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25. The client with benign prostatic hyperplasia (BPH) is considering use of medication in the management of symptoms. Which of the following drugs reduces the size of the prostate without lowering circulating levels of testosterone? A) Finasteride (Proscar) B) Tamsulosin (Flomax) C) Terazosin (Hytrin) D) Oxybutynin chloride (Ditropan)
Ans: A Feedback: Finasteride (Proscar) inhibits the conversion of testosterone depriving the gland of dihydrotestosterone (more potent type of testosterone), which stimulates prostatic growth. Tamsulosin (Flomax) and terazosin (Hytrin) work by reducing the tone of smooth muscle in the bladder neck and prostate gland but have little effect on reducing prostate size. Oxybutynin chloride (Ditropan) is antimuscarinic, antispasmodic drug used for treatment of overactive bladder.
Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis? A) Ensure immunizations against infectious diseases such as mumps. B) Engage in activities and exercises that minimize heavy lifting. C) Encourage the consumption of foods that are rich in fat and starch. D) Urge the limited intake of foods and fluids containing caffeine.
Ans: A Feedback: Nurses should advocate for infant and childhood immunizations against infectious diseases such as mumps to reduce potential adult complications such as orchitis. Minimizing activities involving heavy lifting or urging limited intake of caffeine have no effect on the potential for adult complications such as orchitis. The nurse should encourage foods that are low in fat and starch; however, this also would have no effect on the potential for orchitis.
12. Which assessment finding is most important in determining which client has a higher risk for developing testicular cancer? A) Previous sexually transmitted infection (STI) B) Low sperm count C) Cryptorchidism as an infant D) Family history of cancer
Ans: C Feedback: Caucasian men who have had cryptorchidism as an infant, regardless of whether an orchiopexy was performed, are at higher risk for incidence of testicular cancer. STIs, low sperm count, and family history of general cancers are not indicative of testicular cancer risk.
25. A client, who wishes to preserve childbearing, asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse? A) "Symptoms of endometriosis are increased during normal menstrual cycle." B) "Contraceptives will allow blood to be diverted to the peritoneal cavity." C) "Trapping blood causes less pain or discomfort for clients with endometriosis." D) "Endometriosis is usually cured with surgical menopause."
Ans: A Feedback: The use of estrogen-progestin contraceptives keeps the client in a nonbleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extrauterine bleeding. Blood that is trapped in the peritoneal cavity causes more pain as adhesions form. Endometriosis is cured by natural or surgical menopause but can be
32. Because ovarian cancer has nonspecific symptoms and can result in lethal outcome, diagnostic testing may be indicated for some women. Which risk factors support the need for screening? Select all that apply. A) Carrying genetic mutation for the disease B) Being nulliparous C) Family history of lung cancer D) Breastfeeding E) Use of oral contraceptives for 5 years or more F) Multiple full-term pregnancies
Ans: A, B Feedback: Woman who are nulliparous, have a family history of ovarian cancer, and or carry a genetic mutation tend to develop ovarian cancer more often than others. Preventative measures recommended to lower the risk of ovarian cancer include having at least 2 full-term pregnancies, breastfeeding after pregnancies, and using oral contraceptives for 5 years or more. History of lung cancer is not a risk factor.
29. The physician and nurse are completing a physical examination of the male genitalia. Which assessment findings are documented? Select all that apply. A) Inspection for urethral drainage B) Cultures C) Digital rectal examination D) Transillumination E) Palpation of the testes F) Prostate-specific antigen leve
Ans: A, C, D, E Feedback: The nurse and physician document the physical assessment including inspection of external genitalia and noting any drainage. A digital rectal examination and transillumination also provides physical assessment data of the status of the prostate gland. Cultures and prostate-specific antigen levels provide diagnostic information.
