Patho Exam ? Ch 42

c) By the ninth fetal month Pg. 1092 Chrt 42-1 If the inguinal canal remains open after the descent of the testes (between 7 and 9 months of fetal life), the male is at risk for the development of an inguinal hernia, which could cause vascular damage.

14. In order to minimize the risk of developing a hernia, when should the fetal inguinal canal close completely? a) Before the child begins walking b) By the first birthday c) By the ninth fetal month d) Immediately after birth

c) "Yes; some 80- and 90-year-old men have been known to father children" Pg. 1095 Changes with Aging Gonadal and reproductive failures usually are not related directly to age because a man remains fertile into advanced age; 80- and 90-year-old men have been known to father children. Past history may not identify fertility. Asking "why" is considered a confrontational response.

17. A 70-year-old male tells the health care provider he is now in a relationship with a younger woman who is capable of reproduction. The client asks if he may still be fertile. The best response would be: a) "No, fertility ends at 50 years of age" b) "Have you ever fathered a child before?" c) "Yes; some 80- and 90-year-old men have been known to father children" d) "Why do you want children at your age?"

a) Total testosterone levels Pg. 1094 Diagnosis Diagnosis of hypogonadism includes measurement of total testosterone levels (ideally at 8:00 AM, when the testosterone level is at its peak) in the ambulatory man.

5. The client presents with symptoms consistent with hypogonadism. For a diagnosis of hypogonadism, the nurse expects which diagnostic test to be ordered? a) Total testosterone levels b) Nitric oxide level c) Growth releasing hormone level d) Thyroid stimulating hormone level

c) "The hernia is a loop of bowel protruding through a weak spot in my abdominal muscles" Pg. 1088 Testes and Scrotum An inguinal hernia or "rupture" is a protrusion of the parietal peritoneum and part of the intestine through an abnormal opening from the abdominal cavity. A loop of small bowel may become incarcerated in an inguinal hernia (strangulated hernia), in which case its lumen may become obstructed and its vascular supply compromised.

6. A male client is diagnosed with an inguinal hernia. Which statement by the client indicates that the nurse's teaching about the hernia has been effective? a) "My hernia is a result of a congenital abnormality" b) "I will need immediate surgery since the hernia is blocking blood supply to my intestines" c) "The hernia is a loop of bowel protruding through a weak spot in my abdominal muscles" d) "Most men my age develop hernias so there is no cause for concern"

b) Prostate-specific antigen (PSA) of 12 ng/mL (12 µg/L) Pg. 1089 Accessory Organs A prostate-specific antigen (PSA) level of 12 ng/mL is high (<4.0 ng/mL is considered normal); all other tests are within normal limits. Uroflow examination shows obstruction with a flow of less than 7 mL/second (average normal flow is 12 mL/second). The findings are positive for prostate cancer. PSA testing may be recommended annually for men, starting at age 50.

7. A nurse is evaluating diagnostic tests for a client suspected of having prostate cancer. Which result requires further evaluation? a) Creatinine 1.0 mg/dL (88.4 µmol/L) b) Prostate-specific antigen (PSA) of 12 ng/mL (12 µg/L) c) Uroflow examination 12 mL/second d) BUN 20 mg/dL (7.14 mmol/L)

c) An enlarged prostate gland Pg. 1089 Accessory Organs Symptoms of obstruction, including dribbling after urinating and the continuous sensation of having to urinate, are most likely due to enlargement of a prostate gland. Kidney stones cause intense flank pain; blood clots are usually associated with trauma or surgery; calcium sediment could imply a kidney stone or be a result of a procedure to break up kidney stones into smaller segments.

1. An older adult male client is complaining of dribbling after he urinates and feeling like he never empties his bladder. The nurse suspects the client may have a problem with: a) Blood clots clogging the urethra b) Calcium sediment in the bladder c) An enlarged prostate gland d) Kidney stones

c) "For sperm production, it is best if underwear is loose to keep scrotal temperatures 3.5 to 5°F (2 to 3°C) below body temps" Pg. 1088 Testes and Scrotum The location of the testes in the scrotum is important for sperm production, which is optimal at 3.5 to 5°F (2 to 3°C) below body temperature. Tight fitting undergarments that hold the testes against the body are thought to contribute to a decrease in sperm counts and to increase infertility by interfering with the thermoregulatory function of the scrotum. Once undergarments are washed, there are no excess chemicals remaining in the cloth. Prolonged exposure to elevated temperatures may impair the process of spermatogenesis, which can occur with tight-fitting undergarments that hold the testes against the body.

10. A nurse in a fertility clinic is taking a history from the couple. When asked what type of underwear the male wears, he responds by asking, "Why do you need to know this? It seems a little too personal." Which response by the nurse is most appropriate for the nurse to reply? a) "Since you live in your clothing the better part of the day, tight-fitting underwear is a must to prevent scrotal movement" b) "Only plain white undergarments are best. Chemicals from colored briefs may damage the sperm" c) "For sperm production, it is best if underwear is loose to keep scrotal temperatures 3.5 to 5°F (2 to 3°C) below body temps" d) "Tight fitting undergarments are best so sperm cannot move around too much to become deformed"

c) "Sperm can no longer pass through the ductus deferens" Pg. 1089 Genital Duct System When the male ejaculates, the smooth muscle in the wall of the epididymis contracts vigorously, moving sperm into the next segment of the ductal system, the ductus deferens, also called the vas deferens. A vasectomy severs this conduit, rendering the male effectively infertile within a few weeks of the procedure. The procedure has no hormonal effect and neither the epididymis nor the rete testis are altered.

