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 hydrocele.
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
Bladder outlet obstruction
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
Inguinal herniation and peritonitis
The most common type of hernia is a(n):
A. indirect inguinal hernia.
B. direct inguinal hernia.
C. femoral hernia.
D. umbilical hernia.
indirect inguinal 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.
direct inguinal 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
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
Mumps virus
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
Testicular torsion
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
Refer him to the emergency department as soon as possible
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.
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.
left testicle most often affected.
Anticipated organ survival exceeds 85% with testicular decompression within how many hours of
torsion?
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 hydrocele.
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
Bladder outlet obstruction
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
Inguinal herniation and peritonitis
The most common type of hernia is a(n):
A. indirect inguinal hernia.
B. direct inguinal hernia.
C. femoral hernia.
D. umbilical hernia.
indirect inguinal 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.
direct inguinal 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
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
Mumps virus
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
Testicular torsion
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
Refer him to the emergency department as soon as possible
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.
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.
left testicle most often affected.
Anticipated organ survival exceeds 85% with testicular decompression within how many hours of
torsion?
