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The nurse teaches a patient who has undergone prostate surgery about health promotion measures to be followed at home. Which statement made by the patient indicates the need for further teaching? 1 "I am limiting fluid intake." 2 "I am limiting citrus juices." 3 "I am avoiding heavy lifting." 4 "I am avoiding sexual intercourse."

"I am limiting fluid intake."

When caring for a patient who has been diagnosed with orchitis, the nurse will plan to provide teaching about a. pain management. b. emergency surgical repair. c. aspiration of fluid from the scrotal sac. d. application of warm packs to the scrotum.

ANS: A Orchitis is very painful and effective pain management will be needed. The other therapies will not be used to treat orchitis.

The nurse will plan to provide teaching for a 67-year-old patient who has been diagnosed with orchitis about a. pain management. b. emergency surgical repair. c. application of heat to the scrotum. d. aspiration of fluid from the scrotal sac.

ANS: A Orchitis is very painful, and effective pain management will be needed. Heat, aspiration, and surgery are not used to treat orchitis

Which symptoms are expected in orchitis? (Select all that apply.) a. Scrotal pain b. Dysuria c. Scrotal edema d. Priapism e. Penile discharge f. Inability to ejaculate

ANS: A, B, C, E Manifestations of orchitis include scrotal pain, edema, reports of heavy feelings in the involved testicle(s), dysuria, pain on ejaculation, blood in the semen, and discharge from the penis. Ejaculation may be painful. Priapism is not a manifestation.

A patient reports an inability to attain erection, and the health care provider suspects a change in axial rigidity. For which diagnostic test will the nurse prepare the patient that is beneficial for diagnosis?

Nocturnal penile tumescence

A 73-year-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 the patient anticipatory guidance that what condition may be developing? a. a tumor of the prostate b. benign prostatic hyperplasia c. bladder atony because of age d. age-related altered innervation of the bladder

The nurse should explain to the patient who has had a vasectomy that a. the procedure blocks the production of sperm b. erectile dysfunction is temporary and will return will sexual activity c. the ejaculate will be about half the volume it was before procedure d. an alternative form of contraception will be necessary for 6-8 weeks

A male patient is infertile after having mumps as a child. Which disorder should the nurse inform the patient might occur related to the infertility?

Varicocele

The nurse is providing discharge instructions to a patient after having a vasectomy. What education should be provided in the discharge teaching?

"You will want to use an alternative form of contraception for six weeks."

The nurse is conducting a health history interview for a patient diagnosed with benign prostatic hyperplasia (BPH). Which questions are appropriate while assessing the patient's cognitive-perceptual pattern? Select all that apply.

-"Do you have bladder discomfort?" -"Do you have a sensation of incomplete voiding?"

A nurse planning a community health program on cancer awareness includes the need for testicular self-examination. What target age group would have the highest priority for this educational program?

15 to 35 years

24. A 22-year-old man tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. When assessing for possible etiologic factors, which question should the nurse ask first? a. "Are you using any recreational drugs or drinking a lot of alcohol?" b. "Have you been experiencing an unusual amount of anxiety or stress?" c. "Do you have any history of an erection that lasted for 6 hours or more?" d. "Do you have any chronic cardiovascular or peripheral vascular disease?"

ANS: A A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are not common etiologic factors in younger men.

The registered nurse (RN) is providing care to a patient who requires a bladder irrigation after a transurethral resection of the prostate (TURP) to treat benign prostatic hyperplasia (BPH). Which interventions should the nurse delegate to the licensed practical nurse (LPN) who is assigned to the patient's care team?

Administering prescribed antispasmodics as needed Monitoring catheter drainage for increased blood or clots Increasing the flow of the solution to maintain a light pink color of the outflow

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 Foley catheter C. Assessing the patient's pain and selecting analgesia D. Performing cleansing of the meatus and perineal region

D. Performing cleansing of the meatus and perineal region Performing perineal care is an appropriate task for delegation. Selecting analgesia, irrigating the patient's catheter, and assessing his incision are not appropriate skills or tasks for unlicensed personnel.

The nurse is reviewing the medication administration record for a patient with benign prostatic hypertrophy. Which medication inhibits of the synthesis of dihydrotestosterone?

Finasteride

A patient is experiencing hot flashes, loss of libido, gynecomastia, and erectile dysfunction. What androgen deprivation therapy medication should the nurse educate the patient about?

Goserelin

A patient is diagnosed with benign prostatic hyperplasia. The primary health care provider has recommended using low-wave radiofrequency to heat the prostate. Which complication would the nurse expect in the patient after the procedure? 1 Infection 2 Hematuria 3 Hydrocele 4 Retrograde ejaculation

Hematuria

A nurse is caring for a patient who has undergone radical prostatectomy. During the early postoperative period, the nurse should closely monitor the patient for what? 1 Septicemia 2 Hemorrhage 3 Renal failure 4 Respiratory distress

Hemorrhage

While caring for a patient after a transurethral procedure, the nurse observes that the patient is showing signs of bladder spasms. Which medication does the nurse expect to be prescribed to the patient? 1 Buserelin 2 Triptorelin 3 Oxybutynin 4 Zoledronic acid

Oxybutynin

The nurse is preparing a male patient for therapy to treat castration-resistant prostate cancer. What therapy should the nurse educate the patient about?

Radiotherapy

What complication does the nurse know may occur if benign prostatic hypertrophy is left untreated? 1 Urinary calculi 2 Bladder cancer 3 Prostate cancer 4 Renal insufficiency

Renal insufficiency

An older adult patient reports urinary urgency. What diagnostic findings does the nurse correlate with benign prostatic hyperplasia (BPH)? Multiple selection question Negative urinalysis and culture Elevated serum creatinine levels Residual urine with postvoiding catheterization Enlarged prostate as observed on ultrasonography Vesicle neck obstruction as observed on cystoscopy

Residual urine with postvoiding catheterization Enlarged prostate as observed on ultrasonography Vesicle neck obstruction as observed on cystoscopy

The nurse observes that a male child has the urethral meatus on the ventral surface of the penis. What condition does the nurse document this child has?

The child has hypospadias

A patient is one day postoperative following a transurethral resection of the prostate (TURP). Which event is not an expected normal finding in the care of this patient? 1 The patient requires two tablets of acetaminophen #3 during the night. 2 The patient complains of fatigue and claims to have minimal appetite. 3 The patient has continuous bladder irrigation (CBI) infusing, but output has decreased. 4 The patient has expressed anxiety about his planned discharge home the following day.

The patient has continuous bladder irrigation (CBI) infusing, but output has decreased.

The nurse is performing the physical examination of a patient with benign prostatic hyperplasia (BPH). Which finding is likely to be noted on palpation by digital rectal examination (DRE)? 1 The prostate is symmetrical, movable, and hard. 2 The prostate is asymmetrically enlarged and uneven. 3 The prostate is symmetrically enlarged, firm, and smooth. 4 The prostate is asymmetrically enlarged, movable, and hard.

The prostate is symmetrically enlarged, firm, and smooth.

When teaching a patient with testicular cancer about possible treatment options and their corresponding effects on sexual function, which should the nurse discuss with the patient? Select all that apply.

-Testicular cancer treatment involves high risk of infertility -Consider cryopreservation of sperm in a sperm bank before treatment -Retroperitoneal lymph node dissection can result in ejaculatory dysfunction

A 71-year-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

The nurse conducts a teaching session for a patient who is prescribed transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH). Which patient statements indicate correct understanding of the information presented? Multiple selection question "I will be able to go home after my treatment." "Erectile dysfunction is rare with this treatment." "I may experience urinary incontinence as a result of this treatment." "This procedure has similar results to that of a transurethral resection of the prostate." "My doctor can see my prostate and the surrounding tissue with this treatment option."

"I will be able to go home after my treatment." "Erectile dysfunction is rare with this treatment." When prescribed the TUMT treatment for BPH, the patient will be able to go home after the treatment (since it is an outpatient procedure) and erectile dysfunction is rare; therefore, these patient statements indicate correct understanding of the teaching presented by the nurse. Urinary incontinence is rare with this procedure, the TUMT does not have similar results as the transurethral resection of the prostate, and the healthcare provider cannot see the prostate and surrounding tissue. These patient statements indicate a need for further education from the nurse.

The nurse is educating a patient with testicular cancer regarding follow up-care. What should the nurse inform that patient about diagnostic testing that will be performed to detect signs of reoccurrence? Select all that apply.

-Chest x-ray -Regular physical examinations -Assessment of human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP)

A patient is suspected of having testicular cancer. Which diagnostic tests should the nurse prepare the patient for that will deliver confirmation of the diagnosis and detection of metastasis? Select all that apply.

-Chest x-ray -Ultrasound of the testes -CT-scan of abdomen and pelvis -Blood tests to detect tumor markers

A male patient presents with severe scrotal pain, tenderness, swelling, nausea, and vomiting. Urinary symptoms, fever, and white blood cells (WBCs) or bacteria in the urine are absent. Which findings in the patient would indicate a testicular torsion? Select all that apply.

-Cremasteric reflex is absent on the side of the swelling -Scrotal pain does not reduce on elevation of the scrotum -Doppler ultrasound of the testes shows decreased blood flow.

A patient with an acute inflammation of the testes is diagnosed with orchitis. When taking medical history, about which conditions should the nurse inquire to find the possible cause of orchitis? Select all that apply.

-Mumps -Syphilis -Tuberculosis

A patient is being treated with chemotherapy for testicular cancer. What side effects should the nurse monitor closely for? Select all that apply.

-Nerve damage -Kidney damage -Pulmonary toxicity

The nurse is caring for a patient suspected of having benign prostatic hyperplasia (BPH). For what diagnostic assessment should the nurse prepare the patient? Multiple choice question Colonoscopy Serum sodium Prevoid residual Digital rectal examination

A digital rectal examination A digital rectal examination is a diagnostic assessment that is implemented for any patient who is suspected of having BPH. A cystoscopy, not a colonoscopy, is a diagnostic assessment for BPH. A serum creatinine, not sodium, study is a diagnostic assessment for BPH. A postvoid, not prevoid, residual test is a diagnostic assessment for BPH.

19. When obtaining a focused health history for a patient with possible testicular cancer, the nurse will ask the patient about any history of a. sexually transmitted disease (STD) infection. b. testicular trauma. c. testicular torsion. d. undescended testicles.

ANS: D Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STD infection, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer.

When working in the emergency department you recognize the need for immediate diagnosis and treatment of the patient with A. orchitis. B. phimosis. C. epididymitis. D. testicular torsion.

Answer: D Torsion constitutes a surgical emergency. If the blood supply to the affected testicle is not restored within 4 to 6 hours, testicular ischemia will occur, leading to necrosis and possible removal.

The nurse is educating a patient regarding erectile dysfunction. What risk factor should the nurse be sure to discuss with the patient?

Atherosclerosis

A patient undergoing a TURP returns from surgery with a three-way urinary catheter with continuous bladder irrigation in place. The nurse observes that the urine output has decreased and the urine is clear red with multiple clots. The patient is complaining of painful bladder spasms. The most appropriate action by the nurse is to a. administer the ordered IV morphine sulfate, 4 mg. b. increase the flow rate of the continuous bladder irrigation. c. give the ordered the belladonna and opium suppository. d. manually instill 50 ml of saline and try to remove the clots.

Correct Answer: D Rationale: The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.

A patient with prostatic hyperplasia presents with obstructive symptoms. What instructions should the nurse give to this patient to relieve the symptoms? Select all that apply. 1 Reduce fluid intake. 2 Urinate every two to three hours. 3 Maintain adequate fluid intake. 4 Rapidly increase fluid intake. 5 Urinate when experiencing the first urge to void.

Urinate every two to three hours. Maintain adequate fluid intake. Urinate when experiencing the first urge to void.

What do you tell the patient with chronic bacterial prostatitis who is undergoing antibiotic therapy (select all that apply)? A. Hospitalization is required of all patients. B. Pain will lessen after treatment has ended. C. The course of treatment usually is 2 to 4 weeks. D. Long-term therapy may be indicated for immunocompromised patients. E. If the condition is unresolved and untreated, the patient is at risk for prostate cancer.

answer: B, D Patients with chronic bacterial prostatitis are usually given antibiotics for 4 to 12 weeks. However, antibiotics may be given for a lifetime if the patient is immunocompromised. Although patients with chronic bacterial prostatitis tend to experience a great amount of discomfort, the pain resolves as the infection is treated. If the patient with acute bacterial prostatitis has high fever or other signs of impending sepsis, hospitalization and intravenous antibiotics are prescribed.

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 Foley catheter c. assessing the patient's pain and selecting analgesia d. performing cleansing of the meatus and perineal region

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

b, c, d. TUNA, TUIP, and TUMT are currently done on an outpatient basis or in a health care provider's office.

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.

c. Classic symptoms of uncomplicated BPH are those associated with irritative symptoms, including nocturia, frequency, urgency, dysuria, bladder pain, and incontinence associated with inflammation or infection. Urinary obstruction symptoms 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.

5alpha-Reductase Inhibitors Work by

reducing size of the prostate finasteride (Proscar) & dutasteride (Avodart)

The nurse is conducting a health history for a male patient. Which information does the nurse identify as increasing the patient's risk for benign prostatic hyperplasia (BPH)? Multiple choice question A history of hyperthyroidism A father with a history of BPH A body mass index (BMI) of 28 Physical activity for 30 minutes at least five days a week

A father with a history of BPH A first-degree relative, such as the patient's father, with a history of BPH is a risk factor for developing this condition. A history of diabetes, not hyperthyroidism, is a risk factor. Obesity, not being overweight as indicated by the current BMI, is a risk factor for BPH. A lack of physical activity is a risk for BPH.

A male patient reports fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)?

A very tender prostate gland

After a vasectomy, what teaching should be included in the discharge teaching? A. "You will want to use an alternative form of contraception for 6 weeks." B. "You may lose some secondary sexual characteristics after this surgery." C. "You may have erectile dysfunction for several months after this surgery." D. "You will be uncomfortable, but you may safely have sexual intercourse today."

A. "You will want to use an alternative form of contraception for 6 weeks." As 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, usually at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site. 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.

alpha-Adrenergic Receptor Blockers Promote

smooth muscle relaxation in the prostate; ultimately facilitates urinary flow through urethra Symptomatic relief but do not treat hyperplasia doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin), tamsulosin (Flomax)

A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (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

B. A very tender prostate gland A tender and swollen prostate is indicative of prostatis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatis 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 prostatis.

A 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 the patient anticipatory guidance that what condition may be developing? 1 A tumor of the prostate 2 Benign prostatic hyperplasia 3 Bladder atony because of age 4 Age-related altered innervation of the bladder

Benign prostatic hyperplasia

The nurse finds that a patient has nocturia, bladder pain, and an enlarged prostate. The laboratory findings reveal a serum creatinine level at 1.7 mg/dL, white blood cell count at 18,000 per microliter, and prostate-specific antigen levels at 6.0 ng/mL. Which complication does the nurse expect in the patient? 1 Hypospadias 2 Peyronie's disease 3 Benign prostatic hyperplasia 4 Nonmetastatic prostate cancer

Benign prostatic hyperplasia

When assessing a patient with benign prostatic hyperplasia (BPH), the nurse evaluates possible complications of urinary obstruction. Which are the most appropriate conditions that the nurse should consider? Select all that apply. 1 Bladder calculi 2 Cardiac disorders 3 Digestive problems 4 Urinary tract infection 5 Acute urinary retention

Bladder calculi Urinary tract infection Acute urinary retention

The nurse teaches a 30-year-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, and hot tea

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.