29. While collecting data on reproductive history, the client discloses early menarche, early sexual engagement, chlamydia infection, and treatment for gonorrhea. The nurse knows that this client is at highest risk for the development of which of the following? A) Sexually Transmitted Infections B) Breast cancer C) Fibroid tumor or myoma D) Cervical cancer
Ans: A, D Feedback: Cervical cancer is the second most frequent malignancy of the female reproductive system and is associated with risk factors such as becoming sexually active at an early age, acquiring genital infections, or STIs. Breast cancer and fibroid tumors are not indicated with the history presented.
16. A client reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse? A) "Don't worry, every woman goes through this." B) "These are normal, manageable symptoms of menopause." C) "You need to discuss this with your spouse." D) "Hormone replacement therapy can resolve your symptoms."
Ans: B Feedback: Diminished libido and/or dyspareunia are common symptoms associated with perimenopause. Explaining that this can be a normal finding may help to alleviate worries for the client and provide hope for management of the symptoms. The nurse should avoid telling a client "not to worry" or "talk to someone else" because these can negate client feelings and shut down communication. HRT may not be recommended for this client.
4. A client with erectile dysfunction who had a penile implant inserted has been taught how to identify malfunction of the device. Which of the following if stated by the client as indicative of malfunction would indicate to the nurse that the client has understood the teaching? A) Erosion of penile or urethral tissue B) Underinflation or bulging of the cylinders during inflation C) Erosion of scrotal, bowel, or bladder tissue D) Migration of the cylinders, pump, or reservoir from their intended location
Ans: B Feedback: Malfunction of the device is characterized by the underinflation, bulging of the cylinders during inflation, and a loss of fluid from the implant. Erosion of penile or urethral tissue occurs due to a midsized implant, pressure, or friction of the implanted cylinders. Erosion of scrotal, bowel, or bladder tissue occurs if an implant with a fluid reservoir is used. Migration of the cylinders, pump, or reservoir from their intended location is accompanied by pain, tenderness, and dysfunction of components that are part of the device.
30. The client states to the nurse that he is very anxious about having prostate cancer ever since his prostate-specific antigen (PSA) test came back elevated. The client asks, "Which diagnostic test produces definitive results if cancer is present?" The nurse is most correct to state which of the following? A) Transrectal ultrasonography B) Tissue biopsy C) Tumor marker studies D) Digital rectal exam
Ans: B Feedback: Obtaining an actual piece of the tissue and analyzing it for cancer is a definitive test when cancer is found. A transrectal ultrasonography is a test to view the prostate gland from different angles. This test provides additional data on the status of the prostate gland. The tumor marker studies include the prostate-specific antigen (PSA) level. This antigen indicates a potential problem but is not definitive. PSA elevations have been noted for reasons other than cancer. A digital rectal exam provided data on the shape, size, and texture of the prostate gland.
8. A client with a fibroadenoma is being scheduled for diagnostic testing. Which of the following would the nurse expect as most likely? A) Mammogram B) Ultrasound C) Excisional biopsy D) Culture of discharge
Ans: B Feedback: Ultrasound can reveal physical characteristics unique to a fibroadenoma versus malignant mass with a higher degree of accuracy than mammography. In the case of very young women—an atypical age for breast cancer—an excisional biopsy is performed only if the mass changes or becomes larger. If the mass is detected in a woman with a higher risk for developing breast cancer, such as one with a family history or of an older age, a biopsy is performed to confirm that the tissue is indeed benign. There is no discharge to culture.
13. A young client is admitted with torsion of the spermatic cord. Which is the most appropriate action to be taken by the nurse? A) Elevate the scrotum. B) Keep the client NPO. C) Monitor vital signs for cardiac changes. D) Avoid the use of analgesics.
Ans: B Feedback: With torsion of the spermatic cord, immediate surgery is necessary to prevent atrophy of the cord and preserve fertility. The client should be placed on NPO status in preparation for surgery. Elevating the scrotum intensifies the pain by increasing the degree of twist. Analgesics are prescribed preoperatively to control pain. Cardiac changes are not indicated unless client history warrants assessment.
