Chapter 59 PrepU: Assessment and Management of Patients with Male Reproductive Orders
Which therapy uses low-level radiofrequencies to produce localized heat that destroys prostate tissue? 1. Transurethral needle ablation 2. Microwave thermotherapy 3. Saw palmetto 4. Resection
1. Transurethral needle ablation Explanation: Transurethral needle ablation uses low-level radiofrequencies to produce localized heat that destroys prostate tissue while sparing the urethra, nerves, muscles, and membranes. Sal palmetto is a herbal product used to treat the symptoms associated with benign prostatic hyperplasia. Microwave thermotherapy involves the application of heat to the prostatic tissue. Resection of the prostate can be performed with ultrasound guidance.
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? 1. Use of radioactive seeds implanted into the prostate 2. Surgical castration to decrease the level of circulating testosterone 3. Need for daily treatments over a 7- to 8-week period 4. Use of probes inserted using ultrasound to freeze the tissue
1. 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 involves the insertion of transperineal probes into the prostate to freeze the tissue directly.
The nurse working on the postoperative unit receives a report on various clients. Based on the information provided, whom should the nurse see first? 1. A 55-year-old male patient admitted with orchitis, with tenderness in both testicles, unilateral testicular swelling, and a WBC of 114,000 mm3. Vital signs are temperature 100.2°F, pulse 82, respirations 18, and blood pressure 140/80. 2. A 67-year-old male patient recovering from a prostatectomy, with a potassium level of 4.0 mEq/L and a serum sodium level of 130 mEq/L. Vital signs are temperature 99.2°F, pulse 88, respirations 22, and blood pressure 156/92. 3. A 45-year-old man diagnosed with acute bacterial prostatitis and painful urination. Vital signs are temperature 101.2°F, pulse 92, respirations 16, blood pressure 148/88. 4. A 35-year-old man 1 hour after vasectomy, with scrotal swelling, a pain rating of 5, and scrotal ecchymoses. Vital signs are temperature 98.9°F, pulse 72, respirations 16, and blood pressure 140/82.
2. A 67-year-old male patient recovering from a prostatectomy, with a potassium level of 4.0 mEq/L and a serum sodium level of 130 mEq/L. Vital signs are temperature 99.2°F, pulse 88, respirations 22, and blood pressure 156/92. Explanation: This client's condition is consistent with hyponatremia and needs to be reported to the physician. Scrotal swelling, discomfort, and ecchymoses are expected findings following a vasectomy. Acute prostatitis is characterized by the sudden onset of fever, dysuria, perineal prostatic pain, and severe lower urinary tract symptoms (dysuria, frequency, urgency, hesitancy, and nocturia). The signs and symptoms listed are expected in a client with orchitis.
A nurse is working in an oncology treatment center. Which clinical manifestation when reported by a client would the nurse know may be related to metastasis from prostate cancer? 1. Large amounts of dilute urine when voiding 2. Constant hip aching and discomfort 3. Frequent nighttime urination 4. Weight gain of 3 pounds in 1 month
2. Constant hip aching and discomfort Explanation: Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, oliguria, weight loss, weakness, nausea, and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.
Which of the following should nurses teach all men, especially those who have had cryptorchidism? 1. Need to undergo a baseline and follow up lymph node biopsies 2. How to perform a testicular self-examination 3. Importance of regular monitoring of prostate-specific antigen (PSA) levels 4. Need for blood tests to measure serum acid phosphatase levels
2. How to perform a testicular self-examination Explanation: 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.
The nurse is obtaining a medication history from a client who is reporting erectile dysfunction. Which medication would the nurse identify as being least likely to contribute to the client's condition? 1. Spironolactone 2. Ibuprofen 3. Cimetidine 4. Methyldopa
2. Ibuprofen Explanation: Certain medications, such as antihypertensive agents (e.g. methyldopa and spironolactone), antidepressants, narcotics, and cimetidine cause sexual dysfunction in men. Ibuprofen is not associated with causing erectile dysfunction.
