NUR 314 FINAL EXAM

While summarizing teaching about genital herpes, which patient statement indicates a need for further instruction? "No cure is available for my genital herpes." "I will utilize my medication when I begin to have symptoms." "Genital herpes may be caused by herpes simplex virus type 1 or 2" "I am not able to infect a sexual partner unless I have active lesions."

"I am not able to infect a sexual partner unless I have active lesions." Rationale: The majority of herpes simplex virus (HSV) transmission occurs during *asymptomatic periods*. When active lesions are present, the patient is most likely to infect others. There is no cure for HSV, but antiviral medication is prescribed for current infections or suppression of recurrent infections. Early treatment reduces the duration of ulcers and risk of transmission. HSV-1 is often associated with cold sores or fever blisters. HSV-2 has been more associated with genital disease. However, HSV-1 and HSV-2 can cause oral or genital lesions.

The nurse provides medication teaching for a 30-yr-old woman who is prescribed clomiphene (Clomid). Which patient statement is most important for the nurse to clarify? "Hormone production and release will be increased." "I should avoid intercourse while taking this medication." "This medication will stimulate my ovaries to produce eggs." "This drug is like natural estrogen and is used to treat infertility."

"I should avoid intercourse while taking this medication." Rationale: Clomiphene is an oral medication *administered for infertility*. The medication is a selective estrogen-stimulation modulator (SERM) that stimulates ovulation, making pregnancy after intercourse or artificial insemination more likely. The drug increases gonadotropin-releasing hormone production. In addition, the release of the follicle-stimulating hormone and luteinizing hormone is increased.

The nurse obtains a history from a 34-year-old man diagnosed with chlamydia. Which patient statement indicates additional teaching is required? "This infection can be cured by taking antibiotics." "It is important to use condoms for all sexual activity." "I will avoid sexual contact for 1 week after taking the antibiotics." "My sexual partner does not have symptoms and will not need treatment."

"My sexual partner does not have symptoms and will not need treatment." Rationale: All sexual partners require treatment. Most men & women w/ chlamydial infections are either asymptomatic or have minor symptoms. Chlamydial infections are caused by Chlamydia trachomatis, a gram-negative bacterium. Antibiotics will cure this disease. Patients should avoid sexual intercourse for 7 days after completing treatment with antibiotics. Condoms should be used for all sexual contacts.

A 50-yr-old patient is preparing to begin breast cancer treatment with tamoxifen. What point should the nurse emphasize when teaching the patient about her new drug regimen? "Report any changes in your vision immediately." "The medication may cause some breast sensitivity." "The drug often alleviates some menopausal symptoms." "Abstain from drinking alcohol after you begin taking tamoxifen."

"Report any changes in your vision immediately." Rationale: Tamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not associated with tamoxifen. It is not necessary to abstain from alcohol.

The nurse teaches a 53-yr-old patient about screening for early detection of breast cancer. Which statement requires clarification by the nurse? "I should plan to have a mammogram every year." "A breast examination should be done right after my menstrual period." "I will see the health care provider every year for a breast examination." "Self-breast examination is a reliable way to detect breast cancer early."

"Self-breast examination is a reliable way to detect breast cancer early." Rationale: Screening for the early detection of breast cancer includes *yearly mammograms starting at age 45 years*. Breast self-examination (BSE) has benefits and limitations and may not be a reliable method for early detection of breast cancer. BSE is optional, but it should be done in premenopausal women right after the menstrual period when the breasts are less lumpy and tender.

The nurse is caring for an obese woman after a right mastectomy with axillary lymph node dissection. Which discharge instruction should the nurse include? "Arm exercises should not be started for 4 to 6 weeks.""Discontinue arm exercises if you have discomfort or pain.""Special massage therapy can decrease swelling in your arm." "Keep your right arm in a sling to decrease pain and swelling."

"Special massage therapy can decrease swelling in your arm." Rationale: Decongestive therapy may be used for acute lymphedema & includes a massage-like technique to mobilize the subcutaneous accumulation of fluid. Arm exercises should be performed to prevent contractures & muscle shortening, maintain muscle tone, & improve lymph & blood circulation. The *arm exercises should be initiated after surgery & increased gradually*. Pain medications should be administered 30 minutes before arm exercises. The *operative arm should be kept at the level of the heart* but not in a sling; a sling discourages use of the arm.

After a vasectomy, what instruction should be included in discharge teaching? "Some secondary sexual characteristics may be lost after the surgery." "Use an alternative form of contraception until your semen is sperm free." "Erectile dysfunction may be present for several months after this surgery." "You will be uncomfortable, but you may safely have sexual intercourse today."

"Use an alternative form of contraception until your semen is sperm free." Rationale: Because vasectomies are usually done for sterilization purposes, to safely have sexual intercourse, the patient will need to use an alternative form of contraception until semen examination reveals no sperm. Hormones are not affected, so there is no loss of secondary sexual characteristics or erectile function. Most men experience too much pain to have sexual intercourse on the day of their surgery, so this is not an appropriate comment by the nurse.

A 22-yr-old man is being treated at a college health care clinic for gonorrhea. What should the nurse include in patient teaching? "While being treated for the infection, you will not be able to pass this infection on to your sexual partner." "It is important to complete your full course of antibiotics in order to ensure that you become resistant to reinfection." "While you're taking the antibiotics, you will need to abstain from participating in sexual activity and drinking alcohol." "The symptoms will resolve on their own, but it is important for you to abstain from sexual activity while this is occurring."

"While you're taking the antibiotics, you will need to abstain from participating in sexual activity and drinking alcohol." Rationale: Treatment for gonorrhea necessitates *abstinence from sexual activity (to prevent infection of partners) & alcohol* (to avoid urethral irritation). The disease is not self-limiting, nor does successful treatment confer future resistance.

Tamoxifen

(Nolvadex, Soltamox) - Estrogen Receptor Modulator (SERMs) Antiestrogens, hormonal oncologics - Thromboembolism, PE - Stroke - Endometrial CA - may cause *visual changes*

What medications would the nurse anticipate given for Prostatitis?

