Chapter 59: Assessment and Management of Problems Related to Male Reproductive Processes

What should a male client older than age 50 do to help ensure early identification of prostate cancer? A. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B. Have a transrectal ultrasound every 5 years. C. Perform monthly testicular self-examinations, especially after age 50. D. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels checked yearly.

A (Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. (Explanation: 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.)

32. A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time? A) Provide empathy and encouragement in an effort to foster a positive outlook. B) Tell the patient it is his decision whether to accept or reject chemotherapy. C) Report the patient's statement to members of his support system. D) Refer the patient to social work.

A Feedback: Patients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the patient's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the patient's statement to members of his support system and there is no obvious need for a social work referral.

16. A 35-year-old man is seen in the clinic because he is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem? A) Chronic bacterial prostatitis B) Orchitis C) Benign prostatic hyperplasia D) Urolithiasis

A Feedback: Prostatitis is an inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. Symptoms are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge. Urinary incontinence and retention occur with benign prostatic hyperplasia or hypertrophy. The patient may experience nocturia, urgency, decrease in volume and force of urinary stream. Urolithiasis is characterized by excruciating pain. Orchitis does not cause urinary symptoms.

22. A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply. A) Phimosis B) Priapism C) Herpes simplex infection D) Increasing age E) Lack of circumcision

A,D,E Feedback: Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV, smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two-thirds of cases occur in men older than 65 years of age), lichen sclerosus, and balanitis xerotica obliterans. Priapism and HSV are not known risk factors.

1. An adolescent is identified as having a collection of fluid in the tunica vaginalis of his testes. The nurse knows that this adolescent will receive what medical diagnosis? A) Cryptorchidism B) Orchitis C) Hydrocele D) Prostatism

C Feedback: A hydrocele refers to a collection of fluid in the tunica vaginalis of the testes. Cryptorchidism is the most common congenital defect in males, characterized by failure of one or both of the testes to descend into the scrotum. Orchitis is an inflammation of the testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical, or unknown factors. Prostatism is an obstructive and irritative symptom complex that includes increased frequency and hesitancy in starting urination, a decrease in the volume and force of the urinary stream, acute urinary retention, and recurrent urinary tract infections.

27. A nurse is 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 5 years. During the examination, the physician finds that digital rectal examination (DRE) reveals "stoney" hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what? A) A normal finding B) A sign of early prostate cancer C) Evidence of a more advanced lesion D) Metastatic disease

C Feedback: Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is stony hard and fixed. This finding is not suggestive of metastatic disease.

8. A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family? A) The patient should not be in contact with the baby after delivery. B) The patient's treatment poses no risk to his daughter or her infant. C) The patient's brachytherapy may be contraindicated for safety reasons. D) The patient should avoid close contact with his daughter for 2 months.

D Feedback: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient returns home after the procedure. Exposure of others to radiation is minimal, but the patient should avoid close contact with pregnant women and infants for up to 2 months.

A client is having prostate-specific antigen (PSA) testing done. Which result would the nurse identify as abnormal? A. 2.7 nanograms/milliliter B. 3.2 nanograms/milliliter C. 3.8 nanograms/milliliter D. 4.6 nanograms/milliliter

D (4.6 nanograms/milliliter (Explanation: Normal prostate-specific antigen (PSA) levels are less than 4.0 nanograms/milliliter (ng/mL). A level of 4.6 ng/mL would be considered abnormal.)

Which of the following herbal remedies is used to treat symptoms of benign prostatic hypertrophy (BPH)? A. Saw palmetto B. Garlic C. Gingko D. Green tea

A (Saw palmetto (Explanation: Saw palmetto is an herbal product used to treat symptoms associated with BPH.)

Which of the following would the nurse expect to find when assessing a client with phimosis? A. Severe edema accompanied by chronic inflammation at the glans penis B. Difficulty cleaning under the foreskin C. Painful swelling of the glans penis and prepuce D. Urinary retention accompanied by burning sensations in the urinary tract

B (Difficulty cleaning under the foreskin (Explanation: Clients with phimosis report pain with erection and intercourse and difficulty cleaning under the foreskin. Clients with paraphimosis experience painful swelling of the glans. If the condition continues, severe edema and urinary retention may occur.)

Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? Age Medication use Sexual history Undescended testicle

B (Medication use Explanation: Certain medications such as antihypertensive drugs, antidepressants, narcotics, etc. can cause sexual dysfunction in men. Impotence is not a normal part of aging. Undescended testicle is not indicative of ED. Sexual history is not indicative of ED.)

40. A patient presents to the emergency department with paraphimosis. The physician is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, what is usually indicated? A) Needle aspiration of the corpus cavernosum B) Circumcision C) Abstinence from sexual activity for 6 weeks D) Administration of vardenafil

B Feedback: Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated. Vardenafil is Levitra and would not be used for paraphimosis.

34. A patient has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following? A) Pelvic floor exercises B) Intermittent urinary catheterization C) Reduced physical activity D) Active range of motion exercises

A Feedback: Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

38. The nurse is leading a workshop on sexual health for men. The nurse should teach participants that organic causes of erectile dysfunction include what? Select all that apply. A) Diabetes B) Testosterone deficiency C) Anxiety D) Depression E) Parkinsonism

A,B,E Feedback: Organic causes of ED include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic renal failure, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to be psychogenic causes.

7. A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively? A) Fowler's position B) Prone position C) Supine position D) Lithotomy position

D Feedback: Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the patient is placed in a lithotomy position during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or Fowler's position.

9. A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this patient has chronic urinary retention? A) Hypertension B) Peripheral edema C) Tachycardia and other dysrhythmias D) Increased blood urea nitrogen (BUN)

D Feedback: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur with chronic urinary retention and large residual volumes.

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.

A (Testicular cancer is a highly curable type of cancer. Explanation: 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.)

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: A.continuous inflow and outflow of irrigation solution. B. intermittent inflow and continuous outflow of irrigation solution. C. continuous inflow and intermittent outflow of irrigation solution. D. intermittent flow of irrigation solution and prevention of hemorrhage.

A (Continuous inflow and outflow of irrigation solution. (Explanation: 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.)

When assessing a client with benign prostatic hypertrophy, which of the following would the nurse expect the client to report as the initial complaint? A. Dark brown urine B. Increased effort to void C. Narrowing of urinary stream D. Nocturia

B (Increased effort to void (Explanation: The symptoms of BPH appear gradually. At first, the client notices that it takes more effort to void. Eventually, the urinary stream narrows and has decreased force. The bladder empties incompletely. As residual urine accumulates, the client has an urge to void more often and nocturia occurs.)

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? A. Need for daily treatments over a 7- to 8-week period B. Use of radioactive seeds implanted into the prostate C. Surgical castration to decrease the level of circulating testosterone D. Use of probes inserted using ultrasound to freeze the tissue

B (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.)

12. A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? 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.

A Feedback: 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 with lung cancer. Testicular cancer is found more commonly in younger men.

Which of the following is the only definitive way to diagnose testicular cancer? A. Tissue biopsy B. Computed tomography of abdomen C. Ultrasound D. Lactate dehydrogenase levels

A (Tissue biopsy (Explanation: Tissue biopsy is the only definitive way to determine whether cancer is present, and is performed at the time of surgery rather than as a part of the diagnostic workup, to reduce the risk of promoting spread of cancer. A computed tomography scan of the abdomen and pelvis is performed to determine the extent of the disease in the retroperitoneum and pelvis. Lactate dehydrogenase levels and ultrasound examination to determine the presence and size of the testicular mass may also be done.)

5. A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? A) Red wine colored B) Tea colored C) Amber D) Light pink

D Feedback: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.

25. A physician explains to the patient that he has an inflammation of the Cowper glands. Where are the Cowper glands located? A) Within the epididymis B) Below the prostate, within the posterior aspect of the urethra C) On the inner epithelium lining the scrotum, lateral to the testes D) Medial to the vas deferens

B Feedback: Cowper glands lie below the prostate, within the posterior aspect of the urethra. This gland empties its secretions into the urethra during ejaculation, providing lubrication. The Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas deferens.