When assessing a client with benign prostatic hyperplasia, which of the following would the nurse expect the client to report as the initial complaint? 1. Narrowing of urinary stream 2. Increased effort to void 3. Nocturia 4. Dark brown urine
2. 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 59-year-old African American man has opted for hormonal androgen deprivation therapy (ADT) to treat his prostate cancer. Which surgical procedures is the client most likely to undergo? 1. Circumcision 2. Orchiectomy 3. Hydrocelectomy 4. Vasectomy
2. Orchiectomy Explanation: ADT is commonly used to suppress androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of dihydrotestosterone (DHT). As a result, the prostatic epithelium atrophies (decreases in size). This effect is accomplished by an orchiectomy (removal of the testes). 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.
The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? 1. Palpate both testicles simultaneously for comparison. 2. Palpate each testicle separately, following a warm shower. 3. Palpate for a soft, round shape with normal ridges on the testicles. 4. Palpate the front of the testicle first, where most tumors are found.
2. Palpate each testicle separately, following a warm shower. Explanation: 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.
The nurse is preparing a discharge teaching plan for a client who has had a prostatectomy. Which of the following would be appropriate to include? 1. Engaging in strenuous exercise to strengthen abdominal muscles 2. Performing perineal exercises frequently throughout the day 3. Waiting to urinate for 5 to 10 minutes after feeling the initial urge 4. Using a bearing down motion to promote complete bladder emptying when voiding
2. Performing perineal exercises frequently throughout the day Explanation: After a prostatectomy, the client should be instructed in how to perform perineal exercises and to perform them hourly throughout the day, each day. In addition, the client should avoid bearing down (straining) to urinate because of the increased risk for hematuria. He should also avoid strenuous exercise, which increases the tendency to rebleed. The client should be instructed to urinate as soon as he feels the first urge to do so.
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? 1. DRE 2. Prostate biopsy 3. Cystoscopy 4. PSA
2. 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.
Which should be included as part of the home care instructions for a client with epididymitis and orchitis? 1. Resume sexual intercourse. 2. Take prescribed antibiotics. 3. Undertake lifting exercises 4. Apply ice to the area after scrotal swelling subsides.
2. Take prescribed antibiotics. Explanation: Home care for a client with epididymitis and orchitis includes instructions to continue administering prescribed antibiotics, take Sitz baths, apply local heat after scrotal swelling subsides, avoid lifting, and refrain from sexual intercourse until symptoms are relieved.
When developing an educational program for a group of adolescents about sexually transmitted infections (STIs), what should the nurse inform the group about the single greatest risk factor for contracting an STI? 1. The type of contraception used 2. The number of sexual partners 3. Where the patient lives 4. The number of times the person has contact with a partner
2. The number of sexual partners Explanation: The single greatest risk factor for contracting an STI is the number of sexual partners. As the number of partners increases, so does the risk of exposure to a person infected with an STI.
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? 1. Use of probes inserted using ultrasound to freeze the tissue 2. Use of radioactive seeds implanted into the prostate 3. Surgical castration to decrease the level of circulating testosterone 4. Need for daily treatments over a 7- to 8-week period
2. 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 involves the insertion of transperineal probes into the prostate to freeze the tissue directly.
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate? 1. Prepare to remove the catheter. 2. Use sterile technique when irrigating the catheter. 3. Restrict fluids to prevent the client's bladder from becoming distended. 4. Tell the client to try to urinate around the catheter to remove blood clots.
2. Use sterile technique when irrigating the catheter. Explanation: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.
Which client is most likely to develop prostate cancer according to a nurse working at a health screening at the local mall? 1. A 35-year-old African American man 2. A 60-year-old Asian American man 3. A 56-year-old African American man 4. A 17-year-old European American man
3. A 56-year-old African American man Explanation: Age over 40 and African American race are both risk factors for prostate cancer. Age younger than 40 and Asian heritage reduce the risk of prostate cancer.
A client is undergoing treatment for prostate cancer. He has chemotherapy sessions regularly. However, of late he is showing symptoms of food allergy and loss of appetite. He has lost considerable weight as a result. Which is an appropriate nursing task in this situation? 1. Ensure greater fluid intake 2. Administer serotonin blockers 3. Ask the client to keep a diet dairy. 4. Include fruits in the client's diet.
