PrepU Chapter 53: Assessment and Management of Patients with Male Reproductive Disorders

A patient is diagnosed with prostatitis. Which of the following is the most commonly isolated organism that will be present in this patient's laboratory results?

Escherichia coli

A client who is diagnosed with stage II prostate cancer asks the nurse if a transurethral resection of the prostate (TURP) can be done for this disorder. Which is the best response by the nurse?

"A TURP is a removal of only a portion of the prostate gland." -A TURP is not a viable option for treatment of prostate cancer and will only scrape or remove the portion of the gland that is causing obstruction of the urethra. Stage II cancer is a tumor that is still confined to the prostate gland and has not metastasized. The surgical treatment of choice is determined by the surgeon and client together and is not based on feelings but rather evidence-based practice and best prognosis and outcome.

Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction?

Medication use

A patient is planning to use a negative-pressure (vacuum) device to maintain and sustain an erection. What should the nurse caution the patient about with the use of this device?

Do not leave the constricting band in place for longer than 1 hour to avoid penile injury.

A nurse is working in an oncology treatment center. Which clinical manifestation when reported by a client would the nurse know may be related to metastasis from prostate cancer?

Constant hip aching and discomfort -Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, oliguria, weight loss, weakness, nausea, and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.

The nurse is demonstrating the technique for performing a testicular self examination (TSE) to a group of men for a company health fair. One of the men asks the nurse at what age a man should begin performing TSE. What is the best answer by the nurse?

"It should begin in adolescence."

The nurse is teaching a young adult male how to perform testicular self-examination (TSE). The nurse determines that the client has understood the instructions when he states which of the following?

"The best time to do it is once a month after I take my warm morning shower." -TSE is to be performed monthly, usually after a warm bath or shower when the scrotum is more relaxed. Both hands are used to palpate the testis. The index and middle fingers are placed under the testis and the thumb is placed on top. The testis is rolled gently in a horizontal plane between the thumb and fingers. A cordlike structure on the top and back of the testicle is the epididymis. This is normal and does not need to be reported.

A male client being discharged after having an acute myocardial infarction asks why the health care provider omitted a prescription for sildenafil. Which response will the nurse make?

"The medication cannot be taken for at least 6 months." - Sildenafil is a medication used to treat erectile dysfunction. It is contraindicated if the client has had a myocardial infarction within the past 6 months. The prescription was not accidentally omitted and the nurse will not be able to get the prescription for the client before leaving the hospital. The client will not be given the prescription if the appointment is within 6 months following the myocardial infarction.

A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met?

"The surgeon is going to insert a scope through my urethra to remove a portion of the gland."

A client with erectile dysfunction is prescribed sildenafil (Viagra). Which of the following would the nurse include in the teaching plan for this client?

"You may experience headache and some flushing with this drug."

A male client has undergone a semen analysis for evaluation of fertility. The nurse understands that a sperm count of which of the following would suggest infertility?

18 million/mL -A sperm count of fewer than 20 million spermatozoa per milliliter results in infertility. Normal sperm count ranges on average from 60 to 100 million /mL.

The nurse is reviewing the medical record of a client who has been diagnosed with prostate cancer. The nurse notes that the Gleason score was used to grade the cancer. Which total score would the nurse interpret as indicating a highly aggressive cancer?

9 -The Gleason score is the most commonly used tumor grading system which assigns two scores with a combined value ranging from 2 to 10. With each increase in Gleason score, there is an increase in tumor aggressiveness. High Gleason scores indicate more aggressive cancer. A total score of 8 to 10 indicate a high-grade cancer.

Medical management of BPH includes pharmacologic therapy. Which of the following medications would the nurse expect the health care provider to prescribe for this diagnosis?

Alpha-adrenergic blocker

A client is undergoing treatment for prostate cancer. He has chemotherapy sessions regularly. However, of late he is showing symptoms of food allergy and loss of appetite. He has lost considerable weight as a result. Which is an appropriate nursing task in this situation?

Ask the client to keep a diet diary.

A patient is being treated for prostatitis and the nurse is providing education about the treatment. What should the nurse include in the education of this patient?

