Chapter 42 My Nursing Test Banks

Osborn, Medical-Surgical Nursing, 2e
Chapter 42

Question 1

Type: MCSA

A 35-year-old male is concerned about his inability to sustain an erection. Which assessment questions would provide specific information about this condition?

1. What medications, including prescription, over-the-counter, herbal, and street drugs, do you use?

2. Are you married?

3. What kind of work do you do?

4. Did you graduate from college?

Correct Answer: 1

Rationale 1: Drug use, including both prescription and street drugs, can cause erectile dysfunction.

Rationale 2: Marital status is not associated with an inability to sustain an erection.

Rationale 3: Employment status is not associated with an inability to sustain an erection.

Rationale 4: Educational level is not associated with an inability to sustain an erection.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-2

Question 2

Type: MCSA

A 55-year-old patient who has a history of angina and is being treated with nitroglycerine asks for a prescription to aid with erectile dysfunction. Which nursing intervention is indicated?

1. Explain why the erectile dysfunction medication is not a good idea with the heart medication.

2. Provide education about the medication once the prescription is provided.

3. Remind the patient to stop taking the heart medication when planning to take the erectile dysfunction medication.

4. Suggest a behavioral health consult to analyze the reason for the erectile dysfunction.

Correct Answer: 1

Rationale 1: Medications for erectile dysfunction are contraindicated for the patient who is taking medications to manage cardiac conditions.

Rationale 2: Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) should not be taken by men who are also taking nitrate-based drugs.

Rationale 3: Discontinuing cardiac drugs is not advisable.

Rationale 4: A behavioral health consult would not be the first or primary suggestion in this case, as physical issues should be explored.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-2

Question 3

Type: MCSA

A female patient asks the nurse for help because her husband has not been able to attain an erection in several months. Which nursing

intervention should be performed first?

1. Assess the couples most recent sexual practices.

2. Suggest that she seek psychiatric counseling.

3. Suggest that the couple contact a marriage counselor.

4. Suggest that the husband talk to his physician about a prescription for sildenafil (Viagra).

Correct Answer: 1

Rationale 1: Assessment is always the first step of the nursing process. It is essential for health care providers to understand the patient and partners sexual pattern and habits to provide appropriate, individualized care.

Rationale 2: There is no indication that the wife requires psychiatric counseling.

Rationale 3: It is premature to suggest marital counseling.

Rationale 4: Additional assessment should be conducted before a prescription is recommended.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-6

Question 4

Type: MCSA

A patient comes into the emergency department with complaints of an erection that has lasted for more than 4 hours. Which topics should the nurse include in the patients assessment?

1. Use of medications for erectile dysfunction

2. Substance abuse

3. Blood pressure

4. Number of sexual partners

Correct Answer: 1

Rationale 1: Men who use injection therapy or sildenafil (Viagra) for erectile dysfunction are at risk for priapism.

Rationale 2: Substance abuse assessment would be included in any admission process but is not directly relevant to the sustained erection.

Rationale 3: Blood pressure measurements would be included in any admission process but are not directly relevant to the sustained erection.

Rationale 4: The number of sexual partners is not related to the problem.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-2

Question 5

Type: MCSA

A male patient who presents with the complaint of a swollen scrotum is found to have fluid within the scrotum. The nurse understands that this finding is consistent with which condition?

1. A hydrocele

2. A spermatocele

3. A variocele

4. Scrotal cancer

Correct Answer: 1

Rationale 1: A hydrocele, which is the most common cause of scrotal swelling, is a collection of fluid within the tunica vaginalis. A

hydrocele may be differentiated from a solid mass by transillumination or ultrasound of the scrotum.

Rationale 2: A spermatocele is a mobile, usually painless mass that forms when efferent ducts in the epididymis dilate and form a cyst.

Rationale 3: A varicocele is an abnormal dilation of a vein within the spermatic cord. The dilated vein forms a soft mass that may be painful.