3. Ask the client to keep a diet diary. Explanation: 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.
Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis? 1. Urge the limited intake of foods and fluids containing caffeine. 2. Engage in activities and exercises that minimize heavy lifting. 3. Ensure immunizations against infectious diseases such as mumps. 4. Encourage the consumption of foods that are rich in fat and starch.
3. Ensure immunizations against infectious diseases such as mumps. Explanation: Nurses should advocate for infant and childhood immunizations against infectious diseases such as mumps to reduce potential adult complications such as orchitis. Minimizing activities involving heavy lifting or urging limited intake of caffeine have no effect on the potential for adult complications such as orchitis. The nurse should encourage foods that are low in fat and starch; however, this also would have no effect on the potential for orchitis.
A client who comes to the clinic complaining of perineal pain, dysuria, and fever is diagnosed with prostatitis. The nurse understands that which of the following organisms would be the most likely cause? 1. Staphylococcus 2. Streptococcus 3. Escherichia coli 4. Paramyxovirus
3. Escherichia coli Explanation: Prostatitis is an inflammation of the prostate gland and is most often caused by microorganisms that reach the prostate by way of the urethra. Escherichia coli and microbes that cause sexually transmitted infections often are responsible. Staphylococcus and Streptococcus are not typically a cause of prostatitis. Paramyxovirus is the cause of mumps.
A client who comes to the clinic complaining of perineal pain, dysuria and fever is diagnosed with prostatitis. The nurse understands that which of the following organisms would be the most likely cause? 1. Staphylococcus 2. Paramyxovirus 3. Escherichia coli 4. Streptococcus
3. Escherichia coli Explanation: Prostatitis is an inflammation of the prostate gland and is most often caused by microorganisms that reach the prostate by way of the urethra. Escherichia coli and microbes that cause sexually transmitted infections often are responsible. Staphylococcus and streptococcus are not typically a cause of prostatitis. Paramyxovirus is the cause of mumps.
Which of the following patient populations have the highest risk for developing testicular cancer? 1. Hispanic American 2. African American 3. European American 4. Asian American
3. European American Explanation: European American men have a five times greater risk than that of African American men and more than double the risk of Asian American men.
A client is receiving leuprolide as part of his treatment for prostate cancer. The nurse would be alert for which of the following as a possible adverse effect? 1. Reports of increased libido 2. Muscle overgrowth 3. Gynecomastia 4. Nipple retraction
3. Gynecomastia Explanation: Adverse effects associated with leuprolide, a luteinizing hormone-releasing hormone agonist, are related to hypogonadism and include vasomotor flushing, loss of libido, decreased bone density, anemia, fatigue, increased fat mass, decreased muscle mass, gynecomastia, and mastodynia (breast/nipple tenderness).
A nurse is teaching a male client who is older than 50 years about prostate cancer. What teaching should be included by the nurse? 1. Have a transrectal ultrasound every 5 years. 2. Perform monthly testicular self-examinations, especially after age 50. 3. Have a digital rectal examination. 4. Have a complete blood count, blood urea nitrogen, and creatinine levels checked yearly.
3. Have a digital rectal examination. Explanation: 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.
Which of the following may result if prostate cancer invades the urethra or bladder? 1. Hip pain 2. Backache 3. Hematuria 4. Rectal discomfort
3. Hematuria Explanation: Hematuria may result if the cancer invades the urethra or bladder. Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, and oliguria.
After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true? 1. Erectile dysfunction is unrelated to anxiety or depression. 2. Erectile dysfunction rarely occurs in clients with diabetes mellitus. 3. Erectile dysfunction is primarily a normal response to aging. 4. Erectile dysfunction may be due to testosterone insufficiency.
4. Erectile dysfunction may be due to testosterone insufficiency. Explanation: Common causes of erectile dysfunction include neurologic disorder like spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy such as antihypertensives or antidepressants, atherosclerosis, hypertension, and complications of diabetes mellitus. Erectile dysfunction may be related to anxiety or depression. It is not a normal aspect of aging.
