Pathophysiology Reproductive Questions
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) "Circumcised men tend to have a lower incidence of penile cancer." A correlation between circumcision and lower incidence of penile cancer has been noted. Circumcision is unlikely to affect the development of Peyronie disease or priapism, and is not noted to influence the ease of attaining or maintaining erection.
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) "Genital warts can take up to a month after exposure to first become visible." Genital warts can take between 6 weeks to 8 months to incubate after exposure. The virus cannot be eliminated, and condoms do not provide proven protection. Vaccine protects against 4 HPV types.
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) "The lower levels of estrogen since you've begun menopause make your vagina prone to infection." The lack of vaginal epithelial regeneration after menopause predisposes older woman to vaginitis. It is not necessarily a result of vaginal dryness and is not likely sexually transmitted. The etiology is not unknown, and diet alone is unlikely to resolve the problem.
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 The treatment of dysfunctional bleeding of a nonhormonal nature is usually treated with oral contraceptives or cyclic progesterone therapy. Prostaglandin synthetase inhibitors are prescribed for dysmenorrhea. Anxiolytic drugs treat mood changes of PMS.
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) Clotrimazole, an antifungal agent The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if conditions such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.
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) Finasteride (Proscar), a 5a-reductase inhibitor Finasteride (Proscar), a 5a-reductase inhibitor, reduces prostate size by blocking the effect of androgens on the prostate. Vasodilators, BCPs, and GnRH analogs do not decrease prostate size.
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) PSA and DRE starting before the age of 50 The current recommendation of the American Cancer Society and the American Urological Association is that men at increased risk of prostate cancer, such as this patient, who has two risk factors, his race and his family history, should begin screening with an annual digital rectal exam (DRE) and prostate-specific antigen (PSA) measurement starting at age 45. The general population is advised to undergo this process starting at age 50. It is important to note that PSA levels can be a marker of either benign prostatic hyperplasia or cancer, and there is some degree of controversy regarding the benefit of screening for it. Although transrectal ultrasonography may detect small cancers, its prohibitive cost excludes its routine use in screening.
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) Peritoneum While displacement of the uterus, bladder, and rectum can result in uterine prolapse, cystocele, and rectocele, the peritoneum is unlikely to prolapse into the vagina.
A nurse who works on a urologyñgynecology 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) Providing pain control; preparing the client for a laparoscopic procedure or hysterectomy. Pain control is central to treatment of endometriosis, and surgical treatment is ideally performed laparoscopically, though hysterectomy is sometimes indicated. Bleeding is not a common symptom of endometriosis, and neither corticosteroids nor male androgens are common treatments.
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) Seminoma Seminomas are the subtype of germ cell tumors that are most common in the fourth decade and are thought to originate with the seminiferous epithelium and produce a uniform cell population. Nonseminomas tend to produce a variety of cell types, and choriocarcinoma is rare variant of nonseminoma testicular cancer that originates in the placental tissue.
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) Single injection of Rocephin (ceftriaxone) The current treatment recommendation to combat tetracycline- and penicillin-resistant strains of N. gonorrhoeae is ceftriaxone in a single injection; the other medications are not specific for the treatment of gonorrhea.
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) This kind of infection often subsides on its own and doesn't grow more serious over time." Molluscum contagiosum is considered a benign and self-limiting viral illness. Oral antivirals are not a common treatment, and it is not noted to lead to sterility.
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) abdominal pain, bloating, feeling full quickly after ingesting food. Symptoms that are believed to have a strong correlation to ovarian cancer include abdominal pain, increased abdominal size or bloating, and difficulty in eating or feeling full quickly after ingesting food. Pain and bleeding after intercourse are usually associated with an inflammatory process. Colicky low abdominal pain and adnexal mass are associated with cancer of the fallopian tube. Localized abdominal pain to one side with referred shoulder pain is common in ectopic pregnancy.
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 The symptoms of PID include lower abdominal pain, which may start just after a menstrual period; dyspareunia; back pain; purulent cervical discharge; adnexal tenderness; and cervical motion tenderness on bimanual examination with no other apparent cause. Fever, increased erythrocyte sedimentation rate, and elevated WBC are commonly seen.
