Chapter 24: Male Genitourinary System

Which of these statements is most appropriate when the nurse is obtaining a genitourinary history from an elderly man? A) "Do you need to get up at night to urinate?" B) "Do you experience nocturnal emissions, or 'wet dreams'?" C) "Do you know how to perform a testicular self-examination?" D) "Has anyone ever touched your genitals when you did not want them to?"

ANS: A - "Do you need to get up at night to urinate?" The elderly male patient should be asked about the presence of nocturia. This may be due to diuretic medication, fluid retention from mild heart failure or varicose veins, or fluid ingestion 3 hours before bedtime, especially coffee and alcohol. The other questions are more appropriate for younger males.

The nurse is inspecting the scrotum and testes of a 43-year-old man. Which finding would require additional follow-up and evaluation? A) The skin on the scrotum is taut. B) The left testicle hangs lower than the right testicle. C) The scrotal skin has yellowish 1-cm nodules that are firm and nontender. D) The testes move closer to the body in response to cold temperatures.

ANS: A - The skin on the scrotum is taut. Scrotal swelling may cause the skin to be taut and to display pitting edema. Normal scrotal skin is rugae, and asymmetry is normal with the left scrotal half usually lower than the right. The testes may move closer to the body in response to cold temperatures.

When performing a genitourinary assessment, the nurse notices that the urethral meatus is positioned ventrally. This finding is: A) called hypospadias. B) the result of phimosis. C) probably due to a stricture. D) often associated with aging.

ANS: A - called hypospadias. Normally the urethral meatus is positioned just about centrally. Hypospadias is the ventral location of the urethral meatus. The position of the meatus does not change with aging. Phimosis is the inability to retract the foreskin. A stricture is a narrow opening of the meatus.

A newborn baby boy is about to have a circumcision. The nurse knows that indications for circumcision include: A) cultural and religious beliefs. B) prevention of testicular cancer. C) improving the sperm count later in life. D) preventing dysuria

ANS: A - cultural and religious beliefs. Indications for circumcision include cultural and religious beliefs, prevention of phimosis and inflammation of the glans penis and foreskin, decreasing the incidence of cancer of the penis, and decreasing the incidence of urinary tract infections in infancy.

A 59-year-old patient has been diagnosed with prostatitis and is being seen at the clinic for complaints of burning and pain during urination. He is experiencing: A) dysuria. B) nocturia. C) polyuria. D) hematuria.

ANS: A - dysuria. Dysuria or burning with urination is common with acute cystitis, prostatitis, and urethritis. Nocturia is voiding during the night. Polyuria is voiding in excessive quantities. Hematuria is voiding with blood in the urine

During a physical examination, the nurse finds that a male patient's foreskin is fixed and tight and will not retract over the glans. The nurse recognizes that this condition is: A) phimosis. B) epispadias. C) urethral stricture. D) Peyronie's disease.

ANS: A - phimosis. With phimosis, the foreskin is nonretractable, forming a pointy tip of the penis with a tiny orifice at the end of the glans. The foreskin is advanced and so tight that it is impossible to retract over the glans. This may be congenital or acquired from adhesions related to infection. See Table 24-3 for information on urethral stricture. See Table 24-4 for information on epispadias and Peyronie's disease.

An older man is concerned about his sexual performance. The nurse knows that in the absence of disease, a withdrawal from sexual activity later in life may be due to: A) side effects of medications. B) decreased libido with aging. C) decreased sperm production. D) decreased pleasure from sexual intercourse.

ANS: A - side effects of medications. In the absence of disease, a withdrawal from sexual activity may be due to side effects of medications such as antihypertensives, antidepressants, or sedatives. The other options are not correct.

A male patient with possible fertility problems asks the nurse where sperm is produced. The nurse knows that sperm production occurs in the: A) testes. B) prostate. C) epididymis. D) vas deferens.

ANS: A - testes. Sperm production occurs in the testes, not in the other structures listed.

A 16-year-old boy is brought to the clinic for a problem that he refused to let his mother see. The nurse examines him, and finds that he has scrotal swelling on the left side. He had the mumps the previous week, and the nurse suspects that he has orchitis. Which of the assessment findings below support this diagnosis? Select all that apply. A) Swollen testis B) Mass does transilluminate C) Mass does not transilluminate D) Nontender upon palpation E) Tender upon palpation F) Scrotal skin is reddened

ANS: A, C, E, F - Swollen testis - Mass does not transilluminate -Tender upon palpation - Scrotal skin is reddened With orchitis, the testis is swollen, with a feeling of weight, and is tender or painful. The mass does not transilluminate, and the scrotal skin is reddened. Transillumination of a mass occurs with a hydrocele, not orchitis.

