Chapter 59: Assessment and Management of Patients with Male Reproductive Disorders

A nurse is obtaining a male client's health history before performing a physical examination. Which information would most likely not be obtained? A.) age of first ejaculate B.) contraceptive practices C.) pain during sexual intercourse D.) premature ejaculation or other concerns of a sexual nature

Answer: A.) age of first ejaculate Rationale: Age of first ejaculate would most likely not be asked. Premature ejaculation or other concerns of a sexual nature, pain during sexual intercourse, and contraceptive practices would most likely be included in the health history.

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? A.) Do not use the device while taking nitrates. B.) Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. C.) Watch for erosion of the prosthesis through the skin. D.) Watch for the development of infection.

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

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? A.) Asthma with beta-adrenergic inhaler use B.) Hypotension with nitrate use C.) Chronic pain with narcotic use D.) Arthritis with corticosteroid use

Answer: B.) Hypotension with nitrate use Rationale: 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 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? A.) Self-catheterization B.) Kegel exercises C.) Fluid restriction D.) Artificial sphincter use

Answer: B.) Kegel exercises

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? A.) Take a deep breath and hold it when the physician inserts a gloved finger into the rectum. B.) Take a deep breath and exhale when the physician inserts a gloved finger into the rectum. C.) When bending over the examining table, point the feet outward to decrease the discomfort. D.) Inform the patient that the examination is not uncomfortable and will be over in a short period of time.

Answer: B.) Take a deep breath and exhale when the physician inserts a gloved finger into the rectum. Rationale: To minimize discomfort and relax the anal sphincter during the digital rectal examination, the patient is instructed to take a deep breath and exhale slowly as the practitioner inserts a finger. If possible, he should turn his feet inward so his toes are touching.

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.

Answer: - Do not delay the urge to void. - Schedule digital rectal exams. Rationale: 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.

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? A.) Evaluating patency of the drainage lumen B.) Counter-balancing the I.V. pole C.) Attaching the infusion set to an infusion pump D.) Collecting a urine specimen before beginning irrigation

Answer: A.) Evaluating patency of the drainage lumen Rationale: The nurse should evaluate patency of the drainage tubing before leaving the client's room. 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. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make? A.) Testicular cancer is a highly curable type of cancer. B.) Testicular cancer is very difficult to diagnose. C.) Testicular cancer is the number one cause of cancer deaths in males. D.) Testicular cancer is more common in older men.

Answer: A.) Testicular cancer is a highly curable type of cancer. Rationale: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in younger, not older, men.

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? A.) "I'll use my right hand to check the left testicle and the left hand to check the right one." B.) "The best time to do it is once a month after I take my warm morning shower." C.) "If the top and back of the testicle feels cordlike, I'll call my physician." D.) "I should roll the testis in a circular pattern around the palm of my hand."

Answer: B.) "The best time to do it is once a month after I take my warm morning shower." Rationale: TSE is to be performed monthly, usually after a warm bath or shower when the scrotum is more relaxed. Both hands are used to palpate the testis. The index and middle fingers are placed under the testis and the thumb is placed on top. The testis is rolled gently in a horizontal plane between the thumb and fingers. A cordlike structure on the top and back of the testicle is the epididymis. This is normal and does not need to be reported.

A 48-year-old man recently diagnosed with benign prostatic hyperplasia (BPH) reports consuming <i>Serenoa repens</i> (saw palmetto berry). The nurse needs to intervene if the physician orders which treatment? A.) Terazosin B.) Finasteride C.) Sipuleucel-T D.) Ketoconazole

Answer: B.) Finasteride Rationale: 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 nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? A.) Palpate both testicles simultaneously for comparison. B.) Palpate each testicle separately, following a warm shower. C.) Palpate the front of the testicle first, where most tumors are found. D.) Palpate for a soft, round shape with normal ridges on the testicles.

Answer: B.) Palpate each testicle separately, following a warm shower. Rationale: 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.

After teaching about self-care measures to a client who has been diagnosed with prostatitis, the nurse determines that the teaching was successful when the client states which of the following? A.) "I'll take the antibiotic until all the symptoms are gone." B.) "If I have discomfort, a cool shower will give me relief." C.) "I should avoid fluids like coffee and tea." D.) "I need to make sure that I drink lots of fluid."

Answer: C.) "I should avoid fluids like coffee and tea." Rationale: With prostatitis, the client should avoid foods and liquids with diuretic action such as coffee and tea. He also needs to complete the full course of prescribed antibiotic therapy, not just until the symptoms are gone. Hot sitz baths may be used to promote relief. Fluids are encouraged to satisfy thirst but are not forced because an effective medication level must be maintained in the urine.

