Male Repro Problem Ch 54

a. Ultrasound (When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.)

A 33-yr-old patient noticed a painless lump and heaviness in his scrotum during testicular self-examination. The nurse should provide the patient information on which diagnostic test? a. Ultrasound b. Cremasteric reflex c. Doppler ultrasound d. Transillumination with a flashlight

c. decreasing butter and margarine and increasing fruits in the diet may help. (A diet high in saturated fats, found in foods like butter, is associated with an increased risk for BPH. Individuals who eat more fruits and vegetables may be at lower risk. Riding a bicycle does increase prostate-specific antigen (PSA) levels, but this is not associated with development of BPH. Dietary changes and increased exercise do appear to help prevent BPH. Vitamin E supplements do not decrease prostate size.)

A 41-year-old man asks the nurse what he can do to decrease the risk of BPH. The nurse explains that a. riding a bicycle raises prostate specific antigen levels and may increase BPH risk. b. prevention is not possible because prostatic enlargement occurs with normal aging. c. decreasing butter and margarine and increasing fruits in the diet may help. d. taking a daily vitamin E supplement has reduced prostate size in some men.

a. Wash the hands with soap and water after applying it. (The gel may spread the testosterone to others if it is not washed off of his hands after application. If his wife applies the gel, she should wear gloves to prevent absorption of the testosterone and its effects on her body. Clothing over the area until it has dried is recommended. The gel is only topical; a buccal testosterone tablet is called Striant.)

A 47-year-old patient who is experiencing andropause has decided to try the testosterone gel Testim. What should the nurse teach the patient and his wife about this gel? a. Wash the hands with soap and water after applying it. b. His wife should apply it to help him feel better about using it. c. Do not wear clothing over the area until it has been absorbed. d. The gel may be taken buccally if it is not effective on the abdomen.

c. Substituting fresh fruits and vegetables for high-fat foods in the diet may lower the risk of prostate cancer. (Most prostate cancers (about 75%) are considered sporadic. About the only modifiable risk factor for prostate cancer is its association with a diet high in red and processed meat and high-fat dairy products along with a low intake of vegetables and fruits. Age, ethnicity, and family history are risk factors for prostate cancer but are not modifiable. Simple enlargement or hyperplasia of the prostate is not a risk factor for prostate cancer.)

A 55-year-old man with a history of prostate cancer in his family asks the nurse what he can do to decrease the risk of prostate cancer. What should the nurse teach him about prostate cancer risks? a. Nothing can decrease the risk because prostate cancer is primarily a disease of aging. b. Treatment of any enlargement of the prostate gland will help to prevent prostate cancer. c. Substituting fresh fruits and vegetables for high-fat foods in the diet may lower the risk of prostate cancer. d. Using a natural herb, saw palmetto, has been found to be an effective protection against prostate cancer.

d. The device directly applies drugs that increase blood flow in the penis (Intraurethral devices include the use of vasoactive drugs administered as a topical gel, an injection into the penis (intracavernosal self-injection), or a medication pellet (alprostadil) inserted into the urethra (intraurethral) using a medicated urethral system for erection (MUSE) device. A medication pellet inserted into the urethra using a MUSE device, a topical gel, or the intracavernosal self-injection of vasoactive drugs may be used for erectile dysfunction. The vasoactive drugs enhance blood flow into the penile arteries for erection. Erectogenic drugs (e.g., tadalafil [Cialis]) cause smooth muscle relaxation and increase blood flow to promote an erection. Blood drawn into corporeal bodies and held with a ring is achieved with a vacuum constriction device (VCD). Devices implanted into corporeal bodies to firm the penis are penile implants. Androgen or testosterone replacement therapy may also be used for erectile dysfunction.)

A 66-year-old male patient is experiencing erectile dysfunction (ED). He and his wife have used tadalafil (Cialis) but because he experienced priapism, they have decided to change their treatment option to an intraurethral device. How should the nurse explain how this device works? a. The device relaxes smooth muscle in the penis. b. Blood is drawn into corporeal bodies and held with a ring. c. The device is implanted into corporeal bodies to firm the penis. d. The device directly applies drugs that increase blood flow in the penis

a. Resumption of normal urinary drainage (The most significant signs and symptoms of BPH relate to the disruption of normal urinary drainage and consequent urine retention, incontinence, and pain. A laser technique vaporizes prostate tissue and cauterizes blood vessels and is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, impaired sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.)