11. A 41-year-old male client is planning on having a vasectomy. While explaining this surgery to the client, the health care worker will include which physiologic principle as the basis for this contraception technique? a) "Spermatogenesis is inhibited because sex hormones no longer stimulate the Sertoli cells" b) "Spermatozoa can no longer reach the epididymis and do not survive" c) "Sperm can no longer pass through the ductus deferens" d) "The rete testis becomes inhospitable to sperm"

a) Dysfunction of spermatogenesis Pg. 1091 Spermatogenesis Two gonadotropic hormones are secreted by the pituitary gland: FSH and luteinizing hormone (LH). In the male, LH also is called interstitial cell-stimulating hormone. The production of testosterone by the interstitial cells of Leydig is regulated by LH. FSH binds selectively to Sertoli cells surrounding the seminiferous tubules, where it functions in the initiation of spermatogenesis. FSH does not directly affect the production of LH, since both are produced by the anterior pituitary. FSH does not stimulate testosterone synthesis. Impaired detumescence is unlikely to be a direct consequence of changes in FSH synthesis and release.

12. A client has been diagnosed with an anterior pituitary tumor. Synthesis and release of follicle-stimulating hormone (FSH) has become deranged. What are the potential consequences of this alteration in endocrine function? a) Dysfunction of spermatogenesis b) Impaired detumescence c) Inhibition of testosterone synthesis d) Overproduction of luteinizing hormone

d) At about 13 years and throughout the reproductive years Pg. 1091 Spermatogenesis Spermatogenesis refers to the generation of spermatozoa or sperm. It begins at an average age of 13 years and continues throughout the reproductive years of a man's life.

13. The nurse is teaching an all-male class at a local middle school about reproduction. Which time frame should the nurse tell the students that spermatogenesis begins and ends? a) At about 9 years and until 55 years b) At about 16 years and throughout the reproductive years c) At about 9 years and until 21 years d) At about 13 years and throughout the reproductive years

d) Spermatogenesis continues throughout a man's reproductive years Pg. 1088 Testes and Scrotum Spermatogenesis typically begins around 13 years of age and continues throughout the reproductive years of a man's life. Spermatogenesis occurs in the seminiferous tubules of the testes. Sperm in various stages of development are embedded in the Sertoli cells.

15. The nurse conducting a health promotion class for teenage boys on human reproduction determines that the participants are understanding the information when they state: a) Sperm in various stages of development are embedded in the corpora cavernosa b) Spermatogenesis begins during fetal development c) Spermatogenesis occurs in the prostate gland d) Spermatogenesis continues throughout a man's reproductive years

a) Ductile system Pg. 1089 Male Reproductive System The ductile system (epididymis, vas deferens, and ejaculatory ducts) transports and stores sperm, and assists in their maturation. The accessory glands (seminal vesicles, prostate gland, and bulbourethral glands) prepare the sperm for ejaculation.

16. The male reproductive system is composed of two systems. The nurse knows that which system is responsible for the transportation and storage of sperm? a) Ductile system b) Pampiniform plexus c) Symphysis pubis d) Accessory glands

d) Testosterone Pg. 1087-1088 Embryonic Development Testosterone is the most abundant and most active of these hormones. In the male embryo, testosterone is essential for the appropriate differentiation of the internal and external genitalia. Testosterone also is the precursor of dihydrotestosterone (DHT), which functions in the formation of the male urethra, prostate, and external genitalia. Androstenedione and DHEA exert only weak androgenic activity, but their main purpose is to act as a key precursor for testosterone after peripheral conversion.

18. An obstetrician is explaining the differentiation of embryonic tissue into a fetus to an aspiring class of nursing students. Which hormone is primarily responsible for the development of male sex characteristics? a) Dihydrotestosterone b) Androstenedione c) Dehydroepiandrosterone d) Testosterone

a) Type 2 diabetes Pg. 1096 Changes with Aging Risk factors for erectile dysfunction include type 2 diabetes, cardiovascular disease, and hyperlipidemia.

19. The nurse is performing a health history of a client being evaluated for erectile dysfunction. Which disorder places the client at highest risk for the erectile dysfunction? a) Type 2 diabetes b) Venous stasis c) Asthma d) Bell's palsy

c) Testosterone Pg. 1087-1088 Embryonic Development In the male embryo, testosterone is essential for the appropriate differentiation of the internal and external genitalia and it is necessary for descent of the testes in the fetus.

2. A young pregnant mother is told after an ultrasound that the fetus's testes have not descended. What hormone is responsible for the descent of the testes? a) Dihydrotestosterone b) Progesterone c) Testosterone d) Estrogen

b) The prostate gland surrounds the urethra and can produce urinary obstruction Pg. 1089 Accessory Organs Because the prostate gland surrounds the urethra, enlargement of the gland can produce urinary obstruction.

