ch.23 MALE REPRODUCTIVE
The mother of a toddler expresses concern over her son "constantly playing with his penis and scrotum." Which response by the nurse is the most appropriate in this situation? 1. "These practices are normal for a child of this age." 2. "Does she see his father doing the same actions?" 3. "Does he know what it means to be a boy or a girl?" 4. "These behaviors will go away as he gets older."
Correct Answer: 1 Rationale 1: Children often display curiosity with their genitals throughout all age spans. Parents should be reassured that this is normal behavior and part of the child's growth and development. Rationale 2: The behaviors being displayed are normal for the age and are not a reflection of practices noticed by male role models. Rationale 3: The behaviors being displayed are normal for this age and do not reflect any sense of confusion concerning sexual identity. Rationale 4: Children often display curiosity with their genitals throughout all age spans. Parents should be reassured that this is normal behavior and part of the child's growth and development.
The nurse is assessing a male infant and notes cryptorchidism. The mother asks what effect this will have on the child. Which response by the nurse is the most appropriate? 1. "There is an increased risk for testicular cancer." 2. "He will be unable to father children." 3. "He will do fine and have no problems." 4. "There will be an abnormal level of sperm production."
Correct Answer: 1 Rationale 1: Cryptorchidism is a condition where a testicle is undescended. The client will be at an increased risk for testicular cancer. Rationale 2: Cryptorchidism does not affect the ability to produce sperm. Rationale 3: Cryptorchidism increases the risk for testicular cancer. Telling the mother that the infant will do fine and have no problems is too broad and a potentially misleading statement. Rationale 4: Cryptorchidism does not affect the ability to produce sperm.
During the examination of an older adult male client the nurse notes thin, gray pubic hairs and a scrotal sac that hangs significantly lower than the penis. Which action by the nurse is the most appropriate? 1. Document the findings as normal. 2. Inform the client that he is no longer fertile. 3. Notify the healthcare provider of the findings. 4. Ask the client about his sexual practices.
Correct Answer: 1 Rationale 1: The older adult male begins to demonstrate thinning and graying of the pubic hair. The penis and testicles begin to diminish in size and the scrotum hangs lower. Rationale 2: Sperm production in the middle aged and older man is reduced but there is still adequate sperm production to father children. Rationale 3: The findings are normal and do now warrant notification of the healthcare provider. Rationale 4: The sexual practices of the client are not impacted by the findings. Inquiry into them is not indicated at this time.
During the well-child assessment on a toddler-age male client, the nurse notes that the testes are not descended. Based on this data, which action by the nurse is the most appropriate? 1. Report the finding to the healthcare provider. 2. Ask the parent if the child has had any surgeries. 3. Proceed with palpation of the scrotum. 4. Inquire about the child's voiding patterns.
Correct Answer: 1 Rationale 1: Undescended testes, called cryptorchidism, is a common finding, especially if the infant is preterm. The testes should descend spontaneously within the first year of life. If both testes do not descend, the male will be infertile and will be at a greater risk for the development of testicular cancer. Rationale 2: The presence of surgical histories will not influence the condition or the actions that must be taken next. Rationale 3: Palpation of scrotum will not promote the testicles to descend. The healthcare provider must be notified. Rationale 4: Voiding patterns are not related to the occurrence of cryptorchidism.
The nurse is preparing to examine the reproductive system for a male client recently admitted to the medical unit. Which techniques does the nurse plan to incorporate into this physical assessment? Standard Text: Select all that apply. 1. Inspection. 2. Palpation. 3. Percussion. 4. Auscultation. 5. Aspiration.
Correct Answer: 1, 2 Rationale 1: The physical assessment techniques of inspection and palpation are used in the examination of the male reproductive system. Rationale 2: The physical assessment techniques of inspection and palpation are used in the examination of the male reproductive system. Rationale 3: The physical assessment techniques of inspection and palpation are used in the examination of the male reproductive system. Percussion is most often used to assess the gastrointestinal system and the respiratory system. Rationale 4: The physical assessment techniques of inspection and palpation are used in the examination of the male reproductive system. Auscultation is used to assess the gastrointestinal, cardiovascular, and respiratory systems. Rationale 5: The physical assessment techniques of inspection and palpation are used in the examination of the male reproductive system. Aspiration may be used to obtain a specimen.