*Antibiotics* - broad spectrum - Anti-inflammatory meds (can help quickly reduce the size of the prostate aiding in symptom relief) - antipyretic for fever - analgesic for pain

Asymptomatic Inflammatory Prostatitis

*painless* inflammation of prostate without evidence of infection (*no* s/s of infection)

These meds are useful in women diagnosed with PMS, dysmenorrhea, and endometriosis

- Oral contraceptives (regulate hormones) - NSAIDS = ibuprofen + naproxen (pain) = *prostaglandin* inhibitors

5 P's of sexual health history

- Partners - Practices (Sexual) - Past STDs - Pregnancy (history, prevention/protection, and plans) - Protection from STDs (contraception)

Gerontologic Considerations

- Pendulous breasts Loss of subcutaneous fat Loss of structural support Atrophy of mammary glands - ↓ Glandular Tissue density - ↑ Incidence of breast cancer > 50% of breast cancers diagnosed are in women aged 65 or older Pt education • Teach to wear well fitted bras w/ good support, this will improve overall appearance & reduce pain in the upper back, shoulders, & neck. • Wearing a good bra will also decrease the risk of developing dermatitis that occurs when skin lies on top of skin • Encourage the pt to become familiar w/ their own breasts & what is normal for them. As breast cancer risk increases w/ age, it important that older females continue for their yearly mammograms & clinical breast exams, & they are aware of subtle changes in their breast tissue. - Monthly breast exams

Screening guidelines for Pap smear test

- Start at age 21 (to age 29), every 3 years (even if sexually active before then) i. But need annual gyn exam - Every 5 years starting at age 30- 65? - After 65 = pap smear not needed

5 P's of repro assessment

1. *Partners* a. Number of partners...men, women, or both 2. *Practices* (sexual) 3. *Pregnancy* (protection, and/or plans, history) 4. Protection from STIs 5. Past (history) of STIs

25 y.o. woman tells RN she has had sex with multiple male partners in the past year. The nurse will plan to teach about:

1. STI testing 2. Based on results treat, test partners, treat partners, abstain, use barrier protections

Screening test for cervical cancer begins at age 21 for all women

= PAP TEST

A patient comes to the outpatient clinic for treatment of uncomplicated gonorrhea. Which patient statement requires immediate clarification by the nurse? "I should avoid alcohol use for at least 2 weeks." "I will have my sexual partner come in for treatment." "After I start the antibiotic, it is safe to have sex again." "After treatment, I do not need to return to the clinic for retesting."

"After I start the antibiotic, it is safe to have sex again." Rationale: Patients should avoid sexual intercourse for 7 days after completing treatment w/ antibiotics. All sexual contact of patients w/ gonorrhea must be evaluated & treated to prevent reinfection. Patients should *abstain from sexual intercourse & alcohol during treatment*. Sexual intercourse allows the infection to spread & can delay healing. Alcohol is irritating to the healing urethral walls. Patients w/ uncomplicated gonorrhea who are treated do *not* need to return to the clinic to confirm the disease has been cured.

A 60-yr-old woman comes to the clinic reporting unexpected bleeding. What statement should the nurse use regarding diagnosing the cause of bleeding? "It is probably the end of menopause." "A Pap smear is used to diagnose endometrial cancer." "A hysterectomy may be indicated to treat the bleeding." "An endometrial biopsy will help determine the cause of bleeding."

"An endometrial biopsy will help determine the cause of bleeding." Rationale: With unexpected bleeding in a postmenopausal woman, an endometrial biopsy should be done to exclude or diagnose endometrial cancer. The abnormal bleeding should not be ignored just because she is postmenopausal. A hysterectomy w/ bilateral salpingo-oophorectomy w/ lymph node biopsies will be done to treat endometrial cancer if diagnosed. A Pap smear will not diagnose endometrial cancer unless it has spread to the cervix.

The nurse is obtaining a sexual history from a woman who is a new patient in the primary care clinic. It would be most appropriate for the nurse to ask which question first? "Have you ever had a sexually transmitted infection?" "Have you ever been in a relationship with anyone who hurt you?" "Have you ever been forced into sexual acts as a child or an adult?" "Are you satisfied with your sexual relationship with your partner?"

"Are you satisfied with your sexual relationship with your partner?" Rationale: When taking a sexual health history, the nurse should begin with the least sensitive area of questioning and then move to more sensitive areas.

The nurse is caring for a 26-yr-old patient who is being discharged after an induced abortion. Which statement should the nurse include in discharge teaching? "Avoid sexual intercourse for 2 weeks." "Heavy bleeding is expected for 24 hours." "A temperature of 101° F (38.9° C) is normal" "Birth control pills should not be taken for 30 days."

"Avoid sexual intercourse for 2 weeks." Rationale: After an abortion, teach the patient to avoid intercourse for 2 weeks. Contraception can be started the day of the procedure. Symptoms of possible complications include a fever & abnormal vaginal bleeding. These symptoms should be reported immediately.

A woman has sought care because of urinary incontinence. She states that running or jumping often precipitates leakage of urine, an event that has been occurring with increasing regularity in recent months. Which assessment question is most relevant to try to determine the cause of the patient's problem? "Do you know if your mother or sisters have had similar problems?" "Do you find that you are prone to frequent urinary tract infections?" "Did you have any muscle damage when giving birth to your children?" "Do you take part in a regular program of physical exercise and stretching?"

"Did you have any muscle damage when giving birth to your children?" Rationale: Trauma to the pelvic musculature during birth is often the cause of *urge and stress incontinence* in female patients. UTIs, family history, and exercise are less likely to contribute to an ongoing pattern of incontinence.

A woman is scheduled for her first Pap test. The nurse should provide which instructions? "A full bladder is needed for more accurate results." "You should rest for 2 to 3 hours after the procedure." "Do not douche for at least 24 hours before the procedure." "A Pap test will screen for sexually transmitted infections."

"Do not douche for at least 24 hours before the procedure." Rationale: The patient should be told to not douche for at least 24 hours before a Pap test. The patient should empty the bladder before a Pap test. There are no activity restrictions after a Pap test. The patient should rest for 2 to 3 days after a conization. A culture or a smear tests for sexually transmitted infections. A Pap test is a cytologic study used to detect abnormal cells.

The nurse is teaching clinic patients about risk factors for testicular cancer. Which person is at highest risk for developing testicular cancer? A 48-yr-old black man with erectile dysfunction A 30-yr-old white man with a history of cryptorchidism A 19-yr-old Asian man who had surgery for testicular torsion A 28-yr-old Hispanic man with infertility caused by a varicocele

A 30-yr-old white man with a history of cryptorchidism Rationale: The incidence of testicular cancer is *four times higher in white men* than in black men. Testicular tumors are also more common in men who have had *undescended testes (cryptorchidism)* or a *family history* of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to exogenous estrogen, & testicular cancer in the contralateral testis.

The nurse caring for patients in a primary care clinic identifies which patient as at highest risk for developing breast cancer? A 59-yr-old who has inherited the APC gene A 25-yr-old with fibrocystic breast disease A 72-yr-old with a family history of breast cancer A 43-yr-old who is obese and leads a sedentary lifestyle

A 72-yr-old with a family history of breast cancer Rationale: The risk factors most associated w/ breast cancer are *female gender, advancing age, & family history.* The incidence of breast cancer increases dramatically after age 60 years. Mutations in BRCA genes may cause 5% to 10% of breast cancers; The APC gene is associated with colon cancer. Obesity and physical inactivity increase the risk for breast cancer. Fibrocystic breast disease is not associated with the development of breast cancer.

Which male patient does the nurse identify is most susceptible to experiencing erectile dysfunction as a consequence of his drug regimen? A patient who takes a biguanide for type 2 diabetes. A patient who takes a β-adrenergic blocker for hypertension. A patient who uses a proton pump inhibitor to control acid reflux. A patient who is taking a cephalosporin antibiotic in order to treat cellulitis.

A patient who takes a β-adrenergic blocker for hypertension. Rationale: Antihypertensives are commonly implicated in cases of erectile dysfunction. Antibiotics, PPIs, and biguanides are less likely to negatively impact men's sexual function.

