CHP 39-41 Study Guide

A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should the care provider give the client? A) "There is a chance that these will clear up on their own without any treatment." B) "It's important to start treatment soon, so I will prescribe you pills today." C) "Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory disease." D) "I'd like to give you an HPV vaccination if that's okay with you."

Ans: A Feedback: Genital warts may resolve spontaneously, although this does not preclude recurrence. Many individuals will clear the virus and become negative within 1 to 2 years; it is unclear if development of an effective immune response completely clears the infection. Pharmacologic treatments are topical, and vaccination is ineffective after infection has occurred. HPV infection is not correlated with pelvic inflammatory disease (PID).

During infertility workup, the client is diagnosed with chlamydial infection. The health care provider will especially be looking for which complication of chlamydial infections that can interfere with egg transportation? A) Uterine cancer B) Fallopian tube damage C) Amenorrhea D) Vaginal adhesions

Ans: B Feedback: Chlamydia causes a wide variety of genitourinary infections; Chlamydia trachomatis infection is the most common reportable sexually transmitted infection (STI) in the United States. In women, untreated infection can lead to severe reproductive complications, including infertility, pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain, and in men, it can cause prostatitis and epididymitis with subsequent infertility. Chlamydial infections are not associated with any reproductive cancers or amenorrhea.

A 17-year-old male has developed phimosis to the point that he is having difficulty voiding. The nurse should prepare this teenager for: A) Radiation therapy to loosen the foreskin B) Circumcision C) Injection of lidocaine into the head of the penis D) Traumatic retraction of the foreskin

Ans: B Feedback: Phimosis refers to a tightening of the prepuce or penile foreskin that prevents its retraction over the glans. If symptomatic phimosis occurs after childhood, it can cause difficulty with voiding or sexual activity. Circumcision is then the treatment of choice. Radiation therapy is utilized for cancer treatment. Lidocaine and forceful retraction of the foreskin is not a standard treatment for phimosis.

Which of the following statements about screening for prostate cancer is most accurate? A) Digital rectal examination detects the majority of new cases of prostate cancer. B) A positive prostate-specific antigen (PSA) test is definitive for prostate cancer. C) BPH and prostatitis can confound prostate screening results. D) Digital rectal examination and PSA testing have been proven ineffective.

Ans: C Feedback: PSA is a glycoprotein secreted into the cytoplasm of benign and malignant prostatic cells that is not found in other normal tissues or tumors. However, a positive PSA test indicates only the possible presence of prostate cancer. It also can be positive in cases of BPH and prostatitis. Detection using digital rectal examination varies from 1.5% to 7%. Screening remains somewhat controversial, but it has not been proven wholly ineffective.

While taking the history of a female client complaining of irregular, very painful bleeding occurring after menopause, the health care provider is alert to which of the following high-risk indicators of ovarian cancer? A) Never had any children B) Lactation history C) Mammary duct ectasia D) Oral contraceptive use for many years

Ans: A Feedback: A family history of cancer, particularly breast and ovarian cancer, and nulliparity (not been pregnant) increase the risk of developing ovarian cancer, whereas oral contraceptive use, pregnancy, and lactation decrease the risk. There are no effective screening methods for ovarian cancer, and most cancers of the ovary produce no symptoms. Ductal ectasia manifests in older women as a spontaneous, intermittent, usually unilateral, grayish green nipple discharge.

A 22-year-old client has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with: A) Human papillomavirus (HPV) B) Chlamydia trachomatis C) Candida albicans D) Trichomonas vaginalis

Ans: A Feedback: Although a Pap smear does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV infection. An abnormal Pap smear is not indicative of chlamydial infection, trichomoniasis, or candidiasis.

Endometriosis is characterized by painful hemorrhagic lesions in the pelvis, which may develop into which of the following potential complications? A) Pelvic adhesions B) Endometrial cancer C) Candidiasis vaginitis D) Bladder herniation

Ans: A Feedback: Endometriosis is the condition in which functional endometrial tissue is found in ectopic sites outside the uterus. Endometriosis usually becomes apparent in the reproductive years when the lesions are stimulated by ovarian hormones in the same way as normal endometrium, becoming proliferative, then secretory, and finally undergoing menstrual breakdown. Bleeding into the surrounding structures can cause pain and the development of significant pelvic adhesions. Endometrial cancer often develops as a result of prolonged estrogenic stimulation and/or unopposed estrogen therapy with excessive growth (i.e., hyperplasia) of the endometrium inside the uterus. Candidiasis vaginitis is a common yeast infection unrelated to intrapelvic endometriosis. Bladder herniation, cystocele, happens when bladder muscle support weakens with age or multiple births.

A client asks the health care provider to, "Explain this brachytherapy they want to do for my cervical cancer again." The response should include which of the following statements? A) "They will insert a radioactive device into your vagina, position it next to the cervix, so that curative levels of radiation are directly on the cancer site." B) "The physician will take you to surgery, place your legs in the stirrups, and irrigate your entire vaginal cavity with radioactive water. Then they will pack your vaginal with sterile packing." C) "You will go to the x-ray department where they will insert a device in your vagina until it touches the cervix and then turn on a laser." D) "You will come to the radiation department daily for at least 4 weeks where they will insert a device and shine a beam on your cervical cancer area, hoping for it to burn the cancer off."

Ans: A Feedback: External-beam irradiation and intracavitary irradiation or brachytherapy (i.e., insertion of radioactive materials into the body) can be used in the treatment of cervical cancer. Intracavitary radiation provides direct access to the central lesion and increases the tolerance of the cervix and surrounding tissues, permitting curative levels of radiation to be used. None of the other answers describe this process. It usually is inserted in radiology, and then the client is transported to a private room until an allotted timeframe.

Which of the following diagnoses is most likely to require surgical correction? A) Hypospadias B) Orchitis C) Erectile dysfunction D) Spermatocele

Ans: A Feedback: Hypospadias is a congenital disorder of the penis resulting from embryologic defects in the development of the urethral groove and penile urethra; surgery is the treatment of choice for hypospadias. Orchitis, erectile dysfunction (ED), and spermatocele rarely require surgical intervention.

Men whose sexual partners have been diagnosed with Trichomonas vaginalis will likely exhibit: A) No symptoms of infection B) Copious amounts of frothy discharge from the penis C) Numerous pustules on the penal shaft D) Redness and pain at the urethral meatus

Ans: A Feedback: Men harbor the Trichomonas vaginalis in the urethra and prostate and are largely asymptomatic. Chlamydia, gonorrhea, and syphilis cause active infection and symptoms in both men and women.

Which of the following clinical manifestations is most likely to accompany a diagnosis of vulvodynia? A) Vulvar pain B) Purulent discharge C) Urinary incontinence D) Open lesions on the surface of the vulva

Ans: A Feedback: Pain is the defining characteristic of vulvodynia. Contributing factors, such as wounds or lesions, are absent. Incontinence does not normally accompany vulvodynia, and there is an absence of purulent discharge, since the etiology is noninfectious.

