Unit 8

21-year-old college football player has acknowledged to a nurse at a campus clinic that he has been injecting androgens in an effort to increase the size of his musculature and enhance his on-field performance. Which of the following teaching points should the nurse include in a conversation with the player? A) "You run a real risk of developing acne and developing breasts by doing this." B) "You will indeed be able to increase your muscles, but they will rebound by shrinking smaller than they ever were within a few months." C) "Most of the people who do this cause themselves to be permanently sterile." D) "A reduction in the size of your penis and the production of mutated sperm can be an effect of steroid use."

A

A 20-year-old male has presented to a health clinic with multiple genital lesions that are filled with a viscous, creamy exudate and has subsequently been diagnosed with molluscum contagiosum. What is his care provider most likely to tell him about the plan for treating the diagnosis? A) "This kind of infection often subsides on its own and doesn't grow more serious over time." B) "These lesions usually respond well to oral antiviral medications." C) "Treatment of this problem is usually successful, but if untreated, it can lead to sterility." D) "The bacteria that cause this disease are often latent for several years at a time, and you would be contagious for the entire period."

A

A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last 6 months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms? A) Clotrimazole, an antifungal agent B) Penicillin V potassium, a broad-spectrum antibiotic C) Ciprofloxacin, a fluoroquinolone antibiotic D) Tenofovir, an antiviral agent

A

A 29-year-old woman has been trying for many months to become pregnant, and fertilization has just occurred following her most recent ovulation. What process will now occur that will differentiate this ovulatory cycle from those prior? A) Human chorionic gonadotropin will be produced, preventing luteal regression. B) The remaining primary follicles will provide hormonal support for the first 3 months of pregnancy. C) The corpus luteum will atrophy and be replaced by corpus albicans. D) The basal layer of the endometrium will be sloughed in preparation for implantation.

A

A 34-year-old male has been diagnosed with testicular cancer after he visited his family physician with a complaint of an enlarged, painful testicle. Biopsy has indicated that his tumor is malignant, and his oncologist believes that the tumor arose in the seminiferous epithelium and is producing a uniform population of cells. What is the client's most likely specific diagnosis? A) Seminoma B) Choriocarcinoma C) Germ cell tumor D) Nonseminoma

A

A 40-year-old African American patient is at increased risk of developing prostate cancer, since his father was diagnosed with the disease at age 60 and his brother at age 56. What diagnostic measures should be undertaken? A) PSA and DRE starting before the age of 50 B) Transrectal ultrasonography starting immediately C) PSA and DRE starting at age 50 D) Transrectal MRI starting at age 45

A

A 57-year-old woman has been diagnosed with atrophic vaginitis and has expressed surprise to her care provider, citing a lifetime largely free of gynecological health problems. She has asked what may have contributed to her problem. How can the care provider best respond? A) "The lower levels of estrogen since you've begun menopause make your vagina prone to infection." B) "Vaginitis is not usually the direct result of any single problem, but rather an inevitability of the vaginal dryness that accompanies menopause." C) "This type of vaginitis is most commonly a symptom of a latent sexually transmitted infection that you may have contracted in the distant past." D) "The exact cause of this problem isn't known, but it can usually be resolved with a diet high in probiotic bacteria."

A

A 68-year-old male has visited his family physician because the size of his scrotum has increased exponentially in recent months. He has subsequently been diagnosed with an inguinal hernia. Which of the following statements best captures the nature of his health problem? A) Part of his intestine and parietal peritoneum are protruding through the inguinal opening. B) Rupture of the tunica vaginalis has allowed a part of his small bowel to protrude into the intrascrotal space. C) Incomplete closure of the inguinal opening during his development has contributed to testicular hypertrophy and hyperplasia. D) Occlusion of the efferent ductules and epididymis causes massive dilation of the testes.

A

A 70-year-old woman who delivered four children during her reproductive years has weakened pelvic floor muscles. Which of her following anatomical structures is least susceptible to inappropriate herniation into her vagina? A) Peritoneum B) Uterus C) Bladder D) Rectum

A

A campus-based peer counseling group is conducting an information blitz on sexually transmitted diseases. Which of the following statements about genital warts requires correction? A) "Genital warts can take up to a month after exposure to first become visible." B) "There is no existing treatment that can eradicate the virus once it's contracted." C) "Condoms do not necessarily prevent the transmission of the virus that causes genital warts." D) "There are a number of subtypes of the virus that cause genital warts, but current vaccines protect against most common causes of them."

A

A nurse who works on a urology-gynecology ward of a hospital is coming on shift and will be caring for a 34-year-old woman who has been admitted overnight for the treatment of a large endometriosis. What interventions should the nurse most realistically anticipate providing over the course of the shift and the next several days? A) Providing pain control; preparing the client for a laparoscopic procedure or hysterectomy. B) Administration of packed red blood cells to compensate for low hemoglobin; administering hormone therapy. C) Assisting with a Pap smear; administration of high-dose corticosteroids. D) Administration of male androgens to minimize endometrial hyperplasia; facilitating a dilation and curettage.