Avoid foods and liquids with diuretic action or that increase prostatic secretions. -The nurse educates the patient about the importance of completing the prescribed course of antibiotic therapy. If IV antibiotic agents are to be administered at home, the nurse educates the patient and family about correct and safe administration. Arrangements for a home care nurse to oversee administration may be needed. Warm sitz baths (10 to 20 minutes) may be taken several times daily. Fluids are encouraged to satisfy thirst but are not "forced," because an effective medication level must be maintained in the urine. Foods and liquids with diuretic action or that increase prostatic secretions, such as alcohol, coffee, tea, chocolate, cola, and spices, should be avoided.

Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer?

Brachytherapy

Which is inconsistent with a digital rectal examination (DRE)?

Can reveal a hydrocele -DRE is recommended as part of the regular health checkup for every man older than 50 years of age. It is a screening for cancer of the prostate gland. It enables the examiner to assess the size, shape, and consistency of the prostate gland.

After teaching a group of student about structural abnormalities of the male reproductive system, the instructor determines that the teaching was successful when the students identify which of the following as an example?

Cryptorchidism

Which term refers to a failure of one or both or both of the testes to descend into the scrotum?

Cryptorchidism -Cryptorchidism is the failure of one or both of the testes to descend into the scrotum. Hydrocele is a collection of fluid, generally in the tunica vaginalis of the testes. Varicocele is an abnormal dilation of the veins of the pampiniform venous plexus in the scrotum. Phimosis is a condition in which the foreskin is constricted so that is cannot be retracted over the glans.

A patient experiences hypotension, lethargy, and muscle spasms while receiving bladder irrigations after a transurethral resection of the prostate (TURP). What is the first action the nurse should take?

Discontinue the irrigations.

Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis?

Ensure immunizations against infectious diseases such as mumps.

After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true?

Erectile dysfunction may be due to testosterone insufficiency.

Which of the following is the most common organism implicated in prostatitis?

Escherichia coli -Escherichia coli is the most commonly isolated organism implicated in prostatitis. Microorganisms are usually carried to the prostate from the urethra. Staphylococcus aureus, Streptococcus, and methicillin-resistant Staphylococcus aureus are not the most common organism implications in prostatitis.

A client who comes to the clinic complaining of perineal pain, dysuria and fever is diagnosed with prostatitis. The nurse understands that which of the following organisms would be the most likely cause?

Escherichia coli -Prostatitis is an inflammation of the prostate gland and is most often caused by microorganisms that reach the prostate by way of the urethra. Escherichia coli and microbes that cause sexually transmitted infections often are responsible. Staphylococcus and streptococcus are not typically a cause of prostatitis. Paramyxovirus is the cause of mumps.

A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged IV pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow?

Evaluating patency of the drainage lumen

A 48-year-old man recently diagnosed with benign prostatic hyperplasia (BPH) reports consuming <i>Serenoa repens</i> (saw palmetto berry). The nurse needs to intervene if the physician orders which treatment?

Finasteride -Serenoa repens (saw palmetto berry) should not be used with finasteride. Terazosin is an alpha-adrenergic blocker and can be taken with Serenoa repens. Sipuleucel-T is a therapeutic cancer vaccine. Ketoconazole is an adrenal-ablating drug used to inhibit cytochrome P450 enzymes.

The client with benign prostatic hyperplasia (BPH) is considering use of medication in the management of symptoms. Which of the following drugs reduces the size of the prostate without lowering circulating levels of testosterone?

Finasteride (Proscar)

A nurse is teaching a male client who is older than 50 years about prostate cancer. What teaching should be included by the nurse?

Have a digital rectal examination.

Which of the following may result if prostate cancer invades the urethra or bladder?

Hematuria

The nurse is preparing a presentation for a local community group about prostate cancer and possible dietary risk factors. Which of the following would the nurse most likely include?

High-fat diet

The diagnosis of prostate cancer is confirmed by which of the following?

Histologic exam of tissue -The diagnosis of prostate cancer is confirmed by a histologic examination of tissue. Other tests that may be used to establish the extent of the disease include bone scans to detect metastases to the bones, and computed tomography scan to identify metastases in the pelvic lymph nodes.

