Chapter 23: Male Genitalia and Rectum

A 17-year-old male client expresses concern about feeling lumps on his testicles. What response by the nurse would best address the client's concerns?

"The normal testicle contains internal structures that cause lumps on the surface."

A client has admitted to the nurse that he has been having difficulty obtaining and maintaining erections for many months. Which of the nurse's assessment questions most clearly addresses a potential cause for the client's problem?

"What medications are you currently taking?"

A patient presents with - Bone pain - Weight loss - Anemia - SOB - Lymphedema - Lymphadenopathy - Bladder outlet syndromes - Acute urinary retention - Large / locally extensive tumors (tumors often due to BPH) What are these symptoms inductive of?

- Latent / Asymptomatic Stages of Prostate Cancer

Which of the following male clients is most in need of immediate medical treatment?

A 15-year-old boy who has been brought in by his mother for assessment of his severely painful testes that are retracted upward

Francis is a middle-aged man who noted right sided lower abdominal pain after straining with yardwork. Which of the following findings would make a hernia a more likely diagnosis?

Absence of symmetry of the inguinal areas with straining

Which of the following groups has the highest incidence of prostate cancer?

African American men

A 26-year-old woman comes to the clinic complaining of leakage of stool despite generally normal pain-free bowel movements. She denies any blood in her stool or on the toilet paper. She has had no recent episodes of diarrhea. Her past medical history includes a spontaneous vaginal birth 3 months ago. She had a fourth-degree tear of the perineal area (from the vagina through the rectum) that was surgically repaired. A few days later the client developed an abscess in the anal area that had to be incised and drained. She denies using any tobacco, alcohol, or illegal drugs. Her mother and father are both in good health. She denies any weight gain, weight loss, fever, or night sweats. She is still breastfeeding her baby without any problems. Inspection reveals a small opening anterior to the anus with some surrounding erythema. There is not a mass or other inflammation. Digital rectal examination reveals smooth walls with no blood. She has no pain during the rectal examination. Bimanual vaginal examination is also normal. What anal or rectal disorder is the most likely cause of her symptom?

Anorectal fistula

A client has undergone a digital rectal examination. This assessment will allow the clinician to diagnose which of the following?

BPH

When assessing a client during the physical examination of the genitalia, the nurse palpates the scrotal contents. Which finding should the nurse recognize as an indication that an infection or cysts are present?

Beaded or thickened cord

A 60-year-old coach comes to the clinic complaining of difficulty starting to urinate for the last several months. He believes the problem is steadily getting worse. When asked he says he has a very weak stream, and it feels like it takes 10 minutes to empty his bladder. He also has the urge to go to the bathroom more often than he used to. He denies any blood or sediment in his urine and any pain with urination. He has had no fever, weight gain, weight loss, or night sweats. His medical history includes type 2 diabetes and high blood pressure treated with medications. He does not smoke but drinks a six pack of beer weekly. He has been married for 35 years. His mother died of a myocardial infarction in her 70s, and the client's father is currently in his 80s with high blood pressure and arthritis. Examination reveals a mildly obese alert and cooperative man. His blood pressure is 130/70 with a heart rate of 80. He is afebrile, and his cardiac, lung, and abdominal examinations are normal. Visualization of the anus shows no inflammation, masses, or fissures. Digital rectal examination reveals a smooth, enlarged prostate. No discrete masses are felt. There is no blood on the glove. An analysis of the urine shows no red blood cells, white blood cells, or bacteria. What disorder of the anus, rectum, or prostate is most likely?

Benign prostatic hyperplasia (BPH)

A 72-year-old male presents at a local clinic and states: "I have to urinate all the time, and I never feel like my bladder is emptied. It really bothers me at night." What condition might the nurse suspect related to this chief complaint?

Benign prostatic hyperplasia (BPH)

The nurse is palpating the prostate of a 55-year-old client and finds it to be enlarged, smooth, firm, and slightly elastic, without a median sulcus. Which condition should the nurse most suspect?

Benign prostatic hypertrophy

A client is being evaluated for upper gastrointestinal bleeding. The nurse would expect to observe stool that is which color?

Black

A nurse examining a client's external genitalia notices that his scrotum and testes draw up and he shivers. This phenomenon is known as which of the following?

Cremasteric reflex

What is used to screen for prostate cancer

DRE (Digital Rectal Exam) or PSA (prostate specific antigen)

Which of the following would the nurse expect to be done to assess the size of the prostate?

Digital rectal examination

A nurse examines the anal area of a client and observes the presence of a varicose vein. How should the nurse document this finding?

