504 EXAM #3-FITZGERALD GU PRACTICE QUESTIONS WITH
SOLUTIONS
When prescribing antihypertensive therapy for a man with BPH and hypertension, the
nurse practitioner (NP) considers that:
A. Loop diuretics are the treatment of choice.
B. An alpha1-antagonist should not be used as a solo or first-line therapeutic agent.
C. Angiotensin receptor antagonist use is contraindicated.
D. Beta-adrenergic antagonist use often enhances urinary flow. - correct answer B. An
alpha1-antagonist should not be used as a solo or first-line therapeutic agent.
The use of alpha blockers as a solo or first-line antihypertensive agent has been
associated with higher than expected rates of stroke and heat failure. Alpha blockers
should be considered as a desirable agent in treating a man with hypertension and BPH
but only as medication added on to existing antihypertension therapy; an alpha blocker
that is specifically indicated for BPH therapy only, such as tamsulosin, has minimal
effect on blood pressure.
Which of the following medications can contribute to the development of acute urinary
retention in an older man with BPH?
A. Amitriptyline
B. Loratadine
C. Enalapril
D. Lorazepam - correct answer A. Amitriptyline
Drugs with anticholinergic effect, such as tricyclic antidepressants (amitriptyline,
nortriptyline, and imipramine) and first generation antihistamines (e.g., diphenhydramine
[Benadryl®], chlorpheniramine [Chlor-Trimeton®]), can cause acute urinary retention in
men with BPH; opioid use and inactivity also increase the risk of urinary retention.
Finasteride (Proscar®, Propecia®) and dutasteride (Avodart®) are helpful in the
treatment of BPH because of their effect on:
A. Bladder contractility
B. Prostate size
C. Activity at select bladder receptor sites
D. Bladder pressure - correct answer B. Prostate size
The use of finasteride (Proscar®) and dutasteride (Avodart®), 5-alphareductase
inhibitors that block the conversion of testosterone to dihydrotestosterone, helps to
reduce the size of the prostate and ameliorate symptoms.
Tamsulosin (Flomax®) is helpful in the treatment of BPH because of its effect on:
A. Bladder contractility
B. Prostate size
C. Activity at select bladder receptor sites
D. Bladder pressure - correct answer C. Activity at select bladder receptor sites
,The prostate and bladder base contain numerous alpha1 receptor sites. When these
receptor sites are stimulated, the prostate contracts, increasing outflow tract obstruction.
As a result, treatment with alpha1 receptor antagonists (alpha blockers) including
tamsulosin (Flomax®) can be helpful in improving the symptoms of BPH.
Concerning herbal and nutritional therapies for BPH treatment, which of the following
statements is false?
A. The mechanism of action of the most effective and best studied products is similar to
prescription medications for this condition.
B. These therapies are currently considered emerging therapies by the American
Urological Association.
C. Major areas of concern with use of these therapies include issues of product purity
and quality control.
D. These therapies are safest and most effective when used with prescription
medications. - correct answer D. These therapies are safest and most effective when
used with prescription medications.
Herbal and nutritional therapies, including saw palmetto, rye, and pumpkin, are
considered emerging therapies by the American Urological Association, pending further
study. The observed effect of these plant-based therapies is usually attributed to a
mechanism of action similar to approved prescription BPH therapies. As with other
herbal and nutritional therapies available over-the-counter (OTC), issues of product
purity and strength and potential interaction with prescription and other OTC products
remain a concern.
When choosing an antimicrobial agent for the treatment of chronic bacterial prostatitis,
the NP considers that:
A. Gram-positive organisms are the most likely cause of infection
B. Cephalosporins are the first-line choice of therapy
C. Choosing an antibiotic with gram-negative coverage is critical
D. Length of antimicrobial therapy is typically 5 days - correct answer C. Choosing an
antibiotic with gram-negative coverage is critical
Infection with a gram-negative rod such as E. Coli and
Pseudomonas species usually causes acute bacterial prostatitis in older men.
Treatment for acute bacterial prostatitis is similar to treatment for acute pyelonephritis—
an antimicrobial agent with activity against gram-negative organisms and excellent
tissue penetration.