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. monitoring for postoperative urinary retention. b. teaching about the effects of general anesthesia. c. to be informed of the possibility of short-term incontinence. d. instruction about home management of an indwelling catheter.

Correct Answer: D Rationale: 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.

The health care provider orders a blood test for prostate-specific antigen (PSA) when an enlarged prostate is palpated during a routine examination of a 56-year-old man. When the patient asks the nurse the purpose of the test, the nurse's response is based on the knowledge that a. elevated levels of PSA are indicative of metastatic cancer of the prostate. b. PSA testing is the "gold standard" for making a diagnosis of prostate cancer. c. baseline PSA levels are necessary to determine whether treatment is effective. d. PSA levels are usually elevated in patients with cancer of the prostate.

Correct Answer: D Rationale: PSA levels are usually elevated above the normal in patients with prostate cancer. PSA testing does not determine whether metastasis has occurred. A biopsy of the prostate is needed for a definitive diagnosis of prostate cancer. Success of treatment is determined by a fall in PSA to an undetectable level; the patient's baseline PSA is not needed to determine the success of treatment.

The nurse coordinates postoperative care for a 70-year-old man with osteoarthritis after prostate surgery. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN)? A. Teach the patient how to perform Kegel exercises. B. Provide instructions to the patient on catheter care. C. Administer oxybutynin (Ditropan) for bladder spasms. D. Manually irrigate the urinary catheter to determine patency.

D. Manually irrigate the urinary catheter to determine patency. 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, administer antispasmodics and analgesics as needed. A registered nurse may not delegate teaching, assessments, or clinical judgments to a LPN/LVN.

Which factors would place a patient at higher risk for prostate cancer (select all that apply)? a. older than 65 years b. Asian or Native American c. long-term use of an indwelling urethral catheter d. father diagnosed and treated for early stage prostate cancer e. previous history of undescended testicle and testicular cancer

a, d.

A 33-year-old patient noticed a painless lump in his scrotum on self-examination of his testicles and a feeling of heaviness. The nurse should first teach him about what diagnostic test? a. ultrasound b. cremasteric reflex c. doppler ultrasound d. transillumination with a flashlight

A patient scheduled for a prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. 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 erectile dysfunction

The nurse explains to the patient with chronic bacterial prostatitis who is undergoing antibiotic therapy that (select all that apply) 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

b, d.

A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (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

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 now indicate that the prostate cancer may be growing and he needs a change in his care (select all that apply)? a. casts in his urine b. presence of alpha-fetoprotein c. serum PSA of 10ng/mL d. onset of erectile dysfunction e. nodularity of the prostate gland

c, e.

A patient is one day postoperative following a transurethral resection of the prostate (TURP). Which event is not an expected normal finding in the care of this patient? a. the patient requires two tablets of Tylenol #3 during the night b. the patient complains of fatigue and claims to have minimal appetite c. the patient has continuous bladder irritation (CBI) infusing, but output has decreased d. the patient has expressed anxiety about his planned discharge home the following day

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 problems and bilateral scrotal tenderness d. painless mass and heaviness sensation in the scrotal area

Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a three-way urinary catheter with a 30-mL 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 the bladder b. deflate the catheter balloon and then reinflate to ensure 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 he should not try to urinate around the catheter

A patient informs the nurse they have a loss of libido, inability to sustain an erection, fatigue, and mood swings, and laboratory tests show that testosterone levels are 190 ng/dL. Which medications will the nurse educate the patient about that are beneficial to treat the patient's condition? Select all that apply.

-Testim -Acetonide -Androderm

A couple is seen at the infertility clinic because they have not been able to conceive. When performing a focused examination to determine any possible causes for infertility, the nurse will check the man for the presence of a. hydrocele. b. varicocele. c. epididymitis. d. paraphimosis.

ANS: B Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility

The nurse performing a focused examination to determine possible causes of infertility will assess for a. hydrocele. b. varicocele. c. epididymitis. d. paraphimosis.

ANS: B Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility

The nurse is caring for a patient with severe symptoms of benign prostatic hyperplasia (BPH). What might be the American Urological Association (AUA) symptom score?

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-year-old white male with a history of cryptorchidism B. A 48-year-old African American male with erectile dysfunction C. A 19-year-old Asian male who had surgery for testicular torsion D. A 28-year-old Hispanic male with infertility caused by a varicocele

A. A 30-year-old white male with a history of cryptorchidism The incidence of testicular cancer is four times higher in white males than in African American males. Testicular tumors are also more common in males 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 DES, and testicular cancer in the contralateral testis.

The nurse is caring for a 62-year-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 exams are not needed after surgery.

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.

A 71-year-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

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, sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.

A 33-year-old patient noticed a painless lump in his scrotum on self-examination of his testicles and a feeling of heaviness. The nurse should first teach him about what diagnostic test? A. Ultrasound B. Cremasteric reflex C. Doppler ultrasound D. Transillumination with a flashlight

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 22-year-old man tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. When assessing for possible etiologic factors, which question should the nurse ask first? a. "Are you using any recreational drugs or drinking a lot of alcohol?" b. "Have you been experiencing an unusual amount of anxiety or stress?" c. "Do you have any history of an erection that lasted for 6 hours or more?" d. "Do you have any chronic cardiovascular or peripheral vascular disease?"

A client with prostate cancer reports pain in his lower back and legs. Which action by the nurse is most appropriate? a. Discuss medications for arthritis. b. Perform a bladder scan. c. Facilitate imaging studies. d. Encourage weight-bearing exercises.

ANS: C The primary site of metastasis for prostate cancer is the bone of the spine and the legs. The nurse should suspect metastasis and inform the health care provider. The client will need imaging studies to look for metastasis, and the nurse should facilitate them. The other interventions are not appropriate.

A 70-year-old patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) is being discharged from the hospital today, The nurse determines that additional instruction is needed when the patient says which of the following? a. "I should call the doctor if I have incontinence at home." b. "I will avoid driving until I get approval from my doctor." c. "I will increase fiber and fluids in my diet to prevent constipation." d. "I should continue to schedule yearly appointments for prostate exams."

ANS: A Because incontinence is common for several weeks after a TURP, the patient does not need to call the health care provider if this occurs. The other patient statements indicate that the patient has a good understanding of post-TURP instructions

When performing discharge teaching for a patient after a vasectomy, the nurse instructs the patient that he a. should continue to use other methods of birth control for 6 weeks. b. should not have sexual intercourse until his 6-week follow-up visit. c. may have temporary erectile dysfunction (ED) because of swelling. d. will notice a decrease in the appearance and volume of his ejaculate.

ANS: A 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

25. A 53-year-old man tells the nurse he has been having increasing problems with erectile dysfunction (ED) for several years but is now interested in using Viagra (sildenafil). Which action should the nurse take first? a. Ask the patient about any prescription drugs he is taking. b. Tell the patient that Viagra does not always work for ED. c. Discuss the common adverse effects of erectogenic drugs. d. Assure the patient that ED is commonly associated with aging.

ANS: A Because some medications can cause ED and patients using nitrates should not take Viagra, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of Viagra therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease in a 53-year-old.

A 53-year-old man tells the nurse he has been having increasing problems with erectile dysfunction (ED) for several years but is now interested in using Viagra (sildenafil). Which action should the nurse take first? a. Ask the patient about any prescription drugs he is taking. b. Tell the patient that Viagra does not always work for ED. c. Discuss the common adverse effects of erectogenic drugs. d. Assure the patient that ED is commonly associated with aging.

A patient with urinary obstruction from benign prostatic hyperplasia (BPH) tells the nurse, "My symptoms are much worse this week." Which response by the nurse is most appropriate? a. "Have you been taking any over-the-counter (OTC) medications recently?" b. "I will talk to the doctor about ordering a prostate specific antigen (PSA) test." c. "Have you talked to the doctor about surgery such as transurethral resection of the prostate (TURP)?" d. "The prostate gland changes in size from day to day, and this may be making your symptoms worse."

ANS: A Because the patient's increase in symptoms has occurred abruptly, the nurse should ask about OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer

Which statement indicates that a client understands the most appropriate time of day to take an alpha blocker drug for treatment of benign prostatic hyperplasia (BPH)? a. "I'll take my medication at bedtime." b. "As soon as I get up, I will take my medication." c. "I will take my medication with food or milk." d. "I'll take my medication on an empty stomach."

ANS: A Bedtime dosing should decrease the risk of hypotension with an alpha blocker drug. Giving the medication during the day will increase the client's risk of experiencing weakness, lightheadedness, and dizziness.

A client with a catheter in place after a suprapubic prostatectomy has decreased urinary output. Which action by the nurse is most appropriate? a. Assess the client for bladder spasms. b. Encourage the client to drink more water. c. Administer pain medication. d. Have the client try to void around the catheter.

ANS: A Bladder spasms and decreased urinary output can indicate obstruction. The nurse should assess whether the client is experiencing these spasms and should treat the client with an antispasmodic if needed. Encouraging increased intake will not be helpful if the problem is obstruction. Pain medication will not be helpful, although an antispasmodic can be beneficial. Trying to void around the catheter is not recommended.

The nurse will inform a patient with cancer of the prostate that side effects of leuprolide (Lupron) may include a. flushing. b. dizziness. c. infection. d. incontinence.

ANS: A Hot flashes may occur with decreased testosterone production. Dizziness may occur with the alpha-blockers used for benign prostatic hyperplasia (BPH). Urinary incontinence may occur after prostate surgery, but it is not an expected side effect of medication. Risk for infection is increased in patients receiving chemotherapy

20. When caring for a patient who has been diagnosed with orchitis, the nurse will plan to provide teaching about a. pain management. b. emergency surgical repair. c. aspiration of fluid from the scrotal sac. d. application of warm packs to the scrotum.

ANS: A Orchitis is very painful and effective pain management will be needed. The other therapies will not be used to treat orchitis.

A client had a seminoma removed via an open procedure. The following day, the client's abdomen is soft and nontender, but no bowel sounds are present. Which action by the nurse is most appropriate? a. Encourage the client to ambulate several times a day. b. Reassess the client's abdomen in 4 hours. c. Document the finding and call the surgeon immediately. d. Give the client a laxative and encourage high-fiber food.

ANS: A Paralytic ileus is a complication of open seminoma removal. However, on the day after a major, lengthy operation, it is common for bowel sounds to still be absent. Narcotic analgesics can diminish bowel activity. The client can improve peristalsis with increased activity. It is not necessary to re-examine the client in 4 hours, nor is it necessary to call the surgeon right away. A laxative probably is not needed yet. The client should eat high-fiber foods when they can be tolerated.

15. A 32-year-old man who is being admitted for a unilateral orchiectomy for testicular cancer does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is best for the nurse to take? a. Ask the patient if he has any questions or concerns about the diagnosis and treatment. b. Document the patient's lack of communication on the chart and continue preoperative care. c. Assure the patient's wife that concerns about sexual function are common with this diagnosis. d. Teach the patient and the wife that impotence is rarely a problem after unilateral orchiectomy.

ANS: A The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer education about complications after orchiectomy. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.

A 32-year-old man who is being admitted for a unilateral orchiectomy for testicular cancer does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is best for the nurse to take? a. Ask the patient if he has any questions or concerns about the diagnosis and treatment. b. Document the patient's lack of communication on the chart and continue preoperative care. c. Assure the patient's wife that concerns about sexual function are common with this diagnosis. d. Teach the patient and the wife that impotence is rarely a problem after unilateral orchiectomy.

6. A patient with symptomatic benign prostatic hyperplasia (BPH) is scheduled for photovaporization of the prostate (PVP) at an outpatient surgical center. The nurse will plan to teach the patient a. how to care for an indwelling urinary catheter. b. that the urine will appear bloody for several days. c. about complications associated with urethral stenting. d. that symptom improvement will occur in 2 to 3 weeks.

ANS: A The patient will have an indwelling catheter for 24 to 48 hours and will need teaching about catheter care. There is minimal bleeding with this procedure. Symptom improvement is almost immediate after PVP. Stent placement is not included in the procedure.

A patient with symptomatic benign prostatic hyperplasia (BPH) is scheduled for photovaporization of the prostate (PVP) at an outpatient surgical center. The nurse will plan to teach the patient a. how to care for an indwelling urinary catheter. b. that the urine will appear bloody for several days. c. about complications associated with urethral stenting. d. that symptom improvement will occur in 2 to 3 weeks.

Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first? a. 22-year-old who has noticed a firm, nontender lump on his scrotum b. 35-year-old who is concerned that his scrotum "feels like a bag of worms" c. 40-year-old who has pelvic pain while being treated for chronic prostatitis d. 70-year-old who is reporting frequent urinary dribbling after a prostatectomy

ANS: A The patient's age and symptoms suggest possible testicular cancer. Some forms of testicular cancer can be very aggressive, so the patient should be evaluated by the health care provider as soon as possible. Varicoceles do require treatment, but not emergently. Ongoing pelvic pain is common with chronic prostatitis. Urinary dribbling is a common problem after prostatectomy

The following male patients recently arrived in the emergency department. Which one should the nurse assess first? a. 19-year-old who is complaining of severe scrotal pain b. 60-year-old with a nontender ulceration of the glans penis c. 22-year-old who has purulent urethral drainage and back pain d. 64-year-old who has dysuria after brachytherapy for prostate cancer

ANS: A The patient's age and symptoms suggest possible testicular torsion, which will require rapid treatment in order to prevent testicular necrosis. The other patients also require assessment by the nurse, but their history and symptoms indicate nonemergent problems (acute prostatitis, cancer of the penis, and radiation-associated urinary tract irritation)

17. A 46-year-old man who has erectile dysfunction (ED) tells the nurse that he decided to seek treatment because his wife "is losing patience with the situation." The most appropriate nursing diagnosis for the patient is a. ineffective role performance related to effects of ED. b. anxiety related to inability to have sexual intercourse. c. situational low self-esteem related to decrease in sexual activity. d. ineffective sexuality patterns related to frequency of intercourse.

ANS: A The patient's statement indicates that the relationship with his wife is his primary concern. Although anxiety, low self-esteem, and ineffective sexuality patterns also may be concerns, the patient information suggests that addressing the role performance problem will lead to the best outcome for this patient.

A 46-year-old man who has erectile dysfunction (ED) tells the nurse that he decided to seek treatment because his wife "is losing patience with the situation." The most appropriate nursing diagnosis for the patient is a. ineffective role performance related to effects of ED. b. anxiety related to inability to have sexual intercourse. c. situational low self-esteem related to decrease in sexual activity. d. ineffective sexuality patterns related to frequency of intercourse.

A client with BPH asks why his enlarged prostate is causing difficulty with urination. Which is the nurse's most accurate response? a. "It compresses the urethra, blocking the flow of urine." b. "It presses on the kidneys, decreasing urine formation." c. "It secretes acids that weaken the bladder, causing dribbling." d. "It destroys nerves, decreasing awareness of a full bladder."

ANS: A The prostate gland encircles the urethra and bladder neck like a doughnut. Enlargement of the gland constricts the urethra and obstructs the outflow of urine by encroaching on the bladder opening. The other responses are inaccurate.