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? A.) Increased libido B.) Deepening of voice C.) Breast tenderness D.) Enhanced potency

Answer: C.) Breast tenderness Rationale: Feminizing side effects occur with hormone therapy. The client's voice may become higher, hair and fat distribution may change, and breasts may become tender and enlarged. Libido and potency also are diminished.

A client expresses concerns about future reproduction after a surgery to correct the cancer of the testes. For this client, treatment proceeded without first collecting and storing sperm. Which alternative should the nurse suggest to the client? A.) Undertake herbal alternatives B.) Suggest the use of sildenafil C.) Suggest donor insemination or adoption D.) Reverse the surgery

Answer: C.) Suggest donor insemination or adoption

Following a vasectomy, which is the most important instruction to provide to the client? A.) Wear a scrotal support until swelling is resolved. B.) Use a Tylenol as needed for discomfort. C.) Use another form of birth control until further notice. D.) Take a day or two to rest and recuperate from the procedure.

Answer: C.) Use another form of birth control until further notice. Rationale: It may take up to 10 ejaculations to clear sperm and prevent impregnation. The client should be instructed to use another form of reliable birth control until a sperm count proves sterility has occurred. Use of Tylenol, scrotal support, and rest are all helpful during the initial recovery period.

Which client is most likely to develop prostate cancer according to a nurse working at a health screening at the local mall? A.) A 35-year-old African American man B.) A 60-year-old Asian American man C.) A 17-year-old Caucasian man D.) A 56-year-old African American man

Answer: D.) A 56-year-old African American man Rationale: 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.

Which of the following should nurses teach all men, especially those who have had cryptorchidism? A.) Need for blood tests to measure serum acid phosphatase levels B.) Importance of regular monitoring of prostate-specific antigen (PSA) levels C.) Need to undergo a baseline and follow up lymph node biopsies D.) How to perform a testicular self-examination

Answer: D.) How to perform a testicular self-examination Rationale: The nurses should teach all men, especially those who have had cryptorchidism, to perform testicular self-examination to detect any abnormal mass in the scrotum. The nurse instructs the clients to examine the testicles monthly, preferably when warm, such as in the shower. Having regular PSA levels, lymph node biopsies, and blood tests for measuring serum acid phosphatase are for the clients who are treated for prostate cancer.

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? A.) Secretions of the prostate gland increase. B.) Testes become heavier in weight. C.) Spermatogenesis drops significantly D.) Plasma testosterone levels decrease.

Answer: D.) Plasma testosterone levels decrease.

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? A.) Erectile dysfunction B.) Prostatitis C.) Cryptorchidism D.) Priapism

Answer: C.) Cryptorchidism

Which cancer ranks second as the cause of death in American men? A.) prostate B.) testicular C.) skin D.) penis

ANswer: A.) prostate Rationale: Prostatic cancer is second to skin cancer in frequency among American men. It ranks second as the cause of deaths from cancer. Cancer of the testes is a malignancy seen in men between 18 and 40 years of age. Although this cancer is relatively rare, accounting for approximately 1% of cancers in men, it is the most common type in men between 15 and 34 years of age and is the leading cause of cancer deaths in men between 25 and 34 years of age. Skin cancer ranks first in frequency among American men. Penile cancer is rare and occurs more often in men who are uncircumcised.

A nurse is preparing a presentation for a local senior citizen group about age-related changes in the body systems. Which of the following would the nurse include as associated with the male reproductive system? Select all that apply. - Shrinkage of the prostate gland - Decrease in sexual energy level - Loss of testicular firmness - Enlargement of the testes - Thickening of the seminiferous tubules

Answer: - Decrease in sexual energy level - Loss of testicular firmness - Thickening of the seminiferous tubules Rationale: Age-related changes in the male reproductive system are associated with decreased sex hormone secretion, especially testosterone. Subsequently, the older man experiences decreased sexual energy, loss of testicular firmness, shrinkage of the testes, enlargement of the prostate gland, and thickening of the seminiferous tubules.

The nurse is preparing a presentation for an older adult group of males at a senior center. Which of the following would the nurse expect to include when describing the effects of aging on the male reproductive system? A.) The volume and viscosity of seminal fluid increase with age. B.) Men retain the ability to fertilize ova irrespective of age. C.) There is a gradual increase in sperm and testosterone production. D.) The scrotum becomes less pendulous and becomes firm.

