Ch.25 - Male Genitourinary System

16. When performing a genitourinary assessment, the nurse notices that the urethral meatus is ventrally positioned. What does this indicate? a. Hypospadias b. A result of phimosis c. Probably due to a stricture d. Often associated with aging

ANS: A Normally the urethral meatus is positioned just about centrally. Hypospadias is the ventral location of the urethral meatus. The position of the meatus does not change with aging. Phimosis is the inability to retract the foreskin. A stricture is a narrow opening of the meatus.

30. The nurse is inspecting the scrotum and testes of a 43-year-old man. Which finding would require additional follow-up and evaluation? a. Skin on the scrotum is taut. b. Left testicle hangs lower than the right testicle. c. Scrotal skin has yellowish 1-cm nodules that are firm and nontender. d. Testes move closer to the body in response to cold temperatures.

ANS: A Scrotal swelling may cause the skin to be taut and to display pitting edema. Normal scrotal skin is rugae, and asymmetry is normal with the left scrotal half usually lower than the right. The testes may move closer to the body in response to cold temperatures

6. A male patient with possible fertility problems asks the nurse where sperm is produced. Which answer should the nurse give the patient? a. Testes b. Prostate c. Epididymis d. Vas deferens

ANS: A Sperm production occurs in the testes, not in the other structures listed.

13. Which of these statements is most appropriate when the nurse is obtaining a genitourinary history from an older man? a. "Do you need to get up at night to urinate?" b. "Do you experience nocturnal emissions, or 'wet dreams'?" c. "Do you know how to perform a testicular self-examination?" d. "Has anyone ever touched your genitals when you did not want them to?"

ANS: A The older male patient should be asked about the presence of nocturia. Awaking at night to urinate may be attributable to a diuretic medication, fluid retention from mild heart failure or varicose veins, or fluid ingestion 3 hours before bedtime, especially coffee and alcohol. The other questions are more appropriate for younger men.

37. During a physical examination, the nurse finds that a male patient's foreskin is fixed and tight and will not retract over the glans. What is this condition called? a. Phimosis b. Epispadias c. Peyronie disease d. Urethral stricture

ANS: A With phimosis, the foreskin is nonretractable, forming a pointy tip of the penis with a tiny orifice at the end of the glans. The foreskin is advanced and so tight that it is impossible to retract over the glans. This condition may be congenital or acquired from adhesions related to infection. Epispadias is when the meatus opens on the dorsal (upper) side of glans or shaft above a broad, spadelike penis. It is rare but more disabling than hypospadias because of associated urinary incontinence and separation of pubic bones. A urethral stricture is a narrowing of the urethra which appears as a pinpoint, constricted opening at the meatus or inside along the urethra. A gradual decrease in force and caliber of urine stream is the most common symptom. Peyronie disease presents as subcutaneous plaques on the penis and is associated with painful bending of the penis during erection. Its cause is trauma to the penis with resulting scar, deformity, and often erectile dysfunction. The physical findings from this patient's examination indicate phimosis.

2. A 16-year-old boy is brought to the clinic for a problem that he refused to let his mother see. The nurse examines him, and finds that he has scrotal swelling on the left side. He had the mumps the previous week, and the nurse suspects that he has orchitis. Which of the following assessment findings support this diagnosis? (Select all that apply.) a. Swollen testis b. Mass that transilluminates c. Scrotal skin that is reddened d. Mass that does not transilluminate e. Scrotum that is tender upon palpation f. Scrotum that is nontender upon palpation

ANS: A, C, D, E With orchitis, the testis is swollen, with a feeling of weight, and is tender or painful. The mass does not transilluminate, and the scrotal skin is reddened. Transillumination of a mass occurs with a hydrocele, not orchitis.

4. When performing a genital examination on a 25-year-old man, the nurse notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information, how should the nurse proceed? a. Squeeze the glans to check for the presence of discharge. b. Consider this finding as normal, and proceed with the examination. c. Assess the testicles for the presence of masses or painless lumps. d. Obtain a more detailed history, focusing on any scrotal abnormalities the patient has noticed.