Which information will the nurse plan to include when teaching a community health group about testicular self-examination? a. Testicular self-examination should be done in a warm room. b. The only structure normally felt in the scrotal sac is the testis. c. Testicular self-examination should be done at least every week. d. Call the health care provider if one testis is larger than the other.

ANS: A The testes will hang lower in the scrotum when the temperature is warm (e.g., during a shower), and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One testis is normally larger. The patient should perform testicular self-examination monthly

14. Which information will the nurse plan to include when teaching a 19-year-old to perform testicular self-examination? a. Testicular self-examination should be done in a warm area. b. The only structure normally felt in the scrotal sac is the testis. c. Testicular self-examination should be done at least every week. d. Call the health care provider if one testis is larger than the other.

Which information will the nurse plan to include when teaching a 19-year-old to perform testicular self-examination? a. Testicular self-examination should be done in a warm area. b. The only structure normally felt in the scrotal sac is the testis. c. Testicular self-examination should be done at least every week. d. Call the health care provider if one testis is larger than the other.

13. A couple is seen at the infertility clinic because they have not been able to conceive. When performing a focused examination to determine any possible causes for infertility, the nurse will check the man for the presence of a. hydrocele. b. varicocele. c. epididymitis. d. paraphimosis.

ANS: B Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility

A 22-year-old man tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. Which question should the nurse ask first to assess for possible etiologic factors? a. "Do you experience an unusual amount of stress?" b. "Do you use any recreational drugs or drink alcohol?" c. "Do you have chronic cardiovascular or peripheral vascular disease?" d. "Do you have a history of an erection that lasted for 6 hours or more?"

ANS: B A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are not common etiologic factors in younger men

3. The health care provider prescribes finasteride (Proscar) for a 56-year-old patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that a. he should change position from lying to standing slowly to avoid dizziness. b. his interest in sexual activity may decrease while he is taking the medication. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

ANS: B A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient also is taking a medication for erectile dysfunction (ED), it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension.

The health care provider prescribes finasteride (Proscar) for a 56-year-old patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that a. he should change position from lying to standing slowly to avoid dizziness. b. his interest in sexual activity may decrease while he is taking the medication. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

Which childhood disease is often associated with orchitis? A. Measles B. Mumps C. Strep throat D. Chickenpox

Answer: B Orchitis refers to an acute inflammation of the testis. In orchitis, the testis is painful, tender, and swollen. It usually occurs after an episode of bacterial or viral infection, such as mumps. The other disorders are not associated with mumps.

The health care provider prescribes finasteride (Proscar) for a 67-year-old patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that a. he should change position from lying to standing slowly to avoid dizziness. b. his interest in sexual activity may decrease while he is taking the medication. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

ANS: B A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient is also taking a medication for erectile dysfunction (ED), it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension

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.

ANS: B 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 who was treated 1 year ago for testicular cancer now has an elevated serum alpha-fetoprotein level. Which topic is most important for the nurse to teach this client about? a. Sperm banking options b. Effects of chemotherapy c. Hospice philosophy d. Importance of yearly monitoring

ANS: B Alpha-fetoprotein is a tumor marker that is not produced in significant amounts by normal adult tissues. An increase in the level of alpha-fetoprotein after treatment most commonly indicates recurrence or metastasis. Chemotherapy is used to treat recurrent or metastatic disease. The client should already have been taught about sperm banking. Hospice is not indicated at this time. Because a rise in these levels indicates recurrence or metastasis, yearly monitoring is not appropriate.

16. 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. he may have temporary erectile dysfunction (ED) because of postoperative swelling. b. he should continue to use other methods of birth control for 6 weeks. c. he should not have sexual intercourse until his 6-week follow-up visit. d. he will notice a decrease in the appearance and volume of his ejaculate.

ANS: B 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. he may have temporary erectile dysfunction (ED) because of postoperative swelling. b. he should continue to use other methods of birth control for 6 weeks. c. he should not have sexual intercourse until his 6-week follow-up visit. d. he will notice a decrease in the appearance and volume of his ejaculate.

A 58-year-old man with erectile dysfunction (ED) tells the nurse he is interested in using sildenafil (Viagra). Which action should the nurse take first? a. Assure the patient that ED is common with aging. b. Ask the patient about any prescription drugs he is taking. c. Tell the patient that Viagra does not always work for ED. d. Discuss the common adverse effects of erectogenic drugs.

ANS: B Because some medications can cause ED and patients using nitrates should not take sildenafil, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of sildenafil therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease

18. A patient with benign prostatic hyperplasia (BPH) with mild obstruction tells the nurse, "My symptoms have gotten a lot worse this week." Which response by the nurse is most appropriate? a. "I will talk to the doctor about ordering a prostate specific antigen (PSA) test." b. "Have you been taking any over-the-counter (OTC) medications recently?" c. "Have you talked to the doctor about surgical procedures such as transurethral resection of the prostate (TURP)?" d. "The prostate gland changes slightly in size from day to day, and this may be making your symptoms worse."

ANS: B Because the patient's increase in symptoms has occurred abruptly, the nurse should ask about OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer.

A patient with benign prostatic hyperplasia (BPH) with mild obstruction tells the nurse, "My symptoms have gotten a lot worse this week." Which response by the nurse is most appropriate? a. "I will talk to the doctor about ordering a prostate specific antigen (PSA) test." b. "Have you been taking any over-the-counter (OTC) medications recently?" c. "Have you talked to the doctor about surgical procedures such as transurethral resection of the prostate (TURP)?" d. "The prostate gland changes slightly in size from day to day, and this may be making your symptoms worse."

A client's laboratory findings reveal an elevated serum acid phosphatase level and a high-normal prostate-specific antigen level. How does the nurse interpret this information? a. The client shows evidence of renal disease and should be evaluated further. b. These results may indicate prostate cancer. He should be further evaluated. c. These results are not abnormal. He does not need to be evaluated further. d. These results may indicate an infection. He should be evaluated further.

ANS: B Both serum acid phosphatase and prostate-specific antigen levels will be elevated when the client has prostate cancer. The results are not indicative of renal disease or infection, but they are abnormal, may indicate prostate cancer, and should be further evaluated.

A 58-year-old patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because it might affect his ability to maintain an erection during intercourse. Which action should the nurse take? a. Provide teaching about medications for erectile dysfunction (ED). b. Discuss that TURP does not commonly affect erectile function. c. Offer reassurance that sperm production is not affected by TURP. d. Discuss alternative methods of sexual expression besides intercourse.

ANS: B ED is not a concern with TURP, although retrograde ejaculation is likely and the nurse should discuss this with the patient. 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 client is receiving brachytherapy for prostate cancer. Which intervention is most important for the nurse to include in the client's care plan? a. Reassure the client that erectile dysfunction does not occur with brachytherapy. b. Help the client plan activities interspersed with rest periods during the day. c. Remind the client that while hospitalized, he cannot have any visitors. d. Discuss hospice philosophy and availability with the client and family.

ANS: B Fatigue is common throughout treatment and may continue for several months after treatment has concluded. The client will need to learn to manage the fatigue; this can include spacing activities and planning for rest periods throughout the day. Erectile dysfunction can occur as a side effect of brachytherapy. This procedure is usually done on an outpatient basis, and the client does not pose a danger to others. Brachytherapy is often a first-line treatment choice, so discussion of hospice is not appropriate at this time.

11. Leuprolide (Lupron) is prescribed for a patient with cancer of the prostate. In teaching the patient about this drug, the nurse informs the patient that side effects may include a. dizziness. b. hot flashes. c. urinary incontinence. d. increased infection risk.

ANS: B Hot flashes may occur with decreased testosterone production. Dizziness may occur with the -blockers used for benign prostatic hyperplasia (BPH). Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy.

Leuprolide (Lupron) is prescribed for a patient with cancer of the prostate. In teaching the patient about this drug, the nurse informs the patient that side effects may include a. dizziness. b. hot flashes. c. urinary incontinence. d. increased infection risk.

Which client is most likely to have organic erectile dysfunction? a. Middle-aged man who first had sexual intercourse at age 15 b. Middle-aged man who has had diabetes mellitus for 25 years c. Young man who had a myocardial infarction 2 years ago d. Young man who has a job that causes him high stress levels

ANS: B Organic erectile dysfunction occurs as a gradual reduction in sexual functioning. Diabetes mellitus causes microvascular and macrovascular complications that decrease the sensation and autonomic nerve activity required for achievement of an erection. The other factors will not increase the client's risk for development of organic erectile dysfunction.

9. Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of urine. The nurse will plan to teach the patient a. to restrict oral fluid intake. b. pelvic floor muscle exercises. c. the use of belladonna and opium suppositories. d. how to perform intermittent self-catheterization.

ANS: B Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L.

A 57-year-old patient is incontinent of urine following a radical retropubic prostatectomy. The nurse will plan to teach the patient a. to restrict oral fluid intake. b. pelvic floor muscle exercises. c. to perform intermittent self-catheterization. d. the use of belladonna and opium suppositories.

Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of urine. The nurse will plan to teach the patient a. to restrict oral fluid intake. b. pelvic floor muscle exercises. c. the use of belladonna and opium suppositories. d. how to perform intermittent self-catheterization.

A complication of prostatitis is A. prostatic cancer. B. benign prostatic hyperplasia. C. acute urinary retention. D. hydrocele.

Answer: C Acute urinary retention can develop in acute prostatitis, and it requires bladder drainage with suprapubic catheterization. Passage of a catheter through an inflamed urethra is contraindicated in acute prostatitis.

The nurse in a health clinic receives requests for appointments from several patients. Which patient should be seen by the health care provider first? a. A 48-year-old man who has perineal pain and a temperature of 100.4° F b. A 58-year-old man who has a painful erection that has lasted over 6 hours c. A 38-year-old man who states he had difficulty maintaining an erection last night d. A 68-year-old man who has pink urine after a transurethral resection of the prostate (TURP) 3 days ago

ANS: B Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications

26. The nurse working in a health clinic receives calls from all these patients. Which patient should be seen by the health care provider first? a. A 44-year-old man who has perineal pain and a temperature of 100.4° F b. A 66-year-old man who has a painful erection that has lasted over 7 hours c. A 62-year-old man who has light pink urine after having a transurethral resection of the prostate (TURP) 3 days ago d. A 23-year-old man who states he had difficulty maintaining an erection last night

The nurse working in a health clinic receives calls from all these patients. Which patient should be seen by the health care provider first? a. A 44-year-old man who has perineal pain and a temperature of 100.4° F b. A 66-year-old man who has a painful erection that has lasted over 7 hours c. A 62-year-old man who has light pink urine after having a transurethral resection of the prostate (TURP) 3 days ago d. A 23-year-old man who states he had difficulty maintaining an erection last night

10. Following discharge teaching for a patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, a. "I will avoid driving until I get approval from my doctor." b. "I should call the doctor if I have any incontinence at home." c. "I will increase fiber and fluids in my diet to prevent constipation." d. "I should continue to schedule yearly appointments for prostate exams."

ANS: B Since incontinence is common for several weeks after a TURP, the patient does not need to call the health care provider if this occurs. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.

Following discharge teaching for a patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, a. "I will avoid driving until I get approval from my doctor." b. "I should call the doctor if I have any incontinence at home." c. "I will increase fiber and fluids in my diet to prevent constipation." d. "I should continue to schedule yearly appointments for prostate exams."

A client has been taking finasteride (Proscar) for 4 weeks and reports that he has not yet seen a reduction in symptoms. Which response by the nurse is most appropriate? a. "Have you been taking the medication as ordered?" b. "It may take several months to see results." c. "It may not be the right drug for you." d. "We can try dutasteride (Avodart) next."

ANS: B So that he does not become discouraged, the nurse should first reassure the client that this class of medications may take up to 6 months to be effective. The nurse then can assess for compliance, but asking that question first may put the client on the defensive. The client needs to try the medication for several more months before the health care team changes it. Avodart is in the same class of medications, and its use for up to 6 months of therapy may be required before results are seen.

The nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the laboratory results of these patients. Which patient's PSA result is most important to report to the health care provider? a. A 38-year-old who is being treated for acute prostatitis b. A 48-year-old whose father died of metastatic prostate cancer c. A 52-year-old who goes on long bicycle rides every weekend d. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH)

ANS: B The family history of prostate cancer and elevation of PSA indicate that further evaluation of the patient for prostate cancer is needed. Elevations in PSA for the other patients are not unusual

A 27-year-old man who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is best for the nurse to take? a. Teach the patient and the wife that impotence is unlikely after unilateral orchiectomy. b. Ask the patient if he has any questions or concerns about the diagnosis and treatment. c. Document the patient's lack of communication on the chart and continue preoperative care. d. Inform the patient's wife that concerns about sexual function are common with this diagnosis.

ANS: B The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer teaching about complications after orchiectomy. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation

A 71-year-old patient who has benign prostatic hyperplasia (BPH) with urinary retention is admitted to the hospital with elevated blood urea nitrogen (BUN) and creatinine. Which prescribed therapy should the nurse implement first? a. Infuse normal saline at 50 mL/hr. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Schedule a pelvic computed tomography (CT) scan.

ANS: B The patient data indicate that the patient may have acute kidney injury caused by the BPH. The initial therapy will be to insert a catheter. The other actions are also appropriate, but they can be implemented after the acute urinary retention is resolved

You recognize the need to begin testosterone therapy when testosterone levels drop below A. 750 ng/dL. B. 500 ng/dL. C. 400 ng/dL. D. 250 ng/dL.

Answer: D Normal testosterone levels can range from 280 to 1100 ng/dL. Replacement therapy may be considered when levels are below 250 ng/dL.

21. A patient with benign prostatic hyperplasia (BPH) is admitted to the hospital with urinary retention and new onset elevations in the blood urea nitrogen (BUN) and creatinine. Which of these prescribed therapies should the nurse implement first? a. Schedule an abdominal computed tomography (CT) scan. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Infuse normal saline at 50 mL/hr.

ANS: B The patient data indicate that the patient may have acute renal failure caused by the BPH. The initial therapy will be to insert a catheter. The other actions also are appropriate, but they can be implemented after the acute urinary retention is resolved.

A patient with benign prostatic hyperplasia (BPH) is admitted to the hospital with urinary retention and new onset elevations in the blood urea nitrogen (BUN) and creatinine. Which of these prescribed therapies should the nurse implement first? a. Schedule an abdominal computed tomography (CT) scan. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Infuse normal saline at 50 mL/hr.

The nurse will plan to teach the patient scheduled for photovaporization of the prostate (PVP) a. that urine will appear bloody for several days. b. how to care for an indwelling urinary catheter. c. that symptom improvement takes 2 to 3 weeks. d. about complications associated with urethral stenting.

ANS: B The patient will have an indwelling catheter for 24 to 48 hours and will need teaching about catheter care. There is minimal bleeding with this procedure. Symptom improvement is almost immediate after PVP. Stent placement is not included in the procedure

A 52-year-old man tells the nurse that he decided to seek treatment for erectile dysfunction (ED) because his wife "is losing patience with the situation." The most appropriate nursing diagnosis for the patient is a. situational low self-esteem related to effects of ED. b. ineffective role performance related to effects of ED. c. anxiety related to inability to have sexual intercourse. d. ineffective sexuality patterns related to infrequent intercourse.

