porth essentials of pathophysiology chapt 39
A 54-year-old diabetic patient has come to the urology clinic complaining of erectile dysfunction. His history includes obesity, coronary artery disease which required CABG three years ago, hypertension, and gout. The nurse practitioner is reviewing his record in order to prescribe medication. The practitioner is considering prescribing sildenafil (Viagra). Which of the following home medications is contraindicated if taken concurrently with sildenofil?
Imdur (isosorbide mononitrate), a vasodilator
A patient is admitted with a prolonged and painful erection that has lasted longer than four hours. The nurse knows that this is a true urologic emergency, and that the cause is which of the following?
Impaired blood flow in the corpora cavernosa of the penis
An older male patient complains of inhibited sexual functioning. The nurse knows which of the following nursing diagnoses could be a priority for his inhibited sexual function?
Impaired self-esteem
A male client has developed priapism. The nurse is aware that the client is at risk for:
Impotence
A male client reports sudden pain and a bulging in the scrotal sac after lifting a heavy object. The swelling does not reduce when the client is supine and he begins to sweat profusely. What condition is the likely cause of these manifestations?
Inguinal hernia
A patient requests a prescription for sildenafil (Viagra) to assist him with achieving and maintaining an erection. Which of the following types of medication would contraindicate the use of sildenafil?
Nitrate
Which of these complications does the nurse recognize may occur after illness with parotitis (mumps)in young men?
Orchitis with residual sterility
During a visit to the health care provider, a client complains of swelling in the scrotum. The health care worker suspects a hydrocele and performs an exam by shining a light through the scrotum. If the hydrocele is dense, the health care worker should:
Order an ultrasound or biopsy to rule out testicular cancer.
The nurse inserts a Foley catheter in an uncircumcised male patient for the treatment of urinary retention and does not place the foreskin back over the glans penis. Several hours later, the patient complains of severe pain at the catheter site and, when assessed, the nurse is unable to retract the foreskin. Which of the following problems does the nurse know has occurred?
Paraphimosis
The parents of a newborn boy have decided against circumcision. The nurse emphasizes that, as the child grows, the mother must properly cleanse the area beneath the foreskin and to return the foreskin to the original position to prevent which of these?
Paraphimosis
A nurse is providing teaching to the parents of a child who has undergone corrective surgery for cryptorchidism. The most important information for the nurse to provide is:
Parents should be taught that their child needs frequent follow-up visits.
Priapism (a prolonged painful erection not associated with sexual excitement) can occur at any age. In boys, ages 5 to 10, what are the most common causes of priapism?
Sickle cell disease or neoplasms
A young male patient comes to the clinic and informs the nurse practitioner that he and his new bride have been trying to conceive for the last 4 months. He then states that he is afraid that he may be sterile because he read recently that jockey underwear can cause sterility. What would be the nurse's best response to this?
Sperm production requires temperatures that are 2-3 degrees C below body temperature.
The nurse conducting a health promotion class for teenage boys on human reproduction determines that the participants are understanding the information when they state:
Spermatogenesis continues throughout a man's reproductive years.
An elderly male client has been diagnosed with prostate cancer. However, because he has a history of heart failure with an ejection fraction of 20% and chronic obstructive pulmonary disease due to many years of smoking, the client is not a candidate for major surgery. Which of the following treatments should the nurse anticipate being utilized for this client?
Stent placed to widen and maintain the patency of the urethra
The nurse has just completed the admission assessment of a client diagnosed with invasive penile cancer. The most likely plan of treatment will be:
Surgical removal of the affected area
The testes secrete several male sex hormones. Which of these hormones is the most abundant and considered the main testicular hormone?
Testosterone
Which of the following hormones is responsible for the development of male facial hair and change in voice to a deeper level?
Testosterone
The nursing instructor is teaching the class about the male hormone testosterone. Which of the following statements made by a student indicates a need for further instruction?
Testosterone does not have any effect on development of increased musculature during puberty
With the aging male, many changes are measurable. The measurable changes in the reproductive system of the older male are particularly attributable to which hormone?
Testosterone hormone
A male patient is being prepared for a physical examination of his prostate gland. How will the nurse explain the location of the prostate gland?
The prostate gland is located in the pelvis, inferior to the bladder.
