Chapter 59
A 35-year-old man is seen in the clinic because he is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem? A) Chronic bacterial prostatitis B) Orchitis C) Benign prostatic hyperplasia D) Urolithiasis
Ans: A Chronic bacterial prostatitis Feedback: Prostatitis is an inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. Symptoms are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge. Urinary incontinence and retention occur with benign prostatic hyperplasia or hypertrophy. The patient may experience nocturia, urgency, decrease in volume and force of urinary stream. Urolithiasis is characterized by excruciating pain. Orchitis does not cause urinary symptoms.
A 75-year-old male patient is being treated for phimosis. When planning this patient's care, what health promotion activity is most directly related to the etiology of the patient's health problem? A) Teaching the patient about safer sexual practices B) Teaching the patient about the importance of hygiene C) Teaching the patient about the safe use of PDE-5 inhibitors D) Teaching the patient to perform testicular self-examination
Ans: B Teaching the patient about the importance of hygiene Feedback: Poor hygiene often contributes to cases of phimosis. This health problem is unrelated to sexual practices, the use of PDE-5 inhibitors, or testicular self-examination.
A patient presents to the emergency department with paraphimosis. The physician is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, what is usually indicated? A) Needle aspiration of the corpus cavernosum B) Circumcision C) Abstinence from sexual activity for 6 weeks D) Administration of vardenafil
Ans: B Circumcision Feedback: Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated. Vardenafil is Levitra and would not be used for paraphimosis
A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply. A) Phimosis B) Priapism C) Herpes simplex infection D) Increasing age E) Lack of circumcision
Ans: A, D, E Feedback: Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV, smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two-thirds of cases occur in men older than 65 years of age), lichen sclerosus, and balanitis xerotica obliterans. Priapism and HSV are not known risk factors.
A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group? A) Native Americans B) Caucasian Americans C) African Americans D) Asian Americans
Ans: C African Americans Feedback: African American men have a high risk of prostate cancer; furthermore, they are more than twice as likely to die from prostate cancer as men of other racial or ethnic groups.
A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response? A) A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. B) HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant. C) Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer. D) Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.
Ans: A A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. Feedback: A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is associated with breast cancer.
A nurse is providing care for a patient who has recently been admitted to the postsurgical unit from PACU following a transuretheral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action? A) Closely monitoring the input and output of the bladder irrigation system B) Administering parenteral nutrition and fluids as ordered C) Monitoring the patient's level of consciousness and skin turgor D) Scanning the patient's bladder for retention every 2 hours
Ans: A Closely monitoring the input and output of the bladder irrigation system Feedback: Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.
A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens? A) Continuous inflow and outflow of irrigation solution B) Intermittent inflow and continuous outflow of irrigation solution C) Continuous inflow and intermittent outflow of irrigation solution D) Intermittent flow of irrigation solution and prevention of hemorrhage
Ans: A Continuous inflow and outflow of irrigation solution Feedback: For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.
To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what? A) Report the planned use of dietary supplements to the physician. B) Decrease the intake of fluids to prevent urinary retention. C) Abstain from sexual activity for 2 weeks following the initiation of treatment. D) Anticipate a temporary worsening of urinary retention before symptoms subside.
Ans: A Report the planned use of dietary supplements to the physician. Feedback: Some herbal supplements are contraindicated with Proscar, thus their planned use should be discussed with the physician or pharmacist. The patient should maintain normal fluid intake. There is no need to abstain from sexual activity and a worsening of urinary retention is not anticipated.
A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him emasculated and a shell of a man. The nurse should identify what nursing diagnosis when planning the patient's subsequent care? A) Disturbed Body Image Related to Effects of Surgery B) Spiritual Distress Related to Effects of Cancer Surgery C) Social Isolation Related to Effects of Surgery D) Risk for Loneliness Related to Change in Self-Concept
Ans: A Disturbed Body Image Related to Effects of Surgery Feedback: The patient's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This patient is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the patient's concerns.