ANS: B After adolescence, the scrotal skin is deeply pigmented and has large sebaceous follicles and appears corrugated.

36. During a genital examination, the nurse notices that a male patient has clusters of small vesicles on the glans, surrounded by erythema. What does this finding suggest? a. Genital warts b. Genital herpes c. Peyronie disease d. Syphilitic chancres

ANS: B Genital herpes, or herpes simplex virus 2 (HSV-2), infections present as clusters of small vesicles with surrounding erythema, which are often painful and erupt on the glans or foreskin. The lesions of genital warts are soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch. They occur on the shaft of the penis, behind the corona, or around the anus, where they may grow into large grapelike clusters. Peyronie disease presents as subcutaneous plaques on the penis and is associated with painful bending of the penis during erection. Its cause is trauma to the penis with resulting scar, deformity, and often erectile dysfunction. Syphilitic chancres begin within 2 to 4 weeks of infection as a small, solitary, silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. The symptoms this patient is presenting with are those of genital herpes.

10. An older man is concerned about his sexual performance. In addition to a disease, what else should the nurse explain can cause a withdrawal from sexual activity later in life? a. Decreased sperm production b. Side effects of medications c. Decreased libido with aging d. Decreased pleasure from sexual intercourse

ANS: B In the absence of disease, a withdrawal from sexual activity may be attributable to side effects of medications such as antihypertensives, antidepressants, sedatives, psychotropics, antispasmotics, tranquilizers or narcotics, and estrogens; loss of spouse; depression; preoccupation with work; marital or family conflict; heavy use of alcohol; lack of privacy (living with adult children or in nursing home); economic or emotional stress; poor nutrition; or fatigue. Although there is a decrease in sperm production and other physical changes with aging, they need not interfere with the libido and pleasure from sexual intercourse.

19. When performing a scrotal assessment, the nurse notices that the scrotal contents show a red glow with transillumination. How should the nurse proceed? a. Assess the patient for the presence of a hernia. b. Suspect the presence of serous fluid in the scrotum. c. Refer the patient for evaluation of a mass in the scrotum. d. Consider this finding normal and proceed with the examination.

ANS: B Normal scrotal contents do not allow light to pass through the scrotum. However, serous fluid does transilluminate and shows as a red glow. Neither a mass nor a hernia would transilluminate.

8. The mother of a 10-year-old boy asks the nurse about the recognition of puberty. How should the nurse reply? a. "Puberty usually begins around 15 years of age." b. "The first sign of puberty is an enlargement of the testes." c. "The penis size does not increase until about 16 years of age." d. "The development of pubic hair precedes testicular or penis enlargement."

ANS: B Puberty begins sometime between age 9 for African Americans and age 10 for Caucasians and Hispanics. The first sign is an enlargement of the testes. Pubic hair appears next, and then penis size increases.

18. When assessing the scrotum of a male patient, the nurse notices the presence of multiple firm, nontender, yellow 1-cm nodules. What does this finding indicate? a. Urethritis b. Sebaceous cysts c. Subcutaneous plaques d. Due to an inflammation of the epididymis

ANS: B Sebaceous cysts are commonly found on the scrotum. These yellowish 1-cm nodules are firm, nontender, and often multiple. Urethritis is infection of the urethra which causes painful, burning urination or pruritis. Meatus edges are reddened, everted, and swollen with purulent drainage. Subcutaneous plaque on the penis is called Peyronie disease and is associated with painful bending of the penis during erection. Its cause is trauma to the penis with resulting scar, deformity, and often erectile dysfunction. Inflammation of the epididymis (epididymitis) causes swelling and severe pain of sudden onset in the scrotum, which is relieved by elevation. The multiple yellowish 1 cm nodules this patient has are sebaceous cysts. Sebaceous cysts are commonly found on the scrotum. These yellowish 1-cm nodules are firm, nontender, and often multiple.

1. Which is a structure of the external male genital? a. Testis b. Scrotum c. Epididymis d. Vas deferens

ANS: B The external male genital structures include the penis and scrotum. The testis, epididymis, and vas deferens are internal structures.

