N C L E X Male Reproductive Problems

Which symptoms are expected in orchitis? (Select all that apply.) a. Scrotal pain b. Dysuria c. Scrotal edema d. Priapism e. Penile discharge f. Inability to ejaculate

ANS: A, B, C, E Manifestations of orchitis include scrotal pain, edema, reports of heavy feelings in the involved testicle(s), dysuria, pain on ejaculation, blood in the semen, and discharge from the penis. Ejaculation may be painful. Priapism is not a manifestation.

A patient scheduled for a transurethral resection of the prostate (TURP) for BPH tells the nurse that he has delayed having surgery because he is afraid it will affect his sexual function. When responding to his concern, the nurse explains that a. with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur. b. information about penile implants used for ED is available if he is interested. c. there are many methods of sexual expression that can be alternatives to sexual intercourse. d. sterility will not be a problem after surgery because sperm production will not be affected.

Correct Answer: A Rationale: Erectile problems are rare, but retrograde ejaculation may occur after TURP. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns.

On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need a. monitoring for postoperative urinary retention. b. teaching about the effects of general anesthesia. c. to be informed of the possibility of short-term incontinence. d. instruction about home management of an indwelling catheter.

Correct Answer: D Rationale: Because of edema, urinary retention, and delayed sloughing of tissue that occurs with a laser prostatectomy, the patient will have postprocedure catheterization for up to 7 days. The procedure is done under local anesthetic, and incontinence is not usually a problem.

The health care provider orders a blood test for prostate-specific antigen (PSA) when an enlarged prostate is palpated during a routine examination of a 56-year-old man. When the patient asks the nurse the purpose of the test, the nurse's response is based on the knowledge that a. elevated levels of PSA are indicative of metastatic cancer of the prostate. b. PSA testing is the "gold standard" for making a diagnosis of prostate cancer. c. baseline PSA levels are necessary to determine whether treatment is effective. d. PSA levels are usually elevated in patients with cancer of the prostate.

Correct Answer: D Rationale: PSA levels are usually elevated above the normal in patients with prostate cancer. PSA testing does not determine whether metastasis has occurred. A biopsy of the prostate is needed for a definitive diagnosis of prostate cancer. Success of treatment is determined by a fall in PSA to an undetectable level; the patient's baseline PSA is not needed to determine the success of treatment.

When caring for a patient who has been diagnosed with orchitis, the nurse will plan to provide teaching about a. pain management. b. emergency surgical repair. c. aspiration of fluid from the scrotal sac. d. application of warm packs to the scrotum.

ANS: A Orchitis is very painful and effective pain management will be needed. The other therapies will not be used to treat orchitis.

A 51-year-old man is scheduled for an annual physical exam at the outpatient clinic. The nurse will plan to teach the patient about the purpose of a. urinalysis collection. b. uroflowmetry studies. c. prostate specific antigen (PSA) testing. d. transrectal ultrasound scanning (TRUS).

ANS: C An annual digital rectal exam (DRE) and PSA are recommended starting at age 50 for men who have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA are abnormal.

A client with a catheter in place after a suprapubic prostatectomy has decreased urinary output. Which action by the nurse is most appropriate? a. Assess the client for bladder spasms. b. Encourage the client to drink more water. c. Administer pain medication. d. Have the client try to void around the catheter.

ANS: A Bladder spasms and decreased urinary output can indicate obstruction. The nurse should assess whether the client is experiencing these spasms and should treat the client with an antispasmodic if needed. Encouraging increased intake will not be helpful if the problem is obstruction. Pain medication will not be helpful, although an antispasmodic can be beneficial. Trying to void around the catheter is not recommended.

A 22-year-old man tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. When assessing for possible etiologic factors, which question should the nurse ask first? a. "Are you using any recreational drugs or drinking a lot of alcohol?" b. "Have you been experiencing an unusual amount of anxiety or stress?" c. "Do you have any history of an erection that lasted for 6 hours or more?" d. "Do you have any chronic cardiovascular or peripheral vascular disease?"

ANS: A A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are not common etiologic factors in younger men.

A 53-year-old man tells the nurse he has been having increasing problems with erectile dysfunction (ED) for several years but is now interested in using Viagra (sildenafil). Which action should the nurse take first? a. Ask the patient about any prescription drugs he is taking. b. Tell the patient that Viagra does not always work for ED. c. Discuss the common adverse effects of erectogenic drugs. d. Assure the patient that ED is commonly associated with aging.

ANS: A Because some medications can cause ED and patients using nitrates should not take Viagra, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of Viagra therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease in a 53-year-old.

