CH 59 - MALE REPRODUCTIVE
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
"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
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 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 of the following patients 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 Being over the age of 40 and being African American are both risk factors for prostate cancer. Being under the age of 40 and being of Asian heritage reduce the risk of prostate cancer
The nurse is educating a patient about performing testicular self-examination (TSE). The nurse informs the patient that the best time to perform the exam is when?
After a warm bath or shower Correct Explanation: Testicular self-examination is to be performed once a month. The test is neither difficult nor time-consuming. A convenient time is usually after a warm bath or shower when the scrotum is more relaxed
Which of the following is inconsistent with a digital rectal examination?
Can reveal a hydrocele Correct Explanation: The 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 is a failure of one or both or both of the testes to descend into the scrotum?
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 students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true?
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 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?
Gynecomastia Adverse effects associated with leuprolide, a luteinizing hormone-releasing hormone agonist, are related to hypogonadism and include vasomotor flushing, loss of libido, decreased bone density, anemia, fatigue, increased fat mass, decreased muscle mass, gynecomastia, and mastodynia (breast/nipple tenderness
What should a male client older than age 50 do to help ensure early identification of prostate cancer?
Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland because of its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastasis
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?
Kegel exercises Explanation: 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
Which of the following would a nurse include in a teaching plan for a client with benign prostatic hyperplasia who is not yet a candidate for surgery?
Maintaining optimal bladder emptying Explanation: For the client with benign prostatic hyperplasia who is not yet a candidate for surgery, the nurse would teach a client how to maintain optimal bladder emptying. The surgical client requires support and information to allay anxiety. The nurse teaches deep breathing and leg exercises for the client who is to have surgery.
Which of the following terms refers to the surgical removal of one of the testes?
Orchiectomy is required when the testicle has been damaged. Circumcision is excision of the foreskin, or prepuce, of the glans penis. Vasectomy is the ligation and transection of part of the vas deferens to prevent the passage of the sperm from the testes. Hydrocelectomy describes the surgical repair of a hydrocele, a collection of fluid in the tunica vaginalis
The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique?
Palpate each testicle separately, following a warm shower. It is best to examine and palpate each testicle following a warm shower, when the testes are relaxed and not retracted. Because one testicle is normally larger and hangs lower, comparing the two sides is not indicated. Both testes should be oval in shape, smooth, and firm without masses or tenderness. Most tumors are located on the lateral aspect of the testicles
The nurse is preparing a discharge teaching plan for a client who has had a prostatectomy. Which of the following would be appropriate to include?
Performing perineal exercises frequently throughout the day Explanation: After a prostatectomy, the client should be instructed in how to perform perineal exercises and to perform them hourly throughout the day, each day. In addition, the client should avoid bearing down (straining) to urinate because of the increased risk for hematuria. He should also avoid strenuous exercise, which increases the tendency to rebleed. The client should be instructed to urinate as soon as he feels the first urge to do so.
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 client reports bladder spasms and the urge to void Explanation: 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
Which of the following is not a definition of erectile dysfunction? a) The inability to sustain erection for a satisfactory period of time b) The inability to achieve or maintain an erection that is sufficiently rigid for sexual activity c) The inability to achieve an erection after sexual activity d) The inability to achieve an erection
The inability to achieve an erection after sexual activity The ability to achieve an erection after sexual activity varies and depends on the man's age, health, and sexual excitement. This statement is included in the definition of erectile dysfunction. Additionally, there must be multiple or persistent incidences of failed erection for the disorder to be considered pathologic
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 radioactive seeds implanted into the prostate Explanation: 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 invovles the insertion of transperineal probes into the prostate to freeze the tissue directly.
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?
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
A young client is admitted with torsion of the spermatic cord. Which is the most appropriate action to be taken by the nurse?
You selected: Keep the client NPO. With torsion of the spermatic cord, immediate surgery is necessary to prevent atrophy of the cord and preserve fertility. The client should be placed on NPO status in preparation for surgery. Elevating the scrotum intensifies the pain by increasing the degree of twist. Analgesics are prescribed preoperatively to control pain. Cardiac changes are not indicated unless client history warrants assessment.
A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:
continuous inflow and outflow of irrigation solution. When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.
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. 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
A client asks the nurse what PSA is. The nurse should reply that it stands for:
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.
Which of the following may result if prostate cancer invades the urethra or bladder?
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 oliguri
The diagnosis of prostate cancer is confirmed by which of the following?
Histologic exam of tissue Explanation: The diagnosis of prostate cancer is confirmed by a histologic examination of tissue. Other tests that may be used to establish the extent of the disease include bone scans to detect metastases to the bones, and computed tomography scan to identify metastases in the pelvic lymph nodes
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. Explanation: With aging, plasma testosterone levels decrease, prostatic secretions increase, testes decrease in weight, and spermatogenesis continues
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?
You selected: Take the patient's blood pressure. Explanation: 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
Which of the following would be most important to include in a teaching plan for a client who has had a vasectomy?
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
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?
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 storng 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
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?
Prostate biopsy Explanation: 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
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?
Prostate biopsy Explanation: 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