A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B) Have a transrectal ultrasound every 5 years. C) Perform monthly testicular self-examinations, especially after age 60. D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.
Ans: A Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. Feedback: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.
A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional dribbling of urine. How should the nurse best respond to this patient's concern? A) Inform the patient that urinary control is likely to return gradually. B) Arrange for the patient to be assessed by his urologist. C) Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D) Teach the patient to perform intermittent self-catheterization.
Ans: A Inform the patient that urinary control is likely to return gradually. Feedback: It is important that the patient know that regaining urinary control is a gradual process; he may continue to dribble after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.
A patient has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following? A) Pelvic floor exercises B) Intermittent urinary catheterization C) Reduced physical activity D) Active range of motion exercises
Ans: A Pelvic floor exercises Feedback: Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.
A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time? A) Provide empathy and encouragement in an effort to foster a positive outlook. B) Tell the patient it is his decision whether to accept or reject chemotherapy. C) Report the patient's statement to members of his support system. D) Refer the patient to social work.
Ans: A Provide empathy and encouragement in an effort to foster a positive outlook. Feedback: Patients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the patient's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the patient's statement to members of his support system and there is no obvious need for a social work referral.
A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? A) Testicular cancer is a highly curable type of cancer. B) Testicular cancer is very difficult to diagnose. C) Testicular cancer is the number one cause of cancer deaths in males. D) Testicular cancer is more common in older men.
Ans: A Testicular cancer is a highly curable type of cancer. Feedback: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.
The nurse is leading a workshop on sexual health for men. The nurse should teach participants that organic causes of erectile dysfunction include what? Select all that apply. A) Diabetes B) Testosterone deficiency C) Anxiety D) Depression E) Parkinsonism
Ans: A, B, E Feedback: Organic causes of ED include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic renal failure, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to be psychogenic causes.
A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurse's response? A) Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B) All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C) Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D) Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.
Ans: B All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. Feedback: All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.
A physician explains to the patient that he has an inflammation of the Cowper glands. Where are the Cowper glands located? A) Within the epididymis B) Below the prostate, within the posterior aspect of the urethra C) On the inner epithelium lining the scrotum, lateral to the testes D) Medial to the vas deferens
Ans: B Below the prostate, within the posterior aspect of the urethra Feedback: Cowper glands lie below the prostate, within the posterior aspect of the urethra. This gland empties its secretions into the urethra during ejaculation, providing lubrication. The Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas deferens.
A patient has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action? A) Cleanse the skin surrounding the suprapubic tube. B) Inform the urologist of this finding. C) Remove the suprapubic tube and apply a wet-to-dry dressing. D) Administer antispasmodic drugs as ordered.
Ans: B Inform the urologist of this finding. Feedback: The physician should be informed if there is significant leakage around a suprapubic catheter. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.
A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history prior to instructing the patient on the use of this medication. What disorder will contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Retinopathy C) Hypotension D) Diabetic nephropathy
Ans: B Retinopathy Feedback: Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil (Cialis) and sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil (Viagra) are usually contraindicated with diabetic retinopathy.
A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication? A) Sexual stimulation is not needed to obtain an erection. B) The drug should be taken 1 hour prior to intercourse. C) Facial flushing or headache should be reported to the physician immediately. D) The drug has the potential to cause permanent visual changes
Ans: B The drug should be taken 1 hour prior to intercourse. Feedback: The patient must have sexual stimulation to create the erection, and the drug should be taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side effects of Viagra and do not normally warrant reporting to the physician. Some visual disturbances may occur, but these are transient.
A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the patient's history, what might the nurse note that contributes to erectile dysfunction? A) The patient has been treated for a UTI twice in the past year. B) The patient has a history of hypertension. C) The patient is 66 years old. D) The patient leads a sedentary lifestyle.