A prolactin assay will detect...

A prolactin assay will detect *pituitary dysfunction that can cause amenorrhea.*

A male patient reports fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? A very tender prostate gland Reports of chills and rectal pain Reports of urgency and frequency Escherichia coli bacteria in his urine

A very tender prostate gland Rationale: A tender and swollen prostate is indicative of prostatitis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatitis and lead to epididymitis or cystitis. E. coli in his urine, chills & rectal pain, and urgency & frequency are all present with a UTI & not specifically indicative of prostatitis.

Q: Characterized by round, rubbery mobile lumps that are painless and well delineated. Commonly found in teens and young women

A: Fibroadenomas

Q: Painful fluid-filled sacs which are well-delineated and mobile, common in middle-aged women

A: Fibrocystic changes in breasts

Q: Soft flesh-colored bumps or cauliflower-like appearance located on the genitals

A: Genital warts Cause: HPV (not cancerous) i. 2 different strains, one that causes cancer ii. Most likely need testing/pap to see if cancerous strain is present

Q: In this condition, men are more likely to experience dysuria and urethral discharge leading to early treatment

A: Gonorrhea Many people are asymptomatic Complications: infertility Testing period = 60 days Abstain from sexual intercourse for 7 days during treatment

Q: Occurs most often in adolescence males because of hormonal imbalance. Can also occur due to medication side effects

A: Gynecomastia Older gentleman = medications such as spironolactone

Q: Staphylococcus aureus and clogged milk ducts can lead to this condition

A: Mastitis (lactational)

Q: Characterized by chancre in primary stage, palmer rash in secondary stage

A: Syphilis Third stage = spreads to internal organs (can cause neuro syphilis) Treatment = penicillin in any stage Testing period = 90 days Pregnant with syphilis = will give baby syphilis, but most cause stillbirth or many complications that will not allow viable life

Q: Characterized by malodorous vaginal drainage, itching, and dysuria

A: Trichomoniasis Cause = protozoan

Q: Characterized by a firm, IMMOBILE, irregularly shaped, painless lump

A: a. Breast cancer!!! (Generalized description) Form of breast cancer without a lump = inflammatory

Q: STI caused by HSV and is not curable

A: genital herpes (caused by HSV 2) b. Burning, itching, tingling c. If pregnant = C SECTION INDICATED d. Contagious ALWAYS e. Treated = ACYCLOVIR (antiviral) i. ORAL Ii. Topical does not show any benefits to genital

The patient is being treated for a recurrent episode of Chlamydia. What should the nurse include in patient teaching? If you are treated, your sexual partner will not need to be treated. Abstain from sexual intercourse for 7 days after finishing the treatment. You will probably get gonorrhea if you have another recurrence of Chlamydia. Because you have been treated before, you do not need to take all the medication this time.

Abstain from sexual intercourse for 7 days after finishing the treatment. Rationale: Patients treated for Chlamydia infections should abstain from sexual intercourse for 7 days after treatment until all sexual partners have completed a full course of treatment to prevent recurrence, and a follow-up culture is done. A single-dose treatment is also available. Because Chlamydia & gonococcal infections are closely associated, they are frequently both treated, but having Chlamydia does not give the patient gonorrhea. *Each time a patient is treated for Chlamydia, a full course of treatment is required.*

In working with teenagers, what should the nurse include when teaching about prevention of STIs? Spermicidal jellies reduce the risk of getting STIs. Douches for women and cleaning the penis will prevent STIs. Abstinence and then latex barriers, such as condoms, are the best prevention. Getting an STI is embarrassing so you will want to use preventive measures.

Abstinence and then latex barriers, such as condoms, are the best prevention. Rationale: *Abstinence & then latex barriers, such as condoms, are the best prevention of STIs.* Spermicidal jellies or creams do not reduce the risk of contracting STIs. Most STIs are curable, but complications are serious & costly if they are not cured. Douches may spread the infection, undermine local immune responses, and do not prevent STIs. Cleansing of the penis will provide comfort after an STI has been diagnosed but will not prevent STIs. Nurses should provide supportive counseling and not reinforce feelings of embarrassment.

Which event discovered during pregnancy would alert the nurse that a cesarean section delivery is indicated? Contact with a person with syphilis 2 weeks ago Treatment for gonococcal pharyngitis before conception Treatment for C. trachomatis at her 20th week of gestation Active herpes simplex virus type 2 vesicles on her cervix at the time of delivery

Active herpes simplex virus type 2 vesicles on her cervix at the time of delivery Rationale: The woman w/ active herpes simplex virus type 2 at the time of delivery has the greatest risk for the fetus, & the baby will be delivered by cesarean section to prevent infection. Syphilis has an average incubation period of 21 days, so even if the contact was sexual, the syphilis should not infect the baby at birth. The woman treated for gonococcal pharyngitis should have been cured with treatment, but the baby's eyes will be treated at birth to prevent gonorrheal eye infection regardless. Treatment of the pregnant woman with C. trachomatis prevents transfer of the infection to the fetus.

A female patient is recovering from rectocele repair surgery. Which interventions should be included in the plan of care? (Select all that apply.) Maintain complete bed rest. Administer a stool softener. Provide a cleansing enema. Apply ice to the perineal area. Urinary catheter care twice a day. Sitz bath may be used in a few days.

Administer a stool softener. Apply ice to the perineal area. Urinary catheter care twice a day. Rationale: Administering a stool softener will reduce straining & disruption of the surgical repair. Ice will reduce pain & swelling at the surgical site. Urinary catheter care is provided twice a day to reduce catheter-associated urinary tract infections. A sitz bath may be given a few days after surgery for comfort. Maintaining strict bed rest is not indicated. A cleansing enema is provided before surgery, not after.

Metformin (Glucophage)

Anti-diabetic medication (T2) Infertility, *PCOS* - AEs: Lactic acidosis, megaloblastic anemia, hepatotoxicity, diarrhea, nausea, vomiting, flatulence

A young male patient is seeking treatment for recurrence of genital tingling, burning, and itching. The nurse will expect a prescription for which class of medications? Antivirals Antibiotics Vaccination Contraceptives

Antivirals Rationale: This patient has a reoccurrence of genital herpes (HSV2). Although not a cure, he will be treated w/ antiviral medications to decrease the duration of viral shedding & the healing time of genital lesions & reduce outbreaks. Antibiotics & contraceptives are not used to treat acute HSV2. There are no vaccinations for HSV.

The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. What intervention should the nurse use to decrease the lymphedema? Keep affected arm flat at the patient's side. Apply an elastic bandage on the affected arm. Assess blood pressure only on unaffected arm. Restrict exercise of the affected arm for 1 week.

Assess blood pressure only on unaffected arm. Rationale: Blood pressure readings, venipunctures, & injections should not be done on the affected arm. Elastic bandages should not be used in the early postoperative period because they inhibit collateral lymph drainage. The affected arm should be elevated above the heart, and isometric exercises are recommended and gradually increased starting in the recovery room to reduce fluid volume in the arm.