A 71-yr-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a contact laser technique. What is the primary goal of this intervention? a. Resumption of normal urinary drainage b. Maintenance of normal sexual functioning c. Prevention of acute or chronic renal failure d. Prevention of fluid and electrolyte imbalances

b. Benign prostatic hyperplasia (Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells & stromal tissue. It occurs in about 50% of men older than age 50 years & 80% of men older than age 80 years. Only about 16% of men develop prostate cancer. Bladder atony & age-related altered innervations of the bladder do not lead to a weakened stream.)

A 73-yr-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give anticipatory guidance regarding what condition? a. A tumor of the prostate b. Benign prostatic hyperplasia c. Bladder atony because of age d. Age-related altered innervation of the bladder

d. "What has your health care provider told you about this choice of therapy?" (Saw palmetto is an alternative therapy for benign prostatic hyperplasia (BPH) that has not yet been proven to be therapeutic. A client's decision to use this as the primary form of treatment should be discussed with his provider. Some herbs and natural products interfere with the actions of medications taken for other conditions. The other statements do not give the client accurate information to help him make this decision.)

A client has decided to treat his enlarged prostate with saw palmetto. Which is the nurse's best response? a. "You'll need to get permission from your health care provider to make that decision." b. "Saw palmetto is a well-respected alternative therapy for benign prostatic hyperplasia." c. "Have you discussed this decision with your family?" d. "What has your health care provider told you about this choice of therapy?"

b. Inform the client that results are normal and schedule a digital rectal examination. (A normal PSA in men younger than age 50 is less than 2.5 ng/mL. Although the finding is within normal limits for a PSA value, a client could have prostate cancer and not present with an elevated PSA. Also, laboratory findings should not be used as the sole screening tool. Without a digital rectal examination (DRE), the health care provider cannot know whether the client is in the early stages of prostate cancer. The client should be informed that although the level is within the normal range, he still needs a DRE.)

A client's prostate-specific antigen (PSA) level is 2.0 ng/mL. Which action by the nurse is most appropriate? a. Inform the client that the results are normal and no cancer has been detected. b. Inform the client that results are normal and schedule a digital rectal examination. c. Let the client know that the results are elevated and he is at risk for prostate cancer. d. Tell the client that cancer is indicated and that the health care provider recommends watchful waiting.

b. A very tender prostate gland (A tender and swollen prostate is indicative of prostatitis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatitis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatitis.)

A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a UTI? a. E. coli bacteria in his urine b. A very tender prostate gland c. Complaints of chills and rectal pain d. Complaints of urgency and frequency

d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells. (Hyperplasia is an increase in the number of cells and in benign prostatic hyperplasia (BPH), it is thought that the enlargement caused by the increase in new cells results from hormonal changes associated with aging. Hypertrophy refers to an increase in the size of existing cells. The hyperplasia is not considered a tumor, nor has BPH been proven to predispose to cancer of the prostate.)

A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. Thebest response by the nurse includes what information about BPH? a. BPH is a benign tumor that does not spread beyond the prostate gland. b. BPH is a precursor to prostate cancer but does not yet show any malignant changes. c. BPH is an enlargement of the gland caused by an increase in the size of existing cells. d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells.

c. Continuous bladder irrigation (CBI) infusing, but output has decreased (A decrease or cessation of output in a patient with CBI requires immediate intervention. The nurse should temporarily stop the CBI and attempt to resume output by repositioning the patient or irrigating the catheter. Complaints of pain, fatigue, and low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient's CBI.)

A patient is one day postoperative after a transurethral resection of the prostate (TURP). Which event is an unexpected finding? a. Requires two tablets of Tylenol #3 during the night b. Complains of fatigue and claims to have minimal appetite c. Continuous bladder irrigation (CBI) infusing, but output has decreased d. Expressed anxiety about his planned discharge home the following day

a. It is important to determine if ED is reversible before treatment is started (Before treatment for erectile dysfunction is initiated, the cause must be determined so that appropriate treatment can be planned. Only a small percentage of erectile dysfunction is caused by psychologic factors. In the case of the 80% to 90% of erectile dysfunction that is of physiologic causes, interventions are directed at correcting or eliminating the cause or restoring function by medical means. New invasive or experimental treatments are not widely used and should be limited to research centers and patients with systemic diseases can be treated medically if the cause cannot be eliminated.)