Which statement indicates that a client understands the most appropriate time of day to take an alpha blocker drug for treatment of benign prostatic hyperplasia (BPH)? a. "I'll take my medication at bedtime." b. "As soon as I get up, I will take my medication." c. "I will take my medication with food or milk." d. "I'll take my medication on an empty stomach."

ANS: A Bedtime dosing should decrease the risk of hypotension with an alpha blocker drug. Giving the medication during the day will increase the client's risk of experiencing weakness, lightheadedness, and dizziness.

A client had a seminoma removed via an open procedure. The following day, the client's abdomen is soft and nontender, but no bowel sounds are present. Which action by the nurse is most appropriate? a. Encourage the client to ambulate several times a day. b. Reassess the client's abdomen in 4 hours. c. Document the finding and call the surgeon immediately. d. Give the client a laxative and encourage high-fiber food.

ANS: A Paralytic ileus is a complication of open seminoma removal. However, on the day after a major, lengthy operation, it is common for bowel sounds to still be absent. Narcotic analgesics can diminish bowel activity. The client can improve peristalsis with increased activity. It is not necessary to re-examine the client in 4 hours, nor is it necessary to call the surgeon right away. A laxative probably is not needed yet. The client should eat high-fiber foods when they can be tolerated.

A 32-year-old man who is being admitted for a unilateral orchiectomy for testicular cancer does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is best for the nurse to take? a. Ask the patient if he has any questions or concerns about the diagnosis and treatment. b. Document the patient's lack of communication on the chart and continue preoperative care. c. Assure the patient's wife that concerns about sexual function are common with this diagnosis. d. Teach the patient and the wife that impotence is rarely a problem after unilateral orchiectomy.

ANS: A The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer education about complications after orchiectomy. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.

A patient with symptomatic benign prostatic hyperplasia (BPH) is scheduled for photovaporization of the prostate (PVP) at an outpatient surgical center. The nurse will plan to teach the patient a. how to care for an indwelling urinary catheter. b. that the urine will appear bloody for several days. c. about complications associated with urethral stenting. d. that symptom improvement will occur in 2 to 3 weeks.

ANS: A The patient will have an indwelling catheter for 24 to 48 hours and will need teaching about catheter care. There is minimal bleeding with this procedure. Symptom improvement is almost immediate after PVP. Stent placement is not included in the procedure.

A 46-year-old man who has erectile dysfunction (ED) tells the nurse that he decided to seek treatment because his wife "is losing patience with the situation." The most appropriate nursing diagnosis for the patient is a. ineffective role performance related to effects of ED. b. anxiety related to inability to have sexual intercourse. c. situational low self-esteem related to decrease in sexual activity. d. ineffective sexuality patterns related to frequency of intercourse.

ANS: A The patient's statement indicates that the relationship with his wife is his primary concern. Although anxiety, low self-esteem, and ineffective sexuality patterns also may be concerns, the patient information suggests that addressing the role performance problem will lead to the best outcome for this patient.

A client with BPH asks why his enlarged prostate is causing difficulty with urination. Which is the nurse's most accurate response? a. "It compresses the urethra, blocking the flow of urine." b. "It presses on the kidneys, decreasing urine formation." c. "It secretes acids that weaken the bladder, causing dribbling." d. "It destroys nerves, decreasing awareness of a full bladder."

ANS: A The prostate gland encircles the urethra and bladder neck like a doughnut. Enlargement of the gland constricts the urethra and obstructs the outflow of urine by encroaching on the bladder opening. The other responses are inaccurate.

Which information will the nurse plan to include when teaching a 19-year-old to perform testicular self-examination? a. Testicular self-examination should be done in a warm area. b. The only structure normally felt in the scrotal sac is the testis. c. Testicular self-examination should be done at least every week. d. Call the health care provider if one testis is larger than the other.

ANS: A The testes will hang lower in the scrotum when the temperature is warm (e.g., during a shower), and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One testis is normally larger. The patient should perform testicular self-examination monthly.

The health care provider prescribes finasteride (Proscar) for a 56-year-old patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that a. he should change position from lying to standing slowly to avoid dizziness. b. his interest in sexual activity may decrease while he is taking the medication. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

ANS: B A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient also is taking a medication for erectile dysfunction (ED), it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension.

A client's prostate-specific antigen (PSA) level is 2.0 ng/mL. Which action by the nurse is most appropriate? a. Inform the client that the results are normal and no cancer has been detected. b. Inform the client that results are normal and schedule a digital rectal examination. c. Let the client know that the results are elevated and he is at risk for prostate cancer. d. Tell the client that cancer is indicated and that the health care provider recommends watchful waiting.

ANS: B A normal PSA in men younger than age 50 is less than 2.5 ng/mL. Although the finding is within normal limits for a PSA value, a client could have prostate cancer and not present with an elevated PSA. Also, laboratory findings should not be used as the sole screening tool. Without a digital rectal examination (DRE), the health care provider cannot know whether the client is in the early stages of prostate cancer. The client should be informed that although the level is within the normal range, he still needs a DRE.

