Chapter 26 Assessing Male Genitalia Rectum Prep U

A 68-year-old man comes to the clinic reporting that he is having difficulty obtaining an erection. When reviewing the client's history what might the nurse note that contributes to impotence?

History of hypertension

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

How to perform a testicular self-examination.

On inspection and palpation, the nurse finds that a client's testes are small, probably less than 2 cm, and firm. Which of the following conditions should the nurse most suspect in this situation?

Klinefelter's syndrome

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 50-year-old truck driver comes to the clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system complaints. Past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different company. He smokes one pack of cigarettes a day, drinks fewer than six beers a week, and denies any illegal drugs. His mother has high blood pressure and arthritis; his father died of lung cancer in his 60s. On examination, the client's blood pressure is 130/80 and pulse is 80. Cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but digital rectal examination reveals a soft, smooth, nontender, pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation?

Rectal polyp

The nurse is providing a sex education informational session for a group of male clients. Which information should the nurse include?

The hepatitis A vaccine is recommended for men who have sex with men.

After positioning a 34-year-old client for examination of the anal region, the nurse notes a small opening above the gluteal crease that contains a tuft of hair. How should the nurse interpret this assessment finding?

The pilonidal cyst and sinus are usually benign, but can occasionally become infected or develop further sinuses.

An adult male client comes to the clinic for his annual physical examination. During the nursing assessment, the nurse asks, "Do you have any current or chronic illnesses such as diabetes, hypertension, respiratory problems, or cardiovascular disease?" Why does the nurse ask this question?

To assess risk for erectile dysfunction

A teenager presents at the ER with severe scrotal and abdominal pain, vomiting, and nausea. He tells the nurse that he participated in a polar bear plunge in his community (jumping into cold water off-season). What conditions would the nurse suspect?

Torsion of the spermatic cord

A 22-year-old unemployed roofer presents to the clinic with pain in his testicle and penis. He states the pain began last night and has steadily worsened. He states it hurts when he urinates; he has not attempted intercourse since the pain began. He has tried acetaminophen and ibuprofen without improvement. He denies any fever or night sweats. His past medical history is unremarkable. He has had four previous sexual partners and has had a new partner for the last month. She uses oral contraceptives so he has not used condoms. His parents are both in good health. Examination shows a young man lying on his side. He appears mildly ill. His temperature is 38.2°C, and his blood pressure, respirations, and pulse are normal. On visualization of the penis he is circumcised with no lesions or discharge from the meatus. Visualization of the scrotal skin appears unremarkable. Palpation of the testes shows severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness when palpating the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges being noted with bearing down. His prostate examination is unremarkable. Urine analysis shows white blood cells and bacteria. What diagnosis of the male genitalia is most likely in this case?

Acute epididymitis

A 42-year-old man comes to the clinic complaining of pain with defecation and profuse bleeding in the toilet after a bowel movement. He was in his usual state of health until 2 weeks ago when he was injured in a car accident. After the accident he began taking prescription narcotics for the pain in his shoulder. Since then he has had very few bowel movements. His stool is hard and pebble-like. He states he has always been "regular" in the past with easy-to-pass bowel movements. His diet has not changed, but he states that he is exercising less since the accident. His past medical history includes hypertension for which he takes a low-dose diuretic. He has had no other chronic illnesses or surgeries. He has a family history of hypertension, coronary heart disease, and diabetes, but no cancer. He is divorced with three children. He smokes two packs of cigarettes per day and quit drinking more than 10 years ago. He has had no recent weight loss, weight gain, fever, or night sweats. On examination, he appears muscular and healthy; he is afebrile. His blood pressure is 135/90 with a pulse of 80. His cardiac, lung, and abdominal examinations are normal. He is wearing a sling on his left arm. Observation of the anus shows a swollen bluish ovoid mass that appears to contain a blood clot. Digital rectal examination is extremely painful for the client. No other mass is palpated within the anus or rectum. What anal disorder is this client likely to have?

External hemorrhoid

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

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

What information should nurse include in the teaching plan for a client considering a vasectomy?

offers permanent birth control

A nurse is palpating the prostate of a client and finds it to be swollen, tender, firm, and warm to the touch. Which condition should the nurse most suspect?

Acute prostatitis

A nurse is caring for a client with prostatitis. The nurse knows that what nursing care measure will be employed when caring for this client?

Administer the prescribed dose of antibiotics

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

A client asks the nurse when a colonoscopy is recommended. Which advise by the nurse provides the most appropriate advice?

"A flexible sigmoidoscopy should be done every five years starting at age 50"

The nurse is asked to prepare material on erectile dysfunction to be placed in a urologist's office waiting room. What should the nurse include as reasons for the development of this disorder? Select all that apply.

- Diabetes - Depression - Alcohol use -Antihypertensive medications

During a health assessment interview, a nurse learns that the client has a family history of colorectal cancer. What information should the nurse give the client about reducing the risk for colorectal cancer? Select all that apply.

- Get regular exercise for at least 30 minutes every day - Fecal occult blood test (FOBT) should be done yearly - Consume foods with adequate folic acid

The nurse notes that a male client's scrotal sac is documented as being "normal." What should the nurse expect to assess in this client? Select all that apply.

- Rugated - Thin skin - Few strands of hair - Color darker than the penis

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

Which client would the nurse identify as being at highest risk for the development of testicular cancer?

