Chapter 59: Assessment and Management of Patients with Male Reproductive Disorders

A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)? "I've had trouble getting started when I urinate, often straining to do so." "I'm waking up at night to urinate and I've noticed some burning, too." "I've had some pain in my lower abdomen lately and felt a bit sick to my stomach." "I've had a fever and noticed I've been running to the bathroom more often."

"I've had trouble getting started when I urinate, often straining to do so." Symptoms that might alert the nurse to BPH include difficulty initiating urination and abdominal straining with urination. Although fever, urinary frequency, nocturia, pelvic pain, nausea, vomiting, and fatigue may be noted, they also may suggest other conditions such as urinary tract infection. Fever, nausea, vomiting, and fatigue are general symptoms that can accompany many conditions.

The nurse is demonstrating the technique for performing a testicular self examination (TSE) to a group of men for a company health fair. One of the men asks the nurse at what age a man should begin performing TSE. What is the best answer by the nurse? "It should begin in adolescence." "It should begin at age 40." "It should begin in men over age 50." "It should be performed in high-risk males over age 30."

"It should begin in adolescence." TSE should begin during adolescence.

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? "If you have a fever, call the physician so he can order an antibiotic right away." "Apply ice to the top of your scrotum to help reduce the swelling." "Keep your scrotum elevated on a folded towel until the swelling goes down." "Engage in sexual intercourse frequently to help drain the area."

"Keep your scrotum elevated on a folded towel until the swelling goes down." 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.

A client is having prostate-specific antigen (PSA) testing done. Which result would the nurse identify as abnormal? 4.6 nanograms/milliliter 3.2 nanograms/milliliter 3.8 nanograms/milliliter 2.7 nanograms/milliliter

4.6 nanograms/milliliter 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 7 3 5

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

A patient has demonstrated interest in obtaining a penile implant. What should the patient consider prior to making this decision? Select all that apply. Expectations of the patient and his partner Occupation ADLs Financial status Social activities

ADLs Social activities Expectations of the patient and his partner Factors to consider in choosing a penile prosthesis are the patient's activities of daily living, social activities, and the expectations of the patient and his partner.

Which is inconsistent with a digital rectal examination (DRE)? Can reveal a hydrocele Assists in screening for cancer of prostate gland Enables examiner to assess size, shape, and consistency of prostate gland Recommended for men older than 40 years of age

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

Which of the following patient populations have the highest risk for developing testicular cancer? Mexican American Caucasian American Asian American African American

Caucasian American Caucasian American men have a five times greater risk than that of African American men and more than double the risk of Asian American men.

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. Increase the rate of the IV fluids. Administer a unit of packed red blood cells. Prepare the patient for an ECG.

Discontinue the irrigations. 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 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 Staphylococcus Streptococcus Paramyxovirus

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

Which of the following may result if prostate cancer invades the urethra or bladder? Rectal discomfort Hip pain Backache Hematuria

Hematuria 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? Sexual dysfunction Catheter obstruction Hemorrhagic shock Deep vein thrombosis

Hemorrhagic shock 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 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? Methyldopa Cimetidine Spironolactone Ibuprofen

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

Which statement is accurate regarding sildenafil? Sexual stimulation is not needed to produce an erection. It can be taken twice daily for increased effect. Its side effects include headache, flushing, and dizziness. The medication should be taken right before intercourse.

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

Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? Sexual history Age Medication use Undescended testicle

Medication use 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.

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. The scrotum becomes less pendulous and becomes firm. There is a gradual increase in sperm and testosterone production. The volume and viscosity of seminal fluid increase with age.

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

The nurse is preparing a presentation for a men's community group about health promotion. Which of the following would the nurse include as a current recommendation for screening? Annual prostate-specific antigen (PSA) testing after age 40 years Annual digital rectal examination (DRE) after age 35 years Transrectal ultrasound every 5 years after age 50 years Monthly testicular self-examination (TSE)

Monthly testicular self-examination (TSE) 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.