A

In a busy STD clinic on a large university campus, a group of students have developed tetracycline- and penicillin-resistant strains of N. gonorrhoeae. Given these results, the nurse can expect that which of the following medications will be prescribed? A) Single injection of Rocephin (ceftriaxone) B) A 7-day supply of Augmentin (amoxicillin and clavulanate) C) Nizoral (ketoconazole), an antifungal medication D) Fluconazole (Diflucan), for yeast infections

A

Long, stretchy cervical mucus that exhibits ferning on a microscope slide is characteristic of which of the following? A) Crystallization of inorganic salts B) Low estrogen levels C) High progesterone levels D) Low human chorionic gonadotropin levels

A

Of the following list of medications, which would likely be prescribed to a patient with benign prostatic hyperplasia (BPH) as a way to decrease the prostate size by blocking the effects of androgens on the prostate? A) Finasteride (Proscar), a 5a-reductase inhibitor B) Imdur (isosorbide mononitrate), a vasodilator C) Birth control pills containing both estrogen and progestin D) Leuprolide (Lupron), a gonadotropin-releasing hormone analog

A

Two nursing students are debating the merits and demerits of infant circumcision. Which of the following statements is most accurate? A) "Circumcised men tend to have a lower incidence of penile cancer." B) "Getting circumcised basically rules out the possibility of getting Peyronie disease later in life." C) "Circumcision reduces pressure on the deep dorsal vein and the dorsal artery, making erection easier later in life." D) "The odds of getting infant priapism fall with circumcision."

A

While explaining milk production and release to a group of expectant parents, the nurse educates the parents on the fact that suckling by the infant provides the stimulus for milk ejection. This suckling sends feedback to the hypothalamus, which stimulates the release of which hormone from the pituitary gland responsible for the ejection of milk into the ductal system? A) Oxytocin B) Prolactin C) Progesterone D) Follicle-stimulating hormone

A

While teaching a class on female cancers, the instructor emphasizes to the nursing students that many patients with ovarian cancer may display A) abdominal pain, bloating, feeling full quickly after ingesting food. B) pain after intercourse, bleeding irregularities, perineal tenderness. C) colicky low abdominal pain, adnexal mass present without palpation. D) lower abdominal pain localized to one side, referred shoulder pain.

A

A patient with excruciating back pain that has been getting worse over the past few months comes to the Emergency Department. His chief complaint is excruciating back pain that has been getting worse over the past few months. He has also noticed decreased sensation in his lower extremities, some urinary incontinence, and feels like he never really empties his bladder all the way after voiding. Following diagnostic testing, the patient is diagnosed with advanced prostate cancer with spinal cord compression. The nurse should anticipate administering which medications to this patient? Select all that apply. A) Ketoconazole, a fungicide, to lower serum testosterone levels. B) Bisphosphonates, such as pamidronate, to inhibit bone loss C) Phosphate-binding agents such as aluminum hydroxide D) Sulfonamides with trimethoprim (Bactrim) to treat the urinary tract infection (UTI) E) Calcium carbonate to prevent osteoporosis

A B

A pregnant teenager has arrived at a free clinic seeking care. She has had no prenatal care and is currently 27 weeks' gestation. Upon testing for a sexually transmitted disease (STD), it is found that she has active T. pallidum (syphilis). Given the fact that she has active syphilis at this stage in her pregnancy, it is very likely her fetus is at risk for: Select all that apply. A) being born prematurely. B) congenital defects. C) unstable blood glucose levels. D) cyanosis in limbs after delivery. E) blindness.

A B

A couple has been trying to get pregnant for over 2 years. After infertility testing, the physician has informed the male that he has a low sperm count. The nurse knows which of the following causes of low sperm count may lead to impaired spermatogenesis? Select all that apply. A) Prolonged fever B) Wearing tight briefs rather than boxers C) Undescended testes D) Swimming in cold-water lakes E) Vacationing in a tropical location

A B C

A 31-year-old woman and her husband have presented to their family physician due to their inability to conceive a child after trying for the last 18 months. Which of the following will the nurse practitioner want to specifically rule out as potential contributing factors? Select all that apply. A) Cryptorchidism in the husband B) Slow maturation of the endothelial lining after ovulation C) Low levels of LH and FSH in the wife D) Large amounts of clear, stretchy cervical mucus E) Sexually transmitted diseases like gonorrhea or chlamydial infection.

A B C E

While working in a sexually transmitted disease (STD) clinic, the nurse should be aware that which of the following diagnostic tools are available for diagnosing chlamydial infections? Select all that apply. A) Gram stain where polymorphonuclear leukocytes are identified B) Direct fluorescent antibody testing C) Enzyme-linked immunosorbent assay (ELISA) D) Western blot testing E) Nucleic acid amplification tests (NAATs)

A B C E

The health nurse is dealing with a case of untreated chlamydial infection. The nurse suspects the patient has developed Reiter syndrome. Which of the following clinical manifestations would support this diagnosis? Select all that apply. A) Diffuse pinkness of the conjunctiva along with watery and itchy eyes B) Asymmetric complaints of stiffness and pain in knees and sacroiliac joints C) Cervical tissue very friable and bleeds easily D) Pain when urinating E) Fatigue and tiredness from heart valve vegetation

A B D

Prior to performing a laparoscopy, a patient exhibiting which of the following clinical manifestations would be treated with oral antibiotic therapy for suspected pelvic inflammatory disease (PID)? Select all that apply. A) Lower abdominal pain. B) Tenderness when cervix is touched during bimanual exam. C) Feeling of fullness and bloating in abdomen. D) Purulent cervical drainage noted on tissue after voiding. E) Elevated white cell count.