A client who was treated 1 year ago for testicular cancer now has an elevated serum alpha-fetoprotein level. Which topic is most important for the nurse to teach this client about? a. Sperm banking options b. Effects of chemotherapy c. Hospice philosophy d. Importance of yearly monitoring

ANS: B Alpha-fetoprotein is a tumor marker that is not produced in significant amounts by normal adult tissues. An increase in the level of alpha-fetoprotein after treatment most commonly indicates recurrence or metastasis. Chemotherapy is used to treat recurrent or metastatic disease. The client should already have been taught about sperm banking. Hospice is not indicated at this time. Because a rise in these levels indicates recurrence or metastasis, yearly monitoring is not appropriate.

When performing discharge teaching for a patient who has undergone a vasectomy in the health care provider's office, the nurse instructs the patient that a. he may have temporary erectile dysfunction (ED) because of postoperative swelling. b. he should continue to use other methods of birth control for 6 weeks. c. he should not have sexual intercourse until his 6-week follow-up visit. d. he will notice a decrease in the appearance and volume of his ejaculate.

ANS: B Because it takes about 6 weeks to evacuate sperm that are distal to the vasectomy site, the patient should use contraception for 6 weeks. ED that occurs after vasectomy is psychologic in origin and not related to postoperative swelling. The patient does not need to abstain from intercourse. The appearance and volume of the ejaculate are not changed because sperm are a minor component of the ejaculate.

A patient with benign prostatic hyperplasia (BPH) with mild obstruction tells the nurse, "My symptoms have gotten a lot worse this week." Which response by the nurse is most appropriate? a. "I will talk to the doctor about ordering a prostate specific antigen (PSA) test." b. "Have you been taking any over-the-counter (OTC) medications recently?" c. "Have you talked to the doctor about surgical procedures such as transurethral resection of the prostate (TURP)?" d. "The prostate gland changes slightly in size from day to day, and this may be making your symptoms worse."

ANS: B Because the patient's increase in symptoms has occurred abruptly, the nurse should ask about OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer.

A client's laboratory findings reveal an elevated serum acid phosphatase level and a high-normal prostate-specific antigen level. How does the nurse interpret this information? a. The client shows evidence of renal disease and should be evaluated further. b. These results may indicate prostate cancer. He should be further evaluated. c. These results are not abnormal. He does not need to be evaluated further. d. These results may indicate an infection. He should be evaluated further.

ANS: B Both serum acid phosphatase and prostate-specific antigen levels will be elevated when the client has prostate cancer. The results are not indicative of renal disease or infection, but they are abnormal, may indicate prostate cancer, and should be further evaluated.

A client is receiving brachytherapy for prostate cancer. Which intervention is most important for the nurse to include in the client's care plan? a. Reassure the client that erectile dysfunction does not occur with brachytherapy. b. Help the client plan activities interspersed with rest periods during the day. c. Remind the client that while hospitalized, he cannot have any visitors. d. Discuss hospice philosophy and availability with the client and family.

ANS: B Fatigue is common throughout treatment and may continue for several months after treatment has concluded. The client will need to learn to manage the fatigue; this can include spacing activities and planning for rest periods throughout the day. Erectile dysfunction can occur as a side effect of brachytherapy. This procedure is usually done on an outpatient basis, and the client does not pose a danger to others. Brachytherapy is often a first-line treatment choice, so discussion of hospice is not appropriate at this time.

Leuprolide (Lupron) is prescribed for a patient with cancer of the prostate. In teaching the patient about this drug, the nurse informs the patient that side effects may include a. dizziness. b. hot flashes. c. urinary incontinence. d. increased infection risk.

ANS: B Hot flashes may occur with decreased testosterone production. Dizziness may occur with the -blockers used for benign prostatic hyperplasia (BPH). Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy.

Which client is most likely to have organic erectile dysfunction? a. Middle-aged man who first had sexual intercourse at age 15 b. Middle-aged man who has had diabetes mellitus for 25 years c. Young man who had a myocardial infarction 2 years ago d. Young man who has a job that causes him high stress levels

ANS: B Organic erectile dysfunction occurs as a gradual reduction in sexual functioning. Diabetes mellitus causes microvascular and macrovascular complications that decrease the sensation and autonomic nerve activity required for achievement of an erection. The other factors will not increase the client's risk for development of organic erectile dysfunction.

Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of urine. The nurse will plan to teach the patient a. to restrict oral fluid intake. b. pelvic floor muscle exercises. c. the use of belladonna and opium suppositories. d. how to perform intermittent self-catheterization.