ANS: B The patient's statement indicates that the relationship with his wife is his primary concern. Although anxiety, low self-esteem, and ineffective sexuality patterns may also be concerns, the patient information suggests that addressing the role performance problem will lead to the best outcome for this patient

When caring for a patient with continuous bladder irrigation after having transurethral resection of the prostate, which action could the nurse delegate to unlicensed assistive personnel (UAP)? a. Teach the patient how to perform Kegel exercises. b. Report any complaints of pain or spasms to the nurse. c. Monitor for increases in bleeding or presence of clots. d. Increase the flow rate of the irrigation if clots are noted.

ANS: B UAP education and role includes reporting patient concerns to supervising nurses. Patient teaching, assessments for complications, and actions such as bladder irrigation require more education and should be done by licensed nursing staff

A client had a transurethral prostatectomy and has incontinence. Which statement by the client indicates a need for clarification about managing this condition? a. "I will practice stopping the urine stream to strengthen my sphincter control." b. "I will limit my fluid intake every day to prevent incontinence." c. "I will avoid vigorous activity for the first 3 weeks after surgery." d. "I will avoid caffeinated beverages and spicy foods."

ANS: B Unless fluid restriction is needed because of another medical problem, clients with incontinence should drink plenty of water and other fluids. Client statements regarding Kegel exercises, activity restrictions post-surgery, and avoiding bladder irritants are all indicative of understanding.

An older client with benign prostatic hyperplasia (BPH) and hypertension is being treated with doxazosin (Cardura) while staying in the hospital. Which activity does the nurse delegate to the unlicensed assistive personnel (UAP) as a priority? a. Helping the client choose low-sodium meal items b. Assisting the client whenever he gets out of bed c. Encouraging the client to use the spirometer hourly d. Frequently re-orienting the client to his surroundings

ANS: B When treating a client in an inpatient setting with alpha blockers such as doxazosin (Cardura) or terazosin (Hytrin), the nurse must provide for the client's safety because this medication can cause orthostatic hypotension or syncope. The nurse should instruct the UAP to help the client whenever he gets out of bed, to prevent injury. Because this medication is being used for BPH and not for hypertension, a low-sodium diet is not necessary. Using the spirometer is always a good intervention, but it use is not related to safety and to this medication. The client, although older, may not be confused and may not need frequent reorientation.

A client has returned to the nursing unit after a prostatectomy. Which activities does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Demonstrating how to use the incentive spirometer b. Measuring and recording output from the in-dwelling catheter c. Encouraging the client to get out of bed and into the chair d. Irrigating the catheter with normal saline for blood clots e. Re-taping the catheter tape if the client reports pain

ANS: B, C The UAP can assess and document intake and output and can encourage the client to get out of bed. Use of the incentive spirometer is taught by the nurse or respiratory therapist. The catheter is irrigated by the nurse. The catheter should be taped so that slight traction is left on it to help with bleeding; this may cause discomfort and would need to be explained to the client. The catheter should not be repositioned and then re-taped.

The nurse is assessing a client who has undergone a transurethral resection of the prostate (TURP). Which assessment finding requires immediate action by the nurse? a. Passing small blood clots after catheter removal b. Experiencing urinary frequency after catheter removal c. Having bright red drainage with multiple blood clots d. Having the urge to void continuously while the catheter is inserted

ANS: C A client who undergoes a TURP is at risk for bleeding during the first 24 hours after surgery. Passage of small blood clots and tissue debris, urinary frequency and leakage, and the urge to void continuously while the client still has the catheter inserted are all considered to be expected complications of the procedure. They will resolve as the client continues to recover and the catheter is removed. However, the presence of bright red blood with clots indicates arterial bleeding and should be reported to the provider.

A client had a spermatocele removed in an outpatient surgical center. Which statement by the client indicates good understanding of discharge instructions? a. "The heavy drainage will go away within a few days." b. "I need to buy dressing supplies at the drugstore." c. "I should report any redness or drainage from the incision." d. "Because of all the narcotics I'll be taking, I will need laxatives."

ANS: C A spermatocele is removed via a small scrotal incision. Heavy drainage should not occur, nor should extensive dressing supplies be needed. The small incision should not require the use of large doses of narcotics.

The health care provider prescribes the following interventions for a patient with acute prostatitis caused by E. coli. Which intervention should the nurse question? a. Instruct patient to avoid sexual intercourse until treatment is complete. b. Administer ibuprofen (Advil) 400 mg every 8 hours as needed for pain. c. Catheterize the patient as needed if symptoms of urinary retention develop. d. Give trimethoprim/sulfamethoxazole (Bactrim) DS 1 tablet daily for 28 days.

ANS: C Although acute urinary retention may occur, insertion of a catheter through an inflamed urethra is contraindicated and the nurse will anticipate that the health care provider will need to insert a suprapubic catheter. The other actions are appropriate

7. A 51-year-old man is scheduled for an annual physical exam at the outpatient clinic. The nurse will plan to teach the patient about the purpose of a. urinalysis collection. b. uroflowmetry studies. c. prostate specific antigen (PSA) testing. d. transrectal ultrasound scanning (TRUS).

ANS: C An annual digital rectal exam (DRE) and PSA are recommended starting at age 50 for men who have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA are abnormal.

A 51-year-old man is scheduled for an annual physical exam at the outpatient clinic. The nurse will plan to teach the patient about the purpose of a. urinalysis collection. b. uroflowmetry studies. c. prostate specific antigen (PSA) testing. d. transrectal ultrasound scanning (TRUS).

A 53-year-old man is scheduled for an annual physical exam. The nurse will plan to teach the patient about the purpose of a. urinalysis collection. b. uroflowmetry studies. c. prostate specific antigen (PSA) testing. d. transrectal ultrasound scanning (TRUS).

ANS: C An annual digital rectal exam (DRE) and PSA are usually recommended starting at age 50 for men who have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA is abnormal

A client is scheduled for a penectomy for penile cancer. Which action by the nurse is most important? a. Teaching the client to sit when he urinates b. Demonstrating dressing changes and wound cleaning c. Assessing the client's psychosocial status and support d. Explaining the purpose of the in-dwelling catheter

ANS: C Clients may have strong emotional responses to penectomy, even when they seem to be accepting of the surgery, and the risk for suicide is present. It is critical to assess the client's emotional status and support systems before the operation is performed (and afterward). The other actions are appropriate too but do not take priority over ensuring the client's safety.

The nurse taking a focused health history for a patient with possible testicular cancer will ask the patient about a history of a. testicular torsion. b. testicular trauma. c. undescended testicles. d. sexually transmitted infection (STI).

ANS: C Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STI, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer

A client diagnosed with early prostate cancer is confused that surgery has not been planned. Which is the nurse's best response? a. "The disease is slow-growing. The risks of surgery at your age are not justified by the outcome." b. "Your disease is so advanced that surgery at this point would not increase your chances of cure." c. "Your disease is in a very early stage and is slow-growing. Your doctor will monitor you." d. "This stage indicates that you do not really have cancer, so surgery is not necessary."

ANS: C Early prostate cancer may have no clinical manifestations and may be found on a routine physical. It is slow-growing and may never become a problem for the client. Close follow-up (or watchful waiting) is the common prescription for this stage unless the client experiences symptoms. Telling the client that surgery is not justified, or that the cancer is too advanced at this point, and stating that he does not have cancer are inaccurate statements.

Which information will the nurse teach a patient who has chronic prostatitis? a. Ibuprofen (Motrin) should provide good pain control. b. Prescribed antibiotics should be taken for 7 to 10 days. c. Intercourse or masturbation will help relieve symptoms. d. Cold packs used every 4 hours will decrease inflammation.

ANS: C Ejaculation helps drain the prostate and relieve pain. Warm baths are recommended to reduce pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed but usually do not offer adequate pain relief. Antibiotics for chronic prostatitis are taken for 4 to 12 weeks

12. Which information will the nurse include when teaching a patient who has a diagnosis of chronic prostatitis? a. Ibuprofen (Motrin) should provide good pain control. b. Prescribed antibiotics should be taken for 7 to 10 days. c. Sexual intercourse and masturbation will help relieve symptoms. d. Cold packs should be used every 4 hours to reduce inflammation.

Which information will the nurse include when teaching a patient who has a diagnosis of chronic prostatitis? a. Ibuprofen (Motrin) should provide good pain control. b. Prescribed antibiotics should be taken for 7 to 10 days. c. Sexual intercourse and masturbation will help relieve symptoms. d. Cold packs should be used every 4 hours to reduce inflammation.

Which action by the unlicensed assistive personnel (UAP) who are assisting with the care of patients with male reproductive problems indicates that the nurse should provide more teaching? a. The UAP apply a cold pack to the scrotum for a patient with mumps orchitis. b. The UAP help a patient who has had a prostatectomy to put on antiembolism hose. c. The UAP leave the foreskin pulled back after cleaning the glans of a patient who has a retention catheter. d. The UAP encourage a high oral fluid intake for patient who had transurethral resection of the prostate yesterday.

ANS: C Paraphimosis can be caused by failing to replace the foreskin back over the glans after cleaning. The other actions by UAP are appropriate

When obtaining the pertinent health history for a man who is being evaluated for infertility, which question is most important for the nurse to ask? a. "Are you circumcised?" b. "Have you had surgery for phimosis?" c. "Do you use medications to improve muscle mass?" d. "Is there a history of prostate cancer in your family?"

ANS: C Testosterone or testosterone-like medications may adversely affect sperm count. The other information will be obtained in the health history but does not affect the patient's fertility.

27. 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.

ANS: C 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.

22. When reviewing patient laboratory results, the nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the following four patients. Which patient's PSA result is most important to report to the health care provider? a. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH) b. A 38-year-old who is being treated for acute prostatitis c. A 48-year-old whose father died of metastatic prostate cancer d. A 52-year-old who goes on long bicycle rides every weekend

ANS: C The family history and elevation of PSA in the 48-year-old indicate that further evaluation of the patient for prostate cancer is needed. The elevations in PSA for the other patients are not unusual.

When reviewing patient laboratory results, the nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the following four patients. Which patient's PSA result is most important to report to the health care provider? a. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH) b. A 38-year-old who is being treated for acute prostatitis c. A 48-year-old whose father died of metastatic prostate cancer d. A 52-year-old who goes on long bicycle rides every weekend

A patient returning from surgery for a perineal radical prostatectomy will have a nursing diagnosis of risk for infection related to a. urinary incontinence. b. prolonged urinary stasis. c. possible fecal wound contamination. d. placement of a suprapubic bladder catheter.

ANS: C The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery

8. A 64-year-old has a perineal radical prostatectomy for prostatic cancer. In the immediate postoperative period, the nurse establishes the nursing diagnosis of risk for infection related to a. urinary stasis. b. urinary incontinence. c. possible fecal contamination of the surgical wound. d. placement of a suprapubic catheter into the bladder.

A 64-year-old has a perineal radical prostatectomy for prostatic cancer. In the immediate postoperative period, the nurse establishes the nursing diagnosis of risk for infection related to a. urinary stasis. b. urinary incontinence. c. possible fecal contamination of the surgical wound. d. placement of a suprapubic catheter into the bladder.

5. When teaching a patient who is scheduled for a transurethral resection of the prostate (TURP) about continuous bladder irrigation, which information will the nurse include? a. Bladder irrigation decreases the risk of postoperative bleeding. b. Hydration and urine output are maintained by bladder irrigation. c. Bladder irrigation prevents obstruction of the catheter after surgery. d. Antibiotics are infused on a continuous basis with bladder irrigation.

ANS: C The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or improve hydration. Antibiotics are given by the IV route, not through the bladder irrigation.

When teaching a patient who is scheduled for a transurethral resection of the prostate (TURP) about continuous bladder irrigation, which information will the nurse include? a. Bladder irrigation decreases the risk of postoperative bleeding. b. Hydration and urine output are maintained by bladder irrigation. c. Bladder irrigation prevents obstruction of the catheter after surgery. d. Antibiotics are infused on a continuous basis with bladder irrigation.

The nurse is caring for a young adult who just got married and has been diagnosed with testicular cancer. To which community resource does the nurse refer him? a. American Cancer Society b. Red Cross c. Sperm bank d. Public Health Department

ANS: C The young man with testicular cancer should be referred to a sperm bank, so that he will have the option to have children in the future if he so desires. The other resources listed will not provide assistance in this area. The American Cancer Society does offer several resources for clients with cancer and their families, but referral to a sperm bank would be the priority owing to the man's age and his newly married status.

A client is taking goserelin (Zoladex). What periodic assessment does the nurse plan for this client? a. Weight and abdominal girth b. Pulmonary function tests c. Bone density testing d. Abdominal ultrasound

ANS: C Zoladex is a luteinizing hormone-releasing hormone (LH-RH) agonist. Side effects include hot flashes, erectile dysfunction, decreased libido, gynecomastia, and osteoporosis. A periodic bone density screening test should be done to assess for osteoporosis. The other assessments would not be needed to assess for side effects of this drug.

Which client statement indicates understanding about a transrectal ultrasound? a. "This will determine if the outlet of my bladder is obstructed." b. "This will determine the amount of residual urine present." c. "This is performed to view the interior of the bladder and urethra." d. "This is performed to view the prostate and do a tissue biopsy."

ANS: D A transrectal ultrasound is performed to view the prostate and surrounding structures and possibly also to do a tissue biopsy. A urodynamic pressure flow study will determine if the outlet of the client's bladder is obstructed. A bladder scan will determine the amount of residual urine that is present. A cytoscopy will allow the interior of the bladder and urethra to be visualized.

When obtaining a focused health history for a patient with possible testicular cancer, the nurse will ask the patient about any history of a. sexually transmitted disease (STD) infection. b. testicular trauma. c. testicular torsion. d. undescended testicles.

2. A patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because he is afraid it might affect his ability to have intercourse. Which action should the nurse take? a. Offer reassurance that sperm production is not affected by TURP. b. Discuss alternative methods of sexual expression besides intercourse. c. Provide education about the use of medications for erectile dysfunction (ED) occurring after TURP. d. Teach that ED is not a common complication following a TURP.

ANS: D ED is not a concern with TURP, although retrograde ejaculation is likely and the nurse should discuss this with the patient. 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 who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because he is afraid it might affect his ability to have intercourse. Which action should the nurse take? a. Offer reassurance that sperm production is not affected by TURP. b. Discuss alternative methods of sexual expression besides intercourse. c. Provide education about the use of medications for erectile dysfunction (ED) occurring after TURP. d. Teach that ED is not a common complication following a TURP.

A client is going home after outpatient surgery for a hydrocele. Which information does the nurse emphasize in teaching this client? a. "Report to the doctor immediately any drainage from your drain." b. "Use a condom during intercourse to prevent incisional infection." c. "Sit when you urinate until all swelling is gone and drainage has stopped." d. "Wear the scrotal support device for at least 3 weeks after surgery."

ANS: D Edema from residual inflammation can remain for several weeks. This problem is increased if the scrotum is not supported and can cause the client considerable discomfort. The client needs to wear a supportive garment such as a jockstrap during this time. If the client goes home with a drain in place, serosanguineous drainage can be expected for up to 2 days.