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? 1. Arthritis with corticosteroid use 2. Chronic pain with narcotic use 3. Asthma with beta-adrenergic inhaler use 4. Hypotension with nitrate use
4. Hypotension with nitrate use Explanation: 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.
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? 1. There is a gradual increase in sperm and testosterone production. 2. The scrotum becomes less pendulous and becomes firm. 3. The volume and viscosity of seminal fluid increase with age. 4. Men retain the ability to fertilize ova irrespective of age.
4. Men retain the ability to fertilize ova irrespective of age. Explanation: As men age, they retain the ability to fertilize ova even though there is a gradual decrease in sperm and testosterone production. Along with decreased sperm production, the volume and viscosity of seminal fluid decrease with age. A loss of muscular tone causes the scrotum to become more pendulous.
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? 1. Annual digital rectal examination (DRE) after age 35 years 2. Transrectal ultrasound every 5 years after age 50 years 3. Annual prostate-specific antigen (PSA) testing after age 40 years 4. Monthly testicular self-examination (TSE)
4. Monthly testicular self-examination (TSE) Explanation: Screening typically includes monthly TSE starting in adolescence and annual DRE for men older than 50 years. PSA testing along with DRE 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 of African-American ethnicity. Transrectal ultrasound is performed in clients with abnormalities detected by DRE and in those with elevated PSA levels.
Which term refers to a failure of one or both of the testes to descend into the scrotum? 1. Cryptorchidism 2. Varicocele 3. Hydrovele 4. Phimosis
1. Cryptorchidism Explanation: Cryptorchidism is the failure of one or both of the testes to descend into the scrotum. Hydrocele is a collection of fluid, generally in the tunica vaginalis of the testes. Varicocele is an abnormal dilation of the veins of the pampiniform venous plexus in the scrotum. Phimosis is a condition in which the foreskin is constricted so that is cannot be retracted over the glans.
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? 1. Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. 2. Do not use the device while taking nitrates. 3. Watch for erosion of the prosthesis through the skin. 4. Watch for the development of infection.
1. Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. Explanation: Negative-pressure (vacuum) devices may also be used to induce an erection. A plastic cylinder is placed over the flaccid penis, and negative pressure is applied. When an erection is attained, a constriction band is placed around the base of the penis to maintain the erection. To avoid penile injury, the patient is instructed not to leave the constricting band in place for longer than 1 hour.
Which age-related change affects the male reproductive system? 1. Increased patency 2. Decreased plasma testosterone levels 3. Increased prostate secretion 4. Testes become soft
2. Decreased plasma testosterone levels Explanation: Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.
A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make? 1. Testicular cancer is a highly curable type of cancer. 2. Testicular cancer is the number one cause of cancer deaths in males. 3. Testicular cancer is more common in older men. 4. Testicular cancer is very difficult to diagnose.
1. 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.
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? 1. "I'll use my right hand to check the left testicle and the left hand to check the right one." 2. "The best time to do it is once a month after I take my warm morning shower." 3. "If the top and back of the testicle feels cordlike, I'll call my physician." 4. "I should roll the testis in a circular pattern around the palm of my hand."
2. "The best time to do it is once a month after I take my warm morning shower." Explanation: 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.
Which client would the nurse identify as being at highest risk for the development of testicular cancer? 1. A 39-year-old Black male who is HIV-negative 2. A 25-year-old male with a history of cryptorchidism 3. A 75-year-old White male with erectile dysfunction 4. A 45-year-old White male with a history of hypertension
2. A 25-year-old male with a history of cryptorchidism Explanation: Testicular cancer is most common in between 15 and 34 years of age and is the leading cause of cancer deaths in men between 25 to 34 years of age. Its incidence is higher in White men and men with a history of cryptorchidism. Other clients at risk are those with a family history of the disease, those who are HIV-positive or have developed AIDS, and those who already have had cancer in one testicle.
Which of the following is the most common organism implicated in prostatitis? 1. Staphylococcus aureus 2. Escherichia coli 3. Methicillin-resistant Staphylococcus aureus 4. Streptococcus
2. Escherichia coli Explanation: Escherichia coli is the most commonly isolated organism implicated in prostatitis. Microorganisms are usually carried to the prostate from the urethra. Staphylococcus aureus, Streptococcus, and methicillin-resistant Staphylococcus aureus are not the most common organism implications in prostatitis.