11. A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B) Have a transrectal ultrasound every 5 years. C) Perform monthly testicular self-examinations, especially after age 60. D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.

A Feedback: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the 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 due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

39. A patient has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The patient's interdisciplinary plan of care should prioritize which of the following interventions? A) Penile implant B) PDE-5 inhibitors C) Physical therapy D) Psychotherapy

D Feedback: Patients with erectile dysfunction from psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction. Because of the absence of an organic cause, medications and penile implants are not first-line treatments. Physical therapy is not normally effective in the treatment of ED.

15. A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the patient's history, what might the nurse note that contributes to erectile dysfunction? A) The patient has been treated for a UTI twice in the past year. B) The patient has a history of hypertension. C) The patient is 66 years old. D) The patient leads a sedentary lifestyle.

B Feedback: Past history of infection and lack of exercise do not contribute to impotence. With advancing age, sexual function and libido and potency decrease somewhat, but this is not the primary reason for impotence. Vascular problems cause about half the cases of impotence in men older than 50 years; hypertension is a major cause of such problems.

35. A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply. A) Abstaining from sexual intercourse for at least 14 days postprocedure B) Wearing a scrotal support garment C) Using sitz baths D) Applying a heating pad intermittently E) Staying on bed rest for 48 to 72 hours postprocedure

B,C Feedback: Applying ice bags intermittently to the scrotum for several hours after surgery can reduce swelling and relieve discomfort, and is preferable to the application of heat. The nurse advises the patient to wear snug, cotton underwear or a scrotal support for added comfort and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and sexual activity can usually be resumed in 1 week.

6. A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? A) It is most common among men over 55. B) It is one of the least curable solid tumors. C) It typically does not metastasize. D) It is highly responsive to treatment.

D Feedback: Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

Which of the following terms refers to the surgical removal of one of the testes? A. Orchiectomy B. Circumcision C. Vasectomy D. Hydrocelectomy

A (Orchiectomy (Explanation: 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.)

19. A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response? A) A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. B) HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant. C) Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer. D) Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.

A Feedback: A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is associated with breast cancer.

31. A nurse is providing care for a patient who has recently been admitted to the postsurgical unit from PACU following a transuretheral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action? A) Closely monitoring the input and output of the bladder irrigation system B) Administering parenteral nutrition and fluids as ordered C) Monitoring the patient's level of consciousness and skin turgor D) Scanning the patient's bladder for retention every 2 hours

A Feedback: Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.

13. A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens? A) Continuous inflow and outflow of irrigation solution B) Intermittent inflow and continuous outflow of irrigation solution C) Continuous inflow and intermittent outflow of irrigation solution D) Intermittent flow of irrigation solution and prevention of hemorrhage

A Feedback: 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.

24. A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional "dribbling" of urine. How should the nurse best respond to this patient's concern? A) Inform the patient that urinary control is likely to return gradually. B) Arrange for the patient to be assessed by his urologist. C) Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D) Teach the patient to perform intermittent self-catheterization.

A Feedback: It is important that the patient know that regaining urinary control is a gradual process; he may continue to dribble after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

17. To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what? A) Report the planned use of dietary supplements to the physician. B) Decrease the intake of fluids to prevent urinary retention. C) Abstain from sexual activity for 2 weeks following the initiation of treatment. D) Anticipate a temporary worsening of urinary retention before symptoms subside.

A Feedback: Some herbal supplements are contraindicated with Proscar, thus their planned use should be discussed with the physician or pharmacist. The patient should maintain normal fluid intake. There is no need to abstain from sexual activity and a worsening of urinary retention is not anticipated.

30. A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him "emasculated" and "a shell of a man." The nurse should identify what nursing diagnosis when planning the patient's subsequent care? A) Disturbed Body Image Related to Effects of Surgery B) Spiritual Distress Related to Effects of Cancer Surgery C) Social Isolation Related to Effects of Surgery D) Risk for Loneliness Related to Change in Self-Concept

A Feedback: The patient's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This patient is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the patient's concerns.