A patient is seeking medical intervention for erectile dysfunction. Why should he be thoroughly evaluated? a. It is important to determine if ED is reversible before treatment is started b. Psychologic counseling can reverse the problem in 80% to 90% of the cases. c. Most treatments for erectile dysfunction are contraindicated in patients with systemic diseases. d. New invasive and experimental techniques currently used have unknown risks.

d. painless mass and heaviness sensation in the scrotal area.

In assessing a patient for testicular cancer, the nurse understands that the manifestations of this disease often include a. acute back spasms and testicular pain b. rapid onset of scrotal swelling and fever c. fertility problem and bilateral scrotal tenderness d. painless mass and heaviness sensation in the scrotal area.

c. Provide wound care after each bowel movement to prevent infection. (A prostatectomy performed with a perineal approach has a high risk for infection because of the proximity of the wound to the anus, so wound care is the priority. Chemotherapy is usually not the first choice of drug therapy following surgery, nor is sildenafil. The catheter size would not be changed but the catheter would be removed. Urinary incontinence is a bigger problem than retention.)

Priority Decision: When caring for a patient following a radical prostatectomy with a perineal approach, what is the priority nursing intervention the nurse should use to prevent complications? a. Use chemotherapeutic agents to prevent metastasis. b. Administer sildenafil (Viagra) as needed for erectile dysfunction. c. Provide wound care after each bowel movement to prevent infection. d. Insert a smaller indwelling urinary catheter to prevent urinary retention.

d. Surgery to correct the problem (Varicocele is the most common testicular cause of infertility. Surgical ligation of the spermatic vein is done to correct the problem. Antibiotics are used if there is an infection but this is not as common as a varicocele. Semen analysis is the first study done when investigating male infertility but it is not a treatment. Avoidance of scrotal heat is a lifestyle change that may be used with idiopathic infertility.)

The couple has not been able to become pregnant. The wife has not been diagnosed with any infertility problems. Which treatment will the nurse expect to teach the couple about if the problem is the most common testicular problem causing male infertility? a. Antibiotics b. Semen analysis c. Avoidance of scrotal heat d. Surgery to correct the problem

a. Uroflowmetry (Urinary flow meters are used to measure the urinary flow rate, which is slowed with increased obstruction. Cystourethroscopy may also evaluate the degree of obstruction but a cystometrogram measures bladder tone. A transrectal ultrasound may determine the size and configuration of the prostate gland. Postvoiding catheterization measures residual urine.)

The extent of urinary obstruction caused by BPH can be determined by which diagnostic study? a. Uroflowmetry b. A cystometrogram c. Transrectal ultrasound d. Postvoiding catheterization

b,e (The nurse may delegate the following to an LPN/LVN: monitor catheter drainage for increased blood or clots, increase flow of irrigating solution to maintain light pink color in outflow, and administer antispasmodics and analgesics as needed. The UAP will clean around the catheter daily. A registered nurse may not delegate teaching, assessments, or clinical judgments to a LPN/LVN.)

The nurse coordinates postoperative care for a 70-yr-old man with osteoarthritis after prostate surgery. Which task is appropriate for the nurse to delegate to an LPN/LVN (select all that apply.)? a. Clean around the catheter daily. b. Increase flow of irrigation solution. c. Teach the patient how to perform Kegel exercises. d. Provide instructions to the patient on catheter care. e. Administer oxybutynin (Ditropan) for bladder spasms. f. Manually irrigate the urinary catheter to restore catheter flow.

b, d,

The nurse explains to the patient with chronic bacterial prostatitis who is undergoing antibiotic therapy that (SATA) a. all patients require hospitalization b. pain will lessen once treatment has ended c. course of treatment is generally 2-4 weeks d. long-term therapy may be indicated in immunocompromised patients e. if the condition is unresolved and untreated he is at risk for prostate cancer.

a. Avoid straining during defecation. (Activities that increase abdominal pressure, such as sitting or walking for prolonged periods and straining to have a bowel movement (Valsalva maneuver), should be avoided in the postoperative recovery period to prevent a postoperative hemorrhage. Instruct the patient to drink at least 2 L of fluid every day. Digital rectal examinations should be performed yearly. The prostate gland is not totally removed and may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, and decreased orgasmic sensation.)

