Ch 53: Male Reproductive Disorders
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." Explanation: 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.
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?Lately, a 75-year-old man is having difficulty emptying his bladder. He is unable to empty it completely and yet it feels full, causing discomfort. The physician suspects prostate cancer. Which question(s) would you expect the physician to ask the client? Select all that apply.
"Do you pass blood in your urine?" "Do you feel thirsty often?" "Do you have difficulty urinating?" "Do you have a family history of prostate cancer?" Explanation: The symptoms of prostate cancer include a slow urinary stream; hematuria, which is passing blood with urine; diffuclty urinating; urinary hesitancy; incomplete bladder emptying; and dysuria (painful urination). A family history of prostate cancer would increase the client's risk of developing it himself. Urine leakage is a symptom of cervical cancer. Thirst is not related to prostate cancer.
After teaching about self-care measures to a client who has been diagnosed with prostatitis, the nurse determines that the teaching was successful when the client states which of the following?
"I should avoid fluids like coffee and tea." Explanation: With prostatitis, the client should avoid foods and liquids with diuretic action such as coffee and tea. He also needs to complete the full course of prescribed antibiotic therapy, not just until the symptoms are gone. Hot sitz baths may be used to promote relief. Fluids are encouraged to satisfy thirst but are not forced because an effective medication level must be maintained in the urine.
A client recovering from urethral dilation to correct a urethral stricture is instructed by the nurse about post-procedure care. Which statement indicates to the nurse that teaching was successful?
"It will take a year to determine if the treatment was successful." Explanation: Urethral stricture is a condition in which a section of the urethra is narrowed. Treatment involves dilation of the urethra. Treatment should not be considered successful until at least 1 year has passed because strictures may recur at any time during that period. A weak urine stream is a symptom of a urethral stricture. The client should not have difficulty voiding for months after the surgery. Prostatitis is a common complication of urethral strictures.
A client diagnosed with epididymitis is being discharged from the emergency department. Which of the following would be most important for the nurse to include as part of the client's discharge teaching?
"Keep your scrotum elevated on a folded towel until the swelling goes down." Explanation: The scrotum is elevated with a folded towel, four tail bandage, or adhesive tape across the upper thighs to relieve pain by lessening the weight of the testes. Ice is applied under the scrotum not on top or leaning against it. Sexual intercourse is to be avoided until symptoms are relieved. Antibiotics are typically prescribed as part of the initial treatment, not when the client develops a fever.
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." Explanation: 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 client is prescribed dutasteride (Avodart) as part of treatment for benign prostatic hyperplasia (BPH). When teaching the client about this drug, the nurse integrates knowledge of the drug's action. Which statement best reflects this?
"The drug interferes with testosterone, which causes the prostate to shrink in size." Explanation: Dutasteride is a 5-alpha-reductase inhibitor that prevents the conversion of testosterone to DHT, thereby causing a decrease in prostate size. Alpha-adrenergic blockers such as alfuzosin, terazosin, doxazosin, and tamsulosin relax the smooth muscle of the bladder neck and prostate. Nitrous oxide is released in the vasculature of the penis during sexual stimulation, leading to smooth muscle relaxation in blood vessels and resulting in increased blood flow and an erection. Phosphodiesterase-5 inhibitors increase blood flow to the penis and are used to treat erectile dysfunction. Dutasteride does not restore the normal flora of the bladder. The contents of the bladder are sterile.
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." Explanation: 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.
Which of the following medication classifications are associated with erectile dysfunction? Select all that apply.
Antifungals Antipsychotics Beta blockers Antiseizure agents Antispasmodics Explanation: Classes of medications associated with erectile dysfunction include antifungals, antipsychotics, beta blockers, antiseizure agents, and antispasmodics.
A client who is scheduled for a vasectomy tells the nurse, "My partner and I will never have to worry about contraception ever again." Which response by the nurse would be most appropriate?
"You still need to use a reliable method until the physician checks your semen." Explanation: Fertility remains for a varying time after a vasectomy until the sperm stored distally in the seminal vesicles have been evacuated. Therefore, a reliable method of contraception should be used until the urologist confirms infertility during a follow-up examination of an ejaculate specimen. Telling the client that he must be relieved provides false reassurance. The client needs to be informed about the remaining fertility. Vasectomy does not increase the risk for sexually transmitted infections; however, it does not provide protection from them. Vasectomy usually has no effect on sexual potency, erection, ejaculation, or male hormone production.