A B D E

Following a workup that included endocrine studies (FSH/LH, prolactin, testosterone, DHEAS levels), a 22-year-old college student complaining of abnormal bleeding has been diagnosed with dysmenorrhea due to alterations in her hormone levels. The nurse should anticipate that she will likely be prescribed: Select all that apply. A) oral contraceptives. B) estrogen only. C) prostaglandin synthetase inhibitors. D) anxiolytic medications. E) androgens.

A C

A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are active in the development of her breasts? Select all that apply. A) Prolactin B) Human growth hormone C) Luteinizing hormone D) Estrogen E) Follicle-stimulating hormone F) Progesterone

A C D E F

A 66-year-old man has presented to a nurse practitioner to get a refill for his antiplatelet medication. The client has a history of ischemic heart disease and suffered a myocardial infarction 5 years ago and has unstable angina; he uses a transdermal nitroglycerin patch to control his angina. The client has a 40 pack-year smoking history and uses nebulized bronchodilators at home for the treatment of transient shortness of breath. He has long-standing hypertension that is treated with a potassium-sparing diuretic and a -adrenergic-blocking medication. During the nurse's assessment, the man states that he has been unable to maintain his erection in recent months. Which of the following aspects of the man's health problems and treatments would the nurse identify as contributing to his erectile difficulty (ED)? Select all that apply. His A) antihypertensive medications. B) use of bronchodilators. C) hypertension. D) diuretic use. E) smoking history. F) age.

A C E F

A 31-year-old male has been referred to a fertility clinic following a count of 2 million sperm/mL on seminal fluid analysis. Which of the following hormone levels would a clinician want to examine in an effort to ascertain the cause of the client's low sperm count? Select all that apply. A) Luteinizing hormone (LH) B) Adrenocorticotropic hormone (ACTH) C) Follicle-stimulating hormone (FSH) D) Cortisol E) Somatostatin F) Gonadotropin-releasing hormone (GnRH)

A C F

A 40-year-old male client with multiple health problems has been diagnosed with a testosterone deficiency. The nurse knows that which of the following assessment findings would correlate with a testosterone deficiency? Select all that apply. A) A high-pitched voice B) Long-lasting chronic hip dysplasia C) Complaints of multiple upper respiratory infections D) A low muscle mass in proportion to his total body weight E) Hot flashes and diaphoresis

A D

A 20-year-old female has come to the clinic complaining of severe menstrual cramps. The clinic nurse practitioner knows that dysmenorrhea occurs when which muscle group contracts? A) Perimetrium B) Myometrium C) Endometrium D) Fundus

B

A 20-year-old male has been diagnosed with testicular cancer and is seeking information about his diagnosis from a number of Web sites. Which of the following statements that he has read is most plausible? A) "Testicular cancer is a leading cause of death among males who should be in the prime of their life." B) "Men with cryptorchidism--the term for an undescended testicle--are known to have a higher risk of developing testicular cancer." C) "For most men with testicular cancer, bloody urine is their first sign that something is wrong." D) "Recent developments in the treatment of testicular cancer mean that few men now need to have a testicle removed."

B

A 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What are the woman's most likely treatment and prognosis? A) Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy. B) Oral antiprotozoals to the patient and sexual partners to help prevent complications. C) Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection. D) Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.

B

A 31-year-old patient with breast cancer is concerned about being prescribed a hormonal medication to help block the effects of estrogen on the growth of breast cancer cells. The nurse should provide education about which of the following likely medications? A) Trastuzumab (Herceptin), a biologic therapy B) Nolvadex (Tamoxifen), a nonsteroidal antiestrogen C) Progesterone, a hormone. D) Arimidex (anastrozole), an aromatase inhibitor

B

A 60-year-old woman who is 11 years menopausal has presented to the emergency department stating, "I haven't had my period in years, but lately I've been bleeding again, and quite heavily in the last few days." The care team needs to rule out endometrial cancer. How should they best explain the most accurate plan for confirming or ruling out the diagnosis? A) "We're going to book a CT scan for you as soon as possible so that we can see what is inside your uterus." B) "We're going to have to open your cervix with a speculum and take scrapings from the wall of your uterus." C) "We are going to order blood work that will measure your hormone levels." D) "We can do a Pap smear right now, and we will get the results as soon as we can."

B

A male college student has arrived at the student clinic complaining of tingling, itching, and pains in his groin. Upon inspection, the nurse notices some pustules and vesicles. While taking a detailed sexual history, the nurse should ask which of the following questions to rule out further complications? A) "Do you get cold sores very often?" B) "Do you have pain when you urinate or have difficulty starting the stream?" C) "Have you noticed excessive swelling in your scrotum the last few days?" D) "Have you been experiencing flank pain and bloody urine?"

B

A newborn male has been diagnosed with hypospadias following his postpartum assessment by a pediatrician. Which of the following diagnostics and treatment options is the physician most likely to rule out first? A) Chromosomal studies B) Circumcision C) Surgical repair D) Testosterone supplementation

B

A nurse practitioner has a 30-year-old male patient presenting with fever and chills, urinary frequency and urgency, and pain with urination. A urine sample displays cloudy and foul-smelling urine. During digital rectal exam of the prostate, the nurse notes a thick white discharge. A likely diagnosis would be A) urinary tract infection requiring a prescription of sulfur drugs. B) acute bacterial prostatitis requiring antimicrobial therapy. C) testicular cancer requiring appointment with an urologist. D) inflammation of the epididymis requiring scrotal elevation.

