MS prep u 53: Patients with Male Reproductive Disorders
A nurse is preparing a client for a scheduled adenosine stress test. Which statement made by the client indicates a need for further education?
"My family is bringing me a cup of coffee to drink before the test." Explanation: Caffeine must be avoided for 4 hours prior to the stress test. Caffeine acts as an adenosine receptor antagonist. If caffeine is ingested, the test must be rescheduled. It is true that the effects of the medication wear off quickly. The half-life of adenosine is less than 10 seconds. Adenosine will affect the heart like exercise, and flushing or nausea can occur.
The nurse is assessing vital signs on a client who is 3 months status post myocardial infarction (MI). While the healthcare provider is examining the client, the client's spouse approaches the nurse and states "We are too afraid he will have another heart attack, so we just don't have sex anymore." What is the nurse's best response?
"The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill." Explanation: The physiologic demands are greatest during orgasm. The level of activity is equivalent to walking 3 to 4 miles per hour on a treadmill. Sexuality is an important quality of life, so the healthcare provider will be determining when it is safe to have intercourse. Erectile dysfunction may be a side effect of beta-blockers, but other medications may be substituted.
The nurse is assessing a client taking an anticoagulant. What nursing intervention is most appropriate for a client at risk for injury related to side effects of medication enoxaparin?
: Report any incident of bloody urine, stools, or both. Explanation: The client who takes an anticoagulant, such as a low-molecular-weight heparin, is routinely screened for bloody urine, stools, or both. Clients taking enoxaparin will not need to take calcium supplements or have potassium imbalances related to the medication. The clubbing of fingers may occur with chronic pulmonary diseases.
The client with prostatitis presents with low back pain, dysuria, and unusual sensation following ejaculation. Which treatment(s) does the nurse anticipate being prescribed? Select all that apply. Analgesics Sitz baths Antibiotics Treatment of sexual partner
Analgesics Sitz baths Antibiotics Treatment of sexual partner Prostatitis is an inflammation of the prostate gland that is most often caused by microorganisms. Treatment consists of up to 30 days of antibiotic therapy, mild analgesics, and sitz baths. Sexual partners also need to be treated. Regular drainage of the prostate gland through masturbation or intercourse can be helpful in decreasing the inflammation and discomfort.
A patient is being treated for prostatitis and the nurse is providing education about the treatment. What should the nurse include in the education of this patient?
Avoid foods and liquids with diuretic action or that increase prostatic secretions. Explanation: The nurse educates the patient about the importance of completing the prescribed course of antibiotic therapy. If IV antibiotic agents are to be administered at home, the nurse educates the patient and family about correct and safe administration. Arrangements for a home care nurse to oversee administration may be needed. Warm sitz baths (10 to 20 minutes) may be taken several times daily. Fluids are encouraged to satisfy thirst but are not "forced," because an effective medication level must be maintained in the urine.
A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal?
B-type natriuretic peptide (BNP) Explanation: The client's symptoms suggest heart failure. BNP is a neurohormone that's released from the ventricles when the ventricles experience increased pressure and stretch, such as in heart failure. A BNP level greater than 51 pg/ml is commonly associated with mild heart failure. As the BNP level increases, the severity of heart failure increases. Potassium levels aren't affected by heart failure. CRP is an indicator of inflammation. It's used to help predict the risk of coronary artery disease. There is no indication that the client has an increased CRP.
The nurse is assessing an older adult's cardiovascular system. Which assessment finding indicates to the nurse that the client is experiencing age-related changes to the conduction system? Select all that apply. Murmur Bradycardia Presence of an S4 Exercise intolerance Point of maximum impulse displaced to the left
Bradycardia Exercise intolerance Explanation: An age-related change to the conduction system of the cardiovascular system includes bradycardia. This is caused by a slower sinoatrial node rate of impulse discharge that slows conduction across the atrioventricular node and ventricular conductive system. Bradycardia can contribute to exercise intolerance, so this is also a potential sign of age-related change to the conduction system. Changes to the cardiac valves causes abnormal blood flow across the valves which may lead to the development of murmurs. Age-related changes to the left ventricle, not the conduction system, can cause the development of an S4 and displacement of the point of maximum impulse to the left.
The nurse reviews a client's lab results and notes a serum calcium level of 7.9 mg/dL. It is most appropriate for the nurse to monitor the client for what condition?
Impaired myocardial contractility Explanation: Normal serum calcium is 8.9 to 10.3 mg/dL. A reading of 7.9 is below normal. Hypocalcemia is associated with slow nodal functioning and impaired myocardial contractility, which can increase the risk of heart failure.
A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. The client's temperature is 99.8° F (37.7° C). The client's blood pressure is 104/68 mm Hg. The client's pulse rate is 76 beats/minute. The nurse detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take?
Contact the health care provider and report the findings. Explanation: The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the health care provider immediately to preserve the blood flow in the client's leg. Documenting findings and checking the client again in 1 hour, slowing the I.V. fluid, and encouraging the client to perform isometric leg exercises aren't appropriate actions for the nurse to take at this time.