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 Explanation: 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.
A client is having prostate-specific antigen (PSA) testing done. Which result would the nurse identify as abnormal?
4.6 nanograms/milliliter Explanation: Normal prostate-specific antigen (PSA) levels are less than 4.0 nanograms/milliliter (ng/mL). A level of 4.6 ng/mL would be considered abnormal.
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 Explanation: 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.
Which client would the nurse identify as being at highest risk for the development of testicular cancer?
A 25-year-old male with a history of cryptorchidism Explanation: Testicular cancer is most common in between 15 and 34 years of age and is the leading cause of cancer deaths in men between 25 to 34 years of age. Its incidence is higher in White men and men with a history of cryptorchidism. Other clients at risk are those with a family history of the disease, those who are HIV-positive or have developed AIDS, and those who already have had cancer in one testicle.
Several male clients are scheduled to come to the clinic for an annual physical examination. The nurse would expect to prepare which client for a digital rectal examination (DRE)?
A 52-year-old man in good health Explanation: DRE is used to screen for prostate cancer and is recommended annually for every man older than 50 years or those 45 years old at high risk (African-American men and men with a strong family history of prostate cancer). Therefore, a DRE would be most likely for the 52-year-old client. A DRE would not necessarily be done for the other clients, even with their history of other underlying conditions.
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 Explanation: Alpha-adrenergic blockers relax the smooth muscle of the bladder neck and prostate, improving urine flow and relieving BPH symptoms.
Bright red bleeding following prostate surgery indicates which of the following?
Arterial bleed Explanation: Bright red bleeding with increased viscosity and numerous clots usually indicates arterial bleeding, and requires surgical intervention. Venous bleeding, which is dark red in color, may be controlled by the provider via "overinflating" the urinary catheter balloon and applying traction to the catheter so that the balloon holding the urinary catheter in place applies pressure to the prostatic fossa. It does not represent disseminated intravascular coagulation or thrombocytopenia.
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. Explanation: The appropriate nursing task in this situation is to assess the amount of food eaten. This assessment will help determine nutrient intake. The nurse should ensure adequate fluid hydration before, during, and after drug administration when the client has side effects of nausea and vomiting. Administration of fruits is not recommended when the client is at risk of infection, such as during chemotherapy. Serotonin blockers are administered to control nausea and vomiting.
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. Explanation: 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 Explanation: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. Hormone therapy for advanced prostate cancer suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of DHT. Teletherapy involves 6 to 7 weeks of daily radiation treatments. High-dose ketoconazole (HDK) lowers testosterone through its abilities to decrease both testicular and endocrine production of androgen.
A client with Stage IV prostate cancer is to receive hormone therapy. The nurse would inform the client about possible adverse effects including which of the following?
Breast tenderness Explanation: Feminizing side effects occur with hormone therapy. The client's voice may become higher, hair and fat distribution may change, and breasts may become tender and enlarged. Libido and potency also are diminished.
Which of the following is a major cause of relapsing urinary tract infections in men?
Chronic bacterial prostatitis Explanation: Chronic bacterial prostatitis is a major cause of relapsing urinary tract infection in men. Complications of prostatitis include swelling of the prostate gland, urinary retention, epididymitis, bacteremia, and pyelonephritis.
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 Explanation: 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.
Which term refers to a failure of one or both or both of the testes to descend into the scrotum?
Cryptorchidism Explanation: 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.
Which assessment finding is most important in determining which client has a higher risk for developing testicular cancer?
Cryptorchidism as an infant Explanation: Men who have had cryptorchidism as an infant, regardless of whether an orchiopexy was performed, are at higher risk for incidence of testicular cancer. STIs, low sperm count, and family history of general cancers are not indicative of testicular cancer risk.
Which age-related change affects the male reproductive system?
Decreased plasma testosterone levels Explanation: Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.
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. Explanation: Transurethral resection syndrome is a rare but potentially serious complication of TURP. Symptoms include lethargy, hypotension, and muscle spasms. The first action the nurse should take is to discontinue irrigation. The other interventions listed are not appropriate.