The nurse is caring for a 62-yr-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? a. Avoid straining during defecation. b. Restrict fluids to prevent incontinence. c. Sexual functioning will not be affected. d. Prostate examinations are not needed after surgery.

a. A 30-yr-old white man with a history of cryptorchidism (The incidence of testicular cancer is four times higher in white men than in African American men. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to exogenous estrogen, and testicular cancer in the contralateral testis.)

The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer? a. A 30-yr-old white man with a history of cryptorchidism b. A 48-yr-old African American man with erectile dysfunction c. A 19-yr-old Asian man who had surgery for testicular torsion d. A 28-yr-old Hispanic man with infertility caused by a varicocele

b. "I should avoid heavy lifting, climbing, and driving until my follow-up visit." (Activities that increase intraabdominal pressure should be avoided until the surgeon approves these activities at a follow-up visit. Stool softeners and high-fiber diets may be used to promote bowel elimination but enemas should not be used because they increase intraabdominal pressure and may initiate bleeding. Because TURP does not remove the entire prostate gland, the patient needs annual prostatic examinations to screen for cancer of the prostate. Fluid intake should be high but caffeine and alcohol should not be used because they have a diuretic effect and increase bladder distention.)

The nurse provides discharge teaching to a patient following a TURP and determines that the patient understands the instructions when he makes which statement? a. "I should use daily enemas to avoid straining until healing is complete." b. "I should avoid heavy lifting, climbing, and driving until my follow-up visit." c. "At least I don't have to worry about developing cancer of the prostate now." d. "Every day I should drink 10 to 12 glasses of liquids such as coffee, tea, or soft drinks."

b,d

The nurse should explain to the patient who has ED that (SATA) a. the most common cause is BPH b. ED may be due to medications or conditions such as diabetes c. only men who are over 65 years or older benefit from PDE5 inhibitors d. there are medications and devices that can be used to help with erections e. this condition is primarily due to anxiety and best treated with psychotherapy

c. Baked chicken, peas, apple slices, and skim milk (A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.)

The nurse teaches a 30-yr-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? a. Grilled steak, French fries, and vanilla shake b. Hamburger with cheese, pudding, and coffee c. Baked chicken, peas, apple slices, and skim milk d. Grilled cheese sandwich, onion rings, & hot tea

c. Obtain a thorough sexual, health, and psychosocial history. (The nurse's first action to help this patient is to obtain a thorough sexual, health, and psychosocial history. Alternative treatments for the cardiac disease would then be explored if that had not already been done. Further examination or diagnostic testing would be based on the history and physical assessment, including hormone levels, counseling, or penile implant options.)

The patient has a history of cardiovascular disease and has developed erectile dysfunction. He is frustrated because he is taking nitrates and cannot take erectogenic medications. What should the nurse do first? a. Give the patient choices for penile implant surgery. b. Recommend counseling for the patient and his partner. c. Obtain a thorough sexual, health, and psychosocial history. d. Assess levels of testosterone, prolactin, luteinizing hormone, and thyroid hormones.

c,e (The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth. Development of a urinary tract infection may indicate urinary retention or could be related to other issues.)

The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago, his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations indicate prostate cancer may be extending and require a change in the plan of care (select all that apply.)? a. Casts in his urine b. Presence of α-fetoprotein c. Serum PSA level 10 ng/mL d. Onset of erectile dysfunction e. Nodularity of the prostate gland f. Development of a urinary tract infection

a, b, f (Pelvic or perineal pain, fatigue, malaise, and a hard asymmetric prostate may be present with prostate cancer. Annual prostate examination is recommended starting at a younger age for African American men because of increased diagnosis and mortality from prostate cancer in this ethnic group. An orchiectomy may be done with prostatectomy or for metastatic stages of prostate cancer. Hormonal treatment includes androgen deprivation therapy, luteinizing hormone-releasing hormone agonists, and androgen receptor blockers. Early detection of prostate cancer is best detected with annual rectal exams and serum PSA. Elevated prostatic acid phosphatase (PAP) will be seen with metastasis, not a new diagnosis.)