Rationale 4: Scrotal cancer would be manifested by a solid mass rather than a fluid-filled area.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-1

Question 6

Type: MCMA

A 40-year-old male presents with symptoms of epididymitis. The nurse asks assessment questions related to which most common causes of epididymitis in this mans age group?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Urinary tract instrumentation

2. Prostatitis

3. A structural lesion

4. Gonorrhea

5. Undiagnosed congenital disorder

Correct Answer: 1,2,3

Rationale 1: In men older than 35, epididymitis is associated with instrumentation of the urinary tract. This instrumentation may occur as part of a clinical procedure such as catheterization.

Rationale 2: Prostatitis is a common cause of epididymitis in men older than 35.

Rationale 3: Lesions that involve the epididymis may result in epididymitis.

Rationale 4: Gonococcal infection is a common cause of epididymitis in men under age 35.

Rationale 5: Congenital disorders are not associated with epididymitis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-2

Question 7

Type: MCSA

A patient who is being treated for epididymitis stops taking his antibiotics. The nurse is concerned that this patient is at risk for developing which complication?

1. Orchitis

2. Priapism

3. Hydrocele

4. Spermatocele

Correct Answer: 1

Rationale 1: Orchitis is an acute inflammation or infection of the testes. It most commonly occurs as a complication of a systemic illness or as an extension of epididymitis.

Rationale 2: Priapism is a condition of the male reproductive system, but it is not associated with the presence of an infectious condition.

Rationale 3: Hydrocele is a condition of the male reproductive system, but it is not associated with the presence of an infectious

condition.

Rationale 4: Spermatocele is a condition of the male reproductive system, but it is not associated with the presence of an infectious condition.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-2

Question 8

Type: MCSA

A patient who is complaining of heaviness in his scrotum has learned that his serum lactate dehydrogenase level is elevated. A single painless lump is palpated in the patients scrotum. How would the nurse evaluate these results?

1. The patient needs more diagnostic tests for testicular cancer.

2. The patient has testicular cancer.

3. The patient does not have testicular cancer.

4. The patient has a spermatocele.

Correct Answer: 1

Rationale 1: Elevations in serum lactate dehydrogenase levels are associated with the presence of testicular cancer and may be significantly elevated with metastatic disease. It is likely a biopsy will be performed.

Rationale 2: This elevated level alone is not sufficient to make a diagnosis of cancer.

Rationale 3: The serum lactate dehydrogenase level is used to stage the cancer.

Rationale 4: Levels of serum lactate dehydrogenase would not be useful in the diagnosis of spermatocele.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-3

Question 9

Type: MCSA

A male patient is diagnosed with stage I testicular cancer. The nurse would prepare this patient for which treatment?

1. Surgical removal of the testicle

2. Aspiration of the enlarged testicle

3. Chemotherapy

4. Surgical removal of both testicles

Correct Answer: 1

Rationale 1: Radical orchiectomy is the treatment used in all forms and stages of testicular cancer.

Rationale 2: Aspiration is not a treatment for testicular cancer.

Rationale 3: Chemotherapy is often indicated for stage III disease.

Rationale 4: Typically, only the involved testicle is removed.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-2

Question 10

Type: MCMA

The nurse is planning instructions for a patient diagnosed with prostatitis. What should be included in these instructions?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Increase fluid intake up to 3 liters per day.

2. Avoid alcohol and caffeine.

3. Keep in mind that prostatitis does not cause cancer.

4. Take antibiotics only when symptoms are present.

5. Withhold voiding for as long as possible.

Correct Answer: 1,2,3

Rationale 1: Teaching for the man with prostatitis focuses on symptom management. Men with acute and chronic bacterial prostatitis should be taught to increase fluid intake to around 3 liters daily.

Rationale 2: Alcohol and caffeine can irritate the bladder, making symptoms worse.

Rationale 3: The cause of prostate cancer is unknown, and a history of prostatitis does not appear to increase the risk.

Rationale 4: It is important to teach the man to finish the course of antibiotic therapy.

Rationale 5: Men with acute and chronic bacterial prostatitis should be taught to void often.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-2

Question 11

Type: MCSA

A 65-year-old male patient complains of problems emptying his bladder, especially at night. The nurse would ask additional assessment questions related to which disorder?

1. Benign prostatic hypertrophy

2. Urinary tract infection

3. Bladder cancer

4. Testicular cancer

Correct Answer: 1

Rationale 1: It is estimated that more than half of all men over age 60 have benign prostatic hypertrophy (BPH). Primary symptoms are associated with voiding and difficulty starting the urine stream, dysuria, and nocturia.

