Male Reproductive Practice Questions

Which organ produces testosterone? 1 Testes 2 Prostate gland 3 Pituitary gland 4 Hypothalamus

1. Testosterone is produced by the testes and circulates in the blood. The prostate gland produces dihydrotestosterone and estrogens. The pituitary glands produce many hormones but not testosterone. The hypothalamus produces antidiuretic hormone and oxytocin.

Which term is used for an undescended testis? 1 Hydrocele 2 Varicocele 3 Spermatocele 4 Cryptorchidism

4. The other name for undescended testis is cryptorchidism. A hydrocele is a collection of fluid around the testicle. A varicocele involves dilated vessels around the testicle. A spermatocele is a self-contained cystic mass on the testicle.

A patient with erectile dysfunction (ED) is prescribed phosphodiesterase-5 (PDE-5) inhibitors. Which side effect is related to the dosing of PDE-5? Select all that apply. One, some, or all responses may be correct. 1 Dyspepsia 2 Headache 3 Stuffy nose 4 Facial flushing 5 Urinary incontinence 6 High blood pressure

1, 2, 3, 4 The side effects caused by PDE-5 inhibitors in people with ED are stuffy nose, facial flushing, dyspepsia, and headaches. Intake of more than one PDE-5 pill daily may cause leg and back cramps, along with nausea and vomiting. Urinary incontinence may occur after a prostatectomy, but it is not an expected side effect of PDE-5 inhibitors. These drugs may cause severe hypotension and reduced blood flow to vital organs when taken along with nitrates and are therefore contraindicated.

Which risk factor is common for prostate cancer? Select all that apply. One, some, or all responses may be correct. 1 African-American descent 2 Presence of BRCA2 gene mutations 3 Intake of foods rich in omega-3 fatty acids 4 Low animal fat and high fiber intake in the diet 5 Mutation in the glutathione S-transferase (GSTP1) gene

1, 2, 5 Men of African-American descent, BRCA2 gene mutation, GSTP1 gene, and exposure to environmental toxins like arsenic are high risk factors for prostate cancer. Diets that include low animal fat, high-fiber foods, and omega-3 fatty acids are thought to be helpful in preventing cancer.

Which risk factor in a patient's health history is associated with testicular cancer? Select all that apply. One, some, or all responses may be correct. 1 History of cryptorchidism 2 Frequent chlamydial infection 3 Infection with human immune deficiency virus (HIV) 4 Family history of testicular cancer in a close male relative 5 Mutation in the glutathione S-transferase (GSTP1) gene

1, 3, 4 The risk factors associated with testicular cancer are the presence of cryptorchidism and HIV infection. Testicular cancer also runs in families; close male relatives, brothers, or identical twins of a patient are more at risk for developing testicular cancer. Frequent chlamydial infections may cause epididymitis, not testicular cancer. The presence of mutation in the GSTP1 gene is a risk factor for prostate cancer, not testicular cancer.

Which information is important for the nurse to include when teaching a patient with benign prostatic hyperplasia about alpha-adrenergic blockers? Select all that apply. One, some, or all responses may be correct. 1 Be careful when changing positions. 2 Take the medication in the afternoon. 3 Avoid drugs used to treat erection problems. 4 Hearing tests will need to be conducted periodically. 5 Keep all appointments for follow-up laboratory testing.

1, 3, 5 Drugs used to treat erectile dysfunction can worsen side effects, such as hypotension. Alpha-adrenergic blockers may cause orthostatic hypotension and can cause liver damage, so it is important to keep appointments for follow-up laboratory testing. These drugs do not affect hearing. Alpha-adrenergic blockers should be taken in the evening to decrease the risk for problems related to hypotension.

On which topic will a sperm bank facility provide information? Select all that apply. One, some, or all responses may be correct. 1 Semen collection 2 Storage of blood 3 Storage of semen 4 Urine specimens 5 The insemination process

1, 3, 5 A sperm bank facility provides comprehensive information on semen collection, storage of semen, the storage contract, costs, and the insemination process. Storage of blood is done by a blood bank. Urine specimens are stored in a laboratory.

