NRNP 6531 Final Exam
A patient who has had a swollen, nontender scrotum for one week is found to have a mass
within the tunica vaginalis that transilluminates readily. The family nurse practitioner suspects:
a.) a hydrocele.
b.) a varicocele.
c.) an indirect inguinal hernia.
d.) carcinoma of the testis.
A client had excessive blood loss and prolonged hypotension during surgery. His postoperative
urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most
likely cause for the change is acute:
A) Prerenal inflammation
B) Bladder outlet obstruction
C) Tubular necrosis
D) Intrarenal nephrotoxicity
Mr. S. comes to you with scrotal pain. The examinations of his scrotum, penis, and rectum are
normal. Which of the following conditions outside of the scrotum may present as scrotal pain?
A. Inguinal herniation and peritonitis
B. Renal colic and cardiac ischemia
C. Pancreatitis and Crohn ' s disease
D. Polyarteritis nodosa and ulcerative colitis
The most common type of hernia is a(n):
A. indirect inguinal hernia.
B. direct inguinal hernia.
C. femoral hernia.
D. umbilical hernia.
Max, age 70, is obese. He is complaining of a bulge in his groin that has been there for months.
He states that it is not painful, but it is annoying. You note that the origin of swelling is above
the inguinal ligament directly behind and through the external ring. You diagnose this as a(n):
,A. indirect inguinal hernia.
B. direct inguinal hernia.
C. femoral hernia.
D. strangulated hernia.
A 35 year old sexually active man presents with a 1 week history of fever and pain over the left
scrotum. It is accompanied by frequency and dysuria. The scrotum is edematous and tender to
touch. He denies flank pain, nausea, and vomiting. He reports that eh pain is lessend when he
uses scrotal-support briefs. The urinalysis shows 2 + blood and a large number of leukocytes.
What is the most likely diagnosis?
A. Acute urinary tract infection
B. Acute pyelonephritis
C. Acute orthitis
D. Acute epididymitis
Orchitis is caused by which of the following?
A. Mumps virus
B. Measles virus
C. Chlamydia trachomatis
D. Chronic urinary tract infections that are not treated adequately
A 10 year old boy complains of sudden onset of scrotal pain upon awakening that morning. He
is also complaining of severe nausea and vomiting. During the physical examination, the nurse
practitioner finds a tender, warm, and swollen left scrotum. The cremastic reflex is negative and
the urine dipstick is negative for leukocytes, nitrites, and blood. The most likely diagnosis is:
A. Acute epididymitis
B. Severe salmonella infection
C. Testicular torsion
D. Acute orchitis
What type of follow up should this patient receive?
A. Refer to a urologist within 48 hours
B. Refer him to the emergency department as soon as possible
C. Prescribe ibuprofen (advil) 600 mg QID for pain
D. Order a testicular ultrasound for further evaluation
,A 24-year-old man presents with sudden onset of left-sided scrotal pain. He reports having
intermittent unilateral testicular pain in the past but not as severe as this current episode.
Confirmation of testicular torsion would include all of the following findings except:
A. unilateral loss of the cremasteric reflex.
B. the affected testicle held higher in the scrotum.
C. testicular swelling.
D. relief of pain with scrotal elevation.
In assessing a man with testicular torsion, the NP is most likely to note:
A. elevated PSA level.
B. white blood cells reported in urinalysis.
C. left testicle most often affected.
D. increased testicular blood flow by color-flow Doppler ultrasound.
Anticipated organ survival exceeds 85% with testicular decompression within how many hours
of torsion?
A. 1
B. 6
C. 16
D. 24
To prevent a recurrence of testicular torsion, which of the following is recommended?
A. use of a scrotal support
B. avoidance of testicular trauma
C. orchiopexy
D. limiting the number of sexual partners
Jordan appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank.
You are trying to differentiate between epididymitis and testicular torsion. Which test to
determine whether swelling is in the testis or the epididymis should be your first choice?
A. X-ray
B. Ultrasound
C. Technetium scan
D. Physical examination
, The nurse practitioner recognizes that the most common cause of epididymitis in a young man
is:
A chlamydia
B E. coli
C mycoplasma
D Proteus species
Your 25-year-old male patient has had a fever, dysuria, low back pain, and scrotal edema.
Which of the following is likely the diagnosis?
A acute bacteria prostatitis
B acute pyelonephritis
C epididymitis
D urinary tract infection
The action of a 5 alpha-reductace inhibitor in the treatment of BPH is to:
- reduce action of androgens in the prostate.
Milton, a 72 year old unmarried, sexually active white man presents to your clinic with
complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although you suspect
benign prostatic hypertrophy, what else should your differential diagnosis include?
- Urethral stricture (may develop as a result of sexually transmitted diseases and should be
considered in a sexually active individual no matter what the age)
Harry has BPH and complains of some incontinence. Your first step in diagnosing overflow
incontinence would be to order a:
- Post void residual urine measurement
Lower urinary tract symptoms in males can present as a constellation of storage or voiding
symptoms. Storage symptoms include:
- urgency and nocturia
A 63-year-old man presents to you with hematuria, hesitancy, and dribbling. DRE reveals a
A patient who has had a swollen, nontender scrotum for one week is found to have a mass
within the tunica vaginalis that transilluminates readily. The family nurse practitioner suspects:
a.) a hydrocele.
b.) a varicocele.
c.) an indirect inguinal hernia.
d.) carcinoma of the testis.
