tenderness
C. Hot flashes
D. Stress urinary incontinence
B. Cervical motion tenderness
A patient has recurrent painful grouped genital vesicles. Which condition best explains the findings?
A. HPV
B. HSV-2
C. PCOS
D. Vulvovaginal candidiasis
B. HSV-2
Which patient should the nurse assess FIRST?
A. Patient with PCOS asking about fertility
B. Patient with uncomplicated candidiasis reporting itching
C. Patient with suspected ectopic pregnancy reporting sudden severe abdominal pain and dizziness
D. Patient with fibroids reporting chronic heavy periods
C. Patient with suspected ectopic pregnancy reporting sudden severe abdominal pain and dizziness
A patient with uncomplicated vulvovaginal candidiasis asks what action is appropriate. Which response is best?
A. Complete the prescribed antifungal therapy
B. Stop medication as soon as itching improves
C. Begin leftover antibiotics
D. Douche daily until symptoms resolve
A. Complete the prescribed antifungal therapy
A patient treated for a UTI reports less dysuria and urinary frequency and remains afebrile. How should the nurse interpret this?
A. Improving
B. Declining
C. Unchanged
D. Developing kidney failure
A. Improving
Linda Chen, age 69, is admitted with fever, right flank pain, nausea, and increasing weakness. She has a history of recurrent kidney stones. On arrival: T 102.8°F, HR 112/min, BP 102/64 mmHg, RR 22/min. She has right CVA tenderness. Urinalysis shows positive leukocyte esterase, positive nitrites, pyuria, and hematuria. WBC is 17,800/mm³ and creatinine is 1.8 mg/dL.
Two hours later, Linda becomes restless and confused. T 103.2°F, HR 128/min, BP 84/48 mmHg, RR 26/min, and urine output has fallen to 15 mL/hr. CT shows an obstructing ureteral stone with hydronephrosis.
Identify FOUR priority cues that show Linda is deteriorating.
Priority cues may include hypotension, tachycardia, new confusion/restlessness, fever, oliguria, elevated WBC/creatinine, obstructing stone, and hydronephrosis.
A 56-year-old patient reports a new breast lump. Which finding is MOST concerning for malignancy?
A. Tender, mobile lump that changes with the menstrual cycle
B. Firm, irregular, non-tender mass with skin dimpling
C. Bilateral breast tenderness
D. Diffuse breast discomfort after caffeine intake
B. Firm, irregular, non-tender mass with skin dimpling
A patient reports irregular menses, infertility, acne, and increased facial hair. Which disorder best connects these findings?
A. PCOS
B. PID
C. Menopause
D. Uterine fibroids
A. PCOS
Which patient should the nurse see FIRST?
A. BPH patient reporting nocturia
B. Kidney-stone patient reporting pain 8/10
C. Pyelonephritis patient with T 103°F, HR 124, BP 86/52
D. Breast cancer patient anxious before surgery
C. Pyelonephritis patient with T 103°F, HR 124, BP 86/52
A patient with a kidney stone is told to strain all urine. What is the primary purpose?
A. Measure urine glucose
B. Retrieve the stone for analysis
C. Prevent urinary infection
D. Reduce flank pain
B. Retrieve the stone for analysis
A patient with a kidney stone receives treatment. Which finding best indicates improvement?
A. Pain decreases and urine output remains adequate
B. New fever and chills develop
C. Urine output drops to 10 mL/hr
D. Creatinine rises rapidly
A. Pain decreases and urine output remains adequate
2. State the priority hypothesis/complication.
Priority hypothesis: sepsis with severe hypoperfusion/septic shock related to an infected obstructed urinary system.
A 70-year-old male with BPH is waiting for discharge teaching. Which new finding requires immediate follow-up?
A. Nocturia twice nightly
B. Weak urinary stream
C. Severe suprapubic pressure with no urine output for 8 hours
D. Urinary hesitancy
C. Severe suprapubic pressure with no urine output for 8 hours
A 46-year-old has heavy prolonged menstrual bleeding, pelvic pressure, and an enlarged irregular uterus. Which diagnosis is most consistent?
A. Uterine leiomyoma (fibroids)
B. Cervical cancer
C. Vulvovaginitis
D. Ectopic pregnancy
A. Uterine leiomyoma (fibroids)
Which patient requires the most immediate assessment?
A. CKD patient with fatigue and Hgb 9.2 g/dL
B. Post-TURP patient with bright-red urine, large clots, decreasing output, and bladder pressure
C. Prostate cancer patient asking about treatment
D. UTI patient reporting urinary frequency
B. Post-TURP patient with bright-red urine, large clots, decreasing output, and bladder pressure
A patient with pyelonephritis has urine and blood cultures ordered along with IV antibiotics. Which action is best?