4. A patient has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level. The nurse will anticipate that the patient will need teaching about a. cystourethroscopy. b. uroflowmetry studies. c. magnetic resonance imaging (MRI). d. transrectal ultrasonography (TRUS).

ANS: D In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound (TRUS) is used to visualize the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be used before prostatectomy but will not be done until after the TRUS and biopsy. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process.

A patient has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level. The nurse will anticipate that the patient will need teaching about a. cystourethroscopy. b. uroflowmetry studies. c. magnetic resonance imaging (MRI). d. transrectal ultrasonography (TRUS).

The nurse will anticipate that a 61-year-old patient who has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level will need teaching about a. cystourethroscopy. b. uroflowmetry studies. c. magnetic resonance imaging (MRI). d. transrectal ultrasonography (TRUS).

ANS: D In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to visualize the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be used before prostatectomy but will not be done until after the TRUS and biopsy. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process

The nurse is performing a psychosocial assessment of a young man diagnosed with testicular cancer. Which does the nurse include as a priority in the assessment? a. Encouraging the client to verbalize his thoughts and feelings to his health care provider b. Assisting the client in locating a support group for men with testicular cancer c. Asking the client to rate his fears of sexual deficiency on a scale of 1 to 10 d. Identifying all components of his support system, including his partner

ANS: D Part of conducting a psychosocial assessment is determining who makes up the client's support system. It would be ineffective merely to refer the client to a support group, ask him to rate his fears of sexual inadequacy, or encourage him to discuss thoughts and feelings not with the nurse, but with his provider.

A 76-year-old patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. The nurse will plan to a. vaccinate the patient with sipuleucel-T ( Provenge). b. provide the patient with information about cryotherapy. c. teach the patient about placement of intraurethral stents. d. schedule the patient for annual prostate-specific antigen testing.

ANS: D Patients who opt for active surveillance need to have annual digital rectal exams and prostate-specific antigen testing. Vaccination with sipuleucel-T, cryotherapy, and stent placement are options for patients who choose to have active treatment for prostate cancer

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).

ANS: D 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.

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?"

ANS: D 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.

To determine the severity of the symptoms for a 68-year-old patient with benign prostatic hyperplasia (BPH) the nurse will ask the patient about a. blood in the urine. b. lower back or hip pain. c. erectile dysfunction (ED). d. force of the urinary stream.

ANS: D The American Urological Association (AUA) Symptom Index for a patient with BPH asks questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and back or hip pain are not typical symptoms of BPH

1. To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH) the nurse will ask the patient about a. blood in the urine. b. lower back or hip pain. c. erectile dysfunction (ED). d. strength of the urinary stream.

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH) the nurse will ask the patient about a. blood in the urine. b. lower back or hip pain. c. erectile dysfunction (ED). d. strength of the urinary stream.

After a transurethral resection of the prostate (TURP), a 64-year-old patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take first? a. Increase the flow rate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter.

ANS: D The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot

23. After a transurethral resection of the prostate (TURP), a patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes a decrease in urine output and clots in the urine. Which action should the nurse take first? a. Increase the flow rate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter.

Where is the urethra opening located in cases of hypospadias? A. On the ventral surface of the penis B. On the dorsal surface of the penis C. At the upper portion of the testicular vault D. Within a bladder extrophy

Answer: A Hypospadias is a urologic abnormality in which the urethral opening is located on the ventral surface of the penis anywhere from the corona to the perineum. Hormonal influences in utero, environmental factors, and genetic factors are possible causes.

After a transurethral resection of the prostate (TURP), a patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes a decrease in urine output and clots in the urine. Which action should the nurse take first? a. Increase the flow rate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter.

A client is scheduled for a prostatectomy for benign prostatic hyperplasia (BPH). On the morning of surgery, the laboratory report on the client's urine indicates the presence of red blood cells, white blood cells, and bacteria. Which is the nurse's highest priority action? a. Document the report in the client's chart. b. Insert a new Foley catheter before surgery. c. Strain the client's urine. d. Assess the client's vital signs and notify the health care provider.

ANS: D The client may have a urinary tract infection. The nurse should obtain a set of vital signs and notify the provider of the laboratory results. Any surgery may need to be delayed if the client has infection. Documentation is needed after other actions have been taken. Inserting a catheter and straining the client's urine will not be beneficial.

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

ANS: D 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 intervention helps the client with chronic prostatitis prevent spread of infection to other areas of the urinary tract? a. "Wear a condom during intercourse." b. "Avoid alcohol and caffeinated beverages." c. "Be sure to empty your bladder completely at each voiding." d. "Sexual intercourse or masturbation can help drain the prostate."

ANS: D The prostate is not easily penetrated by antibiotics and can serve as a reservoir for microorganisms, which can infect other areas of the genitourinary tract. Draining the prostate regularly through intercourse or masturbation decreases the number of microorganisms present and reduces the risk for further infection. The other interventions listed will be ineffective with prostatitis.

Which information about continuous bladder irrigation will the nurse teach to a patient who is being admitted for a transurethral resection of the prostate (TURP)? a. Bladder irrigation decreases the risk of postoperative bleeding. b. Hydration and urine output are maintained by bladder irrigation. c. Antibiotics are infused continuously through the bladder irrigation. d. Bladder irrigation prevents obstruction of the catheter after surgery.

ANS: D The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or improve hydration. Antibiotics are given by the IV route, not through the bladder irrigation.

Which client diagnosed with prostate cancer is not a candidate for watchful waiting? a. Client with very early cancer of the prostate b. Client who is asymptomatic c. Client who wants to avoid urinary incontinence as a result of treatment d. Client who refuses frequent digital rectal examinations (DREs)

ANS: D To participate in watchful waiting, the client must be monitored on a regular basis with a DRE and prostate-specific antigen (PSA) testing. Clients who are asymptomatic, who have early cancer, and who wish to avoid urinary incontinence from treatment would all be excellent candidates for watchful waiting.

Which client statement indicates understanding about post-orchiectomy care for testicular cancer? a. "I will avoid contact sports to prevent injury and development of cancer in my remaining testis." b. "I will always use a condom because I am at increased risk for acquiring a sexually transmitted disease." c. "I will wear an athletic supporter and cup to prevent testicular cancer in my remaining testicle." d. "I will continue to perform testicular self-examination (TSE) monthly on my remaining testicle."

ANS: D Treatment (e.g., surgery, radiation, chemotherapy) for testicular cancer does not protect the person from development of testicular cancer in the remaining testicle. A monthly TSE should be performed to monitor for changes in size, shape, or consistency of the testis. The other statements are inaccurate. Testicular cancer is not caused by trauma, cannot be prevented by an athletic cup, and does not cause increased risk for sexually transmitted diseases.

The nurse is planning care for a patient diagnosed with benign prostatic hyperplasia (BPH). Which diagnostic assessment does the nurse expect to be included in the plan of care as a method of active surveillance for this disease process? Multiple choice question Serum creatinine Urinalysis with culture Transrectal ultrasound (TRUS) Annual prostate-specific antigen (PSA)

Annual prostate-specific antigen (PSA) An annual PSA test is a diagnostic assessment that is conducted when active surveillance of BPH is required. While serum creatinine, urinalysis with culture, and TRUS are all diagnostic assessments as well, they are not appropriate for active surveillance of BPH.

Six weeks after a vasectomy, the patient has a sperm-free semen analysis result. What should the couple conclude? A. The patient is sterile. B. One additional semen free test is required. C. Alternative contraception is still required. D. Intercourse should be avoided for 2 more weeks.

Answer: A After vasectomy, the patient should not notice any difference in the look or feel of the ejaculate because its major component is seminal and prostatic fluid. The patient should use an alternative form of contraception until semen examination reveals no sperm. This usually requires at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site.

Which instructions should you include in the discharge instructions for a patient with epididymitis? A. Refrain from sexual intercourse. B. Continue to participate in liberal exercise. C. Take frequent sitz baths. D. Eat a low-salt diet.

Answer: A Patients with epididymitis should be encouraged to refrain from sexual intercourse during the acute phase. Conservative treatment consists of bed rest with elevation of the scrotum, use of ice packs, and analgesics. Ambulation places the scrotum in a dependent position and increases pain. Salt does not affect epididymitis recovery.

During the bath of a male patient, the nursing assistive personnel reports to you that the patient's foreskin cannot be retracted over the head of the penis. You recognize this condition as A. phimosis. B. prostatitis. C. priapism. D. epispadias.

Answer: A Phimosis is tightness or constriction of the foreskin around the head of the penis, which makes retraction difficult. Paraphimosis is tightness of the foreskin resulting in the inability to pull it forward from a retracted position and preventing normal return over the glans. Prostatitis is inflammation of the prostate, and epispadias occurs when the urethral opening is on the dorsal surface of the penis.

What is an erection lasting longer than 6 hours called? A. Priapism B. Peyronie's disease C. Hydrocele D. Hypospadias

Answer: A Priapism is a painful erection lasting longer than 6 hours. It is caused by an obstruction of the venous outflow in the penis. The condition may constitute a medical emergency. Causes of priapism include thrombosis of the corpus cavernosal veins, leukemia, sickle cell anemia, diabetes mellitus, degenerative lesions of the spine, neoplasms of the brain or spinal cord, vasoactive medications injected into the corpus cavernosa, and medications (e.g., sildenafil, cocaine, trazodone).

What is the primary purpose of a three-way urinary catheter after a transurethral resection of the prostate (TURP)? A. Promote hemostasis and drainage of clots B. Relieve bladder spasms C. Reduce edema D. Increase bladder tone

Answer: A A large three-way indwelling catheter with a 30-mL balloon is inserted into the bladder after the procedure to provide hemostasis and to facilitate urinary drainage. The bladder is irrigated, either continuously or intermittently, usually for the first 24 hours to prevent obstruction from mucus and blood clots.

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

Answer: A A major complication after a prostatectomy (even with nerve-sparing procedures) is erectile dysfunction

An elderly male patient is experiencing difficulty in initiating voiding and a feeling of incomplete bladder emptying. What causes these symptoms in benign prostatic hyperplasia (BPH)? A. Obstruction of the urethra B. Untreated chronic prostatitis C. Decreased bladder compliance D. Excessive secretion of testosterone

Answer: A BPH is a benign enlargement of the prostate gland. The enlargement of the prostate gradually compresses the urethra, eventually causing partial or complete obstruction. Compression of the urethra ultimately leads to the development of clinical symptoms.

After you perform teaching regarding medication therapy for erectile dysfunction (ED), you know the teaching was successful when the patient states, A. "I will take the drug once each day about an hour before sexual activity." B. "I will take the drug two times each day but not more than three." C. "I can take the drug in the morning, and I will be able to have an erection anytime throughout the day." D. "There are no precautions to take while I am on this medication."

Answer: A Medication is taken orally about 1 hour before sexual activity, but not more than once each day. These drugs have been found to be generally safe and effective for the treatment of most types of ED.

Which factors place a patient at high risk for prostate cancer (select all that apply)? A. Age older than 65 years B. Asian or Native American ethnicity C. Personal history of BPH D. Brother diagnosed and treated for prostate cancer E. History of undescended testicle and testicular cancer

Answer: A,D Age, ethnicity, and family history are known risk factors for prostate cancer. The incidence of prostate cancer rises markedly after age 50, and more than 66% of men diagnosed are older than 65 years. The incidence of prostate cancer worldwide is higher among African Americans than in any other ethnic group. A family history of prostate cancer, especially first-degree relatives (fathers, brothers), is associated with an increased risk.

Which ethnic group has the highest incidence of prostate cancer? A. African Americans B. Asians C. Whites D. Hispanics

Answer: A The incidence of prostate cancer worldwide is higher among African Americans than in any other ethnic group. The reasons for the higher rate are unknown.

A patient with benign prostatic hyperplasia is scheduled for TURP. After you assess the patient's knowledge of the procedure and its effects on reproductive function, you determine a need for further teaching when the patient says, A. "It is possible that I'll be sterile after this procedure." B. "I understand that some retrograde ejaculation may occur." C. "I will have a catheter for several days to keep my urinary system open." D. "It is unlikely that I would become impotent from this procedure."

Answer: A The patient will not be sterile; he may experience retrograde ejaculation and some erectile dysfunction. It is unlikely he will become impotent. He will need a catheter.

You notice that the patient's urinary drainage 4 hours after TURP is redder than 1 hour ago. What is your priority intervention? A. To increase the rate of bladder irrigation B. To manually irrigate the urinary catheter C. To notify the physician D. To obtain vital signs

Answer: A With CBI, irrigating solution is continuously infused and drained from the bladder. The rate of infusion is based on the color of drainage. Ideally, urine drainage should be light pink without clots. Continuously monitor the inflow and outflow of the irrigant.

A patient asks you, "How can I decrease my risk of prostate cancer?" You teach the patient to avoid which foods (select all that apply)? A. Red meat B. High-fat dairy products C. Fruits D. Vegetables E. Chicken

Answer: A, B Dietary factors may be associated with prostate cancer. 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.

Which diagnostic evaluation is used for a patient with a suspected testicular cancer? A. Prostate-specific antigen (PSA) B. α-Fetoprotein (AFP) C. Complete blood cell count D. Urine and semen analyses

Answer: B Palpation of the scrotal contents is the first step in diagnosing testicular cancer. A cancerous mass is firm and does not transilluminate. Ultrasound of the testes is indicated when testicular cancer (e.g., palpable mass) is suspected or when persistent or painful testicular swelling is present. If testicular cancer is suspected, blood is obtained to determine the serum levels of AFP, lactate dehydrogenase (LDH), and human chorionic gonadotropin (hCG).

For the patient with inoperable prostate cancer, you expect the physician to order which type of hormone? A. Gonadotropin-releasing hormone B. Androgen deprivation C. Luteinizing hormone D. Estrogen

Answer: B Prostate cancer growth largely depends on androgens, and androgen deprivation is a primary therapeutic approach for some men with prostatic cancer. Hormone therapy, also known as androgen-deprivation therapy (ADT), focuses on reducing the levels of circulating androgens to diminish tumor growth.

Which fact in the patient's history could be related to the presence of testicular cancer? A. Epispadias B. Cryptorchidism C. Hernia repair D. Uncircumcised penis

Answer: B The incidence of testicular cancer is four times higher among white men (especially those of Scandinavian descent) than African American males. It occurs more commonly in the right testicle than the left. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or have a family history of testicular cancer or anomalies. Epispadias and lack of circumcision are not related to testicular cancer. Hernia repair is related to future hernias, but not testicular cancer.

What is the most common cause of male infertility? A. A hydrocele B. A varicocele C. Alcohol use D. Epididymitis.

Answer: B The most common cause of male infertility is a varicocele, not a hydrocele. Other factors that influence the testes include infection such as epididymitis and alcohol use, but they are not the most common causes.

You have provided teaching to the male patient regarding a vasectomy procedure. Which statement by the patient indicates the teaching has been successful? A. "I will need to not eat or drink anything for 24 hours before the procedure." B. "The physician will use local anesthetic, and I will be awake." C. "I will be able to have unprotected intercourse in 3 weeks." D. "I acknowledge there is a risk of impotence."

