Patho Exam ? Ch 43

a) Painful enlargement of the testes with fever 3 days after infection Pg. 1107 Clinical Manifestations and Diagnosis Onset of mumps orchitis is sudden—approximately 3 to 4 days after the onset of the infection. Symptoms include fever, painful enlargement of the testes, and small hemorrhages into the tunica albuginea. Urinary symptoms are absent. Sexual drive is not increased. Androgenic hormone function is usually maintained in these cases.

1. A client is concerned about having mumps orchitis and asks the nurse about the symptoms. What is the nurse's best response? a) Painful enlargement of the testes with fever 3 days after infection b) Painful urination with the presence of urethral discharge c) Abnormal increase in sexual drive d) Purplish or red-colored scrotum after an abdominal procedure

c) Hydrocele Pg. 1104 Hydrocele Hydroceles are palpated as cystic masses that may attain massive proportions. If there is enough fluid, the mass may be mistaken for a solid tumor. Transillumination of the scrotum (i.e., shining a light through the scrotum for the purposes of visualizing its internal structures) or ultrasonography can help to determine whether the mass is solid or cystic and whether the testicle is normal.

10. The mother of a 5-year-old boy brings him into the clinic because there is a firm feeling and swelling around one of his testes. What would the suspected diagnosis be? a) Peyronie disease b) Cryptorchidism c) Hydrocele d) Priapism

d) Hematocele Pg. 1104 Hematocele Disorders of the scrotum and testes include collection of fluid (hydrocele), blood (hematocele), or sperm (spermatocele) in the tunica vaginalis; another disorder involves varicosities of the veins in the pampiniform venous plexus (varicocele).

17. The nurse is assessing a client with a collection of blood in the tunica vaginalis of the scrotum. How does the nurse correctly document this in the medical record? a) Spermatocele b) Varicocele c) Hydrocele d) Hematocele

d) Peyronie disease Pg. 1099 Peyronie Disease Peyronie disease involves a localized and progressive fibrosis of unknown origin that affects the tunica albuginea (i.e., the tough, fibrous sheath that surrounds the corpora cavernosa) of the penis. The disorder is characterized initially by an inflammatory process that results in dense fibrous plaque formation. The plaque usually is on the dorsal midline of the shaft, causing upward bowing of the shaft during erection.

9. A 75-year-old man presents at the clinic complaining of pain during intercourse and an upward bowing of his penis during erection. The client's history mentions an inflammation of the penis that was treated 3 months ago. The physician's physical examination of the client notes beads of scar tissue along the dorsal midline of the penile shaft. What would be the suspected diagnosis of this client? a) Cavernosa disease b) Balanitis c) Paraphimosis disease d) Peyronie disease

c) Hypospadias Pg. 1098 Hypospadias and Epispadias In hypospadias, the termination of the urethra is on the ventral or underside surface of the penis. The etiology is unknown. Surgery is the treatment of choice and circumcision is avoided. Epispadias is a condition in which the urethral opening is on the dorsal or upper surface of the penis and is a less common condition. Phimosis refers to a tightening of the prepuce or penile foreskin that prevents its retraction over the glans. Balanitis is an acute or chronic inflammation of the glans penis, which generally occurs in 11% of adult males and 3% of boys.

13. The nurse is performing a newborn assessment on a 2-day-old male infant. Assessment reveals the presence of the urethral opening on the ventral side of the penis. The nurse would document this finding as being: a) Balanitis b) Epispadias c) Hypospadias d) Phimosis

d) Orchitis with residual sterility Pg. 1106 Orchitis The residual effects seen after the acute phase of the mumps infection include hyalinization of the seminiferous tubules and atrophy of the testes (seen in half of affected men). Spermatogenesis is irreversibly impaired in approximately 30% of testes damaged by mumps orchitis. If both testes are involved, permanent sterility can result. Androgenic hormone function is usually maintained.

14. Which of these complications does the nurse recognize may occur after illness with parotitis (mumps) in young men? a) Cancer of the seminiferous tubules b) Feminization c) Glomerulonephritis d) Orchitis with residual sterility

a) The obstruction is causing urine to flow backward and cause kidney dysfunction Pg. 1109 Benign Prostatic Hyperplasia Enlargement of the prostate causes obstruction to urinary outflow which may cause infection, damage to the bladder wall, cause hydroureter or hydronephrosis. This back-pressure on the urinary system may cause renal failure.