The nurse is preparing to examine a male client's reproductive organs. Which actions by the nurse are appropriate to prepare for this examination? Standard Text: Select all that apply. 1. Secure a private examination room. 2. Use clean hands for the examination. 3. Ask the client to lie down on the exam table. 4. Ask the client to empty his bladder. 5. Make sure the room's temperature is comfortable.
Correct Answer: 1, 2, 4, 5 Rationale 1: A private room is indicated to perform a physical examination. Rationale 2: The examiner must have clean hands to perform the exam. This will reduce the transmission of infections. Rationale 3: The examination may be performed with the client sitting or standing. The client does not need to lie flat. Rationale 4: Emptying the bladder will reduce discomfort during palpation portions of the exam. In addition, a full bladder may impede the examination. Rationale 5: The examination room must be comfortable for the client.
The nurse is interviewing a male client with an elevated prostate specific antigen level (PSA). In order to determine other risk factors for this client, which questions are appropriate for the nurse to include in the assessment process? Standard Text: Select all that apply. 1. "Do you have a positive family history for prostate cancer?" 2. "Do you masturbate?" 3. "How frequently do you have sexual intercourse?" 4. "Do you smoke?" 5. "Do you have a history of urinary tract infections?"
Correct Answer: 1, 4 Rationale 1: Family history is a significant risk factor for the development of prostate cancer. Rationale 2: Masturbation is not considered a risk factor for the development of prostate cancer. Rationale 3: The frequency of sexual intercourse does not have a bearing on the occurrence of prostate cancer. Rationale 4: Smoking has been linked to the development of prostate cancer. Rationale 5: Urinary tract infections are not linked to the incidence of prostate cancer.
The nurse is examining a male adolescent with suspected spermatic cord torsion. Which is the priority intervention for this client? 1. Medicate for pain with narcotics. 2. Prepare for surgery. 3. Elevate the scrotum. 4. Administer anti-inflammatory medications
Correct Answer: 2 Rationale 1: Medication for pain with narcotics may be ordered by the healthcare provider. It does not, however, present a higher priority than preparing the client for surgery. Rationale 2: Torsion of the spermatic cord requires immediate surgical intervention, making this the priority for the nurse in this situation. Rationale 3: The scrotum may be elevated after the procedure but elevation is not a priority in the preoperative period. Rationale 4: The administration of anti-inflammatory medications is not indicated for this client.
The nurse is interviewing a male client who states "I feel like I have a bag of worms in my scrotum." Based on this data, which condition does the nurse suspect? 1. Orchitis. 2. Varicocele. 3. Epididymitis. 4. Inguinal Hernia.
Correct Answer: 2 Rationale 1: Orchitis refers to a swelling and inflammation of the testicles. Rationale 2: A varicocele is a distention of the spermatic cord and may be described as a "bag of worms." Rationale 3: Epididymitis is an inflammatory condition of the epididymis. Rationale 4: An inguinal hernia feels like a bulge or mass upon palpation of the inguinal canal, which indicates a protrusion of the intestine into the groin region.
An older adult client reports to the ambulatory care clinic for a routine physical examination. During the assessment the client reports plans to marry a much younger woman in the coming weeks. The client voices concerns about his ability to father children. Which information will the nurse provide to the client? 1. The client is facing infertility in the next few years, as the majority of older men become infertile by age 70 years. 2. Although the production of sperm may be reduced in the older male, fathering a child is still possible with advancing age. 3. There are no changes to fertility of a man associated with aging. 4. Limited studies concerning the fertility of men are available and there is no definitive information available.
Correct Answer: 2 Rationale 1: Sperm production begins to decline with middle age but the male is still able to produce adequate quantities of viable sperm to father children. A man of age 70 is able to father children. Rationale 2: Sperm production begins to decline with middle age but the male is still able to produce adequate quantities of viable sperm to father children. Rationale 3: Sperm production begins to decline with middle age but the male is still able to produce adequate quantities of viable sperm to father children. Rationale 4: There is adequate research available to prove the ability of older men to father children.
The nurse is assessing a male client who has epididymitis. Which statement by the nurse would provide appropriate education regarding this condition? 1. "You will have a decrease in testosterone production." 2. "Your sperm maturity may be affected." 3. "There will be a decrease in blood flow to your penis." 4. "There may be erectile difficulties."
Correct Answer: 2 Rationale 1: Testosterone is produced within the testes. Inflammation of the epididymis will not impact testosterone production. Rationale 2: The final storage area for sperm is the epididymis. Inflammation of this area may impact sperm maturity. Rationale 3: The epididymis does not impact blood flow to the penis. Rationale 4: The epididymis does not have a role in the achievement of an erection.