Appropriate antimicrobial treatment for a 25-year-old man with acute bacterial prostatitis
is:
A. Oral azithromycin
B. IM ceftriaxone followed by oral doxycycline
C. Oral ofloxacin
, D. Oral amoxicillin-clavulanate - correct answer B. IM ceftriaxone followed by oral
doxycycline
In younger men (<35 years) or men at risk for
Stis, gonorrhea or chlamydia or both are most often implicated. In men younger than 35
years, a single dose of ceftriaxone followed by doxycycline is recommended; causative
organisms are usually the sexually transmitted organisms C. Trachomatis and N.
Gonorrhoeae. Length of doxycycline therapy is usually 10 to 14 days.
Appropriate antimicrobial treatment for a 65-year old man with acute bacterial prostatitis
is a course of oral:
A. Erythromycin.
B. Cefepime.
C. TMP-SMX.
D. Ciprofloxacin. - correct answer D. Ciprofloxacin.
In men 35 years old and older or men who have sex with men, antimicrobial therapy
with a higher-dose fluoroquinolone, such as ciprofloxacin or levofloxacin, for 10-14 days
is advised.
Which of the following is the best choice of therapy in chronic bacterial prostatitis?
A. Oral trimethoprim-sulfamethoxazole for 2 weeks
B. Parenteral ampicillin for 4 weeks
C. Oral ciprofloxacin for 4 weeks
D. Injectable gentamicin for 2 weeks - correct answer C. Oral ciprofloxacin for 4 weeks
In patients with chronic bacterial prostatitis, irritative
Voiding symptoms, low back and perineal pain, and a history of urinary tract infection
are typically reported. Objective findings include a tender, boggy, or indurated prostate.
Urinalysis results are usually normal from a freshly voided specimen. Urinalysis and
culture after prostatic massage usually yields leukocytes and the causative organism;
prostatic massage is not recommended if acute prostatitis is known to be present.
Antimicrobial therapy for 4 to 12 weeks using a product with excellent tissue penetration
and strong gram-negative coverage is usually required
Which of the following medications for ED treatment has the longest half-life?
A. Sildenafil (Viagra®)
B. Tadalafil (Cialis®)
C. Vardenafil (Levitra®)
D. Avanafil (Stendra®) - correct answer B. Tadalafil (Cialis®)
The half-life of sildenafil, avanafil, and vardenafil is approximately 4 to 5 hours, whereas
tadalafil has a longer half-life of approximately 17 hours; as a result of its long T1/2,
tadalafil is the only ED medication recommended for lower-dose daily use.
SOLUTIONS
When prescribing antihypertensive therapy for a man with BPH and hypertension, the
nurse practitioner (NP) considers that:
A. Loop diuretics are the treatment of choice.
B. An alpha1-antagonist should not be used as a solo or first-line therapeutic agent.
C. Angiotensin receptor antagonist use is contraindicated.
D. Beta-adrenergic antagonist use often enhances urinary flow. - correct answer B. An
alpha1-antagonist should not be used as a solo or first-line therapeutic agent.
The use of alpha blockers as a solo or first-line antihypertensive agent has been
associated with higher than expected rates of stroke and heat failure. Alpha blockers
should be considered as a desirable agent in treating a man with hypertension and BPH
but only as medication added on to existing antihypertension therapy; an alpha blocker
that is specifically indicated for BPH therapy only, such as tamsulosin, has minimal
effect on blood pressure.
Which of the following medications can contribute to the development of acute urinary
retention in an older man with BPH?
A. Amitriptyline
B. Loratadine
C. Enalapril
D. Lorazepam - correct answer A. Amitriptyline
Drugs with anticholinergic effect, such as tricyclic antidepressants (amitriptyline,
nortriptyline, and imipramine) and first generation antihistamines (e.g., diphenhydramine
[Benadryl®], chlorpheniramine [Chlor-Trimeton®]), can cause acute urinary retention in
men with BPH; opioid use and inactivity also increase the risk of urinary retention.
Finasteride (Proscar®, Propecia®) and dutasteride (Avodart®) are helpful in the
treatment of BPH because of their effect on:
A. Bladder contractility
B. Prostate size
C. Activity at select bladder receptor sites
D. Bladder pressure - correct answer B. Prostate size
The use of finasteride (Proscar®) and dutasteride (Avodart®), 5-alphareductase
inhibitors that block the conversion of testosterone to dihydrotestosterone, helps to
reduce the size of the prostate and ameliorate symptoms.
Tamsulosin (Flomax®) is helpful in the treatment of BPH because of its effect on:
A. Bladder contractility
B. Prostate size
C. Activity at select bladder receptor sites
D. Bladder pressure - correct answer C. Activity at select bladder receptor sites
,The prostate and bladder base contain numerous alpha1 receptor sites. When these
receptor sites are stimulated, the prostate contracts, increasing outflow tract obstruction.