The primary reason genital herpes has reached epidemic proportions throughout the world relates to the fact that: A) A large percentage (70%) of those infected experience no symptoms of the disease. B) The lesions (LSILs) occur on the cervix and can only be detected by a Pap test. C) Lesions take a long time to incubate and the small papules are usually located inside the vagina. D) The organism spreads upward to the prostate gland in males and fallopian tubes in females.

Ans: A Feedback: Persons infected with HSV-1 remain at risk for acquiring HSV-2. Most cases of HSV-2 infection are subclinical, manifesting as asymptomatic or symptomatic but unrecognized infections. These subclinical infections can occur in people who have never had a symptomatic outbreak or they can occur between recognized clinical recurrences. Up to 70% of genital herpes is spread through asymptomatic shedding by people who do not realize they have the infection. Transient HPV infections can develop low-grade squamous intraepithelial lesions (LSILs) of the cervix as detected on a Pap test, colposcopy, or biopsy. Lesions of LGV can incubate for a few days to several weeks and thereafter cause small, painless papules or vesicles that may go undetected. If untreated, gonorrhea spreads from its initial sites upward into the genital tract. In males, it spreads to the prostate and epididymis; in females, it commonly moves to the fallopian tubes.

Which of the following processes is a component of the pathogenesis of proliferative breast lesions without atypia? A) Growth of ductile or lobular epithelial cells B) Cystic dilation of terminal ducts C) Increase in fibrous breast tissue D) Fat necrosis leading to lesion formation

Ans: A Feedback: Proliferative lesions without atypia are characterized by proliferation of ductile or lobular epithelial cells. Dilation of the terminal milk ducts and a general increase in fibrous breast tissue are associated with fibrocystic breast changes. Fat necrosis is not implicated in the development of proliferative breast lesions without atypia.

An elderly female has slowly developed dementia and loss of vision. She is being evaluated for nursing home placement. Routine admission blood work reveals that the client tested positive for which STI associated with her current symptoms? A) Tertiary syphilis B) Chlamydial C) Gonorrhea D) Human papillomavirus infection

Ans: A Feedback: Tertiary syphilis is a delayed response of the untreated disease. The symptomatic tertiary stage frequently affects the cardiovascular system, central nervous system, liver, bones, and testes. In women, chlamydial infections may cause urinary frequency, dysuria, and vaginal discharge. In women, gonorrhea has recognizable symptoms, which include unusual genital or urinary discharge, dysuria, dyspareunia, pelvic pain or tenderness, unusual vaginal bleeding (including bleeding after intercourse), and fever. HPV infection is associated with genital warts that typically present as soft, raised, fleshy lesions on the external genitalia, including the penis, vulva, scrotum, perineum, and perianal skin. External warts may appear as small bumps, or they may be flat, rough surfaced, or pedunculated.

After seeking care due to recent history of testicular enlargement and scrotal pain, a 22-year-old college student has been diagnosed with testicular cancer. Which of the client's following statements indicates the need for further teaching? A) "I can't shake this feeling like I've received a death sentence." B) "I have to admit that the prospect of losing a testicle is a bit overwhelming." C) "I really hope the cancer hasn't spread anywhere, because I've read that it's a possibility." D) "I guess there's some solace in the fact that this cancer wasn't a result of an unhealthy lifestyle."

Ans: A Feedback: Testicular cancer has the potential for metastasis, but outcomes are positive for most clients and survival rates are high. With appropriate treatment, the prognosis for men with testicular cancer is excellent. Orchiectomy remains the standard treatment, and the pathogenesis of testicular cancer is not thought to be related to lifestyle factors.

During physical exam of a newborn, the nurse palpates the scrotal sac and only locates one testicle. Which statement about undescended testicles is most accurate? A) "The child can become infertile later in life as a result of decreased sperm count." B) "This is more common in full-term infants when compared to premature births." C) "This may be a precursor to the development of prostate cancer later in life." D) "The child will need surgery to move the testes back into the scrotal sac since they rarely descend spontaneously."

Ans: A Feedback: The consequences of cryptorchidism include infertility, testicular torsion, testicular (rather than prostate) malignancy, and the possible psychological effects of an empty scrotum. Males with cryptorchidism usually have decreased sperm counts, poorer-quality sperm, and lower fertility rates than do men whose testicles descend normally. Spontaneous descent often occurs during the first 3 months of life, and by 6 months of age, the incidence decreases to 0.8%. Spontaneous descent rarely occurs after 4 months of age.

A female client presents an STD clinic. She is in the first trimester of pregnancy and has tested positive for gonorrhea. Because strains of N. gonorrhoeae have become resistant to penicillin, the current treatment recommendation includes: A) High-dose cefixime given in a single dose B) Ten-day supply of Flagyl C) Doxycycline over the course of 1 week D) No treatment until after the baby is born

Ans: A Feedback: The current treatment recommendation to combat penicillin- and tetracycline-resistant strains of gonorrhea is ceftriaxone or cefixime in a single injection. While a single injection of cefixime is still the standard treatment, some strains of N. gonorrhoeae have begun to show resistance to this dose. Metronidazole (Flagyl) is one treatment of choice against anaerobic protozoans, which can cure Trichomonas vaginalis. The treatment of choice for syphilis is penicillin. Tetracycline or doxycycline is used for treatment in persons who are sensitive to penicillin, but these medications cannot be used in pregnancy. Obviously, the client will receive treatment. However, at time of delivery, the infant will be tested and treated as necessary.

A client presents to a STI clinic. Her primary complaint is related to purulent exudate and bleeding after intercourse. The health care worker will primarily focus on the diagnosis of which STI? A) Gonorrhea B) Chlamydial infection C) Human papillomavirus infection D) Genital herpes simplex virus infection

Ans: A Feedback: The gonococcus is a pyogenic (i.e., pus-forming), gram-negative diplococcus that evokes inflammatory reactions characterized by purulent exudates. Internal human papillomavirus (HPV) condylomata acuminata warts are cauliflower-shaped lesions that affect the mucous membranes of the vagina, urethra, anus, or mouth. The initial symptoms of primary genital herpes (herpes simplex virus, HSV) infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles.

A 29-year-old client had a Papanicolaou smear performed during her most recent visit to her primary care provider. This diagnostic procedure aims to identify: A) Atypical cervix cellular changes B) Human papillomavirus (HPV) antibodies C) Cervical polyps D) Lesions at the transformation zone

Ans: A Feedback: The primary purpose of a Pap smear is to obtain cytology samples from the cervix to examine the cervical cells for atypical changes. These precancerous changes represent a continuum of morphologic changes with indistinct boundaries that may gradually progress to cancer in situ and then to invasive cancer. The performance of a Pap smear allows for visualization of the cervix, but the primary diagnostic purpose is not the identification of lesions and polyps. Cytology samples are not tested for HPV antibodies.

A client has been diagnosed with an anterior pituitary tumor, and synthesis and release of follicle-stimulating hormone has become deranged. What are the potential consequences of this alteration in endocrine function? A) Dysfunction of spermatogenesis B) Overproduction of luteinizing hormone C) Inhibition of testosterone synthesis D) Impaired detumescence

Ans: A Feedback: Two gonadotropic hormones are secreted by the pituitary gland: FSH and luteinizing hormone (LH). In the male, LH also is called interstitial cell-stimulating hormone. The production of testosterone by the interstitial cells of Leydig is regulated by LH. FSH binds selectively to Sertoli cells surrounding the seminiferous tubules, where it functions in the initiation of spermatogenesis. FSH does not directly affect the production of LH, since both are produced by the anterior pituitary. FSH does not stimulate testosterone synthesis, and impaired detumescence is unlikely to be a direct consequence of changes in FSH synthesis and release.