The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected with 3 positive for cancer cells. The patient has stage IIB breast cancer. Which nursing intervention would be most effective in planning care? Evaluate left arm lymphatic accumulation. Maintain joint flexibility and left arm function. Teach her about chemotherapy and radiation therapy. Assess the patient's response to the diagnosis of breast cancer.

Assess the patient's response to the diagnosis of breast cancer. Rationale: Assessment is the first step in planning patient care. Because the nurse is the patient's advocate and this is an extremely stressful time for the patient and family, the nurse should focus on the patient's response to the diagnosis of breast cancer when planning care. The approach for the care of the left arm and teaching the patient about further therapy will be based on the initial assessment.

A hospitalized older patient reports his foreskin is retracted and will not return to normal. Which action is the priority? Start oral antibiotics. Apply ice to reduce swelling. Attempt to move the foreskin over the glans. Call the provider to prepare for circumcision.

Attempt to move the foreskin over the glans. Rationale: Paraphimosis can occur when the foreskin is pulled back during bathing, during catheter insertion, or after intercourse & not returned to the normal position. Attempting to return the foreskin over glans is the priority action. If the nurse is unsuccessful, then ice would be applied to decrease swelling. If the foreskin is not returned to the normal position manually by the HCP, then circumcision would be indicated. Paraphimosis is considered a urologic emergency because arterial blood flow to the glans penis is impaired.

The nurse is caring for a 62-yr-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? Avoid straining during defecation. Restrict fluids to prevent incontinence. Sexual functioning will not be affected. Prostate examinations are not needed after surgery.

Avoid straining during defecation. Rationale: Activities that increase abdominal pressure, such as sitting or walking for prolonged periods & straining to have a bowel movement (Valsalva maneuver), should be avoided in the postop recovery period to prevent a postoperative hemorrhage. Teach the patient to drink at least 2-3 L of fluid every day. *Digital rectal examinations should be performed yearly*. The prostate gland is not totally removed & may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, & decreased orgasmic sensation.

The nurse teaches a 30-yr-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? Hamburger with cheese, pudding, and coffee Grilled steak, French fries, and vanilla shake Baked chicken, peas, apple slices, and skim milk Grilled cheese sandwich, onion rings, and hot tea

Baked chicken, peas, apple slices, and skim milk Rationale: A diet high in red meat & high-fat dairy products along w/ a low intake of vegetables & fruits may increase the risk of prostate cancer.

During the health history interview, a 73-yr-old male patient states that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give anticipatory guidance about what condition? A tumor of the prostate Benign prostatic hyperplasia Bladder atony because of age Age-related altered innervation of the bladder

Benign prostatic hyperplasia Rationale: Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells & stromal tissue. It occurs in about 50% of men older than age 50 years and 80% of men older than age 80 years. Only about 16% of men develop prostate cancer. Bladder atony & age-related altered innervations of the bladder do not lead to a weakened stream.

How does alcohol, caffeine, & spicy foods increase symptoms of Prostatitis?

Causes irritation to the GU tract leading to spasms

A patient comes to the clinic after being informed by a sexual partner of possible recent exposure to syphilis. The nurse will examine the patient for what characteristic finding of syphilis in the primary clinical stage? Chancre Alopecia Condylomata lata Regional adenopathy

Chancre Rationale: Chancres appear in the primary stage of the bacterial invasion of Treponema pallidum, the causative organism of syphilis. The other findings do not appear until the secondary stage of syphilis, occurring a few weeks after the chancres appear.

A 23-yr-old woman admitted with a possible ectopic tubal pregnancy reports sudden intense pelvic pain radiating to the left shoulder. Which action by the nurse should receive the highest priority? Observe the amount of vaginal bleeding every 15 minutes for 1 hour. Check the vital signs and immediately notify the health care provider. Administer the prescribed pain medication and reassess in 30 minutes. Assess the fetal heart tones and determine the presence of fetal movement.

Check the vital signs and immediately notify the health care provider. Rationale: A ruptured ectopic pregnancy may produce pelvic or abdominal pain & vaginal bleeding. If the tube ruptures, the pain is intense & may be referred to the shoulder. External vaginal bleeding may not be an accurate indicator of actual blood loss. Vital signs should be monitored closely along w/ observation for signs of shock. A ruptured ectopic pregnancy is an emergency because of the risk of hemorrhage & hypovolemic shock. The patient may need a blood transfusion & IV fluid therapy. In addition, the patient will need emergency surgery. Fetal assessment is not indicated for an ectopic pregnancy.

Herceptin (Trastuzumab)

Chemotherapy It can treat breast, stomach, and esophageal cancer.

Pap smear/test

Collects cells form the cervix to assess for abnormal cells - Start at age 21 (to age 29), every 3 years (even if sexually active before then) i. But need annual gyn exam ii. Every 5 years starting at age 30- 65? iii. After 65 = pap smear not needed iv. Conducted by using speculum

Direct visualization of cervix with binocular microscope. Used as a follow up for abnormal pap. Cervical biopsies can also be obtained

Colposcopy

done in postmenopausal women who present with abnormal uterine bleeding

Concerned for cancer of endometrial lining = *endometrial biopsy needed*

A patient is 1 day postoperative after a transurethral resection of the prostate (TURP). Which event is an unexpected finding? Requires 2 tablets of Tylenol #3 during the night. Reports fatigue and claims to have minimal appetite. Continuous bladder irrigation infusing with decreased output. Expresses anxiety about his planned discharge home the next day.

Continuous bladder irrigation infusing with decreased output. Rationale: A decrease or cessation of output in a patient w/ CBI requires immediate intervention. The nurse should temporarily stop the CBI & attempt to resume output by repositioning the patient or irrigating the catheter. Pain, fatigue, & low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient's CBI.

Epididymitis: Diagnostics & Nursing Interventions

Diagnostic Tests • UA, Urine Culture • WBC- *20,000 to 30,000* • Scrotal ultrasound • Aspiration of fluid from epididymis Interventions • *Antibiotics* • Ceftriaxone 250mg IM single dose & Doxycycline 100mg twice daily for 10days • *Anti-inflammatory* • *Analgesics*

To monitor the progression of decreased urinary stream, the nurse should encourage which type of regular screening? Uroflowmetry Transrectal ultrasound Digital rectal examination (DRE) Prostate-specific antigen (PSA) monitoring

Digital rectal examination (DRE) Rationale: DRE is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia (BPH) in men older than 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.

The nurse is performing an assessment on a female patient. What assessment finding should be documented and reported to the primary health care provider? Dimpling of breast Dark pink genitalia Watery cervical mucus Triangular hair distribution

Dimpling of breast Rationale: Dimpling of the breast is highly suspicious for carcinoma of the breast. Dark pink genitalia, watery cervical mucus, and triangular pubic hair distribution are all normal female reproductive system assessment findings.

A 58-yr-old woman is 1-day postoperative after an abdominal hysterectomy. Which intervention should the nurse perform to prevent VTE? Place the patient in a high Fowler's position. Provide pillows to place under the patient's knees. Encourage the patient to change positions frequently. Teach the patient deep breathing and coughing exercises.