ANS: B Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L.

A couple is seen at the infertility clinic because they have not been able to conceive. When performing a focused examination to determine any possible causes for infertility, the nurse will check the man for the presence of a. hydrocele. b. varicocele. c. epididymitis. d. paraphimosis.

ANS: B Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility

The nurse working in a health clinic receives calls from all these patients. Which patient should be seen by the health care provider first? a. A 44-year-old man who has perineal pain and a temperature of 100.4° F b. A 66-year-old man who has a painful erection that has lasted over 7 hours c. A 62-year-old man who has light pink urine after having a transurethral resection of the prostate (TURP) 3 days ago d. A 23-year-old man who states he had difficulty maintaining an erection last night

ANS: B Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications.

Following discharge teaching for a patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, a. "I will avoid driving until I get approval from my doctor." b. "I should call the doctor if I have any incontinence at home." c. "I will increase fiber and fluids in my diet to prevent constipation." d. "I should continue to schedule yearly appointments for prostate exams."

ANS: B Since incontinence is common for several weeks after a TURP, the patient does not need to call the health care provider if this occurs. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.

A client has been taking finasteride (Proscar) for 4 weeks and reports that he has not yet seen a reduction in symptoms. Which response by the nurse is most appropriate? a. "Have you been taking the medication as ordered?" b. "It may take several months to see results." c. "It may not be the right drug for you." d. "We can try dutasteride (Avodart) next."

ANS: B So that he does not become discouraged, the nurse should first reassure the client that this class of medications may take up to 6 months to be effective. The nurse then can assess for compliance, but asking that question first may put the client on the defensive. The client needs to try the medication for several more months before the health care team changes it. Avodart is in the same class of medications, and its use for up to 6 months of therapy may be required before results are seen.

A patient with benign prostatic hyperplasia (BPH) is admitted to the hospital with urinary retention and new onset elevations in the blood urea nitrogen (BUN) and creatinine. Which of these prescribed therapies should the nurse implement first? a. Schedule an abdominal computed tomography (CT) scan. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Infuse normal saline at 50 mL/hr.

ANS: B The patient data indicate that the patient may have acute renal failure caused by the BPH. The initial therapy will be to insert a catheter. The other actions also are appropriate, but they can be implemented after the acute urinary retention is resolved.

A client had a transurethral prostatectomy and has incontinence. Which statement by the client indicates a need for clarification about managing this condition? a. "I will practice stopping the urine stream to strengthen my sphincter control." b. "I will limit my fluid intake every day to prevent incontinence." c. "I will avoid vigorous activity for the first 3 weeks after surgery." d. "I will avoid caffeinated beverages and spicy foods."

ANS: B Unless fluid restriction is needed because of another medical problem, clients with incontinence should drink plenty of water and other fluids. Client statements regarding Kegel exercises, activity restrictions post-surgery, and avoiding bladder irritants are all indicative of understanding.

An older client with benign prostatic hyperplasia (BPH) and hypertension is being treated with doxazosin (Cardura) while staying in the hospital. Which activity does the nurse delegate to the unlicensed assistive personnel (UAP) as a priority? a. Helping the client choose low-sodium meal items b. Assisting the client whenever he gets out of bed c. Encouraging the client to use the spirometer hourly d. Frequently re-orienting the client to his surroundings

ANS: B When treating a client in an inpatient setting with alpha blockers such as doxazosin (Cardura) or terazosin (Hytrin), the nurse must provide for the client's safety because this medication can cause orthostatic hypotension or syncope. The nurse should instruct the UAP to help the client whenever he gets out of bed, to prevent injury. Because this medication is being used for BPH and not for hypertension, a low-sodium diet is not necessary. Using the spirometer is always a good intervention, but it use is not related to safety and to this medication. The client, although older, may not be confused and may not need frequent reorientation.

A client has returned to the nursing unit after a prostatectomy. Which activities does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Demonstrating how to use the incentive spirometer b. Measuring and recording output from the in-dwelling catheter c. Encouraging the client to get out of bed and into the chair d. Irrigating the catheter with normal saline for blood clots e. Re-taping the catheter tape if the client reports pain

ANS: B, C The UAP can assess and document intake and output and can encourage the client to get out of bed. Use of the incentive spirometer is taught by the nurse or respiratory therapist. The catheter is irrigated by the nurse. The catheter should be taped so that slight traction is left on it to help with bleeding; this may cause discomfort and would need to be explained to the client. The catheter should not be repositioned and then re-taped.