A patient has been diagnosed with congestive heart failure (CHF). The health care provider has ordered a medication to enhance contractility. The nurse would expect which medication to be prescribed for the patient?
Digoxin Explanation: Contractility is enhanced by circulating catecholamines, sympathetic neuronal activity, and certain medications, such as Lanoxin. Increased contractility results in increased stroke volume. The other medications are classified as platelet-inhibiting medications.
Which of the following should be included when teaching a client about the management of benign prostatic hyperplasia (BPH)? Select all that apply. Moderate use of alcohol is useful for bladder relaxation. Do not delay the urge to void. Low-dose Benadryl will promote restful sleep. Prolonged exposure to heat increases bladder spasms. Painless hematuria is a common symptom of BPH. Schedule digital rectal exams.
Do not delay the urge to void. Schedule digital rectal exams. Explanation: The client should be instructed to void promptly when the urge to empty the bladder is signaled by the stretch receptors in the bladder. Voiding promptly will decrease the risk for urinary retention. Digital rectal exams should be monitored to detect further enlargement of the gland and/or presence of prostatic nodules. Alcohol and antihistamines (e.g., Benadryl) should be avoided in the management of BPH. Exposure to heat and painless hematuria are not significant in the management of BPH. Alcohol and antihistamines interact with many BPH drugs.
When caring for a client with dysfunction in the conduction system, at which period would the nurse note that cells are resistant to stimulation?
During the refractory period Explanation: The refractory period is the time when cells are resistant to electrical stimulation. Repolarization is when the ions realign themselves to wait for an electrical signal. Depolarization occurs during muscle contraction when positive ions move inside the myocardial cell membrane and negative ions move outside. Before an impulse is generated, the cells are in a polarized state.
Which of the following herbal remedies is used to treat symptoms of benign prostatic hypertrophy (BPH)?
Saw palmetto Explanation: Saw palmetto is an herbal product used to treat symptoms associated with BPH.
A 48-year-old client recently diagnosed with benign prostatic hyperplasia (BPH) reports consuming serenoa repens (saw palmetto berry). The nurse needs to intervene if the physician orders which treatment? You Selected: Finasteride Correct response: Finasteride Explanation: Serenoa repens (saw palmetto berry) should not be used with finasteride. Terazosin is an alpha-adrenergic blocker and can be taken with Serenoa repens. Sipuleucel-T is a therapeutic cancer vaccine. Ketoconazole is an adrenal-ablating drug used to inhibit cytochrome P450 enzymes.
A 48-year-old client recently diagnosed with benign prostatic hyperplasia (BPH) reports consuming serenoa repens (saw palmetto berry). The nurse needs to intervene if the physician orders which treatment? You Selected: Finasteride Correct response: Finasteride Explanation: Serenoa repens (saw palmetto berry) should not be used with finasteride. Terazosin is an alpha-adrenergic blocker and can be taken with Serenoa repens. Sipuleucel-T is a therapeutic cancer vaccine. Ketoconazole is an adrenal-ablating drug used to inhibit cytochrome P450 enzymes.
The client with a diagnosis of heart failure reports frequently awakening during the night with the need to urinate. What explanation will the nurse offer to explain the urination?
Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys. Explanation: Nocturia is common in patients with heart failure. Fluid collected in dependent areas during the day is reabsorbed into the circulation at night when the client is recumbent. The kidneys excrete more urine with the increased circulating volume. The client's sleeping position does not cause bladder constriction and increased urination. The client's blood pressure is not causing more urination. The fluid in the client's lungs does not move to the kidneys at night.
The nurse cares for a client prescribed warfarin orally. The nurse reviews the client's prothrombin time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate?
international normalized ratio (INR) Explanation: The INR, reported with the PT, provides a standard method for reporting PT levels and eliminates the variation of PT results from different laboratories. The INR, rather than the PT alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5, although specific ranges vary based on diagnosis. The other laboratory values are not used to evaluate the effectiveness of warfarin.
A nurse is reviewing laboratory values for a client diagnosed with hyperlipidemia 6 months ago. Which results indicate that the client has been following a therapeutic regimen?
High density lipoproteins (HDL) increase from 25 mg/dl to 40 mg/dl. Explanation: The goal of treating hyperlipidemia is to decrease total cholesterol and LDL levels while increasing HDL levels. HDL levels should be greater than 35 mg/dl. This client's increased HDL levels indicate that a therapeutic regimen has been followed. Recommended total cholesterol levels are below 200 mg/dl. LDL levels should be less than 160 mg/dl, or, in clients with known coronary artery disease (CAD) or diabetes mellitus, less than 70 mg/dl. Triglyceride levels should be between 100 and 200 mg/d.
The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history?
Hypotension with nitrate use Explanation: Due to the action of the medication on the smooth muscles and blood vessels, clients are advised not to take medications to treat erectile dysfunction when also prescribed a nitrate drug for chest pain or heart problems. Combining medication could result in a serious drop in blood pressure. Although all disease processes and medication therapy should be screened for interactions, hypotension with nitrate use the most serious side effects.