A couple presents to an infertility clinic. The health care provider will focus testing on which of the following sexually transmitted infections (STIs) that is very damaging to the reproductive system but rarely exhibits symptoms of infection? A) Chlamydial infection B) Herpes simplex virus infection C) Gonorrhea D) Syphilis

Ans: A Feedback: Women with chlamydial infection may be asymptomatic and may unknowingly experience damage to the reproductive system. A large number of cases go unreported because most people with chlamydial infection are asymptomatic and do not seek testing. Herpes simplex virus (HSV), syphilis, and gonorrhea consistently produce symptoms in infected women.

A male diagnosed with gonorrhea will likely complain of which of the following clinical manifestations? Select all that apply. A) Creamy, yellow discharge B) Pain in the urethra with urination C) Difficulty starting a stream of urine D) "Fish"-smelling discharge from the penis E) Diffuse pelvic pain

Ans: A, B Feedback: In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody, discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.

Which of the following would be considered a structural abnormality or disease process that could cause menstrual pain known as secondary dysmenorrhea? Select all that apply. A) Endometriosis B) Uterine fibroids C) Cervicitis D) Cystocele E) Rectocele

Ans: A, B Feedback: Secondary dysmenorrhea is menstrual pain caused by structural abnormalities or disease processes such as endometriosis, uterine fibroids, adenomyosis, pelvic adhesions, IUDs, or PID. In women with secondary dysmenorrhea, the pain often lasts longer than the menstrual period; it may begin before menstrual bleeding begins; and it may become worse during menstruation. Cervicitis is an acute or chronic inflammation of the cervix. Acute cervicitis may result from the direct infection of the cervix, or it may occur secondary to a vaginal or uterine infection. Cystocele is a herniation of the bladder into the vagina. It occurs when the normal muscle support for the bladder is weakened, and the bladder sags below the uterus. This causes the bladder to herniate into the vagina due to the force of gravity and pressures from coughing, lifting, or straining at stool. Rectocele is the herniation of the rectum into the vagina.

As a result of endocrine disorder, the client with polycystic ovary syndrome will like exhibit which of the following clinical manifestations? Select all that apply. A) Male pattern baldness B) Metabolic syndrome with insulin resistance C) Irregular menstrual cycles D) Infections of the cervix E) BP 100/70s, low normal

Ans: A, B, C Feedback: Women with PCOS typically have abnormal gonadotropin levels, a problem that is manifested by increased release of LH in relation to FSH release. This causes an increase in production of androstenedione and testosterone by the theca cells of the ovary. PCOS is a common endocrine disorder affecting 5% to 10% of women of reproductive age and is a frequent source of chronic anovulation. The disorder is characterized by varying degrees of menstrual irregularity, signs of hyperandrogenism (acne and hirsutism or male pattern hair loss), infertility, and hyperinsulinemia or insulin resistance. A substantial number of women who are diagnosed with PCOS are obese, and most have polycystic ovaries. Hypertension is also common in women with PCOS.

A woman who has developed vulvovaginal candidiasis will likely go to her health care provider complaining of: Select all that apply. A) Redness B) Edema C) Frothy, foul-smelling discharge D) Painful urination E) Pustules on labia

Ans: A, B, D Feedback: Women with vulvovaginal candidiasis commonly complain of vulvovaginal pruritus accompanied by irritation, erythema, swelling, dysuria, and dyspareunia. The characteristic discharge, when present, is usually thick, white, and odorless. Trichomoniasis manifestations include presentation with copious, frothy, malodorous green or yellow discharge.

While undergoing annual breast exam assessing for any manifestations of breast cancer, the nurse will discuss which of the following factors that place the client at high risk for cancer? Select all that apply. A) Late menopause B) First child born when she was 40 years old C) History of STIs and frequent vaginitis D) Multiple pregnancies E) Currently smokes approximately 2 packs/day of cigarettes

Ans: A, B, E Feedback: Risk factors for breast cancer include sex, increasing age, personal or family history of breast cancer (i.e., at highest risk are those with multiple affected first-order relatives), history of benign breast disease (i.e., primary "atypical" hyperplasia), and hormonal influences that promote breast maturation and may increase the chance of cell mutation (i.e., early menarche, late menopause, and no term pregnancies or first child after 30 years of age). Modifiable risk factors include obesity (particularly after menopause), physical inactivity, caffeine—moderate to heavy consumption—cigarette smoking, and long-term use of postmenopausal hormone therapy. Women with sexually transmitted diseases (STDs) may have high-risk behaviors that can increase their chances of having reproductive organ and possible oral or nipple infection, rather than breast tumors.

Which of the following clinical manifestations are characteristic for clients with Peyronie disease? Select all that apply. A) Painful erection B) Thick, yellow discharge from the penis C) Presence of a hard mass on the tunica albuginea of the penis D) Papillary lesions on penis filled with serous-colored fluid E) Thick, nonretractable foreskin of uncircumcised male

Ans: A, C Feedback: Peyronie disease involves a localized and progressive fibrosis of unknown origin that affects the tunica albuginea (i.e., the tough, fibrous sheath that surrounds the corpora cavernosa) of the penis. The manifestations of Peyronie disease include painful erection, bent erection, and the presence of a hard mass at the site of fibrosis. Approximately two thirds of men complain of pain as a symptom. Discharge and lesions from the penis is usually caused from infections or STDs. Thick, nonretractable foreskin of uncircumcised male is associated with balanitis xerotica obliterans.

A college student presents to the nurse's office complaining of premenstrual syndrome. Which of the following clinical manifestations would confirm this diagnosis? Select all that apply. A) Painful, edematous breasts B) Burning during urination C) Abdominal bloating D) Thick, cheesy vaginal secretions E) Painful intercourse

Ans: A, C Feedback: Physical symptoms of PMS include painful and swollen breasts, bloating, abdominal pain, headache, and backache. Burning with urination could be caused by a vaginal or bladder infection. A thick, cheesy, vaginal secretion is usually associated with a yeast infection.

A female receives a PAP smear result indicating she has human papillomavirus (HPV) infection. As part of her education, the nurse will emphasize the need for continued follow-up since HPV is directly associated with: A) Uterine cancer B) Cervical dysplasia C) Genital herpes lesions D) Urinary tract infections

Ans: B Feedback: A relation between HPV and genital neoplasms has become increasingly apparent since the mid-1970s. HPV infection can be detected in cervical Papanicolaou (Pap) smears, with the first neoplastic changes noted on the Pap smear termed dysplasia. Testicular cancer is not associated with HPV. Although genital herpes (HSV) is also a sexually transmitted disease, it is a common cause of genital ulcers rather than cancer. Bacteria are the usual cause of urinary tract infections, rather than anogenital warts.