Following morning hygiene of an elderly client, the nurse is unable to replace the retracted foreskin of the penis. Which is the most likely outcome? Erection of the penis Painful swelling Nausea and vomiting Unclean glans

Painful swelling 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.

Which is an age-related change affecting the male reproductive system? Patency increases. Prostate secretion increases. Testes become soft. Plasma testosterone levels decrease.

Plasma testosterone levels decrease. 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. Secretions of the prostate gland increase. Spermatogenesis drops significantly Testes become heavier in weight.

Plasma testosterone levels decrease. With aging, plasma testosterone levels decrease, prostatic secretions increase, testes decrease in weight, and spermatogenesis continues.

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? DRE Prostate biopsy PSA Cystoscopy

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

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? Administer atropine 0.5 mg. Start an IV. Take the patient's blood pressure. Ask the patient to obtain a urine specimen.

Take the patient's blood pressure. 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.

A client is diagnosed with stage II cancer of the prostate. The nurse interprets this as indicating which of the following? Tumor has expanded to the bladder. Tumor has spread beyond the prostrate. Cancer is small with no symptoms. Tumor is confined to the prostate gland.

Tumor is confined to the prostate gland. Stage II cancer of the prostate involves a tumor that is larger than stage I but is still confined to the prostate gland; if left untreated it is more likely to spread beyond the prostate and cause symptoms. Stage I cancer of the prostate involves a small slow growing cancer that may never cause symptoms or other health problems. Stage III involves a tumor that has spread beyond the prostate but has not reached the bladder, rectum, lymph nodes, or other organs. Stage IV involves a tumor that has spread to the bladder, rectum, lymph nodes, or distant organs such as the bones.

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate? Prepare to remove the catheter. Tell the client to try to urinate around the catheter to remove blood clots. Restrict fluids to prevent the client's bladder from becoming distended. Use sterile technique when irrigating the catheter.

Use sterile technique when irrigating the catheter. If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.

Which of the following would be most important to include in a teaching plan for a client who has had a vasectomy (male sterilization)? Using a reliable method of contraception for several weeks. Applying warm compresses to the scrotum for the first 24 hours Resuming sexual activity in 24 to 48 hours Taking a prescribed opioid analgesic for pain relief

Using a reliable method of contraception for several weeks. 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 has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe? scrotal support circumcision increased hygienic measures narcotic analgesics

circumcision Circumcision is recommended to relieve phimosis and paraphimosis permanently.

A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to: cryptorchidism. sexually transmitted disease. testosterone therapy during childhood. early onset of puberty.

cryptorchidism. Cryptorchidism (failure of one or both testes to descend into the scrotum) appears to play a role in testicular cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early onset of puberty aren't risk factors for testicular cancer.

Which cancer ranks second as the cause of death in American men? prostate skin testicular penis

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

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

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

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 A 39-year-old African American male who is HIV-negative A 75-year-old white male with erectile dysfunction A 45-year-old white male with a history of hypertension

A 25-year-old male with a history of cryptorchidism (undescended testicles) 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 Caucasians 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.

Which client is most likely to develop prostate cancer according to a nurse working at a health screening at the local mall? A 56-year-old African American man A 60-year-old Asian American man A 35-year-old African American man A 17-year-old Caucasian man

A 56-year-old African American man Age over 40 and African American race are both risk factors for prostate cancer. Age younger than 40 and Asian heritage reduce the risk of prostate cancer.

A client is suspected of having prostate cancer. The nurse would expect to prepare the client for which of the following to confirm the diagnosis? Digital rectal examination (DRE) Biopsy via transrectal ultrasound Transurethral needle ablation (TUNA) Prostate-specific antigen (PSA) testing

Biopsy via transrectal ultrasound Although abnormal findings on DRE and elevated levels of PSA may raise suspicion of prostate cancer, detection requires confirmation with a needle biopsy of the prostate using transrectal ultrasound.

Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer? Hormone therapy Chemotherapy Teletherapy Brachytherapy

Brachytherapy 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 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? Ensure greater fluid intake. Include fruits in the client's diet. Administer serotonin blockers. Ask the client to keep a diet diary.