A patient is suspected to have small varicoceles in his left scrotum. Which of the following assessment techniques may help accentuate small varicosities?
Valsalva maneuver
A client who has a strong family history of prostate cancer asks the nurse if there are any dietary modifications to decrease his risk factors. The best response would be: Select all that apply.
• Consumption of green tea • Vitamin D and E supplementation • Increasing tomato-rich products
Which of the following are the clinical manifestations of decreased levels of testosterone?
• Decreased sexual energy • Infertility • Decreased testicular size
The nurse is assessing a client in the urology clinic with suspected benign prostatic hypertrophy (BPH). For which of these symptoms consistent with BPH does the nurse question the client?
• Urinary frequency • Dribbling after urination • Awakening at night to void
The parents of a baby born with hypospadias ask the nurse if the baby can be circumcised. The best response would be:
"The circumcision will not be done now; the foreskin is needed for surgical repair."
A 41-year-old male has presented to his family physician stating that for the last 2 years his erection "is as crooked as a dog's hind leg and hurts too". He has subsequently been diagnosed with Peyronie disease. Which of the following statements by his physician is most appropriate?
"This might need surgery but it could possibly disappear over time without needing treatment."
A male client is diagnosed with an inguinal hernia. Which statement by the client indicates that the nurse's teaching about the hernia has been effective?
"The hernia is a loop of bowel protruding through a weak spot in my abdominal muscles."
While the cause of BPH is unknown, we do know that the incidence of BPH increases with age. What ethnic group is BPH highest in?
African American
Following a long history of intermittent back pain and urinary urgency, a 50-year-old client has been diagnosed with chronic bacterial prostatitis. Which of the following factors is most likely to influence his healthcare provider's choice of treatment?
Antibacterial drugs penetrate poorly into the chronically inflamed prostate.
A client asks the gynecologist what gland is responsible for urethral lubrication during male sexual stimulation. The best response would be:
Bulbourethral glands
Cryptorchidism, left untreated, is a high risk for testicular cancer and infertility. What are the treatment goals for boys with cryptorchidism?
Easier cancer detection
If a male has a history of impaired blood flow in his vascular system, he may be prone to developing:
Erectile dysfunction.
Of the following list of medications, which would likely be prescribed to a patient with benign prostatic hyperplasia (BPH) as a way to decrease the prostate size by blocking the effects of androgens on the prostate?
Finasteride (Proscar), a 5a-reductase inhibitor
When performing a rectal examination of an elderly male client, the nurse practitioner recognizes the the prostate of a client who has prostate cancer is often described in which of these ways?
Hard and irregular
A 27-year-old male developed mumps and was ill for several days. The patient suddenly developed a fever and painful enlargement of the testes approximately 4 days after recovering. Which of the following should the nurse suspect has developed?
Orchitis
Circumcision is avoided in infants who have hypospadias so that the foreskin can be used for surgical repair.
True
The male reproductive system is comprised of two systems. The nurse knows that which system is responsible for the transportation and storage of sperm?
Ductile system
The prostate gland functions in the elimination of urine. The nurse knows that the prostate gland if enlarged can cause which dysfunction of the urinary system?
Obstruction
A client who had been utilizing pharmacologic management for BPH is now experiencing severe signs of obstruction. The client would most likely require:
Transurethral prostatectomy
The pediactric nurse is teaching the mother of a newborn with hypospadias about this disorder. Which of these does the nurse convey?
The opening of the urethra is found on the underside of the penis.
Which of the following cause the urethral and bulbourethral glands to secrete mucus to aid in lubrication for sexual activity?
Parasympathetic system
The nurse is assessing a client with a history of erectile dysfunction (ED) who is requesting a prescription for treatment. When assessing for additional information related to causes of ED, for which of these does the nurse question the client?
Presence of arterial occlusive disease
The nurse is assigned to care for newborns in the nursery and performs an assessment on a newborn male, 12 hours old. The newborn has right cryptorchidism as documented in the doctors progress notes and assessed by the nurse. Where will the nurse assess for this disorder?
Scrotum
Spermatogenesis, or generation of spermatozoa or sperm, begins at approximately 13 years of age and continues as long as a man remains fertile. It is in the seminiferous tubules that spermatogenesis takes place. Of what is the inner lining of the seminiferous tubules composed?