As a result, treatment with alpha1 receptor antagonists (alpha blockers) including
tamsulosin (Flomax®) can be helpful in improving the symptoms of BPH.
Concerning herbal and nutritional therapies for BPH treatment, which of the following
statements is false?
A. The mechanism of action of the most effective and best studied products is similar to
prescription medications for this condition.
B. These therapies are currently considered emerging therapies by the American
Urological Association.
C. Major areas of concern with use of these therapies include issues of product purity
and quality control.
D. These therapies are safest and most effective when used with prescription
medications. - correct answer D. These therapies are safest and most effective when
used with prescription medications.
Herbal and nutritional therapies, including saw palmetto, rye, and pumpkin, are
considered emerging therapies by the American Urological Association, pending further
study. The observed effect of these plant-based therapies is usually attributed to a
mechanism of action similar to approved prescription BPH therapies. As with other
herbal and nutritional therapies available over-the-counter (OTC), issues of product
purity and strength and potential interaction with prescription and other OTC products
remain a concern.
When choosing an antimicrobial agent for the treatment of chronic bacterial prostatitis,
the NP considers that:
A. Gram-positive organisms are the most likely cause of infection
B. Cephalosporins are the first-line choice of therapy
C. Choosing an antibiotic with gram-negative coverage is critical
D. Length of antimicrobial therapy is typically 5 days - correct answer C. Choosing an
antibiotic with gram-negative coverage is critical
Infection with a gram-negative rod such as E. Coli and
Pseudomonas species usually causes acute bacterial prostatitis in older men.
Treatment for acute bacterial prostatitis is similar to treatment for acute pyelonephritis—
an antimicrobial agent with activity against gram-negative organisms and excellent
tissue penetration.
Appropriate antimicrobial treatment for a 25-year-old man with acute bacterial prostatitis
is:
A. Oral azithromycin
B. IM ceftriaxone followed by oral doxycycline
C. Oral ofloxacin
, D. Oral amoxicillin-clavulanate - correct answer B. IM ceftriaxone followed by oral
doxycycline
In younger men (<35 years) or men at risk for
Stis, gonorrhea or chlamydia or both are most often implicated. In men younger than 35
years, a single dose of ceftriaxone followed by doxycycline is recommended; causative
organisms are usually the sexually transmitted organisms C. Trachomatis and N.
Gonorrhoeae. Length of doxycycline therapy is usually 10 to 14 days.
Appropriate antimicrobial treatment for a 65-year old man with acute bacterial prostatitis
is a course of oral:
A. Erythromycin.
B. Cefepime.
C. TMP-SMX.
D. Ciprofloxacin. - correct answer D. Ciprofloxacin.
In men 35 years old and older or men who have sex with men, antimicrobial therapy
with a higher-dose fluoroquinolone, such as ciprofloxacin or levofloxacin, for 10-14 days
is advised.
Which of the following is the best choice of therapy in chronic bacterial prostatitis?
A. Oral trimethoprim-sulfamethoxazole for 2 weeks
B. Parenteral ampicillin for 4 weeks
C. Oral ciprofloxacin for 4 weeks
D. Injectable gentamicin for 2 weeks - correct answer C. Oral ciprofloxacin for 4 weeks
In patients with chronic bacterial prostatitis, irritative
Voiding symptoms, low back and perineal pain, and a history of urinary tract infection
are typically reported. Objective findings include a tender, boggy, or indurated prostate.
Urinalysis results are usually normal from a freshly voided specimen. Urinalysis and
culture after prostatic massage usually yields leukocytes and the causative organism;
prostatic massage is not recommended if acute prostatitis is known to be present.
Antimicrobial therapy for 4 to 12 weeks using a product with excellent tissue penetration
and strong gram-negative coverage is usually required
Which of the following medications for ED treatment has the longest half-life?
A. Sildenafil (Viagra®)
B. Tadalafil (Cialis®)
C. Vardenafil (Levitra®)
D. Avanafil (Stendra®) - correct answer B. Tadalafil (Cialis®)
The half-life of sildenafil, avanafil, and vardenafil is approximately 4 to 5 hours, whereas
tadalafil has a longer half-life of approximately 17 hours; as a result of its long T1/2,
tadalafil is the only ED medication recommended for lower-dose daily use.