Which information would the nurse provide a patient with benign prostatic hyperplasia (BPH) who asks which natural remedies may alleviate the symptoms? Select all that apply. One, some, or all responses may be correct. 1 Take saw palmetto. 2 Consume cranberry juice. 3 Increase oral fluid intake. 4 Use the bathroom at the first urge. 5 Have frequent sexual intercourse

1, 5 Saw palmetto is a natural substance that has shown some improvement in BPH symptoms. However, the patient and nurse would need to discuss this with the health care provider first. Having frequent sexual intercourse reduces the symptoms as it causes prostatic fluid release. Cranberry juice, increasing oral fluid intake, and using the bathroom at the first urge prevent urinary tract infections.

The nurse assesses a patient with benign prostatic hyperplasia (BPH) and notices signs and symptoms of depression. Which urinary symptom is likely contributing to his depression? Select all that apply. One, some, or all responses may be correct. 1 Nocturia 2 Straining 3 Weak stream 4 Sexual dysfunction 5 Postvoid incontinence

1,4,5 Nocturia can cause sleep disturbance, which often causes depression. Inability to function sexually frequently leads to depression. Incontinence can result in social isolation because of embarrassment, leading to depression. Straining and weak stream have lower social and emotional implications, so they are less likely to contribute to depression.

A patient with testicular cancer is worried about sterility and the ability to conceive children later. To which resource will the nurse refer the patient before surgery takes place? 1 Sperm bank 2 American Cancer Society 3 American Fertility Society 4 RESOLVE: The National Fertility Association

1. After radiation therapy or chemotherapy has been started, the patient is at increased risk for producing mutagenic sperm, which may not be viable or may result in fetal abnormalities. If the patient is interested in having children, he should be encouraged to arrange for semen storage as soon as possible after diagnosis. Sperm collection should be completed before radiation therapy or chemotherapy is started. The patient is referred to the American Cancer Society for more generalized information on testicular cancer. The American Fertility Society and RESOLVE: The National Infertility Association are appropriate referrals if permanent sterility occurs and sperm storage has not been feasible.

Which statement indicates a need for further teaching on how to prepare a patient with benign prostatic hyperplasia (BPH) for a digital rectal examination (DRE)? 1 "The residual urine will be measured during the examination." 2 "BPH presents as a uniform, elastic, and nontender enlargement." 3 "The patient may feel the urge to urinate when the prostate is palpated." 4 "The patient should be assisted to a side-lying fetal position for the examination."

1. Residual urine may be measured with cystoscopy, not during a DRE of the prostate for BPH. During a DRE, the prostate gland is palpated and massaged to obtain a fluid sample to rule out prostatitis. BPH presents as a uniform, elastic, and nontender enlargement. The patient may feel the urge to urinate when the prostate is palpated. The patient is assisted to a side-lying fetal position, or the patient bends over the examination table for the DRE.

Which information will the nurse teach the patient when preparing for a digital rectal examination (DRE) of the prostate? 1 The patient must void before the physical examination. 2 The residual urine will be measured during the examination. 3 The patient will be assisted to a prone position for examination. 4 On examination, the normal prostate feels like a stony-hard nodule.

1. The patient must void before the DRE because the patient may feel an urge to urinate during the examination. The DRE is performed with the patient bent over an examination table or in a side-lying fetal position. In a patient with cancer, the prostate feels like a stony-hard nodule on examination. The prostate gland is palpated and massaged to obtain a fluid sample to rule out prostatitis.

A patient is undergoing a diagnostic workup for suspected testicular cancer. Which serum tumor marker is indicative of testicular cancer? 1 Alpha-fetoprotein (AFP) 2 Luteinizing hormone 3 Serum acid phosphatase 4 Serum alkaline phosphatase

1. The serum tumor marker AFP is used to confirm the diagnosis of testicular cancer. It is also used to evaluate the response to therapy and detect residual or recurring testicular cancer. Luteinizing hormone is secreted from the pituitary gland and stimulates the Leydig cells to produce testosterone. Serum alkaline phosphatase levels are increased in bone disorders or bone metastasis and are not indicative of testicular cancer. Elevated levels of serum acid phosphatase are indicative of prostate cancer rather than testicular cancer.