Which of the following should nurses teach all men, especially those who have had cryptorchidism?

How to perform a testicular self-examination

A 65-year-old man complains to his health care provider that, when he urinates, he has to start and stop several times over a period of minutes in order to fully empty his bladder. The nurse is aware that this is not uncommon in men over the age of 60. This "double voiding" is directly related to which of the following?

Hyperplasia of the prostate gland

The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history?

Hypotension with nitrate use -Due to the action of the medication on the smooth muscles and blood vessels, clients are advised not to take medications to treat erectile dysfunction when also prescribed a nitrate drug for chest pain or heart problems. Combining medication could result in a serious drop in blood pressure. Although all disease processes and medication therapy should be screened for interactions, hypotension with nitrate use the most serious side effects.

The nurse is obtaining a medication history from a client who is reporting erectile dysfunction. Which medication would the nurse identify as being least likely to contribute to the client's condition?

Ibuprofen - Certain medications, such as antihypertensive agents (e.g. methyldopa and spironolactone), antidepressants, narcotics, and cimetidine cause sexual dysfunction in men. Ibuprofen is not associated with causing erectile dysfunction.

When assessing a client with benign prostatic hyperplasia, which of the following would the nurse expect the client to report as the initial complaint?

Increased effort to void -The symptoms of BPH appear gradually. At first, the client notices that it takes more effort to void. Eventually, the urinary stream narrows and has decreased force. The bladder empties incompletely. As residual urine accumulates, the client has an urge to void more often and nocturia occurs.

Which statement is accurate regarding sildenafil?

Its side effects include headache, flushing, and dizziness. -Side effects of sildenafil include headache, flushing, and dizziness. Is should be taken 30 minutes to 4 hours before intercourse. Taking this medication more than once a day will not have an increased effect. The client will have no erection if stimulation does not occur.

After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?

Kegel exercises

The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following?

Light yellow and clear

A patient informs the nurse that his father died of prostate cancer, so he wants to know ways in which to reduce his risk factors for developing it. What education can the nurse give to the patient to decrease modifiable risk factors?

Limit red meat and dairy products high in fat.

The nurse is preparing a presentation for an older adult group of males at a senior center. Which of the following would the nurse expect to include when describing the effects of aging on the male reproductive system?

Men retain the ability to fertilize ova irrespective of age. -As men age, they retain the ability to fertilize ova even though there is a gradual decrease in sperm and testosterone production. Along with decreased sperm production, the volume and viscosity of seminal fluid decrease with age. A loss of muscular tone causes the scrotum to become more pendulous.

The nurse is preparing a presentation for a men's community group about health promotion. Which of the following would the nurse include as a current recommendation for screening?

Monthly testicular self-examination (TSE)

Which of the following nursing assessment findings would be most significant in determining sterility in a male client?

Mumps at age 15 years -Viral mumps infection that occurs after puberty can be the cause of orchitis, which may result in testicular atrophy and sterility. Uncircumcised penis, UTIs, and number of sex partners are not indicated with sterility.

A 59-year-old male client has opted for hormonal androgen deprivation therapy (ADT) to treat prostate cancer. Which surgical procedures is the client most likely to undergo?

Orchiectomy -ADT is commonly used to suppress androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of dihydrotestosterone (DHT). As a result, the prostatic epithelium atrophies (decreases in size). This effect is accomplished by an orchiectomy (removal of the testes). Circumcision is excision of the foreskin, or prepuce, of the glans penis. Vasectomy is the ligation and transection of part of the vas deferens to prevent the passage of the sperm from the testes. Hydrocelectomy describes the surgical repair of a hydrocele, a collection of fluid in the tunica vaginalis.

Which term refers to the surgical removal of one or both testes?

Orchiectomy -Orchiectomy is required when the testicle(s) has been damaged. Circumcision is excision of the foreskin, or prepuce, of the glans penis. Vasectomy is ligation and transection of part of the vas deferens to prevent the passage of sperm from the testes. Hydrocelectomy describes the surgical repair of a hydrocele, a collection of fluid in the tunica vaginalis.

Following morning hygiene of an older adult client, the nurse is unable to replace the retracted foreskin of the penis. Which is the most likely outcome?