After a physical examination, the provider diagnosed a patient with a grade 4 heart murmur. When auscultating a murmur, what does the nurse expect to hear?
Loud and may be associated with a thrill sound similar to (a purring cat). Explanation: Heart murmurs are characterized by location, timing, and intensity. A grading system is used to describe the intensity or loudness of a murmur. A grade 1 is very faint and difficult to describe, whereas a grade 6 is extremely loud. Refer to Box 12-3 in the text for a description of grades 1 to 6.
It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur:
Right ventricular pressure must be higher than pulmonary arterial pressure. Explanation: For the right ventricle to pump blood in need of oxygenation into the lungs via the pulmonary artery, right ventricular pressure must be higher than pulmonary arterial pressure.
Students preparing for a test are reviewing the structure and function of the reproductive system. They demonstrate understanding of the material when they identify which of the following as the site of spermatogenesis? You Selected: Testes Correct response: Testes Explanation: The testes are responsible for producing sperm (spermatogenesis). The vas deferens are the tubes that carry the sperm from the testicles and epididymis to the seminal vesicles, which acts as the reservoir for testicular secretions. The prostate gland produces a secretion that is chemically and physiologically suitable to the needs of the sperm in their passage from the testes.
Students preparing for a test are reviewing the structure and function of the reproductive system. They demonstrate understanding of the material when they identify which of the following as the site of spermatogenesis? You Selected: Testes Correct response: Testes Explanation: The testes are responsible for producing sperm (spermatogenesis). The vas deferens are the tubes that carry the sperm from the testicles and epididymis to the seminal vesicles, which acts as the reservoir for testicular secretions. The prostate gland produces a secretion that is chemically and physiologically suitable to the needs of the sperm in their passage from the testes.
The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. What priority reason will the nurse notify the healthcare provider?
The client is at risk for renal failure due to the contrast agent that will be given during the procedure. Explanation: The contrast medium must be excreted by the kidneys. If there is already a degree of renal impairment, indicated by the increased BUN and creatinine, the risk for contrast agent-induced nephropathy and renal failure is high. Renal impairment is not usually associated with dysrhythmias. The increased BUN and creatinine do not indicate overhydration, but decreased kidney function. The BUN and creatinine levels do not interfere with coagulability or bleeding.
Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? You Selected: Sexual history Correct response: Medication use Explanation: 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.
Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? You Selected: Sexual history Correct response: Medication use Explanation: 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.
Which of the following is the most immediate danger after prostate surgery? You Selected: Bleeding Correct response: Bleeding Explanation: The immediate danger after prostate surgery is bleeding and hemorrhagic shock. If, after 20 minutes, the bleeding is not controlled, surgical exploration may be considered. Since bleeding is increased in the sitting position, which increases bladder and venous pressure, the patient is encouraged to rest in bed with the head of the bed slightly elevated.
Which of the following is the most immediate danger after prostate surgery? You Selected: Bleeding Correct response: Bleeding Explanation: The immediate danger after prostate surgery is bleeding and hemorrhagic shock. If, after 20 minutes, the bleeding is not controlled, surgical exploration may be considered. Since bleeding is increased in the sitting position, which increases bladder and venous pressure, the patient is encouraged to rest in bed with the head of the bed slightly elevated.
What is the term for the ability of the cardiac muscle to shorten in response to an electrical impulse?
contractility Explanation: Contractility is the ability of the cardiac muscle to shorten in response to an electrical impulse. Depolarization is the electrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell. Repolarization is the return of the cell to the resting state, caused by reentry of potassium into the cell while sodium exits the cell. Diastole is the period of ventricular relaxation resulting in ventricular filling.
The nurse auscultates the apex beat at which anatomical location?
fifth intercostal space, midclavicular line Explanation: The left ventricle is responsible for the apex beat or the point of maximum impulse, which is normally palpable in the left midclavicular line of the chest wall at the fifth intercostal space. The right ventricle lies anteriorly, just beneath the sternum. Use of inches to identify the location of the apex beat is inappropriate based upon variations in human anatomy. Auscultation below and to the left of the xiphoid process will detect gastrointestinal sounds, but not the apex beat of the heart.
During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure?
wheezes with wet lung sounds Explanation: If the left side of the heart fails to pump efficiently, blood backs up into the pulmonary veins and lung tissue. For abnormal and normal breath sounds, the nurse auscultates the lungs. With left-sided congestive heart failure, auscultation reveals a crackling sound, wheezes, and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe. With left-sided congestive heart failure, auscultation does not reveal a high pitched sound.
A client is to undergo a TURP for BPH. Which statement is accurate with regard to a TURP?
Urethral strictures are more frequent for TURP than for nontransurethral procedures. Explanation: Urethral strictures are more frequent for TURP than with nontransurethral procedures. TURP rarely causes erectile dysfunction. It requires an overnight stay. There is danger of retrograde ejaculation.
What does decreased pulse pressure reflect?
reduced stroke volume Explanation: Decreased pulse pressure reflects reduced stroke volume and ejection velocity or obstruction to blood flow during systole. Increased pulse pressure would indicate reduced distensibility of the arteries, along with bradycardia.