A nurse is caring for a client admitted to the unit with a seizure disorder. The client seems upset and asks the nurse, "What will they do to me? I'm scared of the tests and of what they'll find out." The nurse should focus her teaching plans on which diagnostic tests? A. Transesophageal echocardiogram (TEE), troponin levels, and a complete blood count B. EEG, blood cultures, and neuroimaging studies C. X-ray of the brain, bone marrow aspiration, and EEG D.. Electrocardiography, TEE, prothrombin time (PT), and International Normalized Ratio (INR)

B (EEG, blood cultures, and neuroimaging studies (Explanation: Physicians use EEG and neuroimaging studies to diagnose neurologic problems. Blood cultures can identify infection that can cause seizures. Electrocardiography, TEE, and troponin levels are cardiac-specific diagnostic tests. X-ray of the brain reveals skeletal condition. Bone marrow aspiration isn't indicated for seizure disorder. PT and INR reflect blood coagulation.)

28. A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurse's response? A) Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B) All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C) Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D) Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.

B Feedback: All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.

10. A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history prior to instructing the patient on the use of this medication. What disorder will contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Retinopathy C) Hypotension D) Diabetic nephropathy

B Feedback: Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil (Cialis) and sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil (Viagra) are usually contraindicated with diabetic retinopathy.

23. A 75-year-old male patient is being treated for phimosis. When planning this patient's care, what health promotion activity is most directly related to the etiology of the patient's health problem? A) Teaching the patient about safer sexual practices B) Teaching the patient about the importance of hygiene C) Teaching the patient about the safe use of PDE-5 inhibitors D) Teaching the patient to perform testicular self-examination

B Feedback: Poor hygiene often contributes to cases of phimosis. This health problem is unrelated to sexual practices, the use of PDE-5 inhibitors, or testicular self-examination.

21. A 35-year-old father of three tells the nurse that he wants information on a vasectomy. What would the nurse tell him about ejaculate after a vasectomy? A) There will be no ejaculate after a vasectomy, though the patient's potential for orgasm is unaffected. B) There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. C) There is a marked decrease in the amount of ejaculate after vasectomy, though this does not affect sexual satisfaction. D) There is no change in the quantity of ejaculate after vasectomy, but the viscosity is somewhat increased.

B Feedback: Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland, which are unaffected by vasectomy, thus no noticeable decrease in the amount of ejaculate occurs (volume decreases approximately 3%), even though it contains no spermatozoa. The viscosity of ejaculate does not change.

4. A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication? A) Sexual stimulation is not needed to obtain an erection. B) The drug should be taken 1 hour prior to intercourse. C) Facial flushing or headache should be reported to the physician immediately. D) The drug has the potential to cause permanent visual changes.

B Feedback: The patient must have sexual stimulation to create the erection, and the drug should be taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side effects of Viagra and do not normally warrant reporting to the physician. Some visual disturbances may occur, but these are transient.

29. A patient has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action? A) Cleanse the skin surrounding the suprapubic tube. B) Inform the urologist of this finding. C) Remove the suprapubic tube and apply a wet-to-dry dressing. D) Administer antispasmodic drugs as ordered.

B Feedback: The physician should be informed if there is significant leakage around a suprapubic catheter. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

A health care provider prescribes ketoconazole (Nizoral), a second-line hormonal agent for the treatment of prostatic cancer. The nurse explained to the patient that this drug acts by: A. Decreasing the level of circulating plasma testosterone. B.Interrupting the conversion of dihydrotestosterone (DHT). C. Decreasing the endocrine production of androgen. D. Suppressing androgenic stimuli to the prostate.

C (Decreasing the endocrine production of androgen. Explanation: Nizoral is an adrenal-ablating drug that inhibits enzymes required for the synthesis of androgens.)

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? A. DRE B. PSA C. Prostate biopsy D. Cystoscopy

C (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.)

18. A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group? A) Native Americans B) Caucasian Americans C) African Americans D) Asian Americans

C Feedback: African American men have a high risk of prostate cancer; furthermore, they are more than twice as likely to die from prostate cancer as men of other racial or ethnic groups.

