APEA 3P Exam Prep- Men's Health Questions and Answers with Explanations, Exams of Nursing

Download APEA 3P Exam Prep- Men's Health Questions and Answers with Explanations and more Exams Nursing in PDF only on Docsity! APEA 3P Exam Prep- Men's Health Questions and Answers with Explanations A 50-year-old male comes to the nurse practitioner clinic for evaluation. He complains of chills, pelvic pain, and dysuria. He should be diagnosed with (VS in image): acute bacterial prostatitis. chronic bacterial prostatitis. urinary tract infection. nonbacterial prostatitis. A. Acute bacterial prostatitis should always be considered first in a male patient who presents with these symptoms. He may have cloudy urine and symptoms of obstruction, like dribbling. Chronic bacterial prostatitis presents with a more subtle presentation, such as frequency, urgency, and rarely, low-grade fever. Urinary tract infection is far less common in men than women and is usually associated with anal intercourse or being uncircumcised. Nonbacterial prostatitis presents like chronic prostatitis except that urine and prostate secretion cultures are negative. Noninfectious epididymitis is common in: soccer players. truck drivers. Correct marathon runners. men who wear boxer-style underwear. B. Noninfectious epididymitis occurs when there is reflux of urine into the epididymis from the ejaculatory ducts and vas deferens. This can cause ductal obstruction and acute inflammation without infection. This can occur if males spend a lot of time sitting. Truck drivers are particularly susceptible because they spend many uninterrupted hours sitting when they are driving. Other typical risk factors are vigorous exercise that involve heavy lifting or upper body workouts; especially sit-ups or abdominal crunches. The following PSA levels have been observed in a patient. What conclusion can be made following these annual readings (SEE IMAGE) They are all within the normal range. None are within the normal range. There is a steady increase that is worrisome. There is a steady increase but not worrisome. C. Evaluation of PSA velocity generally requires three serial readings over a 12-24 month period. The PSA velocity (the rate of PSA change over time), is concerning. A PSA velocity > .35 ng/mL per year is associated with high risk of death from prostate cancer. This patient should have prostate biopsy by a urologist. A 71-year-old male patient is taking dutasteride (Avodart), a 5-alpha-reductase inhibitor. What effect might this have on his PSA level? It will increase. It will decrease. There is no predictable change. There will be a clinically insignificant increase. B. The 5-alpha-reductase inhibitors like dutasteride and finasteride will reduce PSA levels will sustain this reduction as long as the medication is taken. This class of medication interferes with the prostatic intracellular androgen response mechanism. A patient with testicular torsion will have a: positive cremasteric reflex on the affected side. A 28-year-old male patient has epididymitis. His most common complaint will be: burning with urination. testicular pain. scrotal pain. penile discharge. C. The most common complaint in a patient who has epididymitis is scrotal pain. It usually develops over a period of days. Chlamydia and gonorrhea are the most common causes of epididymitis in men < age 35 years. Occasionally, epididymitis develops acutely and will be accompanied by fever, chills, and a very ill-appearing patient. Burning with urination is possible if the underlying cause is a urinary tract infection. However, this is more common in an older male (age > 35 years). Testicular pain is not a common complaint with epididymitis. Penile discharge may occur with gonorrhea or chlamydia infection. However, the most common presenting symptom is scrotal pain. What class of medications can be used to treat benign prostatic hyperplasia and provide immediate relief? Alpha-1 blockers 5-alpha reductase inhibitors Diuretics Analgesics A. Alpha blockers (alpha-adrenergic antagonists) provide immediate relief of symptoms. The alpha-1 receptors are abundant in the prostate gland and base of the bladder. They are used to help decrease bladder outlet obstruction and thus increase flow of urine. The body of the bladder has few alpha-1 receptors. Those alpha blockers most commonly used are tamsulosin (Flomax), silodosin (Rapaflo), and alfuzosin (Uroxatral). These are urospecific alpha blockers and are more commonly used than older agents like doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin). A 70-year-old male presents to your clinic with a lump in his breast. How should this be evaluated? Palpation and ultrasound Mammogram and ultrasound Ultrasound only Mammogram only B. This patient has a lump identified in the breast. Since males can develop breast cancer, it must be evaluated as a female breast lump would be evaluated. He should have a clinical breast exam to identify the position of the lump and any other abnormal findings such as nodes, nipple discharge, or other lumps. Then, he should have mammogram and ultrasound to help evaluate the lump. If the findings are suspicious for a malignancy, the patient would be referred to a surgeon. What symptom listed below might be seen in a male patient with benign prostatic hyperplasia? Dysuria Nocturia Low back pain Pain with bearing down B. Men with benign