Ch.59 Assessment and Management of Patients with Male Reproductive Disorders

A client is having prostate-specific antigen (PSA) testing done. Which result would the nurse identify as abnormal?

4.6 nanograms/milliliter Normal PSA levels are less than 4.0ng/mL

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 client with Stage IV prostate cancer is to receive hormone therapy. The nurse would inform the client about possible adverse effects including which of the following?

Breast tenderness

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

Cryptorchidism

Which age-related change affects the male reproductive system?

Decreased plasma testosterone levels

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.

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.

Which of the following may result if prostate cancer invades the urethra or bladder?

Hematuria

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

How to perform a testicular self-examination.

Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction?

Medication use

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 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.

Which condition is associated with the buildup of fibrous plaques in the sheath of the corpus cavernosum, causing curvature of the penis when it is erect?

Peyronie's disease

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 immediate surgery is necessary to prevent atropy 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 nurse is teaching a client about a circumision. Which external reproductive structure is removed by circumcision?

Prepuce

Which is the most common type of prostate surgery?

TURP

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 exhale when the physician inserts a gloved finger into the rectum.

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. suggests 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.

When developing an educational program for a group of adolescents about sexually transmitted infections (STIs), what should the nurse inform the group about the single greatest risk factor for contracting an STI?

The number of sexual partners

The client states to the nurse that he is very anxious about having prostate cancer ever since his prostate-specific antigen (PSA) test came back elevated. The client asks, "Which diagnostic test produces definitive results if cancer is present?" The nurse is most correct to state which of the following?

Tissue biopsy

Which therapy uses low-level radiofrequencies to produce localized heat that destroys prostate tissue?

Transurethral needle ablation

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

A nurse is obtaining a male client's health history before performing a physical examination. Which information would most likely not be obtained?

age of first ejaculate

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.

Medical management of BPH includes pharmacologic therapy. Which of the following medications would the nurse expect the health care provider to prescribe for this diagnosis?

Alpha-adrenergic blocker These relax smooth muscle of the bladder and prostate

Which cancer ranks second as the cause of death in American men?

Prostate

A nurse is instructing a client in testicular self-examination. Which client statement indicates the need for additional teaching?

"I should do this exam at least once a week." Should be done monthly

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."

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."

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?

"The best time to do it is once a month after I take my warm morning shower."

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?

"The surgeon is going to insert a scope through my urethra to remove a portion of the gland."

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?

"When was the last time you experienced ejaculation?" PSA values may increase after ejaculation

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 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 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?

Ask the client to keep a diet diary.

Bright red bleeding following prostate surgery indicates which of the following?

Arterial bleed

A nurse is working in an oncology treatment center. Which clinical manifestation when reported by a client would the nurse know may be related to metastasis from prostate cancer?

Constant hip aching and discomfort

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

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. Transurethral resection syndrome is a rare but potentially serious complication of TURP

A patient is planning to use a negative-pressure (vacuum) device to maintain and sustain an erection. What should the nurse caution the patient about with the use of this device?

Do not leave the constricting band in place for longer than 1 hour to avoid penile injury.

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 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

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.

Which of the following is an immediate danger after a prostate surgery?

Hemorrhagic shock

The nurse is preparing a presentation for a local community group about prostate cancer and possible dietary risk factors. Which of the following would the nurse most likely include?

High-fat diet

The diagnosis of prostate cancer is confirmed by which of the following?

Histologic exam of tissue

When assessing a client with benign prostatic hyperplasia, which of the following would the nurse expect the client to report as the initial complaint?

Increased effort to void

A young client is admitted with torsion of the spermatic cord. Which is the most appropriate action to be taken by the nurse?

Keep the client NPO because they will need immediate surgery

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

The nurse is caring for a client who had transurethral resection of the prostate (TURP) 1 day ago. Which assessment finding(s) does the nurse expect? Select all that apply.

Large amounts of amber-colored urine in the drainage bag Reports of the urge to void from the client Drainage tube secured to the inner thigh

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)

Which term refers to the surgical removal of one or both testes?

Orchiectomy

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

A 57-year-old Caucasian man is being treated in the outpatient community center. The client reports that most nights he wakes up twice to urinate. In addition, he reports occasional blood in his urine. The client's laboratory tests reveal a PSA level of 3.8 ng/mL and a white blood cell (WBC) count of 6,000 mm3. The nurse most likely suspects that the client is experiencing which condition?

Prostatism Symptoms of prostatism include increased frequency of urination, nocturia, urgency, dribbling, hematuria, and a sensation that the bladder has not completely emptied. PSA and WBC levels are within expected ranges. Prostatitis is an inflammation of the prostate gland

Which of the following herbal remedies is used to treat symptoms of benign prostatic hypertrophy (BPH)?

Saw palmetto (Serenoa repens) Shouldn't be used with Finasertide

The student nurse studying the male reproductive tract demonstrates understanding movement of testicular secretions when they exit the penis by selecting which pathway?

Seminiferous tubules, epididymis, vas deferens, ejaculatory duct

Which should be included as part of the home care instructions for a client with epididymitis and orchitis?

Take prescribed antibiotics.

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?

Take the patient's blood pressure.

A client comes to the emergency department reporting severe testicular pain that started about 1 hour ago. Examination reveals a thickened spermatic cord, an elevated testis, and testicular tenderness. The nurse would interpret these findings to suggest which of the following?

Testicular torsion

What does the nurse tell the patient is the best way to decrease the risk of developing penile cancer?

Use good genital hygiene.

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.

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