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. Explanation: Negative-pressure (vacuum) devices may also be used to induce an erection. A plastic cylinder is placed over the flaccid penis, and negative pressure is applied. When an erection is attained, a constriction band is placed around the base of the penis to maintain the erection. To avoid penile injury, the patient is instructed not to leave the constricting band in place for longer than 1 hour.
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. Explanation: Nurses should advocate for infant and childhood immunizations against infectious diseases such as mumps to reduce potential adult complications such as orchitis. Minimizing activities involving heavy lifting or urging limited intake of caffeine have no effect on the potential for adult complications such as orchitis. The nurse should encourage foods that are low in fat and starch; however, this also would have no effect on the potential for orchitis.
The nurse is providing preoperative care to a client who is to undergo a radical prostatectomy for prostate cancer. The client's plan of care includes the nursing diagnosis of "anxiety related to surgery and its outcome." Which of the following would be most appropriate for the nurse to do?
Ensure privacy when discussing sensitive or embarrassing sexual issues. Explanation: To help reduce anxiety, the nurse should provide clear explanations about the events before, during, and after surgery, reinforcing information already provided by the surgeon. In addition, the nurse should establish a trusting relationship and allow the client to ask questions and verbalize his feelings related to the diagnosis, surgery, and outcomes. Because the surgery involves reproductive issues that the client may find sensitive or embarrassing, the nurse needs to ensure the client's privacy when discussing any of these issues. Telling the client that the cancer is very curable and informing him of a lower risk of recurrence would give the client false reassurance. In addition, anxiety could be increased, especially if the client's cancer is not at an early stage. Regardless of the diagnosis, clients need to participate in their care to foster autonomy and feelings of control over the situation.
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. Explanation: Common causes of erectile dysfunction include neurologic disorder like spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy such as antihypertensives or antidepressants, atherosclerosis, hypertension, and complications of diabetes mellitus. Erectile dysfunction may be related to anxiety or depression. It is not a normal aspect of aging.
Which of the following is the most common organism implicated in prostatitis?
Escherichia coli Explanation: 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 reporting 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 Explanation: 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 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 Explanation: 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 Explanation: The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.
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?
Explanation: Structural abnormalities include cryptorchidism, torsion of the spermatic cord, phimosis, paraphimosis, hydrocele, spermatocele, and varicocele. Erectile dysfunction and priapism are erection disorders. Prostatitis is an infectious disorder.
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 Explanation: 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) Explanation: Finasteride (Proscar) inhibits the conversion of testosterone, depriving the gland of dihydrotestosterone (more potent type of testosterone), which stimulates prostatic growth. Tamsulosin (Flomax) and terazosin (Hytrin) work by reducing the tone of smooth muscle in the bladder neck and prostate gland but have little effect on reducing prostate size. Oxybutynin chloride (Ditropan) is an antimuscarinic, antispasmodic drug used for treatment of overactive bladder.
A client is receiving leuprolide as part of his treatment for prostate cancer. The nurse would be alert for which of the following as a possible adverse effect?
Gynecomastia Explanation: Adverse effects associated with leuprolide, a luteinizing hormone-releasing hormone agonist, are related to hypogonadism and include vasomotor flushing, loss of libido, decreased bone density, anemia, fatigue, increased fat mass, decreased muscle mass, gynecomastia, and mastodynia (breast/nipple tenderness).
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. Explanation: A serum prostate-specific antigen level test and a digital rectal exam, which are recommended by the American Cancer Society, are used to screen for prostate cancer in men with at least a 10-year life expectancy and for men at high risk, including those with a strong family history of prostate cancer. Testicular self-examinations won't identify changes in the prostate gland because of its location in the body. A transrectal ultrasound, complete blood count, blood urea nitrogen, and creatinine level test are usually done after diagnosis to identify the extent of the disease and potential metastasis.
Which of the following may result if prostate cancer invades the urethra or bladder?
Hematuria Explanation: Hematuria may result if the cancer invades the urethra or bladder. Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, and oliguria.
Which of the following is an immediate danger after a prostate surgery?
Hemorrhagic shock Explanation: The immediate dangers after prostate surgery are bleeding and hemorrhagic shock. The patient is monitored for major complications such as hemorrhage, infection, deep vein thrombosis, catheter obstruction, and sexual dysfunction.
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 Explanation: Although the cause of prostatic cancer is unknown, there seems to be a relationship with increased testosterone levels and a diet high in fat. No other dietary links have been suggested.
