NURS 660 ACTUAL 2026 STUDY GUIDE QUESTIONS AND
SOLUTIONS RATED A+
✔✔ED Symptoms - ✔✔loss of desire
inability to obtain/maintain erection
premature ejaculation
absence of emission
inability to achieve orgasm
✔✔ED Diagnostic Exam - ✔✔genital exam-testes less than 4 cm hypogonadism can be
considered
feminization-gynecomastia
neuro-erectile reflex, anal sphincter tone, perineal sensation, bulbocavernous reflex-
reflex from squeezing tip of penis contracts anal sphincter, peripheral neuropathy
abdominal exam
✔✔ED Diagnostic - ✔✔Look for underlying cause
DM-blood sugars
Lipid profile
TSH
PSA
Testosterone level-if below 300 prolactin warrantedLookL
✔✔ED Management - ✔✔Behavioral/sex based therapy-psych
non-pharm-vacuum constrictive devices, vasoactive therapy, penile prosthesis, penile
re-vascularization
Oral PDE-5 Inhibitors
HRT
✔✔Oral PDE-5 Inhibitors - ✔✔Slidenafil (Viagra), Vardenafil (Levitra), Taldalafil (Cialis),
Avanafil
take 1 hr before anticipated intercourse
DO NOT USE WITH NITRATES
Cialis has half life of 17 hrs-approved for daily use
DO NOT USE-angina, uncontrolled HTN, MI, CHF, arrythmias, cardiomyopathies
✔✔BPH - ✔✔Benign enlargement of prostate
can lead to bladder outlet obstruction and cause lower urinary tract symptoms
does NOT lead to prostate CA, but can be present with CA
Can have elevated PSA levels
50% of men over 50
80% of men over 80
40-50% of all men
obesity, lack of exercise increase risk
,✔✔BPH Symptoms - ✔✔Frequent nocturia or during day
sudden urge to urinate
burning, painful urination
weak flow
sensation that bladder isn't empty after voiding
inability to urinate
trouble stopping and starting urine flow
✔✔BPH Diagnostic - ✔✔hx, exam-prostate exam, urinary output testing, PVR
PSA
Screen questionnaires: Amer Uro Associate Symptom index, intl prostate symptom
score, QOL questions, bladder impact index
✔✔BPH Treatment - ✔✔No dietary supplement approved-saw palmetto, urtica dioica
Watchful waiting-mild symptoms, yearly exams, no surgery/meds, lifestyle modifications
Alpha blockers
5-alpha reductase inhibitors
PDE inhibitors
Minimally invasive-TUMT, TURP, Laser Therapy
Invasive-Prostatectomy
✔✔Alpha Blockers - ✔✔BP Meds, not first line therapy for BP
mild to severe symptoms
works immediately
S/E- hypotension, dizziness, fatigue, nasal congestion, abnormal ejection, drug
interactions with other meds
can cause stroke
✔✔5-alpha reductase inhibitors - ✔✔Proscar, Avodart, Propecia, Finesteride
shrinking prostate itself-blocks conversion of testosterone
for men with marked enlargement
reduces risk of surgery need
S/E ED/impotence, lower libido, ejaculation disorders, lowers PSA-can interfere with
prostate CA detection
✔✔PDE Inhibitors - ✔✔Tadalafil-Cialis
cannot be used in combination with alpha blocker or patients taking nitrates
✔✔PSA Recommendations - ✔✔Men 55-69 individual decision- risk vs benefit
No screening over 70
PSA below 4 normal
4-10 suspiciious 25% prostate ca
10 and above concerning for 50% prostate CA
Factors that increase-catheter, bx, prostatitis, riding bike, sex in last 24 hrs,
testosterone, UTI
, ✔✔Referral to Urology - ✔✔LUTS
Recurrent UTI
abnormal prostate findings
abnormal PSA
Abnormal UA-hematuria, pyuria, abnormal urine cytology
PVR > 100
bladder distention or stones
hydronephrosis
stress urinary incontinence
✔✔Prostate CA - ✔✔Second most common CA in men
older age, african/carribean descent, family hx
good prognosis with localized/locoregional CA
✔✔Prostate CA Symptoms - ✔✔LUTS
Hematuria
ED
Bone Pain
✔✔Prostate CA Treatment - ✔✔Conservative vs Invasive
Radiation, surgery, androgen deprivation therapy
✔✔UTI - ✔✔Most frequent bacterial infection diagnosed
common outpatient infection 50-60% of women over lifetime
prevalence doubles over 65 (20%)
RF: females, sexually active, older adults/younger childre
post menopause
diaghragms and sperimicides
incomplete bladder emptying/UT obstruction/abnormality
DM. immunocompromised, pregnant, prior UTI
✔✔Cystitis (UTI) - ✔✔bladder or lower urinary tract infection
colonization of vaginal introitus or urethral meatus
✔✔Pyelonephritis - ✔✔infection of kidney/upper UT
develops when pathogens ascend to kidneys by ureters
seeding of kidneys from bacteremia
possible of seeding of bacteria from lymphatics
✔✔UTI-common bacteria - ✔✔E. Coli is most common
enterobacteriaceae: Klebsiella pneumoniae, proteus mirabilis, p. aeruginosa
Other: staph saprophyticus
✔✔UTI Diagnostic - ✔✔Dysuria, frequency, urgency, suprapubic pain, hematuria