While performing prostate palpation, the nurse notes that the client expresses severe tenderness and discomfort during the procedure. Based on this data, which condition does the nurse suspect? 1. Prostate cancer. 2. Prostatitis. 3. Enlargement of the prostate. 4. Urinary tract infection.
Correct Answer: 2 Rationale 1: The presence of extreme hardness or nodules is characteristic of prostate cancer. Rationale 2: The prostate should feel smooth, firm, or rubbery, and extend no larger than one centimeter into the rectal area. This exam should not cause tenderness, which is an indication of inflammation. Rationale 3: Enlargement of the prostate will cause urinary tract symptoms such as difficulty in starting a stream, or dribbling of urine. Rationale 4: Urinary tract infections will cause painful and frequent urination.
The nurse has completed testicular self-exam teaching for a male client. Which client statements indicate appropriate understanding of the content presented? Standard Text: Select all that apply. 1. "I will feel hardened areas where the testicles and epididymis are located." 2. "I should perform this exam monthly." 3. "I should be in a warm room or the shower to perform this exam." 4. "I should apply gentle pressure to each testicle to feel the area." 5. "It is normal to feel testicular pain during this exam."
Correct Answer: 2, 3, 4 Rationale 1: The contour of the testicles should be firm and smooth. Rationale 2: The testicular self-examination should be performed monthly beginning in adolescence. Rationale 3: The most opportune time to perform the testicular self-examination is in the shower or bath. Heat and steam will warm the hands and will help their movement over the skin surface. Rationale 4: The correct technique utilizes a gentle pressure over the surface of the skin. Rationale 5: The client should not feel discomfort during the exam. If discomfort is experienced the client is pressing too hard during the exam.
The nurse is preparing a presentation on testicular cancer and wishes to target the age group most frequently affected. Which settings would provide the nurse with audiences at an increased risk for this disease process? Standard Text: Select all that apply. 1. Elementary schools. 2. Colleges. 3. Cub Scout groups. 4. High schools. 5. Senior assisted living facilities.
Correct Answer: 2, 4 Rationale 1: Children in elementary schools are too young to initiate the examination. Testicular cancer is the most common type of cancer in males between the ages of 20 and 34. It is recommended that testicular self-examinations be performed monthly beginning in adolescence and continue on through adulthood. Rationale 2: College-age males are in the target group and should be included. Testicular cancer is the most common type of cancer in males between the ages of 20 and 34. It is recommended that testicular self-examinations be performed monthly beginning in adolescence and continue on through adulthood. Rationale 3: Cub scouts is a service group consisting primarily of elementary school-aged children. This group is too young to be considered in the target group. Testicular cancer is the most common type of cancer in males between the ages of 20 and 34. It is recommended that testicular self-examinations be performed monthly beginning in adolescence and continue on through adulthood. Rationale 4: Testicular cancer is the most common type of cancer in males between the ages of 20 and 35. It is recommended that testicular self-examinations be performed monthly beginning in adolescence and continue on through adulthood. Testicular cancer is the most common type of cancer in males between the ages of 20 and 34. It is recommended that testicular self-examinations be performed monthly beginning in adolescence and continue on through adulthood. Rationale 5: Testicular cancer is the most common type of cancer in males between the ages of 20 and 34. It is recommended that testicular self-examinations be performed monthly beginning in adolescence and continue on through adulthood.
A couple is seeking infertility information from the nurse. Which statement made by the couple would indicate the need for intervention by the nurse? 1. "We have been to two doctors already." 2. "We have intercourse at least three times a week." 3. "We are using temperature tracking for ovulation prediction." 4. "We have been trying to conceive for a year."
Correct Answer: 4 Rationale 1: The number of healthcare providers being seen by the family is not relevant to the nurse's immediate actions. Rationale 2: The couple is engaging in sexual intercourse. This indicates a lack of intercourse should not be of issue. Rationale 3: The use of the basal body temperature to assess for ovulation is recommended as an initial step in attempting to conceive. Rationale 4: Couples are not considered for infertility treatment until they have tried to conceive for at least one year.
The nurse is conducting a health interview for a 55-year-old client who presents to the clinic for an annual physical examination. The client questions the need to begin screening for prostate cancer at this examination. Which response by the nurse is the most appropriate? 1. "Unless you are at an increased risk for the development of prostate cancer no additional screening indicated." 2. "PSA screening tests should be performed once you reach age 75." 3. "You need to begin having an annual prostate examination." 4. "A cystoscopy should be performed annually to assess for prostate changes at age 55."