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 Inhibitors of adrenal androgen synthesis (ketoconazole) are used for treatment of patients with advanced prostate cancer who present with spinal cord compression. This is because these men need rapid decreases in their testosterone levels. The bisphosphonates (pamidronate) act by inhibiting osteoclastic activity. They prevent osteopenia, prevent and delay skeletal complications in patients with metastatic bone involvement, and provide palliation of bone pain. There is no indication that this patient has a UTI. Patients with this malignancy usually have hypercalcemia, and therefore administration of calcium supplements would be contraindicated.
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 There is rapid transplacental transmission of the organism from the mother to the fetus after 16 weeks' gestation, so that active infection in the mother during pregnancy can produce congenital syphilis in the fetus. Untreated syphilis can cause prematurity, stillbirth, and congenital defects and active infection in the infant. Unstable blood glucose levels can occur with diabetic mothers, and many infants have some acrocyanosis immediately following birth. Blindness from syphilis can occur decades after initial infection, so it would not be present at birth
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 Cryptorchidism, luteal phase defects, low pituitary hormone levels, and an inability of the tubes to pick up an ovum can all contribute to infertility. A large amount of clear, stretchy cervical mucus is a normal finding. Cervical cultures for gonorrhea, chlamydial infection, and mycoplasmal infection should be obtained and treatment instituted as needed.
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 Diagnosis of chlamydial infections takes several forms. The identification of polymorphonuclear leukocytes on Gram stain of penile discharge in the man or cervical discharge in the woman provides presumptive evidence. The direct fluorescent antibody test and enzyme-linked immunosorbent assay that use antibodies against an antigen in the Chlamydia cell wall are rapid tests that are highly sensitive and specific. Nucleic acid amplification tests (NAATs) do not require viable organisms for detection and can produce a positive signal from as little as a single copy of the target DNA or RNA. Western blot is used to verify HIV after a positive ELISA result for HIV.
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 The most serious complication of untreated chlamydial infection is the development of Reiter syndrome. This triad of symptoms includes urethritis, conjunctivitis, and arthritis of weight-bearing joints, such as the knees and sacroiliac and vertebral joints. Pain when urinating occurs in both men and women and is associated with urethritis. Women can also develop reactive arthritis, but the male-to-female ratio for this complication is 5:1. The arthritis begins 1 to 3 weeks after the onset of chlamydial infection. The joint involvement is asymmetric, with multiple affected joints and a predilection of the lower extremities. Cervical tissue friability is not part of Reiter syndrome.
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 b-adrenergicñblocking 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 Hypertension, antihypertensive medications, age, and smoking are all implicated in the etiology of ED. Ischemic heart disease and bronchodilators are less likely to directly contribute to the condition.
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) "Do you have pain when you urinate or have difficulty starting the stream?" The initial symptoms of primary genital herpes infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. In men, the infection can cause urethritis and lesions of the penis and scrotum. Urethritis is characterized by pain with urination and difficulty starting the stream. Cold sores are not related to genital herpes. Swelling of the scrotum is common in epididymitis, while flank pain and bloody urine are associated primarily with kidney stone formation.
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?"
B) "Have you had unprotected sex in the past?" Sexually transmitted infections are a common contributing factor to epididymitis. Mumps are more often a precursor to orchitis, and heaviness on the left side is associated with varicocele. Pain with an erection is not a noted symptom of epididymitis.
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) "If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with." Vaginal delivery is safe in the absence of lesions at the onset of labor. HSV does not preclude breast-feeding, and antivirals would not be commonly used in pregnancy, nor would they guarantee a risk-free vaginal delivery.
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) "Men with cryptorchidism the term for an undescended testicle are known to have a higher risk of developing testicular cancer." Cryptorchidism is an identified risk factor for the development of testicular cancer. The diagnosis is no longer a leading cause of death. Hematuria is not a common symptom, and orchiectomy is still the standard treatment modality.
A 60-year-old woman who is 11 years menopausal has presented to the emergency department stating, ìI haven't had my period in years, but lately I've been bleeding again, and quite heavily in the last few days.î 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) "We're going to have to open your cervix with a speculum and take scrapings from the wall of your uterus." D&C is a more accurate diagnostic procedure for endometrial cancer than CT, Pap smear, or blood work analysis.
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) A 42-year-old who has decided to try to have one more child and has had her tubal ligation reversed. Previous tubal ligation is an identified risk factor for ectopic pregnancy. Young age, use of injectable contraception, and low BMI are not specifically associated with ectopic pregnancy.
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) Antibacterial drugs penetrate poorly into the chronically inflamed prostate. The fact that antibacterial drugs penetrate poorly into the chronically inflamed prostate makes treatment difficult. Inflammatory prostatitis, not chronic prostatitis, is believed to be an autoimmune problem. Urethral catheterization does not provide resolution of the underlying infection, though treatment modalities do exist.
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) Antidepressant and antiepileptic medications Treatment of vulvodynia necessitates a long-term, chronic pain approach; antidepressants and antiepileptic medications are often used. Alternative therapies, standard analgesic regimens, and simple lifestyle modifications are less likely to be effective.
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) Circumcision Because the foreskin is often used in surgical repair of hypospadias, circumcision is normally contraindicated. Chromosomal studies are frequently warranted, and surgery is the standard treatment for the repair of the urethra. Testosterone supplementation is often necessary.
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) Nolvadex (Tamoxifen), a nonsteroidal antiestrogen Hormone therapy is used to block the effects of estrogen on the growth of breast cancer cells. Tamoxifen is a nonsteroidal antiestrogen that binds to estrogen receptors and blocks the effects of estrogens on the growth of malignant cells in the breast. Herceptin is used to stop the growth of breast tumors that express the HER2/neu receptor on their cell surface. Arimidex, an aromatase inhibitor, blocks the enzyme that converts androstenedione and testosterone to estrogen in the peripheral tissues. This reduces the circulating estrogen levels in postmenopausal women.
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) acute bacterial prostatitis requiring antimicrobial therapy. Manifestations of acute bacterial prostatitis include fever and chills, malaise, frequent and urgent urination, and dysuria. The urine may be cloudy and malodorous because of urinary tract infection. Rectal examination reveals a swollen, tender prostate. During exam, prostatic massage produces a thick discharge with WBCs that grow a large numbers of pathogens on culture.
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) enlargement of the testicle. Often the first sign of testicular cancer is a slight enlargement of the testicle that may be accompanied by some degree of discomfort. Back pain and hemoptysis are last signs leading to a metastatic lesion. It is normal for the testicle to hang lower than the other.
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) looking at the spores on a wet-mount slide using 20% potassium hydroxide. Accurate diagnosis is made by identification of budding yeast filaments or spores on a wet-mount slide using 20% potassium hydroxide. When the wet-mount technique is negative but the clinical manifestations are suggestive of candidiasis, a culture may be necessary. Definite diagnosis consists of more than a visual look at the secretions. Diagnosis of bacterial vaginosis is made by looking at the number of Lactobacillus species under the microscope. DNA testing may be required when dealing with HSV infection.
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)Oral antiprotozoals to the patient and sexual partners to help prevent complications. The treatment of choice for Trichomonas vaginalis is oral, metronidazole or tinidazole, medications that are effective against anaerobic protozoans. Antifungals are not a relevant treatment, and eradication of the infection is possible with treatment.
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 Both androgens (testosterone and dihydrotestosterone) and estrogens appear to contribute to the development of BPH. Testosterone is the most important factor for prostatic growth. DHT, the biologically active metabolite of testosterone, is thought to be the ultimate mediator of prostatic hyperplasia, with estrogen serving to sensitize the prostatic tissue to the growth-producing effects of DHT. Glucocorticoids do not play a role in making the prostate gland enlarge.
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 Reported risk factors for the overgrowth of C. albicans include recent antibiotic therapy, which suppresses the normal protective bacterial flora; high hormone levels owing to pregnancy or the use of oral contraceptives, which cause an increase in vaginal glycogen stores; and uncontrolled diabetes mellitus or HIV infection, because they compromise the immune system. Exercise and glandular inflammation are not noted risk factors for yeast infections.
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 The HPV vaccine has decreased the risk of cervical cancer by 97%. Gardisil is one type of HPV vaccine to prevent infection with the HPV subtypes 16, 18, 9, and 11. This vaccine has been approved for girls and boys between 9 and 26 years of age (prior to becoming sexually active) to prevent HPV 6 and 11 genital warts. The vaccine targets the two strains of HPV (16 and 18) responsible for 70% of the cervical cancer. There is no treatment that is 100% effective against cervical cancer.
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) "How many sexual partners have you had?" Having multiple sex partners is a factor that has been identified in the development of PID. The use of tampons, inadequate hygiene, and a history of TA are less likely to predispose to PID.
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) "I need to stop breast-feeding until all my antibiotics have been taken." Mastitis is inflammation of the breast. It most frequently occurs during lactation but also can result from other conditions. In the lactating woman, inflammation results from an ascending infection that travels from the nipple to the ductile structures. The most common organism isolated is Staphylococcus. The offending organism originates from the suckling infant's nasopharynx or the mother's hands. Infection and inflammation cause obstruction of the ductile system. The breast becomes hard and, inflamed. It is advisable for the mother to continue breast-feeding during antibiotic therapy to prevent this.
A 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) "This might need surgery, but it could possibly disappear over time without needing treatment." While spontaneous resolution is possible, surgery is sometimes necessary for the treatment of Peyronie disease. Circumcision would not be an effective treatment, and lifestyle factors are not noted to contribute to the etiology or resolution.
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) "You should know that there might be adverse effects on your sexual function after treatment is finished." Orchiectomy is the standard treatment for testicular cancer. Steroidal treatments are not used, and sexual function is commonly affected. Recurrence is possible even after orchiectomy.
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 sharp reduction in the number of lactobacilli in the client's vaginal flora. Vaginosis is a disorder characterized by a shift in the vaginal flora from one dominated by hydrogen peroxideñproducing Lactobacillus to one with greatly reduced numbers of Lactobacillus species and an overgrowth of other organisms. Autoinoculation or sexual transmission of bacteria or protozoa is unlikely to contribute.
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) Condylomata acuminata HPV is an identified precursor to condylomata acuminata, or genital warts. Herpes, gonorrhea, and candidiasis are not likely to result directly from HPV.
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.
C) If the prostate is hardened on examination, a biopsy is indicated for further investigation. Abnormalities detected during a DRE provide a rationale for further investigation by biopsy. PSA is used to screen for prostate cancer; however, it is also positive in BPH. The anatomic location of the prostate at the bladder neck contributes to the pathophysiology and symptomatology of BPH. A BPH is not a definitive sign of prostate cancer. DRE is recommended annually for all men over age 50.
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) Imdur (isosorbide mononitrate), a vasodilator Sildenafil (Viagra) is a selective inhibitor of phosphodiesterase type 5 (PDE-5), the enzyme that inactivates cGMP. This acts by facilitating corporeal smooth muscle relaxation in response to sexual stimulation. The concomitant use of PDE-5 inhibitors and nitrates (Imdur) is absolutely contraindicated because of the risk of profound hypotension. The other medications listed are not nitrates and do not have this adverse reaction.
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) Estrogenñprogesterone 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) Lifestyle modifications to include weight loss by lowering calories and fat consumption Lifestyle modifications are the treatment of choice for PCOS. Hormone therapy, surgery, and use of oral contraceptives are less likely to be a primary treatment option.
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) Men who have sex with men are at particular risk of LGV. In the United States, men who have sex with men are the population with the highest prevalence and incidence of LGV. It is bacterial in etiology and affects more men than women.
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 hypothalamicñpituitaryñovarian disorder B) Hormone therapy aimed at resolving her estrogen deprivation C) Pain control with prostaglandin synthetase inhibitors D) Dilation and curettage
C) Pain control with prostaglandin synthetase inhibitors Because she has been diagnosed with primary rather than secondary dysmenorrhea, treatment of a specific underlying condition is not indicated. Treatment will likely focus on adequate pain control. D&C is not a relevant intervention.
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) Testicular torsion The combination of the boy's age, signs, and symptoms is indicative of testicular torsion. Epididymitis normally lacks cremaster muscle involvement, and hydrocele is marked by massive distention of the scrotum. Varicocele is often asymptomatic or marked by heaviness in the scrotum.
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) Treatment with GnRH agonists alone The sharp rise in PSA, coupled with an increase in levels of serum acid phosphatase, is strongly indicative of metastatic cancer (which could be confirmed via molecular imaging such as MRI). Unopposed GnRH agonists initially cause LH and FSH levels to rise, stimulating the production of testosterone, which acts as fuel for the fire of prostatic metastasis. Thus, their use alone would not be appropriate. However, if these agonists are combined with antiandrogens, testosterone levels can be quelled from two different fronts simultaneously. Ketoconazole is a chemical castrating agent that could bring down testosterone levels rapidly and might be more appropriate for cases of advanced and widespread metastasis. Bisphosphonates address the effects of metastatic bone involvement and of osteoporosis resulting from antiandrogen therapy.
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. D) Latency
C, B, D, A The primary stage of syphilis includes chancre formation, while the secondary stage often involves a rash on the palms and feet. Latency occurs between the second and third stages, the latter often including cardiovascular effect such as aneurysm formation.
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) "Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it." Seventy-five percent of woman with chlamydial infections are asymptomatic. Blindness is a rare complication in adults who live in industrialized countries, and both men and women can become sterile from the effects. Syphilis, not chlamydial infections, has a course of three distinct stages.
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) "Even when I'm not having a recurrence, I could still pass the virus on to you." HSV transmission can occur both during and between recurrences. HSV-2 is associated more with genital herpes than cold sores, and cold sores do not provide antibody protection. Prior contact with the virus does not confer immunity.
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) "Screening mammography and clinical exams are the cornerstones of breast cancer screening." Self-exam has recently been deemphasized by the American Cancer Society with emphasis now placed on mammography and trained exam. If done, self-exam should be performed around the time of menses, and clinical exams every 3 years are believed to be sufficient for women under 40.
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) "While distressing to look at, this condition usually doesn't have any significant consequences and won't need treatment." Hydrocele in adult males is normally considered benign condition that does not warrant treatment unless mobility is affected. Fluid accumulates in the space between the tunica vaginalis and tunica albuginea, not within the testes themselves, and hormone therapy is not indicated.
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) Metronidazole The character of the discharge, lack of recent sexual activity, and current antibiotic treatment point to infection with Trichomonas vaginalis, which can exist asymptomatically and flare up only if conditions such as an imbalance in normal vaginal flora resulting from antibiotic treatment enable the protozoan to proliferate. Patients with trichomoniasis respond well to treatment with metronidazole.
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) A 41-year-old with a diagnosis of mucopurulent cervicitis While C. albicans, T. vaginalis, Neisseria gonorrhoeae, Gardnerella vaginalis, Chlamydia trachomatis, Ureaplasma urealyticum, and herpes simplex virus can all contribute to cervicitis. C. trachomatis is the organism most commonly associated with mucopurulent cervicitis. Vulvodynia, vaginal cancer, and endometriosis are less likely to have a sexually transmitted etiology.
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) Gonorrhea The rapid onset and bloody penile discharge that the client cites are characteristics of gonorrhea. Neither the onset nor the symptomatology matches syphilis or chancroid, and Chlamydia typically takes longer to manifest and does not normally include bloody discharge.
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) Loop electrosurgical excision procedure (LEEP) Because adenocarcinoma of the cervix is being detected more frequently, especially in women younger than 35 years of age, a Pap smear result of atypical glandular cells warrants further evaluation. The LEEP has taken the place of cone biopsies in most situations and is now the first-line management for CIN II/III. This outpatient procedure allows for the simultaneous diagnosis and treatment of dysplastic lesions found on colposcopy. In skilled hands, this wire can remove the entire transformation zone, providing adequate treatment for the lesion while obtaining a specimen for further histological evaluation. Cone biopsy is a surgical procedure that removes a cone-shaped wedge of cervix. Trachelectomy is removal of the cervix, and intracavitary irradiation is a form of brachytherapy to treat cervical cancer.
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) menometrorrhagia. Menometrorrhagia is heavy bleeding during and between menstrual periods. Polymenorrhea is frequent menstruation with periods less than 21 days apart. Amenorrhea is absence of menstruation. Dyspareunia is pain following intercourse.