A 55-year-old man is in the clinic for a yearly check-up. He is worried because his father died of prostate cancer. The nurse knows that which tests should be done at this time? Select all that apply. A) Blood test for prostate-specific antigen B) Urinalysis C) Transrectal ultrasound D) Digital rectal examination E) Prostate biopsy

ANS: A, D - Blood test for prostate-specific antigen - Digital rectal examination Prostate cancer is typically detected by testing the blood for prostate-specific antigen (PSA) or by a digital rectal exam (DRE). It is recommended that both PSA and DRE be offered to men yearly, beginning at age 50 years. If the PSA is elevated, then further lab work or a transrectal ultrasound (TRUS) and biopsy may be recommended.

The nurse is describing how to perform a testicular self-examination to a patient. Which of these statements is most appropriate? A) "A good time to examine your testicles is just before you take a shower." B) "If you notice an enlarged testicle or a painless lump, call your health care provider." C) "The testicle is egg shaped and movable. It feels firm and has a lumpy consistency." D) "Perform a testicular exam at least once a week to detect the early stages of testicular cancer."

ANS: B - "If you notice an enlarged testicle or a painless lump, call your health care provider." If the patient notices a firm painless lump, a hard area, or an overall enlarged testicle, he should call his health care provider for further evaluation. The testicle normally feels rubbery with a smooth surface. A good time to examine the testicles is during the shower or bath, when one's hands are warm and soapy, and the scrotum is warm. It should be performed once a month.

The mother of a 10-year-old boy asks the nurse to discuss the recognition of puberty. The nurse should reply by saying: A) "Puberty usually begins about age fifteen." B) "The first sign of puberty is enlargement of the testes." C) "Penis size does not increase until about the age of sixteen." D) "The development of pubic hair precedes testicular or penis enlargement."

ANS: B - "The first sign of puberty is enlargement of the testes." Puberty begins sometime between ages 9 1/2 and 13 1/2 years. The first sign is enlargement of the testes. Next, pubic hair appears and then penis size increases.

A 55-year-old man is experiencing severe pain of sudden onset in the scrotal area. It is somewhat relieved by elevation. On examination the nurse notices an enlarged, red scrotum that is very tender to palpation. It is difficult to distinguish the epididymis from the testis, and the scrotal skin is thick and edematous. This description is consistent with which of these? A) Varicocele B) Epididymitis C) Spermatocele D) Testicular torsion

ANS: B - Epididymitis Epididymitis presents as severe pain of sudden onset in the scrotum that is somewhat relieved by elevation. On examination, the scrotum is enlarged, reddened, and exquisitely tender. The epididymis is enlarged and indurated and may be hard to distinguish from the testis. The overlying scrotal skin may be thick and edematous. See Table 24-6 for more information and for descriptions of the other terms

The external male genital structures include the: A) testis. B) scrotum. C) epididymis. D) vas deferens.

ANS: B - Scrotum The external male genital structures include the penis and scrotum. The testis, epididymis, and vas deferens are internal structures.

During an examination of an aging male, the nurse recognizes that normal changes to expect would be: A) a change in scrotal color. B) a decrease in the size of the penis. C) enlargement of the testes and scrotum. D) an increase in the number of rugae over the scrotal sac.

ANS: B - a decrease in the size of the penis. When assessing the genitals of an older man, the nurse may notice thinner, graying pubic hair and a decrease in the size of the penis. The size of the testes may be decreased, they may feel less firm, and the scrotal sac is pendulous with less rugae. There is no change in scrotal color.

When performing a genital examination on a 25-year-old man, the nurse notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information the nurse would: A) squeeze the glans to check for the presence of discharge. B) consider this a normal finding and proceed with the examination. C) assess the testicles for the presence of masses or painless lumps. D) obtain a more detailed history focusing on any scrotal abnormalities the patient has noticed.

ANS: B - consider this a normal finding and proceed with the examination. After adolescence, the scrotal skin is deeply pigmented and has large sebaceous follicles. The scrotal skin looks corrugated.

When assessing the scrotum of a male patient, the nurse notices the presence of multiple firm, nontender, yellow 1-cm nodules. The nurse knows that these nodules are most likely: A) from urethritis. B) sebaceous cysts. C) subcutaneous plaques. D) from inflammation of the epididymis.

ANS: B - sebaceous cysts. Sebaceous cysts are commonly found on the scrotum. These are yellowish 1-cm nodules and are firm, nontender, and often multiple. The other options are not correct.