A 25-year-old man with a history of cryptorchidism.

When invaginating the skin of the scrotum to assess the inguinal regions, which of the following is an expected finding?

Inability to introduce the index finger into the inguinal ring

Induration along the ventral surface of the penis suggests which of the following?

Urethral stricture

Which of the following recommendations should the nurse provide to clients in an effort to reduce their risk of developing colorectal cancer?

A high-fiber diet coupled with regular exercise

Which of the following is inconsistent with a digital rectal examination?

Can reveal a hydrocele

A client presents at the clinic with severe scrotal pain. What is the presumptive diagnosis?

Testicular torsion

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 nurse has assessed a male client and determines that one of the testes is absent. The nurse should explain to the client that this condition is termed

cryptorchidism.

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

The inguinal canal in a male client is located

just above and parallel to the inguinal ligament.

The prostate gland consists of two lobes separated by the

median sulcus.

A client presents to the health care clinic with reports of clay-colored stool. The nurse recognizes that this finding is most likely a result of which of the following?

Lack of bile pigment

Which client should a nurse recognize has the highest risk to develop prostate cancer?

65-year-old Caucasian male whose father had prostate cancer at age 55

What ethnic group has a significantly higher incidence rate of prostate cancer?

African American

When palpating the rectal mucosa, how does the nurse rotate the examining hand?

Clockwise, then counterclockwise

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 client visits the clinic and tells the nurse that her stools have been black for the past 3 days. The nurse should assess the client for

gastrointestinal bleeding.

The corpora spongiosum extends distally to form the acorn-shaped

glans.

A nurse observes that the mucosa of the rectum and the rectal wall of a female client protrudes out through the anal opening. It appears as a red, doughnut-like mass with radiating folds. How should the nurse document this condition of the rectum?

prolapse

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

A client reports the new onset of mucous in the stool. How should the nurse document this in the client's history?

Steatorrhea

A nurse is assessing the genitalia of a male client. The nurse finds that the client has a piercing in his penis. Why is it important to investigate details of the piercing?

To assess for health risks relating to how it was performed

Which of the following would lead the nurse to suspect a hydrocele versus other causes of scrotal swelling?

A positive transillumination test

You are caring for a 33 year old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in five years. During the examination the physician finds that digital rectal examination (DRE) reveals extensive hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what

A sign of early prostate cancer

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

African American men

The nurse is preparing an instructional session for male clients about preventing penile cancer. Which non-modifiable risk factor should the nurse include in the teaching?

Age 60 years or older

A 36-year-old married bank teller comes to the office complaining of pain with defecation and occasional blood on the toilet paper. She states that last week she had food poisoning with nausea, vomiting, and diarrhea. She had runny stools but no black or bloody stools. Since her illness, she has continued to have severe pain with bowel movements. She now tries to delay defecation as long as possible. Although she is having constipation, she denies any further diarrhea or leakage of stool. She has a past medical history of hypothyroidism and two spontaneous vaginal births. She has had no other chronic illnesses or surgeries. She does not smoke and rarely drinks. She has two children. There is no family history of breast or colon cancer. She has had no weight gain, weight loss, fever, or night sweats. On examination she is afebrile with a blood pressure of 123/70 and a pulse of 80. Abdominal examination reveals active bowel sounds, nontender in all quadrants, and no hepatosplenomegaly. Inspection of the anus reveals inflammation on the posterior side with erythema. Digital rectal examination is painful for the client, but no abnormalities are palpated. Anoscope examination reveals no inflammation or bleeding. What is the anal disorder that best describes her symptoms?

Anal fissure

How should a nurse proceed with palpation of the anus to best facilitate the exam without causing the client undo discomfort?

Ask the client to bear down and place the lubricated finger on the anal opening

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

BPH

During a prostate examination, the prostate is noted to have a rubbery or boggy glandular consistency. The nurse recognizes that this is what?

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)

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 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

A client is concerned about his risk for developing testicular cancer. Which of the following should the nurse mention as a risk factor for this type of cancer?

Cryptorchidism

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

Digital rectal examination

All of the following symptoms are potential indicators of testicular disorders except:

Dull ache in the lower abdomen

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.

A nurse examines the external genitalia of a client and observes that the scrotum is enlarged, reddened, and swollen. On palpation, the epididymis is tender and the client complains of sudden pain. How should the nurse document this condition?

Epididymitis

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

A male client is complaining of pain with urination, rectal pain and urethral discharge. The nurse suspects this is what?

Gonorrhea

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

Herpes

During palpation of the male genitalia, which of the following is an expected finding?

Palpable spermatic cord

An uncircumcised, 78 year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination it is noted that the foreskin is very constricted. What is this condition called?

Phimosis

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

When performing the physical assessment of a client, the nurse notes the presence of a small cyst that contains hair, which is located midline in the sacrococcygeal area and has a palpable sinus tract. How should the nurse document this finding?

Pilonidal cyst

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

On palpation of a client's prostate, a nurse detects hard, fixed, and irregular nodules on the prostate. Which condition should the nurse most suspect in this client?

Prostate cancer

An adult male client comes to the clinic complaining of awakening at night to void and voiding more than once in a 2-hour time period. The client has a history of bladder irritation. What would be an appropriate nursing diagnosis for this client?

Risk for urge incontinence

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