Which of the following physiologic processes results from the synthesis and release of testosterone? A) Protein catabolism B) Musculoskeletal growth C) Release of luteinizing hormone (LH) D) Prostatic hyperplasia

Ans: B Feedback: Among the numerous effects of testosterone are the promotion of musculoskeletal growth in particular and protein anabolism in general. LH and FSH precede the synthesis and release of testosterone, whereas prostatic hyperplasia is not a normal effect of testosterone.

When educating a teenager diagnosed with genital herpes (herpes simplex virus type 2, HSV-2), the health care provider needs to inform her of the importance of careful follow-up since she may be at greater risk for future development of: A) Cervical cancer B) HIV transmission C) Localized necrosis D) Urinary tract infection

Ans: B Feedback: As with other ulcerative STIs, genital herpes (HSV-2) increases the risk of HIV transmission and is believed to play an important role in the heterosexual spread of HIV. There is no known cure for genital herpes, and the methods of treatment are largely symptomatic. Human papillomavirus (HPV), rather than HSV, is considered a cause of cervical cancer. Although HSV can reoccur, the lesions resolve and heal completely without tissue necrosis or scarring. Urinary tract infections are associated with bacterial vaginosis/vaginitis STIs.

The most prevalent vaginal infection to be spread through sexual contact is: A) Candidiasis B) Trichomoniasis C) Vulvovaginitis D) Bacterial vaginosis

Ans: B Feedback: Candidiasis is a yeast infection with a white cheesy discharge that causes vulvovaginitis. Bacterial vaginosis is a nonspecific type of infection that produces a characteristic fishy-smelling discharge, the result of an imbalance of the normal vaginal flora. These infections are not normally spread by sexual contact. Trichomoniasis is usually spread through sexual contact.

Common risk factors associated with erectile dysfunction due to generalized penile arterial insufficiency include: A) Cryptorchidism B) Cigarette smoking C) Testicular torsion D) Benign prostate hypertrophy

Ans: B Feedback: Common risk factors for generalized penile arterial insufficiency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation. Cigarette smoking induces vasoconstriction and penile venous leakage because of its effects on cavernous smooth muscle. Cryptorchidism is a major risk factor for testicular cancer. Benign prostate hypertrophy (BPH) is a risk factor for ejaculatory pathway obstruction rather than erectile difficulties. With testicular torsion, testicular arterial perfusion is impaired.

A client comes to the OB/GYN clinic complaining of difficulty in emptying the bladder and frequency and urgency of urination. After examination, the health care provider will likely diagnose: A) Rectocele B) Cystocele C) Endometritis D) Prolapsed uterus

Ans: B Feedback: Cystocele is herniation of the bladder into the vagina that occurs when the normal muscle support for the bladder is weakened, the bladder sags below the uterus, herniates through the anterior vaginal wall, and a cystocele forms. The symptoms include difficulty in emptying the bladder, frequency and urgency of urination, and stress incontinence. Rectocele is herniation of the rectum into the vagina; symptoms include discomfort because of the protrusion of the rectum and difficulty in defecation. Uterine prolapse is the bulging of the uterus into the vagina that occurs when the primary supportive ligaments are stretched; symptoms result from irritation of the exposed mucous membranes of the cervix and vagina and the discomfort of the protruding mass. Endometritis symptoms include abnormal vaginal bleeding, mild to severe uterine tenderness, fever, malaise, and foul-smelling discharge.

A 21-year-old college student has sought care because of the vaginal burning, itching, and redness that have become worse in recent weeks. Which of the clinician's assessment questions is most likely to apply to a diagnosis of vaginitis? A) "Have your periods been regular in the last few months?" B) "Have you ever had a sexually transmitted infection?" C) "Are you using oral contraceptives?" D) "Have you ever been pregnant?"

Ans: B Feedback: In women of childbearing years, causes of vaginitis are often a manifestation of some organisms that can be transmitted sexually. The use of oral contraceptives and menstrual disorders are not associated with the incidence of vaginitis, and previous pregnancies are not identified as risk factors or causes.

Which of the following assessment questions is most likely to address the causation of a woman's new case of candidiasis? A) "Have you recently begun a new sexual relationship?" B) "Have you been on antibiotics recently?" C) "Have you noticed any new growths on your vagina in recent months?" D) "Do you use condoms during sexual activity?"

Ans: B Feedback: Recent antibiotic therapy frequently underlies causes of candidiasis. The disease is not normally transmitted by sexual contact, and tissue growth is not an associated sign.

A client with herpes simplex virus (HSV) presents to the clinic stating, "I can stop taking my drugs because I'm cured. My lesions are gone." The health care provider bases his or her response knowing the pathophysiology behind the disappearance of HSV symptoms infection relates to: A) Replication of the squamous epithelium B) Periods of latency in the nervous system C) Inhibition of cell-mediated immunity D) Production of exotoxins

Ans: B Feedback: The clinical course of HSV infection is a product of the virus's ability to remain latent in the dorsal root ganglia for long periods. Latency refers to the ability to maintain disease potential in the absence of clinical signs and symptoms. When latent, the immune system is ineffective, but the virus does not actively inhibit the cell-mediated immune system. HSV does not produce exotoxins, and replication of squamous epithelium accounts for the warts caused by HSV.

An elderly male client has been diagnosed with prostate cancer. However, because he has a history of heart failure with an ejection fraction of 20% and chronic obstructive pulmonary disease due to many years of smoking, the client is not a candidate for major surgery. Which of the following treatments should the nurse anticipate being utilized for this client? A) Transurethral prostatectomy (TURP) that only utilizes epidural blocks and small amounts of Versed and Fentanyl B) Stent placed to widen and maintain the patency of the urethra C) Teaching the client how to perform a straight catheterization every time they feel the need to empty their bladder D) Brachytherapy inserted into the penis and instilled into the prostate tissue

Ans: B Feedback: The surgical removal of an enlarged prostate can be accomplished by the transurethral, suprapubic, or perineal approach. Currently, transurethral prostatectomy (TURP) is the most commonly used technique. For men who have heart or lung disease or a condition that precludes major surgery, a stent may be used to widen and maintain the patency of the urethra. A stent is a device made of tubular mesh that is inserted under local or regional anesthesia. Within several months, the lining of the urethra grows to cover the inside of the stent. It would be highly unlikely for the client to be asked to straight cath for urination. Brachytherapy would not be a treatment of choice since it would block the passage of urine from the bladder.

The physiological reasoning behind giving acyclovir, an antiviral medication, to a client diagnosed with genital herpes would include the fact that these drugs: A) Attack the cell wall and totally destroy the virus, thus curing the client B) Interfere with viral DNA replication, which can decrease the frequency of recurrences C) Will prevent the organism from developing a resistance to the treatment protocols D) Can be obtained without a prescription and usually applied topically

Ans: B Feedback: There is no known cure for genital herpes, and the methods of treatment are largely symptomatic. The oral antiviral drugs acyclovir, valacyclovir, and famciclovir have become the cornerstone for management of genital herpes. By interfering with viral DNA replication, these drugs decrease the frequency of recurrences, shorten the duration of active lesions, reduce the number of new lesions formed, and decrease viral shedding. There are no FDA-approved PCR tests for chancroids. The chancroid organism has shown resistance to treatment with sulfamethoxazole alone and to tetracycline. Uncomplicated cases of candidiasis (not herpes) are treated with antifungal medications (e.g., clotrimazole, miconazole) that are available as topical preparations (creams or suppositories) that can be obtained without a prescription.

