Chapter 11: Urological and Gynecological Disorders

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. Which ethnic group has the highest incidence of prostate cancer?
A. Asians
B. Hispanics
C. African Americans
D. American Indians

____ 2. Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to what
intervals?
A. Every 6 months
B. Yearly
C. Every 2 years
D. Every 2 to 4 years

____ 3. All of the following may be reasons associated with an elevated PSA besides prostate cancer except:
A. Prostatitis
B. Urinary tract infection
C. Perineal trauma
D. Digital rectal exam

____ 4. In the diagnosis of acute bacterial prostatitis, a midstream urine culture is of benefit. To be
diagnostic, the specimen should reveal how many white blood cells per high-power field?
A. Five
B. Ten
C. Fifteen
D. Twenty

____ 5. In chronic bacterial prostatitis, what is the organism most commonly associated with the disease?
A. Klebsiella
B. Proteus
C. Pseudomonas
D. Escherichia coli

____ 6. In acute prostatitis, an exam of the prostate may find the gland to be:
A. Nodular
B. Cool and pliable
C. Swollen and tender
D. Asymmetrical

____ 7. All of the following antimicrobials may be indicated in chronic bacterial prostatitis except:
A. Ciprofloxacin
B. Levofloxacin
C. Trimethoprim
D. Azithromycin
____ 8. Age-related changes in the bladder, urethra, and ureters include all of the following in older women
except:
A. Increased estrogen production’s influence on the bladder and ureter
B. Decline in bladder outlet function
C. Decline in ureteral resistance pressure
D. Laxity of the pelvic muscle

____ 9. Mr. Jones is a 68-year-old retired Air Force pilot that has been diagnosed with prostate cancer in the
past week. He has never had a surgical procedure in his life and seeks clarification on the availability
of treatments for prostate cancer. He asks the nurse practitioner to tell him the side effects of a
radical prostatectomy. Which of the following is NOT a potential side effect of this procedure?
A. Urinary incontinence
B. Impotence
C. Dribbling urine
D. Selected low back pain

____ 10. The nurse practitioner is evaluating a patient’s pelvic muscle strength by digital examination. This is
performed when:
A. A male patient complains of nocturia and dribbling
B. The nurse practitioner needs to confirm a cystocele or stress incontinence
C. The patient reports sudden loss of large amounts of urine or urge incontinence
D. The nurse practitioner suspects overflow incontinence

____ 11. A pelvic mass in a postmenopausal woman:

____ 12. A 79-year-old man is being evaluated for frequent urinary dribbling without burning. Physical
examination reveals a smooth but slightly enlarged prostate gland. His PSA level is 3.3 ng/mL. The
patient undergoes formal urodynamic studies, and findings are as follows: a decreased bladder
capacity of 370 mL; a few involuntary detrusor contractions at a low bladder volume of 246 mL; an
increased postvoid residual urine volume of 225 mL; and a slightly decreased urinary flow rate.
Which of the following is not consistent with a normal age-associated change?
A. PSA level of 3.3 ng/mL
B. Decreased bladder capacity
C. Involuntary detrusor contradictions
D. Increased postvoid residual urine volume

____ 13. Mrs. Smith, a 65-year-old woman presents to clinic for the first time and complains of urinary
incontinence and dyspareunia. She went through menopause 10 years ago without any hormone
replacement therapy and had a hysterectomy for a fibroid. Her mother had a hip fracture at 82 years
of age. The patient’s most recent mammogram was 5 years ago and no known family history of
breast cancer. She is not taking any medications. Her physical examination is unremarkable except
for findings consistent with atrophic vaginitis. You decide to begin topical hormone replacement
therapy. Which of the following evaluations would be necessary prior to initiating hormone
replacement therapy?
 A. Mammogram
B. Endometrial biopsy
C. Bone mineral density measurement
D. Papanicolaou smear
____ 14. Mrs. L. Billings is a 77-year-old Caucasian female who has a history of breast cancer. She has been
in remission for 6 years. As her primary care provider, you are seeing her for follow-up of her recent
complaint of intermittent abdominal pain of a 3-month duration and some general malaise. Given the
brief history above, what will you direct your assessment at during physical examination?
A. Examination of her thyroid to rule out thyroid nodules that may contribute to her
feeling fatigued.
B. Auscultation of her abdomen for abnormal bowel sounds to rule out peritonitis.
C. Thorough abdominal and gynecological exam to rule out masses and identify any
tenderness.
D. A rectal examination to rule out colon cancer as a secondary site for breast cancer.

____ 15. A 78-year-old female comes to the office because she has pain when she urinates. She has been seen
three times for this problem in the last 3 months. Each time she was told she had a UTI and was
given antibiotics. She carefully followed the instructions but has had no relief of symptoms. Last
UA:
WBCs: 2-3/high-power field
RBCs: 0-2/high-power field
Epithelial cells: Few
Nitrite: Negative
Leuckocyte esterase: Negative
Which of the following should be done next?
A. Obtain a clean catch urine for UA and urine for C&S
B. Perform a pelvic examination
C. Reassure the patient that she has asymptomatic bacteriuria and does not need
antibiotics
D. Order a pelvic ultrasound
Chapter 11: Urological and Gynecological Disorders
Answer Section

MULTIPLE CHOICE

1. ANS: C PTS: 1
2. ANS: C PTS: 1
3. ANS: B PTS: 1
4. ANS: B PTS: 1
5. ANS: D PTS: 1
6. ANS: C PTS: 1
7. ANS: D PTS: 1
8. ANS: A PTS: 1
9. ANS: D PTS: 1
10. ANS: B PTS: 1
11. ANS: C PTS: 1
12. ANS: D PTS: 1
13. ANS: A PTS: 1
14. ANS: C PTS: 1
15. ANS: B PTS: 1