15. The nurse is caring for a client with significant benign prostatic hyperplasia (BPH) and hydronephrosis who is fearful of having corrective surgery. Which information is important for the nurse to convey? a) The obstruction is causing urine to flow backward and cause kidney dysfunction b) Medications which shrink prostate tissue will begin to work in a week or so c) Herbal preparations can be helpful and are free from side effects d) If not treated promptly, this condition may become cancerous

a) Circumcision is avoided as the foreskin will be used to repair the urinary opening Pg. 1098 Hypospadias and Epispadias Surgery is the treatment of choice for hypospadias (termination of the urethra is on the ventral surface of the penis). Circumcision is avoided because the foreskin is used for surgical repair, usually performed between the ages of 6 and 12 months.

16. The mother requests that a circumcision be performed on a newborn with hypospadias. Which information related to treatment of hypospadias should the nurse convey? a) Circumcision is avoided as the foreskin will be used to repair the urinary opening b) Genetic screening must be done prior to discharge c) Circumcision may be performed during discharge and the repair of hypospadias delayed until adolescence d) The child should not leave the hospital until undescended testes are ruled out

b) Impotence Pg. 1102 Priapism Priapism is an involuntary, prolonged (>4 hours), abnormal, and painful erection that continues beyond, or is unrelated to, sexual stimulation. The prolonged erection can result in ischemia and fibrosis of the erectile tissue with significant risk of subsequent impotence. The other results will not occur.

20. A client has developed priapism. For which outcome is this client at risk? a) Swelling of the testicles b) Impotence c) Cancer of the penis d) Premature ejaculation

c) Acute superficial balanoposthitis Pg. 1089 Balanitis and Balanoposthitis The symptoms for this client are suggestive of acute superficial balanoposthitis. It occurs in males who have phimosis or a large redundant prepuce. Balanitis xerotica occurs in uncircumcised males.

11. An adolescent male comes to the urgent care clinic. Upon assessment, the following is noted: history of circumcision, erythema of the glans, and prepuce with a malodorous discharge. Based on symptoms, the probable diagnosis would be: a) Acute phimosis b) Penile carcinoma c) Acute superficial balanoposthitis d) Balanitis xerotica obliterans

b) Hypospadias Pg. 1098 Hypospadias and Epispadias Hypospadias is a congenital disorder of the penis resulting from embryologic defects in the development of the urethral groove and penile urethra; surgery is the treatment of choice for hypospadias. Orchitis, erectile dysfunction (ED), and spermatocele rarely require surgical intervention.

12. Which diagnosis is most likely to require surgical correction? a) Orchitis b) Hypospadias c) Erectile dysfunction d) Spermatocele

a) Promotes increase in blood flow to the corpora cavernosa Pg. 1100 Disorders of erectile Dysfunction Erection involves increased inflow of blood into the corpora cavernosa of the penis; the blood then becomes trapped. These drugs act by facilitating corporal smooth muscle relaxation in response to sexual stimulation, which permits increased flow of blood into the penis.

8. The nurse in the urology unit is teaching about medication to treat erectile dysfunction. The mechanism of action of most of these medications is that the medication: a) Promotes increase in blood flow to the corpora cavernosa b) Promotes arousal by eliminating depression or other psychological factors c) Promotes trapping of blood in the corpora cavernosa d) Promotes nerve signaling to penile vessels

a) Prostate gland Pg. 1109 Benign Prostatic Hyperplasia The contraction of the smooth muscle in the prostate gland promotes semen expulsion during ejaculation.

18. The nurse is teaching a high school student about male sexual function. Which organ contains the muscle that promotes semen expulsion during ejaculation? a) Prostate gland b) Epididymis c) Testes d) Vas deferens

b) Acute bacterial prostatitis Pg. 1108 Acute Bacterial Prostatitis The manifestations of acute bacterial prostatitis include fever and chills, malaise, myalgia, arthralgia, frequent and urgent urination, dysuria, and urethral discharge. Dull, aching pain often is present in the perineum, rectum, or sacrococcygeal region. Benign prostatic hyperplasia is an enlargement of the prostate and gives signs and symptoms of weak urinary stream, postvoid dribbling, frequency of urination, and nocturia. Epididymitis is characterized by unilateral pain and swelling, accompanied by erythema and edema of the overlying scrotal skin. Orchitis is associated with enlarged testis, tenderness, scrotal skin redness, edema of the scrotum, and induration of the testes.

19. An adult male reports painful urination, rectal pain, fever/chills, general malaise and myalgia. Vital signs are: temperature, 101.7°F (38.7°C); blood pressure, 105/74 mm Hg; pulse, 98 bpm; respiration, 22 breaths/min. What condition should the health care provider suspect? a) Epididymitis b) Acute bacterial prostatitis c) Benign prostatic hyperplasia d) Orchitis

a) Normal leukocyte count Pg. 1109 Inflammatory Prostatitis Men with non-inflammatory prostatitis have symptoms resembling those of nonbacterial prostatitis but have negative urine culture results and no evidence of prostatic inflammation (i.e., normal leukocyte count). A normal leukocyte count indicates no evidence of prostatic inflammation and is a key factor to consider when making a non-inflammatory prostatitis diagnosis. PSA and bacterial culture are not used in considering either of these diagnoses.