Correct Answer: 3 Rationale 1: Annual prostate screening is recommended to begin at age 50 years. Rationale 2: PSA screening tests are not recommended for men over age 75 years. Rationale 3: Annual prostate screening is recommended to begin at age 50 years. Rationale 4: The cystoscopy is a diagnostic test that is used to assess the inside of the bladder. It is not used to assess for the presence of prostate cancer.
The nurse is examining a male client's genitalia and notes the scrotum is asymmetric. The left side hangs lower than the right side. Based on this data, which action by the nurse is the most appropriate? 1. Reassess after increasing the temperature in the room. 2. Report the finding to the healthcare provider. 3. Consider this a normal finding and proceed with palpation of the scrotum. 4. Ask if the client if has noticed this before.
Correct Answer: 3 Rationale 1: Elevation in temperatures will facilitate the scrotum's dropping away from the body. It will not correct symmetry issues. Rationale 2: The complete assessment findings will need to be shared with the healthcare provider but the nurse will need to have completed the assessment first to be able to provide adequate information. Rationale 3: This is a normal finding, but palpation of the scrotum is indicated to aid in determining any related abnormalities. Rationale 4: Asking the client for additional subjective information is not the priority action at this time.
A couple seeking infertility treatments has just received the results of a semen analysis, which shows a diminished sperm count. Which question is most appropriate for the nurse to address to the male partner at this time? 1. "How often do you masturbate?" 2. "Do you smoke?" 3. "How old is your present house?" 4. "Do you still want to have children?"
Correct Answer: 3 Rationale 1: Masturbation does not influence sperm count and the ability to father children. Rationale 2: Tobacco use does not impact sperm count and the ability to father children. Rationale 3: The age of the home may be influencing the sperm count. Lead paint may be present in older homes built before 1979. Lead exposure may result in reduced libido, diminished sperm count and abnormal sperm motility. Rationale 4: The responsibility of the nurse is to assess for related causes, not to assess the desire to father children.
During the focused interview, a male client describes his erection and ejaculate in terms that are less than professional. Which action by the nurse is the most appropriate? 1. Ask the client to refrain from using the terms. 2. Ask the client to define the terms. 3. Document the client's responses in the terms used. 4. Find another nurse to complete the assessment.
Correct Answer: 3 Rationale 1: Men may be embarrassed to discuss health problems or concerns involving their reproductive organs. During the interview use words that the man can understand, and do not be embarrassed or offended by the words he uses. Rationale 2: Asking the client to define terms may promote a sense of inferiority. Men may be embarrassed to discuss health problems or concerns involving their reproductive organs; it is important for the nurse to ask questions in a non-threatening, matter-of-fact manner. Rationale 3: The words and responses of the client will need to be documented. They provide the framework of the subjective data from the assessment. Rationale 4: Asking another nurse to complete the interview reduces the quality and continuity of care and is inappropriate.
During the examination of a male client's scrotum the nurse detects a hardened area in the right side of the scrotal sac. Which is the priority nursing action based on this finding? 1. Ask the client about voiding patterns. 2. Notify the healthcare provider of this finding. 3. Use a light to perform transillumination. 4. Ask the client about sexual practices.
Correct Answer: 3 Rationale 1: Voiding patterns are not related to the findings of the examination. Rationale 2: Abnormalities noted on the assessment will need to be reported to the healthcare provider, but first the nurse must obtain additional supporting information to include in the report. Rationale 3: Transillumination is indicated to obtain further information. Upon transillumination, light should shine through the scrotum with a red glow, with the testes showing up as oval structures. Abnormal areas, such as masses, will not show penetration of the light Rationale 4: The client's sexual practices do not have direct bearing on the findings.
When caring for a male client scheduled for a prostatectomy due to cancer, which data would the nurse expect for a client with this condition data? Standard Text: Select all that apply. 1. Enlargement of the scrotal sac. 2. Pyuria. 3. Increase in prostatic specific antigen (PSA). 4. Dribbling of urine. 5. Difficulty in initiating urine stream.
