A 55 year-old cisgender male patient comes to the primary care office for a general physical examination. He has had some lower back pain but denies change in bowel habits or rectal bleeding. His examination is unremarkable except for a digital rectal examination notable for irregular, asymmetric, hard nodule on the otherwise smooth posterior surface of the prostate. Examination of the scrotum and penis are normal. What disorder of the anus, rectum, or prostate is the most likely cause of these findings?
Anorectal cancer
Benign prostatic hyperplasia
Prostatitis
Prostate cancer
The Correct Answer is D
Abnormal findings on digital rectal examination (DRE) are critical in identifying disorders of the prostate, rectum, and surrounding structures. Prostate cancer typically presents with firm, irregular, and asymmetric nodules on the prostate surface due to malignant infiltration and tissue distortion. Unlike benign conditions, malignant prostate changes are often hard, fixed, and non-tender. Differentiating malignant from inflammatory or benign enlargement is essential for early diagnosis and management.
Rationale:
A. Anorectal cancer usually presents with symptoms such as rectal bleeding, pain, changes in bowel habits, or a palpable mass in the rectal canal rather than isolated prostate abnormalities. It would not typically produce an irregular nodule confined to the prostate on digital rectal examination. The normal rectal and systemic findings in this patient make anorectal cancer unlikely.
B. Benign prostatic hyperplasia (BPH) is characterized by a smooth, symmetric, and enlarged prostate due to nonmalignant glandular and stromal proliferation. It typically causes urinary symptoms such as hesitancy, weak stream, and nocturia rather than hard, irregular nodules. The presence of an asymmetric, hard lesion is not consistent with BPH.
C. Prostatitis is an inflammatory condition of the prostate that often presents with tenderness, warmth, and systemic symptoms such as fever or urinary discomfort. On examination, the prostate is usually tender, boggy, and enlarged rather than firm and nodular. The absence of pain and systemic signs makes prostatitis less likely.
D. Prostate cancer is the most likely diagnosis because it commonly presents with a hard, irregular, asymmetric nodule on digital rectal examination. Malignant prostate tissue becomes firm due to uncontrolled cellular growth and fibrotic changes. These findings are highly suspicious for localized prostate malignancy, even in the absence of urinary or systemic symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Functional assessment in older adults evaluates their ability to perform tasks necessary for independent living and self-care. These abilities are categorized into basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). IADLs involve more complex skills required for managing a household and maintaining independence in the community. Conditions such as rheumatoid arthritis can significantly impair fine motor skills and joint function, affecting tasks like cooking and meal preparation.
Rationale:
A. Instrumental activities of daily living include complex tasks such as meal preparation, housekeeping, medication management, transportation, and financial management. Difficulty with meal preparation indicates impairment in these higher-level functional tasks. Severe rheumatoid arthritis can cause joint pain, stiffness, and deformities that interfere with hand function, making IADLs the appropriate classification.
B. Activities of daily living refer to basic self-care tasks such as bathing, dressing, toileting, transferring, and eating. While rheumatoid arthritis may eventually affect these abilities in severe cases, meal preparation is not classified under basic ADLs. Therefore, this option does not accurately reflect the described deficit.
C. Functional activities of daily living is not a standard classification term in clinical functional assessment frameworks. The recognized categories are basic ADLs and instrumental ADLs. Because this option is not a validated classification, it is not appropriate for documentation.
D. Independent activities of daily living is not a formal category used in functional assessment tools. While independence is the overall goal of care, it is not a distinct classification for documenting specific deficits. The correct established category for meal preparation difficulty is instrumental activities of daily living.
Correct Answer is ["A","D"]
Explanation
Preeclampsia is a pregnancy-specific hypertensive disorder characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. It reflects abnormal placental perfusion leading to widespread endothelial dysfunction and end-organ involvement. Early recognition is essential because it can progress to severe complications affecting the kidneys, liver, brain, and fetus. Diagnostic concern is based on blood pressure elevation and evidence of protein loss in urine.
Rationale:
A. A blood pressure of 165/115 mmHg is significantly elevated and meets the criteria for severe-range hypertension in pregnancy. Such readings suggest increased systemic vascular resistance and endothelial dysfunction, both characteristic of preeclampsia. This level of hypertension places the patient at high risk for complications such as eclampsia, stroke, and placental insufficiency.
B. Elevated white blood cell count is not a diagnostic indicator of preeclampsia and may be seen in normal pregnancy or in response to infection or stress. Preeclampsia is primarily a vascular and placental disorder rather than an infectious or hematologic condition. Therefore, WBC elevation alone does not support the diagnosis.
C. Decreased serum creatinine level is typically a normal physiological finding in pregnancy due to increased glomerular filtration rate. In preeclampsia, renal impairment would more commonly result in elevated creatinine levels rather than decreased values. Thus, this finding is not concerning for preeclampsia.
D. Protein 1+ on urine dipstick indicates proteinuria, which is a key diagnostic feature of preeclampsia. It reflects glomerular endothelial damage leading to leakage of protein into the urine. When combined with hypertension after 20 weeks gestation, this finding strongly supports the diagnosis of preeclampsia.
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