Rationale 2: A patient with a urinary tract infection would not have difficulty starting the urine stream.

Rationale 3: Bladder cancer may also have pain as a symptom and is also accompanied frequently by hematuria.

Rationale 4: Testicular cancer would first be manifested by a growth in the testicle.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-1

Question 12

Type: MCSA

A patient is diagnosed with benign prostatic hypertrophy (BPH). What rationale does the nurse provide for measuring the patients blood pressure?

1. To help determine whether the patient can tolerate doxazosin mesylate (Cardura)

2. As baseline BP if surgery is indicated

3. To help determine the volume of urine being retained in the bladder

4. To determine the dose of finasteride (Proscar)

Correct Answer: 1

Rationale 1: Excessive, smooth muscle contraction in BPH may be blocked with alpha-adrenergic antagonists such as doxazosin mesylate (Cardura) and tamsulosin (Flomax). These medications may cause orthostatic hypotension.

Rationale 2: Surgical intervention to manage BPH may not be performed.

Rationale 3: The volume of urinary residual does not have bearing in this question.

Rationale 4: The Proscar dose is not influenced by blood pressure.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-2

Question 13

Type: MCSA

A 55-year-old male patient has an abnormal digital rectal examination (DRE) with an elevated PSA (prostate-specific antigen). The nurse anticipates that this patient will likely be scheduled for which procedure?

1. Transrectal ultrasonography (TRUS)

2. Bone scan

3. MRI

4. CT scan of the spine

Correct Answer: 1

Rationale 1: Transrectal ultrasonography (TRUS) may be used when the DRE is abnormal or if the PSA level is elevated. In the TRUS test, the physician removes a sample of tissue from the prostate gland for examination.

Rationale 2: A bone scan may be performed at a later date to determine the presence of tumor metastasis.

Rationale 3: An MRI may be performed at a later date to determine the presence of tumor metastasis.

Rationale 4: A CT scan may be performed at a later date to determine the presence of tumor metastasis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-3

Question 14

Type: MCMA

A patient had a transurethral resection of the prostate (TURP), and the urine in the urinary irrigation drainage bag is very dark red. Which nursing actions should be included in his plan of care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Check for catheter occlusion.

2. Increase the flow rate of irrigant solution.

3. Check vital signs.

4. Ask the patient to drink more fluids.

5. Assess the patient for hyponatremia.

Correct Answer: 1,2

Rationale 1: Following prostatectomy, urine should appear light pink to clear with an occasional blood clot. Urine that is very dark red may indicate increased venous bleeding or inadequate urine dilution. The catheter may be occluded and should be checked first.

Rationale 2: Increasing the flow rate of irrigant should assist in making the urine clear. If the urine does not clear, the nurse should notify the physician.

Rationale 3: Checking vital signs is important but not specific to this situation.

Rationale 4: Asking the patient to increase fluid intake may increase urine output and assist in diluting the urine, but this may take several hours.

Rationale 5: Assessing for hyponatremia is a nursing action to detect absorption of bladder irrigation solution.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-2

Question 15

Type: MCMA

Which discharge instructions should be given to the patient following radical prostatectomy for cancer?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Avoid sitting for long periods.

2. Urinary incontinence is common immediately after surgery but will improve with time.

3. Call the physician if urinary tract bleeding occurs.

4. Drink 2 to 3 quarts of liquid each day.

5. You may return to work next week.

Correct Answer: 1,2,3,4

Rationale 1: The patient should avoid sitting for long periods as this may place strain on suture lines.

Rationale 2: Urinary incontinence is possible after catheter removal but should improve with time.

Rationale 3: There is a possibility of urinary tract bleeding, which should be reported immediately.

Rationale 4: Increased fluid intake supports kidney function and keeps the urinary tract flushed.

Rationale 5: The patient should follow up with the health care provider in 1 to 3 weeks for further instructions. Returning to work should be addressed at that time.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-5

Question 16

Type: MCSA

A patient has been diagnosed with a hydrocele. Which teaching should the nurse provide about this condition?

