chapter 23 Prep U

Cremasteric reflex : The scrotum can maintain temperature control because the cremaster muscle is sensitive to changes in temperature. The muscle contracts when too cold, raising the scrotum and testes upward toward the body for warmth (cremasteric reflex). This accounts for the wrinkled appearance of the scrotal skin. The patellar reflex occurs when a physician strikes the patellar tendon of the knee and the leg jerks. The rooting reflex occurs in infants when they turn their heads toward anything that strokes the cheek or mouth. The vasovagal reflex is a contraction of muscles in the gastrointestinal tract in response to distension of the tract following consumption of food and drink.

A nurse examining a client's external genitalia notices that his scrotum and testes draw up and he shivers. This phenomenon is known as which of the following? Vasovagal reflex Patellar reflex Cremasteric reflex Rooting reflex

foreskin. : If the man has not been circumcised, a hood-like fold of skin called the foreskin or prepuce covers the glans

If a male client is uncircumcised, the glans of the penis is covered by the foreskin. corona. epididymis. frenulum.

Suspended by the spermatic cord

The testes in the male scrotum are suspended by the spermatic cord. the location of the vas deferens. able to produce progesterone. joined with the ejaculatory duct.

Reassure the client that this is not unusual. If a client experiences an erection during the exam, the nurse should reassure the client that this is not unusual and continue the exam in an unhurried and unflappable manner. The nurse needs to acknowledge the event, because the client is most likely feeling embarrassed. Stopping the exam and leaving the room may promote additional embarrassment or guilt in the client. Asking if continuing will embarrass him emphasizes what the client is already feeling and would most likely make it worse.

When the nurse is examining a male client's genitalia, the client experiences an erection. What would be most appropriate for the nurse to do? As the client whether continuing the exam will embarrass him. Reassure the client that this is not unusual. Stop the exam and leave the room for 10 minutes. Don't say anything but continue the exam.

"Have you and your wife attempted a pregnancy together?" : Varicoceles are associated with infertility. Therefore it would be important to determine if the client has been able to have children. Asking if the client wants to have children, although important, does not provide information related to the client's problem. The client may complain of discomfort and testicular heaviness but not pain during intercourse. On testicular exam, tortuous veins would be palpable.

Which question would be most important to ask a married male client with a varicocele? "Have you ever felt a mass during your testicular exam?" "Have you and your wife attempted a pregnancy together?" "Do you want to have children?" "Does intercourse cause you pain?"

Benign prostatic hyperplasia (BPH) Initial symptoms of BPH may be urinary difficulties. The client does not empty his bladder completely when he voids and finds that he must void frequently, often during the night. He may also find starting to void increasingly difficult or painful and may notice traces of blood in his urine. Cystitis may result. The client with chronic prostatitis is usually asymptomatic, but he may complain of back or perineal pain. Symptoms of orchitis include pain and swelling in the scrotum and sometimes urethral irritation. Symptoms of epididymitis include redness, pain, and various degrees of scrotal swelling.

A 72-year-old male presents at a local clinic and states: "I have to urinate all the time, and I never feel like my bladder is emptied. It really bothers me at night." What condition might the nurse suspect related to this chief complaint? Epididymitis Chronic bacterial prostatitis (CBP) Benign prostatic hyperplasia (BPH) Orchitis

Scrotum : The external genitalia include the penis and scrotum. The testis, vas deferens, and spermatic cord are internal genitalia

A group of students is reviewing information about the male genitalia in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as external genitalia? Vas deferens Scrotum Testis Spermatic cord

Risk for infection : Risk for infection is related to inadequate knowledge, urinary reflux, recent trauma, and urinary catheter placement. The other answers are distracters for the question

The client received in the ICU was shot in the lower abdomen, suffered bladder trauma, and now has a urinary catheter. With these risk factors, what would be an appropriate nursing diagnosis for this client? Ineffective sexuality pattern Risk for infection Risk for urinary retention Risk for urge incontinence

Is highly responsive to treatment. Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

The public health nurse has been asked to provide a health promotion session at a wellness center. The topic of the session is to be testicular cancer. What should the nurse inform the participants about testicular cancer?

hemorrhoids. : The anorectal junction is not palpable, but may be visualized during internal examination. The folds contain a network of arteries, veins, and visceral nerves. If the veins in these folds undergo chronic pressure, they may become engorged with blood, forming hemorrhoids.