What accurately describes prostate cancer detection and/or treatment (select all that apply)? a. The symptoms of pelvic or perineal pain, fatigue, and malaise may be present. b. Palpation of the prostate reveals hard and asymmetric enlargement with areas of induration or nodules. c. Orchiectomy is a treatment option for all patients with prostatic cancer except those with stage IV tumors. d. The preferred hormonal therapy for treatment of prostate cancer includes estrogen and androgen receptor blockers. e. Early detection of cancer of the prostate is increased with annual rectal examinations and serum prostatic acid phosphatase (PAP) measurements. f. An annual prostate examination is recommended starting at age 45 for African American men because of the increased mortality rate from prostatic cancer in this population

d. Most common reason for recurrent UTIs in adult men

What differentiates chronic bacterial prostatitis from acute prostatitis? a. Postejaculatory pain b. Frequency, urgency, and dysuria c. Symptoms of a urinary tract infection d. Most common reason for recurrent UTIs in adult men

d. Retracted tight foreskin preventing return over the glans (Paraphimosis is tightness of the foreskin and the inability to pull it forward from a retracted position to return it over the glans. It is usually associated with poor hygiene techniques. Painful, prolonged erection is priapism. Epididymitis is inflammation of the epididymis. A painful downward curvature of an erect penis is chordee.)

What is an explanation that the nurse should give to the patient who asks what his diagnosis of paraphimosis means? a. Painful, prolonged erection b. Inflammation of the epididymis c. Painful downward curvature of an erect penis d. Retracted tight foreskin preventing return over the glans

a. A reduction in the size of the prostate gland (Finasteride results in suppression of androgen formation by inhibiting the formation of the testosterone metabolite dihydroxytestosterone, the principal prostatic androgen, and results in a decrease in the size of the prostate gland. α-Adrenergic blockers are used to cause smooth muscle relaxation in the prostate that improves urine flow. Drugs affecting bladder tone are not indicated.)

What is the effect of finasteride (Proscar) in the treatment of BPH? a. A reduction in the size of the prostate gland b. Relaxation of the smooth muscle of the urethra c. Increased bladder tone that promotes bladder emptying d. Relaxation of the bladder detrusor muscle promoting urine flow

d. Digital rectal examination (The prostate gland can be easily palpated by rectal examination & enlargement of the gland is detected early if yearly examinations are performed. If symptoms of prostatic hyperplasia are present, further diagnostic testing, including a urinalysis, prostate-specific antigen (PSA), & cystoscopy, may be indicated.)

What is the most common screening intervention for detecting BPH in men over age 50? a. PSA level b. Urinalysis c. Cystoscopy d. Digital rectal examination

c. he should continue to use other methods of birth control for 6-8 weeks. (Because it takes about 6 weeks to evacuate sperm that are distal to the vasectomy site, the patient should use contraception for 6 weeks. ED that occurs after vasectomy is psychologic in origin and not related to postoperative swelling. The patient does not need to abstain from intercourse. The appearance and volume of the ejaculate are not changed because sperm are a minor component of the ejaculate.)

When performing discharge teaching for a patient who has undergone a vasectomy in the health care provider's office, the nurse instructs the patient that a. The amount of ejaculate will be noticably decreased b. he may difficulty maintaining an erection for several months due to postop swelling c. he should continue to use other methods of birth control for 6-8 weeks. d. the testes will gradually decrease production of sperm and testosterone

c. urinary hesitancy, postvoid dribbling, and weak urinary stream. (Classic symptoms of uncomplicated BPH are those associated with urinary obstruction and include diminished caliber and force of the urinary stream, hesitancy, difficulty initiating voiding, intermittent urination, dribbling at the end of urination, and a feeling of incomplete bladder emptying because of urinary retention. Irritative symptoms, including nocturia, frequency, dysuria, urgency, or hematuria, occur if infection results from urinary retention.)

When taking a nursing history from a patient with BPH, the nurse would expect the patient to report a. nocturia, dysuria, and bladder spasms. b. urinary frequency, hematuria, and perineal pain. c. urinary hesitancy, postvoid dribbling, and weak urinary stream. d. urinary urgency with a forceful urinary stream and cloudy urine.

d. Testicular tumors most often present on the testis as a lump or nodule that is very firm, is nontender, and cannot be transilluminated. There may also be scrotal swelling and a feeling of heaviness. All of the other options are normal findings.