B

A nursing student studying obstetrics asks the faculty, "How does the sperm get so much energy to swim up the fallopian tubes?" The instructor responds based on which pathophysiological principle? A) Usually the ejaculation is so powerful that it propels the sperm far up into the fallopian tubes. B) Fructose is secreted by the seminal vesicles and provides energy for motility of the sperm. C) The seminal vesicles secrete fluid for the semen, and they can secrete catecholamines that energize the sperm. D) Estrogen, which is being secreted when the ova are ripe and ready for penetration, assists by attracting the sperm in the right direction.

B

A patient with a yeast infection asks the nurse how they diagnose this infection. The nurse will base her response knowing this is primarily diagnosed by A) the look and smell of the secretions. B) looking at the spores on a wet-mount slide using 20% potassium hydroxide. C) looking for Lactobacillus species under the microscope. D) sending a blood test to lab for DNA testing on the specimen

B

A pregnant 23-year-old diagnosed with herpes simplex virus (HSV) is receiving prenatal care from her family physician. To prevent transmission of the virus to her baby, the physician will educate to include which of the following accurate statements? A) "After your caesarean section, it will be safest if you don't breast-feed your child." B) "If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with." C) "A vaginal delivery will be safe as long as you are consistent with taking your valacyclovir." D) "We'll have to book you a caesarian delivery in order to ensure your baby isn't exposed to the virus."

B

A woman consults her physician about a study (Women's Health Initiative) discussing an increased risk for breast cancer if taking hormones. The physician can allay her fears by sharing which of the following findings? A) Only women with a family history of breast cancer had an increased risk for developing breast cancer while on birth control pills. B) This 26% increased risk for developing invasive breast cancer occurred in women taking combined continuous estrogen-progesterone therapy. C) The increased risk for developing inflammatory breast cancer occurred in women taking hormone replacement therapy when they were over the age of 45. D) Follow-up studies demonstrated that there was only a 3% increase in risk for developing breast cancer if hormones were discontinued immediately.

B

After a long and frustrating course of constant vaginal pain, a 38-year-old woman has diagnosed with generalized vulvodynia by her gynecologist. What treatment plan is her physician most likely to propose? A) Alternative herbal therapies coupled with antifungal medications B) Antidepressant and antiepileptic medications C) Lifestyle modifications aimed at accommodating and managing neuropathic pain D) Narcotic analgesia and nonsteroidal anti-inflammatory medications

B

After hearing daunting reports from her slightly older coworkers and friends, a 44-year-old woman has a number of questions for her physician about what to expect during perimenopause and why. Which of the following teaching points is most accurate? A) "The decrease in estrogen and most other hormones in your body do cause a lot of instability for most women around menopause." B) "Hot flashes are a reality for most women in menopause, and the exact cause of them isn't known yet." C) "The emotional swings that often accompany menopause result from changes to the limbic center in the brain, which governs emotion." D) "There are a lot of changes to the gastrointestinal and respiratory systems that exist around menopause that ultimately result from estrogen deficiency."

B

An elderly male patient is complaining of dribbling after he urinates and feeling like he never empties his bladder. The nurse suspects the patient may have a problem with A) kidney stones. B) an enlarged prostate gland. C) blood clots clogging the urethra. D) calcium sediment in the bladder.

B

During a group prenatal class, the nurse teaching the course is explaining the thinning of the cervix that accompanies the stages of labor leading up to delivery. A participant admits that she is not familiar with either the location or normal role of the cervix. Which of the following responses by the nurse would be most appropriate? A) "Your cervix is just the term for the lowest part of your uterus, and it is tightly shut at all times except in woman who are giving birth." B) "The cervix is the opening between the uterus and the vagina, and so it opens wide during the lead-up to birth." C) "Your cervix is the part of your uterus where the fallopian tubes join in and the baby has to pass through it to the vagina." D) "The cervix is the soft lining of your uterus that has to expand greatly to accommodate your baby during delivery."

B

Following a long history of intermittent back pain and urinary urgency, a 50-year-old client has been diagnosed with chronic bacterial prostatitis. Which of the following factors is most likely to influence his health care provider's choice of treatment? A) The diagnosis is thought to have an autoimmune etiology with limited response to steroid treatments. B) Antibacterial drugs penetrate poorly into the chronically inflamed prostate. C) Urethral catheterization provides symptom relief and contributes to resolution of the underlying infection. D) There are no proven treatments for chronic prostatitis that address the infectious process.