Ask the client to keep a diet diary. 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.

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? Fluid restriction Kegel exercises Artificial sphincter use Self-catheterization

Kegel exercises 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.

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 Prepare the client for circumcision Apply a scrotal support Apply a dressing over the scrotum

Prepare the client for surgery 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 client diagnosed with prostate cancer is to receive brachytherapy. Which of the following would the nurse include when discussing this therapy with the client? Use of probes inserted using ultrasound to freeze the tissue Use of radioactive seeds implanted into the prostate Need for daily treatments over a 7- to 8-week period Surgical castration to decrease the level of circulating testosterone

Use of radioactive seeds implanted into the prostate Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. External beam radiation therapy (teletherapy) involves the use of radiation treatments, usually 5 days/week over 7 to 8 weeks. Surgical castration is a type of androgen-deprivation therapy. Cryosurgery involves the insertion of transperineal probes into the prostate to freeze the tissue directly.

A client asks the nurse what PSA is. The nurse should reply that it stands for: pneumococcal strep antigen, which is a bacteria that causes pneumonia. Papanicolaou-specific antigen, which is used to screen for cervical cancer. protein serum antigen, which is used to determine protein levels. prostate-specific antigen, which is used to screen for prostate cancer.

prostate-specific antigen, which is used to screen for prostate cancer. PSA stands for prostate-specific antigen, which is used to screen for prostate cancer.

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? "If the top and back of the testicle feels cordlike, I'll call my physician." "I'll use my right hand to check the left testicle and the left hand to check the right one." "The best time to do it is once a month after I take my warm morning shower." "I should roll the testis in a circular pattern around the palm of my hand."

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

A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met? "I'll have to stay in the hospital for about 3 to 4 days after the surgery." "The surgeon is going to insert a scope through my urethra to remove a portion of the gland." "The surgeon is going to remove the entire prostate gland." "I'll have a small incision on my lower abdomen after the procedure."

"The surgeon is going to insert a scope through my urethra to remove a portion of the gland." TURP involves the surgical removal of the inner portion of the gland through an endoscope inserted through the urethra. There is no external skin incision. Typically, the procedure is performed in an outpatient setting but may require an overnight hospital stay.

A client with erectile dysfunction is prescribed sildenafil (Viagra). Which of the following would the nurse include in the teaching plan for this client? "You need to take this medication throughout the day to be effective." "You may experience headache and some flushing with this drug." "Your blood glucose level might increase when you take this drug." "The effects of this medication usually last for up to 48 hours."

"You may experience headache and some flushing with this drug." Sildenafil (Viagra) may cause headache, flushing, dyspepsia, diarrhea, nasal congestion, and lightheadedness. It is taken 30 minutes to 4 hours before sexual activity. It can be taken more than once a day, but doing so will not increase its effect. It should be taken only when the client wants to have intercourse, to a maximal dose of 100 mg/24 hours. The drug may cause low blood glucose levels and abnormal liver function tests.

A client with a history of hypertension and heart disease is being seen by the urologist because of erectile dysfunction. What would be the most likely cause of the client's erectile dysfunction? atherosclerosis All options are correct. depression hypertension medication

All options are correct. Common causes of ED include neurologic disorder such as spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy, atherosclerosis, hypertension, and complications of diabetes mellitus. Certain medications such as antihypertensive drugs (e.g., methyldopa, spironolactone), antidepressants, narcotics, and cimetidine can cause sexual dysfunction in men. Atherosclerosis is a common cause of ED. ED may be related to anxiety or depression.

Which of the following would a nurse include in the teaching plan for a client who has had surgery for cancer of the testes? Consuming a well-balanced diet with adequate fluids. Refraining from any sexual activity until impotency is ruled out. Measuring the quantity of urine for at least 3 months after surgery. Masturbating regularly to drain the prostate gland.

Consuming a well-balanced diet with adequate fluids. A client who has had surgery for cancer of the testes is advised to drink plenty of fluids and eat a well-balanced diet to avoid constipation. The client is also advised to obtain adequate rest and avoid fatigue and heavy lifting. Sexual activity or masturbation is not advised until the incision heals and not until impotency is ruled out. It is not necessary to measure the frequency and quantity of urine for at least 3 months after surgery.