When teaching a patient testicular self-examination, the nurse instructs the patient to report which finding? a. An irregular-feeling epididymis b. One testis larger than the other c. The spermatic cord within the testicle d. A firm, nontender nodule on the testis

c. The patient has had a gradual decrease in the force of his urinary stream. (The decrease in urinary stream may indicate benign prostatic hyperplasia (BPH) or prostate cancer, which are contraindications to the use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient.)

Which assessment information about a 62-year-old man is most important for the nurse to report to the health care provider when the patient is asking for a prescription for testosterone replacement therapy? a. The patient's symptoms have increased steadily over the last few years. b. The patient has been using sildenafil (Viagra) several times every week. c. The patient has had a gradual decrease in the force of his urinary stream. d. The patient states that he has noticed a decrease in energy level for a few years.

e, f (The transurethral resection of the prostate (TURP) is the most common surgical procedure to treat BPH and uses a resectoscopic excision and cauterization of prostate tissue. A simple open prostatectomy is used for a large prostate and has an external incision. Transurethral incision into the prostate to expand the urethra for a small to moderate-sized prostate is done with a transurethral incision of the prostate (TUIP).)

Which characteristics describe transurethral resection of the prostate (TURP) (select all that apply)? a. Best used for a very large prostate gland b. Inappropriate for men with rectal problems c. Involves an external incision prostatectomy d. Uses transurethral incisions into the prostate e. Most common surgical procedure to treat BPH f. Resectoscopic excision and cauterization of prostate tissue

c. Reporting complaints of pain or bladder spasms (Cleaning around the catheter, recording intake and output, and reporting complaint of pain or bladder spasms to the registered nurse are appropriate tasks for delegation to the UAP. Selecting analgesia, irrigating the patient's catheter, and assessing the incision are not appropriate skills or tasks for unlicensed personnel.)

Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy? a. Assessing the patient's incision b. Irrigating the patient's urinary catheter c. Reporting complaints of pain or bladder spasms d. Evaluating the patient's pain and selecting analgesia

b. Transurethral needle ablation (TUNA) (The transurethral needle ablation (TUNA) uses lowwave radiofrequency to heat the prostate, causing necrosis. Laser prostatectomy uses a laser beam. Transurethral microwave thermotherapy (TUMT) uses microwave radiating heat to produce coagulative necrosis of the prostate and is not used for men with rectal problems. Transurethral electrovaporization of prostate (TUVP) uses electrosurgical vaporization and desiccation to destroy prostate tissue.)

Which treatment for BPH uses a low-wave radiofrequency to precisely destroy prostate tissue? a. Laser prostatectomy b. Transurethral needle ablation (TUNA) c. Transurethral microwave thermotherapy (TUMT) d. Transurethral electrovaporization of prostate (TUVP)

c. Attempt to move the foreskin over the glans. (Paraphimosis can occur when the foreskin is pulled back during bathing, during catheter insertion, or after intercourse and not returned to the normal position. Attempting to return the foreskin over glans is the priority action. If the nurse is unsuccessful, then ice would be applied to decrease swelling. If the foreskin is not returned to the normal position manually by the health care provider, then circumcision would be indicated. Paraphimosis is considered a urologic emergency because arterial blood flow to the glans penis is impaired.)

A hospitalized older patient reports his foreskin is retracted and will not return to normal. Which action is the priority? a. Start antibiotics. b. Apply ice to reduce swelling. c. Attempt to move the foreskin over the glans. d. Call the physician to prepare for circumcision.

a. erectile dysfunction can occur even with a nerve-sparing procedure

A patient scheduled for a prostatectomy for prostate cancer expresses fear that he will have ED. In responding to this patient, the nurse should keep in mind that: a. erectile dysfunction can occur even with a nerve-sparing procedure b.retrograde ejaculation affects sexual function more frequently than erectile dysfunction c. the most common complication of this surgery is postoperative bowel incontinence d. preoperative sexual function is the most important factor in determining postoperative ED.

a. with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur. (Erectile problems are rare, but retrograde ejaculation may occur after TURP. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns.)