A client presents to the GYN clinic complaining of large amounts of frothy yellow-green discharge that smells very foul. Immediately, the health care provider is thinking this client most likely has: A) Candidiasis B) Trichomoniasis C) Bacterial vaginosis D) Chlamydial infection

Ans: B Feedback: Trichomoniasis causes a copious, frothy, malodorous, green or yellow discharge. The characteristic vaginal discharge of candidiasis, when present, is usually odorless, thick, and cheesy. The predominant symptom of bacterial vaginosis is a thin, grayish white discharge that has a foul, fishy odor. Chlamydial STD may be asymptomatic, but most women have mucopurulent drainage or hypertrophic cervical changes on examination.

A client visited her health care provider and was diagnosed with acute cervicitis. A clinical manifestation that accompanies acute cervicitis may include: A) Abscess formation B) Mucopurulent drainage C) Thick gray-white plaques D) Persistent pruritic vulvitis

Ans: B Feedback: With acute cervicitis, the cervix becomes reddened and edematous; irritation from the infection results in copious mucopurulent drainage and leukorrhea. Bartholin gland obstruction causes a cyst to form, becomes purulent, and results in abscess formation. Lichen simplex chronicus lesions are labial thick, gray-white plaques. Squamous cell vulvar carcinoma is characterized by a recurrent, persistent, pruritic vulvitis, sometimes as the only complaint.

Which of the following statements are accurate when it comes to changes in the male reproductive system as one ages? Select all that apply. A) Androgen hormone levels increase with age. B) Sexual energy levels decrease as one ages with decreasing testosterone levels. C) The testes become smaller and lose their firmness. D) The prostate gland enlarges with age. E) The force of ejaculation increases with age.

Ans: B, C, D Feedback: Male sex hormone levels, particularly testosterone, decrease with age. The sex hormones play a part in the structure and function of the reproductive system and other body systems from conception to old age; they affect protein synthesis, salt and water balance, bone growth, and cardiovascular function. Decreasing levels of testosterone affect sexual energy, muscle strength, and the genital tissues. The testes become smaller and lose their firmness. The prostate gland enlarges, and its contractions become weaker. The force of ejaculation also decreases because of a reduction in the volume and viscosity of the seminal fluid.

Progesterone maintains pregnancy but also has which of the following local effects on the body? Select all that apply. A) Decrease in absorption of sodium B) Increase in basal body temperature C) Increase in secretion of aldosterone by the adrenal cortex D) Relaxation of smooth muscle

Ans: B, C, D Feedback: Progesterone can compete with aldosterone at the level of the renal tubule, causing a decrease in sodium reabsorption, with a resultant increase in secretion of aldosterone by the adrenal cortex (as occurs in pregnancy). Although the mechanism is uncertain, progesterone increases basal body temperature and is responsible for the increase in body temperature that occurs with ovulation. Smooth muscle relaxation under the influence of progesterone plays an important role in maintaining pregnancy.

Which of the following disorders of the male genitourinary system creates the most urgent need for prompt and aggressive surgical treatment? A) Spermatocele B) Benign prostatic hyperplasia (BPH) C) Intravaginal testicular torsion D) Erectile dysfunction

Ans: C Feedback: Although all of the noted health problems warrant monitoring and possible treatment, intravaginal testicular torsion is an emergency that requires prompt surgery to save the torsed testicle.

Which of the following physiologic processes is caused by estrogens? A) Increased release of gonadotropin-releasing hormone (GnRH) B) Stimulation of lactation in the postpartum period C) Promotion of ovarian follicle growth D) Progesterone synthesis

Ans: C Feedback: Among the effects of estrogens is the promotion of ovarian follicle growth. Increased estrogen levels normally have an inhibitory effect on GnRH levels, whereas progesterone synthesis is not a result of estrogen's. Lactation is stimulated by prolactin.

Which of the following clients is at greatest risk for developing balanitis xerotica obliterans? A) A homosexual male with a monogamous partner B) A client who has had their pituitary gland removed due to cancer C) A male who has an uncircumcised penis D) A middle-aged male with history of chronic prostatitis

Ans: C Feedback: Balanitis xerotica obliterans is a chronic, sclerosing, atrophic process of the glans penis that occurs solely in uncircumcised men. As such, the uncircumcised state supersedes the influence of sexual behavior, prostatitis, or hormonal effects of not having a pituitary gland.

Men older than age 50 are at high risk for prostatic hypertrophy with complications that include: A) Hypospadias B) Scrotal edema C) Urine retention D) Testicular cancer

Ans: C Feedback: Benign prostatic hypertrophy (BPH) is a common disorder in men over 50; because the prostate encircles the urethra, BPH exerts its effect through obstruction of urinary outflow from the bladder. Hypospadias is a congenital condition in which the termination of the urethra is on the ventral surface of the penis. Scrotal edema is often the result of testicular disease or inflammation rather than prostate enlargement. Often the first sign of testicular cancer is a slight enlargement of the testicle that may be accompanied by some degree of discomfort.

When educating a group of teenagers about sexually transmitted infections (STIs), the school nurse also mentions that cervical cancer has been associated with which of the following viral infections? A) Chlamydia trachomatis B) Herpes simplex C) Human papilloma D) Varicella zoster

Ans: C Feedback: Carcinoma of the cervix is often considered a sexually transmitted disease. A preponderance of evidence suggests a causal link between human papilloma virus (HPV) infection and cervical cancer. Herpes simplex II and Chlamydia trachomatis cause infections that are considered sexually transmitted infections (STIs) and are unrelated to neoplastic changes of the cervix. Herpes varicella zoster is secondary chickenpox, also known as shingles, which forms along a dermatome path.

A client comes to the college campus nurse complaining of unilateral pain, swelling, and redness on his scrotal area. The nurse knows these clinical manifestations are likely caused by: A) Syphilis B) Testicular torsion C) Epididymitis D) Ticks bites

Ans: C Feedback: Epididymitis is characterized by unilateral pain and swelling, accompanied by erythema and edema of the overlying scrotal skin that develops over a period of 24 to 48 hours. Initially, the swelling and induration are limited to the epididymis. Syphilis is a sexually transmitted disease that is contagious and caused by a spirochete (Treponema pallidum). If left untreated it can produce chancres, rashes, and systemic lesions in a clinical course with three stages continued over many years. Twisting of the spermatic cord (which is very painful) with a resulting compromise of the blood supply to the testis is known as testicular torsion. There is no indication that the client has experienced a tick bite.

During a visit to the health care provider, a client complains of swelling in the scrotum. The health care worker suspects a hydrocele and performs an exam by shining a light through the scrotum. If the hydrocele is dense, the health care worker should: A) Continue to monitor the client every 6 months to see if there is a change in size. B) Prescribe diuretics like Lasix to help remove excess fluid. C) Order an ultrasound or biopsy to rule out testicular cancer. D) Gently try to express the fluid out of the scrotal sac.