B

If a male has a history of impaired blood flow in his vascular system, he may be prone to develop A) premature ejaculation. B) erectile dysfunction. C) penile engorgement. D) vascular clots in pudendal arteries

B

The cremaster muscles work in concert with the pampiniform plexus that surrounds the testicular artery to A) move the testes into the scrotum. B) maintain testicular temperature. C) empty fluid from the seminal vesicles into the genital ducts. D) move sperm from the ampulla to the penis

B

The nurse knows that when combined continuous estrogen-progesterone therapy (CCEPT) is prescribed, the drug is considered effective if which of the following occurs? A) More regular periods for women with irregular menses B) Inhibited endometrial development resulting in no menses C) Relaxation of the myometrium, thereby limited painful cramps D) Shedding of the endometrial build-up on a more regular basis

B

Which of the following sexually active women most likely faces the highest risk of developing an ectopic pregnancy? A) A 14-year-old who experienced menarche 2 years prior. B) A 42-year-old who has decided to try to have one more child and has had her tubal ligation reversed. C) A 27-year-old who stopped using medroxyprogesterone contraceptive injection (Depo-Provera) several months ago. D) A 22-year-old who has a history of anorexia nervosa and who has a body mass index (BMI) of 12.0 (normal weight = 18.5 to 24.9).

B

While teaching a health class to junior and senior male high school students, the school nurse educates them regarding the first sign of testicular cancer, which would include A) one testicle being lower than the other in the scrotal sac. B) enlargement of the testicle. C) back pain. D) coughing bloody sputum.

B

The nurse knows that if which of the following hormones listed below are not available during embryonic development, a male embryo with an XY chromosomal pattern may develop female external genitalia? Select all that apply. A) Anti-Müllerian hormone (AMH) B) Testosterone C) Dihydrotestosterone (DHT) D) Acrosome E) Follicle-stimulating hormone (FSH)

B C

A 51-year-old man is receiving his annual physical exam, and his care provider is explaining the rationale for performing a digital rectal exam (DRE). Which of the following statements best captures the rationale for the procedure? A) DRE, combined with a measurement of prostate-specific antigen (PSA), is the easiest way to confirm or rule out benign prostatic hyperplasia (BPH). B) The presence of an enlarged prostate provides a definitive diagnosis of prostate cancer. C) If the prostate is hardened on examination, a biopsy is indicated for further investigation. D) DRE is a screening test recommended for men who are experiencing either reduced urine flow or pain on urination.

B C D

When explaining to a patient why his prostate is enlarging, the nurse will mention that which of the following hormones may contribute to the prostatic hyperplasia? Select all that apply. A) Glucocorticoids B) Testosterone C) Dihydrotestosterone D) Estrogens E) Progesterone

B C D

Which of the following factors are known to contribute to vaginal yeast infections? Select all that apply. A) Inflammation of the Skene and Bartholin glands. B) Poorly controlled diabetes C) Recent antibiotic therapy D) Excessive physical exercise E) Use of oral contraceptives F) High hormone levels during pregnancy

B C E F

While educating a mother about the benefits of giving her child the human papilloma virus (HPV) vaccine, gardisil, which of the following statements will the nurse need to clarify for the parent? Select all that apply. The vaccine is A) best administered before the child becomes sexually active. B) 100% effective against development of cervical cancer for her life span. C) effective against the two most common strains of genital warts. D) only recommended for females between the ages of 9 and 26. E) recommended prior to exposure to HPV, and if the child has genital warts, they are already exposed.

B D

41-year-old male has presented to his family physician stating that for the last 2 years his erection "is as crooked as a dog's hind leg and hurts too." He has subsequently been diagnosed with Peyronie disease. Which of the following statements by his physician is most appropriate? A) "Even though it's obviously distressing, you should know that this will likely resolve on its own with time." B) "I'll refer you to a urologist who will likely want to perform a circumcision." C) "This might need surgery, but it could possibly disappear over time without needing treatment." D) "There are things you can do to minimize this, such as getting more exercise, stopping smoking, and maintaining a healthy diet."

C

A 13-year-old patient undergoing puberty is alarmed to find small, white bumps surrounding the areolae on her nipples. You reassure her that these are a normal sign of her sexual maturation and tell her that they are which of the following? A) Skene glands B) Bartholin glands C) Montgomery tubercles D) Cooper ligaments

C

A 14-year-old boy has been brought to the emergency department by his mother in excruciating pain that is radiating from his scrotum to his inguinal area. The boy's heart rate is 122 beats/minute, and he has vomited twice before arrival at the hospital. Examination reveals that his scrotum is reddened and slightly swollen, and the testes are firm to touch and tender, with extensive cremaster muscle contraction noted. What is the boy's most likely diagnosis? A) Epididymitis B) Hydrocele C) Testicular torsion D) Varicocele

C

A 15-year-old female has presented to her family physician complaining of frequent discomfort around the time of her period. She has subsequently been diagnosed with primary dysmenorrhea. Which of the following treatments is most likely to be effective? A) Investigation and resolution of her hypothalamic-pituitary-ovarian disorder B) Hormone therapy aimed at resolving her estrogen deprivation C) Pain control with prostaglandin synthetase inhibitors D) Dilation and curettage

C

A 23-year-old woman has been referred to a fertility clinic after 1 year of attempting to become pregnant. Her diagnostic workup has resulted in a diagnosis of polycystic ovary syndrome (PCOS). What will the first line of treatment most likely consist of? A) Estrogen-progesterone hormone therapy and the administration of clomiphene B) Surgical resection of the ovaries using laparoscopy C) Lifestyle modifications to include weight loss by lowering calories and fat consumption D) Temporary use of oral contractive agents

C

A 24-year-old male patient with a complete transection of the spinal cord asks, "Will I be able to father children in the future?" The nurse responds, A) "Probably not since your spinal cord has been completely severed." B) "An urologist may be able to insert a needle into your testes and withdraw some sperm." C) "With proper stimulation of your genitals, you may be able to produce an erection and ejaculation." D) "It takes sympathetic innervation to produce an erection and ejaculation which is loss with your type of injury."