1. The swelling in your scrotum is a cyst filled with sperm.

2. The fluid in your scrotum will probably reabsorb in time.

3. Be sure to take your entire antibiotic prescription.

4. It is good that you came in early since this is an emergency situation.

Correct Answer: 2

Rationale 1: A spermatocele is a cyst filled with sperm.

Rationale 2: Hydrocele is often managed conservatively as the fluid will generally reabsorb given enough time.

Rationale 3: Antibiotics are not generally used in the treatment of hydrocele.

Rationale 4: Hydrocele is not an emergent situation.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-1

Question 17

Type: MCSA

The nurse is placing an indwelling urinary catheter in an uncircumcised male patient and replaces the foreskin after insertion. What is the rationale for this nursing action?

1. Paraphimosis may result from long-term retraction of the foreskin, causing ischemia of the glans.

2. Phimosis may occur due to chronic infections and adhesions under the foreskin, which results in constriction of the foreskin.

3. Priapism may occur as a result of impaired blood flow in the penis.

4. Replacement of the foreskin prevents malignant changes in the penis.

Correct Answer: 1

Rationale 1: Paraphimosis may occur as a result of long-term retraction of the foreskin and cause ischemia of the glans.

Rationale 2: The foreskin may not be retracted in the patient with phimosis due to the constriction resulting from chronic infections and adhesions. The nurse should not attempt this action during catheterization.

Rationale 3: Priapism occurs with sustained painful erections that impair blood flow in the penis. It does not involve the foreskin.

Rationale 4: Phimosis, or tight foreskin, can prevent adequate hygiene, which may lead to malignant changes in the penis.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-2

Question 18

Type: MCMA

A patient has a possible cancer on his penis. The nurse would assess for which risk factors in this patients history?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Phimosis

2. Human papillomavirus (HPV) infection

3. AIDS infection

4. Excessive ultraviolet light exposure

5. Being circumcised

Correct Answer: 1,2,3,4

Rationale 1: Cancer of the penis is rare in North America, but risk factors include the presence of phimosis.

Rationale 2: Cancer of the penis is rare in North America, but risk factors include HPV infection.

Rationale 3: Cancer of the penis is rare in North America, but risk factors include AIDS.

Rationale 4: Cancer of the penis is rare in North America, but risk factors include exposure to ultraviolet light, such as that used to treat psoriasis.

Rationale 5: Not being circumcised is a risk factor.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-5

Question 19

Type: MCSA

The nurse takes immediate action based on which interpretation of a patients data?

1. Testicular torsion

2. Varicocele

3. Orchitis

4. Indirect inguinal hernia

Correct Answer: 1

Rationale 1: Testicular torsion, twisting of the spermatic cord with scrotal swelling and pain, may occur spontaneously or following trauma or physical exertion. The torsion reduces or stops testicular circulation, which results in vascular engorgement and ischemia.

Rationale 2: Varicocele is an abnormal dilation of a vein within the spermatic cord, which allows blood to pool in the spermatic cord and forms a soft mass that may be painful, but ischemia is not present.

Rationale 3: Orchitis is an inflammatory process, commonly a complication of a systemic illness or epididymitis. Manifestations include a high fever, scrotal redness, and pain.

Rationale 4: Indirect inguinal hernia involves a protrusion of the intestines into the inguinal canal, which may descend into the scrotum. Manifestations include a dull ache or sharp pain, a mass that is not painful to palpation, and absence of ischemia.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-1

Question 20

Type: MCSA

On review of a patients record, which manifestation does the nurse recognize as supporting a diagnosis of prostatodynia?

1. Negative urine culture

2. Denies history of STIs

3. Lower back pain

4. Fever absent

Correct Answer: 1

Rationale 1: The lack of evidence of urinary or prostatic infection or inflammation is confirmation of prostatodynia.

Rationale 2: The fact that STIs are denied does not support or refute the diagnosis of prostatodynia.

Rationale 3: Chronic back pain can occur in bacterial prostatitis or in prostatodynia.