External hemorrhoid

Upon inspection and palpation of the front of the client's thigh, the nurse discovers a bulge that appears when the client coughs. The nurse should document this finding as which type of hernia?

Femoral

An Advanced Practice Nurse is preparing to do a rectal examination on a 77-year-old client. The client complains of pain as soon as the examination begins. What might this client have?

Fissures

A nurse is planning to palpate for a urethral discharge in a male client. Which technique would be best for the nurse to use?

Gently squeeze the glans between the thumb and index finger.

The nurse is assessing male genitalia and finds clusters of pimple-like clear vesicles. The nurse recognizes this as what?

Herpes

An adolescent present at the free clinic with a collection of fluid in the tunica vaginalis of the testes. The nurse knows that the term that defines this condition is what?

Hydrocele

During a client's genitourinary exam, the nurse notes that the client's scrotum is enlarged and easily transilluminates. What should the nurse suspect?

Hydrocele

Upon observation, the nurse documents that a male child's urethral meatus is located on the underside of his penis. What is the term for this structural abnormality?

Hypospadias

A client presents to the health care clinic with reports of yellow stool. Which condition should the nurse most suspect?

Increased fat content

A patient presents with - Hesitancy - Dribbling - Frequency - Urgency - Nocturia - Retention - Slow stream - Feeling of bladder fullness What are these symptoms inductive of?

Later stages of prostate cancer / prostate enlargement

While assessing the scrotum of an adult client, the nurse notes thin and rugated scrotal skin with little hair dispersion. How would the nurse document this finding?

Normal findings

While assessing the scrotum of an adult client, the nurse notes thin and rugated scrotal skin with little hair dispersion. The nurse interprets this finding as which of the following?

Normal findings

Palpation of a male client's urethra produces a yellowish-white discharge. What is the nurse's best action?

Obtain a sample of the discharge for culture.

Hypospadias and Epispadias Spasdias

Opening of the urethra Hypospadias: opening of the urethra is UNDER (hypo) instead of at the tip Epispadias: opening of the urethra is ON TOP (epi) instead of at the tip

A client with which of the following cancers is prone to developing phimosis?

Penile

During the physical examination of the genitalia for an uncircumcised client, the nurse asks the client to retract the foreskin of the penis. The nurse observes that the foreskin is tight and cannot be retracted. How should the nurse document this condition?

Phimosis

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.

On inspecting a client's external genitalia, a nurse notes that he is uncircumcised. This means that which of the following covers the glans of the penis?

Prepuce

prostate gland What is seminal fluid

Produces Seminal Fluid Seminal fluid = Semen = transport sperm

During DRE, a 46-year-old client cries out in pain as the nurse palpates his swollen, firm prostate. Which of the following problems should the nurse first suspect?

Prostatitis

Mr. Jackson, 50 years old, has had discomfort between his scrotum and anus. He also has had some fevers and dysuria. Rectal examination is halted by tenderness anteriorly, but no frank mass is palpable. What is the most likely diagnosis?

Prostatitis

A nurse prepares a male client for a physical assessment of the external genitalia. Which instruction is appropriate for the nurse to inform the client of before the examination?

Reassure him that it is not unusual to have an erection

A nurse prepares a male client for a physical assessment of the external genitalia. Which instruction is appropriate for the nurse to give the client before the examination?

Reassure him that it is not unusual to have an erection during the examination

The client received in the ICU was shot in the lower abdomen, suffered bladder trauma, and now has a urinary catheter. With these risk factors, what would be an appropriate nursing diagnosis for this client?

Risk for infection

Upon inspection and palpation of the scrotum, the nurse discovers a mass. The nurse asks the client to lie down, and the bulge remains. On auscultation, the nurse finds bowel sounds. The nurse should document this finding as which type of hernia?

Scrotal

The client tells the nurse that he has little or no interest in sex. He says he is concerned and he knows his wife is unhappy with his lack of libido. What can the nurse tell the client often causes lack of libido?

Side effects of medications

How should the testis feel to the nurses fingers when performing palpation of the scrotal contents? Select all that apply.

Smooth Firm Rubbery

During a class, a student asks the instructor, "What does the anal canal contain?" Which of the following would the instructor include in the response?

Somatic sensory nerves

Tanner stages

Stage 1 - PREPUBERTAL - younger than 10 - no pubic hair, small penis Stage 2 - 10-13 - Sparse hair, slight enlargement, coarse and redding of skin Stage 3 - 12 - 14 - Curlier & darker hair, more enlargement Stage 4 - 13 - 15 - Pubic hair covers entire pubic but not spread to legs Stage 5 - 14 - 17 - Full size penis, diamond shape, hair extend to thighs

A nurse is beginning the physical exam of a male client's genitals. The nurse is sitting on a stool in front of the client. Which position would be best to place the client in?