The rectum is lined with folds of mucosa, and each fold contains a network of arteries, veins, and visceral nerves. When these veins undergo chronic pressure, the result may be polyps. fissures. tumors. hemorrhoids.

epispadias

While reviewing the medical record before examining a male clinic patient, the nurse notes that the urinary meatus is located on the top of the glans of the penis. The nurse understands the correct term for this congenital defect is epispadias hydrocele hypospadias varicocele

A spermatocele is a sperm-filled cystic mass located on the epididymis.

what is a sperm-filled cystic mass located on the epididymis?

A varicocele is an abnormal dilation of veins in the spermatic cord.

what is an abnormal dilation of veins in the spermatic cord?

Orchitis is inflammation of the testes.

what is the inflammation of the testes?

Torsion of the spermatic cord Torsion of the spermatic cord is usually accompanied by a sudden, severe pain of the scrotum and is a urological emergency. A spermatocele is a sperm-filled cystic mass located on the epididymis. Orchitis is inflammation of the testes. A varicocele is an abnormal dilation of veins in the spermatic cord.

A 23 year old male comes to the clinic complaining of sudden and severe pain in his scrotum. The nurse would suspect what? Orchitis Spermatocele Varicocele Torsion of the spermatic cord

Anorectal fistula : Anorectal fistula can commonly cause leakage of stool even while not having a bowel movement. These fistulas are common after infections, especially after trauma to the anal musculature (such as in a fourth-degree perineal tear). With more chronic gastrointestinal symptoms, this finding may lead you to suspect Crohn's disease.

A 26-year-old woman comes to the clinic complaining of leakage of stool despite generally normal pain-free bowel movements. She denies any blood in her stool or on the toilet paper. She has had no recent episodes of diarrhea. Her past medical history includes a spontaneous vaginal birth 3 months ago. She had a fourth-degree tear of the perineal area (from the vagina through the rectum) that was surgically repaired. A few days later the client developed an abscess in the anal area that had to be incised and drained. She denies using any tobacco, alcohol, or illegal drugs. Her mother and father are both in good health. She denies any weight gain, weight loss, fever, or night sweats. She is still breastfeeding her baby without any problems. Inspection reveals a small opening anterior to the anus with some surrounding erythema. There is not a mass or other inflammation. Digital rectal examination reveals smooth walls with no blood. She has no pain during the rectal examination. Bimanual vaginal examination is also normal. What anal or rectal disorder is the most likely cause of her symptom? Anal fissure External hemorrhoids Anorectal fistula Internal hemorrhoids

Prepare the client for surgery. For the client with torsion, immediate surgery is necessary to prevent atropy 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 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? Apply a dressing over the scrotum. Prepare the client for circumcision. Apply scrotal support. Prepare the client for surgery.

Black Black stool may indicate upper gastrointestinal bleeding. Red stool may be found with hemorrhoids, polyps, cancer or colitis. Clay-colored stool suggest a biliary obstruction; yellow stool suggests steatorrhea.

A client is being evaluated for upper gastrointestinal bleeding. The nurse would expect to observe stool that is which color? Yellow Black Red Clay

Gonorrhea Gonorrhea symptoms include pain with urination, rectal pain and urethral discharge. Chlamydia is generally asymptomatic. Scabies is associated with papules, vesicles, pustules and itching. Syphilis has five stages but is exhibited by a genital lesion.

A male client is complaining of pain with urination, rectal pain and urethral discharge. The nurse suspects this is what? Scabies Syphilis Chlamydia Gonorrhea

Position the client in a left side-lying position. : The most frequently used position for inspection and palpation of the anus, rectum, and prostate is the left lateral position. This position allows adequate inspection and palpation of the anus, rectum, and prostate (in men) and is usually more comfortable for the client. Pain control should not be necessary. Some men may be anxious or fearful during this exam, but the nurse would not normally raise this possibility unless he or she had reason to believe that the client felt this way.

A nurse is a preparing to assess a male client's anus and rectum. How should the nurse best prepare the client for this assessment? Ask the client if he is feeling anxious or fearful about the exam. Assist the client into the supine position. Position the client in a left side-lying position. Administer a dose of analgesia 15 minutes before the exam.