Encourage the patient to change positions frequently. Rationale: The patient should be encouraged to change positions frequently & ambulate to prevent venous stasis. The high Fowler's position & pressure under the knees should be avoided to prevent VTE. Deep breathing & coughing are therapeutic exercises but do not directly address the risk of VTE.

What action should be recommended to a woman recovering from surgical repair of a fistula? Douche daily to prevent postoperative infection. Remove and cleanse her pessary on a daily basis. Resume normal activity to prevent adhesion formation. Ensure that she does not place stress on the repaired area.

Ensure that she does not place stress on the repaired area. Rationale: After surgical repair of a fistula, the patient should avoid placing stress on the repaired region. Normal activity is not resumed until significant healing has occurred. *Douching is contraindicated*, and pessaries are used to treat prolapses, not fistulas.

The nurse is teaching health promotion to a variety of women in a community center. How should the nurse respond when asked about when a female should begin having a Pap smear? Every year beginning at age 30 years Every 3 years beginning at age 21 years Every 3 years beginning at age 18 years if sexually active Every year beginning at the onset of menarche and continuing until menopause

Every 3 years beginning at age 21 years Rationale: A Pap test (Pap smear) should be done at least once *every 3 years at the age of 21 years* regardless of when a woman becomes sexually active. Women *65 years or older* may *stop* having Pap tests after having *no abnormal Pap test results for the previous 2 years*.

The patient at the clinic reports abdominal bloating, depression, and irritability related to premenstrual syndrome. What should the nurse recommend initially? (Select all that apply.) Take diuretics. Exercise regularly. Take antidepressants. Take antianxiety agents. Increase pork, chicken, and milk intake. Consider psychological counseling to resolve symptoms.

Exercise regularly. Increase pork, chicken, and milk intake. Rationale: The nurse can recommend regular exercise to help manage stress, elevate the mood, & have a relaxing effect. Eating foods rich in vitamin B6 (pork, milk, and legumes) and tryptophan (dairy and poultry) will promote serotonin production and improve symptoms. Diuretics, antidepressants, and antianxiety agents are not prescribed unless symptoms persist or interfere with daily functioning. Psychological counseling does not address physiological symptoms, but it may improve coping mechanisms.

A 30-yr-old woman reports the recent appearance of itchy, slightly painful lesions on her vulva, some of which have recently burst. Which STI should the nurse suspect first? Gonorrhea Chlamydia Genital warts Genital herpes

Genital herpes Rationale: A primary episode of genital herpes is often marked by multiple small, vesicular lesions on the genitals. This symptomatology is not associated with genital warts, gonorrhea, or Chlamydia.

Monoclonal antibody to HER-2 receptive breast cancers

Herceptin

A 72-yr-old patient had a mastectomy for breast cancer 6 months ago and wants to have breast reconstructive surgery. Which motivation for surgery would be most likely? Improve the woman's self-image. Be able to experience sexual arousal. To get a tummy tuck as well as the breast mound. Restore the premastectomy appearance of the breast.

Improve the woman's self-image. Rationale: The most likely motivation for this patient to seek breast reconstructive surgery is to improve her self-esteem. With this surgery, she will not be able to experience sexual arousal through breast stimulation or restore the premastectomy appearance of the breast. The abdominoplasty (tummy tuck) effect will only be a possibility with the transverse rectus abdominis musculocutaneous (TRAM) flap, not with a breast implant or tissue expansion.

Epididymitis

Inflammation of epididymis • Younger men- Gonorrhea & Chlamydia • Older men- UTI, Prostatitis • Usually *unilateral* • May be complication of catheterization/cystoscopy Assessment findings • Scrotal pain • Scrotal erythematous • Change in walk- *duck waddle* • Tenderness over spermatic cord • Dysuria, frequency, & urgency • *Urethral discharge* may be present • Fever, nausea, vomiting

Urethritis

Inflammation of the urethra Causes- • Bacterial or viral infections • STDs Assessment findings • Purulent/clear discharge • Dysuria, hesitancy, intermittency • Frequent urination Diagnostic Tests • STI screenings • UA • Culture & Sensitivity Treat underlying cause and inflammation

Prostatitis

Inflammatory condition of the prostate gland • Acute Bacterial • Chronic Bacterial • Chronic prostatitis pelvic pain syndrome • Asymptomatic inflammatory prostatitis • Both acute & chronic generally caused by organisms reaching gland

Because of the risks, a 50-yr-old patient does not want hormone replacement therapy for perimenopausal symptoms. She asks the nurse how to minimize hot flashes and night sweats. What should the nurse recommend first? Increase warmth to avoid chills. Good nutrition to avoid osteoporosis Vitamin B complex and vaginal lubrication Keep the bedroom cool and limit alcohol use.

Keep the bedroom cool and limit alcohol use. Rationale: To avoid hot flashes & sweating at night, decrease heat production with a cool environment, limit caffeine and alcohol, and practice relaxation techniques. Heat loss may be facilitated with increased circulation in the room, avoidance of heavy bedding, and wearing loose-fitting clothes. Warmth will facilitate hot flashes. Nutrition, vitamin B complex, and vaginal lubrication will help with other complications of perimenopause but not hot flashes and sweating at night.

Prostate Cancer

Known risk factors: • Age, ethnicity, and family history are non-modifiable risk factors. • Incidence rises markedly after age 50. • Median age at diagnosis is 67 years old. • Highest in Jamaican men of African descent • Having a first-degree relative w/ prostate cancer increases risk. • No single gene cause • No genetic testing is available to determine predisposition • Having family hx does not mean certainty of developing

When doing breast self-examination, the female patient should report which finding to the health care provider? Denser breast tissue Palpable rib margins Left nipple deviation Different sized breasts

Left nipple deviation Rationale: Unilateral deviation of a nipple may be a clinical indicator of breast cancer or other problem and should be reported to the health care provider. Dense breast tissue, palpable rib margins, and different sized breasts are all normal findings.

What should the nurse emphasize when teaching a woman diagnosed with pelvic inflammatory disease (PID)? The importance of contraception Manifestations of further infection The importance of maintaining hygiene Benefits of hormone replacement therapy (HRT)

Manifestations of further infection Rationale: PID frequently progresses to serious infection of the reproductive structures. The diagnosis does not present a particular need for contraception or specific hygiene measures. HRT is not used to treat PID.

The nurse is asked to teach an adolescent female patient about menstruation. What is important for the nurse to include when teaching the adolescent? The length of the menstrual cycle should be 28 days. Menstrual cycles are often irregular for the first 1 to 2 years. The female loses around 1 cup of blood with each menstrual period. Follicle-stimulating hormone (FSH) causes maturity of the follicle for ovulation.

Menstrual cycles are often irregular for the first 1 to 2 years. Rationale: Teaching the patient that menstrual cycles are often irregular for the first 1 to 2 years is important. The length of a menstrual cycle may be from 21 to 35 days, with the average length being 28 days. About 20 to 80 mL (which at most is only 1/3 cup) of blood is lost with each menstrual period. FSH begins the follicle maturation, but LH must be present for complete maturation and ovulation to occur.