Answer: B The procedure requires only 15 to 30 minutes and is usually performed with the patient under local anesthesia on an outpatient basis. Vasectomy is considered a permanent form of sterilization but does not affect the ability to achieve an erection. After vasectomy, the patient should not notice any difference in the look or feel of the ejaculate because its major component is seminal and prostatic fluid. The patient should use an alternative form of contraception until semen examination reveals no sperm. This usually requires at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site.

A 73-year-old man 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." You would give the patient anticipatory guidance that which condition is likely to be developing? A. A tumor of the prostate B. Benign prostatic hyperplasia C. Bladder atony because of age D. Age-related altered innervation of the bladder

Answer: B BPH is an enlarged prostate gland caused by an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men older than 50 years and 80% of men older than 80 years.

You should encourage a patient with bacterial prostatitis to A. remain on bed rest until antibiotic therapy has been in place for 72 hours. B. significantly increase fluid intake of noncaffeinated beverages. C. empty the bladder every hour with a straight catheter. D. weigh daily before the first voiding of the morning.

Answer: B Because the prostate can serve as a source of bacteria, fluid intake should be kept at a high level for all patients experiencing prostatitis. Nursing interventions are aimed at encouraging the patient to drink plenty of fluids. This is especially important for those with acute bacterial prostatitis because of the increased fluid needs associated with fever and infection. Bed rest is not indicated, and activity should be encouraged. The bladder should be emptied, although not with a catheter, and it is not necessary to do so every hour. Weight gain should be reported, but the patient does not need to weigh before voiding.

You are teaching the patient with BPH about interventions that can assist in alleviating symptoms. Which behavior in the patient indicates successful teaching? A. The patient increases use of decongestants. B. The patient decreases intake of caffeinated beverages and artificial sweeteners. C. The patient increases activities such as walking. D. The patient voids every 30 minutes.

Answer: B In some patients who have symptoms that appear and then disappear, a conservative treatment approach has value. Dietary changes (decreasing intake of caffeine and artificial sweeteners, limiting spicy or acidic foods), avoiding medications such as decongestants and anticholinergics, and restricting evening fluid intake may result in improvement of symptoms. A timed voiding schedule may reduce or eliminate symptoms, negating the need for further intervention, but 30 minutes is too frequent.

Which best indicates that treatment for cancer of the prostate is effective? A. Increase in urinary stream B. Decrease of PSA to 2 ng/mL C. Decreased blood in the urine D. White blood cell (WBC) count of 10,000/μL

Answer: B The PSA value is used to detect prostate cancer and to monitor the success of treatment. When treatment has been successful in removing prostate cancer, PSA levels should decrease and reach normal levels (less than 4 ng/mL). The regular measurement of PSA levels after treatment is important to evaluate the effectiveness of treatment and possible recurrence of prostate cancer.

What is the most significant factor in the development of clinical symptoms associated with BPH? A. Size of the prostate B. Location of the enlargement C. Age of the patient D. Length of the urethra

Answer: B There is no direct relationship between the size of the prostate and degree of obstruction. The location of the enlargement significantly affects development of obstructive symptoms. For example, it is possible for mild hyperplasia to cause severe obstruction, and it is possible for extreme hyperplasia to cause few obstructive symptoms.

When providing patient teaching about medication therapy for BPH with 5α-reductase inhibitors such as finasteride (Proscar), what information should you include? A. Ninety percent of patients show improvement with the drug. B. The drug can be taken periodically as symptoms occur. C. Women who are pregnant should not handle the drug. D. Effects are seen in 1 week.

Answer: C Although more than 50% of men who are treated with the drug show symptom improvement, it takes about 6 months to be effective. The drug must be taken on a continuous basis to maintain therapeutic results. Women who may be or are pregnant should not handle tablets.

To decrease the patient's discomfort about care involving his reproductive organs, you 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.

Answer: C Conducting routine health assessments on men places you in a unique position. It provides an opportunity to ask the patient questions pertaining to general health and to sexual health and function. Given the opportunity, men are less hesitant to answer these questions when they know that someone cares and can provide them with answers. You must remain nonjudgmental about sexual practices.

The patient with epididymitis asks you when he can resume his exercise routine. You should respond with which piece of information? A. When there is no evidence of urethral discharge B. After 1 week of antibiotic therapy C. When scrotal pain has subsided D. As soon as he feels able

Answer: C Most tenderness subsides within 1 week, although swelling may last for weeks or months. One week of antibiotic therapy may not relieve pain and swelling. "When the patient feels able" is a vague response, and the patient should remain on rest until scrotal swelling has subsided. There may be no urethral discharge in epididymitis.

What is the first step in the identification of the cause of male infertility? A. Estrogen levels B. Progesterone levels C. Semen analysis D. Time to ejaculation

Answer: C The first test in an infertility study is a semen analysis. The test determines the sperm concentration, motility, and morphology

What is the most common cause of erectile dysfunction? A. Aging B. Benign prostatic hyperplasia C. Vascular disease D. Psychological distress

Answer: C Common causes of ED include diabetes, vascular disease, side effects from medications, results of surgery (e.g., prostatectomy), trauma, chronic illness, decreased gonadal hormone secretion, stress, difficulty in a relationship, or depression. The most common cause of ED is vascular disease.

A 62-year-old man is seen at the health clinic because he is concerned about a gradual decrease in sexual performance. The nursing history does not identify any specific risk factors related to erectile dysfunction. What is your priority at this time? A. Consult with the health care provider about testing the patient for hypogonadism. B. Refer the patient to a qualified therapist to explore possible psychologic causes of decreased function. C. Explain normal age-related changes in sexual performance to the patient. D. Discuss the variety of aids and devices available to increase sexual performance.

Answer: C Normal physiologic age-related changes are associated with changes in erectile function and may be an underlying cause of ED for some men.

You expect which finding in a patient as a complication of prostatic hyperplasia? A. Dysuria B. Hematuria C. Urinary retention D. Urinary frequency

Answer: C Obstructive symptoms caused by prostate enlargement include a decrease in the caliber and force of the urinary stream, difficulty in initiating voiding, intermittency (stopping and starting stream several times while voiding), and dribbling at the end of urination. These symptoms result from urinary retention.

During the first 4 hours after TURP, the patient receives 1200 mL of bladder irrigation solution, and his urine output is 1000 mL. What is your priority intervention? A. Slowing the rate of bladder irrigation B. Continuing to observe the patient C. Checking catheter patency D. Encouraging oral fluids

Answer: C You should continuously monitor the inflow and outflow of the irrigant. If outflow is less than inflow, assess the catheter for kinks or clots. If the outflow is blocked and patency cannot be reestablished by manual irrigation, stop the CBI and notify the physician.

What should you explain to the patient who has had a vasectomy? A. The procedure blocks the production of sperm B. Erectile dysfunction is temporary and will return with sexual activity. C. The ejaculate will be about half the volume it was before the procedure. D. An alternative form of contraception will be necessary for 6 to 8 weeks.

Answer: D After a vasectomy, the patient should use an alternative form of contraception until semen examination reveals no sperm. This usually requires at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site.

In assessing a patient for testicular cancer, you understand 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 problems and bilateral scrotal tenderness. D. painless mass and heaviness sensation in the scrotal area.

Answer: D Clinical manifestations of testicular cancer include a painless lump in the scrotum, scrotal swelling, and a feeling of heaviness. The scrotal mass usually is not tender and is very firm. Some patients complain of a dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum.

A priority nursing diagnosis for the patient with bacterial prostatitis is A. activity intolerance related to fatigue. B. sexual dysfunction related to painful ejaculation. C. deficient fluid volume related to decreased fluid intake. D. impaired urinary elimination related to urethral compression.

Answer: D Acute urinary retention can develop in acute prostatitis, and it requires bladder drainage with suprapubic catheterization. The patient may experience fatigue, but this is not the priority. Sexual dysfunction can occur, but the pain occurs after ejaculation. Fluid volume should be increased.

Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a three-way urinary catheter with a 30-mL balloon. When he complains of bladder spasms with the catheter in place, you should A. deflate the catheter balloon to 10 mL to decrease bulk in the bladder. B. deflate the catheter balloon and then reinflate it 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.

Answer: D Bladder spasms occur as a result of irritation of the bladder mucosa from the insertion of the resectoscope, presence of a catheter, or clots leading to obstruction of the catheter. Instruct the patient not to urinate around the catheter because this increases the likelihood of spasm.

A 45-year-old man asks you if it is advisable to have his prostate-specific antigen (PSA) level tested, because his father and brother have prostate cancer. What is your response? A. "You should wait until you are age 50." B. "You should have a transurethral resection of the prostate as a preventive measure." C. "You should have a voiding cystourethrogram yearly." D. "You should have annual PSA levels assessed and a digital examination of the prostate."

Answer: D The American Cancer Society recommends an annual digital rectal examination (DRE) and a blood test for PSA beginning at age 50 for men who are at average risk for prostate cancer. During DRE, an abnormal prostate may feel hard, nodular, and asymmetric.

When providing teaching regarding potential complications after perineal resection of the prostate, what should you include? A. Deep vein thrombosis B. Pulmonary embolism C. Colonic constipation D. Urinary incontinence

Answer: D The two major complications after a radical prostatectomy are erectile dysfunction and urinary incontinence.

A 73-year-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 the patient anticipatory guidance that what condition may be developing? A. A tumor of the prostate B. Benign prostatic hyperplasia C. Bladder atony because of age D. Age-related altered innervation of the bladder

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

A 45-year-old man reports having recent problems attaining an erection. Which medication will the nurse further explore as the possible etiology of this patient's sexual dysfunction? A. Furosemide (Lasix) B. Fluoxetine (Prozac) C. Clopidogrel (Plavix) D. Nitroglycerin (Nitrostat)

B. Fluoxetine (Prozac) Fluoxetine is a selective serotonin reuptake inhibitor used in the treatment of depression. A common adverse effect of this medication is sexual problems (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest) in nearly 70% of men and women.

To accurately monitor progression of a symptom of decreased urinary stream, the nurse should encourage the patient to have which primary screening measure done on a regular basis? A. Uroflowmetry B. Transrectal ultrasound C. Digital rectal examination (DRE) D. Prostate-specific antigen (PSA) monitoring

C. Digital rectal examination (DRE) Digital rectal examination 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 in men over 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.

The patient has had cardiovascular disease for some time and has now developed erectile dysfunction. He is frustrated because he cannot take erectogenic medications because he takes nitrates for his cardiac disease. What should the nurse do first to help this patient? 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, LH, and thyroid hormones.

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 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 now indicate that the prostate cancer may be growing and he needs a change in his 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

C. Serum PSA level 10 ng/mL E. Nodularity of the prostate gland 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.

A patient is one day postoperative following a transurethral resection of the prostate (TURP). Which event is not an expected normal finding in the care of this patient? A. The patient requires two tablets of Tylenol #3 during the night. B. The patient complains of fatigue and claims to have minimal appetite. C. The patient has continuous bladder irrigation (CBI) infusing, but output has decreased. D. The patient has expressed anxiety about his planned discharge home the following day.

C. The patient has 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 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.

Correct Answer: A Rationale: 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 32-year-old man scheduled for a unilateral orchiectomy for testicular cancer is admitted to the hospital the morning of surgery. He is accompanied by his wife but does not talk to her and does not initiate interaction with the nurse. The most appropriate action by the nurse is to a. ask the patient if he has any questions or concerns about the diagnosis and treatment. b. tell the patient's wife that concerns about sexual function are common with this diagnosis. c. teach the patient that impotence is rarely a problem after unilateral orchiectomy. d. document the patient's lack of communication on the chart and continue preoperative care.

Correct Answer: A Rationale: The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, it is inappropriate for the nurse to initiate teaching. It would be inappropriate for the nurse to provide patient teaching without further assessment of the patient's teaching needs and concerns. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.

A patient with symptomatic BPH is scheduled for visual laser ablation of the prostate (VLAP) at an outpatient surgical center. The nurse will plan to teach the patient a. how to care for an indwelling urinary catheter. b. that the urine will appear bloody for several days. c. to expect an immediate improvement in urinary force. d. that an intraprostatic urethral stent will be placed.

Correct Answer: A Rationale: The patient will have indwelling catheter for up to a week and will need to be instructed on catheter care to avoid problems such as infection. There is minimal bleeding with this procedure. It will take several weeks before the full benefits of the procedure take effect. Stent placement is not included in the procedure.

Leuprolide (Lupron), an LH-RH Agonist, and bicalutamide (Casodex), an androgen receptor blocker, are prescribed for a patient with cancer of the prostate. In teaching the patient about these drugs, the nurse informs the patient that side effects may include a. low blood pressure. b. decreased sexual drive. c. urinary incontinence. d. frequent infections.

Correct Answer: B Rationale: Hormonal therapy blocks the effects of testosterone and decreases libido. Hypotension is associated with the -blockers used for BPH. Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy.

Following discharge teaching for a patient who has had a transurethral prostatectomy for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, a. "I will increase fiber and fluids in my diet to prevent constipation." b. "I should call the doctor if I have any incontinence at home." c. "I will avoid heavy lifting or driving until I get approval from my health care provider." d. "I should continue to schedule yearly appointments for prostate exams."

Correct Answer: B Rationale: Incontinence is common for several weeks after a TURP. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.

The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate? a. "The bladder irrigation is needed to stop the postoperative bleeding in the bladder." b. "The irrigation is needed to keep the catheter from being occluded by blood clots." c. "Normal production of urine is maintained with the irrigations until healing occurs." d. "Antibiotics are being administered into the bladder with the irrigation solution."

Correct Answer: B Rationale: The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or maintain urine production. Antibiotics are given by the IV route, not through the bladder irrigation.

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.

Correct Answer: C Rationale: 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.

Correct Answer: C Rationale: 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.

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. the presence of blood in the urine. b. any erectile dysfunction (ED). c. occurrence of a weak urinary stream. d. lower back and hip pain.

Correct Answer: C Rationale: The American Urological Association (AUA) Symptom Index for a patient with BPH asks questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and back or hip pain are not typical symptoms with BPH.

A 64-year-old man undergoes a perineal radical prostatectomy for stage C prostatic cancer. Postoperatively, the nurse establishes the nursing diagnosis of risk for infection related to a. urinary stasis. b. urinary incontinence. c. possible fecal contamination of the surgical wound. d. placement of a suprapubic catheter into the bladder.

Correct Answer: C Rationale: The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery.

A patient presents with symptoms of benign prostatic hyperplasia (BPH). Which symptom should the nurse record as a symptom related to obstruction? 1 Incontinence 2 Bladder pain 3 Urinary frequency 4 Difficulty in initiating voiding

Difficulty in initiating voiding

To accurately monitor progression of a decreased urinary stream, the nurse should encourage the patient to have which primary screening measure done on a regular basis? 1 Uroflowmetry 2 Transrectal ultrasound 3 Digital rectal examination (DRE) 4 Prostate specific antigen (PSA) monitoring

Digital rectal examination (DRE)

The nurse is teaching measures to be followed by a patient who has acute bacterial prostatitis. During the follow-up visit, the nurse finds that the patient's condition has improved. What did the patient likely do in order for his condition to have improved? Select all that apply. 1 Drinking citrus juice 2 Drinking plenty of fluids 3 Doing prostate massage 4 Performing Kegel exercises 5 Taking doxycycline regularly

Drinking plenty of fluids Doing prostate massage Taking doxycycline regularly

A patient has been diagnosed with benign prostatic hyperplasia (BPH). About which medication will the nurse educate the patient that will help reduce the size of the prostate gland?