A patient scheduled for a transurethral resection of the prostate (TURP) for BPH tells the nurse that he has delayed having surgery because he is afraid it will affect his sexual function. When responding to his concern, the nurse explains that a. with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur. b. information about penile implants used for ED is available if he is interested. c. there are many methods of sexual expression that can be alternatives to sexual intercourse. d. sterility will not be a problem after surgery because sperm production will not be affected.

b. "Use an alternative form of contraception until your semen is sperm free." (Because vasectomies are usually done for sterilization purposes, to safely have sexual intercourse, the patient will need to use an alternative form of contraception until semen examination reveals no sperm. Hormones are not affected, so there is no loss of secondary sexual characteristics or erectile function. Most men experience too much pain to have sexual intercourse on the day of their surgery, so this is not an appropriate comment by the nurse.)

After a vasectomy, what instruction should be included in discharge teaching? a. "Some secondary sexual characteristics may be lost after the surgery." b. "Use an alternative form of contraception until your semen is sperm free." c. "Erectile dysfunction may be present for several months after this surgery." d. "You will be uncomfortable, but you may safely have sexual intercourse today."

b. This surgery results in some degree of retrograde ejaculation. (Because of injury to the internal urinary sphincter, there is usually some degree of retrograde ejaculation following most transurethral surgeries, especially following TURP. The semen is ejaculated into the bladder and is eliminated with the next voiding. Urinary incontinence, erectile dysfunction, and continued catheterization are uncommon following TURP.)

Before undergoing a TURP, what should the patient be taught? a. Some degree of urinary incontinence is likely to occur. b. This surgery results in some degree of retrograde ejaculation. c. Erectile dysfunction is a common complication of this prostate surgery. d. An indwelling catheter will be used to maintain urinary output until healing is complete.

c. Increase the rate of the irrigation and take the patient's vital signs. (Bleeding and blood clots from the bladder are expected after prostatectomy and continuous irrigation is used to keep clots from obstructing the urinary tract. The rate of the irrigation may be titrated to keep the clots from forming, if ordered, but the nurse should also check the vital signs because hemorrhage is the most common complication of prostatectomy. The traction on the catheter applies pressure to the operative site to control bleeding and should be relieved only if specific orders are given. The catheter does not need to be manually irrigated unless there are signs that the catheter is obstructed and clamping the drainage tube is contraindicated because it would cause distention of the bladder.)

Following a TURP, a patient has continuous bladder irrigation. Four hours after surgery, the catheter is draining thick, bright red clots and tissue. What should the nurse do? a. Release the traction on the catheter. b. Manually irrigate the catheter until the drainage is clear. c. Increase the rate of the irrigation and take the patient's vital signs. d. Clamp the drainage tube and notify the patient's health care provider.

c. instruction about home management of an indwelling catheter. (Because of edema, urinary retention, and delayed sloughing of tissue that occurs with a laser prostatectomy, the patient will have postprocedure catheterization for up to 7 days. The procedure is done under local anesthetic, and incontinence is not usually a problem.)

On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need a. teaching about the effects of general anesthesia. b. to be informed of the possibility of short-term incontinence. c. instruction about home management of an indwelling catheter. d. monitoring for postoperative urinary retention.

d. explain that this feeling is normal and that he should not try to urinate around the catheter

Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a three-way urinary catheter with a 30ml balloon. When he complains of bladder spasms with the catheter in place the nurse should a. deflate the catheter balloon to 10ml to decrease bulk in bladder b.deflate the catheter balloon and then reinflate to ensure that it is patent c.encourage the patient to try to have a bowel movement to relieve colon pressure d. explain that this feeling is normal and that he should not try to urinate around the catheter

b. Assess the patency of the catheter. (The nurse should first check for the presence of clots obstructing the catheter or tubing and then may administer a belladonna and opium (B&O) suppository if one is ordered. The patient should not try to void around the catheter because this will increase the spasms. The flow rate of the irrigation fluid may be decreased if orders permit because fast-flowing, cold fluid may also contribute to spasms.)