Painful swelling

The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique?

Palpate each testicle separately, following a warm shower.

The nurse is preparing a discharge teaching plan for a client who has had a prostatectomy. Which of the following would be appropriate to include?

Performing perineal exercises frequently throughout the day

Which condition is associated with buildup of fibrous plaques in the sheath of the corpus cavernosum, causing curvature of the penis when it is erect?

Peyronie's disease -Peyronie's disease may require surgical removal of the plaques when the disease makes sexual intercourse painful, difficult, or impossible. Bowen's disease refers to a form of squamous cell carcinoma in situ of the penile shaft. Phimosis refers to the condition in which the foreskin is constricted so that it cannot be retracted over the glans. Priapism refers to an uncontrolled, persistent erection of the penis occurring from either neural or vascular causes.

Nursing students are reviewing information about the male reproductive system and normal age-related changes. They demonstrate understanding of the topic when they identify which of the following as occurring?

Plasma testosterone levels decrease.

Which is an age-related change affecting the male reproductive system?

Plasma testosterone levels decrease.

A client comes to the emergency department complaining of sudden, sharp testicular pain. Further examination reveals torsion of the spermatic cord. Which of the following would the nurse expect to do next?

Prepare the client for surgery

A patient is suspected to have prostate cancer related to observed clinical symptoms. What definitive test can the nurse assist with to confirm a diagnosis of prostate cancer?

Prostate biopsy -If prostate cancer is detected early, the likelihood of cure is high (Eggert, 2010). It can be diagnosed through an abnormal finding with the digital rectal examination (DRE), serum prostate-specific antigen (PSA), and ultrasound-guided transrectal ultrasound (TRUS) with biopsy. Detection is more likely with the use of combined diagnostic procedures. The diagnosis of prostate cancer is confirmed by a histologic examination of tissue removed surgically by transurethral resection of the prostate (TURP), open prostatectomy, or ultrasound-guided transrectal needle biopsy.

Which of the following is the obstructive and irritative symptom complex caused by benign prostatic hypertrophy?

Prostatism

Consuming a diet high in which of the following has been found to increase the risk for prostate cancer?

Red meats

Which of the following herbal remedies is used to treat symptoms of benign prostatic hypertrophy (BPH)?

Saw palmetto

A client expresses concerns about future reproduction after a surgery to correct the cancer of the testes. For this client, treatment proceeded without first collecting and storing sperm. Which alternative should the nurse suggest to the client?

Suggest donor insemination or adoption

Which should be included as part of the home care instructions for a client with epididymitis and orchitis?

Take prescribed antibiotics -Home care for a client with epididymitis and orchitis includes instructions to continue administering prescribed antibiotics and to take Sitz baths, apply local heat after scrotal swelling subsides, avoid lifting, and refrain from sexual intercourse until symptoms are relieved.

Students preparing for a test are reviewing the structure and function of the male reproductive system. They demonstrate understanding of the material when they identify which of the following as the site of spermatogenesis?

Testes

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make?

Testicular cancer is a highly curable type of cancer. -Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in younger, not older, men.

A client comes to the emergency department reporting severe testicular pain that started about 1 hour ago. Examination reveals a thickened spermatic cord, an elevated testis, and testicular tenderness. The nurse would interpret these findings to suggest which of the following?

Testicular torsion -Testicular torsion is manifested by student pain in the testicle, usually developing over 1 to 2 hours, accompanied by swelling of the scrotum, testicular tenderness, elevated testis, thickened spermatic cord, and a swollen, painful scrotum. Epididymitis is manifested by low-grade fever, chills, and heaviness in the affected testicle developing over 1 to 2 days. Orchitis is manifested by fever, pain, tenderness in one or both testicles, testicular swelling, penile discharge, blood in the semen, and leukocytosis. It is common after an episode of mumps. Testicular cancer is manifested by a lump or mass on the testicle and usually painless enlargement of the testis that appears gradually.

After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?

The client reports bladder spasms and the urge to void.

The client states to the nurse that he is very anxious about having prostate cancer ever since his prostate-specific antigen (PSA) test came back elevated. The client asks, "Which diagnostic test produces definitive results if cancer is present?" The nurse is most correct to state which of the following?