The diagnosis of prostate cancer is confirmed by which of the following?
Histologic exam of tissue Explanation: 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 Explanation: The nurses should teach all men, especially those who have had cryptorchidism, to perform testicular self-examination to detect any abnormal mass in the scrotum. The nurse instructs the clients to examine the testicles monthly, preferably when warm, such as in the shower. Having regular PSA levels, lymph node biopsies, and blood tests for measuring serum acid phosphatase are for the clients who are treated for prostate cancer.
A nurse is reviewing the history of a client who is experiencing difficulty sustaining an erection. Which of the following might the nurse suspect as a possible contributing factor?
Hypertension Explanation: Hypertension may be a contributing factor because some types of antihypertensive agents can reduce a male's ability to achieve or sustain an erection. A history of lower back pain, sinus infections, or asthma is unrelated to erectile dysfunction.
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 Explanation: 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 Explanation: 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.
Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction?
Medication use Explanation: Certain medications such as antihypertensive drugs, antidepressants, narcotics, etc. can cause sexual dysfunction in men. Impotence is not a normal part of aging. Undescended testicle is not indicative of ED. Sexual history is not indicative of ED.
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 Explanation: 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. Explanation: 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 Explanation: Kegel exercises are noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for the client with increased detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for post-prostatectomy incontinence. Self-catheterization may be used as a temporary measure but isn't a primary intervention.
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 Explanation: Typically a three-way catheter drainage system is removed when the urine appears clear and amber (light yellow). Reddish-pink urine with clots usually occurs in the immediate postoperative period. Eventually the urine becomes light pink within 24 hours after surgery. Dark amber urine suggests concentrated urine commonly associated with dehydration.
A health care provider prescribed a luteinizing hormone-releasing hormone (LHRH) agonist to suppress testicular androgen and treat prostate cancer. Which medication is the primary drug of choice?
Lupron Explanation: Lupon is an LHRH agonist. The other three choices are antiandrogen receptor antagonists.
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. Explanation: 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) Explanation: Screening typically includes monthly TSE starting in adolescence and annual DRE for men older than 50 years. PSA testing along with DRE are used to screen for prostate cancer in men with at least a 10-year life expectancy and for men at high risk, including those with a strong family history of prostate cancer and of African-American ethnicity. Transrectal ultrasound is performed in clients with abnormalities detected by DRE and in those with elevated PSA levels.
Which of the following nursing assessment findings would be most significant in determining sterility in a male client?
Mumps at age 15 years Explanation: 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.
The nurse is reviewing the history of a client with erectile dysfunction. Which of the following would the nurse least likely identify as contributing to the client's condition?
New onset of anemia being treated with iron supplements Explanation: Anemia and iron supplements are not associated with erectile dysfunction. Diabetes, depression, and certain medications such as metoprolol and fluoxetine are associated with erectile dysfunction.
Which statement should be included in the teaching plan for a client prescribed sildenafil?
Only one tablet of the prescribed dose should be taken each day. Explanation: Taking sildenafil more than once a day will not improve its effects and the client may experience back and leg aches, as well as nausea and vomiting. Sildenafil should be taken one hour before intercourse. It will not create the erection. The erection must be created by sexual stimulation. Sildenafil does not restore desire or sex drive.
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 Explanation: 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.
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 Explanation: Paraphimosis results in strangulation of the glans penis from inability to replace the retracted foreskin. The strangulation results in painful swelling of the glans. Erection of the penis in the presence of phimosis can cause pain but is not a result of retracted foreskin. Nausea and vomiting are not indicated with retraction of foreskin.
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 Explanation: After a prostatectomy, the client should be instructed in how to perform perineal exercises and to perform them hourly throughout the day, each day. In addition, the client should avoid bearing down (straining) to urinate because of the increased risk for hematuria. He should also avoid strenuous exercise, which increases the tendency to rebleed. The client should be instructed to urinate as soon as he feels the first urge to do so.
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 Explanation: 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.
Which condition is associated with the buildup of fibrous plaques in the sheath of the corpus cavernosum, causing curvature of the penis when it is erect?
Peyronie's disease Explanation: 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 of the penile shaft in situ. 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.
Which is an age-related change affecting the male reproductive system?