Dutasteride

When explaining transurethral needle ablation (TUNA) as a treatment option to a patient, which common disadvantages of the procedure should the nurse include? Select all that apply. 1 Hematuria 2 Risk of erectile dysfunction 3 Urinary retention 4 Retrograde ejaculation 5 Irritative voiding symptoms

Hematuria Urinary retention Irritative voiding symptoms

The nurse is assessing a male patient with a large mass of the scrotum. Transillumination with a flashlight is used. What does the nurse suspect is occurring with this patient?

Hydrocele

A patient presents with a sudden and painful inability to urinate. Which is a priority nursing action to manage acute urinary retention? 1 Place the patient on bed rest. 2 Advise follow-up after two days. 3 Insert a catheter to drain the bladder. 4 Administer antibiotics and IV fluids.

Insert a catheter to drain the bladder.

When explaining treatment options for benign prostatic hyperplasia (PBH) to a patient, which options should the nurse consider as minimally invasive therapy? Select all that apply. 1 Laser prostatectomy 2 Open prostatectomy 3 Transurethral needle ablation (TUNA) 4 Transurethral resection of the prostate (TURP) 5 Transurethral microwave thermotherapy (TUMT)

Laser prostatectomy Transurethral needle ablation (TUNA) Transurethral microwave thermotherapy (TUMT)

Which clinical manifestation of prostate enlargement would the nurse consider when assessing a patient for benign prostatic hyperplasia (BPH)? 1 The onset of symptoms is sudden. 2 The symptoms are immediately noticed. 3 Manifestations are associated with respiratory tract symptoms. 4 Manifestations are associated with lower urinary tract symptoms.

Manifestations are associated with lower urinary tract symptoms.

When evaluating the criteria for open prostatectomy, which types of patients would the nurse identify as appropriate candidates? Select all that apply. 1 Men with large prostates 2 Men with low sperm counts 3 Men with bladder damage 4 Men without complicating factors 5 Men with benign prostatic hyperplasia (BPH)

Men with large prostates Men with bladder damage Men with benign prostatic hyperplasia (BPH)

A nurse assesses a male patient who has numerous urinary symptoms. Which early signs of benign prostatic hypertrophy does the nurse recognize? Select all that apply. 1 Nocturia 2 Urinary frequency 3 Erectile dysfunction 4 Overflow incontinence 5 Reduced force of urinary stream 6 Difficulty in starting the flow of urine

Nocturia Urinary frequency Reduced force of urinary stream Difficulty in starting the flow of urine

The nurse is assessing a patient with stage II prostate cancer. Which findings would the nurse expect to note? Multiple selection question PSA level is 10-20. Gleason score is 2. Tumor is seen by imaging. Tumor is confined to prostate. Cancer has spread to seminal vesicles.

PSA level is 10-20. Tumor is seen by imaging. Tumor is confined to prostate.

What instructions should the nurse tell a patient regarding the management of urinary incontinence after prostate surgery? Select all that apply. 1 Limit fluid intake. 2 Drink citrus juices. 3 Perform Kegel exercise. 4 Avoid caffeine products. 5 Avoid alcohol consumption.

Perform Kegel exercise. Avoid caffeine products. Avoid alcohol consumption.

Which task can the nurse delegate to unlicensed assistive personnel (UAP) in the care of a patient who recently has undergone prostatectomy? 1 Assessing the patient's incision 2 Irrigating the patient's Foley catheter 3 Assessing the patient's pain and selecting analgesia 4 Performing cleansing of the meatus and perineal region

Performing cleansing of the meatus and perineal region

An older adult 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? 1 Resumption of normal urinary drainage 2 Maintenance of normal sexual functioning 3 Prevention of acute or chronic renal failure 4 Prevention of fluid and electrolyte imbalances

Resumption of normal urinary drainage

The nurse provides immediate postoperative care for a patient who has undergone perineal prostatectomy. Which nursing diagnosis is the highest priority? 1 Problems with urinary control 2 Sexual dysfunction related to nerve disruption 3 Risk for infection related to location of surgical incision 4 Impaired physical mobility related to epidural pain management

Risk for infection related to location of surgical incision

The nurse is preparing education for a patient scheduled to begin radiation therapy and hormone manipulation for prostate cancer. What information is appropriate for the nurse to include? 1 Constipation is usually a problem; a high-fiber diet is recommended. 2 Sexual ability may be affected; discussion with the partner is recommended. 3 An intense daily exercise program will help prevent urinary dysfunction and fatigue. 4 Facial hair loss and a change in voice tone are expected side effects of hormone therapy.

Sexual ability may be affected; discussion with the partner is recommended.

Which treatment is given to a patient with advanced hormone-refractory prostate cancer? 1 Alfuzosin 2 Cephalexin 3 Sipuleucel-T 4 Indomethacin

Sipuleucel-T

Which medication is administered to a patient with benign prostatic hyperplasia associated with erectile dysfunction? 1 Tadalafil 2 Ibuprofen 3 Bleomycin 4 Carbenicillin

Tadalafil

The treatment plan for a patient diagnosed with benign prostatic hyperplasia (BPH) includes taking finasteride. When teaching the patient about this drug, which instructions should the nurse include as essential information? Select all that apply. 1 The drug takes about six months to be effective. 2 The drug should be taken for a short time. 3 The drug can be taken intermittently with good results. 4 Serum PSA levels are decreased during this drug therapy. 5 The drug should be taken continuously to maintain results.

The drug takes about six months to be effective. Serum PSA levels are decreased during this drug therapy. The drug should be taken continuously to maintain results.

When explaining to a patient about the advantages of contact laser techniques over transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), what information should the nurse include? Multiple selection question There is no need for a catheter after the surgery. The laser cauterizes blood vessels, so bleeding is minimal. The contact laser techniques lead to shorter recovery times. The contact laser technique can be performed on patients taking anticoagulants. The laser does not directly touch the prostate, so there is less tissue damage

The laser cauterizes blood vessels, so bleeding is minimal. The contact laser techniques lead to shorter recovery times. The contact laser technique can be performed on patients taking anticoagulants. During the laser-assisted procedure, the blood vessels near the laser tip are immediately cauterized, so there is minimal bleeding. The procedure is advantageous over TURP because it means faster recovery time, and it can be performed on patients taking anticoagulants. A three-way indwelling catheter must be used but can be removed within six to eight hours after the procedure. With contact laser techniques, the laser makes direct contact with the prostate tissue, immediately vaporizing the tissue.

The nurse is teaching the patient about transurethral microwave thermotherapy (TUMT) prior to the procedure. Which instruction is most appropriate for the nurse to include? 1 This procedure is performed within 10 minutes. 2 This procedure is performed in young patients. 3 This procedure is appropriate for men with rectal problems. 4 This procedure is not appropriate for men with rectal problems.

This procedure is not appropriate for men with rectal problems.

The patient's report shows abnormal findings after a digital rectal examination and elevated prostate-specific antigen levels. Which examination should be recommended for the patient? 1 Cystoscopy 2 Transrectal ultrasound 3 White blood cell count 4 Computerized tomography scan

Transrectal ultrasound

The nurse is providing care to a patient with benign prostatic hyperplasia. When planning the patient's care, which treatment technique does the nurse anticipate because it is the least invasive? 1 Open prostatectomy 2 Transurethral needle ablation 3 Transurethral incision of the prostate 4 Transurethral resection of the prostate

Transurethral needle ablation

After a vasectomy, what teaching should be included in the discharge teaching? a. "you will want to use an alternative form of contraception for 6 weeks" b. "you may lose some secondary sexual characteristics after this surgery" c. "you may have erectile dysfunction for several months after this surgery" d. "you will be uncomfortable, but you may safely have sexual intercourse today"

An older male patient is experiencing difficulty in vitiating voiding and a feeling of incomplete bladder emptying. These 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

The patient has had cardiovascular disease for some time and has now developed erectile dysfunction. He is frustrated because he cannot take erectogenic medications because he takes nitrates for his cardiac disease. What should the nurse do first to help this patient? 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, LH, and thyroid hormones

To accurately monitor progression of a symptom of decreased urinary stream, the nurse should encourage the patient to have which primary screening measure done on a regular basis? a. uroflowmetry b. transrectal ultrasound c. digital rectal examination (DRE) d. prostate-specific antigen (PSA) monitoring

To decrease the patient's 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

The nurse is assessing a male patient and suspects paraphimosis. What physical finding causes the nurse to determine this?

Permanent retracted position of the foreskin behind the penis

A patient informs the nurse that during an erection, his penis curves downward causing pain. What condition does the nurse suspect that this patient has?

Peyronie's disease

A male patient has human immunodeficiency virus (HIV) infection. When educating the patient regarding risk factors for the development of opportunistic diseases, what should the nurse include in the education?

Testicular cancer

The nurse is caring for a patient who is newly diagnosed with an enlarged prostate. Which test does the nurse expect the health care provider to order to differentiate benign prostate hypertrophy (BPH) from prostate cancer?

Transrectal ultrasound

A patient diagnosed with prostate cancer has enlarged prostate symmetry that is similar to that of benign prostatic hyperplasia (BPH). Which diagnostic test would the nurse review that is used to differentiate prostate cancer from BPH?

Transrectal ultrasound (TRUS)

A patient had an abnormal digital rectal exam (DRE) followed by an elevated prostate specific antigen (PSA). For what diagnostic study will the nurse prepare the patient after receiving these results?

Transrectal ultrasound (TRUS)

The nurse is providing care to a patient with benign prostatic hyperplasia. When planning the patient's care, which treatment technique does the nurse anticipate because it is the least invasive?

Transurethral needle ablation

The nurse is preparing a patient for a cystoscopy in order to remove prostate tissue. What procedure does the nurse anticipate the healthcare provider will use to treat this patient?

Transurethral resection of prostate (TURP)

A patient reports feeling a painless lump in the scrotum with swelling and a feeling of heaviness and dull pain in the lower abdomen. Which diagnostic study does the nurse prepare the patient for to diagnose the problem?

Ultrasound

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).

b. 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.

The nurse is educating a patient with benign prostatic hyperplasia (BPH) regarding the medication he is prescribed. Which statement made by the patient indicates the need for further teaching about the medication?

"Alpha-blockers reduce the size of the prostate."

The nurse is caring for a patient with orchitis. What treatment should the nurse anticipate educating this patient regarding? Select all that apply.

-Analgesic medication -Antibiotic treatment if organism is known -Bed rest with scrotum elevated on ice pack

A patient presents with a lump in the scrotum. Which findings would lead the nurse to suspect testicular cancer? Select all that apply.

-Feeling of heaviness -Aching in lower abdomen -Nontender and firm scrotal mass

A patient arrives in the emergency department reporting severe scrotal pain, nausea, and vomiting that began one hour ago. For which diagnostic tests should the nurse prepare the patient? Select all that apply.

-Nuclear scan -Doppler ultrasound

The nurse is performing a primary screening for a patient with erectile dysfunction. Which assessments should the nurse perform during the screening? Select all that apply.

-Self-administered assessment -Treatment-related questionnaires -Sexual, health, and psychosocial history

The nurse is educating a patient regarding the treatment of erectile dysfunction (ED). What should the nurse be sure to include when discussing this with the patient? Select all that apply.

-Side effects like headache, dyspepsia, and flushing can occur -Rare side effects like visual disturbances and hearing loss can occur -Patients should immediately seek medical attention in case of priapism

When teaching patients about the use of the drug sildenafil, which instructions should the nurse include in the teaching? Select all that apply.

-The drug should only be taken once a day -The drug is contraindicated in patients taking nitrates -The drug may cause an erection lasting more than four hours -The drug should be taken 30 to 60 minutes before sexual activity

When teaching a patient about testicular self-examination, which observations should the nurse identify as normal findings? Select all that apply.

-The testes are pain free -The testis feels round and smooth -One testis may be larger than the other

4. The health care provider prescribes finasteride (Proscar) for a 56-year-old male patient who has a BPH symptom score of 12 on the AUA Symptom Index. When teaching the patient about the drug, the nurse informs him that a. his interest in sexual activity may decrease while he is taking the medication. b. he should change position from lying to standing slowly to avoid dizziness. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

Answer: A Rationale: A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Orthostatic hypotension is a side effect of the α-blocking agents. Improvement in symptoms of obstruction takes 3 to 6 months. The medication does not cause hypertension. Cognitive Level: Application Text Reference: p. 1417 Nursing Process: Implementation NCLEX: Physiological Integrity

20. A 53-year-old man tells the nurse he has not been able to function sexually for several years but is now interested in using Viagra (sildenafil). In responding to the patient's interest, the nurse a. questions the patient about any prescription drugs he is taking. b. tells the patient that Viagra is an appropriate treatment for only a few types of ED. c. asks the patient about any previous treatment for hydrocele. d. reassures the patient that a gradual decline in erectile function is common with aging.

Answer: A Rationale: Because some medications can cause ED and patients using nitrates should not take Viagra, the nurse should ask about prescription drug use. Viagra is a helpful therapy for most types of ED. Hydrocele is not a risk factor for ED or a contraindication to erectogenic drugs. Severe ED is not a normal consequence of aging in a 53-year-old patient. Cognitive Level: Application Text Reference: p. 1435 Nursing Process: Implementation NCLEX: Physiological Integrity

2. 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.

Answer: A Rationale: 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. Cognitive Level: Application Text Reference: p. 1418 Nursing Process: Implementation NCLEX: Physiological Integrity

11. Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of urine. An appropriate nursing intervention for this patient is to teach the patient a. pelvic floor muscle training. b. the use of belladonna and opium suppositories. c. how to perform intermittent self-catheterization. d. to restrict oral fluid intake.

Answer: A Rationale: Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L. Cognitive Level: Application Text Reference: p. 1428 Nursing Process: Planning NCLEX: Physiological Integrity

17. A 32-year-old man scheduled for a unilateral orchiectomy for testicular cancer is admitted to the hospital the morning of surgery. He is accompanied by his wife but does not talk to her and does not initiate interaction with the nurse. The most appropriate action by the nurse is to a. ask the patient if he has any questions or concerns about the diagnosis and treatment. b. tell the patient's wife that concerns about sexual function are common with this diagnosis. c. teach the patient that impotence is rarely a problem after unilateral orchiectomy. d. document the patient's lack of communication on the chart and continue preoperative care.

Answer: A Rationale: The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, it is inappropriate for the nurse to initiate teaching. It would be inappropriate for the nurse to provide patient teaching without further assessment of the patient's teaching needs and concerns. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation. Cognitive Level: Application Text Reference: p. 1428 Nursing Process: Implementation NCLEX: Psychosocial Integrity

8. A patient with symptomatic BPH is scheduled for visual laser ablation of the prostate (VLAP) at an outpatient surgical center. The nurse will plan to teach the patient a. how to care for an indwelling urinary catheter. b. that the urine will appear bloody for several days. c. to expect an immediate improvement in urinary force. d. that an intraprostatic urethral stent will be placed.