Sertoli cells
Which of the following men is most at risk for experiencing erectile dysfunction (ED)?
A 54-year-old with history of smoking one pack of cigarettes per day for 30 years
In the male stages of the sexual act, emission precedes which of the following stages, which is mediated through spinal cord reflexes?
Ejaculation
While teaching a health class to junior and senior male high school students, the school nurse educates them that which of the following is the first sign of testicular cancer?
Enlargement of the testicle
An elderly male patient states that he is unable to gain satisfactory sexual intercourse because he is not able to maintain an erection. The nurse understands that the underlying problem of inability to maintain an erection is which of the following?
Impaired blood flow
A nurse is performing a genital examination on a male client who develops an erection. Which of the following is the nurse's most appropriate intervention?
reassure the client that this is a normal response and continue with the examination
The prostate gland secretes a fluid that increases the bulk of the semen during ejaculation. The nurse knows that the content of this fluid is comprised of which of the following? Select all that apply.
• A clotting enzyme • Profibrinolysin • Citric acid
A male client seeks treatment for erectile dysfunction. What factors contribute to this condition? Select all that apply.
• Age 65 years • Cardiovascular disease • Antihypertensive medications
Sperm follow a prescribed route through the excretory ducts of the male reproductive system. Place the following components of the genital duct system in the order that sperm follow. Use all the options.
• Efferent ductules • Ductus deferens • Prostatic urethra • Urethra • Seminiferous tubules • Epididymis
Which of the following statements are accurate when it comes to changes in the male reproductive system as one ages? Select all that apply.
• Sexual energy levels decrease as one ages with decreasing testosterone levels. • The testes become smaller and lose their firmness. • The prostate gland enlarges with age
In the male the sexual act is a complex process. The nurse knows that besides involvement with the vascular system, which of the other following systems are involved? Select all that apply.
• Spinal cord reflexes • Higher neural centers • Endocrine system
A patient comes to the clinic and informs the nurse that he was playing soccer and was kicked in the scrotal area on the right side. The nurse observes that the scrotal skin on the right side is dark red. Which of the following should the nurse suspect this patient may have?
Hematocele
The nurse in the urology clinic is reviewing the chart of a client with erectile dysfunction. Which of these factors in the client's history does the nurse recognize is a hormone-based conditions that may contribute to erectile dysfunction?
Hypogonadism
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:
Acute superficial balanoposthitis
In order to minimize the risk of developing a hernia, when should the fetal inguinal canal close completely?
After the ninth fetal month
A 40-year-old man presents at the clinic complaining of painful urination and rectal pain. His vital signs are temperature, 101.7°F; blood pressure, 105/74; pulse, 98; respiration, 22. While taking a history, the nurse notes the client has had chills, malaise, and myalgia. What would the nurse suspect as a diagnosis?
Acute bacterial prostatitis
A nurse practitioner has a 30-year-old male patient presenting with fever/chills, urinary frequency/urgency and pain with urination. A urine sample displays cloudy and foul-smelling urine. During digital rectal exam of the prostate, the nurse notes a thick white discharge. A likely diagnosis would be which of the following?
Acute bacterial prostatitis requiring antimicrobial therapy
The nurse is re-enforcing information given to the client who is asking about screening for prostrate cancer. Which of these will be nurse teach the client about the PSA test?
An elevated score on a PSA test does not necessarily indicate the presence of cancer.
An elderly male patient is complaining of dribbling after he urinates and feeling like he never empties his bladder. The nurse suspects the patient may have a problem with:
An enlarged prostate gland.
When caring for the client with acute bacterial prostatitis, the nurse plans for which of these interventions?
Antibiotics
A nurse is performing a genital examination on a 25-year-old man client. The nurse notes pigmented, wrinkled scrotal skin. Based on this information, what should the nurse do next?
Consider this a normal finding and proceed with the examination.
A patient 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 to indicate testicular torsion?
Cremasteric reflex
A nurse suspects an elderly client is experiencing benign prostatic hyperplasia (BPH). Which of the following questions should the nurse ask this client?
"Has the force of your urinary stream decreased?"
An 18-month-old boy is diagnosed with cryptorchidism. Based on this diagnosis, which of the following does the nurse expect to observe during the physical assessment?