The diagnosis of prostate cancer is confirmed by which of the following? 1. Computed tomography 2. Histologic exam of tissue 3. Magnetic resonance imaging 4. Bone scan
2. Histologic exam of tissue Explanation: 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.
The nurse is obtaining a medication history from a client who is reporting erectile dysfunction. Which medication would the nurse identify as being least likely to contribute to the client's condition? 1. Methyldopa 2. Ibuprofen 3. Cimetidine 4. Spironolactone
2. Ibuprofen Explanation: Certain medications, such as antihypertensive agents (e.g. methyldopa and spironolactone), antidepressants, narcotics, and cimetidine cause sexual dysfunction in men. Ibuprofen is not associated with causing erectile dysfunction.
The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following? 1. Light pink with few red streaks 2. Light yellow and clear 3. Dark amber with copious mucous 4. Reddish-pink with numerous clots
2. Light yellow and clear Explanation: Typically a three-way catheter drainage system is removed when the urine appears clear and amber (light yellow). Reddish-pink urine with clots usually occurs in the immediate postoperative period. Eventually the urine becomes light pink within 24 hours after surgery. Dark amber urine suggests concentrated urine commonly associated with dehydration.
A client has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe? 1. narcotic analgesics 2. circumcision 3. scrotal support 4. increased hygienic measures
2. circumcision Explanation: Circumcision is recommended to relieve phimosis and paraphimosis permanently.
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? 1. Increase the rate of the IV fluids. 2. Prepare the patient for an ECG. 3. Discontinue the irrigations. 4. Administer a unit of packed red blood cells.
3. Discontinue the irrigations. Explanation: 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.
Which of the following should nurses teach all men, especially those who have had cryptorchidism? 1. Need to undergo a baseline and follow up lymph node biopsies. 2. Need for blood tests to measure serum acid phosphatase levels. 3. How to perform a testicular self-examination. 4. Importance of regular monitoring of prostate-specific antigen (PSA) levels.
3. How to perform a testicular self-examination. Explanation: 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 prostrate cancer.
Which of the following is an immediate danger after a prostate surgery? 1. Deep vein thrombosis 2. Catheter obstruction 3. Sexual dysfunction 4. Hemorrhagic shock
4. Hemorrhagic shock Explanation: The immediate dangers after prostate surgery are bleeding and hemorrhagic shock. The patient is monitored for major complications such as hemorrhage, infection, deep vein thrombosis, catheter obstruction, and sexual dysfunction.
Which assessment finding would create the greatest risk to a client ordered a phosphodiesterase inhibitor such as sildenafil? 1. Use of diuretics 2. History of hypertension 3. Type 2 diabetes 4. Use of nitrates
4. Use of nitrates Explanation: PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa via vasodilation of the blood vessels. If a client is using nitrates (which also exhibit vasodilation) hypotension is likely to occur. History of hypertension and diabetes does not interfere with the administration of PDE5 inhibitors. Use of diuretics is not significant.
Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? 1. Medication use 2. Sexual history 3. Undescended testicle 4. Age
1. 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.
A nurse is teaching a client about a circumcision. Which external reproductive structure is removed by circumcision? 1. Prepuce 2. Glans 3. Mons pubis 4. Corpora cavernosa
1. Prepuce Explanation: In an uncircumcised male, the prepuce, sometimes referred to as the foreskin, that covers the glans is removed by circumcision. The glans is the rounded head of the penis. The corpora cavernosa is erectile tissue. The mons pubis is fatty tissue near the pubic bones.
Which cancer ranks second as the cause of death in American men? 1. testicular 2. skin 3. penis 4. prostate
4. prostate Explanation: 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.
Which should be included as part of the home care instructions for a client with epididymitis and orchitis? 1. Take prescribed antibiotics 2. Resume sexual intercourse 3. Apply ice to the ara after scrotal swelling subsides 4. Undertake lifting exercises
1. Take prescribed antibiotics Explanation: Home care for a client with epididymitis and orchitis includes instructions to continue administering prescribed antibiotics and to take Sitz baths, apply local heat after scrotal swelling subsides, avoid lifting, and refrain from sexual intercourse until symptoms are relieved.