Correct Answer: 3, 4, 5 Rationale 1: The scrotal sac will not be enlarged with a diagnosis for prostate cancer. Scrotal sac enlargement may be noted in the presence of inflammation of the testicles or the epididymis. Rationale 2: Pyruia refers to pus in the urine. Pus in the urine is not consistent with the presence of prostate cancer. Rationale 3: Low levels of prostatic specific antigen are present in normal, healthy men. Laboratory values for the PSA will be elevated in the presence of prostate cancer. Rationale 4: The dribbling of urine may be seen with prostate cancer. Dribbling will occur in the presence of prostate enlargement. Rationale 5: Prostate enlargement as seen in malignant conditions may result in the client experiencing difficulty in initiating the urine stream.
An adult male presents to the urologist office with concerns relating to his fertility. Which data in the client's medical history warrants further investigation? 1. The client was treated for gonorrhea 2 years ago. 2. The client has a history of genital herpes simplex. 3. The client's medical history indicates a past history of marijuana use. 4. The client works in a paint manufacturing company.
Correct Answer: 4 Rationale 1: Gonorrhea in a male has not been linked to infertility. In addition, there are no factors provided to infer that damage has resulted from the disease. Rationale 2: Men with genital herpes simplex are not infertile. Rationale 3: A history of marijuana use is not associated with male-related infertility. Rationale 4: Chronic exposure to chemicals has been implicated in the development of male caused infertility.
During the examination of a male client, the nurse detects a bulge in the right inguinal area as the client is bearing down. Based on this data, which condition does the nurse suspect? 1. Varicocele. 2. Prostatitis. 3. Orchitis. 4. Inguinal Hernia.
Correct Answer: 4 Rationale 1: The varicocele is a distention of the spermatic cord. It feels most like a "bag of worms" rather than a mass. Rationale 2: Examination of the prostate gland is performed via the rectum, rather than the inguinal area. Rationale 3: Orchitis refers to an inflammation in the testicular region. This would present as a pain and swelling in the scrotal region. Rationale 4: An inguinal hernia feels like a bulge or mass upon palpation of the inguinal canal, which indicates a protrusion of the intestine into the groin region
During the examination of an adult male the nurse notes thick, curly hair over the pubis area, a pear-shaped scrotum, and slightly darkened skin on the penis. Based on this data, which action is appropriate? 1. Ask the client about recent illnesses. 2. Ask the client about sexual practices. 3. Notify the healthcare provider the findings. 4. Document the findings as normal
Correct Answer: 4 Rationale 1: There is no need to explore medical health history relating to this normal physical appearance. Rationale 2: The sexual practices of the client have no bearing on the normal findings. Rationale 3: The assessment findings are normal and do not warrant notification of the healthcare provider. Rationale 4: The findings are normal for a healthy adult male.
During the examination of a male client who has not been circumcised, the nurse attempts to retract the foreskin of the penis, but skin is very tight and cannot be pulled back. Based on this data, which condition does the nurse anticipate for this client? 1. Urethral stricture. 2. Paraphimosis. 3. Urethritis. 4. Phimosis.
Correct Answer: 4 Rationale 1: Urethral strictures would be suspected in the event of voiding problems or if a pinpoint size meatus opening was noted, not an inability to retract the foreskin over the glans penis. Rationale 2: Paraphimosis is a condition in which the foreskin cannot be moved back over the glans penis once it has been retracted. Rationale 3: Urethritis manifests with symptoms including redness and edema around the glans and foreskin, eversion of the urethral mucosa, and drainage. Rationale 4: Phimosis refers to a condition in which the foreskin cannot be moved back over the glans penis.
The parents of a school-age male client voice concerns about the seemingly advanced level of sexual maturity of their son. The examination reveals the child has thick pubic hair and enlarged genitalia. Based on this data, which intervention does the nurse anticipate for this client? 1. Administration of estrogen to reduce the impact of escalating testosterone levels. 2. Continued observation of the rate of maturation for the next 6 to 9 months. 3. Referral to an endocrinologist. 4. Reduction of processed foods in the diet to reduce hormone exposure.
Correct Answer: Referral to an endocrinologist Rationale 1: Estrogen is not administered to males to manage precocious puberty. A prompt diagnosis of the condition is warranted. Rationale 2: A prompt diagnosis of the condition is warranted. It would be inappropriate to continue observation for the next 6 to 9 months. Rationale 3: Precocious puberty may be idiopathic or caused by a genetic trait, lesions in the pituitary gland or hypothalamus, or testicular tumors. Referral to an endocrinologist may be required for definitive diagnosis. Rationale 4: While processed foods may contain excess hormones and chemicals the child in the scenario will need a prompt diagnosis of this condition.
