Week 12 Genitourinary Flashcards
An asymptomatic pregnant woman has a positive leukocyte esterase and positive nitrites on a urine dipstick screening. What will the nurse practitioner do next?
A Since she is asymptomatic, she does not require further testing or treatment
B Order a urine culture
C Order a renal ultrasound
D Prescribe trimethoprim-sulfamethoxazole (TMP-SMZ)
B. UC
Urine culture is the definitive test and should be obtained in all pregnant women. Asymptomatic bacteria during pregnancy requires treatment. Renal ultrasound is used to identify abnormalities or obstructions that may be causing recurrent symptoms. TMP-SMZ should not be used during pregnancy.
An 18-year-old male presents for itchiness of the urethral meatus and and white urethral discharge for 2 days. He denies urinary symptoms, testicular pain, or fever. His abdominal and genital exam are normal. His urine dipstick is negative. Which of the following should the nurse practitioner include in the plan of care?
A Order a urine culture
B Treat for candida with a topical antifungal cream
C Treatment with azithromycin and ceftriaxone
D Treatment with oral metronidazole
C. Tx azithromycin and ceftriaxone
The patients symptoms are consistent with urethritis. Chlamydia and gonorrhea testing should be performed and he should receive empiric treatment to cover both infections per the CDC guidelines. Given the patients age and negative UA, a urine culture is not warranted. Candida would not cause urethral discharge and there is no skin abnormality on exam. Trichomonas should be considered in the differential but is less common and does not require empiric treatment unless testing is positive.
A 25-year-old female with no past medical history presents with several days of dysuria and urgency and today, developed pain in her right flank. She denies fever or chills, but has slight nausea without vomiting. On exam, she has no abdominal tenderness but the right CVA is tender. Her urine dipstick is positive for large amount of leukocyte esterace, trace blood, and is negative for nitrite. The nurse practitioner should
A treat her with ciprofloxacin.
B order a urine culture and treat based on the result
C treat her with nitrofurantoin.
D order a renal ultrasound.
A. Ciprofloxacin
This patient likely has early pyelonephritis. Fever may be absent early in the infection. Her urine dipstick, exam and symptoms are suggestive of pyelonephritis. This requires empiric treatment and should not wait 2 days until the culture results return. Nitrofurantoin is first line for UTI, but not for pyelonephritis. An imaging study is not warranted at this time, only if she was not improving in 3 days.
A 55-year-old male presents with dysuria, urinary frequency, urgency, and suprapubic pain. His urine dipstick reveals moderate leukocyte esterace and positive nitrites. He is afebrile and has a normal physical exam. The nurse practitioner diagnoses him with
A a complicated urinary tract infection.
B acute pyelonephritis.
C an uncomplicated urinary tract infection.
D urethritis.
A. Complicated UTI
The patient’s symptoms are consistent with UTI.
All urinary tract infections (UTIs) in males are considered complicated, because the infection source is not due to ascending infection. The patient is afebrile with a normal exam, no report of flank pain so pyelonephritis can be ruled out. Given the patient’s age, bladder symptoms, and no report of penile discharge, and positive nitrites on UA, urethritis is less likely.
The daughter of an elderly female patient with mild cognitive impairment reports that her mother recently developed urinary incontinence occurring several times each day. Her mother denies fever, pain, or dysuria, and the daughter reports no change to her baseline mental status. What will the nurse practitioner do initially?
A Obtain a urine sample for urinalysis (UA) and culture
B Order serum creatinine and blood urea nitrogen tests
C Perform a bladder scan to determine distention and retention
D Tell the daughter that this is expected given her mother’s age and cognitive impairment
A. Obtain UA UC
Elderly patients often have atypical symptoms of urinary tract infection such as new onset incontinence and confusion. The first step in evaluating this patient is to check a UA and culture to check for UTI, hematuria, proteinuria or glucosuria. Serum creatinine and BUN may be performed if renal disease is suspected. Bladder scans may be performed if the UA is normal to evaluate physiologic causes. It is not correct to offer reassurance without ruling out other causes.
A 3-month-old male infant has edema and painless swelling of the left scrotum. On physical examination, the nurse practitioner can transilluminate the scrotum. What will the provider recommend?
A A Doppler ultrasound to evaluate the scrotal structures
B A short course of empiric antibiotic therapy
C Immediate referral to a genitourinary surgeon for repair
D Observation and reassurance that spontaneous resolution may occur
D Observation and reassurance that spontaneous resolution may occur
This infant has symptoms of hydrocele; these disorders often resolve spontaneously during infancy and do not require treatment unless symptoms, such as pain, occur. It is not necessary to perform other studies or refer to a surgeon. Antibiotics are not indicated, since this is not infectious.
A 70-year-old male reports urinary hesitancy, postvoid dribbling, and a diminished urine stream. A digital rectal exam (DRE) reveals an enlarged nontender prostate gland that feels rubbery and smooth. Which tests will the nurse practitioner order based on these findings?