A client had excessive blood loss and prolonged hypotension during surgery. His postoperative
urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most
likely cause for the change is acute:
A) Prerenal inflammation
B) Bladder outlet obstruction
C) Tubular necrosis
D) Intrarenal nephrotoxicity
Mr. S. comes to you with scrotal pain. The examinations of his scrotum, penis, and rectum are
normal. Which of the following conditions outside of the scrotum may present as scrotal pain?
A. Inguinal herniation and peritonitis
B. Renal colic and cardiac ischemia
C. Pancreatitis and Crohn ' s disease
D. Polyarteritis nodosa and ulcerative colitis
The most common type of hernia is a(n):
A. indirect inguinal hernia.
B. direct inguinal hernia.
C. femoral hernia.
D. umbilical hernia.
Max, age 70, is obese. He is complaining of a bulge in his groin that has been there for months.
He states that it is not painful, but it is annoying. You note that the origin of swelling is above
the inguinal ligament directly behind and through the external ring. You diagnose this as a(n):
,A. indirect inguinal hernia.
B. direct inguinal hernia.
C. femoral hernia.
D. strangulated hernia.
A 35 year old sexually active man presents with a 1 week history of fever and pain over the left
scrotum. It is accompanied by frequency and dysuria. The scrotum is edematous and tender to
touch. He denies flank pain, nausea, and vomiting. He reports that eh pain is lessend when he
uses scrotal-support briefs. The urinalysis shows 2 + blood and a large number of leukocytes.
What is the most likely diagnosis?
A. Acute urinary tract infection
B. Acute pyelonephritis
C. Acute orthitis
D. Acute epididymitis
Orchitis is caused by which of the following?
A. Mumps virus
B. Measles virus
C. Chlamydia trachomatis
D. Chronic urinary tract infections that are not treated adequately
A 10 year old boy complains of sudden onset of scrotal pain upon awakening that morning. He
is also complaining of severe nausea and vomiting. During the physical examination, the nurse
practitioner finds a tender, warm, and swollen left scrotum. The cremastic reflex is negative and
the urine dipstick is negative for leukocytes, nitrites, and blood. The most likely diagnosis is:
A. Acute epididymitis
B. Severe salmonella infection
C. Testicular torsion
D. Acute orchitis
What type of follow up should this patient receive?
A. Refer to a urologist within 48 hours
B. Refer him to the emergency department as soon as possible
C. Prescribe ibuprofen (advil) 600 mg QID for pain
D. Order a testicular ultrasound for further evaluation
,A 24-year-old man presents with sudden onset of left-sided scrotal pain. He reports having
intermittent unilateral testicular pain in the past but not as severe as this current episode.
Confirmation of testicular torsion would include all of the following findings except:
A. unilateral loss of the cremasteric reflex.
B. the affected testicle held higher in the scrotum.
C. testicular swelling.
D. relief of pain with scrotal elevation.
In assessing a man with testicular torsion, the NP is most likely to note:
A. elevated PSA level.
B. white blood cells reported in urinalysis.
C. left testicle most often affected.
D. increased testicular blood flow by color-flow Doppler ultrasound.
Anticipated organ survival exceeds 85% with testicular decompression within how many hours
of torsion?
A. 1
B. 6
C. 16
D. 24
To prevent a recurrence of testicular torsion, which of the following is recommended?
A. use of a scrotal support
B. avoidance of testicular trauma
C. orchiopexy
D. limiting the number of sexual partners
Jordan appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank.
You are trying to differentiate between epididymitis and testicular torsion. Which test to
determine whether swelling is in the testis or the epididymis should be your first choice?
A. X-ray
B. Ultrasound
C. Technetium scan
D. Physical examination
, The nurse practitioner recognizes that the most common cause of epididymitis in a young man
is:
A chlamydia
B E. coli
C mycoplasma
D Proteus species
Your 25-year-old male patient has had a fever, dysuria, low back pain, and scrotal edema.
Which of the following is likely the diagnosis?
A acute bacteria prostatitis
B acute pyelonephritis
C epididymitis
D urinary tract infection
The action of a 5 alpha-reductace inhibitor in the treatment of BPH is to:
- reduce action of androgens in the prostate.
Milton, a 72 year old unmarried, sexually active white man presents to your clinic with
complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although you suspect
benign prostatic hypertrophy, what else should your differential diagnosis include?
- Urethral stricture (may develop as a result of sexually transmitted diseases and should be
considered in a sexually active individual no matter what the age)
Harry has BPH and complains of some incontinence. Your first step in diagnosing overflow
incontinence would be to order a:
- Post void residual urine measurement
Lower urinary tract symptoms in males can present as a constellation of storage or voiding
symptoms. Storage symptoms include:
- urgency and nocturia
A 63-year-old man presents to you with hematuria, hesitancy, and dribbling. DRE reveals a