Which noninvasive technique is available to destroy excess prostate tissue in patients with benign prostatic hyperplasia (BPH) who do not experience a relief of urinary symptoms with drug therapy? Select all that apply. One, some, or all responses may be correct. 1. Contact laser prostatectomy 2. Transurethral needle ablation 3. Transurethral microwave therapy 4. Electrovaporization of the prostate 5. Transurethral resection of the prostate 6. Holmium laser enucleation of the prostate

1. 2. 3. 4 Noninvasive techniques available to destroy excess prostate tissue include transurethral microwave therapy, transurethral needle ablation, electrovaporization of the prostate, and contact laser prostatectomy. Transurethral resection of the prostate is a surgical technique involving the endoscopic removal of the enlarged portion of prostate tissue. Holmium laser enucleation of the prostate is a minimally invasive technique.

When teaching a patient pending discharge after a vasectomy, the nurse would provide which information? Select all that apply. One, some, or all responses may be correct. 1 Return to work in 1 to 2 weeks. 2 Mild pain and swelling are normal. 3 Leave bandages in place for 48 hours. 4 Apply ice packs to the scrotum for 1 to 2 days. 5 Use alternate contraception for 2 to 3 weeks.

2, 3, 4 The nurse should instruct the patient that mild pain and swelling are normal but to notify the health care provider if it becomes worse. The nurse should also instruct the patient to leave the bandages in place for 48 hours and apply ice packs to the scrotum for 1 to 2 days. The patient can return to work in 1 to 2 days. Alternate contraception must be used for 3 months.

Which symptom is likely to occur with benign enlargement of the prostate? Select all that apply. One, some, or all responses may be correct. 1 Severe anemia Correct2 Bladder calculi Correct3 Urinary tract infections Correct4 Increased residual urine Correct5 Chronic urinary retention Correct6 Overflow urinary incontinence

2, 3, 4, 5. The most common symptoms of prostate enlargement include bladder calculi, urinary tract infections, increased residual urine, chronic urinary retention, and overflow urinary incontinence. Although some men with benign prostate enlargement experience microscopic hematuria if they have an infection, it is unlikely that enough blood will be lost to result in severe anemia.

Which factor would place a patient at risk for developing testicular cancer? Select all that apply. One, some, or all responses may be correct. 1 Prostatitis 2 Family history 3 Cryptorchidism 4 Erectile dysfunction 5 Human immune deficiency virus (HIV)

2, 3, 5 A patient with a family history of testicular cancer is at a higher risk for developing testicular cancer. Cryptorchidism, or undescended testes, and HIV can also place a person at risk for testicular cancer. Prostatitis and erectile dysfunction do not increase the risk for testicular cancer.

Which risk factor is associated with the development of prostate cancer? 1 Prolonged sexual activity 2 Presence of BRCA2 gene mutations 3 Increased intake of soy and its products 4. Intake of foods high in omega-3 fatty acids

2.

When discussing the diagnosis of benign prostatic hyperplasia (BPH) with the patient, the nurse would likely make which statement? 1 "BPH is caused by a poor diet." 2 "The exact cause of BPH is unclear." 3 "BPH affects men's ability to reproduce." 4 "BPH is a natural occurrence in older-adult men."

2. Although BPH is likely the result of a combination of aging and the influence of androgens, it is not a natural part of the aging process and the exact cause is unclear. An improved diet can reduce the symptoms of BPH, but a poor diet is not the cause. BPH does not affect a man's ability to reproduce.

Which statement about the classification of testicular cancers is correct? 1 Germ cell tumors may arise from Leydig cells. 2 Nonseminomas are testicular germ cell tumors. 3 Androblastomas often metastasize to distant organs. 4 Nongerm cell tumors account for most testicular cancers.

2. Testicular germ cell tumors can be classified as seminomas and nonseminomas. Thus nonseminomas are testicular germ cell tumors. Germ cell tumors arise from the sperm-producing cells. Tumors arising from Leydig cells are nongerm cell tumors. Germ cell tumors account for most testicular cancers. Most androblastomas (testicular adenomas) do not metastasize.