prostatic hypertrophy (BPH) have some classic symptoms that include: hesitancy, urgency, postvoid dribbling, and frequency. They will seek help for these symptoms. Although these symptoms are typical of BPH, prostate cancer can also present in the same way. Which of the following medications should be avoided in a 65-year-old male with benign prostatic hyperplasia (BPH)? Diphenhydramine Doxazosin Ciprofloxacin Propanolol A. Antihistamines should be avoided in men with BPH. These will cause urinary retention. Other medications known to impair urination are muscle relaxants, narcotics, tricyclic antidepressants such as amitriptyline, and medications with anticholinergic properties such as antihistamines. A 25-year-old male patient is training for a marathon. He reports an acute onset of scrotal pain after a 10- mile run. He has nausea and is found to have an asymmetric, high-riding testis on the right side. What should be suspected? Sports hernia Epididymitis Testicular torsion Prostatitis C. The most serious cause of acute scrotal pain is testicular torsion. The most common age group for this to occur is adolescents; however, almost 40% of torsion occurs in males older than age 21. This is more common after minor testicular trauma or after strenuous exercise. This is an urgent urological referral. The other choices listed do not produce acute scrotal pain in conjunction with these physical findings. What is the recommendation from the American Cancer Society (ACS) for screening for prostate cancer in an African American male who is 50 years old? PSA screening now if desired PSA screening should have taken place earlier Digital rectal exam only No screening recommendation at this time A. The ACS encourages men to be involved in the decision of whether to screen for prostate cancer. Begin screening discussions at age 40-45 in patients who are at high risk of developing prostate cancer (African Americans and men with a first-degree relative with prostate cancer diagnosed prior to age 65 years). The discussion regarding prostate cancer screening should take place with men who are expected to live at least 10 more years. Following this discussion, men who want to be screened should have PSA measurements with or without digital rectal exam (DRE) beginning at 50 years of age. If initial PSA is > 2.5 ng/mL; annual testing should take place. If the initial PSA is < 2.5 ng/mL; test every 2 years. A 22-year-old male who is otherwise healthy complains of scrotal pain. His pain has developed over the past 4 days. He is diagnosed with epididymitis. What is the most likely etiology? Phimosis Infection with Chlamydia Underlying hydrocele Urinary tract infection B. Several factors predispose males to epididymitis. In men younger than 35 years, the most common cause of epididymitis is infection with Chlamydia trachomatis and Neisseria gonorrhoeae. In older men, urinary tract pathogens are more typical. In prepubertal boys, bicycle riding and heavy physical exertion are most scrotal and abdominal masses. abdominal pain and scrotal erythema. A. An inguinal hernia is characterized by herniation of bowel or omentum into the scrotum. It typically presents with scrotal pain and a scrotal mass or scrotal swelling. Abdominal or groin pain with a scrotal mass is a common presentation. Bowel sounds may be audible in the scrotum. Hesselbach’s triangle forms the landmark for: inguinal hernia. femoral hernia. abdominal hernia. umbilical hernia. A. Direct inguinal hernias occur through Hesselbach’s triangle. The inguinal ligament, the rectus muscle, and the epigastric vessels form the triangle. When there is a weakness in the floor of the inguinal canal, a hernia can result. Inguinal hernias are the most common groin hernias in men and women. Repair of this is the most common surgical procedure performed in the US. A 65-year-old Caucasian male has a firm, nontender, symmetrically enlarged prostate gland on examination. His PSA is 3.9 ng/mL. His PSA level is influenced by: race only. age and race. prostate volume. race, age, and volume. D. These assessment findings probably indicate BPH, but cannot rule out prostate cancer. PSA values may be specific for age and race and are influenced by the volume of prostate tissue present. The greater the amount of prostate tissue present, the greater the PSA value. Thus, these three factors are of great importance in evaluating the PSA value. What is the recommendation of the American Cancer Society (ACS) for screening an average risk 40-year- old Caucasian male for prostate cancer? Digital rectal exam Serum prostate specific antigen (PSA) Digital rectal exam and PSA He should be screened starting at age 50 years. D. The ACS encourages men to be involved in the decision of whether to screen for prostate cancer. Begin screening discussions at age 40-45 in patients who are at high risk of developing prostate cancer (African Americans and men with a first-degree relative with prostate cancer diagnosed prior to age 65 years). The discussion regarding prostate cancer screening should take place in men who are expected to live at least 10 more years. Following this discussion, men who want to be screened should have PSA measurements with or without digital rectal exam (DRE) beginning at 50 years of age. If initial PSA is > 2.5 ng/mL, annual testing should take place. If the initial PSA is < 2.5 ng/mL, test every 2 years.