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

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate? 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. Prepare to remove the catheter. Use sterile technique when irrigating the catheter.

4

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? 3 5 7 9

4

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 Thickening of the seminiferous tubules Fibrotic changes of the corpora cavernosa Hypogonadism

1

A client has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe? circumcision narcotic analgesics increased hygienic measures scrotal support

1

When assessing a client with benign prostatic hyperplasia, which of the following would the nurse expect the client to report as the initial complaint? Dark brown urine Increased effort to void Narrowing of urinary stream Nocturia

2

A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged IV pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow? Evaluating patency of the drainage lumen Counter-balancing the I.V. pole Attaching the infusion set to an infusion pump Collecting a urine specimen before beginning irrigation

1

A nurse is teaching a client about a circumision. Which external reproductive structure is removed by circumcision? Prepuce Glans Corpora cavernosa Mons pubis

1

Which age-related change affects the male reproductive system? Increased prostate secretion Decreased plasma testosterone levels Testes become soft Increased patency

2

Which assessment finding would create the greatest risk to a client ordered a phosphodiesterase inhibitor such as sildenafil? Use of nitrates History of hypertension Type 2 diabetes Use of diuretics

1

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

1

Which instructions regarding future sexual activity should a nurse give a client with a vasectomy? Use a reliable method of contraception until the physician ensures that sperm no longer are present. Administer a mild analgesic before any sexual activity. Sexual activity can only resume after 3 weeks. Expect some bruising and incisional soreness after every sexual activity in the first 2 days.

1

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

1

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. Engage in activities and exercises that minimize heavy lifting. Encourage the consumption of foods that are rich in fat and starch. Urge the limited intake of foods and fluids containing caffeine.

1

Which should be included as part of the home care instructions for a client with epididymitis and orchitis? Take prescribed antibiotics Undertake lifting exercises Apply ice to the area after scrotal swelling subsides Resume sexual intercourse

1

A 55-year-old Asian man has a PSA level of 4.8 ng/mL. Based on the client's PSA level, which assessment question does the nurse need to ask? "How often do you include foods high in purines in your diet?" "When was the last time you experienced ejaculation?" "Will you remember to schedule your next PSA test in 1 year?" "Do you wear boxers or briefs?"

2

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

2

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? Need for daily treatments over a 7- to 8-week period Use of radioactive seeds implanted into the prostate Surgical castration to decrease the level of circulating testosterone Use of probes inserted using ultrasound to freeze the tissue

2

Which client would the nurse identify as being at highest risk for the development of testicular cancer? A 45-year-old white male with a history of hypertension 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

2

Which is the most common type of prostate surgery? Retropubic prostatectomy Transurethral resection of the prostate Suprapubic prostatectomy Perineal prostatectomy

2

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

2

Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer? Hormone therapy Brachytherapy Teletherapy Chemotherapy2

2

A nurse is assessing an uncircumcised male. Which client symptoms would the nurse expect to find when assessing a client with phimosis? Select all that apply. Severe edema accompanied by chronic inflammation at the glans penis Difficulty cleaning under the foreskin Painful erections Urinary retention Low sperm count

2,3

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

4

A client is receiving leuprolide as part of his treatment for prostate cancer. The nurse would be alert for which of the following as a possible adverse effect? Reports of increased libido Muscle overgrowth Gynecomastia Nipple retraction

3

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? Staphylococcus Streptococcus Escherichia coli Paramyxovirus

3

A patient is diagnosed with prostatitis. Which of the following is the most commonly isolated organism that will be present in this patient's laboratory results? Staphylococcus aureus Proteus Escherichia coli Pseudomonas

3

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

4

A client is scheduled for a transurethral rescection 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." "I'll have a small incision on my lower abdomen after the procedure." "The surgeon is going to remove the entire prostate gland." "The surgeon is going to insert a scope through my urethra to remove a portion of the gland."

4

During a physical examination, the nurse inspects the external genitalia of a male client. Which of the following would the nurse identify as an abnormality? Absence of urethral discharge Skin lesions Prepuce covering the glans penis Slightly pendulous scrotum

2

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 PSA Prostate biopsy Cystoscopy

3

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. Ask the client to keep a diet diary. Include fruits in the client's diet. Administer serotonin blockers.

2

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? The volume and viscosity of seminal fluid increase with age. Men retain the ability to fertilize ova irrespective of age. There is a gradual increase in sperm and testosterone production. The scrotum becomes less pendulous and becomes firm.

2

The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? Palpate both testicles simultaneously for comparison. Palpate each testicle separately, following a warm shower. Palpate the front of the testicle first, where most tumors are found. Palpate for a soft, round shape with normal ridges on the testicles.

2

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? Erectile dysfunction Prostatitis Cryptorchidism Priaprism

3

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? The urine in the drainage bag appears red to pink. The client reports bladder spasms and the urge to void. The normal saline irrigant is infusing at a rate of 50 drops/minute. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.

2

Students preparing for a test are reviewing the structure and function of the male reproductive system. They demonstrate understading of the material when they identify which of the following as the site of spermatogenesis? Vas deferens Testes Prostate gland Seminal vesicles

2

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.

2

Bright red bleeding following prostate surgery indicates which of the following? Arterial bleed Venous bleed Disseminated intravascular coagulation Thrombocytopenia

1

A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? Transurethral resection of the prostate (TURP) Suprapubic prostatectomy Retropubic prostatectomy Transurethral laser incision of the prostate

1

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

1

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

1

A urologist suspects that a client might have prostate cancer. Which test would be used to make a diagnosis of cancer? tissue biopsy prostate-specific antigen cystoscopy digital rectal examination

1

Which term refers to the surgical removal of one or both testes? Orchiectomy Circumcision Vasectomy Hydrocelectomy

1

A client has been diagnosed with epididymitis after examination and diagnostic tests. What treatments would the nurse expect the healthcare provider to order? Select all that apply. Scrotal elevation Comfort measures Cold compresses Frequent ejaculations Exercise plan

1,2,3

During a routine office visit, a client mentions difficulty maintaining an erection. While reviewing the client's medical history, the nurse notes the client's medication history. Which medication would the nurse interpret as a potential cause of erectile dysfunction? Select all that apply. Clonidine Lorazepam Nadolol Fluoxetine Warfarin

1,2,3,4

The physician orders an alpha-adrenergic blocker for a client with benign prostatic hyperplasia. The nurse understands that this drug acts to achieve which of the following? Prevent urinary tract infections Relieve urinary symptoms Slow the prostatic enlargement Block testosterone conversion

2