C

A 40-year-old woman with gray, runny vaginal discharge that has a foul, fishy odor has been told that she most likely has vaginosis. Which of the following phenomena most likely contributed to her present condition? A) Unprotected sex with a new partner who is a carrier of the relevant bacteria. B) Autoinoculation from a cold sore, wart, or oral fungal infection. C) A sharp reduction in the number of lactobacilli in the client's vaginal flora. D) Proliferation of sexually transmitted protozoa.

C

A 51-year-old woman who has been receiving estrogen and progesterone therapy (EPT) for the last 5 years has visited her care provider because her peers have told her about the risks of heart disease, stroke, and breast cancer that could accompany hormone therapy (HT). How should her care provider respond to her concerns? A) "There is a demonstrable increase in breast cancer risk with HT, but the risk of stroke or heart disease actually go down slightly." B) "All considered, the benefits of HT outweigh the slightly increased risks of heart disease, stroke, or breast cancer." C) "HT is actually associated with a decrease in heart disease risk, but there is an increase in stroke risk; the breast cancer connection is still unclear." D) "There's in fact a slight protective effect against stroke associated with HT, but this is partially offset by increased rates of heart disease and breast cancer."

C

A 54-year-old diabetic patient has come to the urology clinic complaining of erectile dysfunction. His history includes obesity, coronary artery disease that required CABG 3 years ago, hypertension, and gout. The nurse practitioner is reviewing his record in order to prescribe medication. The practitioner is considering prescribing sildenafil (Viagra). Which of the following home medications is contraindicated if taken concurrently with sildenafil? A) Diltiazem (Cardizem), a calcium channel blocker B) Cordarone (amiodarone), an antiarrhythmic C) Imdur (isosorbide mononitrate), a vasodilator D) Lasix (furosemide), a diuretic

C

A 68-year-old man has revealed to his care provider that he is distraught over his increasingly frequent inability to maintain an erection. Which of the following teaching points is most warranted? A) "Above the age of 65, erectile dysfunction is largely inevitable and untreatable." B) "With lifestyle modifications like exercise, weight loss, and quitting smoking, you can most likely correct this and prevent it in the future." C) "While this problem is often a part of the aging process, it might be a result of some of the medications that you take." D) "Most often this problem is transient and will resolve with time."

C

A 71-year-old man diagnosed with a stage T2 prostate tumor 2 years ago has elected watchful waiting, based upon an underlying heart condition that renders surgery potentially fatal. Recently, his PSA has jumped considerably, as have his levels of serum acid phosphatase. Which course of action would be least appropriate at this stage? A) Combination treatment with an antiandrogen and a GnRH agonist B) Treatment with bisphosphonates C) Treatment with GnRH agonists alone D) Treatment with ketoconazole

C

A 71-year-old man has visited his family physician for a checkup, during which the physician has initiated a discussion about the client's sexual function. Which of the following phenomena would the physician most likely consider pathological rather than age-related changes? A) The presence of an enlarging prostate gland B) A decrease in the size and firmness of the client's testes C) Cessation of androgen production D) A decrease in the force of the man's ejaculation

C

A couple who have three daughters would like to add a son to their family, and they have recently learned that the woman is pregnant. Which of the following phenomena would most likely be associated with the woman's eventual delivery of a healthy son? A) The production of dihydrotestosterone (DHT) by the embryo and DHT's differentiation into testosterone B) Development of testes under the influence of the X chromosome C) Suppression of female reproductive structures by anti-Müllerian hormone (AMH) D) Atrophy of the Wolffian ducts during embryonic development

C

A medical student is assessing a 22-year-old male who has come to the emergency department because of pain and swelling in his scrotum over the past 36 hours. The attending physician has told the student that she suspects epididymitis. Which of the medical student's following questions is most likely to be useful in the differential diagnosis of epididymitis? A) "Do you know if your vaccinations for mumps are up to date?" B) "Have you had unprotected sex in the past?" C) "Do you have a sensation of heaviness in the left side of your scrotum?" D) "Has it been painful when you get an erection lately?"

C

A patient who is still breast-feeding her infant has arrived at the clinic complaining of sore breasts. The physician has diagnosed mastitis. Which of the following statements made by the patient will require correction by the nurse? A) "They tell me this is usually caused by a Staph infection." B) "I need to make sure to wash my hands thoroughly before touching my breasts." C) "I need to stop breast-feeding until all my antibiotics have been taken." D) "A clogged duct in my breast has become clogged."

C

A pregnant client who is taking Risperidone (Risperdal), an antipsychotic prescribed for her bipolar disorder, is at high risk for developing which of the following hormonal adverse effects? A) Increased growth hormone production B) Decreased human chorionic gonadotropin levels C) Excess prolactin secretion D) Decreased follicle-stimulating hormone secretion

C

After hearing horror stories about the signs, symptoms, and course of lymphogranuloma venereum (LGV), a high school student has asked a visiting sexual health educator about the odds of acquiring the disease among sexually active Americans. Which of the following facts will most accurately underlie the educator's response? A) LGV has been eradicated in the United States but still has significant prevalence and incidence in Southeast Asia and Central America. B) This disease is not common in the United States, but existing cases disproportionately affect women. C) Men who have sex with men are at particular risk of LGV. D) The virus that causes LGV is rare outside the tropics.

