Chapter 26-Assessing Male Genitalia

A nurse is caring for a client with prostatitis. The nurse knows that what nursing care measure will be employed when caring for this client?

Administer the prescribed dose of antibiotics

A patient has undergone a digital rectal examination. This assessment will allow the clinician to diagnose which of the following?

Benign Prostatic Hyperplasia

Which client would the nurse identify as being at highest risk for the development of testicular cancer?

A 25-year-old man with a history of cryptorchidism

During assessment of the inguinal regions for herniating masses, the nurse instructs the standing male client do which of the following?

bear down

When palpating the rectal mucosa, how does the nurse rotate the examining hand?

clockwise, then counterclockwise

The nurse is documenting current health concerns during the health history of an older adult male client. Identification of what may help most at this time?

previous problems

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

cryptorchidism.

The nurse notes that a client has a small red papule that is clean, smooth, and glistening on the penis. What should the nurse suspect is causing this lesion?

primary syphilis

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

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

hemorrhoids

A client presents to the health care clinic with reports of clay-colored stool. The nurse recognizes that this finding is most likely a result of which of the following?

lack of bile pigment

What information should nurse include in the teaching plan for a client considering a vasectomy?

offers permanent birth control

A patient presents at the clinic with severe scrotal pain. What is the presumptive diagnosis?

testicular torsion

Prostate cancer is the leading cancer diagnosed in men in the United States. To increase knowledge of risk factors, the nurse would teach men that (Select all that apply.)

-each decade after age 50 increases the risk -it occurs earlier and is more advanced in African American men -15% have an affected first-degree relative

What care should a nurse take when performing the hands-on assessment of the anus, rectum, and prostate? Select all that apply.

-Explain each step of the examination and encourage the client to relax -Use gentle movements with the finger and ensure adequate lubrication -Listen and watch for signs of discomfort and tensing muscles

Which client should a nurse recognize has the highest risk to develop prostate cancer?

65-year-old Caucasian male whose father had prostate cancer at age 55

A nurse is palpating the prostate of a client and finds it to be swollen, tender, firm, and warm to the touch. Which condition should the nurse most suspect?

Acute prostatitis

Upon inspection and palpation of the front of the client's thigh, the nurse discovers a bulge that appears when the client coughs. The nurse should document this finding as which type of hernia?

femoral

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

has anal intercourse with other males.

The client tells the nurse that he has little or no interest in sex. He says he is concerned and he knows his wife is unhappy with his lack of libido. What can the nurse tell the client often causes lack of libido?

side effects of medications

During a physical examination, the nurse inspects the eternal genitalia of a male client. Which of the following would the nurse identify as an abnormality?

skin lesions

The testes in the male scrotum are

suspended by the spermatic cord.

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

Gonorrhea

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

Reassure him that it is not unusual to have an erection

A 25-year-old client asks the nurse how often he should have a testicular examination. After instructing the client about the American Cancer Society's guidelines, the nurse determines that the client has understood the instructions when he says he should have a testicular examination every

3 years

You are caring for a 33 year old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in five years. During the examination the physician finds that digital rectal examination (DRE) reveals extensive hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what

A sign of early prostate cancer

Francis is a middle-aged man who noted right sided lower abdominal pain after straining with yardwork. Which of the following findings would make a hernia a more likely diagnosis?

Absence of symmetry of the inguinal areas with straining

A 22-year-old unemployed roofer presents to the clinic with pain in his testicle and penis. He states the pain began last night and has steadily worsened. He states it hurts when he urinates; he has not attempted intercourse since the pain began. He has tried acetaminophen and ibuprofen without improvement. He denies any fever or night sweats. His past medical history is unremarkable. He has had four previous sexual partners and has had a new partner for the last month. She uses oral contraceptives so he has not used condoms. His parents are both in good health. Examination shows a young man lying on his side. He appears mildly ill. His temperature is 38.2°C, and his blood pressure, respirations, and pulse are normal. On visualization of the penis he is circumcised with no lesions or discharge from the meatus. Visualization of the scrotal skin appears unremarkable. Palpation of the testes shows severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness when palpating the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges being noted with bearing down. His prostate examination is unremarkable. Urine analysis shows white blood cells and bacteria. What diagnosis of the male genitalia is most likely in this case?