27. When performing a genital assessment on a middle-aged man, the nurse notices multiple soft, moist, painless papules in the shape of cauliflower-like patches scattered across the shaft of the penis. What does this finding suggest? a. Carcinoma b. Genital warts c. Genital herpes d. Syphilitic chancres

ANS: B The lesions of genital warts are soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch. They occur on the shaft of the penis, behind the corona, or around the anus, where they may grow into large grapelike clusters. Genital carcinoma begins as red, raised, warty growth or as an ulcer with watery discharge which almost always occur on the glans or inner lip of foreskin. Genital herpes (HSV-2 infection) appears as clusters of small vesicles with surrounding erythema which are often painful and erupt on the glans, foreskin, or anus. Syphilitic chancres begin within 2 to 4 weeks of infection as a small, solitary, silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. The symptoms this patient is experiencing are those of genital warts.

26. During an examination of an aging man, what finding would the nurse expect? a. Change in scrotal color b. Decrease in the size of the penis c. Enlargement of the testes and scrotum d. Increase in the number of rugae over the scrotal sac

ANS: B When assessing the genitals of an older man, the nurse may notice thinner, graying pubic hair and a decrease in the size of the penis. The size of the testes may be decreased, they may feel less firm, and the scrotal sac is pendulous with less rugae. No change in scrotal color is observed.

31. A 55-year-old man is experiencing severe pain of sudden onset in the scrotal area. It is somewhat relieved by elevation. On examination the nurse notices an enlarged, red scrotum that is very tender to palpation. Distinguishing the epididymis from the testis is difficult, and the scrotal skin is thick and edematous. What do these findings suggest? a. A varicocele b. Epididymitis c. A spermatocele d. Testicular torsion

ANS: B Epididymitis presents as severe pain of sudden onset in the scrotum that is somewhat relieved by elevation. On examination, the scrotum is enlarged, reddened, and exquisitely tender. The epididymis is enlarged and indurated and may be hard to distinguish from the testis. The overlying scrotal skin may be thick and edematous. A varicocele can present with either a dull pain, constant pulling or dragging sensation, or be asymptomatic. Appearance upon inspection may be normal or the lighter scrotal skin may have a bluish color and the testis on side of varicocele may be smaller due to impaired circulation. When standing a soft irregular mass posterior to and above testis which feels like a "bag of worms" may be palpable and collapses when supine and then refills when upright. A spermatocele is usually a painless, round, freely movable mass lying above and behind testis and if large may feel like a third testis. Testicular torsion presents with sudden onset of excruciating unilateral pain in testicle; red, swollen scrotum with one testes (usually the left) higher owing to rotation of shortening; and extremely tender to palpation and difficult to distinguish epididymis from testis.

2. Which is an accessory glandular structure for the male genital organs? a. Testis b. Scrotum c. Prostate d. Vas deferens

ANS: C Glandular structures accessory to the male genital organs are the prostate, seminal vesicles, and bulbourethral glands.

22. The nurse is describing how to perform a testicular self-examination to a patient. Which statement is most appropriate? a. "A good time to examine your testicles is just before you take a shower." b. "The testicle is egg shaped and movable. It feels firm and has a lumpy consistency." c. "If you notice an enlarged testicle or a painless lump, call your health care provider." d. "Perform a testicular examination at least once a week to detect the early stages of testicular cancer."

ANS: C If the patient notices a firm painless lump, a hard area, or an overall enlarged testicle, then he should call his health care provider for further evaluation. The testicle normally feels rubbery with a smooth surface. A good time to examine the testicles is during the shower or bath, when one's hands are warm and soapy and the scrotum is warm. Testicular self-examination should be performed once a month.

23. A 2-month-old uncircumcised infant has been brought to the clinic for a well-baby checkup. How would the nurse proceed with the genital examination? a. Elicit the cremasteric reflex. b. The glans is assessed for redness or lesions. c. Retracting the foreskin should be avoided until the infant is 3 months old. d. Any dirt or smegma that has collected under the foreskin should be noted.