The nurse is assessing a client who has undergone a transurethral resection of the prostate (TURP). Which assessment finding requires immediate action by the nurse? a. Passing small blood clots after catheter removal b. Experiencing urinary frequency after catheter removal c. Having bright red drainage with multiple blood clots d. Having the urge to void continuously while the catheter is inserted

ANS: C A client who undergoes a TURP is at risk for bleeding during the first 24 hours after surgery. Passage of small blood clots and tissue debris, urinary frequency and leakage, and the urge to void continuously while the client still has the catheter inserted are all considered to be expected complications of the procedure. They will resolve as the client continues to recover and the catheter is removed. However, the presence of bright red blood with clots indicates arterial bleeding and should be reported to the provider.

A client had a spermatocele removed in an outpatient surgical center. Which statement by the client indicates good understanding of discharge instructions? a. "The heavy drainage will go away within a few days." b. "I need to buy dressing supplies at the drugstore." c. "I should report any redness or drainage from the incision." d. "Because of all the narcotics I'll be taking, I will need laxatives."

ANS: C A spermatocele is removed via a small scrotal incision. Heavy drainage should not occur, nor should extensive dressing supplies be needed. The small incision should not require the use of large doses of narcotics.

A client is scheduled for a penectomy for penile cancer. Which action by the nurse is most important? a. Teaching the client to sit when he urinates b. Demonstrating dressing changes and wound cleaning c. Assessing the client's psychosocial status and support d. Explaining the purpose of the in-dwelling catheter

ANS: C Clients may have strong emotional responses to penectomy, even when they seem to be accepting of the surgery, and the risk for suicide is present. It is critical to assess the client's emotional status and support systems before the operation is performed (and afterward). The other actions are appropriate too but do not take priority over ensuring the client's safety.

A client diagnosed with early prostate cancer is confused that surgery has not been planned. Which is the nurse's best response? a. "The disease is slow-growing. The risks of surgery at your age are not justified by the outcome." b. "Your disease is so advanced that surgery at this point would not increase your chances of cure." c. "Your disease is in a very early stage and is slow-growing. Your doctor will monitor you." d. "This stage indicates that you do not really have cancer, so surgery is not necessary."

ANS: C Early prostate cancer may have no clinical manifestations and may be found on a routine physical. It is slow-growing and may never become a problem for the client. Close follow-up (or watchful waiting) is the common prescription for this stage unless the client experiences symptoms. Telling the client that surgery is not justified, or that the cancer is too advanced at this point, and stating that he does not have cancer are inaccurate statements.

Which information will the nurse include when teaching a patient who has a diagnosis of chronic prostatitis? a. Ibuprofen (Motrin) should provide good pain control. b. Prescribed antibiotics should be taken for 7 to 10 days. c. Sexual intercourse and masturbation will help relieve symptoms. d. Cold packs should be used every 4 hours to reduce inflammation.

ANS: C Ejaculation helps drain the prostate and relieve pain. Warm baths are recommended to reduce pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed but usually do not offer adequate pain relief. Antibiotics for chronic prostatitis are taken for 4 to 12 weeks.

Which assessment information about a 62-year-old man is most important for the nurse to report to the health care provider when the patient is asking for a prescription for testosterone replacement therapy? a. The patient's symptoms have increased steadily over the last few years. b. The patient has been using sildenafil (Viagra) several times every week. c. The patient has had a gradual decrease in the force of his urinary stream. d. The patient states that he has noticed a decrease in energy level for a few years.

ANS: C The decrease in urinary stream may indicate benign prostatic hyperplasia (BPH) or prostate cancer, which are contraindications to the use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient.

When reviewing patient laboratory results, the nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the following four patients. Which patient's PSA result is most important to report to the health care provider? a. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH) b. A 38-year-old who is being treated for acute prostatitis c. A 48-year-old whose father died of metastatic prostate cancer d. A 52-year-old who goes on long bicycle rides every weekend

ANS: C The family history and elevation of PSA in the 48-year-old indicate that further evaluation of the patient for prostate cancer is needed. The elevations in PSA for the other patients are not unusual.

A 64-year-old has a perineal radical prostatectomy for prostatic cancer. In the immediate postoperative period, the nurse establishes the nursing diagnosis of risk for infection related to a. urinary stasis. b. urinary incontinence. c. possible fecal contamination of the surgical wound. d. placement of a suprapubic catheter into the bladder.

ANS: C The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery.

A client with prostate cancer reports pain in his lower back and legs. Which action by the nurse is most appropriate? a. Discuss medications for arthritis. b. Perform a bladder scan. c. Facilitate imaging studies. d. Encourage weight-bearing exercises.

ANS: C The primary site of metastasis for prostate cancer is the bone of the spine and the legs. The nurse should suspect metastasis and inform the health care provider. The client will need imaging studies to look for metastasis, and the nurse should facilitate them. The other interventions are not appropriate.