Plasma testosterone levels decrease. Explanation: Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.
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. Explanation: With aging, plasma testosterone levels decrease, prostatic secretions increase, testes decrease in weight, and spermatogenesis continues.
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 Explanation: For the client with torsion, immediate surgery is necessary to prevent atrophy of the spermatic cord and preserve fertility. Analgesics would be given preoperatively. Postoperatively, a scrotal support is applied and dressings are inspected for drainage. Circumcision is done to relieve phimosis or paraphimosis.
A nurse is teaching a client about a circumcision. Which external reproductive structure is removed by circumcision?
Prepuce Explanation: In an uncircumcised male, the prepuce, sometimes referred to as the foreskin, that covers the glans is removed by circumcision. The glans is the rounded head of the penis. The corpora cavernosa is erectile tissue. The mons pubis is fatty tissue near the pubic bones.
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 Explanation: 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.
Consuming a diet high in which of the following has been found to increase the risk for prostate cancer?
Red meats Explanation: Data suggest that men who consume a diet containing excessive amounts of red meat or dairy products that are high in fat are at increased risk for prostate cancer.
Which of the following herbal remedies is used to treat symptoms of benign prostatic hypertrophy (BPH)?
Saw palmetto Explanation: Saw palmetto is an herbal product used to treat symptoms associated with BPH.
A patient is having a DRE in the physician's office and the nurse is to assist in the examination. What can the nurse instruct the client to do to decrease the discomfort from the exam?
Take a deep breath and exhale when the physician inserts a gloved finger into the rectum. Explanation: To minimize discomfort and relax the anal sphincter during the digital rectal examination, the patient is instructed to take a deep breath and exhale slowly as the practitioner inserts a finger. If possible, he should turn his feet inward so his toes are touching.
Which should be included as part of the home care instructions for a client with epididymitis and orchitis?
Take prescribed antibiotics Explanation: 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.
A patient comes to the emergency department and tells the nurse, "I took a pill to help me perform and then passed out." The nurse is assessing the patient and finds a nitroglycerin patch on his back. What is the first intervention the nurse must perform?
Take the patient's blood pressure. Explanation: Based on the patient's comments, he is most likely taking a phosphodiesterase type 5 (PDE-5) inhibitor, which is an oral medication used to treat erectile dysfunction. The most common side effects of this medication include headache, flushing, dyspepsia, diarrhea, nasal congestion, and lightheadedness. These agents are contraindicated in men who take organic nitrates (e.g., isosorbide [Isordil], nitroglycerin), because taken together, these medications can cause side effects such as severe hypotension.
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 Explanation: The testes are responsible for producing sperm (spermatogenesis). The vas deferens are the tubes that carry the sperm from the testicles and epididymis to the seminal vesicles, which acts as the reservoir for testicular secretions. The prostate gland produces a secretion that is chemically and physiologically suitable to the needs of the sperm in their passage from the testes.
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 Explanation: 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.
Which is the most common type of prostate surgery?
Transurethral resection of the prostate Explanation: Transurethral resection of the prostate, or TURP, is the most common procedure used and can be carried out through endoscopy. Suprapubic, perineal, and retropubic prostatectomies are surgical procedures for the prostate, but they are not the most common.
A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?
Transurethral resection of the prostate (TURP) Explanation: TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; each requires an incision.
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 Explanation: 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.
Which instruction regarding future sexual activity should a nurse give a client with a vasectomy?
Use a reliable method of contraception until the physician ensures that sperm no longer are present Explanation: For a client with a vasectomy, the nurse advises the client to use a reliable method of contraception until the physician ensures that sperm no longer are present, which may be determined after 10 or more ejaculations. The client should resume sexual activity when comfort allows, usually in 1 week. Administer a mild analgesic such as aspirin or acetaminophen for discomfort, not before the sexual activity. The client should expect some bruising and incisional soreness after the local anesthetic wears off.
Following a vasectomy, which is the most important instruction to provide to the client?
Use another form of birth control until further notice. Explanation: It may take up to 10 ejaculations to clear sperm and prevent impregnation. The client should be instructed to use another form of reliable birth control until a sperm count proves sterility has occurred. Use of Tylenol, scrotal support, and rest are all helpful during the initial recovery period.
What does the nurse tell the patient is the best way to decrease the risk of developing penile cancer?