Ans: B The patient has a history of hypertension. Feedback: Past history of infection and lack of exercise do not contribute to impotence. With advancing age, sexual function and libido and potency decrease somewhat, but this is not the primary reason for impotence. Vascular problems cause about half the cases of impotence in men older than 50 years; hypertension is a major cause of such problems.
A 35-year-old father of three tells the nurse that he wants information on a vasectomy. What would the nurse tell him about ejaculate after a vasectomy? A) There will be no ejaculate after a vasectomy, though the patient's potential for orgasm is unaffected. B) There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. C) There is a marked decrease in the amount of ejaculate after vasectomy, though this does not affect sexual satisfaction. D) There is no change in the quantity of ejaculate after vasectomy, but the viscosity is somewhat increased.
Ans: B There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. Feedback: Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland, which are unaffected by vasectomy, thus no noticeable decrease in the amount of ejaculate occurs (volume decreases approximately 3%), even though it contains no spermatozoa. The viscosity of ejaculate does not change.
A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply. A) Abstaining from sexual intercourse for at least 14 days postprocedure B) Wearing a scrotal support garment C) Using sitz baths D) Applying a heating pad intermittently E) Staying on bed rest for 48 to 72 hours post-procedure
Ans: B, C Feedback: Applying ice bags intermittently to the scrotum for several hours after surgery can reduce swelling and relieve discomfort, and is preferable to the application of heat. The nurse advises the patient to wear snug, cotton underwear or a scrotal support for added comfort and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and sexual activity can usually be resumed in 1 week.
A nursing student is learning how to perform sexual assessments using the PLISSIT model. According to this model, the student should begin an assessment by doing which of the following? A) Briefly teaching the patient about normal sexual physiology B) Assuring the patient that what he says will be confidential C) Asking the patient if he is willing to discuss sexual functioning D) Ensuring patient privacy
Ans: C Asking the patient if he is willing to discuss sexual functioning Feedback: The PLISSIT (permission, limited information, specific suggestions, intensive therapy) model of sexual assessment and intervention may be used to provide a framework for nursing interventions. By beginning with the patient's permission, the nurse establishes a patient-centered focus.
A nurse is caring for a 33-year-old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in 5 years. During the examination, the physician finds that digital rectal examination (DRE) reveals stoney hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what? A) A normal finding B) A sign of early prostate cancer C) Evidence of a more advanced lesion D) Metastatic disease
Ans: C Evidence of a more advanced lesion Feedback: Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is stony hard and fixed. This finding is not suggestive of metastatic disease.
An adolescent is identified as having a collection of fluid in the tunica vaginalis of his testes. The nurse knows that this adolescent will receive what medical diagnosis? A) Cryptorchidism B) Orchitis C) Hydrocele D) Prostatism
Ans: C Hydrocele Feedback: A hydrocele refers to a collection of fluid in the tunica vaginalis of the testes. Cryptorchidism is the most common congenital defect in males, characterized by failure of one or both of the testes to descend into the scrotum. Orchitis is an inflammation of the testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical, or unknown factors. Prostatism is an obstructive and irritative symptom complex that includes increased frequency and hesitancy in starting urination, a decrease in the volume and force of the urinary stream, acute urinary retention, and recurrent urinary tract infections.
A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? A) Urinary tract infection B) Chronic pain C) Permanent vascular damage D) Future erectile dysfunction
Ans: C Permanent vascular damage Feedback: The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or erectile dysfunction.
An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem? A) Bowen's disease B) Peyronie's disease C) Phimosis D) Priapism
Ans: C Phimosis Feedback: Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans. Bowen's disease is an in situ carcinoma of the penis. Peyronie's disease is an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels.
A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort, burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient is exhibiting symptoms of what? A) Varicocele B) Epididymitis C) Prostatitis D) Hydrocele
Ans: C Prostatitis Feedback: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation is indicative of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele is a collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the spermatic cord.
