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? Answer "Viagra is contraindicated with isosorbide mononitrate; let's discuss other options." In teaching a patient how to do a testicular self-examination, which of the following should the clinician advise? Answer "Make an appointment if you note any hard lumps directly on the testicle, regardless of whether they are tender." A 72-year-old male presents to the office for a 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? Answer; Finasteride 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? Answer Prescribing an alpha-adrenergic blocker 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? Answer an external vacuum device 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 which diagnosis? AnswerB varicocele
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