Gently squeeze the glans between the thumb and index finger. : To palpate for urethral discharge, the nurse would gently squeeze the glans between the thumb and index finger. Having the client hold the penis, observing the glans, or inspecting the scrotal skin would be insufficient because discharge in the urethra cannot be visualized.

A nurse is planning to assess a male client for urethral discharge. Which technique would be best for the nurse to use? Inspect the scrotal skin while holding the penis aside. Observe the glans of the penis for signs of abnormal discharge. Gently squeeze the glans between the thumb and index finger. Have the client hold the penis while the examiner looks for discharge.

Hypertension 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

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? Lower back pain Hypertension Asthma Sinus infections

Reassure him that it is not unusual to have an erection during the examination

A nurse prepares a male client for a physical assessment of the external genitalia. Which instruction is appropriate for the nurse to give the client before the examination?

BPH : A rubbery or boggy glandular consistency may indicate BPH, a common finding in men older than 60 years of age. The gland may feel soft, tender, and boggy from infection.

A patient has undergone a digital rectal examination. This assessment will allow the clinician to diagnose which of the following? ED Testicular cancer BPH Urinary incontinence

Testicular torsion : Any patient with scrotal pain should be presumed to have testicular torsion until another diagnosis can be proven.

A patient presents at the clinic with severe scrotal pain. What is the presumptive diagnosis? Varicocele Priapism Hydrocele Testicular torsion

Left testicular torsion : Signs of testicular torsion include acute pain that is not relieved by elevating the testicle, nausea, and vomiting. Epididymitis usually presents in adult males. The client presents with unilateral pain to one testis, but fever, dysuria, and possibly urethral discharge. Hydrocele is the accumulation of fluid around a testicle. This condition usually presents as a non-tender and soft testicle. Often testicular cancer presents lump or swelling, which may or may not be painful. The condition could also present with pain in the abdomen or low back.

A teenage male client comes to the ED with severe left testicular pain and vomiting. Elevation of his left testicle does not lessen the pain. What could these symptoms indicate for this patient? Epididymitis Testicular cancer Left testicular torsion Hydrocele

has anal intercourse with other males. : Because HIV is preventable, knowing risks and practicing risk-reducing behaviors will help to stem the epidemic of this infection. Risks include having unprotected sex (especially male-on-male anal intercourse).

During assessment of an adult client, which of the following lifestyle practices would indicate to the nurse that the client may be at high risk for HIV/AIDS? A client who uses a condom on a regular basis. has multiple female partners. has anal intercourse with other males. smokes marijuana occasionally.

prostate enlargement. : Difficulty urinating may indicate an infection or blockage, including prostatic enlargement.

During assessment of an elderly male client, the client tells the nurse that he has had difficulty urinating for the past few weeks. The nurse should refer the client to the physician for possible prostate enlargement. inguinal hernia. sexually transmitted disease. impotence.

Strenuous activity : Strenuous activity and heavy lifting may predispose a client to the development of an inguinal hernia. Exposure to radiation and certain chemicals increases the risk of developing cancer. Erectile dysfunction occurs frequently in adult males and may be attributed to various factors, some of which include the use of alcohol, diabetes, or depression. Fear can cause stress and inhibition and decrease sexual satisfaction.

During the assessment of a client, the nurse recognizes that which of the client's lifestyle practices may predispose to the development of an inguinal hernia? Erectile dysfunction Stress and inhibition Exposure to radiation Strenuous activity

Prepuce If the man has not been circumcised, a hood-like fold of skin called the foreskin, or prepuce, covers the glans. In the center of the corpus spongiosum is the urethra, which travels through the shaft and opens as a slit at the tip of the glans as the urethral meatus. The shaft of the penis is composed of three cylindrical masses of vascular erectile tissue that are bound together by fibrous tissue—two corpora cavernosa on the dorsal side and the corpus spongiosum on the ventral side.