Tissue biopsy

Which is the most common type of prostate surgery?

Transurethral resection of the prostate

A client with erectile dysfunction who had a penile implant inserted has been taught how to identify malfunction of the device. Which of the following if stated by the client as indicative of malfunction would indicate to the nurse that the client has understood the teaching?

Underinflation or bulging of the cylinders during inflation - Malfunction of the device is characterized by the underinflation, bulging of the cylinders during inflation, and a loss of fluid from the implant. Erosion of penile or urethral tissue occurs due to a mis-sized implant, pressure, or friction of the implanted cylinders. Erosion of scrotal, bowel, or bladder tissue occurs if an implant with a fluid reservoir is used. Migration of the cylinders, pump, or reservoir from their intended location is accompanied by pain, tenderness, and dysfunction of components that are part of the device.

A client is to undergo a TURP for BPH. Which statement is accurate with regard to a TURP?

Urethral strictures are more frequent for TURP than for nontransurethral procedures.

The nurse is reviewing a client's medication and health history. Which assessment finding would cause the nurse to question the client's new prescription for the phosphodiesterase inhibitor sildenafil?

Use of nitrates -PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa via vasodilation of the blood vessels. If a client is using nitrates (which also exhibit vasodilation) hypotension is likely to occur. History of hypertension and diabetes does not interfere with the administration of PDE5 inhibitors. Use of diuretics is not significant.

Which of the following would be most important to include in a teaching plan for a client who has had a vasectomy?

Using a reliable method of contraception for several weeks.

Hydrocele

a fluid-filled sac in the scrotum along the spermatic cord leading from the testicles

A client has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe?

circumcision

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:

continuous inflow and outflow of irrigation solution. -When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to:

cryptorchidism.

A client is preparing for an annual prostate digital examination, and asks the nurse to explain the role of the prostate gland. What is the function of the prostatic fluid?

ensuring sperm survival

A client with a penile implant is to be informed about the possible complications after discharge. Which complication occurs due to a midsized implant, pressure, or friction of the implanted cylinders?

erosion of penile or urethral tissue

Which cancer ranks second as the cause of death in American men?

prostate -Prostatic cancer is second to skin cancer in frequency among American men. It ranks second as the cause of deaths from cancer. Cancer of the testes is a malignancy seen in men between 18 and 40 years of age. Although this cancer is relatively rare, accounting for approximately 1% of cancers in men, it is the most common type in men between 15 and 34 years of age and is the leading cause of cancer deaths in men between 25 and 34 years of age. Skin cancer ranks first in frequency among American men. Penile cancer is rare and occurs more often in men who are uncircumcised.

Which structure is involved in keeping the testes at the necessary temperature to ensure sperm production?

scrotum -To maintain the temperature of the testes 3 degrees cooler than body temperature, smooth and skeletal muscles in the scrotum pull the tissue toward the body when external temperatures are cold. On the other hand, the smooth muscles relax, causing the scrotum to become loose and hang away from the body when environmental temperatures are hot. The scrotum is the divided sac of skin that contains the right and left testes, also called testicles. The location of the testes within the scrotal sac ensures optimum conditions for sperm production.

A young client who awoke with sudden, severe testicular pain with edema arrives at the ED unable to walk and nauseated. After examination, what treatment would the physician likely order?

surgery

Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically address testicular cancer risk, a nurse should modify client teaching for male clients to include:

testicular self-examination.

A urologist suspects that a client might have prostate cancer. Which test would be used to make a diagnosis of cancer?

tissue biopsy -A needle biopsy of prostatic tissue is obtained to diagnose a definitive cancer of the prostate. The PSA assay is a blood test that, when elevated, may correspond with prostate cancer. However, an elevated PSA does not always indicate a malignancy; it may indicate benign disease or other factors such as an enlarged prostate gland, older age, prostatitis, recent ejaculation, and other innocuous causes. Cystoscopy involves a cystoscope inserted into the urinary meatus to inspect the bladder, prostate, and urethra. This aids in evaluating the degree of encroachment by the prostate on the urethra. A digital rectal examination is performed to assess the prostate for size as well as evidence of tumor.