Standing

While conducting a complete bed bath for a male client, the nurse inspects the scrotum for: (Select all that apply.)

Swelling Lumps Veins

Testicular cancer Prostate cancer Penile cancer

Testicular = Cryptorchidism (undescended testicle at birth) Middle aged White men > Risk Prostate Cancer = Older African American men at risk *second leading cause of cancer death in men Penile Cancer = Phimosis (Cant bring foreskin down) Older, Poor hygiene, HPV

During the health history a young male client asks the nurse why his scrotum rises and relaxes. The nurse would incorporate knowledge of which of the following when responding to this client?

The cremasteric reflex controls the rise and relaxation of the scrotum.

After teaching a group of students about the anal canal, the instructor determines that the teaching was successful when the students state which of the following?

The internal sphincter is under involuntary control.

A 15-year-old high school football player comes to the office with his mother. He complains of severe testicular pain since 8:00 this morning. He denies any sexual activity and states that it hurts so bad he can't even urinate. He is nauseated and vomiting. He denies any recent illness or fever. Past medical history is unremarkable. He denies any tobacco, alcohol, or drug use. His parents are both in good health. Examination shows a young teenager lying on the bed with an emesis basin. He is very uncomfortable and keeps shifting his position. Blood pressure is 150/100, pulse is 110, and respirations are 24. On visualization of the penis he is circumcised; there are no lesions or discharge from the meatus. Scrotal skin is tense and red. Palpation of the left testicle causes severe pain and causes the client to cry. His prostate examination is unremarkable. His cremasteric reflex on the left is absent but normal on the right. Catheterization is necessary to get a urine sample, the analysis of which is unremarkable. The boy is admitted to the emergency department of a nearby hospital for further workup. What is the most likely cause of this young man's symptoms?

Torsion of the spermatic cord

A 23 year old male comes to the clinic complaining of sudden and severe pain in his scrotum. The nurse would suspect what?

Torsion of the spermatic cord

Which of the following would be most important for the nurse to remember when performing the physical examination of the anus and rectum? (Select all that apply.)

Use gentle finger movements. Use adequate lubrication. Watch for nonverbal signs of discomfort.

Study question time

You got this

The nurse suspects that a male client may have a hernia. The nurse should further assess the client for

bowel sounds at the bulge.

The nurse is assessing the genitalia of an adult male client when he tells the nurse that his testes are swollen and painful. The nurse should refer the client to a physician for possible

epididymitis.

While reviewing the medical record before examining a male clinic client, the nurse notes that the urinary meatus is located on the top of the glans of the penis. The nurse understands the correct term for this congenital defect is

epispadias

During assessment of an adult client, which of the following lifestyle practices would indicate to the nurse that the client may be at high risk for HIV/AIDS? A client who

has anal intercourse with other males.

The rectum is lined with folds of mucosa, and each fold contains a network of arteries, veins, and visceral nerves. When these veins undergo chronic pressure, the result may be

hemorrhoids.

A male client has a distinctive bulge in the right inguinal area when standing. What should the nurse suspect is occurring with this client?

hernia

While assessing an adult male client, the nurse detects pimple-like lesions on the client's glans. The nurse explains the need for a referral to the client. The nurse determines that the client has understood the instructions when the client says he may have

herpes infection.

Epididymitis Function of the epididymis Testicular torsion

inflammation of the epididymis - Caused by STDS (chlamydia, gonorrhea, bacterial infection) - Younger than 35 = STI - Linked to PROSTATITIS (esp after surgical intervention) - Symptoms = pain is severe, swelling, fever Where sperm are stored and mature Twists spermatic cord, causes ischemia (aka oxygen cutt off) = surgical emergency TT = Occurs on LEFT SIDE (bc left cord is longer - occurs EARLY AGE (Rare after 20)

The prostate gland consists of two lobes separated by the

median sulcus.

Paraphimosis/Phimosis osis = ?

osis = increase Para: Inflammation of foreskin when retracted (when foreskin CANT move back UP) Phi: Constriction of foreskin that prevents the retraction of the glans penis (when foreskin CANT move back DOWN)

During assessment of an elderly male client, the client tells the nurse that he has had difficulty urinating for the past few weeks. The nurse should refer the client to the physician for possible

prostate enlargement.