When teaching a patient who is scheduled for a transurethral resection of the prostate (TURP) about continuous bladder irrigation, which information will the nurse include? a. Bladder irrigation decreases the risk of postoperative bleeding. b. Hydration and urine output are maintained by bladder irrigation. c. Bladder irrigation prevents obstruction of the catheter after surgery. d. Antibiotics are infused on a continuous basis with bladder irrigation.

ANS: C The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or improve hydration. Antibiotics are given by the IV route, not through the bladder irrigation.

The nurse is caring for a young adult who just got married and has been diagnosed with testicular cancer. To which community resource does the nurse refer him? a. American Cancer Society b. Red Cross c. Sperm bank d. Public Health Department

ANS: C The young man with testicular cancer should be referred to a sperm bank, so that he will have the option to have children in the future if he so desires. The other resources listed will not provide assistance in this area. The American Cancer Society does offer several resources for clients with cancer and their families, but referral to a sperm bank would be the priority owing to the man's age and his newly married status.

A client is taking goserelin (Zoladex). What periodic assessment does the nurse plan for this client? a. Weight and abdominal girth b. Pulmonary function tests c. Bone density testing d. Abdominal ultrasound

ANS: C Zoladex is a luteinizing hormone-releasing hormone (LH-RH) agonist. Side effects include hot flashes, erectile dysfunction, decreased libido, gynecomastia, and osteoporosis. A periodic bone density screening test should be done to assess for osteoporosis. The other assessments would not be needed to assess for side effects of this drug.

Which client statement indicates understanding about a transrectal ultrasound? a. "This will determine if the outlet of my bladder is obstructed." b. "This will determine the amount of residual urine present." c. "This is performed to view the interior of the bladder and urethra." d. "This is performed to view the prostate and do a tissue biopsy."

ANS: D A transrectal ultrasound is performed to view the prostate and surrounding structures and possibly also to do a tissue biopsy. A urodynamic pressure flow study will determine if the outlet of the client's bladder is obstructed. A bladder scan will determine the amount of residual urine that is present. A cytoscopy will allow the interior of the bladder and urethra to be visualized.

When obtaining a focused health history for a patient with possible testicular cancer, the nurse will ask the patient about any history of a. sexually transmitted disease (STD) infection. b. testicular trauma. c. testicular torsion. d. undescended testicles.

ANS: D Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STD infection, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer.

A patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because he is afraid it might affect his ability to have intercourse. Which action should the nurse take? a. Offer reassurance that sperm production is not affected by TURP. b. Discuss alternative methods of sexual expression besides intercourse. c. Provide education about the use of medications for erectile dysfunction (ED) occurring after TURP. d. Teach that ED is not a common complication following a TURP.

ANS: D ED is not a concern with TURP, although retrograde ejaculation is likely and the nurse should discuss this with the patient. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns.

A client is going home after outpatient surgery for a hydrocele. Which information does the nurse emphasize in teaching this client? a. "Report to the doctor immediately any drainage from your drain." b. "Use a condom during intercourse to prevent incisional infection." c. "Sit when you urinate until all swelling is gone and drainage has stopped." d. "Wear the scrotal support device for at least 3 weeks after surgery."

ANS: D Edema from residual inflammation can remain for several weeks. This problem is increased if the scrotum is not supported and can cause the client considerable discomfort. The client needs to wear a supportive garment such as a jockstrap during this time. If the client goes home with a drain in place, serosanguineous drainage can be expected for up to 2 days.

A patient has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level. The nurse will anticipate that the patient will need teaching about a. cystourethroscopy. b. uroflowmetry studies. c. magnetic resonance imaging (MRI). d. transrectal ultrasonography (TRUS).

ANS: D In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound (TRUS) is used to visualize the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be used before prostatectomy but will not be done until after the TRUS and biopsy. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process.

The nurse is performing a psychosocial assessment of a young man diagnosed with testicular cancer. Which does the nurse include as a priority in the assessment? a. Encouraging the client to verbalize his thoughts and feelings to his health care provider b. Assisting the client in locating a support group for men with testicular cancer c. Asking the client to rate his fears of sexual deficiency on a scale of 1 to 10 d. Identifying all components of his support system, including his partner

ANS: D Part of conducting a psychosocial assessment is determining who makes up the client's support system. It would be ineffective merely to refer the client to a support group, ask him to rate his fears of sexual inadequacy, or encourage him to discuss thoughts and feelings not with the nurse, but with his provider.

The client with sickle cell anemia has had an erection for longer than 4 hours. How does the nurse intervene? a. Administer a diuretic to increase urine output. b. Attempt to relieve pressure by catheterizing the client. c. Document the finding and reassess in 4 hours. d. Notify the health care provider and prepare to give meperidine (Demerol).