Acute epididymitis

A 16-year-old high school student comes to the clinic with his father. The teenager was taught in his health class at school to do monthly self-testicular checks. Yesterday when he felt his left testicle it was enlarged and tender. He isn't sure if he has had burning with urination; he says he has never had sexual intercourse. He has had a sore throat, cough, and runny nose for the last 3 days. His past medical history is significant for a tonsillectomy as a small child. His father has high blood pressure; his mother is healthy. Examination reveals a teenager in no acute distress. Temperature is 38.1°C; blood pressure and pulse are unremarkable. On visualization of his penis he is uncircumcised with no lesions or discharge. His scrotum is red and tense on the left and normal appearing on the right. Palpating his left testicle reveals a mildly sore swollen testicle. The right testicle is unremarkable. An examining finger is put through both inguinal rings and there are no bulges with bearing down. His prostate examination is unremarkable. Urine analysis is also unremarkable. What abnormality of the testes does this teenager most likely have?

Acute orchitis

Which of the following groups has the highest incidence of prostate cancer?

African American men

What ethnic group has a significantly higher incidence rate of prostate cancer?

African Americans

The nurse is preparing an instructional session for male clients about preventing penile cancer. Which non-modifiable risk factor should the nurse include in the teaching?

Age 60 years or older

The nurse suspects that a male client may have a hernia. The nurse should further assess the client for

Bowel sounds at the buldge

When assessing a client during the physical examination of the genitalia, the nurse palpates the scrotal contents. Which finding should the nurse recognize as an indication that an infection or cysts are present?

Beaded or thickened cord

A 60-year-old coach comes to the clinic complaining of difficulty starting to urinate for the last several months. He believes the problem is steadily getting worse. When asked he says he has a very weak stream, and it feels like it takes 10 minutes to empty his bladder. He also has the urge to go to the bathroom more often than he used to. He denies any blood or sediment in his urine and any pain with urination. He has had no fever, weight gain, weight loss, or night sweats. His medical history includes type 2 diabetes and high blood pressure treated with medications. He does not smoke but drinks a six pack of beer weekly. He has been married for 35 years. His mother died of a myocardial infarction in her 70s, and the client's father is currently in his 80s with high blood pressure and arthritis. Examination reveals a mildly obese alert and cooperative man. His blood pressure is 130/70 with a heart rate of 80. He is afebrile, and his cardiac, lung, and abdominal examinations are normal. Visualization of the anus shows no inflammation, masses, or fissures. Digital rectal examination reveals a smooth, enlarged prostate. No discrete masses are felt. There is no blood on the glove. An analysis of the urine shows no red blood cells, white blood cells, or bacteria. What disorder of the anus, rectum, or prostate is most likely?

Benign prostatic hyperplasia (BPH)

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?

Benign prostatic hyperplasia (BPH)

The nurse is palpating the prostate of a 55-year-old client and finds it to be enlarged, smooth, firm, and slightly elastic, without a median sulcus. Which condition should the nurse most suspect? You Selected:

Benign prostatic hypertrophy

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?

Cremasteric reflex

A nurse examines the external genitalia of a client and observes that the scrotum is underdeveloped and the testis can not be palpated. How should the nurse document this condition?

Cryptorchidism

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

Cryptorchidism

Which of the following would the nurse expect to be done to assess the size of the prostate?

Digital rectal examination

All of the following symptoms are potential indicators of testicular disorders except:

Dull ache in the lower abdomen

An adolescent male client is diagnosed with testicular torsion. The nurse should prepare the client for which treatment?

Emergency surgery

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.

Which of the following statements is true of prostate cancer?

Ethnicity is a risk factor

A nurse examines the anal area of a client and observes the presence of a varicose vein. How should the nurse document this finding?