ANS: C If uncircumcised, then the foreskin is normally tight during the first 3 months and should not be retracted because of the risk for tearing the membrane attaching the foreskin to the shaft. The cremasteric reflex (retracting the scrotal contents) is strong in infants and care should be taken not to elicit it. Since retracting the foreskin on an uncircumcised infant is not recommended until the infant is 3 months old, the glans and dirt and smegma under the foreskin cannot be assessed.

9. During an examination of an aging man, the nurse recognizes which finding is an expected or normal change? a. Enlarged scrotal sac b. Increased pubic hair c. Decreased penis size d. Increased rugae over the scrotum

ANS: C In the aging man, the amount of pubic hair decreases, the penis size decreases, and the rugae over the scrotal sac decreases. The scrotal sac does not enlarge.

24. A 2-year-old boy has been diagnosed with physiologic cryptorchidism. Considering this diagnosis, what will the nurse most likely observe during the assessment? a. Testes that are hard and painful to palpation b. Atrophic scrotum and a bilateral absence of the testis c. Absence of the testis in the scrotum, but the testis can be milked down d. Testes that migrate into the abdomen when the child squats or sits cross-legged

ANS: C Migratory testes (physiologic cryptorchidism) are common because of the strength of the cremasteric reflex and the small mass of the prepubertal testes. The affected side has a normally developed scrotum and the testis can be milked down. The other responses are not correct.

29. When the nurse is performing a testicular examination on a 25-year-old man, which finding is considered normal? a. Nontender subcutaneous plaques b. Scrotal area that is dry, scaly, and nodular c. Testes that feel oval and movable and are slightly sensitive to compression d. Single, hard, circumscribed, movable mass, less than 1 cm under the surface of the testes

ANS: C Testes normally feel oval, firm and rubbery, smooth, and bilaterally equal and are freely movable and slightly tender to moderate pressure. The scrotal skin should not be dry, scaly, or nodular or contain subcutaneous plaques. Any mass would be an abnormal finding.

15. The nurse is examining the glans and knows which finding is normal for this area? a. Hair is without pest inhabitants. b. The skin is wrinkled and without lesions. c. Smegma may be present under the foreskin of an uncircumcised male. d. The meatus may have a slight discharge when the glans is compressed.

ANS: C The glans looks smooth and without lesions and does not have hair. The meatus should not have any discharge when the glans is compressed. Some cheesy smegma may have collected under the foreskin of an uncircumcised male.

32. The nurse is performing a genitourinary assessment on a 50-year-old obese male laborer. On examination, the nurse notices a painless round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. What type of hernia do these findings suggest? a. Scrotal b. Femoral c. Direct inguinal d. Indirect inguinal

ANS: C Direct inguinal hernias occur most often in men over the age of 40 years. It is an acquired weakness brought on by heavy lifting, obesity, chronic cough, or ascites. The direct inguinal hernia is usually a painless, round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. A scrotal hernia appears with an enlarged testis that does not transilluminate and may reduce when supine. It may be painful with straining. Upon palpation a soft, mushy mass which is distinct from the normal testis can be palpated and the palpating fingers cannot get above the mass. A femoral hernia usually presents with pain that is constant and may be severe and become strangulated. With indirect inguinal hernias, pain occurs with straining and a soft swelling increases with increased intra-abdominal pressure, which may decrease when the patient lies down.

25. What is a common assessment finding in a boy younger than 2 years old? a. Inflamed and tender spermatic cord b. Presence of a hernia in the scrotum c. Penis that looks large in relation to the scrotum d. Presence of a hydrocele, or fluid in the scrotum

ANS: D A common scrotal finding in boys younger than 2 years of age is a hydrocele, or fluid in the scrotum. The other options are not correct.

7. A 62-year-old man states that his physician told him that he has an "inguinal hernia." He asks the nurse to explain what a hernia is. Which response by the nurse is best? a. "Don't worry, most men your age develop hernias." b. "A hernia is often the result of a prenatal growth abnormality." c. "You should talk to your physician since he or she made the initial diagnosis." d. "A hernia is a loop of bowel protruding through a weak spot in the abdominal muscles."