Rationale 4: Absence of fever does not indicate absence of infection.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-1

Question 21

Type: MCSA

A patient who was recently diagnosed with hypertension and placed on propranolol (Inderal) is seen in the clinic for an unrelated issue. Noting that the blood pressure is elevated, the nurse asks if the patient has been taking his medication. The patient says he quit because I didnt like how I felt when I took it. Based on this statement, what would be an appropriate response?

1. Many male patients can experience side effects of this drug, which include altered libido and impotence. This is common. Tell me how you felt when you took the drug.

2. You shouldnt stop taking the drug without first talking to the doctor!

3. Write a note in the patients record but say nothing to the patient.

4. Im going to give you some information about this medication to take home and read. At your next visit, Ill have the doctor talk to you about it.

Correct Answer: 1

Rationale 1: Antihypertensive drugs are a common cause of erectile dysfunction (ED) and loss of libido, and many men do not report the disorder. The side effects should be discussed when the prescription is given and reviewed at any follow-up visits. Offering an opening to discuss sexual dysfunction is relevant.

Rationale 2: Admonishing a patient for not taking medications does not address the problem.

Rationale 3: Merely noting the issue in the patients chart does not address the problem.

Rationale 4: Offering factual information is relevant, but in this case the patients hypertension remains untreated.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-2

Question 22

Type: MCMA

A patient seen in the emergency department for priapism is sent to the medical unit. The admitting nurse should anticipate performing which actions as part of the nursing care plan?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Assess the penis for color changes.

2. Assess the penis for firmness and rigidity.

3. Administer an analgesic as prescribed for pain.

4. Apply ice packs as prescribed.

5. Push oral fluids.

Correct Answer: 1,2,3,4

Rationale 1: Priapism is an involuntary, sustained, painful erection that is not associated with sexual arousal. Impaired blood flow results in ischemia. The nurse will assess the penis for color changes.

Rationale 2: Baseline assessment is necessary for comparison to treatment outcomes.

Rationale 3: Analgesics are given for pain control.

Rationale 4: Ice packs are a primary treatment modality.

Rationale 5: Intake and output should be monitored, as acute urinary retention can occur. Excessive oral intake would be inappropriate.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-2

Question 23

Type: MCSA

A patient reports to the emergency department with complaints of scrotal swelling and a pain level of 2 on a scale of 1 to 10. He reports feeling a dull ache with prolonged standing or walking. The physical assessment reveals a bag of worms appearance to the scrotum. The nurse would ask additional assessment questions related to which disorder?

1. Testicular torsion

2. Hydrocele

3. Prostatitis

4. Varicocele

Correct Answer: 4

Rationale 1: Testicular torsion presents with severe pain.

Rationale 2: A hydrocele transluminates and is generally not painful.

Rationale 3: Patients experiencing prostatitis report problems with urinary elimination.

Rationale 4: A varicocele is an enlargement of the veins in the scrotum. It is associated with swelling and dull ache in the scrotum and presents with a bag of worms appearance to the scrotum.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-1

Question 24

Type: MCSA

The nurse is giving a presentation on testicular cancer to a community group. What concepts should be included in this presentation?

1. African American men have the highest rate of testicular cancer.

2. The development of testicular cancer is most common in men over the age of 40.

3. Farmers may have a higher incidence for the development of testicular cancer than white-collar workers.

4. The mortality rate for men diagnosed with stage I testicular cancer is approximately 20%.

Correct Answer: 3

Rationale 1: The highest rate of testicular cancer is in men of Scandinavian descent.

Rationale 2: The incidence of testicular cancer is highest in men ages 20 to 39.

Rationale 3: The development of testicular cancer is associated with exposure to insecticides. The work activities of a farmer involve a greater exposure to these chemicals than do office-related duties.

Rationale 4: About 95% of men with stage I testicular cancer are cured.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-6

Question 25

Type: MCSA

An 86-year-old patient has just been diagnosed with benign prostatic hyperplasia (BPH). While discussing the condition with the nurse, the patient shakes his head and states, I thought this disease was more common in middle-aged men. Which response by the nurse is most appropriate?

1. I understand how you feel.

2. No one really knows why this happens in older men.

3. This disease is most common in men between the ages of 40 and 55.

4. This condition is seen in about 90% of men your age.

Correct Answer: 4

Rationale 1: Saying that one understands that the patient is upset does not meet the needs of the interaction.