When performing a scrotal assessment, the nurse notices that the scrotal contents transilluminate and show a red glow. On the basis of this finding the nurse would: A) assess the patient for the presence of a hernia. B) suspect the presence of serous fluid in the scrotum. C) consider this normal and proceed with the examination. D) refer the patient for evaluation of a mass in the scrotum.

ANS: B - suspect the presence of serous fluid in the scrotum. Normal scrotal contents do not transilluminate. Serous fluid does transilluminate and s

A 2-month-old uncircumcised infant has been brought to the clinic for a well-baby checkup. How would the nurse proceed with the genital examination? A) Elicit the cremasteric reflex. B) Assess the glans for redness or lesions. C) Avoid retracting the foreskin until the infant is 3 months old. D) Note any dirt or smegma that has collected under the foreskin.

ANS: C - Avoid retracting the foreskin until the infant is 3 months old. If uncircumcised, then the foreskin is normally tight during the first 3 months and should not be retracted because of the risk of tearing the membrane attaching the foreskin to the shaft. The other options are not correct.

The nurse is aware that which of these statements is true regarding the incidence of testicular cancer? A) Testicular cancer is the most common cancer in men aged 30 to 50 years. B) The early symptoms of testicular cancer are pain and induration. C) Men with a history of cryptorchidism are at greatest risk for development of testicular cancer. D) The cure rate for testicular cancer is low.

ANS: C - Men with a history of cryptorchidism are at greatest risk for development of testicular cancer. Men with undescended testicles (cryptorchidism) are at greatest risk for development of testicular cancer. The overall incidence of testicular cancer is rare. Testicular cancer has no early symptoms. When detected early and treated before metastasis, the cure rate is almost 100%.

An accessory glandular structure for the male genital organs is the: A) testis. B) penis. C) prostate. D) vas deferens.

ANS: C - Prostate Glandular structures accessory to the male genital organs are the prostate, seminal vesicles, and bulbourethral glands.

When the nurse is performing a testicular examination on a 25-year-old man, which of these findings is considered normal? A) Nontender subcutaneous plaques B) A scrotal area that is dry, scaly, and nodular C) Testes that feel oval and movable and are slightly sensitive to compression D) A single, hard, circumscribed, movable mass, less than 1 cm under the surface of the testes

ANS: C - Testes that feel oval and movable and are slightly sensitive to compression Testes normally feel oval, firm and rubbery, smooth, and equal bilaterally and are freely movable and slightly tender to moderate pressure. The scrotal skin should not be dry, scaly, or nodular or contain subcutaneous plaques. Any mass would be an abnormal finding.

During an examination, the nurse notices that a male patient has a red, round, superficial ulcer with a yellowish serous discharge on his penis. On palpation, the nurse finds a nontender base that feels like a small button between the thumb and fingers. At this point the nurse suspects that this patient has: A) genital warts. B) a herpes infection. C) a syphilitic chancre. D) a carcinoma lesion.

ANS: C - a syphilitic chancre. This lesion indicates syphilitic chancre, which begins within 2 to 4 weeks of infection. See Table 24-4 for descriptions of the other options.

A 2-year-old boy has been diagnosed with "physiologic cryptorchidism." Given this diagnosis, during assessment the nurse will most likely observe: A) testes that are hard and painful to palpation. B) an atrophic scrotum and absence of the testis bilaterally. C) an absence of the testis in the scrotum, but the testis can be milked down. D) testes that migrate into the abdomen when the child squats or sits cross-legged.

ANS: C - an absence of the testis in the scrotum, but the testis can be milked down. Migratory testes (physiologic cryptorchidism) are common because of the strength of the cremasteric reflex and the small mass of the prepubertal testes. The affected side has a normally developed scrotum and the testis can be milked down. The other responses are not correct.

During an examination of an aging male, the nurse recognizes that normal changes to expect would be: A) enlarged scrotal sac. B) increased pubic hair. C) decreased penis size. D) increased rugae over the scrotum.

ANS: C - decreased penis size. In the aging male the amount of pubic hair decreases, the penis size decreases, and there is a decrease in the rugae over the scrotal sac. The scrotal sac does not enlarge.

The nurse is performing a genitourinary assessment on a 50-year-old obese male laborer. On examination the nurse notices a painless round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. These findings are most consistent with a(n) _____ hernia. A) scrotal B) femoral C) direct inguinal D) indirect inguinal

ANS: C - direct inguinal Direct inguinal hernias occur most often in men over the age of 40 years. It is an acquired weakness brought on by heavy lifting, obesity, chronic cough, or ascites. The direct inguinal hernia is usually a painless, round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. See Table 24-6 for a description of scrotal hernia. See Table 24-7 for descriptions of femoral hernias and indirect inguinal hernias.