A Bladder scan for postvoid residual
B Prostate-specific antigen (PSA)
C Urinalysis
D CBC with differential
C. urinalysis
The DRE reveals a prostate gland consistent with benign prostatic hyperplasia (BPH). The primary provider should order a urinalysis to evaluate for possible infection. A bladder scan is ordered at the discretion of the urologist. The prostate exam isn’t consistent with prostate cancer, so PSA and bladder imaging are not necessary. Symptoms of prostatitis would indicate a need for evaluation of possible infection.
A young adult male reports a mild, dull pain in the right scrotum for 1 week and the provider notes a bluish color showing through the skin on the affected side. There is no scrotal edema. Palpation reveals a bag of worms on the proximal spermatic cord. What is an important next step in managing this patient?
A Treatment with ceftriaxone or doxycycline
B Consideration of underlying causes of this finding
C Reassurance that this is benign and may resolve spontaneously
D Referral to an emergency department for surgical consultation
B Consideration of underlying causes of this finding
This patient has symptoms of varicocele. Because varicocele is rare on the right side, the provider should look for underlying causes of these findings. Left sided varicoceles are much more common and are benign. Antibiotic therapy is indicated for epididymitis. This patient’s symptoms or exam do not suggest torsion so he does not require an emergent referral for surgery.
An adolescent male reports acute onset of severe pain in one testicle for 3 hours. The nurse practitioner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention?
A Doppler ultrasound to assess testicular blood flow
B Immediate referral to the emergency department
C Prescribing antibiotic to treat the infection
D Transillumination to assess for a “blue dot” sign
B Immediate referral to the emergency department
This patient has symptoms of testicular torsion, which is a surgical emergency. An immediate referral is warranted. Doppler US and transillumination are useful in establishing a diagnosis, but the referral is the most important. An ultrasound can be deferred in this case given the high probability in this case to save time. Antibiotic agents are used if epididymitis is suspected
A 60-year-old male with a history of BPH presents for malaise, dysuria, weaker urine stream than usual, and perineal pain for several days. He denies fever, abdominal pain, flank pain, nausea, or vomiting. On exam, he appears well, he has no abdominal or flank tenderness, his prostate is tender and boggy, and his urine dipstick shows a large amount of leukocyte esterase. Which of the following is an appropriate management plan?
A Send the urine for culture and treat with ciprofloxacin for at least 10 days
B Massage the prostate gland and repeat the urine test
C Refer the patient to the hospital for treatment with IV antibiotics
D Treat empirically for chlamydia and gonorrhea with ceftriaxone and doxycycline
A. Send the urine for culture and treat with ciprofloxacin for at least 10 days
This patient has acute prostatitis. He does not meet criteria for admission. Chlamydia/gonorhea is more common in men <35 or if risk factors present. Gram negative bacteria cause most cases of acute prostatitis. The prostate exam should be performed gently to avoid the risk of bacteremia. Outpatient management options are cipro, levofloxacin and bactrim (where there is less than 20% resistance) which penetrate the prostate well. Co-management with a urologist is often indicated.
The nurse practitioner is counseling a patient who has stress incontinence about ways to minimize accidents. What will the nurse practitioner suggest initially?
A Increasing fluid intake to dilute the urine
B Referral to a physical therapist
C Taking pseudoephedrine daily
D Voiding every 2 hours during the day
D. void Q2 hrs
Timed voiding is useful to help minimize stress incontinence and is used initially. Increasing fluid intake will increase symptoms. PT referral may be done if other measures fail to help with exercises to strengthen the pelvic floor muscles. Pseudoephedrine is useful, but not an initial therapy.
The nurse practitioner prescribes the oral phosphodiesterase type 5 inhibitor sildenafil to treat erectile dysfunction (ED) in a 65-year-old male patient. What will be included when teaching this patient about taking this medication? Select all that apply.
A The medication does not initiate an erection, stimulation is required for an erection to occurThe medication does not initiate an erection, stimulation is required for an erection to occur
B Most common side effects include headache and flushing
C Most common side effects include urinary urgency and abdominal pain
D Take the medication 30–60 minutes prior to sexual activity, once daily as needed
E Seek immediate medical attention if you have an erection lasting longer than 2 hours
ABD
The nurse practitioner is evaluating a patient for potential causes of urinary incontinence and performs a postvoid residual (PVR) test, which yields 30 mL of urine. What is the interpretation of this result?
A The patient may have overflow incontinence.
B The patient probably has a urinary tract infection (UTI).
C This is a normal result.
D This represents incomplete emptying.
C This is a normal result
A 50-year-old man reports having erectile dysfunction (ED) that has developed gradually over time. What is an important response by the nurse practitioner when developing a plan of care for this patient?
A Considering testosterone hormone replacement therapy
B Evaluating the patient for cardiovascular disease
C Prescribing an oral phosphodiesterase type 5 inhibitor
D Referring the patient for psychotherapy and counseling
B. evaluating the patient for CVD
Men under age 60 years with ED are at higher risk for cardiovascular disease, so this patient should be evaluated for this condition. Until the underlying cause is found, prescribing medications or hormones is not indicated. Cardiovascular risk must be assessed prior to pharmacologic treatment. Psychotherapy and counseling are used when psychogenic ED is present
what is a complication of varicocele?
testicular damage
primary infertility in L sided varicocele