On inspecting a client's external genitalia, a nurse notes that he is uncircumcised. This means that which of the following covers the glans of the penis? Corpus cavernosa Corpus spongiosum Prepuce Urethral meatus

Obtain a sample of the discharge for culture. Any urethral discharge should be cultured. A urine sample may be indicated, but this is not always the case. Repeating palpation of the urethra after voiding will not add meaningful data. The presence of discharge does not create a direct indication for scrotal and testicular palpation, although these actions are part of the overall genitourinary assessment.

Palpation of a male client's urethra produces a yellowish-white discharge. What is the nurse's best action? Obtain a urine sample for culture and sensitivity testing. Obtain a sample of the discharge for culture. Ask the client to void and then repeat palpation of the client's urethra. Palpate the client's scrotum and testes for the presence of fluid.

cryptorchidism. Absence of a testis suggests cryptorchidism (an undescended testicle).

The nurse has assessed a male client and determines that one of the testes is absent. The nurse should explain to the client that this condition is termed orchitis. cryptorchidism. hematocele. hypospadias.

Herpes : Herpes is associated with clusters of pimple-like clear vesicles. Gonorrhea has drainage. Syphilis has a chancre. Chlamydia is asymptomatic.

The nurse is assessing male genitalia and finds clusters of pimple-like clear vesicles. The nurse recognizes this as what? Herpes Gonorrhea Chlamydia Syphilis

Standing : When beginning the exam, the nurse sits on a stool in front of the client while the client assumes a standing position. This allows the nurse to inspect the genitalia.

The nurse is beginning the physical exam of a male client's genitals. The nurse is sitting on a stool in front of the client. In which position would be best to place the client?

Scrotal : The nurse should document this finding as scrotal hernia if the bulge remains when the client lies down and bowel sounds can be auscultated over it. If the mass in the scrotum cannot be pushed into the abdomen, it could be an incarcerated hernia. A hernia is strangulated if the blood supply is cut off. A bulge or mass on the front of the thigh in the femoral canal area is a femoral hernia.

Upon inspection and palpation of the scrotum, the nurse discovers a mass. The nurse asks the client to lie down, and the bulge remains. On auscultation, the nurse finds bowel sounds. The nurse should document this finding as which type of hernia? Incarcerated Scrotal Strangulated Femoral

Hemorrhoids Hemorrhoids are veins that are engorged with blood. Anal crypts are recessed areas between the columns of Morgagni within the anal canal. The rectovesical pouch is the area where the peritoneum that lines the upper two-thirds of the anterior rectum dips down enough so that it can be palpated. Fibroids are benign tumors occurring in the uterus.

When assessing the rectum, the nurse observes what appear to be engorged areas near the rectal opening. The nurse would most likely document this finding as which of the following? Anal crypts Rectovesical pouch Hemorrhoids Fibroids

Normal prostate The prostate is normally nontender and rubbery with two lateral lobes that are smooth, 2.5 cm long, and heart shaped. Swelling and tenderness suggest prostatitis. Enlargement of a smooth, firm, slightly elastic prostate suggests benign hypertrophy. A hardened area on the prostate or hard fixed irregular nodules suggest prostate cancer.

When palpating the prostate, the nurse detects a nontender, rubbery prostate with lateral lobes that are 2.5 cm and heart-shaped. The nurse would interpret this finding as indicating which of the following? Cancer Benign hypertrophy Normal prostate Prostatitis

Pilonidal cyst : A reddened, swollen, or dimpled area covered by a small tuft of hair on the lower sacrum suggests a pilonidal cyst. A cavity of pus around the anal opening would suggest a perianal abscess. A thrombosed swollen area would suggest a hemorrhoid. A small round opening in the skin surrounding the anal opening suggest an anorectal fistula.

Which of the following would a nurse suspect when finding a dimpled area covered by a small tuft of hair located on the lower sacrum? Anorectal fistula Hemorrhoids Perianal abscess Pilonidal cyst

Normal findings Scrotal skin is normally thin and rugated with little hair. Inflammation of the penis and scrotum may be seen in Reiter's syndrome. Absence or scarcity of pubic hair may suggest chemotherapy. A yellow urethral discharge is usually seen with gonorrhea.

While assessing the scrotum of an adult client, the nurse notes thin and rugated scrotal skin with little hair dispersion. The nurse interprets this finding as which of the following? Normal findings Gonorrhea Effects of chemotherapy Reiter's syndrome