A. Give the antibiotic and obtain cultures tomorrow
B. Obtain ordered cultures promptly, then administer antibiotics without unnecessary delay
C. Hold antibiotics until the patient is afebrile
D. Encourage ambulation before treatment
B. Obtain ordered cultures promptly, then administer antibiotics without unnecessary delay
A patient with pyelonephritis has these trends: 0800—HR 108, BP 104/68, T 102.1°F, urine output 35 mL/hr. 1000—HR 126, BP 88/52, T 103°F, urine output 15 mL/hr. What is the best interpretation?
A. Improving
B. Stable
C. Declining
D. Expected antibiotic response
C. Declining
3. Identify TWO immediate nursing actions.
Immediate actions should focus on rapid sepsis response: notify/escalate immediately, support ABCs/perfusion, obtain ordered cultures/labs, initiate prescribed IV fluids and antibiotics promptly, monitor urine output/hemodynamics, and prepare for urgent relief of the obstruction as ordered.
A patient with chronic kidney disease has the following morning results. Which finding is the priority cue?
A. Hemoglobin 9.4 g/dL
B. Potassium 6.2 mEq/L
C. Creatinine 4.1 mg/dL
D. Phosphorus 5.3 mg/dL
B. Potassium 6.2 mEq/L
A patient has severe flank pain radiating toward the groin, nausea, and hematuria. Which disorder is most likely?
A. Pyelonephritis
B. Nephrolithiasis
C. BPH
D. Neurogenic bladder
B. Nephrolithiasis
Four patients call the nurse. Who should be assessed FIRST?
A. Patient with cervical cancer reporting mild fatigue
B. Patient with AKI whose potassium increased from 5.1 to 6.4 mEq/L
C. Patient with renal stone requesting scheduled analgesic
D. Patient with BPH asking when to take finasteride
B. Patient with AKI whose potassium increased from 5.1 to 6.4 mEq/L
A patient with BPH is prescribed tamsulosin. Which teaching is most important?
A. Rise slowly because dizziness/orthostatic hypotension can occur
B. Expect the medication to permanently cure prostate enlargement after one dose
C. Double the dose if urinary hesitancy occurs
D. Restrict all fluids during the day
A. Rise slowly because dizziness/orthostatic hypotension can occur
A CKD patient is being treated for fluid overload. Which trend best indicates improvement?
A. Increasing crackles and weight gain
B. Decreasing edema, easier breathing, and lower daily weight
C. Rising potassium with new weakness
D. Falling oxygen saturation
B. Decreasing edema, easier breathing, and lower daily weight
4. Identify TWO parameters you would monitor to determine whether treatment is effective.
Effective-treatment indicators include improving BP/MAP, HR, mental status, urine output, temperature, and other ordered perfusion markers.
A 31-year-old with an 8-week pregnancy reports unilateral pelvic pain and light vaginal bleeding. Which additional finding would make the nurse MOST concerned for a ruptured ectopic pregnancy?
A. Breast tenderness
B. Urinary frequency
C. Shoulder pain with dizziness and hypotension
D. Mild nausea in the morning
C. Shoulder pain with dizziness and hypotension
A patient with urinary obstruction has rising creatinine and bilateral hydronephrosis. Which mechanism best explains the kidney injury?
A. Increased erythropoietin production
B. Back pressure from impaired urine drainage reduces renal function
C. Excess insulin damages the glomeruli immediately
D. Increased bladder emptying causes dehydration
B. Back pressure from impaired urine drainage reduces renal function
Which patient is the highest priority?
A. 52-year-old with a new painless breast lump
B. 67-year-old with painless hematuria awaiting cystoscopy
C. 29-year-old with PID and pelvic pain 6/10
D. 73-year-old with pyelonephritis who is newly confused, BP 82/48, HR 128, urine output 15 mL/hr
D. 73-year-old with pyelonephritis who is newly confused, BP 82/48, HR 128, urine output 15 mL/hr
A patient with AKI has potassium 6.3 mEq/L and peaked T waves. Which provider order should the nurse implement as the highest priority?
A. Routine oral iron supplement
B. Continuous cardiac monitoring and prescribed emergency hyperkalemia treatment
C. Encourage a potassium-rich snack
D. Schedule discharge teaching
B. Continuous cardiac monitoring and prescribed emergency hyperkalemia treatment
A post-TURP patient initially had bladder pressure, large clots, and poor catheter drainage. After intervention, drainage is flowing, urine is light pink, bladder pressure resolves, and vital signs remain stable. How should the nurse interpret the outcome?
A. Declining
B. Improving
C. Unchanged
D. Developing pyelonephritis
B. Improving
Explain WHY the obstructing stone makes this situation especially dangerous.
The obstruction prevents normal drainage, promotes infected urine stasis and hydronephrosis, and may require urgent decompression/source control.