Absence of the testis in the scrotum bilaterally
The nurse is caring for a client recently diagnosed with testicular cancer. The nurse evaluates the medical record for which of these diagnostic tests, typically altered in this type of malignancy?
Alpha fetoprotein test
The nursing student is teaching an all-male class at a local middle school about reproduction. When should she tell the students that spermatogenesis begins and ends?
At about 13 years and throughout the reproductive years
A male patient has experienced a forceful hit to the testes. The nurse expects that the sensory nerves that transmit pain impulses are associated with which nervous system?
Autonomic nervous system
Which of the following is the final site for sperm maturation?
Epididymis
A client comes to the college campus nurse complaining of unilateral pain, swelling, and redness on his scrotal area. The nurse knows these clinical manifestations are likely caused by:
Epididymitis
Benign prostatic hypertrophy (BPH) and prostatic adenocarcinomas presently differently. The nurse is aware of which of the following differences?
BPH is commonly located in the periurethral zone of the prostate, while prostate cancers are commonly located in the peripheral zones of the prostate.
A male patient who is in his 60s comes to the clinic for his yearly checkup. After examining the patient, the physician informs him that he has an overgrowth of mucosal glands of the prostate. Based solely on this finding, what diagnosis should the nurse suspect in this case?
Benign prostate hyperplasia (BPH)
The anatomy of the prostate gland is made up of three concentric areas surrounding the prostatic uretha, into which they open. The nurse understands that an overgrowth of the mucosal glands can cause which disorder in older men?
Benign prostatic hypertrophy
A patient complains of not being able to experience satisfactory sexual intercourse. The nurse knows that erectile dysfunction is now recognized as a marker for which of the following?
Cardiovascular disease
Epididymitis can be sexually transmitted, or it can be caused by a variety of other reasons, including abnormalities in the genitourinary tract. What are the most common causes of epididymitis in young men without underlying genitourinary disease?
Chlamydia trachomatis and Neisseria gonorrhoeae
When caring for a group of clients, the nurse recognizes which of these individuals has increased risk for balanitis?
Client with a sexually transmitted disease
A client asks the nurse what can cause or contributes to the development of benign prostatic hypertrophy (BPH). The best response would be:
Dihydrotestosterone (DHT) proliferates the growth of prostatic stromal cells, leading to a reduction in the death of the epithelial cells.
The gerontology nurse recognizes that aging male clients may enter a stage referred to as andropause. Which of these does the nurse recognize as characteristic of this stage?
Decline in sexual function
A 60-year-old man comes to the clinic and has been found to have a history of type 2 diabetes mellitus and cardiovascular disease. The manifestations of these diseases will warrant the nurse to assess the patient for which of the following problems?
Erectile dysfunction
In the complex interaction of the sexual act in males, the nurse is aware that there are four stages involved. Which of the following stages involves shunting of blood into the corpus cavernosum?
Erection
The male reproductive system is controlled by the hypothalamus and the anterior pituitary gonadotropic hormones regulated by a negative feedback loop. What gonadotropic hormones regulate control of the male reproductive system?
Follicle-stimulating hormone and luteinizing hormone
The nursing students are studying about testosterone and androgens and the role they play in the male. The student correctly identifies which of the following to be a situation where hormone replacement is recommended?
For aging men with low androgen levels
The nurse in the urology unit teaches is teaching about medication to treat erectile dysfunction. The nurse teaches the client that the mechanism of action of most of these medications is which of these?
Promotes increase in blood flow to the corporus cavernosa
The nurse is teaching a high school student about male sexual function. Which of these organs contains the muscle that promotes semen expulsion during ejaculation?
Prostate gland
A nurse is evaluating diagnostic tests for a client suspected of having prostate cancer. Which of the following results requires further evaluation?
Prostate-specific antigen (PSA) of 12 ng/mL
A 52-year-old male diagnosed with erectile dysfunction (ED) asks the nurse what will be implemented as a first option for treatment. The best response would be:
Psychosexual counseling and PDE-5 inhibitor medications
The nurse is caring for a client with significant benign prostatic hyperplasia (BPH)and hydronephrosis who is fearful of having corrective surgery. Which of these is important for the nurse to convey?
The obstruction is causing urine to flow backward and cause kidney dysfunction.