8. A client with erectile dysfunction has opted to self-administer a urethral suppository as a means to produce an erection. Which of the following agents would most likely be used? A) Sildenafil B) Vardenafil C) Alprostadil D) Papaverine
Ans: C Feedback: Alprostadil is the drug used for self-administration via a urethral suppository. Sildenafil and vardenafil are examples of phosphodiesterase inhibitors that are taken orally. Papaverine with phentolamine is used for self-injection into the corpora cavernosa to achieve an erection.
19. The nurse knows that the safest treatment for erectile dysfunction in a client with coronary artery disease (CAD) includes which of the following medications? A) Sildenafil (Viagra) B) Tadalafil (Cialis) C) Apomorphine (Uprima) D) Vardenafil (Levitra)
Ans: C Feedback: Apomorphine (Uprima), a dopamine agonist, is a possible alternative to phosphodiesterase (PDE5) inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) for the treatment of ED. Uprima is safer for men with CAD and does not cause mass vasodilation of the blood vessels such as the PDE5 inhibitors.
7. The nurse is obtaining a medication history from a client who is reporting erectile dysfunction. Which medication would the nurse identify as being least likely to contribute to the client's condition? A) Spironolactone B) Cimetidine C) Ibuprofen D) Methyldopa
Ans: C Feedback: Certain medications, such as antihypertensive agents (e.g., methyldopa and spironolactone), antidepressants, narcotics, and cimetidine cause sexual dysfunction in men. Ibuprofen is not associated with causing erectile dysfunction. Cimetidine is a histamine2-receptor antagonist used for gastric ulcers.
4. While obtaining the history, a client reports that her mother was treated with diethylstilbestrol (DES) during her pregnancy. The nurse determines that this client is at risk for which of the following? A) Vulvar cancer B) Breast cancer C) Cervical cancer D) Endometrial cancer
Ans: C Feedback: Cervical cancer affects the lowest portion of the uterus and is associated with the risk factor of being born to mothers treated with DES during their pregnancy. DES is not a risk factor associated with vulvar or breast cancers. Endometrial cancer occurs in women who take estrogens without the addition of progesterone for 5 or more years during and after menopause.
14. Following morning hygiene of an elderly client, the nurse is unable to replace the retracted foreskin of the penis. Which is the most likely outcome? A) Erection of the penis B) Unclean glans C) Painful swelling D) Nausea and vomiting
Ans: C Feedback: Paraphimosis results in strangulation of the glans penis from inability to replace the retracted foreskin. The strangulation results in painful swelling of the glans. Erection of the penis in the presence of phimosis can cause pain but is not a result of retracted foreskin. Nausea and vomiting are not indicated with retraction of foreskin.
6. A client who comes to the clinic complaining of perineal pain, dysuria, and fever is diagnosed with prostatitis. The nurse understands that which of the following organisms would be the most likely cause? A) Staphylococcus B) Streptococcus C) Escherichia coli D) Paramyxovirus
Ans: C Feedback: Prostatitis is an inflammation of the prostate gland and is most often caused by microorganisms that reach the prostate by way of the urethra. Escherichia coli and microbes that cause sexually transmitted infections often are responsible. Staphylococcus and Streptococcus are not typically a cause of prostatitis. Paramyxovirus is the cause of mumps.
16. The client with prostatitis presents with low back pain, dysuria, and unusual sensation following ejaculation. Which of the following treatments will the nurse anticipate being ordered for this client? A) Analgesics B) Sitz baths C) Antibiotics D) Abstinence
Ans: C Feedback: Prostatitis is an inflammation of the prostate gland that is most often caused by microorganisms. Treatment consists of up to 30 days of antibiotic therapy. Mild analgesics and warm sitz baths may be ordered for discomfort but not a primary action. Regular drainage of the prostate gland through masturbation or intercourse can be helpful in decreasing the inflammation and discomfort.