Priority Decision: A patient with continuous bladder irrigation following a prostatectomy tells the nurse that he has bladder spasms and leaking of urine around the catheter. What should the nurse do first? a. Slow the rate of the irrigation. b. Assess the patency of the catheter. c. Encourage the patient to try to urinate around the catheter. d. Administer a belladonna and opium (B&O) suppository as prescribed.

b. α-fetoprotein (AFP) and human chorionic gonadotropin (hCG). (α-Fetoprotein (AFP) and human chorionic gonadotropin (hCG) are glycoproteins that may be elevated in testicular cancer. If they are elevated before surgical treatment, the levels are noted, and if response to therapy is positive, the levels will decrease. Lactate dehydrogenase (LDH) may also be elevated. Tumor necrosis factor (TNF) is a normal cytokine responsible for tumor surveillance and destruction. C-reactive protein (CRP) is found in inflammatory conditions and widespread malignancies. PSA and PAP are used for screening of prostatic cancer. Carcinoembryonic antigen (CEA) is a tumor marker for cancers of the GI system. Antinuclear antibody (ANA) is found most frequently in autoimmune disorders.)

Serum tumor markers that may be elevated on diagnosis of testicular cancer and used to monitor the response to therapy include a. tumor necrosis factor (TNF) and C-reactive protein (CRP). b. α-fetoprotein (AFP) and human chorionic gonadotropin (hCG). c. prostate-specific antigen (PSA) and prostate acid phosphatase (PAP). d. carcinoembryonic antigen (CEA) and antinuclear antibody (ANA).

d. Notify the health care provider and prepare to give meperidine (Demerol). (Prolonged penile erection—priapism—is common during sickle cell crisis. It is considered a urologic emergency because circulation to the penis may be compromised, and the client may not be able to void. Therefore, the provider must be notified promptly. Demerol is often given to induce hypotension. A diuretic will not help the client. Catheterization should be reserved for the man who cannot void. Waiting another 4 hours to intervene may lead to ischemia.)

The client with sickle cell anemia has had an erection for longer than 4 hours. How does the nurse intervene? a. Administer a diuretic to increase urine output. b. Attempt to relieve pressure by catheterizing the client. c. Document the finding and reassess in 4 hours. d. Notify the health care provider and prepare to give meperidine (Demerol).

d. Testicular torsion (The cremasteric reflex is elicited by light stroking of the inner aspect of the thigh in a downward direction with a tongue blade. In testicular torsion, or a twisted spermatic cord that supplies blood to the testes and epididymis, this reflex is absent on the swollen side. Varicocele is dilation of the veins that drain the testes. Hydrocele is scrotal lymphedema from interference with lymphatic drainage of the scrotum. Spermatocele is a sperm-containing cyst of the epididymis.)

The cremasteric reflex is absent in which problem of the scrotum and testes? a. Hydrocele b. Varicocele c. Spermatocele d. Testicular torsion

a. obstruction of the urethra

The symptoms of BPH are primarily caused by a. obstruction of the urethra b.untreated chronic prostatitis c.decreased bladder compliance d.excessive secretion of testosterone

c. maintain a nonjudgmental attitude toward his sexual practices

To decrease the patients discomfort over care related to his reproductive organs, the nurse should a. relate his sexual concerns to his sexual partner b. arrange to have male nurses care for the patient c. maintain a nonjudgmental attitude toward his sexual practices d. use technical terminology when discussing reproductive function

c. Digital rectal examination (DRE) (DRE is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia (BPH) in men older than 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.)

To monitor the progression of decreased urinary stream, the nurse should encourage which type of regular screening? a. Uroflowmetry b. Transrectal ultrasound c. Digital rectal examination (DRE) d. Prostate-specific antigen (PSA) monitoring

c. Ventral urinary meatus (Hypospadias is the urethral meatus located on the ventral surface of the penis. Scrotal lymphedema is called a hydrocele. An undescended testicle is cryptorchidism. Inflammation of the prepuce or foreskin is called phimosis.)

What describes hypospadias? a. Scrotal lymphedema b. Undescended testicle c. Ventral urinary meatus d. Inflammation of the prepuce

a, d

Which factors would place a patient at higher risk for prostate cancer? SATA a.older than 65 years b.asian or native american c. long-term use of indwelling urethral catheter d. father diagnosed and treated for early stage prostate cancer e. previous history of undescended testicle and testicular cancer.

b,d,e

Which therapies for BPH are done on an outpatient basis (select all that apply)? a. Intraprostatic urethral stents b. Transurethral needle ablation (TUNA) c. Photovaporization of the prostate (PVP) d. Transurethral incision of prostate (TUIP) e. Transurethral microwave therapy (TUMT)