Which issue is often foremost in the minds of men who have been diagnosed with prostate cancer and must be addressed by the nurse? 1 Mobility after treatment 2 Sexual function after treatment 3 Comfort because of surgical pain 4 Nutrition because of radiation side effects

2. Altered sexual function is one of the biggest concerns of men after cancer treatment. Comfort, mobility, and nutrition are important but are typically not the foremost concern in the minds of men with prostate cancer.

Which symptom is common for testicular cancer? 1 Hard, painful mass 2 Hard, painless mass 3 Scrotal swelling and pain 4 Epididymis that is easily palpated

2. Malignant testicular tumors are not painful and are not fluid-filled swellings, although a swelling may be present. The epididymis is not easily palpated with testicular cancer.

Which statement most accurately describes the International Prostate Symptoms Score (I-PSS) system? 1 It assesses the effect of benign prostatic hyperplasia (BPH) on sexual function. 2 It is based on six questions concerning urinary symptoms. 3 It asks the patient about the severity of urinary symptoms. 4 It includes questions about the level of pain during urination.

3 The I-PSS asks the patient a total of eight questions: seven are about the severity of urinary symptoms relating to the enlarged prostate, and one is related to the effect of symptoms on quality of life. None of the questions relate to sexual function. They deal with the symptoms of BPH only (frequency, urgency, and stream). The I-PSS does not ask any questions about pain with urination.

A patient is scheduled for a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. Which preoperative information must the patient understand? 1 Permanent incontinence occurs after TURP. 2 Sexual function is not usually affected with TURP. 3 Blood-tinged urine after the procedure must be reported. 4 General anesthesia will be administered during the surgery.

2. Sexual function is usually not affected with TURP, although retrograde ejaculation may occur. Permanent urinary incontinence does not occur after TURP. While the catheter is in place and immediately after its removal, there may be small blood clots and tissue debris in the urine; it is therefore normal for the urine to be blood-tinged after surgery. Epidural or spinal anesthesia is preferred over general anesthesia during TURP because it is easier to monitor for water retention or fluid overload during the procedure when the patient is awake.

Which preoperative teaching will the nurse provide to a patient who will undergo a transurethral resection of the prostate (TURP)? 1 The patient must report any blood-tinged urine after surgery. 2 Spinal anesthesia will be administered to the patient. 3 The patient will have an indwelling catheter for 3 days after surgery. 4 The patient will not feel the urge to urinate when the catheter is in place.

2. Spinal anesthesia will be administered to the patient undergoing a TURP; this will keep the patient awake, and the patient can be easily monitored for fluid overload or water intoxication. The patient will have an indwelling catheter for at least 1 day after the surgery. The patient will feel the urge to void continuously as a result of the large diameter of the urinary catheter and the pressure of the retention balloon on the internal sphincter of the bladder. It is normal for the urine to be blood-tinged after surgery. Small blood clots and tissue debris may pass while the catheter is in place and immediately after it is removed.

With which male patient will the nurse conduct prostate screening and education? 1 Sexually active patient 2 Adult who is older than 50 years 3 Young adult with a history of urinary tract infections (UTIs) 4 Patient who has sustained an injury to the external genitalia

2. A man who is 50 years or older is at higher risk for prostate cancer. A history of UTIs, injury to the external genitalia, and sexual activity are not risk factors for prostate cancer.

The nurse is caring for a patient who is being treated with a 5-alpha reductase inhibitor (5-ARI) as the first-line drug therapy for benign prostatic hyperplasia (BPH). Which instruction will the nurse give to the patient about this therapy? 1 Increased libido is a side effect of these drugs. 2 Orthostatic hypotension is a side effect of this treatment. 3 It will take at least 2 months before improvement is noticed. 4 Bedtime dosing increases the risk for problems related to hypotension

2. Orthostatic hypotension is a side effect of this treatment, so the patient must change positions carefully and slowly to avoid dizziness. It will take at least 6 months before improvement is noticed. Bedtime dosing decreases the risk for problems related to hypotension. Decreased libido and erectile dysfunction are side effects of this treatment.