26. A client with extensive endometriosis is scheduled for a panhysterectomy. Which statement by the client indicates a need for further teaching? A) "I will be having my uterus, tubes, and ovaries removed." B) "I am finished having children." C) "I will not have to deal with symptoms of menopause." D) "I will now have a greater risk for stroke and heart disease
Ans: C Feedback: Surgical menopause causes a sudden drop in estrogen and progesterone levels resulting in varied symptoms in clients. The risks of heart disease and stroke increase with estrogen reduction. A panhysterectomy is the removal of the uterus, both tubes and ovaries and will result in the inability to conceive children.
22. Which pharmacologic agents pose the greatest risk for urinary retention in a client with benign prostatic hyperplasia (BPH)? A) Muscle relaxers B) Antihypertensives C) Nitrates D) Antihistamines
Ans: D Feedback: Antihistamines and over-the-counter cold medications should be avoided in clients with BPH due to the increase in urinary retention properties. Muscle relaxers are commonly prescribed for treatment of urinary retention. Nitrates and antihypertensive medications do not cause significant risk in the management of BPH.
35. A client is diagnosed with prostatitis. Which of the following is the most important teaching point for the management of this disorder? A) Avoid tub baths. B) Avoid sexual activity. C) Limit fluid intake. D) Avoid prolonged sitting.
Ans: D Feedback: Prolonged sitting can aggravate the condition of prostatitis and should be avoided. Warm tub baths and/or sitz baths can provide comfort. Increasing fluid intake can also flush the urethra of microorganisms and decrease risk of bacterial infection. Regularly draining the prostate gland through masturbation or intercourse can be helpful.
Which of the following should nurses teach all men, especially those who have had cryptorchidism? A) Need for blood tests to measure serum acid phosphatase levels B) Importance of regular monitoring of prostate-specific antigen (PSA) levels C) Need to undergo a baseline and follow up lymph node biopsies D) How to perform a testicular self-examination
Ans: D Feedback: The nurses should teach all men, especially those who have had cryptorchidism, to perform testicular self-examination to detect any abnormal mass in the scrotum. The nurse instructs the clients to examine the testicles monthly, preferably when warm, such as in the shower. Having regular PSA levels, lymph node biopsies, and blood tests for measuring serum acid phosphatase are for the clients who are treated for prostate cancer.
17. Which of the following nursing assessment findings would be most significant in determining sterility in a male client? A) Uncircumcised penis B) Recurrent urinary tract infections (UTI) C) Multiple sex partners D) Mumps at age 15 years
Ans: D Feedback: Viral mumps infection that occurs after puberty can be the cause of orchitis, which may result in testicular atrophy and sterility. Uncircumcised penis, UTIs, and number of sex partners are not indicated with sterility.
32. A client is receiving chemotherapy as adjuvant therapy in the management of testicular cancer. The nurse also notes that the client is ordered filgrastim (Neupogen) and knows that the client is at greatest risk for which assessment finding? A) Increased bruising B) Fever C) Pale color D) Decreased energy
Ans: B Feedback: Filgrastim (Neupogen) is used in the management of clients with low WBC count, which places them at greatest risk for infection. Symptom of fever would alert the nurse to infection. Increased bruising would be significant with low platelet count. Pale color and decreased energy are associated with lower RBC count.
11. The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? A) Palpate both testicles simultaneously for comparison. B) Palpate each testicle separately, following a warm shower. C) Palpate the front of the testicle first, where most tumors are found. D) Palpate for a soft, round shape with normal ridges on the testicles.
Ans: B Feedback: It is best to examine and palpate each testicle following a warm shower, when the testes are relaxed and not retracted. Because one testicle is normally larger and hangs lower, comparing the two sides is not indicated. Both testes should be oval in shape, smooth, and firm without masses or tenderness. Most tumors are located on the lateral aspect of the testicles.
16. The nurse is caring for a client diagnosed with fibrocystic disease and prescribed danazol (Danocrine). Which is essential before drug therapy is initiated? A) Pregnancy test B) Liver function test C) MUGA scan D) Blood chemistry
Ans: A Feedback: Before initiating drug therapy, it is essential to confirm that the client is not pregnant. Ingesting danazol (Danocrine) may be teratogenic to the fetus. Liver function test, MUGA scan, and blood chemistry can provide relevant information of the status of the liver, heart, and general overall condition.