This medication can reduce hyperinsulinemia, improve hyperandrogenism, and restore ovulation in women with PCOS

Metformin

The nurse is caring for a patient with breast cancer who is receiving high-dose doxorubicin (Adriamycin). Which assessment is most important for the nurse to make? Observe for alopecia. Determine visual acuity. Monitor cardiac rhythm. Assess mouth and throat.

Monitor cardiac rhythm. Rationale: Doxorubicin (especially at high doses) may cause cardiotoxicity and heart failure. The nurse should monitor for dysrhythmias, electrocardiogram changes, and manifestations of heart failure. Other adverse effects of doxorubicin include stomatitis and alopecia, but these effects are not as serious as cardiac problems. Tamoxifen may cause visual changes.

Test useful in diagnosing chlamydia, gonorrhea, and trichomoniasis

NAAT

The nurse performs a breast examination on a female patient who has never been pregnant, 1 week after her menstrual period. Which finding, if made by the nurse, would indicate a normal breast examination? Nipples are soft without retractions. Unilateral breast dimpling is present. Milky fluid is expressed from the nipples. Axillary lymph nodes are fixed and palpable.

Nipples are soft without retractions. Rationale: Normal breasts are symmetric without dimpling. Nipples are soft with no drainage, retraction, or lesions noted. No masses, tenderness, or lymphadenopathy is present.

The nurse is volunteering at a community center to teach women about breast cancer. What should the nurse include when discussing risk factors? (Select all that apply.) Nulliparity Alcohol use Age 30 or over Early menarche Late menopause Personal history of colon cancer

Nulliparity Alcohol use Early menarche Late menopause Personal history of colon cancer Rationale: Women are at an increased risk for development of breast cancer if they are older than the age of 50 years; have a family history of breast cancer; have a personal history of breast, colon, endometrial, or ovarian cancer; have a long menstrual history as seen w/ early menarche or late menopause; and have had a first full-term pregnancy after the age of 30 years or are nulliparous. Alcohol use may increase the risk of breast cancer.

The nurse is caring for a 25-yr-old patient who has polycystic ovary syndrome (PCOS). When preparing the teaching plan, which classic manifestation should the nurse associate with severity of symptoms and infertility? Obesity Hirsutism Amenorrhea Irregular menstrual periods

Obesity Rationale: Obesity has been associated with the severity of symptoms such as excess androgens, oligorrhea, amenorrhea, & infertility. This knowledge will affect the teaching the nurse does for this patient to prevent cardiovascular disease & abnormal insulin resistance. Hirsutism, amenorrhea, & irregular menstrual periods are not associated with the severity of the symptoms.

The patient has a history of cardiovascular disease and has developed erectile dysfunction. He is frustrated because he is taking nitrates and cannot take erectogenic medications. What should the nurse do first? Give the patient choices for penile implant surgery. Recommend counseling for the patient and his partner. Obtain a thorough sexual, health, and psychosocial history. Assess levels of testosterone, prolactin, luteinizing hormone, and thyroid hormones.

Obtain a thorough sexual, health, and psychosocial history. Rationale: The nurse's first action to help this pt is to obtain a thorough sexual, health, & psychosocial history. Alternative treatments for the cardiac disease would then be explored if that had not already been done. Further examination or diagnostic testing would be based on the history & physical assessment, including hormone levels, counseling, or penile implant options.

What should the nurse include when teaching about early detection of ovarian cancer? Report any unusual vaginal bleeding. Use estrogen with progestin for menopause. Obtain annual bimanual pelvic examinations. Receive a preventive bilateral oophorectomy.

Obtain annual bimanual pelvic examinations. Rationale: Because it is difficult for a patient to detect early clinical indicators of ovarian cancer, the best method of early detection is to have a yearly bimanual pelvic examination to palpate for an ovarian mass. Although pelvic or vaginal bleeding should be reported soon after it occurs, this rarely occurs with ovarian cancer and is not an early symptom. Oral contraceptives may be used or a preventive bilateral oophorectomy may be done to reduce the risk, but they would not be done to detect early ovarian cancer.

When teaching nursing students about the male sexual response, what should the nurse call the phase that includes ejaculation? Plateau phase Orgasmic phase Resolution phase Excitement phase

Orgasmic phase Rationale: The orgasmic phase is when ejaculation occurs from contraction of the penile and urethral musculature propelling the sperm outward through the meatus. The excitement phase is manifested by penile erection in response to sexual stimulation. The plateau phase is when the erection is maintained. There is a slight increase in vasocongestion and testicle size, and the glans penis may be more reddish-purple. The resolution phase is after ejaculation when the penis gradually returns to its unstimulated, flaccid state.

Classic manifestations: irregular periods, T2DM (insulin resistance), asthma (?), hirsutism, elevated lipids, & obesity. It is one cause of infertility

PCOS = polycystic ovary syndrome - First line medications = metformin

Prostate specific Antigen (PSA) test

PSA is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in the blood. PSA is a protein produced by both cancerous & noncancerous tissue in the prostate (a small gland that sits below the bladder in men)

A patient recently had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care? Immobilize the patient's right arm until postoperative day 3. Maintain the patient's right arm in a dependent position when at rest. Administer diuretics prophylactically for the prevention of lymphedema. Promote gradually increasing mobility as soon as possible following surgery.

Promote gradually increasing mobility as soon as possible following surgery. Rationale: Mobility should be encouraged beginning in the postanesthesia care unit (PACU) and increased gradually throughout the patient's recovery. Immobilization is counterproductive to recovery, and the limb should not be in a dependent position. Diuretics are not used to prevent lymphedema but may be used in active treatment of the problem.

Which nursing action is indicated when providing immediate care for a female patient who is a victim of a sexual assault? Administering a pregnancy test Monitoring of the patient's vital signs Providing emotional and nonjudgmental support Ensuring the patient is left alone whenever possible

Providing emotional and nonjudgmental support Rationale: Many sexual assault survivors need emotional & nonjudgmental support following the assault. *SAFETY* physical and emotional is #1 priority A pregnancy test is premature, & the patient should not be left alone. There is rarely a specific indication for close monitoring of vital signs unless the extent of physical injury indicates a need.

The nurse is performing an admission assessment of an older adult male patient prior to bladder resection surgery. What assessment finding of the patient's genitourinary system would be unexpected? The patient's left testicle hangs lower than his right. Pubic hair is absent from the patient's genital region. The patient's intestines are not palpable through the inguinal rings. The patient's foreskin can be manually retracted to expose the meatus.

Pubic hair is absent from the patient's genital region. Rationale: An absence of pubic hair is an unexpected finding in an older male patient. It is common for the left testicle to hang lower than the right, and the intestines are often not palpable through the inguinal rings. The foreskin should be easily retractable.

The nurse administers a Gardasil vaccine to an 18-yr-old female patient. After the injection, which patient instruction is priority? Avoid sexual activity for 24 to 48 hours. Remain lying down for at least 15 minutes. Return to the clinic in 6 months for a second dose. Use two methods of birth control to avoid pregnancy.