20. A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patient's family history, he states, "My father died of prostate cancer at age 48." The nurse should instruct him on which of the following health promotion activities? A) The patient will need PSA levels drawn starting at age 55. B) The patient should have testing for presence of the CDH1 and STK11 genes. C) The patient should have PSA levels drawn regularly. D) The patient should limit alcohol use due to the risk of malignancy.

C Feedback: PSA screening is warranted by the patient's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the patient should be limited. However, this is not the most important health promotion intervention.

3. A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort, burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient is exhibiting symptoms of what? A) Varicocele B) Epididymitis C) Prostatitis D) Hydrocele

C Feedback: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation is indicative of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele is a collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the spermatic cord.

2. 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. The nurse should recognize the presence of what health problem? A) Bowen's disease B) Peyronie's disease C) Phimosis D) Priapism

C Feedback: Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans. Bowen's disease is an in situ carcinoma of the penis. Peyronie's disease is an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels.

26. A nursing student is learning how to perform sexual assessments using the PLISSIT model. According to this model, the student should begin an assessment by doing which of the following? A)Briefly teaching the patient about normal sexual physiology B)Assuring the patient that what he says will be confidential C)Asking the patient if he is willing to discuss sexual functioning D)Ensuring patient privacy

C Feedback: The PLISSIT (permission, limited information, specific suggestions, intensive therapy) model of sexual assessment and intervention may be used to provide a framework for nursing interventions. By beginning with the patient's permission, the nurse establishes a patient-centered focus.

14. A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? A) Urinary tract infection B) Chronic pain C) Permanent vascular damage D) Future erectile dysfunction

C Feedback: The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or erectile dysfunction.

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? A. "I'll have to stay in the hospital for about 3 to 4 days after the surgery." B. "I'll have a small incision on my lower abdomen after the procedure." C. "The surgeon is going to remove the entire prostate gland." D. "The surgeon is going to insert a scope through my urethra to remove a portion of the gland."

D ("The surgeon is going to insert a scope through my urethra to remove a portion of the gland." (Explanation: TURP involves the surgical removal of the inner portion of the gland through an endoscope inserted through the urethra. There is no external skin incision. Typically, the procedure is performed in an outpatient setting but may require an overnight hospital stay.)

Which of the following is inconsistent with a digital rectal examination (DRE)? A. Recommended for men older than 40 years of age B. Assists in screening for cancer of prostate gland C. Enables examiner to assess size, shape, and consistency of prostate gland D. Can reveal a hydrocele

D (Can reveal a hydrocele 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.)

36. A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient? A) Apply a cold compress to the pubic area. B) Notify the urologist promptly. C) Irrigate the catheter with 30 to 50 mL of normal saline aS ordered. D) Administer a smooth-muscle relaxant as ordered.

D Feedback: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be relieved without the involvement of the urologist, who will normally order medications on a PRN basis.

37. A patient confides to the nurse that he cannot engage in sexual activity. The patient is 27 years old and has no apparent history of chronic illness that would contribute to erectile dysfunction. What does the nurse know will be ordered for this patient to assess his sexual functioning? A) Sperm count B) Ejaculation capacity tests C) Engorgement tests D) Nocturnal penile tumescence tests

D Feedback: Nocturnal penile tumescence tests may be conducted in a sleep laboratory to monitor changes in penile circumference during sleep using various methods to determine number, duration, rigidity, and circumference of penile erections; the results help identify whether the erectile dysfunction is caused by physiologic and/or psychological factors. A sperm count would be done if the patient was complaining of infertility. Ejaculation capacity tests and engorgement tests are not applicable for assessment in this circumstance.

33. A 57-year-old male comes to the clinic complaining that when he has an erection his penis curves and becomes painful. The patient's diagnosis is identified as severe Peyronie's disease. The nurse should be aware of what likely treatment modality? A) Physical therapy B) Treatment with PDE-5 inhibitors C) Intracapsular hydrocortisone injections D) Surgery

D Feedback: Surgical removal of mature plaques is used to treat severe Peyronie's disease. There is no potential benefit to physical therapy and hydrocortisone injections are not normally used. PDE-5 inhibitors would exacerbate the problem.