External Hemorrhoid

A 42-year-old man comes to the clinic complaining of pain with defecation and profuse bleeding in the toilet after a bowel movement. He was in his usual state of health until 2 weeks ago when he was injured in a car accident. After the accident he began taking prescription narcotics for the pain in his shoulder. Since then he has had very few bowel movements. His stool is hard and pebble-like. He states he has always been "regular" in the past with easy-to-pass bowel movements. His diet has not changed, but he states that he is exercising less since the accident. His past medical history includes hypertension for which he takes a low-dose diuretic. He has had no other chronic illnesses or surgeries. He has a family history of hypertension, coronary heart disease, and diabetes, but no cancer. He is divorced with three children. He smokes two packs of cigarettes per day and quit drinking more than 10 years ago. He has had no recent weight loss, weight gain, fever, or night sweats. On examination, he appears muscular and healthy; he is afebrile. His blood pressure is 135/90 with a pulse of 80. His cardiac, lung, and abdominal examinations are normal. He is wearing a sling on his left arm. Observation of the anus shows a swollen bluish ovoid mass that appears to contain a blood clot. Digital rectal examination is extremely painful for the client. No other mass is palpated within the anus or rectum. What anal disorder is this client likely to have?

External hemorrhoid

A nurse examines the anal area of a client and observes the presence of a varicose vein. How should the nurse document this finding?

External hemorrhoid

A male in college presents to the health clinic with complaints of fever, malaise, and swelling of the sides of the neck. A blood test confirms the presence of mumps. The nurse should educate the client to report which changes of his genitalia to the health care provider?

Feelings of heaviness and pain in the scrotum

A client presents to the health care clinic with reports of black stool. The client denies the ingestion of iron supplements or taking Pepto-Bismol. The nurse recognizes that the black stools could be an indication of what disease process?

Gastrointestinal bleeding

A male client has a distinctive bulge in the right inguinal area when standing. What should the nurse suspect is occurring with this client?

Hernia

While assessing an adult male client, the nurse detects pimple-like lesions on the client's glans. The nurse explains the need for a referral to the client. The nurse determines that the client has understood the instructions when the client says he may have

Herpes infection

A 68-year-old man comes to the clinic reporting that he is having difficulty obtaining an erection. When reviewing the patient's history what might the nurse note that contributes to impotence?

History of hypertension

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

How to perform a testicular self-examination.

An adolescent present at the free clinic with a collection of fluid in the tunica vaginalis of the testes. The nurse knows that the term that defines this condition is what?

Hydrocele

A male infant is born with the urethral meatus opening on the underside of the penis. When providing information to the parents, what is the correct terminology to use for this condition?

Hypospadias

During the physical examination of a male client's genitalia, the nurse observes that the urinary meatus is displaced to the ventral surface of the penis. How should the nurse document this condition?

Hypospadias

Upon observation, the nurse documents that a male child's urethral meatus is located on the underside of his penis. What is the term for this structural abnormality?

Hypospadias

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?

Left testicular torsion

Which of the following is a sign or symptom of benign prostatic hypertrophy (BPH)?

Nocturia

A nurse recognizes that which finding is normal upon palpation of the prostate?

Nontender and rubbery

Which of the following unexpected findings of the testes is most likely to result in painful palpation of the testes?

Orchitis

During palpation of the male genitalia, which of the following is an expected finding?

Palpable spermatic cord

After completing the physical examination of the genitalia for an uncircumcised client, the nurse observes that the foreskin is too tight to be returned to cover the glans of the penis. How should the nurse document this condition?

Paraphimosis

During the physical examination of the genitalia for an uncircumcised client, the nurse asks the client to retract the foreskin of the penis. The nurse observes that the foreskin is tight and cannot be retracted. How should the nurse document this condition?

Phimosis

When performing the physical assessment of a client, the nurse notes the presence of a small cyst that contains hair, which is located midline in the sacrococcygeal area and has a palpable sinus tract. How should the nurse document this finding?

Pilonidal cyst

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?

Prepuce

On palpation of a client's prostate, a nurse detects hard, fixed, and irregular nodules on the prostate. Which condition should the nurse most suspect in this client?

