Lewis Chapter 54 male reproductive disorders cancer

The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer? A. A 30-year-old white male with a history of cryptorchidism B. A 48-year-old African American male with erectile dysfunction C. A 19-year-old Asian male who had surgery for testicular torsion D. A 28-year-old Hispanic male with infertility caused by a varicocele

A. A 30-year-old white male with a history of cryptorchidism The incidence of testicular cancer is four times higher in white males than in African American males. Testicular tumors are also more common in males who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to DES, and testicular cancer in the contralateral testis.

A 33-year-old patient noticed a painless lump in his scrotum on self-examination of his testicles and a feeling of heaviness. The nurse should first teach him about what diagnostic test? A. Ultrasound B. Cremasteric reflex C. Doppler ultrasound D. Transillumination with a flashlight

A. Ultrasound When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.

A patient scheduled for a prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. In responding to the patient, you should keep in mind that A. erectile dysfunction can occur even with a nerve-sparing procedure. B. retrograde ejaculation affects sexual functioning more frequently than erectile dysfunction. C. the most common complication of this surgery is postoperative bowel incontinence. D. preoperative sexual functioning is the most important factor in determining postoperative erectile dysfunction.

Answer: A A major complication after a prostatectomy (even with nerve-sparing procedures) is erectile dysfunction

Which ethnic group has the highest incidence of prostate cancer? A. African Americans B. Asians C. Whites D. Hispanics

Answer: A The incidence of prostate cancer worldwide is higher among African Americans than in any other ethnic group. The reasons for the higher rate are unknown.

A patient asks you, "How can I decrease my risk of prostate cancer?" You teach the patient to avoid which foods (select all that apply)? A. Red meat B. High-fat dairy products C. Fruits D. Vegetables E. Chicken

Answer: A, B Dietary factors may be associated with prostate cancer. A diet high in red meat and high-fat dairy products, along with a low intake of vegetables and fruits, may increase the risk of prostate cancer.

Which factors place a patient at high risk for prostate cancer (select all that apply)? A. Age older than 65 years B. Asian or Native American ethnicity C. Personal history of BPH D. Brother diagnosed and treated for prostate cancer E. History of undescended testicle and testicular cancer

Answer: A,D Age, ethnicity, and family history are known risk factors for prostate cancer. The incidence of prostate cancer rises markedly after age 50, and more than 66% of men diagnosed are older than 65 years. The incidence of prostate cancer worldwide is higher among African Americans than in any other ethnic group. A family history of prostate cancer, especially first-degree relatives (fathers, brothers), is associated with an increased risk.

Which diagnostic evaluation is used for a patient with a suspected testicular cancer? A. Prostate-specific antigen (PSA) B. α-Fetoprotein (AFP) C. Complete blood cell count D. Urine and semen analyses

Answer: B Palpation of the scrotal contents is the first step in diagnosing testicular cancer. A cancerous mass is firm and does not transilluminate. Ultrasound of the testes is indicated when testicular cancer (e.g., palpable mass) is suspected or when persistent or painful testicular swelling is present. If testicular cancer is suspected, blood is obtained to determine the serum levels of AFP, lactate dehydrogenase (LDH), and human chorionic gonadotropin (hCG).

For the patient with inoperable prostate cancer, you expect the physician to order which type of hormone? A. Gonadotropin-releasing hormone B. Androgen deprivation C. Luteinizing hormone D. Estrogen

Answer: B Prostate cancer growth largely depends on androgens, and androgen deprivation is a primary therapeutic approach for some men with prostatic cancer. Hormone therapy, also known as androgen-deprivation therapy (ADT), focuses on reducing the levels of circulating androgens to diminish tumor growth.

Which fact in the patient's history could be related to the presence of testicular cancer? A. Epispadias B. Cryptorchidism C. Hernia repair D. Uncircumcised penis

Answer: B The incidence of testicular cancer is four times higher among white men (especially those of Scandinavian descent) than African American males. It occurs more commonly in the right testicle than the left. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or have a family history of testicular cancer or anomalies. Epispadias and lack of circumcision are not related to testicular cancer. Hernia repair is related to future hernias, but not testicular cancer.

Which best indicates that treatment for cancer of the prostate is effective? A. Increase in urinary stream B. Decrease of PSA to 2 ng/mL C. Decreased blood in the urine D. White blood cell (WBC) count of 10,000/μL

Answer: B The PSA value is used to detect prostate cancer and to monitor the success of treatment. When treatment has been successful in removing prostate cancer, PSA levels should decrease and reach normal levels (less than 4 ng/mL). The regular measurement of PSA levels after treatment is important to evaluate the effectiveness of treatment and possible recurrence of prostate cancer.

In assessing a patient for testicular cancer, you understand that the manifestations of this disease often include A. acute back spasms and testicular pain. B. rapid onset of scrotal swelling and fever. C. fertility problems and bilateral scrotal tenderness. D. painless mass and heaviness sensation in the scrotal area.

Answer: D Clinical manifestations of testicular cancer include a painless lump in the scrotum, scrotal swelling, and a feeling of heaviness. The scrotal mass usually is not tender and is very firm. Some patients complain of a dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum.

A 45-year-old man asks you if it is advisable to have his prostate-specific antigen (PSA) level tested, because his father and brother have prostate cancer. What is your response? A. "You should wait until you are age 50." B. "You should have a transurethral resection of the prostate as a preventive measure." C. "You should have a voiding cystourethrogram yearly." D. "You should have annual PSA levels assessed and a digital examination of the prostate."

Answer: D The American Cancer Society recommends an annual digital rectal examination (DRE) and a blood test for PSA beginning at age 50 for men who are at average risk for prostate cancer. During DRE, an abnormal prostate may feel hard, nodular, and asymmetric.

A 73-year-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give the patient anticipatory guidance that what condition may be developing? A. A tumor of the prostate B. Benign prostatic hyperplasia C. Bladder atony because of age D. Age-related altered innervation of the bladder

B. Benign prostatic hyperplasia Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men over age 50 and 80% of men over age 80. Only about 16% of men develop prostate cancer. Bladder atony and age-related altered innervations of the bladder do not lead to a weakened stream.

The nurse teaches a 30-year-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? A. Grilled steak, French fries, and vanilla shake B. Hamburger with cheese, pudding, and coffee C. Baked chicken, peas, apple slices, and skim milk D. Grilled cheese sandwich, onion rings, and hot tea

C. Baked chicken, peas, apple slices, and skim milk A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

To accurately monitor progression of a symptom of decreased urinary stream, the nurse should encourage the patient to have which primary screening measure done on a regular basis? A. Uroflowmetry B. Transrectal ultrasound C. Digital rectal examination (DRE) D. Prostate-specific antigen (PSA) monitoring

C. Digital rectal examination (DRE) Digital rectal examination is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia in men over 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.

The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations now indicate that the prostate cancer may be growing and he needs a change in his care (select all that apply)? A. Casts in his urine B. Presence of α-fetoprotein C. Serum PSA level 10 ng/mL D. Onset of erectile dysfunction E. Nodularity of the prostate gland

C. Serum PSA level 10 ng/mL E. Nodularity of the prostate gland The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth.