NR511 / NR 511: Differential Diagnosis & Primary Care Practicum Week 7 Quiz Q & A (Fall 2020) Chamberlain College Of Nursing

NR-511: Differential Diagnosis & Primary Care Practicum Week 7 Quiz Question 1 1 / 1 pts A patient is being treated for erectile dysfunction. The patient is morbidly obese and is also being treated for a coag ...

NR-511: Differential Diagnosis & Primary Care Practicum Week 7 Quiz Question 1 1 / 1 pts A patient is being treated for erectile dysfunction. The patient is morbidly obese and is also being treated for a coagulopathy. Which of the following medications would be contraindicated? Subcutaneous pellet testosterone (Testopel). Topical testosterone (AndroGel).orrect! Alprostadil (Caverject). Sildenafil (Viagra). The vasoactive injectable alprostadil (Caverject) should not be used in patients with sickle cell anemia, coagulopathy, severe cardiovascular disease, myeloma, leukemia, morbid obesity, or penile deformity, fibrosis, or implants. Question 2 1 / 1 pts A 32-year-old male appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank. The nurse practitioner is trying to differentiate between epididymitis and testicular torsion. Which test should be the provider’s first choice? X-ray. Physical examination. Technetium scan.orrect! Ultrasound. If your client has a rapid onset of unilateral scrotal pain radiating up to the groin and flank and you are trying to differentiate between epididymitis and testicular torsion, an ultrasound is useful for determining whether the swelling is in the testis or the epididymis and should be your first choice. Question 3 1 / 1 pts A 51-year-old male requests a prescription for sildenafil (Viagra). He says that the only medication he takes is isosorbide mononitrate (Monoket) oral tablets and that he has diabetes which is controlled with diet alone. What should the nurse practitioner tell him? Correct Answer “Viagra is contraindicated with isosorbide mononitrate; let’s discuss other options.” “I’d better refer you to a urologist.”u Answered “Let’s try a sample and see how you do.” “Because of your history of diabetes, we can’t use it.” Because sexual stimulation leads to the release of nitric oxide in the corpus cavernosum of the penis and sildenafil (Viagra) potentiates that release, there is a double hypotensive effect between sildenafil and a nitric oxide donor such as isosorbide mononitrate (Monoket, Imdur, and Ismo). Therefore, the use of sildenafil with Monoket is contraindicated. Question 4 1 / 1 pts A 72-year-old unmarried, sexually active man, presents to the clinic with complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although the nurse practitioner suspects benign prostatic hyperplasia, what else should the differential diagnosis include? Antihistamine use. Renal calculi. Detrusor hyperreflexia.Correct! Urethral stricture. Urethral strictures may develop as a result of sexually transmitted diseases and should be considered in sexually active individuals (primarily males) no matter their age. Antihistamine use generally will result in hesitancy and urinary retention but not incontinence. Question 5 1 / 1 pts A 54-year-old male is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is: orrect! Diabetes mellitus. Multiple sclerosis. Parkinson disease. Epilepsy. About 50% of men who have had diabetes for longer than 6 years develop erectile dysfunction to some extent as a result of pathological changes in the vascular wall that lead to a reduction of arterial blood flow to the penis. Many other conditions can cause erectile dysfunction as well. These include cerebrovascular accidents (ie, strokes or brain attacks), spinal cord injury, temporal lobe epilepsy, multiple sclerosis, chronic obstructive pulmonary disease, angina, chronic renal failure, and Parkinson disease. Question 6 1 / 1 pts A 58-year-old male has been diagnosed with erectile dysfunction and says that a friend told him about a method that uses a constricting ring around the base of the penis. What is he referring to? Surgery Intracavernous injection therapy. Urethral suppositories. orrect! An external vacuum device. An external vacuum device is a viable method for alleviating erectile dysfunction regardless of the cause of the disorder. A plastic cylinder is placed around the penis, a vacuum pump causes cavernosal engorgement, and a constrictor ring is applied around the base of the penis, allowing the client to hold an erection for 30 minutes. Question 7 1 / 1 pts A 52-year-old male patient is in a new relationship and is not sure whether his erectile dysfunction is organic or is caused by stress about his performance. What simple test could the clinician suggest to determine if he has the ability to have an erection? Intracavernous injection. Penile duplex ultrasonography. Serum prostate-specific antigen (PSA). Correct! Nocturnal penile tumescence and rigidity (NPTR) test. The NPTR test is a simple test the client may do at home by himself to determine if he has the ability to have a nocturnal erection, which would rule out an organic cause of erectile dysfunction. Have the client place the simple device on his penis before going to bed. This device records the frequency, as well as the rigidity, of erections. Question 8 1 / 1 pts A 72-year-old male presents to the office for follow-up of several episodes of orthostatic hypotension. After obtaining a review of systems and a digital rectal examination, it also appears that he has benign prostatic hyperplasia (BPH) with lower urinary tract symptoms. The nurse practitioner reviews his recent ultrasound evaluation, which reports a prostate volume of over 40 mL, and the results of the American Urological Association (AUA) symptom index for BPH, which shows his score to be 12. Based on the preceding information and the patient’s desire for noninvasive medical therapy, what management should he be offered? Phenoxybenzamine (Dibenzyline). Doxazosin (Cardura).orrect! Finasteride (Proscar). Prazosin (Minipress). Finasteride is a 5-alpha-reductase inhibitor and is recommended for individuals with a prostate volume greater than 40 mL to help decrease its size. Question 9 1 / 1 pts A 32-year-old male presents with complaints of a scrotal mass; however, the scrotum is so edematous that it is difficult to assess. How would the nurse practitioner (NP) best determine whether the condition is a hernia or a hydrocele?rrect! Bowel sounds may be heard over a hernia. The NP can transilluminate a hernia. The NP can always return a hernia’s contents to the abdominal cavity. With a hydrocele, a bulge appears on straining. Hydroceles can be illuminated to show the full size and shape, which assist in the diagnosis, however hernias cannot. Hernias, if not incarcerated, will be able to be returned to the abdominal cavity. Buldging upon straining is not one of the characteristics associated with hydrocele but it is with inguinal hernia. While ultrasound would definitively diagnosis the presence of abdominal contents in the scrotum, understanding the pathophysiology of an inguinal hernia is necessary to understand that bowel sounds would be audible over a hernia. All of the other choices are incorrect. While a scrotal ultrasound would definitively confirm the diagnosis, this is not one of the options available. Question 10 1 / 1 pts Regular testicular self-exams have not been studied enough to show if they lower the risk of dying from testicular cancer. This is why the American Cancer Society and other agencies do not have a recommendation about regular testicular self-exams for all men. Still, some practitioners do recommend that all men examine their testicles monthly after reaching puberty. In teaching a patient how to do a testicular self-examination, which of the following should the clinician advise? “Examine your testicles when you are cold because this makes them more sensitive.” “If you feel firmness above and behind the testicle, make an appointment.”orrect! “Make an appointment if you note any hard lumps directly on the testicle, regardless of whether they are tender.” “Make sure your hands are dry to create friction.” If you advise men to perform a monthly testicular self-examination, instruct them to call if they notice any hard lumps directly on the testicle, regardless of whether the lumps are tender. If parts of the testicle above and behind feel rather firm, this is the epididymis and is normal. The spermatic cord, a small, round, movable tube, extends up from the epididymis and also feels firm and smooth. Testicles should be examined with soapy hands when taking a warm shower or bath to allow easy mnipulation of the tissue. Question 11 1 / 1 pts A 62-year-old male has a low International Prostate Symptom Score for lower urinary tract symptoms associated with his benign prostatic hyperplasia (BPH). The nurse practitioner should recommend: rrect! No treatment at this time. Balloon dilation. Immediate referral to urology. Starting an alpha blocker. Asymptomatic clients with BPH rarely require treatment. Watchful waiting is an appropriate strategy for following the progression of the disease and the development of any complications. Question 12 1 / 1 pts A male patient presents to the clinic for evaluation of infertility. Subjectively, the patient complains of pain and fullness of the testes and states, “My testicles feel like a bag of worms.” On physical examination, the nurse practitioner notes tortuous veins posterior to and above the testes that extend up into the external inguinal ring. Based on the preceding assessment, the nurse practitioner refers the patient to urology with a diagnosis of: Orchitis. Hydrocele. Urethritis.orrect! Varicocele. A varicocele is an abnormal degree of venous dilation of the pampiniform plexus in the spermatic cord above the testes, which results in pain and swelling. A patient often describes the sensation as feeling like a “bag of worms.” Question 13 1 / 1 pts A 63-year-old man presents to your office with hematuria, hesitancy, and dribbling. Digital rectal examination (DRE) reveals a smooth, moderately enlarged prostate. The client’s prostate-specific antigen (PSA) is 1.2. What is the most appropriate management strategy at this time? Referring the client to urology. Recommending saw palmetto extract. Prescribing an antibiotic.orrect! Prescribing an alpha-adrenergic blocker. The patient’s symptoms appear to be related to benign prostatic hyperplasia (BPH) and not a urinary tract infection. An alpha-adrenergic blocker will relax the smooth muscle of the prostate and bladder, which will improve flow and relieve symptoms. Benign prostatic hyperplasia (BPH) can be successfully treated by primary health care providers, and a referral is not appropriate until standard treatment is no longer effective. Question 14 1 / 1 pts A 15-year-old male comes to the clinic in acute distress with “belly pain.” When obtaining his history, the nurse practitioner (NP) finds that he fell off his bike this morning and has vomited. Upon closer examination, the NP determines the belly pain to be left-sided groin pain or pain in his left testicle. He is afebrile and reports no dysuria. Which of the following diagnoses is most likely? Varicocele.orrect! Testicular torsion Epididymitis. Hydrocele. Testicular torsion is a condition in which the testis twists on the spermatic cord, thereby compromising blood flow to the testicle. This is a surgical emergency. Examination usually reveals a tender scrotal mass high in the hemiscrotum, and there is frequently a reactive hydrocele around the testis, obscuring anatomical detail. The scrotum can become erythematous and edematous. The cremasteric reflex is frequently blunted on the side of the torsion. Question 15 1 / 1 pts A patient’s chief complaint is pain and heaviness in the scrotum. The nurse practitioner notes swelling of the testes, along with warm scrotal skin. Which of the following diagnoses is most probable? Epididymitis. Testicular torsion.orrect! Orchitis. Cryptorchidism. Orchitis refers to an acute, painful onset of swelling of the testicle accompanied by warm scrotal skin. The client usually complains of a heavy feeling in the scrotum. It is typically unilateral but after 1 week may progress to the other testicle.