Ans: C Feedback: Hydroceles are palpated as cystic masses that may attain massive proportions. If there is enough fluid, the mass may be mistaken for a solid tumor. Transillumination of the scrotum (i.e., shining a light through the scrotum to visualize its internal structures) or ultrasonography can help to determine whether the mass is solid or cystic and whether the testicle is normal. A dense hydrocele that does not illuminate should be differentiated from a testicular tumor. The fluid cannot be removed by diuretics or by trying to express the fluid out of the scrotum.

A client with a family history of breast cancer has just learned that she carries the BRCA1 and BRCA2 mutation. When educating this client about follow-up care, which of the following statements would be most appropriate? A) "You do not have to worry about passing this on to your adult female children." B) "You should schedule a bilateral mastectomy today." C) "You should have more frequent breast evaluations using an MRI rather than standard mammography." D) "You should ask your doctor to order a PET scan to see if you have any cancer lesions anywhere else in your body."

Ans: C Feedback: Mutations in two breast cancer susceptibility genes—BRCA1 on chromosome 17 and BRCA2 on chromosome 13—may account for most inherited forms of breast cancer. A woman with known mutations in BRCA1 has a lifetime risk of approximately 57% for breast cancer and approximately 40% for ovarian cancer. BRCA2 is another susceptibility gene that elevates lifetime breast cancer risk to 49% and ovarian cancer risk to 18%. Breast evaluation using MRI is generally preferred over standard mammography for these women because of its enhanced sensitivity and lack of radiation exposure, which may be safer for them. Prophylactic surgery, in the form of bilateral mastectomy, bilateral oophorectomy, or both, has been shown to decrease the risk of developing cancer. These controversial surgeries can have physical and psychological side effects that warrant careful consideration before proceeding.

While discussing the physiological process behind penile erection, the anatomy and physiology instructor mentions that what substance is released to facilitate smooth muscle relaxation and shunting of blood into the sinusoids? A) Norepinephrine B) Nitroglycerine C) Nitric oxide D) Nicotinic acid

Ans: C Feedback: Parasympathetic innervation must be intact and nitric oxide synthesis must be active for erection to occur. Parasympathetic stimulation results in release of nitric oxide, a nonadrenergic-noncholinergic neurotransmitter, which causes relaxation of the trabecular smooth muscle of the corpora cavernosa. This relaxation permits inflow of blood into the sinuses of the cavernosa at pressures approaching those of the arterial system. The nicotinic acid in cigarette smoke can induce vasoconstriction and penile venous leakage because of its effects on cavernous smooth muscle. Nitroglycerine is a vasodilator that has no effect on trabecular smooth muscle. A norepinephrine action is vasoconstriction, rather than relaxation, as part of sympathetic nervous system response.

A client visits the OB/GYN clinic complaining of low abdominal pain, purulent cervical discharge, and painful intercourse. The health care worker (HCW) diagnoses pelvic inflammatory disease. The HCW educates the client about that fact that this disease may be associated with: A) Chronic endometriosis B) Ruptured tubal pregnancy C) STI polymicrobial infection D) Serous luteal ovarian cysts

Ans: C Feedback: Pelvic inflammatory disease (PID) is an inflammation and polymicrobial infection of the upper reproductive tract that involves the uterus (endometritis), fallopian tubes (salpingitis), or ovaries (oophoritis) associated with sexually transmitted and endogenous organisms. Endometriosis is the condition in which functional endometrial tissue is found in ectopic sites outside the uterus; the displaced endometrial tissue may cause localized inflammation. Ruptured tubal pregnancy causes salpingitis and inflammation unrelated to sexually transmitted disease (STD) infections. Benign ovarian epithelial tumors are almost always serous or mucinous. Serous (fluid-filled) luteal or follicular ovarian cysts are noninfective, are noninflammatory, and frequently resolve spontaneously without treatment.

Which of the following phenomena is thought to underlie the decreased reported incidence of some sexually transmitted infections (STIs)? A) Increased knowledge of the correct use of condoms B) Increased public funding for health promotion activities C) Decreased reporting of cases of certain STIs D) Decreased numbers of sexual partners among young adults

Ans: C Feedback: The actual incidence and prevalence of some STIs are thought to exceed reported rates. Consequently, apparent decreases are not thought to reflect reality. This trend in reported incidence is not attributed to changes in condom use, health promotion, or decreased numbers of sexual partners.

Squamous cell cancer of the penis is characterized by which of the following clinical manifestations? A) Erectile dysfunction with prolonged erection B) Herpes ulcerations on the penile shaft C) Painless lump on the inner surface of the prepuce D) Smegma accumulation in uncircumcised male requiring regular reminders about hygiene

Ans: C Feedback: The cause of penile cancer is unknown. Invasive squamous cell carcinoma of the penis usually begins as a small lump or ulcer on the glans or inner surface of the prepuce. Several risk factors have been suggested, including poor hygiene, human papillomavirus infections (rather than herpes simplex virus infections), ultraviolet radiation exposure, and immunodeficiency states. There is an association between penile cancer and poor genital hygiene and phimosis. Circumcision confers protection, and hence cancer of the penis is extremely rare in men circumcised at birth. It is thought that circumcision is associated with better genital hygiene, which, in turn, reduces exposure to carcinogens that may accumulate in smegma and decreases the likelihood of potentially oncogenic strains of HPV. Erectile dysfunction can be the result of depression, androgen level imbalance, systemic medications, or arterial insufficiency that are unrelated to squamous cell tissue changes.

Which of the following assessments is most likely to reveal a potential exacerbation in a 70-year-old client's diagnosis of benign prostatic hyperplasia (BPH)? A) Urine testing for microalbuminuria B) Blood test for white blood cells and differential C) Digital rectal examination D) Sperm morphology testing

Ans: C Feedback: The diagnosis of BPH is based on history, physical examination, digital rectal examination, urinalysis, blood tests for serum creatinine and prostate-specific antigen (PSA), and urine flow rate. The digital rectal examination is used to examine the external surface and size of the prostate. An enlarged prostate found during a digital rectal examination does not always correlate with the degree of urinary obstruction. Some men can have greatly enlarged prostate glands with no urinary obstruction, but others may have severe symptoms without a palpable enlargement of the prostate. Proteinuria, increased WBCs, and changes in sperm morphology are not associated with BPH.

A client presents to the out-client clinic complaining of gray discharge that has a fishy odor. The health care provider sees "clue cells" on wet-mount microscopic exam. This would most likely lead to the diagnosis of: A) Trichomonas vaginalis B) Chlamydial C) Bacterial vaginosis D) Syphilis

Ans: C Feedback: The diagnosis of bacterial vaginosis is made when at least three of the following signs or symptoms are present: abnormal gray discharge, vaginal pH above 4.5 (usually 5.0-6.0), positive fishy odor of vaginal discharge on addition of 10% potassium hydroxide, and appearance of characteristic "clue cells" on wet-mount microscopic studies. T. vaginalis is an anaerobic protozoan that is shaped like a turnip and has three or four anterior flagella. Chlamydia exists in two morphologically distinct forms during its unique life—a small infectious elementary body and a large noninfectious reticulate body. The diagnosis of syphilis can be made rapidly by dark-field microscopic examination of the exudate from skin lesions. However, the test is reliable only when a specimen with actively motile T. pallidum is examined immediately by a trained microscopist. It does, however, evoke a humoral immune response and production of antibodies that provide the basis for serologic tests.