ANS: D Prolonged penile erection—priapism—is common during sickle cell crisis. It is considered a urologic emergency because circulation to the penis may be compromised, and the client may not be able to void. Therefore, the provider must be notified promptly. Demerol is often given to induce hypotension. A diuretic will not help the client. Catheterization should be reserved for the man who cannot void. Waiting another 4 hours to intervene may lead to ischemia.

A client has decided to treat his enlarged prostate with saw palmetto. Which is the nurse's best response? a. "You'll need to get permission from your health care provider to make that decision." b. "Saw palmetto is a well-respected alternative therapy for benign prostatic hyperplasia." c. "Have you discussed this decision with your family?" d. "What has your health care provider told you about this choice of therapy?"

ANS: D Saw palmetto is an alternative therapy for benign prostatic hyperplasia (BPH) that has not yet been proven to be therapeutic. A client's decision to use this as the primary form of treatment should be discussed with his provider. Some herbs and natural products interfere with the actions of medications taken for other conditions. The other statements do not give the client accurate information to help him make this decision.

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH) the nurse will ask the patient about a. blood in the urine. b. lower back or hip pain. c. erectile dysfunction (ED). d. strength of the urinary stream.

ANS: D The American Urological Association (AUA) Symptom Index for a patient with BPH asks questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and back or hip pain are not typical symptoms of BPH.

After a transurethral resection of the prostate (TURP), a patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes a decrease in urine output and clots in the urine. Which action should the nurse take first? a. Increase the flow rate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter.

ANS: D The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.

A client is scheduled for a prostatectomy for benign prostatic hyperplasia (BPH). On the morning of surgery, the laboratory report on the client's urine indicates the presence of red blood cells, white blood cells, and bacteria. Which is the nurse's highest priority action? a. Document the report in the client's chart. b. Insert a new Foley catheter before surgery. c. Strain the client's urine. d. Assess the client's vital signs and notify the health care provider.

ANS: D The client may have a urinary tract infection. The nurse should obtain a set of vital signs and notify the provider of the laboratory results. Any surgery may need to be delayed if the client has infection. Documentation is needed after other actions have been taken. Inserting a catheter and straining the client's urine will not be beneficial.

Which intervention helps the client with chronic prostatitis prevent spread of infection to other areas of the urinary tract? a. "Wear a condom during intercourse." b. "Avoid alcohol and caffeinated beverages." c. "Be sure to empty your bladder completely at each voiding." d. "Sexual intercourse or masturbation can help drain the prostate."

ANS: D The prostate is not easily penetrated by antibiotics and can serve as a reservoir for microorganisms, which can infect other areas of the genitourinary tract. Draining the prostate regularly through intercourse or masturbation decreases the number of microorganisms present and reduces the risk for further infection. The other interventions listed will be ineffective with prostatitis.

Which client diagnosed with prostate cancer is not a candidate for watchful waiting? a. Client with very early cancer of the prostate b. Client who is asymptomatic c. Client who wants to avoid urinary incontinence as a result of treatment d. Client who refuses frequent digital rectal examinations (DREs)

ANS: D To participate in watchful waiting, the client must be monitored on a regular basis with a DRE and prostate-specific antigen (PSA) testing. Clients who are asymptomatic, who have early cancer, and who wish to avoid urinary incontinence from treatment would all be excellent candidates for watchful waiting.

Which client statement indicates understanding about post-orchiectomy care for testicular cancer? a. "I will avoid contact sports to prevent injury and development of cancer in my remaining testis." b. "I will always use a condom because I am at increased risk for acquiring a sexually transmitted disease." c. "I will wear an athletic supporter and cup to prevent testicular cancer in my remaining testicle." d. "I will continue to perform testicular self-examination (TSE) monthly on my remaining testicle."

ANS: D Treatment (e.g., surgery, radiation, chemotherapy) for testicular cancer does not protect the person from development of testicular cancer in the remaining testicle. A monthly TSE should be performed to monitor for changes in size, shape, or consistency of the testis. The other statements are inaccurate. Testicular cancer is not caused by trauma, cannot be prevented by an athletic cup, and does not cause increased risk for sexually transmitted diseases.

Following discharge teaching for a patient who has had a transurethral prostatectomy for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, a. "I will increase fiber and fluids in my diet to prevent constipation." b. "I should call the doctor if I have any incontinence at home." c. "I will avoid heavy lifting or driving until I get approval from my health care provider." d. "I should continue to schedule yearly appointments for prostate exams."

Correct Answer: B Rationale: Incontinence is common for several weeks after a TURP. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.

