0449: 19-year-old male presents with right-sided testicular pain that has worsened in intensity. The client states that he was sleeping and was awakened with sharp, right-sided abdominal and testicular pain that he describes as 'unbearable and sharp.' He reports the pain as 7/10 on the numerical pain scale. The onset of these symptoms was three hours prior to arrival. He reports that he has never experienced anything like this before. The client denies any trauma to the testicles. On assessment, the client is alert and completely oriented. He is in moderate distress and reports nausea and one episode of emesis prior to arrival. Lung sounds are clear bilaterally. S1/S2 heart tones auscultated. Normoactive bowel sounds, pain in the right lower quadrant with palpation. Peripheral pulses 2+. No peripheral edema. Skin is warm, and the color is normal for ethnicity. Denies dysuria, hematuria, or discharge. Right testicular swelling was noted on visual exam. The testicle was hard and tender with palpation. The client reports being sexually active with multiple partners and has not been recently tested for sexually transmitted infections. The client has no reported medical history besides being treated for multiple sexually transmitted infections, including syphilis, chlamydia, and gonorrhea. The client takes no daily medications. Vital signs: T 99° F (37° C), P 99, RR 19, BP 142/76, pulse oximetry reading 95% on room air.