Which of the following signs and symptoms is most clearly suggestive of primary genital herpes in a male client? A) Presence of purulent, whitish discharge from the penis B) Emergence of hard, painless nodules on the shaft of the penis C) Itching, pain, and the emergence of pustules on the penis D) Production of cloudy, foul-smelling urine

Ans: C Feedback: The initial symptoms of primary genital herpes infection include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. In men, the infection can cause urethritis and lesions of the penis and scrotum. Rectal and perianal infections are possible with anal contact. Firm, subcutaneous nodules are not associated with herpes simplex virus (HSV), and the production of penile discharge and cloudy urine is not suggestive of the disease.

A client is complaining to the health care provider about several vague signs/symptoms. Which of the following raises a "red flag" indicating the client may have developed endometrial cancer? A) Lumps palpated in her breasts B) Small, atrophied ovaries C) Painless abnormal bleeding D) Difficulty emptying the bladder

Ans: C Feedback: The major symptom of endometrial hyperplasia or overt endometrial cancer is abnormal, painless bleeding. Abnormal bleeding is an early warning sign of endometrial cancer in up to 90% of women, and because endometrial cancer tends to be slow growing in its early stages, the chances of cure are good if prompt medical care is sought. Fibrocystic changes, formerly called fibrocystic breast disease, are benign irregular fibrous breast lesions. Ovaries normally atrophy with age. Difficulty emptying the bladder may indicate bladder cancer or cystocele.

Which of the following clients is at high risk for developing acute bacterial prostatitis? A) A middle-aged male with prostate hyperplasia B) A fifth grade male diagnosed with acute pyelonephritis C) An elderly male diagnosed with frequent UTIs testing positive for gram-negative rods D) A sickle cell anemia client complaining of prolonged erection lasting less than 4 hours

Ans: C Feedback: The most likely etiology of acute bacterial prostatitis is an ascending urethral infection or reflux of infected urine into the prostatic ducts. E. coli, other gram-negative rods, and enterococci, organisms known to cause urethritis are the most common infectious agents, rather than a descending bacterial infection from the kidneys (as in pyelonephritis). Benign prostatic hyperplasia (BPH) is an age-related, nonmalignant enlargement of the prostate gland caused by overgrowth of the prostate mucosal glands. Prolonged erection does not increase the probability of developing acute bacteria prostatitis.

Which of the following physiologic changes results in menopause? A) Changes in anterior pituitary function that alter ovarian hormone production B) Gradual resistance of ovarian target cells to LH and FSH stimulation C) Cessation of ovarian function and decreased estrogen levels D) Decreased levels of gonadotropin-releasing hormone (GnRH)

Ans: C Feedback: The physiology of menopause involves a gradual cessation of ovarian function and resultant diminished levels of estrogen. The process is not rooted in pituitary or hypothalamic function, and it does not occur because of resistance by ovarian target cells.

A 30-year-old man has been diagnosed with mumps orchitis. The nurse should educate the client that which of the following complications may occur? A) Erectile dysfunction B) Hematocele formation C) Sterility D) Penile atrophy

Ans: C Feedback: The residual effects seen after the acute phase of mumps orchitis include hyalinization of the seminiferous tubules and atrophy of the testes, along with impaired spermatogenesis that has the potential to result in sterility. Spermatogenesis is irreversibly impaired in approximately 30% of testes damaged by mumps orchitis. Penile atrophy, hematuria, and hematocele are not among the signs, symptoms, and sequelae of mumps orchitis.

When explaining polycystic ovary syndrome (PCOS) to a newly diagnosed client, the health care worker states, "This ovarian dysfunction is caused by: A) Absent FSH." B) Insulin deficit." C) Elevated LH." D) Low androgen."

Ans: C Feedback: The underlying etiology of the disorder is unknown, although most women have altered gonadotropin levels. Most women with PCOS have elevated luteinizing hormone (LH) levels with normal estrogen and follicle-stimulating hormone (FSH) production. This altered LH/FSH ratio often is used as a diagnostic criterion for this condition. The elevated LH level also results in increased androgen production. Hyperinsulinemia may also lead to the excess androgen production; the overall goal of PCOS treatment is to suppress the insulin-facilitated, LH-driven androgen production.

From the following list of clients, which ones are at high risk for developing priapism? Select all that apply. A) A teenage cocaine abuser who has been "high" for the past 72 hours B) An uncircumcised male with poor hygiene habits C) A sixth grade male returning to school following sickle cell crisis D) A college student with complete spinal cord injury at T12 level following auto accident E) A middle-aged adult male with recent history of myocardial infarction

Ans: C, D Feedback: Priapism is due to impaired blood flow in the corpora cavernosa of the penis. Priapism is classified as primary (idiopathic) or secondary to a disease or drug effect. Secondary causes include hematologic conditions (e.g., leukemia, sickle cell disease, polycythemia), neurologic conditions (e.g., stroke, spinal cord injury), and renal failure. Two mechanisms for priapism have been proposed: low-flow (ischemic) priapism, in which there is stasis of blood flow in the corpora cavernosa with a resultant failure of detumescence (diminution of swelling or erection), and Peyronie disease, which involves a localized and progressive fibrosis of unknown origin that affects the tunica albuginea (i.e., the tough, fibrous sheath that surrounds the corpora cavernosa) of the penis. Circumcision trauma to the penis and abnormal tightening of foreskin are external penile problems associated with phimosis rather than the internal vascular problem of priapism.

When evaluating a client with suspected benign prostatic hypertrophy (BPH), the health care worker should collect data related to which of the following signs/symptoms? Select all that apply. A) Frequency of erectile dysfunction B) Enlarged inguinal lymph nodes C) Urinary frequency issues D) Weak urine stream E) Straining to empty the bladder

Ans: C, D, E Feedback: It is now thought that the single most important factor in the evaluation and treatment of BPH is the man's own personal experiences related to the disorder. The American Urological Association Symptom Index consists of seven questions about symptoms regarding incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Erectile dysfunction may develop secondary to the androgen hormone imbalances associated with BPH. Enlarged lymph nodes usually relates to a regional infection.

Of the following STIs, for which STI should the nurse anticipate a prescription for antibiotics such as tetracycline or doxycycline since this infection will respond to antibiotic treatment? A) Human papillomavirus (HPV) infection B) Herpes simplex virus type 2 (HSV-2) infection C) Candidiasis D) Lymphogranuloma venereum (LGV)

Ans: D Feedback: Because HSV-2 and HPV infections and candidiasis have nonbacterial etiologies, these infections are insensitive to antibiotics. Lymphogranuloma venereum (LGV) is an acute and chronic venereal disease caused by Chlamydia trachomatis and is consequently sensitive to antibiotics.