A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patient's family history, he states, My father died of prostate cancer at age 48. The nurse should instruct him on which of the following health promotion activities? A) The patient will need PSA levels drawn starting at age 55. B) The patient should have testing for presence of the CDH1 and STK11 genes. C) The patient should have PSA levels drawn regularly. D) The patient should limit alcohol use due to the risk of malignancy.
Ans: C The patient should have PSA levels drawn regularly. Feedback: PSA screening is warranted by the patient's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the patient should be limited. However, this is not the most important health promotion intervention.
A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient? A) Apply a cold compress to the pubic area. B) Notify the urologist promptly. C) Irrigate the catheter with 30 to 50 mL of normal saline as ordered. D) Administer a smooth-muscle relaxant as ordered.
Ans: D Administer a smooth-muscle relaxant as ordered. Feedback: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be relieved without the involvement of the urologist, who will normally order medications on a PRN basis.
A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this patient has chronic urinary retention? A) Hypertension B) Peripheral edema C) Tachycardia and other dysrhythmias D) Increased blood urea nitrogen (BUN)
Ans: D Increased blood urea nitrogen (BUN) Feedback: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur with chronic urinary retention and large residual volumes.
A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? A) It is most common among men over 55. B) It is one of the least curable solid tumors. C) It typically does not metastasize. D) It is highly responsive to treatment.
Ans: D It is highly responsive to treatment. Feedback: Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.
A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? A) Red wine colored B) Tea colored C) Amber D) Light pink
Ans: D Light pink Feedback: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.
A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively? A) Fowler's position B) Prone position C) Supine position D) Lithotomy position
Ans: D Lithotomy position Feedback: Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the patient is placed in a lithotomy position during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or Fowler's position.
A patient confides to the nurse that he cannot engage in sexual activity. The patient is 27 years old and has no apparent history of chronic illness that would contribute to erectile dysfunction. What does the nurse know will be ordered for this patient to assess his sexual functioning? A) Sperm count B) Ejaculation capacity tests C) Engorgement tests D) Nocturnal penile tumescence tests
Ans: D Nocturnal penile tumescence tests Feedback: Nocturnal penile tumescence tests may be conducted in a sleep laboratory to monitor changes in penile circumference during sleep using various methods to determine number, duration, rigidity, and circumference of penile erections; the results help identify whether the erectile dysfunction is caused by physiologic and/or psychological factors. A sperm count would be done if the patient was complaining of infertility. Ejaculation capacity tests and engorgement tests are not applicable for assessment in this circumstance.
A patient has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The patient's interdisciplinary plan of care should prioritize which of the following interventions? A) Penile implant B) PDE-5 inhibitors C) Physical therapy D) Psychotherapy
Ans: D Psychotherapy Feedback: Patients with erectile dysfunction from psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction. Because of the absence of an organic cause, medications and penile implants are not first-line treatments. Physical therapy is not normally effective in the treatment of ED.
A 57-year-old male comes to the clinic complaining that when he has an erection his penis curves and becomes painful. The patient's diagnosis is identified as severe Peyronie's disease. The nurse should be aware of what likely treatment modality? A) Physical therapy B) Treatment with PDE-5 inhibitors C) Intracapsular hydrocortisone injections D) Surgery
Ans: D Surgery Feedback: Surgical removal of mature plaques is used to treat severe Peyronie's disease. There is no potential benefit to physical therapy and hydrocortisone injections are not normally used. PDE-5 inhibitors would exacerbate the problem.
A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family? A) The patient should not be in contact with the baby after delivery. B) The patient's treatment poses no risk to his daughter or her infant. C) The patient's brachytherapy may be contraindicated for safety reasons. D) The patient should avoid close contact with his daughter for 2 months.
Ans: D The patient should avoid close contact with his daughter for 2 months. Feedback: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient returns home after the procedure. Exposure of others to radiation is minimal, but the patient should avoid close contact with pregnant women and infants for up to 2 months.