20. Men who experience enlarged prostate glands often complain of difficulty urinating. The nurse will be able to explain that this symptom is caused by which reason? a) The prostate gland blocks the opening of the urethra and produces urinary obstruction b) The prostate gland surrounds the urethra and can produce urinary obstruction c) The prostate gland causes the penis to swell and causes urinary obstruction d) The symphysis pubis begins to compress the prostate gland and causes urinary obstruction

c) Testicular torsion Pg. 1094 Common Causes of Primary Gonadal Failure With testicular torsion, the testis rotates about the distal spermatic cord, obstructs perfusion through the testicular arteries and spermatic veins, and obstructs nerve conduction. The torsion obstructs venous drainage, with resultant edema and hemorrhage, and subsequent arterial obstruction. The dartos muscle separates the two testes and responds to changes in temperature by contracting when cold and relaxing when warm. Most squamous cell cancers of the scrotum occur after 60 years of age and are linked to poor hygiene, chronic inflammation, exposure to ultraviolet A radiation, or human papillomavirus (HPV). After descent of the testes, the inguinal canal normally closes almost completely; failure of this canal to close predisposes to the development of an inguinal hernia later in life.

21. A client arrives in the emergency department complaining of severe testicular pain associated with nausea and vomiting. His pulse rate is 120 beats/min. Physical exam reveals an enlarged testis that is painful to palpation. The nurse suspects: a) Cancer of the scrotum b) Inguinal hernia c) Testicular torsion d) Testicular aneurysm

d) Ampulla Pg. 1089 Genital Duct System Spermatozoa can be stored in the ampulla for as long as 4 to 5 weeks and still maintain their fertility, even after a vasectomy.

22. Spermatozoa are produced in the seminiferous tubules of the testes and are moved through the genital ducts to be stored in the ampulla of the vas deferens before ejaculation through the penis. Unlike the female egg, which remains briefly fertile, spermatozoa can remain fertile for up to 42 days. Where are the spermatozoa stored so they maintain their fertility? a) Vas deferens b) Prostate gland c) Genital septum d) Ampulla

a) Inguinal hernia Pg. 1088 Testes and Scrotum An inguinal hernia is when a loop of small bowel slips into the inguinal canal. A strangulated hernia occurs when the bowel becomes trapped and blood supply to the bowel is compromised. Phimosis is when the foreskin is constricted and cannot be easily retracted. Human papillomavirus (HPV) is a sexually transmitted infection which can cause genital warts, and cervical and penile cancers.

3. A male client reports sudden pain and a bulging in the scrotal sac after lifting a heavy object. The swelling does not reduce when the client is supine and he begins to sweat profusely. What condition is the likely cause of these manifestations? a) Inguinal hernia b) HPV infection c) Phimosis d) Benign prostatic hyperplasia

a) Seminiferous tubules b) Prostate gland d) Pair of gonads Pg. 1087 Structure of the Male Reproductive System The male reproductive system consists of a pair of gonads (i.e., testes), a system of excretory ducts (i.e., seminiferous tubules and efferent ducts), the accessory organs (i.e., epididymis, seminal vesicles, prostate, and Cowper glands), and the penis.

4. The nurse knows that which structures are a part of the male reproductive system? Select all that apply. a) Seminiferous tubules b) Prostate gland c) Urinary bladder d) Pair of gonads e) Pair of kidneys

d) Follicle-stimulating hormone and luteinizing hormone Pg. 1091 Spermatogenesis The function of the male reproductive system is under the negative feedback control of the hypothalamus and the anterior pituitary gonadotropic hormones (FSH and LH). Testosterone, AMG, and GH are not part of the negative feedback loop that regulates the male reproductive system.

8. The male reproductive system is controlled by the hypothalamus and the anterior pituitary gonadotropic hormones regulated by a negative feedback loop. What gonadotropic hormones regulate control of the male reproductive system? a) Gonadotropic hormone and follicle-stimulating hormone b) Testosterone and anti-müllerian hormone c) Testosterone and luteinizing hormone d) Follicle-stimulating hormone and luteinizing hormone

b) Hypogonadism Pg. 1093 Hypogonadism Hypogonadism or androgen deficiency may be suspected by certain clinical features (e.g., fatigue, depression, decreased libido); however, the diagnosis needs confirmation by appropriate laboratory testing. A measure of total testosterone is usually initially performed, and if low (generally < 302.5 ng/dL [10.5 nmol/L] additional testing would be done. Hypergonadism and pituitary adenoma would present with increased hormonal activity. Adrenal insufficiency would not render the couple infertile.

9. A couple is undergoing initial testing to determine why they are unable to conceive. One of the tests shows that the man has a testosterone level of 198.8 ng/dL (6.9 nmol/L). The man reports being tired all the time. The woman is completely healthy. Which problem is most likely? a) Adrenal insufficiency b) Hypogonadism c) Pituitary adenoma d) Hypergonadism