C

During unprotected sex, a 17-year-old female high school senior has been exposed to the human papillomavirus (HPV). The school nurse would recognize that the student is at a considerable risk of developing which of the following diagnoses? A) Genital herpes B) Gonorrhea C) Condylomata acuminata D) Candidiasis

C

Following a visit to her campus medical clinic motivated by persistent abdominal pain and dyspareunia, a 20-year-old female college student has been referred for a diagnostic workup to rule out pelvic inflammatory disease. Her elevated white cell and C-reactive protein levels lead her care provider to suspect pelvic inflammatory disease (PID). What follow-up question is most likely to help with the differential diagnosis? A) "Are you using tampons during your period or do you normally use pads?" B) "What does your daily hygiene routine usually consist of?" C) "How many sexual partners have you had?" D) "Have you ever had a therapeutic abortion in the past?"

C

Following ejaculation in a healthy adult, approximately 300 million sperm is present. Which percent of these sperm would be considered normal (mobile and morphologically healthy) and able to fertilize an egg? A) 95% B) 75% C) 55% D) 45%

C

Having heard positive reports of the benefits of hormone therapy (HT) from her sister-in-law and friends, a 49-year-old woman has presented to her family physician asking to start HT. Her uterus is intact, and previous bone scans have indicated low bone density. The client also has a family history of heart disease. She characterizes her symptoms of menopause as "noticeable, but not debilitating by any means." Based on the most current research, what is her physician's best course of action? A) Begin estrogen-progesterone HT (EPT) to prevent future menopausal symptoms and coronary heart disease (CHD). B) Forego HT in light of her preexisting low bone density and consequent risk of osteoporosis. C) Forego HT but consider alternative therapies and reevaluate if her symptoms significantly affect her quality of life. D) Begin low-dose HT but perform regular breast cancer screening and heart health checks.

C

The Women's Health Initiative results have led the Institute of Medicine (2010) to recommend which of the following guidelines related to hip fractures in women? A) All postmenopausal women should take 1200 mg of calcium per day to prevent osteoporosis. B) The standard daily recommended amount of vitamin D was increased to 400 IU/day. C) All adults should take 600 IU/day of vitamin D to maintain healthy bones. D) A combination of calcium and vitamin D does not appear to prevent hip fractures.

C

Which of the following statements best captures an aspect of the neural control of sexual function? A) The sensory system contained in the testes communicates with the spinal cord by way of afferent pathways. B) Perineal stimulation transmits signals to the thalamus and hypothalamus. C) The spinal cord plays a central role, with the limbic system and cerebral cortex also contributing. D) Sympathetic stimulation causes the shunting of blood resulting in erection, while parasympathetic stimulation results in detumescence.

C

Which of the following statements best captures an aspect of the role of progesterone? Progesterone A) production begins shortly after conception and peaks prior to delivery. B) is responsible for the stimulation of lactation in the postpartum period. C) levels peak after ovulation and is present throughout the menstrual cycle. D) is the primary hormone responsible for the development of female secondary sex characteristics.

C

Which of the following statements most accurately captures a characteristic of the external female genitalia? A) Skene and Bartholin glands perform endocrine and exocrine functions. B) Surgical repair is required in the case of a ruptured hymen in prepubescent females. C) The labia majora and clitoris are analogous to the male scrotum and penis, respectively. D) The external genitalia facilitate sexual function and hormonal regulation.

C

Which of the following teaching points by an oncologist is most appropriate for a 33-year-old male who will begin treatment shortly for his testicular cancer? A) "Thanks to new treatment advances, there's a very good chance that I won't have to remove a testicle." B) "If steroid treatment fails, then we can consider surgery and/or chemotherapy." C) "You should know that there might be adverse effects on your sexual function after treatment is finished." D) "The advantage of performing an orchiectomy over other treatments is that it rules out recurrence."

C

Unbeknownst to him, a 30-year-old male has contracted Treponema pallidum during a sexual encounter the night before. Place the following manifestations of the microorganism in the chronological order that they would occur in the absence of treatment. Use all the options. A) Formation of aneurysms B) Appearance of a rash on the man's palms and feet C) Development of painless chancres on the man's scrotum.

C B D A

A 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the client from infecting others in the future. Which of the following statements by the client demonstrates the best understanding of his health problem? A) "Either me or a partner could end up with an eye infection from chlamydia that could make us blind." B) "Even though I couldn't end up sterile, a woman that I give it to certainly could." C) "Each of the three stages of the disease seems to be worse than the previous one." D) "Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it."

D

A 28-year-old female has been told she has atypical glandular cells following Pap smear. The physician will likely recommend which procedure that can be performed in his office to remove the abnormal zone and provide a specimen for further histological evaluation? A) Cone biopsy B) Intracavitary irradiation C) Trachelectomy D) Loop electrosurgical excision procedure (LEEP)

D

A 31-year-old male was diagnosed with genital herpes of the HSV-2 type 5 years ago. He is now broaching the subject with a woman he has recently formed a relationship with. Which of his statements is most accurate? A) "If you've been exposed to the herpes virus in the past, then there's no significant risk of reinfection." B) "The worst case scenario is that you'll develop cold sores, since this is the type of herpes virus that I've got." C) "If you've had cold sores when you were younger, it means that you've got antibodies against this type of herpes virus." D) "Even when I'm not having a recurrence, I could still pass the virus on to you."