A sexually transmitted infection that is caused by a microorganism with two morphologically distinct forms is: A) Chancroid B) Candidiasis C) Trichomonas vaginalis D) Chlamydia

Ans: D Feedback: Chlamydia exists in two morphologically distinct forms during its unique life—a small infectious elementary body and a large noninfectious reticulate body. T. vaginalis is a large anaerobic, pear-shaped, flagellated protozoan. Chancroid is a disease of the external genitalia and lymph nodes caused by the gram-negative bacterium Haemophilus ducreyi. Candida albicans is the most commonly identified organism in vaginal candidiasis (yeast infection), but other candidal species, such as Candida glabrata and Candida tropicalis may also be present.

A 59-year-old woman with a recent diagnosis of breast cancer has begun a course of hormone therapy. What is the goal of this pharmacologic treatment? A) Blocking the effects of progesterone on tumor growth B) Increasing serum hormone levels to promote tumor cell lysis C) Blocking the entry of malignant cells into the axillary lymph nodes D) Blocking effects of estrogen on the growth of malignant cells

Ans: D Feedback: Hormone therapy is used to block the effects of estrogen on the growth of breast cancer cells. Among the most common drugs used for hormone therapy is tamoxifen, a nonsteroidal antiestrogen that binds to estrogen receptors and blocks the effects of estrogens on the growth of malignant cells in the breast. Such drugs do not directly block axillary node involvement or induce tumor cell lysis.

A nurse is conducting a healthy living workshop for a group of women in their 20s. Which of the following screening recommendations should the nurse provide to the participants? A) Monthly breast self-examination (BSE) B) BSE or mammography each year starting at age 40 C) Annual clinical breast examination until age 65 D) Clinical breast examination every 3 years until age 40

Ans: D Feedback: In 2003, the American Cancer Society dropped its recommendation that all women perform regular, systematic self-examination. Women should have a clinical examination by a trained health professional at least every 3 years between 20 and 40 years of age and annually after 40 years of age. Mammogram screenings should be done annually by age 40.

While in its dormant state, herpes simplex virus resides and replicates in the: A) Local lymph nodes B) Subcutaneous tissue C) Mucous membrane D) Dorsal root ganglia

Ans: D Feedback: In genital herpes, the virus ascends through the peripheral nerves to the sacral dorsal root ganglia. The virus can remain dormant in the dorsal root ganglia, or it can reactivate, in which case the viral particles are transported back down the nerve root to the skin, where they multiply and cause a lesion to develop. During the dormant or latent period, the virus replicates in a different manner so that the immune system or available treatments have no effect on it. Local lymph nodes respond to the inflammation of reactivation; the mucous membrane becomes erythematous and painful when lesions form; subcutaneous tissue is not damaged by the vesicles and shallow ulcerations.

While breast-feeding her 3-month-old infant, the mother notices the breast area is hard, inflamed, and tender to touch. The clinic nurse explains that this is likely caused by: A) Intraductal papillomas B) Secretory cell hyperplasia C) Fibrocystic tissue changes D) Ascending bacterial infection

Ans: D Feedback: Mastitis is inflammation of the breast. In the lactating woman, inflammation results from an ascending infection that travels from the nipple to the ductal structures. The most common organisms isolated are Staphylococcus aureus and Streptococcus. Fibrocystic changes, formerly called fibrocystic breast disease, are nondiscrete nodules in a woman without breast disease. The mammary alveoli are lined with secretory cells capable of producing milk or fluid under the proper hormonal conditions. The route of descent of milk and other breast secretions is from alveoli to duct, to intralobar duct, to lactiferous duct and reservoir, to nipple. Intraductal papillomas are benign epithelial tissue tumors that manifest with a bloody nipple discharge.

Which of the following events is associated with the primary stage of syphilis? A) Development of gummas B) Development of central nervous system lesions C) Palmar rash D) Genital chancres

Ans: D Feedback: Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

Which of the following complaints by middle-aged women should prompt a care provider to assess for the possibility of ovarian cancer? A) "I'm having a lot of vaginal discharge lately and it's quite foul." B) "My periods have become quite irregular since last winter." C) "I have a sharp, stabbing pain on my side for the last few days." D) "I'm having a lot of indigestion and bloating, which I've never had before."

Ans: D Feedback: Symptoms of ovarian cancer are frequently misattributed to other health problems because they tend to be vague in nature; these include dyspepsia and bloating. Changes in menstrual pattern, severe pain, and vaginal discharge are not typically associated with ovarian cancer, especially in earlier stages.

A 41-year-old male client is planning on having a vasectomy. While explaining this surgery to the client, the health care worker will include which physiologic principle as the basis for this contraception technique? A) "Spermatogenesis is inhibited because sex hormones no longer stimulate the Sertoli cells." B) "Spermatozoa can no longer reach the epididymis and do not survive." C) "The rete testis becomes inhospitable to sperm." D) "Sperm can no longer pass through the ductus deferens."

Ans: D Feedback: When the male ejaculates, the smooth muscle in the wall of the epididymis contracts vigorously, moving sperm into the next segment of the ductal system, the ductus deferens, also called the vas deferens. A vasectomy severs this conduit, rendering the male effectively infertile within a few weeks of the procedure. The procedure has no hormonal effect and neither the epididymis nor the rete testis is altered.

A client arrives in the emergency department complaining of severe testicular pain associated with nausea and vomiting. Their pulse rate is 120 beats/minute. Physical exam reveals an enlarged testis that is painful to palpation. The nurse suspects: A) Inguinal hernia B) Cancer of the scrotum C) Testicular aneurysm D) Testicular torsion

Ans: D Feedback: With testicular torsion, the testis rotates about the distal spermatic cord, obstructs perfusion through the testicular arteries and spermatic veins, and obstructs nerve conduction. The torsion obstructs venous drainage, with resultant edema and hemorrhage, and subsequent arterial obstruction. The dartos muscle separates the two testes and responds to changes in temperature by contracting when cold and relaxing when warm. Most squamous cell cancers of the scrotum occur after 60 years of age and are linked to poor hygiene, chronic inflammation, exposure to ultraviolet A radiation, or human papilloma virus (HPV). After descent of the testes, the inguinal canal normally closes almost completely; failure of this canal to close predisposes to the development of an inguinal hernia later in life.

Refers to local inflammation of the glans penis ___

Balanitis

Age-related, nonmalignant enlargement of the prostate ___

Benign Prostatic Hyperplasia

___ is an inflammation of the elongated cordlike structure along the posterior border of the testis whose function is the storage, transport, and maturation of spermatozoa

Epididymitis

Forms when excess fluid collects between the layers of the tunica vaginalis ___

Hydrocele

In ___ the termination of the urethra is on the ventral surface of the penis

Hypospadias

Refers to tightening of the penile foreskin preventing retraction ___

Phimosis

Rectal exam reveals a swollen, tender, warm prostate with soft areas ___

Prostatitis

Obstructs venous drainage and subsequent arterial obstruction creating a surgical emergency if the testicle is to be saved ___

Testicular Torsion

Produced and secreted by the interstitial Leydig cells in the testes ___

Testosterone