The nurse is reviewing the results of a patient's prostate-specific antigen (PSA) test and notices an elevation in the findings. Which finding may this represent? 1 Prostatitis 2 Prostate cancer 3 Erectile dysfunction 4 Benign prostatic hyperplasia

2. PSA is a glycoprotein produced by the prostate and is used in aiding the diagnosis of prostate cancer. PSA levels are elevated with prostate cancer. Prostatitis is an inflammation of the prostate diagnosed by obtaining a fluid sample from the prostatic capsule and treated with antibiotic therapy. Benign prostatic hyperplasia is diagnosed by a digital rectal examination and symptoms per the International Prostate Symptom Score. Erectile dysfunction can be diagnosed by either the duplex Doppler ultrasonography or by the nocturnal penile tumescence test.

A patient underwent a transurethral resection of the prostate (TURP) yesterday for benign prostatic hyperplasia. Which intervention will the nurse perform for the patient during the first postoperative day? 1 Assess vital signs every hour. 2 Assess for excessive bleeding. 3 Assess pain two times every day. 4 Assess urine output every 4 hours.

2. Patients who undergo TURP are at risk for severe postoperative bleeding. The bleeding most often occurs within the first 24 hours and may require critical rescue. Vital signs are assessed every 4 hours. The nurse assesses pain every 2 to 4 hours and provides interventions to control it. Urine output is assessed every 2 hours.

When is the best time for the nurse to begin discharge planning and a community-based plan of care for a patient with prostate cancer? 1 After surgery 2 Before surgery 3 The day of discharge 4 Two days before being discharged

2. Planning should begin as early as possible, on admission and before surgery. After surgery is not the correct time to begin planning. Planning should begin earlier than 2 days before discharge.

A patient with prostate cancer is being evaluated for metastasis. Which laboratory test indicates possible bone metastasis? 1 Prostate-specific antigen (PSA) 2 Serum alkaline phosphatase 3 Serum acid phosphatase 4 Early prostate cancer antigen (EPCA-2)

2. Serum alkaline phosphatase levels are increased in bone disorders and are indicative of possible bone metastasis in prostate cancer. PSA, serum acid phosphatase, and EPCA-2 levels are increased in prostate cancer and are also used to monitor the progression of this cancer.

Which major androgen is found in the adult man? 1 Estrogen 2 Testosterone 3 Progesterone 4 Androstenedione

2. Testosterone is the major androgen (male hormones) found in the adult man. Estrogen and progesterone are major female hormones. Androstenedione is a precursor to both male and female hormones.

After returning from a transurethral resection of the prostate, the patient's urine in the continuous bladder irrigation system is a burgundy color. Which patient need will the nurse anticipate after the surgeon evaluates the patient? Select all that apply. One, some, or all responses may be correct. 1 Forced fluids 2 Emergency surgery 3 Antispasmodic drugs 4 Monitoring for anemia 5 Increased intermittent irrigation

3, 4 Although not a common occurrence, bleeding may occur in the postoperative period. Venous bleeding is more common than arterial bleeding. Hemoglobin and hematocrit should be monitored and trended for indications of anemia. The surgeon may apply traction on the catheter for a few hours to control the venous bleeding. Traction on the catheter is uncomfortable and increases the risk for bladder spasms, so analgesics or antispasmodics are usually prescribed. Emergency surgery and increased intermittent irrigation would be indicated for an arterial bleed, which would be a brighter-red color. Forced fluids are indicated after the catheter is removed.

The potential problem of grief is most relevant to a patient after which procedure? 1 Cystoscopy 2 Sperm banking 3 Radical prostatectomy 4 Transurethral microwave therapy

3. A radical prostatectomy may lead to erectile dysfunction, which could present a potential problem of grief at loss of function. Cystoscopy—a test to view the interior of the bladder, the bladder neck, and the urethra—does not affect sexuality. Transurethral microwave therapy is a minimally invasive procedure involving high temperatures that heat and destroy excess prostate tissue. It does not affect sexuality. The process of sperm banking would not result in a diagnosis of altered self-image; however, the diagnosis leading to the necessity of sperm banking might cause this.

Which statement made by a patient taking finasteride indicates understanding of why the medication was prescribed? 1 "Finasteride is used to treat nocturia." 2 "Finasteride treats urinary infections." 3 "Finasteride reduces an enlarged prostate." 4 "Finasteride increases bladder muscle strength."