D

A 39-year-old male client has been recently diagnosed with primary hypogonadism. Which of the following lab results would be most indicative of this diagnosis? A) Normal levels of free testosterone; low levels of total testosterone B) Low free testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels C) Low levels of gonadotropin-releasing hormone (GnRH) D) Low testosterone levels; high levels of LH and FSH

D

A 40-year-old woman has been identified to have a deficiency in estrogen. Which of the following physiological phenomena is most likely to remain unaffected? A) Parathyroid hormone antagonism and the rate of bone resorption B) The regulation of uterine endothelial development C) The maintenance of normal skin and blood vessel structure D) The synthesis and release of adrenal glucocorticoids

D

A 55-year-old male has presented to the emergency department because he is alarmed at the genitourinary symptoms he has experienced over the last several days. He reveals that he has had a number of new sexual relationships during a tropical vacation that ended 5 days ago. Over the last several days, he has had increasing pain in his urethra and a creamy yellow discharge from his penis. For the last 2 days, the discharge has been occasionally blood tinged. What differential diagnosis would be the care team's first priority? A) Chancroid B) Syphilis C) Chlamydia D) Gonorrhea

D

A care aide at a long-term care facility has left a note for the care director stating that an 82-year-old resident has a grossly distended scrotum and a likely inguinal hernia. On examination, the resident has been diagnosed instead with hydrocele. What will the care team most likely tell the resident and his family about his diagnosis? A) "We'll get you to the hospital quickly, because if this isn't treated, it can result in a blockage in the blood flow to your testes." B) "This isn't a result of your intestine entering your scrotum, but an accumulation of fluid within your testes." C) "This can sometimes result from the lower level of sex hormones that comes with age, so you will likely benefit from a testosterone supplement." D) "While distressing to look at, this condition usually doesn't have any significant consequences and won't need treatment."

D

A college student has come to the health clinic complaining of heavy bleeding during and between her menstrual periods. The nurse practitioner will document this as A) dyspareunia. B) amenorrhea. C) polymenorrhea. D) menometrorrhagia.

D

A student asks the instructor what are the parameters of infertility. The instructor responds, "Infertility is defined as" A) 100 million of sperm in ejaculate. B) 50% of sperm has good motility. C) morphology that appears normal. D) 10 million/mL sperm available in seminal fluid.

D

A woman has gone to her gynecologist complaining of pain during intercourse. The physician orders a maturation index on her vaginal scrapings. The results return an index of 75-25-0. The nurse can interpret this to mean A) she is in the beginning of cervical cancer. B) she is in the prime of her reproductive years. C) she is in a perimenopausal phase. D) she is experiencing postmenopausal vaginal dryness.

D

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last 6 months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms? A) Azithromycin B) Valacyclovir C) Penicillin D) Metronidazole

D

Staff at a women's health center are being briefed by their supervisor on the latest recommendations for breast cancer screening. Which of the following guidelines should staff pass on to their clients? A) "Breast self-exam should be ideally performed around the time of the month that you think you're ovulating." B) "The most important thing you can do to identify breast cancer early is to perform regular, systematic self-exams." C) "All postmenarche females should get a clinical exam by a trained professional on an annual basis." D) "Screening mammography and clinical exams are the cornerstones of breast cancer screening."

D

Which of the following situations would be considered pathological in an otherwise healthy, 30-year-old female? A) The woman's ovaries are not producing new ova. B) The woman's ovaries do not synthesize or secrete luteinizing hormone (LH). C) The epithelium covering the woman's ovaries is broken during the time of ovulation. D) The woman's ovaries are not producing progesterone.

D

Which of the following statements best captures an aspect of normal spermatogenesis? A) Testosterone chemically lyses each primary spermatocyte into two secondary spermatocytes with 23 chromosomes each. B) Sertoli cells differentiate into spermatids, each of which can contribute half of the chromosomes necessary for reproduction. C) Spermatogonia adjacent to the tubular wall undergo meiotic division and provide a continuous source of new germinal cells. D) Each primary spermatocyte undergoes two nuclear divisions yielding four cells with 23 chromosomes each.

D

Which of the following women is most likely to have a sexually transmitted infection as a contributing factor to her health problem? A) A 29-year-old woman with a diagnosis of localized vulvodynia B) A 40-year-old who is being treated for vaginal cancer C) A 32-year-old who is undergoing diagnostics to rule out endometriosis D) A 41-year-old with a diagnosis of mucopurulent cervicitis

D

Events in the ovulatory cycle progress in a similar manner each month. Place the following events in the ovulatory cycle in the correct chronological order. Use all the options. A) Formation of the theca B) Formation of the corpus luteum C) Formation of the antral follicle D) Development of the zona pellucida E) Bursting of the mature follicle

D A C E B

Sperm follow a prescribed route through the excretory ducts of the male reproductive system. Place the following components of the genital duct system in the order that sperm follow. Use all the options. A) Efferent ductules B) Ductus deferens C) Prostatic urethra D) Urethra E) Seminiferous tubules F) Epididymis

E A F B C D