A 32-year-old man scheduled for a unilateral orchiectomy for testicular cancer is admitted to the hospital the morning of surgery. He is accompanied by his wife but does not talk to her and does not initiate interaction with the nurse. The most appropriate action by the nurse is to a. ask the patient if he has any questions or concerns about the diagnosis and treatment. b. tell the patient's wife that concerns about sexual function are common with this diagnosis. c. teach the patient that impotence is rarely a problem after unilateral orchiectomy. d. document the patient's lack of communication on the chart and continue preoperative care.

Correct Answer: A Rationale: The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, it is inappropriate for the nurse to initiate teaching. It would be inappropriate for the nurse to provide patient teaching without further assessment of the patient's teaching needs and concerns. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.

A patient with symptomatic BPH is scheduled for visual laser ablation of the prostate (VLAP) at an outpatient surgical center. The nurse will plan to teach the patient a. how to care for an indwelling urinary catheter. b. that the urine will appear bloody for several days. c. to expect an immediate improvement in urinary force. d. that an intraprostatic urethral stent will be placed.

Correct Answer: A Rationale: The patient will have indwelling catheter for up to a week and will need to be instructed on catheter care to avoid problems such as infection. There is minimal bleeding with this procedure. It will take several weeks before the full benefits of the procedure take effect. Stent placement is not included in the procedure.

Leuprolide (Lupron), an LH-RH Agonist, and bicalutamide (Casodex), an androgen receptor blocker, are prescribed for a patient with cancer of the prostate. In teaching the patient about these drugs, the nurse informs the patient that side effects may include a. low blood pressure. b. decreased sexual drive. c. urinary incontinence. d. frequent infections.

Correct Answer: B Rationale: Hormonal therapy blocks the effects of testosterone and decreases libido. Hypotension is associated with the -blockers used for BPH. Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy.

The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate? a. "The bladder irrigation is needed to stop the postoperative bleeding in the bladder." b. "The irrigation is needed to keep the catheter from being occluded by blood clots." c. "Normal production of urine is maintained with the irrigations until healing occurs." d. "Antibiotics are being administered into the bladder with the irrigation solution."

Correct Answer: B Rationale: The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or maintain urine production. Antibiotics are given by the IV route, not through the bladder irrigation.

A 41-year-old man asks the nurse what he can do to decrease the risk of BPH. The nurse explains that a. riding a bicycle raises prostate specific antigen levels and may increase BPH risk. b. prevention is not possible because prostatic enlargement occurs with normal aging. c. decreasing butter and margarine and increasing fruits in the diet may help. d. taking a daily vitamin E supplement has reduced prostate size in some men.

Correct Answer: C Rationale: A diet high in saturated fats, found in foods like butter, is associated with an increased risk for BPH. Individuals who eat more fruits and vegetables may be at lower risk. Riding a bicycle does increase prostate-specific antigen (PSA) levels, but this is not associated with development of BPH. Dietary changes and increased exercise do appear to help prevent BPH. Vitamin E supplements do not decrease prostate size.

When taking a nursing history from a patient with BPH, the nurse would expect the patient to report a. nocturia, dysuria, and bladder spasms. b. urinary frequency, hematuria, and perineal pain. c. urinary hesitancy, postvoid dribbling, and weak urinary stream. d. urinary urgency with a forceful urinary stream and cloudy urine.

Correct Answer: C Rationale: Classic symptoms of uncomplicated BPH are those associated with urinary obstruction and include diminished caliber and force of the urinary stream, hesitancy, difficulty initiating voiding, intermittent urination, dribbling at the end of urination, and a feeling of incomplete bladder emptying because of urinary retention. Irritative symptoms, including nocturia, frequency, dysuria, urgency, or hematuria, occur if infection results from urinary retention.

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. the presence of blood in the urine. b. any erectile dysfunction (ED). c. occurrence of a weak urinary stream. d. lower back and hip pain.

Correct Answer: C Rationale: The American Urological Association (AUA) Symptom Index for a patient with BPH asks questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and back or hip pain are not typical symptoms with BPH.

A 64-year-old man undergoes a perineal radical prostatectomy for stage C prostatic cancer. Postoperatively, the nurse establishes the nursing diagnosis of risk for infection related to a. urinary stasis. b. urinary incontinence. c. possible fecal contamination of the surgical wound. d. placement of a suprapubic catheter into the bladder.

Correct Answer: C Rationale: The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery.

A patient undergoing a TURP returns from surgery with a three-way urinary catheter with continuous bladder irrigation in place. The nurse observes that the urine output has decreased and the urine is clear red with multiple clots. The patient is complaining of painful bladder spasms. The most appropriate action by the nurse is to a. administer the ordered IV morphine sulfate, 4 mg. b. increase the flow rate of the continuous bladder irrigation. c. give the ordered the belladonna and opium suppository. d. manually instill 50 ml of saline and try to remove the clots.

Correct Answer: D Rationale: The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.