Rationale 2: The disease is the result of an overgrowth of prostatic tissue.

Rationale 3: The incidence of BPH increases with aging and is not highest in middle age.

Rationale 4: The disorder is seen in up to 90% of men age 85 and older.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-6

Question 26

Type: MCSA

The nurse is planning care for a patient who has just been diagnosed with testicular cancer. Surgery is planned. Which patient problem should be included in the plan of care?

1. Bowel incontinence

2. Erectile dysfunction

3. Urinary incontinence

4. Altered body image

Correct Answer: 4

Rationale 1: This surgery does not affect bowel incontinence.

Rationale 2: This procedure does not affect erectile dysfunction.

Rationale 3: This surgery does not affect urinary incontinence.

Rationale 4: An orchiectomy is the surgical procedure used to treat testicular cancer. Men undergoing the procedure are faced with a potential change in body image.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-5

Question 27

Type: MCSA

A patient who has benign prostatic hyperplasia (BPH) would like to try an alternative therapy along with the prescribed medication. The nurse would evaluate that education goals have been met when the patient states he will purchase which herbal remedy?

1. Dill weed

2. African star grass

3. St. Johns wort

4. Oil of primrose

Correct Answer: 2

Rationale 1: Dill weed is used in food preparation and has no known effects on BPH.

Rationale 2: African star grass is used to prevent or decrease the symptoms of BPH.

Rationale 3: St. Johns wort is used to manage depression.

Rationale 4: Oil of primrose is used in the management of premenstrual syndrome.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-4

Question 28

Type: MCMA

A 44-year-old man has sought treatment for erectile dysfunction. The patient asks specifically to be considered for sildenafil (Viagra) therapy. Which factors in the patients medical history must be taken into consideration for this particular medication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient was recently hospitalized to regulate his insulin therapy.

2. The patient has angina.

3. The patient has a history of type 2 diabetes managed by oral hypoglycemic medications.

4. The patient has a history of glaucoma.

5. The patient reports a history of hypotension.

Correct Answer: 2,5

Rationale 1: Diabetes is not an indication to limit the use of sildenafil (Viagra).

Rationale 2: Nitroglycerine is used to manage angina. The use of nitrates contradicts the use of sildenafil (Viagra).

Rationale 3: Neither type 2 diabetes nor the use of oral hypoglycemic medications would negatively impact the use of sildenafil (Viagra).

Rationale 4: Glaucoma is not an indication to limit the use of sildenafil (Viagra).

Rationale 5: Sildenafil (Viagra) causes coronary vasodilation and hypotension. A patient with a history of hypotension may have excessively low blood pressure readings as a result of this therapy.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-6

Question 29

Type: MCSA

A patient is preparing to undergo transurethral needle ablation (TUNA). Which statement would the nurse evaluate as indicating education goals for this patient have been met?

1. The reduced complications of this procedure versus those of the TURP will be well worth the TUNAs higher cost.

2. The TUNA procedure will not require a hospital admission.

3. Bleeding is a serious complication associated with the TUNA procedure.

4. I can anticipate needing to have this procedure repeated in 5 to 7 years.

Correct Answer: 2

Rationale 1: TUNA is more economical than many other procedures.

Rationale 2: TUNA is an outpatient procedure.

Rationale 3: TUNA results in fewer problems with bleeding than many other procedures.

Rationale 4: A downside to the procedure is the need to repeat it in 1 to 2 years.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 42-4

Question 30

Type: MCSA

Laboratory testing is ordered for a 61-year-old patient suspected of having chronic prostatitis. The nurse anticipates preparing the patient for which procedure?

1. CT scan

2. IVP

3. Serum sodium level

4. Urinalysis

Correct Answer: 4

Rationale 1: CT scanning is not necessary for this diagnosis.

Rationale 2: IVP is not necessary for this diagnosis.

Rationale 3: Serum sodium level is not diagnostic of chronic prostatitis.

Rationale 4: The patient being tested for prostatitis will have a series of urine specimens collected.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 42-3

Question 31

Type: MCSA

A patient who is suspected of having prostate cancer has had laboratory tests completed. The PSA result is 2.4 ng/mL. What can the nurse infer from this information?