Following a vasectomy, which is the most important instruction to provide to the client? 1. Use another form of birth control until further notice. 2. Wear a scrotal support until swelling is resolved. 3. Take a day or two to rest and recuperate from the procedure. 4. Use a Tylenol as needed for discomfort.
1. Use another form of birth control until further notice. Explanation: 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.
The nurse is reviewing the medical record of a client who has been diagnosed with prostate cancer. The nurse notes that the Gleason score was used to grade the cancer. Which total score would the nurse interpret as indicating a highly aggressive cancer? 1.) 9 2.) 7 3.) 5 4.) 3
1.) 9 Explanation: The Gleason score is the most commonly used tumor grading system which assigns two scores with a combined value ranging from 2 to 10. With each increase in Gleason score, there is an increase in tumor aggressiveness. High Gleason scores indicate more aggressive cancer. A total score of 8 to 10 indicate a high-grade cancer. Reference:
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? 1. Apply a scrotal support 2. Apply a dressing over the scrotum 3. Prepare the client for circumcision 4. Prepare the client for surgery
4. Prepare the client for surgery Explanation: For the client with torsion, immediate surgery is necessary to prevent atrophy of the spermatic cord and preserve fertility. Analgesics would be given preoperatively. Postoperatively, a scrotal support is applied and dressings are inspected for drainage. Circumcision is done to relieve phimosis or paraphimosis.
Which of the following should nurses teach all men, especially those who have had cryptorchidism? 1. Need to undergo a baseline and follow up lymph node biopsies 2. How to perform a testicular self-examination 3. Need for blood tests to measure serum acid phosphatase levels 4. Importance of regular monitoring of prostate-specific antigen (PSA) levels
2. How to perform a testicular self-examination Explanation: 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.
Which statement is accurate regarding sildenafil? 1. Sexual stimulation is not needed to produce an erection. 2. Its side effects include headache, flushing, and dizziness. 3. The medication should be taken right before intercourse. 4. It can be taken twice daily for increased effect.
2. Its side effects include headache, flushing, and dizziness. Explanation: Side effects of sildenafil include headache, flushing, and dizziness. Is should be taken 30 minutes to 4 hours before intercourse. Taking this medication more than once a day will not have an increased effect. The client will have no erection if stimulation does not occur.
Which of the following may result if prostate cancer invades the urethra or bladder? 1. Rectal discomfort 2. Backache 3. Hematuria 4. Hip pain
3. Hematuria Explanation: Hematuria may result if the cancer invades the urethra or bladder. Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, and oliguria.
A hydrocele is suspected in a client with scrotal edema. Which assessment technique would the nurse anticipate to be done first? 1. Palpate for presence of testicle 2. Examine for soft tissue swelling 3. Assess for collection of blood in the scrotum 4. Transillumination of the scrotum
4. Transillumination of the scrotum Explanation: Transillumination, shining a light through the scrotum, will determine if the swelling in the scrotum is caused by serous fluid versus a solid mass. Palpation for testicle is not indicated with a hydrocele. Soft-tissue swelling and/or collection of blood in the scrotum is not indicated with hydrocele.
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: 1. intermittent flow of irrigation solution and prevention of hemorrhage. 2. continuous inflow and intermittent outflow of irrigation solution. 3. intermittent inflow and continuous outflow of irrigation solution. 4. continuous inflow and outflow of irrigation solution.
4. 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.
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: 1. cryptorchidism. 2. early onset of puberty. 3. testosterone therapy during childhood. 4. sexually transmitted disease.
1. cryptorchidism. Explanation: Cryptorchidism (failure of one or both testes to descend into the scrotum) appears to play a role in testicular cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early onset of puberty aren't risk factors for testicular cancer.
A nurse is working in an oncology treatment center. Which clinical manifestation when reported by a client would the nurse know may be related to metastasis from prostate cancer? 1. Large amounts of dilute urine when voiding 2. Weight gain of 3 pounds in 1 month 3. Frequent nighttime urination 4. Constant hip aching and discomfort
4. Constant hip aching and discomfort Explanation: Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, oliguria, weight loss, weakness, nausea, and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.