ANS: D A hernia is a loop of bowel protruding through a weak spot in the musculature of the abdominal wall. It is not a result of a prenatal growth abnormality. Although the patient may need to talk to the physician who diagnosed the hernia, the nurse should still answer his question and should not tell him not to worry, but acknowledge his concerns. A hernia is not a result of a prenatal growth abnormality. The nurse should explain to him that a hernia is a loop of bowel protruding through a weak spot in the musculature of the abdominal wall.

3. Which of these statements is true regarding the penis? a. The urethral meatus is located on the ventral side of the penis. b. The prepuce is the fold of foreskin covering the shaft of the penis. c. The penis is made up of two cylindric columns of erectile tissue. d. The corpus spongiosum expands into a cone of erectile tissue called the glans.

ANS: D At the distal end of the shaft, the corpus spongiosum expands into a cone of erectile tissue, the glans. The penis is made up of three (not two) cylindric columns of erectile tissue. The prepuce is the skin that covers the glans (not the shaft) of the penis. The urethral meatus forms at the tip of the glans (not on the ventral side).

35. During a health history, a patient tells the nurse that he has trouble in starting his urine stream. How should the nurse document this finding? a. Urgency b. Dribbling c. Frequency d. Hesitancy

ANS: D Hesitancy is trouble in starting the urine stream. Urgency is the feeling that one cannot wait to urinate. Dribbling is the last of the urine before or after the main act of urination. Frequency is urinating more often than usual.

17. The nurse is performing a genital examination on a male patient and notices urethral drainage. What should the nurse do when collecting urethral discharge for microscopic examination and culture? a. Ask the patient to urinate into a sterile cup. b. Ask the patient to obtain a specimen of semen. c. Insert a cotton-tipped applicator into the urethra. d. Compress the glans between the examiner's thumb and forefinger, and collect any discharge.

ANS: D If urethral discharge is noticed, then the examiner should collect a smear for microscopic examination and culture by compressing the glans anteroposteriorly between the thumb and forefinger. The other options are not correct actions.

21. The nurse is aware that which statement is true regarding the incidence of testicular cancer? a. The cure rate for testicular cancer is low. b. Testicular cancer is the most common cancer in men aged 30 to 50 years. c. The early symptoms of testicular cancer are pain and induration. d. Men with a history of cryptorchidism are at the greatest risk for the development of testicular cancer.

ANS: D Men with undescended testicles (cryptorchidism) are at the greatest risk for the development of testicular cancer. The overall incidence of testicular cancer is rare. Although testicular cancer has no early symptoms, when detected early and treated before metastasizing, the cure rate is almost 100%.

12. When the nurse is conducting a sexual history from a male adolescent, which statement would be most appropriate to use at the beginning of the interview? a. "Do you use condoms?" b. "You don't masturbate, do you?" c. "Have you had sex in the last 6 months?" d. "Often adolescents your age have questions about sexual activity."

ANS: D The interview should begin with a permission statement, which conveys that it is normal and acceptable to think or feel a certain way. Sounding judgmental, such as saying "You don't masturbate, do you?" should be avoided.

5. Which statement concerning the testes is true? a. The vas deferens is located along the inferior portion of each testis. b. The lymphatic vessels of the testes drain into the abdominal lymph nodes. c. The right testis is lower than the left because the right spermatic cord is longer. d. The cremaster muscle contracts in response to cold and draws the testicles closer to the body.

ANS: D When it is cold, the cremaster muscle contracts, which raises the scrotal sac and brings the testes closer to the body to absorb heat necessary for sperm viability. The lymphatic vessels of the testes drain into the inguinal lymph nodes. The vas deferens is located along the upper portion of each testis. The left testis is lower than the right because the left spermatic cord is longer.

20. When the nurse is performing a genital examination on a male patient, which action is correct? a. Auscultating for the presence of a bruit over the scrotum b. Palpating the inguinal canal only if a bulge is present in the inguinal region during inspection c. Palpating for the vertical chain of lymph nodes along the groin, inferior to the inguinal ligament d. Having the patient shift his weight onto the left (unexamined) leg when palpating for a hernia on the right side

ANS: D When palpating for the presence of a hernia on the right side, the male patient is asked to shift his weight onto the left (unexamined) leg. Auscultating for a bruit over the scrotum is not appropriate. When palpating for lymph nodes, the horizontal chain is palpated. The inguinal canal should be palpated whether a bulge is present or not.