Remain lying down for at least 15 minutes. Rationale: To prevent syncope (fainting) during and after the administration of Gardasil, the patient should remain sitting or lying down for 15 minutes. *The vaccine is not recommended during pregnancy.* Gardasil vaccine is given in *three IM doses over a 6-month period*. There are no sexual activity restrictions after administration of Gardasil.

Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy? Reporting any bladder spasms Assessing the patient's incision Irrigating the patient's urinary catheter Evaluating the patient's pain and selecting analgesia

Reporting any bladder spasms Rationale: Cleaning around the catheter, recording intake & output, & reporting any pain or bladder spasms to the RN are appropriate tasks for delegation to the UAP. Selecting analgesia, irrigating the pt's catheter, & assessing the incision are *not* appropriate skills or tasks for UAP.

A 71-yr-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a photoselective vaporization of the prostate. What is the primary goal of this intervention? Resumption of normal urinary drainage Maintenance of normal sexual functioning Prevention of acute or chronic renal failure Prevention of fluid and electrolyte imbalances

Resumption of normal urinary drainage Rationale: The most significant S/S of BPH relate to the disruption of normal urinary drainage & consequent urine retention, incontinence, & pain. A laser vaporization technique vaporizes prostate tissue & cauterizes blood vessels & is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, impaired sexual functioning, & kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.

Screening guidelines for Mammography

Screening for the early detection of breast cancer includes *yearly mammograms starting at age 45 years*.

The patient has a low-grade cancer on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago, his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations indicate prostate cancer may be extending and require a change in the plan of care? (SATA.) Casts in his urine Presence of α-fetoprotein Serum PSA level 10 ng/mL Onset of erectile dysfunction Nodularity of the prostate gland Development of a urinary tract infection

Serum PSA level 10 ng/mL Nodularity of the prostate gland Rationale: The manifestations of *increased PSA level* along w/ the *new nodularity of the prostate gland* potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth. Development of a urinary tract infection may indicate urinary retention or could be related to other issues.

The nurse is providing teaching to a group of perimenopausal women. Which herbs and supplements would the nurse include in a discussion about effective alternative therapies for menopausal symptoms? (Select all that apply.) Soy Garlic Gingko Vitamin A Cinnamon Black cohosh

Soy Black cohosh Rationale: There is good scientific evidence that soy is useful in decreasing menopausal hot flashes and that black cohosh is safe to use for up to 6 months to decrease menopausal symptoms. *(Soy contains estrogen)* Garlic, gingko, vitamin A, and cinnamon do not affect menopausal symptoms.

A woman with endometriosis is seeking a cure. After identifying childbearing is no longer desired, the nurse should introduce which potential treatment? Danazol Leuprolide (Lupron) Nonsteroidal antiinflammatory drugs Surgical removal of endometrial implants

Surgical removal of endometrial implants Rationale: The only cure for endometriosis is the surgical removal of all endometrial implants, which may include the uterus, fallopian tubes, and ovaries. Leuprolide is a gonadotropin-releasing hormone agonist that causes amenorrhea with menopausal side effects. Danazol is a synthetic androgen that inhibits the anterior pituitary. Nonsteroidal antiinflammatory drugs relieve pain but do not affect the problem of endometriosis.

Gynecomastia (Men)

Transient, *non-inflammatory* enlargement of 1 or both breasts - Men - Temporary, benign • Most common cause: disturbance of normal ratio of active androgen to estrogen in plasma or the breast itself • Can occur in puberty, due to imbalance of estrogen and testosterone • Resolves often by age 18 • Treatment focuses on *reassurance* of the benign nature of this disease. • Can be a manifestation of other problems: Testicular tumors, adrenal cancers, pituitary tumors, hyperthyroidism, liver disease • Side effect of certain drugs: Spironolactone, digitalis, tricyclic antidepressants • Marijuana can cause it.

A pregnant woman is experiencing morning sickness and breast tenderness. In the ninth week after her last menstrual period, she is rushed to the hospital with severe left shoulder pain, blood pressure of 90/60 mm Hg, and heart rate of 112 beats/min. What is the best diagnostic test that is expected to be ordered? Serum hemoglobin Transvaginal ultrasound 12-lead electrocardiogram (ECG) Serial β-human chorionic gonadotropin levels

Transvaginal ultrasound Rationale: Because the patient is known to be pregnant, a transvaginal ultrasound will be used to assess for ectopic pregnancy & tubal rupture. Serum hemoglobin and 12-lead ECG would not define a diagnosis related to the manifestations that she has. Serial β-human chorionic gonadotropin levels could be used if the patient was stable to determine if a spontaneous abortion is occurring because the levels would decrease over time.

Erectile Dysfunction: Treatment

Treatment • Medications- phosphodiesterase type 5 inhibitors • Tadalafil (Cialis) • Sildenafil (Viagra) • Vardenafil (Levitra) • Vacuum Constriction Devices • Penile implants • Highly invasive • Mechanical failure, infection, erosions

What should general teaching for patients with a sexually transmitted infection (STI) include? (Select all that apply.) Treatment of sexual partners. Douching will help to provide relief of itching. Importance of retesting after treatment to confirm cure. Cotton undergarments are preferred over synthetic materials. Sexual abstinence is needed during the communicable phase of a disease. Condoms should be used during and after treatment during sexual activity.

Treatment of sexual partners. Importance of retesting after treatment to confirm cure. Cotton undergarments are preferred over synthetic materials. Sexual abstinence is needed during the communicable phase of a disease. Condoms should be used during and after treatment during sexual activity. Rationale: Teaching for patients with an STI should include the treatment of all sexual partners, retesting after treatment to confirm cure, cotton undergarments are more comfortable, sexual abstinence is needed during the communicable phase of the infection to prevent spread, and condoms should be used for sexual activity during & after treatment to prevent spread & reinfection. Douching may spread the infection or alter the local immune responses & is therefore contraindicated in patients w/ STIs.

A 33-yr-old patient noticed a painless lump and heaviness in his scrotum during testicular self-examination. The nurse should provide the patient information on which diagnostic test? Ultrasound Cremasteric reflex Doppler ultrasound Transillumination with a flashlight

Ultrasound Rationale: When the scrotum has a painless lump, scrotal swelling, & a feeling of heaviness, testicular cancer is suspected, & an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination w/ a flashlight is done to diagnose a hydrocele.

A nurse is teaching a health promotion workshop to a group of women in their 40s and 50s. What information about nipple discharge should the nurse teach to participants? Inappropriate lactation necessitates breast biopsy. Nipple discharge of any type is a precursor to cancer. Galactorrhea is a normal symptom related to perimenopause. Unexpected nipple discharge of any type needs medical follow-up.

Unexpected nipple discharge of any type needs medical follow-up. Rationale: Although most cases of nipple discharge are not related to malignancy, further medical assessment is indicated. Other testing would be done for inappropriate lactation before a breast biopsy would be necessary. Galactorrhea is not considered a normal age-related change, nor is it a common perimenopausal symptom.

A 24-yr-old patient is at the clinic with symptoms of purulent vaginal discharge, dysuria, and dyspareunia. She is sexually active and has multiple partners. What should the nurse explain as the rationale for Chlamydia screening? Chlamydia is frequently comorbid with HIV. Untreated chlamydia infections can lead to sepsis. Untreated chlamydia infections may cause infertility. Chlamydia infections are treatable only in the early stages.