Prostate Cancer

A nurse is assisting a healthcare provider perform a digital rectal examination of a 65-year-old African American client. This test, along with the PSA blood test is used as an early detection of what disease?

Prostate cancer

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

Mr. Jackson, 50 years old, has had discomfort between his scrotum and anus. He also has had some fevers and dysuria. Rectal examination is halted by tenderness anteriorly, but no frank mass is palpable. What is the most likely diagnosis?

Prostatitis

A 50-year-old truck driver comes to the clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system complaints. Past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different company. He smokes one pack of cigarettes a day, drinks fewer than six beers a week, and denies any illegal drugs. His mother has high blood pressure and arthritis; his father died of lung cancer in his 60s. On examination, the client's blood pressure is 130/80 and pulse is 80. Cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but digital rectal examination reveals a soft, smooth, nontender, pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation?

Rectal polyp

An adult male client comes to the clinic complaining of awakening at night to void and voiding more than once in a 2-hour time period. The client has a history of bladder irritation. What would be an appropriate nursing diagnosis for this client?

Risk for urge incontinence

The client tells the nurse that he has little or no interest in sex. He says he is concerned and he knows his wife is unhappy with his lack of libido. What can the nurse tell the client often causes lack of libido?

Side effects of medications

A patient presents at the clinic with severe scrotal pain. What is the presumptive diagnosis?

Testicular torsion

An uncircumcised male client has just come to the recovery room following a 4-hour back surgery. Before surgery a urinary catheter was placed. During the postoperative assessment, the recovery nurse discovers that the client has developed paraphimosis. What might have happened to the client to cause this?

The foreskin was not pulled back over the head of the penis after catheter placement

You are doing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on their right knee. While taking the patient's family history the patient states "my father died of prostate cancer at age 48." The nurse should instruct him on which of the following health promotion activities?

The patient should have PSA levels drawn at age 40-45.

After positioning a 34-year-old woman for examination of the anal region, the nurse notes a small opening above the client's gluteal crease that contains a tuft of hair. How should the nurse interpret this assessment finding?

The pilonidal cyst and sinus are usually benign, but can occasionally become infected or develop further sinuses.

An adult male client comes to the clinic for his annual physical examination. During the nursing assessment, the nurse asks, "Do you have any current or chronic illnesses such as diabetes, hypertension, respiratory problems, or cardiovascular disease?" Why does the nurse ask this question?

To assess risk for erectile dysfunction

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

Torsion of the spermatic cord

A teenager presents at the ER with severe scrotal and abdominal pain, vomiting, and nausea. He tells the nurse that he participated in a polar bear plunge in his community (jumping into cold water off-season). What conditions would the nurse suspect?

Torsion of the spermatic cord

A male client tells the nurse that he has received a diagnosis of hernia. He visits the clinic because he is nauseated and has extreme tenderness on the left side. The nurse should

refer the client to an emergency room.

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?

scrotal

A 29-year-old married computer programmer comes to the clinic complaining of "something strange" going on in his scrotum. Last month while he was doing his self-testicular examination he felt a lump in his left testis. He waited a month and felt the area again but the lump was still there. He has had some aching in his left testis but denies any pain with urination or sexual intercourse. He denies any fever, malaise, or night sweats. His past medical history consists of groin surgery when he was a baby and a tonsillectomy as a teenager. He eats a healthy diet and works out at the gym five times a week. He denies any tobacco or illegal drugs and drinks alcohol occasionally. His parents are both healthy. Examination shows a muscular healthy young man with unremarkable vital signs. On visualization the penis is circumcised with no lesions; there is a scar in his right inguinal region. There is no lymphadenopathy. Palpation of his scrotum is unremarkable on the right but has a large mass on the left. While placing a finger through the inguinal ring on the right, the examiner asks the client to bear down. Nothing is felt. The examiner attempts to place a finger through the left inguinal ring but cannot get above the mass. On rectal examination the client's prostate is unremarkable. What disorder of the testes is most likely?

scrotal hernia