Use good genital hygiene. Explanation: Although uncircumcised men have a greater incidence of penile cancer than circumcised men, the more important factor in preventing penile cancer is good genital hygiene. Circumcision is not recommended as a prevention strategy.
The nurse is caring for client who has had a vasectomy. Which would be most important to include in a teaching plan for this client?
Using a reliable method of contraception for several weeks. Explanation: It may take several weeks or more after surgery before the ejaculatory fluid is free of sperm, and the client is informed to use a reliable method of contraception until sperm no longer are present. The client should apply ice packs to the scrotum to reduce swelling and use a mild analgesic such as aspirin or acetaminophen for pain relief. The client typically can resume sexual activity when comfortable, usually in 1 week.
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. Explanation: It may take several weeks or more after surgery before the ejaculatory fluid is free of sperm, and the client is informed to use a reliable method of contraception until sperm no longer are present. The client should apply ice packs to the scrotum to reduce swelling and use a mild analgesic such as aspirin or acetaminophen for pain relief. The client typically can resume sexual activity when comfortable, usually in 1 week.
A client comes to the outpatient clinic for information on a vasectomy. Which instruction should be included by the nurse?
Vasectomies should be considered a permanent means of birth control. Explanation: Although attempts to reverse a vasectomy have proven successful, a vasectomy should be considered a permanent means of birth control. Scar formation and/or sperm leakage can interfere with restoration of reproductive effectiveness. Sexual intercourse can be resumed when it is comfortable to do so, usually in about 1 week. Postoperative discomfort should be controlled with application of cold to reduce swelling or use of mild analgesics. On occasion, clients have complained of impotence, but vasectomies have no effect on erection or ejaculation.
Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BPH)?
Voiding pattern Explanation: The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.
A nurse is obtaining a male client's health history before performing a physical examination. Which information would most likely not be obtained?
age of first ejaculate Explanation: Age of first ejaculate would most likely not be asked. Premature ejaculation or other concerns of a sexual nature, pain during sexual intercourse, and contraceptive practices would most likely be included in the health history.
A client has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe?
circumcision Explanation: Circumcision is recommended to relieve phimosis and paraphimosis permanently.
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. Explanation: 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 reports experiencing nocturia. The nurse obtains a thorough history including current signs and symptoms. What would the client likely include when describing the symptoms?
decrease in the force of urinary stream Explanation: The symptoms of benign prostatic hyperplasia (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. Changes in sexual function would not be consistent with BPH.
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 Explanation: Erosion of penile or urethral tissue may occur from a midsized implant, pressure, and friction of the implanted cylinders, which is evidenced by seeing the implant through the skin. Migration of the cylinders, pump, and reservoir is a possible complication but not due to a midsized implant, pressure, or friction of the implanted cylinders. Erosion of scrotal, bowel, or bladder tissue can occur when an implant with a fluid reservoir is used. Malfunction of the device can occur with migration, accidental trauma such as a fall, or aggressive or improper use of the device.
A clinical manifestation related to metastasis from prostate cancer is
hip pain. Explanation: Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, oliguria (decreased urine output), and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.
Which cancer ranks second as the cause of death in American men?
prostate Explanation: 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.
A client asks the nurse what PSA is. The nurse should reply that it stands for:
prostate-specific antigen, which is used to screen for prostate cancer. Explanation: PSA stands for prostate-specific antigen, which is used to screen for prostate cancer.
The obstructive and irritative symptom complex caused by benign prostatic hypertrophy is called
prostatism. Explanation: Symptoms of prostatism include increased frequency of urination, nocturia, urgency, dribbling, and a sensation that the bladder has not completely emptied. Prostatitis is an inflammation of the prostate gland. Prostaglandins are physiologically active substances present in tissues with vasodilator properties. Prostatectomy refers to the surgical removal of the prostate gland.
Which structure is involved in keeping the testes at the necessary temperature to ensure sperm production?
scrotum Explanation: 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.
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. Explanation: Testicular self-examination is a relatively simple technique that's extremely useful in detecting cancer-related testicular changes. Physician visits, risk factors, and family history are important to all clients, regardless of gender, and don't specifically address risk factors associated with testicular cancer.
A urologist suspects that a client might have prostate cancer. Which test would be used to make a diagnosis of cancer?
tissue biopsy Explanation: 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.