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

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

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 Erectile dysfunction Prostatitis Priapism

Cryptorchidism 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.

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 rarely occurs in clients with diabetes mellitus. Erectile dysfunction may be due to testosterone insufficiency. Erectile dysfunction is primarily a normal response to aging. Erectile dysfunction is unrelated to anxiety or depression.

Erectile dysfunction may be due to testosterone insufficiency. 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.

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

Hyperplasia of the prostate gland Urination, without bladder emptying, is an indication that the prostate gland is enlarged. It causes an increased sense of urgency to void, as well as a decreased force of the urine stream. Enlargement of the prostate gland is associated with weakening of prostatic contractions and lower urinary tract obstruction.

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? Collecting a urine specimen before beginning irrigation Attaching the infusion set to an infusion pump Evaluating patency of the drainage lumen Counter-balancing the I.V. pole

Evaluating patency of the drainage lumen 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.

A nurse is teaching a male client who is older than 50 years about prostate cancer. What teaching should be included by the nurse? Perform monthly testicular self-examinations, especially after age 50. Have a digital rectal examination. Have a complete blood count, blood urea nitrogen, and creatinine levels checked yearly. Have a transrectal ultrasound every 5 years.

Have a digital rectal examination. 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 and those of African American ethnicity. 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 should nurses teach all men, especially those who have had cryptorchidism? Importance of regular monitoring of prostate-specific antigen (PSA) levels Need for blood tests to measure serum acid phosphatase levels Need to undergo a baseline and follow up lymph node biopsies How to perform a testicular self-examination

How to perform a testicular self-examination 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.

Which of the following should nurses teach all men, especially those who have had cryptorchidism? Need for blood tests to measure serum acid phosphatase levels. How to perform a testicular self-examination. Need to undergo a baseline and follow up lymph node biopsies. Importance of regular monitoring of prostate-specific antigen (PSA) levels.

How to perform a testicular self-examination. 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 prostrate cancer.

A client expresses concerns about future reproduction after a surgery to correct the cancer of the testes. For this client, treatment proceeded without first collecting and storing sperm. Which alternative should the nurse suggest to the client? Reverse the surgery Suggest the use of sildenafil Suggest donor insemination or adoption Undertake herbal alternatives

Suggest donor insemination or adoption For a client after a surgery to correct cancer of the testes and for whom treatment had proceeded without first collecting and storing sperm, the nurse explains other pregnancy options, such as donor insemination or adoption. Reversal of surgery is not possible for testicular cancer. In addition, undertaking herbal alternatives should not be advised by the nurse. Sildenafil would not enhance that chance of that this client could cause a woman to become pregnant.

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 hold it when the physician inserts a gloved finger into the rectum. Take a deep breath and exhale when the physician inserts a gloved finger into the rectum. When bending over the examining table, point the feet outward to decrease the discomfort. Inform the patient that the examination is not uncomfortable and will be over in a short period of time.

Take a deep breath and exhale when the physician inserts a gloved finger into the rectum. 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.

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? Administer a unit of packed red blood cells. Prepare the patient for an ECG. Increase the rate of the IV fluids. Discontinue the irrigations.

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

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make? Testicular cancer is the number one cause of cancer deaths in males. Testicular cancer is very difficult to diagnose. Testicular cancer is a highly curable type of cancer. Testicular cancer is more common in older men.

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

After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded? About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned. The urine in the drainage bag appears red to pink. The normal saline irrigant is infusing at a rate of 50 drops/minute. The client reports bladder spasms and the urge to void.

The client reports bladder spasms and the urge to void. Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency.

Following a vasectomy, which is the most important instruction to provide to the client? Use another form of birth control until further notice. Take a day or two to rest and recuperate from the procedure. Use a Tylenol as needed for discomfort. Wear a scrotal support until swelling is resolved.

Use another form of birth control until further notice. 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.