14. When the nurse is performing a genital examination on a male patient, the patient has an erection. How should the nurse respond? a. Ask the patient if he would like someone else to examine him. b. Continue with the examination as though nothing has happened. c. Stop the examination, leave the room while stating that the examination will resume at a later time. d. Reassure the patient that this is a normal response and continue with the examination.

ANS: D When the male patient has an erection, the nurse should reassure the patient that this is a normal physiologic response to touch and proceed with the rest of the examination. The other responses are not correct and may be perceived as judgmental.

28. When performing a genitourinary assessment on a 16-year-old male adolescent, the nurse notices a swelling in the scrotum that increases with increased intra-abdominal pressure and decreases when he is lying down. The patient reports pain when straining. What do these findings indicate? a. Femoral hernia b. Incisional hernia c. Direct inguinal hernia d. Indirect inguinal hernia

ANS: D With indirect inguinal hernias, pain occurs with straining and a soft swelling increases with increased intra-abdominal pressure, which may decrease when the patient lies down. A femoral hernia usually presents with pain that is constant and may be severe and become strangulated. An incisional, or ventral, hernia occurs at the site of a previous surgical incision in either the groin or abdominal area. A direct hernia is usually painless and is easily reduced when supine. The symptoms this patient is experiencing are those of an indirect hernia.

33. The nurse is providing patient teaching about an erectile dysfunction drug. One of the drug's potential side effects is prolonged, painful erection of the penis without sexual stimulation. What is the medical term for this condition? a. Orchitis b. Phimosis c. Stricture d. Priapism

ANS: D Priapism is prolonged, painful erection of the penis without sexual desire. Orchitis is inflammation of the testes. Stricture is a narrowing of the opening of the urethral meatus. Phimosis is the inability to retract the foreskin.

34. During an examination, the nurse notices that a male patient has a red, round, superficial ulcer with a yellowish serous discharge on his penis. On palpation, the nurse finds a nontender base that feels like a small button between the thumb and fingers. What do these findings indicate? a. Genital warts b. Herpes infection c. Carcinoma lesion d. Syphilitic chancre

ANS: D Syphilitic chancres begin as a small, solitary, silvery papule within 2 to 4 weeks of infection which then erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. The lesions of genital warts are soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch. They occur on the shaft of the penis, behind the corona, or around the anus, where they may grow into large grapelike clusters. Genital herpes (HSV-2 infection) appears as clusters of small vesicles with surrounding erythema which are often painful and erupt on the glans, foreskin, or anus. Genital carcinoma begins as red, raised, warty growth or as an ulcer with watery discharge which almost always occur on the glans or inner lip of foreskin. The symptoms this patient is experiencing are those of syphilitic chancre.

1. A 55-year-old man is in the clinic for a yearly checkup. He is worried because his father died of prostate cancer. The nurse knows which tests should be performed at this time? (Select all that apply.) a. Urinalysis b. Prostate biopsy c. Transrectal ultrasound d. Digital rectal examination (DRE) e. Blood test for prostate-specific antigen (PSA)

ANS: D, E Prostate cancer is typically detected by testing the blood for PSA or by a DRE. It is recommended that both PSA and DRE be offered to men annually, beginning at age 50 years. If PSA is elevated, then further laboratory work or a transrectal ultrasound (TRUS) and biopsy may be recommended.

11. A 59-year-old patient has been diagnosed with prostatitis and is being seen at the clinic for reports of burning and pain during urination. How should the nurse document this finding? a. Dysuria b. Nocturia c. Polyuria d. Hematuria

Dysuria (burning with urination) is common with acute cystitis, prostatitis, and urethritis. Nocturia is voiding during the night. Polyuria is voiding in excessive quantities. Hematuria is voiding with blood in the urine.