2. The nurse is reviewing the laboratory results of a client who has non-inflammatory prostatitis. The nurse would expect the results to include: a) Normal leukocyte count b) Increased PSA level c) Pain radiating down the inner thighs d) Positive urine culture for bacteria

c) If the client does not seek medical attention, impotence may result Pg. 1103 Summary Concepts Priapism is a true urologic emergency because the prolonged erection can result in ischemia and fibrosis of the erectile tissue with significant risk of subsequent impotence. It is caused by impaired blood flow in the corpora cavernosa of the penis.

21. A client calls the clinic and informs the nurse that he has sustained an erection for 3 hours and that it is extremely painful. The client has a history of sickle cell disease and this has not happened to him in the past. Which instruction should the nurse give to the client? a) The client is having an increase in blood flow to the penis b) The client should not be concerned; this often happens in male clients c) If the client does not seek medical attention, impotence may result d) There are no long-term effects of this occurrence

b) Urine retention Pg. 1109 Benign Prostatic Hyperplasia Benign prostatic hyperplasia (BPH) is a common disorder in men older than 40; because the prostate encircles the urethra, BPH exerts its effect through obstruction of urinary outflow from the bladder. Hypospadias is a congenital condition in which the termination of the urethra is on the ventral surface of the penis. Scrotal edema is often the result of testicular disease or inflammation rather than prostate enlargement. Often the first sign of testicular cancer is a slight enlargement of the testicle that may be accompanied by some degree of discomfort.

3. Which complication is associated with prostatic hyperplasia? a) Testicular cancer b) Urine retention c) Scrotal edema d) Hypospadias

d) Intravaginal testicular torsion Pg. 1105 Testicular Torsi Although all of the noted health problems warrant monitoring and possible treatment, intravaginal testicular torsion is an emergency that requires prompt surgery to save the torsed testicle.

4. Which disorder of the male genitourinary system creates the most urgent need for prompt and aggressive surgical treatment? a) Erectile dysfunction b) Spermatocele c) Benign prostatic hyperplasia (BPH) d) Intravaginal testicular torsion

b) Digital rectal examination Pg. 1109 Benign Prostatic Hyperplasia The diagnosis of BPH is based on history, physical examination, digital rectal examination, urinalysis, blood tests for serum creatinine and prostate-specific antigen (PSA), and urine flow rate. The digital rectal examination is used to examine the external surface and size of the prostate. An enlarged prostate found during a digital rectal examination does not always correlate with the degree of urinary obstruction. Some men can have greatly enlarged prostate glands with no urinary obstruction, but others may have severe symptoms without a palpable enlargement of the prostate. Proteinuria, increased WBCs, and changes in sperm morphology are not associated with BPH.

5. Which assessment is most likely to reveal a potential exacerbation in a 70-year-old client's diagnosis of benign prostatic hyperplasia (BPH)? a) Blood test for white blood cells and differential b) Digital rectal examination c) Urine testing for microalbuminuria d) Sperm morphology testing

b) Cremasteric reflex Pg. 1105 Extravaginal Torsion When assessing the client for testicular torsion, the cremasteric reflex is frequently absent. To elicit the cremasteric reflex, the medial aspect of the thigh is stroked and testicular retraction is observed. The other reflexes do not indicate testicular torsion.

6. A client arrives in the emergency department complaining of severe pain in the left testicular area with nausea and vomiting for 2 hours. The left testicle is large and tender to palpation and radiating to the inguinal area. Which of the following reflexes can the nurse assess the absence of in order to indicate testicular torsion? a) Abdominal reflex b) Cremasteric reflex c) Superficial neurologic reflex d) Fluid wave

d) Blood level of prostate-specific antigen (PSA) and digital rectal exam Pg. 1110 Diagnosis The tests currently available to screen for prostate cancer include digital rectal examination, PSA testing, and transrectal ultrasonography. Prostate biopsy and tissue cytology are not screening measures but tests to confirm the cancer. Pelvic ultrasound and x-ray of kidneys, ureter, and bladder are used for detection of kidney stones. Alpha fetoprotein and HCG serum blood levels are used to predict an increased risk for subsequent miscarriage in women.

7. The nurse in the urology office recognizes screening men at risk for prostate cancer includes which diagnostic measures? a) Prostate biopsy and tissue cytology b) Pelvic ultrasound and x-ray of kidneys, ureter, and bladder c) Alpha fetoprotein and human chorionic gonadotropin (HCG) serum blood levels d) Blood level of prostate-specific antigen (PSA) and digital rectal exam