3. Finasteride is a 5-alpha reductase inhibitor (5-ARI). Testosterone is converted to dihydrotestosterone (DHT) in the prostate gland by the enzyme 5-alpha reductase. By taking an enzyme-inhibiting agent, the patient's DHT levels decrease, which results in reducing the enlarged prostate. Although reducing an enlarged prostate may relieve symptoms of nocturia, the primary purpose of finasteride is not to treat nocturia. Finasteride is not an antibiotic, so it is not used to treat urinary infections. It also does not increase bladder muscle strength.

Which type of malignancy grows slowly? 1 Lung cancer 2 Kidney cancer 3 Prostate cancer 4 Pancreas cancer

3. Prostate cancer grows very slowly and metastasizes in a predictable pattern. Lung cancer, kidney cancer, and pancreas cancer grow at a faster rate.

Which method is a common complementary and alternative therapy for benign prostatic hyperplasia (BPH)? 1 Yoga 2 Acupuncture 3 Serenoa repens 4 Calcium supplements

3. Serenoa repens (saw palmetto), a plant extract, is often used by men with early to moderate BPH. They believe that this agent relieves their symptoms and prefer this treatment over prescription drugs or surgery. (It should be noted, however, that studies on the effectiveness of Serenoa repens have not shown that it is effective.) Acupuncture, calcium, and yoga are not common alternative therapies for BPH.

For a patient receiving continuous bladder irrigation (CBI) after a transurethral resection of the prostate (TURP) 2 days ago, which cue indicates the CBI is functioning correctly? 1 Pain level of 7 on a 0-to-10 scale 2 Catheter attached securely to the leg 3 Urine output greater than 3000 mL/24 hr 4 Bright red blood in the urinary drainage bag

3. When the patient has urine output greater than 3000 mL/24 hr, this indicates good renal function and urine elimination and that the CBI is functioning well. The patient's pain level may be related to the surgical procedure and not the CBI. The catheter securely attached to the patient's leg indicates the nurse is maintaining safety, but it does not indicate the CBI is draining well. Bright red blood in the urinary drainage bag can indicate postoperative bleeding.

A patient with prostate cancer asks why he must have surgery instead of radiation, even if his cancer is the least-invasive type. Which response by the nurse is best? 1 "Surgery slows the spread of cancer." 2 "The surgery is to promote urination." 3 "It is because your cancer growth is large." 4 "Surgery is the most common intervention to cure the disease."

4. Because some localized prostate cancers are resistant to radiation, surgery is the most common intervention for a cure. The size of the tumor is not likely to be why the patient is having surgery. A bilateral orchiectomy (removal of both testicles) is palliative surgery that slows the spread of cancer by removing the main source of testosterone. A transurethral resection of the prostate is done to promote urination for patients with advanced disease; it is not used as a curative treatment.

Which patient is most likely to have the greatest risk for prostate cancer? 1 A 12-year-old patient 2 A 25-year-old patient 3 A 50-year-old patient 4 A 70-year-old patient

4. Patients over the age of 65 years have the greatest risk for developing prostate cancer. Therefore a 12-year-old, a 25-year-old, and a 50-year-old are at lower risk.

Which glycoprotein is produced by the prostate gland? 1 Biliary glycoprotein 2 Airway glycoprotein 3 Erythropoietin glycoprotein 4 Prostate-specific antigen glycoprotein

4. Prostate-specific antigen is a glycoprotein produced by the prostate gland. Biliary glycoprotein is a cell adhesion glycoprotein expressed in the colon, liver, and hematopoietic tissues. The lungs produce airway glycoprotein. Erythropoietin, also known as EPO, is a glycoprotein hormone that controls erythropoiesis, or red blood cell production, and is produced in the kidneys.

Which male urologic disorder is a medical emergency? 1 Phimosis 2 Varicocele 3 Epididymitis 4 Testicular torsion

4. Testicular torsion is a urologic emergency as the spermatic cord twists, leading to ischemia. Phimosis is tightness around the foreskin and is resolved with proper hygiene. A varicocele is a vein enlargement inside the scrotum. It usually resolves on its own, and the pain can be managed with over-the-counter analgesics. Epididymitis is an infection of the epididymis and can be treated with antibiotics.