Untreated chlamydia infections may cause infertility. Rationale: Because of the potential for infertility, routine screening for Chlamydia is recommended for women sexually active younger than age 25 years and annually for those older than 25 years with one or more risk factors for the infection. The disease is treatable at all stages of infection. Chlamydia is not a primary risk for sepsis and is not noted to be strongly correlated with HIV infection.

Bacterial Prostatitis

Usually ages 30-50- need to consider STI's • Fever, chills, dysuria, urethral discharge, back pain, perineal pain • *Enlarged, firm, & very tender* prostate on exam Complications • Acute *Urinary Retention* - WHY? prostate surrounds urethra, can basically squeeze it off so no urine can flow through • *Cystitis* (Inflammation of the bladder) • *Epididymitis*

The history and physical of a 29-year-old female patient are indicative of human papillomavirus (HPV) infection. What treatment option should be discussed with the patient? Gardasil Antibiotic therapy Wart removal options Treatment with antiviral drugs

Wart removal options Rationale: Although discussion should focus on the various options for physically removing the symptomatic warts, the removal may or may not decrease infectivity. The HPV vaccine (Gardasil) is ineffective in cases of existing HPV, and neither antiviral nor antibiotic drugs are effective treatments.

HPV 16 and 18 infections and immunosuppression (ex. HIV) increases the risk for female reproductive cancer

a. CERVICAL CANCER b. Diagnosis by... pap test c. Prevention = HPV vaccine (Gardasil 9)

Downward displacement of the bladder into vaginal canal

a. Cystocele (bladder prolapse) b. Most common prolapse: BLADDER Why? Childbirth, increased pressure, weakened musculature between vaginal wall and bladder

Dual antibiotic therapy used to treat gonorrhea for 1-time dose in office

a. IM *ceftriaxone* ONE TIME DOSE b. PO *Azithromycin* ONE TIME DOSE c. (Doxycycline is given multiple days) Teaching: treat all partners, test all contacts within last 60 days, abstain from sex for 7 days, use condom when sexually active again

Normal physiological cessation of menses associated with decline in ovulation

a. Menopause b. Average age = 50s Symptoms = night sweats, hot flashes, insomnia, nocturia, mood fluctuations

Deadliest gynecologic cancer which presents with vague nonspecific symptoms such as abdominal pain and bloating

a. Ovarian cancer b. No regular tests or vaccines

ORAL CONTRACEPTIVES DO NOT ...

do NOT PREVENT STIs

Orchitis

inflammation of the testes Causes • *Rarely primary infections* (comes from something else) • Different organism lead to infection- Mumps, TB, Pneumonia, Syphillis •Trauma, or surgery Assessment findings • Fever & chills • Nausea & vomiting • Tenderness, redness, & warmth to scrotal skin • Scrotal edema • Presence of other infections • Mumps • UTI's • Epididymitis

BPH- medications/treatments

• *5a-reductase inhibitors* • Blocks conversion of testosterone to dihydroxytestosterone • Decreases hyperplasia by suppressing androgens • Finasteride (Proscar) • Duasteride (Duragen) • *Take 6 months to be effective & needs to be continued to maintain improvement*

BPH- medications/treatments

• *Alpha Adrenergic receptor blockers* • Selectively antagonizes prostate alpha-1a adrenergic receptors, relaxing smooth muscle and improving urine flow • *Also used in HTN* • 50-60% efficacy of improvement of symptoms, which occurs in 2-3wks • Doxazosin (Cardura) • Prazosin (Minipress) • Terazosin (Hytrin) • Tamsulosin (Flomax)

Treatment for Prostatitis

• *Antibiotics*- broad spectrum • Pain control • Antipyretics • Hydration

Orchitis: Nursing Interventions

• Antibiotics • Analgesics • Bed rest • Scrotal elevation • Anti-emetics • Anti-inflammatory • Corticosteroids • Ice pack

TESTING for Prostatitis

• CBC • UA with Culture & Sensitivity (Both can test for infection) • PSA (tests for prostate cancer)

Orchitis: Patient education

• Explain medications/scrotal support • If due to mumps- explain risk for infertility

Benign Prostate Hypertrophy (BPH)

• Glandular enlargement, hyperplasia & overgrowth of the smooth muscles & connective tissue • Most common benign tumor of adult male reproductive system • Occurs in 50% of men over 50 and 80% of men over 80% • Does this increase risk of prostate cancer?

erectile dysfunction (ED)

• Inability to attain or maintain an erect penis that allows satisfactory sexual performance • Can occur at any age, but increase in incidence w/ increasing age. • Younger men: Recreational drugs, alcohol • Middle-aged men: DM, HTN, medications Nursing Implications • Emphasize healthy diet & regular exercise • Counsel men that declining sexual health should be brought to attention- early CV risk • Psychosocial concerns HTM medications are known to have this side effect. Can lead to NON-COMPLIANCE

BPH pt education

• Limit amount of fluids taken in at one time • Increase fluid intake 2-3L daily • Urinate at first urge • *AVOID drugs the cause urinary retention* (Anticholinergics, Decongestants, Antidepressants Post-Op Care: • Maintenance of catheter • Minimize bladder spasms • Control bleeding • Aseptic techniques w/ bladder irrigation • Kegel exercise

Benign Prostate Hypertrophy (BPH): Causes

• Not completely understood • Result of endocrine changes associated with aging process • Genetic predisposition • Caucasians have higher incidence

Patient Education for Prostatitis

• Purpose & use of medications • Sitz baths to control pain & spasms • How much daily water? *2000-3000 ml* • How does alcohol, caffeine, & spicy foods increase symptoms? *Causes irritation to the GU* tract leading to spasms

Epididymitis: patient education

• Teach client to elevate scrotum with towel- reduce pain/edema • Scrotal support may need to be worn for up to 6 weeks • Intermittent cold compress & sitz baths • Medication information • Sterility possible complication • *If caused by STI, advise client to avoid sexual intercourse until partner has been examined & treated*

Testicular Torsion

• Twisting of spermatic cord that supplies blood to testes & epididymis. Usually seen in younger men. • Severe pain, swelling, tenderness of scrotum, back pain • Loss of cremasteric reflex on affected side • Ultrasound/nuclear scan of testes to assess blood flow • Surgical emergency- *ischemia if blood supply not returned to testis in 4-6 hrs*

BPH symptoms/studies

• Voiding • Weak stream • Difficulty starting & stopping • Overflow dribbling • Incomplete bladder emptying • Urgency & Frequency • Dysuria & bladder pain • Nocturia • Incontinence

Intraductal Papilloma (Benign, wartlike growth)

↑ risk of BRCA? *Slight ↑ risk of cancer*

Lactational Mastitis

↑ risk of BRCA? No lactating women - Bacteria gain access through cracked nipple. Risk Factors: - May also be due to clogged milk duct - Previous mastitis - Sore or cterm-9racked nipples - Improper nursing techniques - Overly tired or stressed - Poor nutrition - Smoking