Bright red bleeding following prostate surgery indicates which of the following? 1. Thrombocytopenia 2. Disseminated intravascular coagulation 3. Arterial bleed 4. Venous bleed
3. Arterial bleed Explanation: Bright red bleeding with increased viscosity and numerous clots usually indicates arterial bleeding, and requires surgical intervention. Venous bleeding, which is dark red in color, may be controlled by the provider via "overinflating" the urinary catheter balloon and applying traction to the catheter so that the balloon holding the urinary catheter in place applies pressure to the prostatic fossa. It does not represent disseminated intravascular coagulation or thrombocytopenia.
Which is inconsistent with a digital rectal examination (DRE)? 1. Assists in screening for cancer of prostate gland 2. Enables examiner to assess size, shape, and consistency of prostate gland 3. Recommended for men older than 50 years of age 4. Can reveal a hydrocele
4. Can reveal a hydrocele Explanation: 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.
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? 1. Include fruits in the client's diet. 2. Ensure greater fluid intake. 3. Administer serotonin blockers. 4. Ask the client to keep a diet diary.
4. Ask the client to keep a diet diary. Explanation: 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.
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? 1. Priapism 2. Prostatitis 3. Erectile dysfunction 4. Cryptorchidism
4. Cryptorchidism Explanation: Structural abnormalities include cryptorchidism, torsion of the spermatic cord, phimosis, paraphimosis, hydrocele, spermatocele, and varicocele. Erectile dysfunction and priapism are erection disorders. Prostatitis is an infectious disorder.
A patient comes to the emergency department and tells the nurse, "I took a pill to help me perform and then passed out." The nurse is assessing the patient and finds a nitroglycerin patch on his back. What is the first intervention the nurse must perform? 1. Take the patient's blood pressure. 2. Ask the patient to obtain a urine specimen. 3. Start an IV. 4. Administer atropine 0.5 mg.
1. Take the patient's blood pressure. Explanation: Based on the patient's comments, he is most likely taking a phosphodiesterase type 5 (PDE-5) inhibitor, which is an oral medication used to treat erectile dysfunction. The most common side effects of this medication include headache, flushing, dyspepsia, diarrhea, nasal congestion, and lightheadedness. These agents are contraindicated in men who take organic nitrates (e.g., isosorbide [Isordil], nitroglycerin), because taken together, these medications can cause side effects such as severe hypotension.
A client is having prostate-specific antigen (PSA) testing done. Which result would the nurse identify as abnormal? 1) 3.8 nanograms/milliliter 2) 4.6 nanograms/milliliter 3) 2.7 nanograms/milliliter 4) 3.2 nanograms/milliliter
2) 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.
A client comes to the emergency department complaining of moderate to severe testicular pain and tenderness. Both testicles are swollen and a penile discharge is present. The client is diagnosed with viral orchitis. Which of the following would the nurse include in this client's plan of care? 1. Administering prescribed antibiotics 2. Preparing the client for incision and drainage 3. Applying ice to the scrotum 4. Keeping the scrotum in a dependent position
3. Applying ice to the scrotum Explanation: Care for the client with viral orchitis includes elevating the scrotum and applying ice to it, promoting rest, and using analgesics and anti-inflammatory agents for pain relief. Antibiotics would be used if the orchitis was bacterial. Incision and drainage are not performed.
A 35-year-old male client is seeking infertility treatment. The client's diagnostic workup includes a PSA level of 5.0 ng/mL and a WBC count of 8,000 mm3. His physician diagnoses him with prostatitis. Which type of prostatitis is the client most likely experiencing? 1. I 2. II 3. III 4. IV
4. IV Explanation: Clients with type IV prostatitis are usually diagnosed incidentally during a workup for infertility, and they have elevated PSA levels. Acute bacterial prostatitis (type I), chronic bacterial prostatitis (type II), and chronic prostatitis/chronic pelvic pain syndrome (type III) would show an elevated WBC count.