Answer: A Rationale: The patient will have indwelling catheter for up to a week and will need to be instructed on catheter care to avoid problems such as infection. There is minimal bleeding with this procedure. It will take several weeks before the full benefits of the procedure take effect. Stent placement is not included in the procedure. Cognitive Level: Application Text Reference: pp. 1420-1422 Nursing Process: Planning NCLEX: Physiological Integrity

26. When planning teaching for a patient who has had a unilateral orchiectomy and chemotherapy for testicular cancer, the nurse will include information about the need for a. regular follow-up appointments to detect other types of malignancies. b. aspiration of sperm from the remaining testis if infertility occurs. c. testosterone supplements to help maintain erectile function. d. application of ice to the scrotum to minimize pain and swelling.

Answer: A Rationale: The patient will need regular follow-up to detect secondary malignancies that may occur as the result of the chemotherapy. Since infertility occurs as a result of damage to the remaining testis by chemotherapeutic drugs, aspiration of sperm is not used to treat infertility. The remaining testis will produce adequate testosterone. Application of ice will be used to reduce postoperative swelling immediately after surgery, but will not be needed at the time chemotherapy is complete. Cognitive Level: Application Text Reference: p. 1432 Nursing Process: Planning NCLEX: Physiological Integrity

24. A patient with benign prostatic hyperplasia (BPH) with mild obstruction tells the nurse, "My symptoms have gotten a lot worse this week." Which response by the nurse is most appropriate? a. "The prostate gland normally changes slightly in size from day to day, and this may be making your symptoms worse." b. "Have you been taking any over-the-counter (OTC) medications recently?" c. "Have you talked to the doctor about surgical procedures such as transurethral resection of the prostate?" d. "I will talk to the doctor about ordering a prostate specific antigen test."

Answer: B Rationale: Because the patient's increase in symptoms has occurred abruptly, the nurse should ask about OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer and is not indicated in this patient, who has already been diagnosed with BPH. Cognitive Level: Application Text Reference: p. 1421 Nursing Process: Assessment NCLEX: Physiological Integrity

13. Leuprolide (Lupron) and bicalutamide (Casodex) are prescribed for a patient with cancer of the prostate. In teaching the patient about these drugs, the nurse informs the patient that side effects may include a. low blood pressure. b. decreased sexual drive. c. urinary incontinence. d. frequent infections.

Answer: B Rationale: Hormonal therapy blocks the effects of testosterone and decreases libido. Hypotension is associated with the α-blockers used for BPH. Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy. Cognitive Level: Comprehension Text Reference: p. 1426 Nursing Process: Implementation NCLEX: Physiological Integrity

12. Following discharge teaching for a patient who has had a transurethral prostatectomy for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, a. "I will increase fiber and fluids in my diet to prevent constipation." b. "I should call the doctor if I have any incontinence at home." c. "I will avoid heavy lifting or driving until I get approval from my health care provider." d. "I should continue to schedule yearly appointments for prostate exams."

Answer: B Rationale: Incontinence is common for several weeks after a TURP. The other patient statements indicate that the patient has a good understanding of post-TURP instructions. Cognitive Level: Application Text Reference: p. 1422 Nursing Process: Evaluation NCLEX: Physiological Integrity

15. A couple is seen at the infertility clinic because they have not been able to conceive. When performing a focused examination to determine any possible causes for infertility, the nurse will check the man for the presence of a. hydrocele. b. varicocele. c. epididymitis. d. paraphimosis.

Answer: B Rationale: Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility. Cognitive Level: Comprehension Text Reference: p. 1431 Nursing Process: Assessment NCLEX: Physiological Integrity

23. The doctor is considering whether to prescribe testosterone replacement therapy for a 62-year-old man who is concerned about a gradual decrease in sexual performance. Which information obtained by the nurse is most important to communicate to the doctor? a. The patient states that he has noticed a decrease in energy level for a few years. b. The patient has had a gradual decrease in the force of his urinary stream. c. The patient has been using sildenafil (Viagra) several times every week. d. The patient's symptoms have increased steadily over the last few years.

Answer: B Rationale: The decrease in urinary stream may indicate BPH or prostate cancer, which are contraindications to use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient. Cognitive Level: Application Text Reference: p. 1437 Nursing Process: Assessment NCLEX: Physiological Integrity

27. A patient with acute urinary retention associated with BPH is admitted to the emergency department. The patient has had no urine output for 16 hours, and the laboratory work shows a blood urea nitrogen (BUN) level of 50 mg/dl and a creatinine of 3.0 mg/dl. The nurse will anticipate a health care provider order to a. schedule the patient for inpatient hemodialysis. b. insert a retention catheter. c. start an IV line for fluid administration. d. administer furosemide (Lasix).

Answer: B Rationale: The patient data indicate that the patient may have hydronephrosis and acute renal failure caused by the BPH; the initial therapy will be to insert a catheter. Hemodialysis may be needed if the elevation in BUN and creatinine persists, but it will not be ordered initially. Fluid administration and furosemide administration will increase the bladder distension. Cognitive Level: Application Text Reference: p. 1415 Nursing Process: Planning NCLEX: Physiological Integrity

7. The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate? a. "The bladder irrigation is needed to stop the postoperative bleeding in the bladder." b. "The irrigation is needed to keep the catheter from being occluded by blood clots." c. "Normal production of urine is maintained with the irrigations until healing occurs." d. "Antibiotics are being administered into the bladder with the irrigation solution."

Answer: B Rationale: The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or maintain urine production. Antibiotics are given by the IV route, not through the bladder irrigation. Cognitive Level: Comprehension Text Reference: pp. 1420-1421 Nursing Process: Implementation NCLEX: Physiological Integrity

16. In teaching a male patient to perform testicular self-examination, the nurse includes the information that a. the only structure normally felt in the scrotal sac is the testis. b. the examination should be done when the scrotum is warm. c. an appointment with the health care provider is needed if one testis is larger than the other. d. an examination should be performed whenever the patient showers or bathes.

Answer: B Rationale: The testes will hang lower in the scrotum when the temperature is warm, and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One testis is normally larger. The patient should perform testicular self-examination (TSE) monthly. Cognitive Level: Comprehension Text Reference: p. 1433 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

19. A 22-year-old man tells the nurse at the health clinic that he has recently become unable to achieve an erection. When assessing for possible etiologic factors, which question should the nurse ask first? a. "Have you been experiencing an unusual amount of stress?" b. "Do you have any history of an erection that lasted for 6 hours or more?" c. "Are you using any recreational drugs or drinking a lot of alcohol?" d. "Do you have any chronic diseases, such as diabetes mellitus?"

Answer: C Rationale: A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and chronic illness also contribute to ED, but they are not common etiologic factors in younger men. Cognitive Level: Application Text Reference: p. 1434 Nursing Process: Assessment NCLEX: Physiological Integrity

3. 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.

Answer: C Rationale: 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. Cognitive Level: Comprehension Text Reference: p. 1415 Nursing Process: Implementation NCLEX: Physiological Integrity

18. 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. he may have temporary erectile dysfunction (ED) because of postoperative swelling. b. he should not have sexual intercourse until his 6-week follow-up visit. c. he should continue the use of other methods of birth control for 6 weeks. d. he will notice a decrease in the appearance and volume of his ejaculate.

Answer: C Rationale: 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. Cognitive Level: Comprehension Text Reference: pp. 1433-1434 Nursing Process: Implementation NCLEX: Physiological Integrity

25. When obtaining a focused health history for a patient with possible testicular cancer, the nurse will ask the patient about any history of a. testicular torsion. b. STD infection. c. undescended testicles. d. testicular trauma.

Answer: C Rationale: Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STD infection, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer. Cognitive Level: Comprehension Text Reference: pp. 1430-1431 Nursing Process: Assessment NCLEX: Physiological Integrity

14. The nurse will teach the patient with chronic bacterial prostatitis that a. PSA elevation indicates that he has concurrent prostate cancer. b. Nonsteroidal antiinflammatory drugs (NSAIDs) usually provide adequate pain control. c. sexual intercourse and masturbation will relieve symptoms. d. antibiotics should be taken for 7 to 10 days.

Answer: C Rationale: Ejaculation helps drain the prostate and relieve pain. PSA elevation may be due to the prostatitis. NSAIDs are prescribed, but are often inadequate to control pain. Antibiotics should be continued for 4 to 16 weeks. Cognitive Level: Application Text Reference: p. 1429 Nursing Process: Implementation NCLEX: Physiological Integrity

5. A patient with irritative and obstructive bladder symptoms has an enlarged prostate on digital rectal examination (DRE) and an elevated PSA level. The nurse will anticipate that the patient will need teaching about a. uroflometry studies. b. cystourethroscopy. c. transrectal ultrasonography (TRUS). d. magnetic resonance imaging (MRI).

Answer: C Rationale: In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to help differentiate BPH from prostatic cancer. Uroflowmetry studies will help determine the extent of urine blockage and treatment, but a differential diagnosis will be obtained first. Cystourethroscopy may be used after TRUS if the diagnosis is still uncertain. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process. Cognitive Level: Application Text Reference: p. 1416 Nursing Process: Planning NCLEX: Physiological Integrity

1. To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. the presence of blood in the urine. b. any erectile dysfunction (ED). c. occurrence of a weak urinary stream. d. lower back and hip pain.

Answer: C Rationale: The American Urological Association (AUA) Symptom Index for a patient with BPH asks questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and back or hip pain are not typical symptoms with BPH. Cognitive Level: Application Text Reference: pp. 1415-1416 Nursing Process: Assessment NCLEX: Physiological Integrity

10. A 64-year-old man undergoes a perineal radical prostatectomy for stage C prostatic cancer. Postoperatively, the nurse establishes the nursing diagnosis of risk for infection related to a. urinary stasis. b. urinary incontinence. c. possible fecal contamination of the surgical wound. d. placement of a suprapubic catheter into the bladder.

Answer: C Rationale: The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery. Cognitive Level: Application Text Reference: p. 1425 Nursing Process: Diagnosis NCLEX: Physiological Integrity

9. The health care provider orders a blood test for prostate-specific antigen (PSA) when an enlarged prostate is palpated during a routine examination of a 56-year-old man. When the patient asks the nurse the purpose of the test, the nurse's response is based on the knowledge that a. elevated levels of PSA are indicative of metastatic cancer of the prostate. b. PSA testing is the "gold standard" for making a diagnosis of prostate cancer. c. baseline PSA levels are necessary to determine whether treatment is effective. d. PSA levels are usually elevated in patients with cancer of the prostate.

Answer: D Rationale: PSA levels are usually elevated above the normal in patients with prostate cancer. PSA testing does not determine whether metastasis has occurred. A biopsy of the prostate is needed for a definitive diagnosis of prostate cancer. Success of treatment is determined by a fall in PSA to an undetectable level; the patient's baseline PSA is not needed to determine the success of treatment. Cognitive Level: Application Text Reference: p. 1423 Nursing Process: Implementation NCLEX: Physiological Integrity

22. The nurse working in a health clinic receives calls from all these patients. Which patient should be seen by the doctor first? a. A 23-year-old man who states he had difficulty maintaining an erection last night b. A 44-year-old man who has perineal pain and a temperature of 100.4° F c. A 62-year-old man who has light pink urine after having a TURP 3 days ago d. A 66-year-old man who has a painful erection that has lasted over 9 hours

Answer: D Rationale: Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications. Cognitive Level: Analysis Text Reference: p. 1430 Nursing Process: Assessment NCLEX: Physiological Integrity

6. A patient undergoing a TURP returns from surgery with a three-way urinary catheter with continuous bladder irrigation in place. The nurse observes that the urine output has decreased and the urine is clear red with multiple clots. The patient is complaining of painful bladder spasms. The most appropriate action by the nurse is to a. administer the ordered IV morphine sulfate, 4 mg. b. increase the flow rate of the continuous bladder irrigation. c. give the ordered the belladonna and opium suppository. d. manually instill 50 ml of saline and try to remove the clots.

Answer: D Rationale: The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot. Cognitive Level: Application Text Reference: pp. 1420-1421 Nursing Process: Implementation NCLEX: Physiological Integrity

21. A 46-year-old man has had erectile dysfunction (ED) for about 3 years when he finally seeks help for the problem. He tells the nurse that he decided to seek help because his wife "is losing patience with the situation." The most appropriate nursing diagnosis for the patient is a. risk for anxiety related to inability to perform sexually. b. situational low self-esteem related to loss of satisfying sexual activity. c. ineffective sexuality patterns related to ED. d. ineffective role performance related to effects of ED.

Answer: D Rationale: The patient's statement indicates that the relationship with his wife is his primary concern. Although anxiety, low self-esteem, and ineffective sexuality patterns may also be concerns, the data in the stem suggest that addressing the role performance problem will lead to the best outcome for this patient. Cognitive Level: Application Text Reference: p. 1436 Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

Which part in the image causes testicular torsion?

The nurse is caring for a patient with benign prostatic hyperplasia (BPH). Which symptom indicates a partial obstruction may be present?

Difficulty starting to urinate

The nurse is providing care to a patient with erectile dysfunction that has been taking pharmacologic therapy without success. Which highly invasive intervention with potential complication should the nurse discuss with the patient?

Penile implant

The nurse is educating a patient scheduled for a procedure to destroy or cut a portion of the prostate. About what procedure will the nurse educate the patient?

Laser prostatectomy

A patient is experiencing dribbling, dysuria, nocturia, and hesitancy and has elevated levels of the prostatic isoenzyme, serum acid phosphatase. For what procedure should the nurse prepare this patient?

Orchiectomy

The nurse is providing care to a patient who reports a tightened penile foreskin. When assessing this patient, the nurse is unable to pull the foreskin forward from the retracted position. Based on these data, which diagnosis does the nurse anticipate?

Paraphimosis

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.

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.

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

a. 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.

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

a. 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.

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.

a. 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.

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. 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.

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.

b. 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.

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. 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.

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)

b. 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.

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.

c. 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.

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 to know what? a. The effects of general anesthesia b. The possibility of short-term incontinence c. Home management of an indwelling catheter d. Monitoring for postoperative urinary retention

c. 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 or urinary retention is not usually a problem with laser prostatectomy.

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. 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.

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

c. 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.

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.

c. 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.

The nurse teaches the patient having a vasectomy that what occurs after the procedure? a. The amount of ejaculate will be noticeably decreased. b. He may have difficulty maintaining an erection for several months. c. An alternative form of contraception must be used for 6 to 8 weeks. d. The testes will gradually decrease production of sperm and testosterone.

c. Until sperm distal to the anastomotic site is ejaculated or absorbed by the body, the semen will contain sperm and alternative contraceptive methods must be used. When a postoperative semen examination reveals no sperm, the patient is considered sterile. Following vasectomy, there is rarely noticeable difference in the amount of ejaculate because ejaculate is primarily seminal fluid. Vasectomy does not cause erectile dysfunction, nor does it affect testicular production of sperm or hormones.

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

c. 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. Post voiding catheterization measures residual urine.

A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. The best 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.

d. 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 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.

d. 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.

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

d. 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.

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

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.

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

d. 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.

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

d. The prostate gland can be easily palpated by rectal examination and 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), and cystoscopy, may be indicated.

What occurs with chronic bacterial prostatitis but not with acute prostatitis? a. Postejaculatory pain b. Frequency, urgency, and dysuria c. Symptoms of a urinary tract infection d. Enlarged, boggy prostate on palpation

d. The prostate with chronic bacterial prostatitis feels enlarged and firm, often described as boggy, and is tender. The other options are true of both chronic and acute prostatitis.

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

d. 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.

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

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).

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