During a genital examination, the nurse notices that a male patient has clusters of small vesicles on the glans, surrounded by erythema. The nurse recognizes that these lesions are: A) Peyronie disease. B) genital warts. C) genital herpes. D) syphilitic cancer.

ANS: C - genital herpes. Genital herpes, or HSV-2, infections are indicated with clusters of small vesicles with surrounding erythema, which are often painful and erupt on the glans or foreskin. See Table 24-4 for descriptions of the other options.

A 45-year-old mother of two children is seen at the clinic for complaints of "losing my urine when I sneeze." The nurse documents that she is experiencing: A) urinary frequency. B) enuresis. C) stress incontinence. D) urge incontinence.

ANS: C - stress incontinence. Stress incontinence is involuntary urine loss with physical strain, sneezing, or coughing that occurs due to weakness of the pelvic floor. Urinary frequency is urinating more times than usual (more than 5 to 6 times per day). Enuresis is involuntary passage of urine at night after age 5 to 6 years (bed wetting). Urge incontinence is involuntary urine loss from overactive detrusor muscle in the bladder. It contracts, causing an urgent need to void.

When the nurse is conducting sexual history from a male adolescent, which statement would be most appropriate to use at the beginning of the interview? A) "Do you use condoms?" B) "You don't masturbate, do you?" C) "Have you had sex in the last 6 months?" D) "Often boys your age have questions about sexual activity."

ANS: D - "Often boys your age have questions about sexual activity." Start the interview with a permission statement. This conveys that it is normal and all right to think or feel a certain way. Avoid sounding judgmental.

When the nurse is performing a genital examination on a male patient, which of these actions is correct? A) Auscultate for the presence of a bruit over the scrotum. B) Palpate for the vertical chain of lymph nodes along the groin inferior to the inguinal ligament. C) Palpate the inguinal canal only if there is a bulge present in the inguinal region during inspection. D) Have the patient shift his weight onto the left (unexamined) leg when palpating for a hernia on the right side.

ANS: D - Have the patient shift his weight onto the left (unexamined) leg when palpating for a hernia on the right side. When palpating for the presence of a hernia on the right side, ask the male patient to shift his weight onto the left (unexamined) leg. It is not appropriate to auscultate for a bruit over the scrotum. When palpating for lymph notes, palpate the horizontal chain. The inguinal canal should be palpated whether or not a bulge is present.

The nurse is examining the glans and knows that which of these is a normal finding for this area? A) The meatus may have a slight discharge when the glans is compressed. B) Hair is without pest inhabitants. C) The skin is wrinkled and without lesions. D) Smegma may be present under the foreskin of an uncircumcised male.

ANS: D - Smegma may be present under the foreskin of an uncircumcised male. The glans looks smooth and without lesions and does not have hair. The meatus should not have any discharge when the glans is compressed. Some cheesy smegma may have collected under the foreskin of an uncircumcised male.

Which of these statements is true regarding the penis? A) The urethral meatus is located on the ventral side of the penis. B) The prepuce is the fold of foreskin covering the shaft of the penis. C) The penis is composed of two cylindrical columns of erectile tissue. D) The corpus spongiosum expands into a cone of erectile tissue called the glans.

ANS: D - The corpus spongiosum expands into a cone of erectile tissue called the glans. At the distal end of the shaft, the corpus spongiosum expands into a cone of erectile tissue, the glans. The penis is composed of three cylindrical columns of erectile tissue. The prepuce is skin that covers the glans of the penis. The urethral meatus forms at the tip of the glans.

Which of these statements about the testes is true? A) The lymphatics of the testes drain into the abdominal lymph nodes. B) The vas deferens is located along the inferior portion of each testis. C) The right testis is lower than the left because the right spermatic cord is longer. D) The cremaster muscle contracts in response to cold and draws the testicles closer to the body.

ANS: D - The cremaster muscle contracts in response to cold and draws the testicles closer to the body. When it is cold, the cremaster muscle contracts, which raises the scrotal sac and brings the testes closer to the body to absorb heat necessary for sperm viability. The lymphatics of the testes drain into the inguinal lymph nodes. The vas deferens is located along the upper portion of each testis. The left testis is lower than the right because the left spermatic cord is longer.

The nurse is performing a genital examination on a male patient and notices urethral drainage. When collecting urethral discharge for microscopic examination and culture, the nurse should: A) ask the patient to urinate into a sterile cup. B) ask the patient to obtain a specimen of semen. C) insert a cotton-tipped applicator into the urethra. D) compress the glans between the examiner's thumb and forefinger and collect any discharge.