24. Which assessment finding will most likely influence the treatment regime selected by a client with endometriosis? A) Presence of pain B) Family planning C) Dysmenorrhea D) Presence of chocolate cyst
Ans: B Feedback: Selection of a more conservative option may be indicated to preserve the possibility for future childbearing. Pain, dysmenorrhea, and chocolate cysts are all symptoms associated with endometriosis and can influence decision for treatment.
8. A client has just been diagnosed with endometriosis. Which of the following would be most appropriate to provide the client with support and guidance about treatment options? A) "Treatment is essential, so you really need to make a decision pretty quickly." B) "If it was me, I would probably choose the medication options." C) "It might help to include your partner in any of the discussions about options." D) "The test results are clear and another physician would tell you the same thing."
Ans: C Feedback: The nurse assists the client through the decision-making process as it applies to family planning and medical or surgical treatment. Suggesting that the client include her partner or significant other in the discussion of options would be most helpful and therapeutic. The client does not need to make a decision immediately. The nurse should not give advice or offer his or her own opinions to influence the client's choice. The nurse should support the client's option of seeking a second opinion.
17. The client is asking if there is a pill that can be ordered to control the symptoms of menopause. Which assessment finding is most important in determining nursing care in association with hormone replacement therapy? A) Presence of kyphosis B) Symptoms of hot flashes C) Family history of breast cancer D) History of osteoporosis
Ans: C Feedback: The risk of endometrial or breast cancer in women prescribed HRT may outweigh the benefits of relieving symptoms of menopause and preventing kyphosis or hip fractures associated with osteoporosis.
7. A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which of the following best reflects the rationale for using this group of drugs? A) They lower the level of estrogen in the body blocking the tumor's ability to use it. B) They block progesterone-dependent tumors from growing. C) They attach to endogenous protein receptors to slow the growth of cancerous cells. D) They stimulate the immune system to attack a protein common in many tumors.
Ans: A Feedback: Aromatase inhibitors lower the level of estrogen in the body thereby interfering with the ability of hormone-sensitive tumors to use estrogen for growth. Antiprogestin drug, such as mifepristone, blocks progesterone-dependent breast cancers. The monoclonal antibody, trastuzumab attaches to protein receptors to slow the growth of cancer cells
23. In a client with benign prostatic hyperplasia (BPH), which assessment finding provides the best indication of urinary retention? A) Frequency B) Urgency C) Hesitancy D) Dribbling
Ans: A Feedback: As residual urine accumulates, the client has an urge to void more often. Urgency, hesitancy, and dribbling are all urinary symptoms associated with BPH but not specific to urinary retention.
18. Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? A) Age B) Medication use C) Sexual history D) Undescended testicle
Ans: B Feedback: Certain medications such as antihypertensive drugs, antidepressants, narcotics, etc. can cause sexual dysfunction in men. Impotence is not a normal part of aging. Undescended testicle is not indicative of ED. Sexual history is not indicative of ED.
24. Which of the following should be included when teaching a client about the management of benign prostatic hyperplasia (BPH)? Select all that apply. A) Moderate use of alcohol is useful for bladder relaxation. B) Do not delay the urge to void. C) Low-dose Benadryl will promote restful sleep. D) Prolonged exposure to heat increases bladder spasms. E) Painless hematuria is a common symptom of BPH. F) Schedule digital rectal exams.
Ans: B, F Feedback: The client should be instructed to void promptly when the urge to empty the bladder is signaled by the stretch receptors in the bladder. Voiding promptly will decrease the risk for urinary retention. Digital rectal exams should be monitored to detect further enlargement of the gland and/or presence of prostatic nodules. Alcohol and antihistamines (e.g., Benadryl) should be avoided in the management of BPH. Exposure to heat and painless hematuria are not significant in the management of BPH. Alcohol and antihistamines interact with many BPH drugs.