Answer: B.) Men retain the ability to fertilize ova irrespective of age.

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: A.) testosterone therapy during childhood. B.) sexually transmitted disease. C.) early onset of puberty. D.) cryptorchidism.

Answer: D.) cryptorchidism.

A clinical manifestation related to metastasis from prostate cancer is A.) polyuria. B.) hip pain. C.) weight gain. D.) thrombocytopenia.

Answer: B.) hip pain. Rationale: Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, oliguria (decreased urine output), and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.

The diagnosis of prostate cancer is confirmed by which of the following? A.) Histologic exam of tissue B.) Computed tomography C.) Bone scan D.) Magnetic resonance imaging

Answer: A.) Histologic exam of tissue Rationale: 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.

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? A.) Discontinue the irrigations. B.) Increase the rate of the IV fluids. C.) Administer a unit of packed red blood cells. D.) Prepare the patient for an ECG.

Answer: A.) Discontinue the irrigations. Rationale: Transurethral resection syndrome is a rare but potentially serious complication of TURP. Symptoms include lethargy, hypotension, and muscle spasms. The first action the nurse should take is to discontinue irrigation. The other interventions listed are not appropriate.

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? A.) Monthly testicular self-examination (TSE) B.) Annual digital rectal examination (DRE) after age 35 years C.) Annual prostate-specific antigen (PSA) testing after age 40 years D.) Transrectal ultrasound every 5 years after age 50 years

Answer: A.) Monthly testicular self-examination (TSE)

A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? A.) Transurethral resection of the prostate (TURP) B.) Suprapubic prostatectomy C.) Retropubic prostatectomy D.) Transurethral laser incision of the prostate

Answer: A.) Transurethral resection of the prostate (TURP) Rationale: TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; each requires an incision.

A young client is admitted with torsion of the spermatic cord. Which is the most appropriate action to be taken by the nurse? A.) Elevate the scrotum. B.) Keep the client NPO. C.) Monitor vital signs for cardiac changes. D.) Avoid the use of analgesics.

Answer: B.) Keep the client NPO. Rationale: 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.

Which structure is involved in keeping the testes at the necessary temperature to ensure sperm production? A.) scrotum B.) testicles C.) epididymis D.) shaft

Answer: A.) scrotum Rationale: To maintain the temperature of the testes 3 degrees cooler than body temperature, smooth and skeletal muscles in the scrotum pull the tissue toward the body when external temperatures are cold. On the other hand, the smooth muscles relax, causing the scrotum to become loose and hang away from the body when environmental temperatures are hot. The scrotum is the divided sac of skin that contains the right and left testes, also called testicles. The location of the testes within the scrotal sac ensures optimum conditions for sperm production.

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? A.) Ensure greater fluid intake. B.) Ask the client to keep a diet diary. C.) Include fruits in the client's diet. D.) Administer serotonin blockers.

Answer: B.) Ask the client to keep a diet diary. Rationale: The appropriate nursing task in this situation is to assess the amount of food eaten. This assessment will help determine nutrient intake. The nurse should ensure adequate fluid hydration before, during, and after drug administration when the client has side effects of nausea and vomiting. Administration of fruits is not recommended when the client is at risk of infection, such as during chemotherapy. Serotonin blockers are administered to control nausea and vomiting.

A nurse is teaching a male client who is older than 50 years about prostate cancer. What teaching should be included by the nurse? A.) Have a complete blood count, blood urea nitrogen, and creatinine levels checked yearly. B.) Have a digital rectal examination. C.) Have a transrectal ultrasound every 5 years. D.) Perform monthly testicular self-examinations, especially after age 50.

Answer: B.) Have a digital rectal examination. Rationale: A serum prostate-specific antigen level test and a digital rectal exam, which are recommended by the American Cancer Society, 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 strong family history of prostate cancer and those of African American ethnicity. Testicular self-examinations won't identify changes in the prostate gland because of its location in the body. A transrectal ultrasound, complete blood count, blood urea nitrogen, and creatinine level test are usually done after diagnosis to identify the extent of the disease and potential metastasis.

Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically address testicular cancer risk, a nurse should modify client teaching for male clients to include: A.) physician visits. B.) testicular self-examination. C.) risk factors. D.) family history.

Answer: B.) testicular self-examination. Rationale: Testicular self-examination is a relatively simple technique that's extremely useful in detecting cancer-related testicular changes. Physician visits, risk factors, and family history are important to all clients, regardless of gender, and don't specifically address risk factors associated with testicular cancer.