1. The PSA indicates a need to retest every other year.

2. The patient does not have prostate cancer.

3. The PSA results are inconclusive.

4. The PSA results are elevated, signaling likely prostate cancer.

Correct Answer: 1

Rationale 1: PSA levels below 2.5 ng/mL do not warrant immediate concern. If the patient has few risk factors for prostate cancer, the test will be repeated every other year.

Rationale 2: PSA is a screening tool. Some men with low PSA results do have prostate cancer.

Rationale 3: The results are not inconclusive, but there is no true normal range for PSA. Treatment decisions are based on additional assessments along with the PSA.

Rationale 4: This PSA level is low, but continued vigilance is necessary. If the patient has additional symptoms of prostate cancer, other testing should be done.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-3

Question 32

Type: MCSA

A 19-year-old patient presents to the emergency department with complaints of testicular inflammation and pain. Laboratory tests are performed. Which result does the nurse evaluate as consistent with the suspected diagnosis of orchitis?

1. WBC: 14,500/mm3

2. Urinalysis: no white blood cells noted

3. PSA: 12 ng/mL

4. Platelet count: 250,000

Correct Answer: 1

Rationale 1: An elevation in the white blood cells is consistent with the presence of an infection.

Rationale 2: The urinalysis result is within normal limits.

Rationale 3: The PSA is a screening tool used to assess for the likelihood of prostate cancer.

Rationale 4: The platelet count is normal. Platelet count is not used to diagnose orchitis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-3

Question 33

Type: MCSA

The nurse is assigned to a patient who has just had surgery to manage testicular cancer. When preparing the plan of care, which problem will be of the highest priority?

1. Anxiety and fear

2. Pain management

3. Knowledge deficit related to radiation therapy

4. Potential for nausea

Correct Answer: 2

Rationale 1: The patient is likely to feel anxiety and fear that will need to be addressed, but this is not the highest priority.

Rationale 2: Assessing the patients level of pain and addressing complaints of pain will be the highest priority. Until the pain is at an acceptable level, the patient will be unable to meet other postoperative challenges.

Rationale 3: The patient will likely require education about radiation therapy, but this is not the highest priority.

Rationale 4: There will be a potential for nausea that should be addressed, but this is not the highest priority.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 42-5

Question 34

Type: MCSA

A 45-year-old patient who has testicular cancer is undergoing treatment with cisplatin (Platinol-AQ). The nurse has completed the shift assessment and has reviewed the days laboratory results. Which development will require the nurse to notify the health care provider?

1. The patient has voided 500 cc in the past 24 hours.

2. The patient complains of nausea 2 hours after the medication is administered.

3. The patients white blood cell count is 7,000.

4. The patient reports noticing an increase in hair loss over the past 2 days.

Correct Answer: 1

Rationale 1: Cisplatin (Platinol-AQ) may be accompanied by an impairment in renal function. Urinary output of 500 cc over a 24-hour period is inadequate and may signal a reduction in renal function.

Rationale 2: Nausea is an expected adverse effect of cisplatin.

Rationale 3: This white blood cell count is within normal limits.

Rationale 4: Alopecia is an expected effect of cisplatin.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 42-5

Question 35

Type: MCSA

The wife of a man diagnosed with prostate cancer appears disheveled and anxious during a visit to her husband. When the patient leaves the floor for testing, the nurse uses the opportunity to approach her. Which approach by the nurse is most therapeutic?

1. Would you like to talk about your concerns?

2. You must be having problems with all of this.

3. What is wrong?

4. I can see that you are having a difficult time.

Correct Answer: 1

Rationale 1: The spouse of a man diagnosed with prostate cancer is likely to experience stress and anxiety. It is important for the nurse to include her in the plan of care. Asking her to share feelings is a good starting point to assess for her specific needs.

Rationale 2: Stating that the wife must be having problems is a closed statement and does not promote communication.

Rationale 3: Simply asking What is wrong? may suggest that the wife has made an error or is presenting herself in a negative manner.

Rationale 4: Expressing that the nurse can see that the wife is having difficulties suggests a judgment about her coping abilities and is less effective at opening the dialogue than another approach.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 42-5

 

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