ANS: D - compress the glans between the examiner's thumb and forefinger and collect any discharge. If urethral discharge is noticed, then the examiner should collect a smear for microscopic examination and culture by compressing the glans anteroposteriorly between the thumb and forefinger. The other options are not correct actions

A 62-year-old man states that his doctor told him that he has an "inguinal hernia." He asks the nurse to explain what a hernia is. The nurse should: A) tell him not to worry and that most men his age develop hernias. B) explain that a hernia is often the result of prenatal growth abnormalities. C) refer him to his physician for additional consultation because the physician made the initial diagnosis. D) explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles.

ANS: D - explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles. A hernia is a loop of bowel protruding through a weak spot in the musculature. The other options are not correct responses to the patient's question.

When performing a genital assessment on a middle-aged man, the nurse notices multiple soft, moist, painless papules in the shape of cauliflower-like patches scattered across the shaft of the penis. These lesions are characteristic of: A) carcinoma. B) syphilitic chancres. C) genital herpes. D) genital warts.

ANS: D - genital warts. The lesions of genital warts are soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch. They occur on the shaft of the penis, behind the corona, or around the anus, where they may grow into large grape-like clusters. See Table 24-4 for more information and for descriptions of the other options.

During a health history, a patient tells the nurse that he has trouble in starting his urine stream. This problem is known as: A) urgency. B) dribbling. C) frequency. D) hesitancy.

ANS: D - hesitancy. Hesitancy is trouble in starting the urine stream. Urgency is the feeling that one cannot wait to urinate. Dribbling is the lost of urine before or after the main act of urination. Frequency is urinating more often than usual.

When performing a genitourinary assessment on a 16-year-old boy, the nurse notices a swelling in the scrotum that increases with increased intra-abdominal pressure and decreases when he is lying down. The patient complains of pain when straining. The nurse knows that this description is most consistent with a(n) _____ hernia. A) femoral B) incisional C) direct inguinal D) indirect inguinal

ANS: D - indirect inguinal With indirect inguinal hernias there is pain with straining and a soft swelling that increases with increased intra-abdominal pressure, which may decrease when the patient lies down. These findings do not describe the other hernias. See Table 24-7 for descriptions of femoral and direct inguinal hernias

The nurse is providing patient teaching about an erectile dysfunction drug. One of the drug's potential side effects is prolonged, painful erection of the penis without sexual stimulation, which is known as: A) orchitis. B) stricture. C) phimosis. D) priapism.

ANS: D - priapism. Priapism is prolonged, painful erection of the penis without sexual desire. Orchitis is inflammation of the testes. Stricture is a narrowing of the opening of the urethral meatus. Phimosis is the inability to retract the foreskin

When the nurse is performing a genital examination on a male patient, the patient has an erection. The nurse's most appropriate action or response is to: A) ask the patient if he would like someone else to examine him. B) continue with the examination as though nothing has happened. C) stop the examination, leave the room while stating that the examination will resume at a later time. D) reassure the patient that this is a normal response and continue with the examination.

ANS: D - reassure the patient that this is a normal response and continue with the examination. When the male patient has an erection, the nurse should reassure the patient that this is a normal physiologic response to touch and proceed with the rest of the examination. The other responses are not correct and may be perceived as judgmental.

The nurse knows that a common assessment finding in a boy younger than 2 years old is: A) an inflamed and tender spermatic cord. B) the presence of a hernia in the scrotum. C) a penis that looks large in relation to the scrotum. D) the presence of a hydrocele, or fluid in the scrotum.

ANS: D - the presence of a hydrocele, or fluid in the scrotum. A common scrotal finding in boys younger than 2 years of age is a hydrocele, or fluid in the scrotum. The other options are not correct.

A 15-year-old boy is seen in the clinic for complaints of "dull pain and pulling" in the scrotal area. On examination the nurse palpates a soft, irregular mass posterior to and above the testis on the left. This mass collapses when the patient is supine and refills when he is upright. This description is consistent with: A) epididymitis. B) spermatocele. C) testicular torsion. D) varicocele.

ANS: D - varicocele. A varicocele consists of dilated, tortuous varicose veins in the spermatic cord caused by incompetent valves within the vein. Symptoms include dull pain or constant pulling or dragging feeling, or the individual may be asymptomatic. When palpating the mass, the examiner will feel a soft, irregular mass posterior to and above the testis that collapses when the individual is supine and refills when the individual is upright. See Table 24-6 for more information and for descriptions of the other options.