nr 511 differential diagnosis and primary care practicum
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NR 511 Week 7: Quiz
Question 1 pts
A patient is being treated for erectile dysfunction. The patient is morbidly obese and is also being
treated for a coagulopathy. Which of the following medications would be contraindicated?
Subcutaneous pellet testosterone (Testopel).
Topical testosterone (AndroGel).orrect!
Alprostadil (Caverject).
Sildenafil (Viagra).
The vasoactive injectable alprostadil (Caverject) should not be used in patients with sickle cell
anemia, coagulopathy, severe cardiovascular disease, myeloma, leukemia, morbid obesity, or penile
deformity, fibrosis, or implants.
Question 2 pts
A 32-year-old male appears with a rapid onset of unilateral scrotal pain radiating up to the groin and
flank. The nurse practitioner is trying to differentiate between epididymitis and testicular torsion.
Which test should be the provider’s first choice?
X-ray.
Physical examination.
Technetium scan.orrect!
Ultrasound.
If your client has a rapid onset of unilateral scrotal pain radiating up to the groin and flank and you are
trying to differentiate between epididymitis and testicular torsion, an ultrasound is useful for
determining whether the swelling is in the testis or the epididymis and should be your first choice.
Question 3 pts
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?
Correct Answer
“Viagra is contraindicated with isosorbide mononitrate; let’s discuss other options.”
“I’d better refer you to a urologist.”u Answered
“Let’s try a sample and see how you do.”
“Because of your history of diabetes, we can’t use it.”
Because sexual stimulation leads to the release of nitric oxide in the corpus cavernosum of the penis
and sildenafil (Viagra) potentiates that release, there is a double hypotensive effect between sildenafil
and a nitric oxide donor such as isosorbide mononitrate (Monoket, Imdur, and Ismo). Therefore, the
use of sildenafil with Monoket is contraindicated.
, Question 4 pts
A 72-year-old unmarried, sexually active man, presents to the clinic with complaints of hesitancy,
urgency, and occasional uncontrolled dribbling. Although the nurse practitioner suspects benign
prostatic hyperplasia, what else should the differential diagnosis include?
Antihistamine use.
Renal calculi.
Detrusor hyperreflexia.Correct!
Urethral stricture.
Urethral strictures may develop as a result of sexually transmitted diseases and should be considered
in sexually active individuals (primarily males) no matter their age. Antihistamine use generally will
result in hesitancy and urinary retention but not incontinence.
Question 5 pts
A 54-year-old male is complaining of erectile dysfunction. He also has a condition that has reduced
arterial blood flow to his penis. The most common cause of this condition is: orrect!
Diabetes mellitus.
Multiple sclerosis.
Parkinson disease.
Epilepsy.
About 50% of men who have had diabetes for longer than 6 years develop erectile dysfunction to
some extent as a result of pathological changes in the vascular wall that lead to a reduction of arterial
blood flow to the penis. Many other conditions can cause erectile dysfunction as well. These include
cerebrovascular accidents (ie, strokes or brain attacks), spinal cord injury, temporal lobe epilepsy,
multiple sclerosis, chronic obstructive pulmonary disease, angina, chronic renal failure, and Parkinson
disease.
Question 6
pts
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?
Surgery
Intracavernous injection therapy.
Urethral suppositories. orrect!
An external vacuum device.
An external vacuum device is a viable method for alleviating erectile dysfunction regardless of the
cause of the disorder. A plastic cylinder is placed around the penis, a vacuum pump causes
cavernosal engorgement, and a constrictor ring is applied around the base of the penis, allowing the
client to hold an erection for 30 minutes.
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