SOLUTIONS RATED A+
✔✔ED Symptoms - ✔✔loss of desire
inability to obtain/maintain erection
premature ejaculation
absence of emission
inability to achieve orgasm
✔✔ED Diagnostic Exam - ✔✔genital exam-testes less than 4 cm hypogonadism can be
considered
feminization-gynecomastia
neuro-erectile reflex, anal sphincter tone, perineal sensation, bulbocavernous reflex-
reflex from squeezing tip of penis contracts anal sphincter, peripheral neuropathy
abdominal exam
✔✔ED Diagnostic - ✔✔Look for underlying cause
DM-blood sugars
Lipid profile
TSH
PSA
Testosterone level-if below 300 prolactin warrantedLookL
✔✔ED Management - ✔✔Behavioral/sex based therapy-psych
non-pharm-vacuum constrictive devices, vasoactive therapy, penile prosthesis, penile
re-vascularization
Oral PDE-5 Inhibitors
HRT
✔✔Oral PDE-5 Inhibitors - ✔✔Slidenafil (Viagra), Vardenafil (Levitra), Taldalafil (Cialis),
Avanafil
take 1 hr before anticipated intercourse
DO NOT USE WITH NITRATES
Cialis has half life of 17 hrs-approved for daily use
DO NOT USE-angina, uncontrolled HTN, MI, CHF, arrythmias, cardiomyopathies
✔✔BPH - ✔✔Benign enlargement of prostate
can lead to bladder outlet obstruction and cause lower urinary tract symptoms
does NOT lead to prostate CA, but can be present with CA
Can have elevated PSA levels
50% of men over 50
80% of men over 80
40-50% of all men
obesity, lack of exercise increase risk
,✔✔BPH Symptoms - ✔✔Frequent nocturia or during day
sudden urge to urinate
burning, painful urination
weak flow
sensation that bladder isn't empty after voiding
inability to urinate
trouble stopping and starting urine flow
✔✔BPH Diagnostic - ✔✔hx, exam-prostate exam, urinary output testing, PVR
PSA
Screen questionnaires: Amer Uro Associate Symptom index, intl prostate symptom
score, QOL questions, bladder impact index
✔✔BPH Treatment - ✔✔No dietary supplement approved-saw palmetto, urtica dioica
Watchful waiting-mild symptoms, yearly exams, no surgery/meds, lifestyle modifications
Alpha blockers
5-alpha reductase inhibitors
PDE inhibitors
Minimally invasive-TUMT, TURP, Laser Therapy
Invasive-Prostatectomy
✔✔Alpha Blockers - ✔✔BP Meds, not first line therapy for BP
mild to severe symptoms
works immediately
S/E- hypotension, dizziness, fatigue, nasal congestion, abnormal ejection, drug
interactions with other meds
can cause stroke
✔✔5-alpha reductase inhibitors - ✔✔Proscar, Avodart, Propecia, Finesteride
shrinking prostate itself-blocks conversion of testosterone
for men with marked enlargement
reduces risk of surgery need
S/E ED/impotence, lower libido, ejaculation disorders, lowers PSA-can interfere with
prostate CA detection
✔✔PDE Inhibitors - ✔✔Tadalafil-Cialis
cannot be used in combination with alpha blocker or patients taking nitrates
✔✔PSA Recommendations - ✔✔Men 55-69 individual decision- risk vs benefit
No screening over 70
PSA below 4 normal
4-10 suspiciious 25% prostate ca
10 and above concerning for 50% prostate CA
Factors that increase-catheter, bx, prostatitis, riding bike, sex in last 24 hrs,
testosterone, UTI
, ✔✔Referral to Urology - ✔✔LUTS
Recurrent UTI
abnormal prostate findings
abnormal PSA
Abnormal UA-hematuria, pyuria, abnormal urine cytology
PVR > 100
bladder distention or stones
hydronephrosis
stress urinary incontinence
✔✔Prostate CA - ✔✔Second most common CA in men
older age, african/carribean descent, family hx
good prognosis with localized/locoregional CA
✔✔Prostate CA Symptoms - ✔✔LUTS
Hematuria
ED
Bone Pain
✔✔Prostate CA Treatment - ✔✔Conservative vs Invasive
Radiation, surgery, androgen deprivation therapy
✔✔UTI - ✔✔Most frequent bacterial infection diagnosed
common outpatient infection 50-60% of women over lifetime
prevalence doubles over 65 (20%)
RF: females, sexually active, older adults/younger childre
post menopause
diaghragms and sperimicides
incomplete bladder emptying/UT obstruction/abnormality
DM. immunocompromised, pregnant, prior UTI
✔✔Cystitis (UTI) - ✔✔bladder or lower urinary tract infection
colonization of vaginal introitus or urethral meatus
✔✔Pyelonephritis - ✔✔infection of kidney/upper UT
develops when pathogens ascend to kidneys by ureters
seeding of kidneys from bacteremia
possible of seeding of bacteria from lymphatics
✔✔UTI-common bacteria - ✔✔E. Coli is most common
enterobacteriaceae: Klebsiella pneumoniae, proteus mirabilis, p. aeruginosa
Other: staph saprophyticus
✔✔UTI Diagnostic - ✔✔Dysuria, frequency, urgency, suprapubic pain, hematuria
