PrepU Ch 59: Male Reproductive Disorders
A patient comes to the clinic with complaints of inability to sustain an erection and is prescribed a PDE-5 inhibitor, sildenafil (Viagra). What medication should the nurse caution the patient about taking with this medication? a. Lisinopril (Prinivil) b. Levothyroxine (Synthroid) c. Isosorbide (Isordil) d. Diphenhydramine (Benadryl)
c. Isosorbide (Isordil) Rationale: These agents are contraindicated in men who take organic nitrates (e.g., isosorbide [Isordil], nitroglycerin), because taken together, these medications can cause side effects such as severe hypotension (Lee, 2011; Porth & Matfin, 2009; Wein et al., 2012).
Which is inconsistent with a digital rectal examination (DRE)? a. Can reveal a hydrocele b. Recommended for men older than 50 years of age c. Assists in screening for cancer of prostate gland d. Enables examiner to assess size, shape, and consistency of prostate gland
a. Can reveal a hydrocele Rationale: DRE is recommended as part of the regular health checkup for every man older than 50 years of age. It is a screening for cancer of the prostate gland. It enables the examiner to assess the size, shape, and consistency of the prostate gland.
A patient is planning to use a negative-pressure (vacuum) device to maintain and sustain an erection. What should the nurse caution the patient about with the use of this device? a. Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. b. Watch for erosion of the prosthesis through the skin. c. Do not use the device while taking nitrates. d. Watch for the development of infection.
a. Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. Rationale: Negative-pressure (vacuum) devices may also be used to induce an erection. A plastic cylinder is placed over the flaccid penis, and negative pressure is applied. When an erection is attained, a constriction band is placed around the base of the penis to maintain the erection. To avoid penile injury, the patient is instructed not to leave the constricting band in place for longer than 1 hour.
Which of the following patient populations have the highest risk for developing testicular cancer? a. European American b. African American c. Asian American d. Hispanic American
a. European American Rationale: European American men have a five times greater risk than that of African American men and more than double the risk of Asian American men.
Which of the following should nurses teach all men, especially those who have had cryptorchidism? a. How to perform a testicular self-examination b. Need for blood tests to measure serum acid phosphatase levels c. Importance of regular monitoring of prostate-specific antigen (PSA) levels d. Need to undergo a baseline and follow up lymph node biopsies
a. How to perform a testicular self-examination Rationale: The nurses should teach all men, especially those who have had cryptorchidism, to perform testicular self-examination to detect any abnormal mass in the scrotum. The nurse instructs the clients to examine the testicles monthly, preferably when warm, such as in the shower. Having regular PSA levels, lymph node biopsies, and blood tests for measuring serum acid phosphatase are for the clients who are treated for prostate cancer.
A nurse is reviewing a journal article about benign prostatic hyperplasia and possible risk factors associated with this condition. Which factor would the nurse most likely find as playing a role in increasing a man's risk for this condition? Select all that apply. a. Hypertension b. Diabetes c. Atrial fibrillation d. Social alcohol use e. Smoking
a. Hypertension b. Diabetes e. Smoking Rationale: Recent studies have identified smoking (both current and former smoking), heavy alcohol consumption, hypertension, heart disease, and diabetes as risk factors associated with BPH. Atrial fibrillation has not been associated with BPH.
A client with erectile dysfunction who had a penile implant inserted has been taught how to identify malfunction of the device. Which of the following if stated by the client as indicative of malfunction would indicate to the nurse that the client has understood the teaching? a. Migration of the cylinders, pump, or reservoir from their intended location b. Erosion of penile or urethral tissue c. Underinflation or bulging of the cylinders during inflation d. Erosion of scrotal, bowel, or bladder tissue
a. Migration of the cylinders, pump, or reservoir from their intended location Rationale: Malfunction of the device is characterized by the underinflation, bulging of the cylinders during inflation, and a loss of fluid from the implant. Erosion of penile or urethral tissue occurs due to a mis-sized implant, pressure, or friction of the implanted cylinders. Erosion of scrotal, bowel, or bladder tissue occurs if an implant with a fluid reservoir is used. Migration of the cylinders, pump, or reservoir from their intended location is accompanied by pain, tenderness, and dysfunction of components that are part of the device.
A nurse is instructing a client in testicular self-examination. Which client statement indicates the need for additional teaching? a. "A good place to do this is when I'm showering." b. "I should do this exam at least once a week." c. "My thumb goes on top and my index and middle fingers go under the testis." d. "It's normal for one testis to be larger than the other."
b. "I should do this exam at least once a week." Rationale: Testicular self-examination is performed monthly, preferably when warm, such as in the shower. The client should place his thumb on top and his middle and index fingers under the testis. It is normal for one testis to be larger than the other.
The nurse is preparing a presentation for an older adult group of males at a senior center. Which of the following would the nurse expect to include when describing the effects of aging on the male reproductive system? a. The scrotum becomes less pendulous and becomes firm. b. Men retain the ability to fertilize ova irrespective of age. c. There is a gradual increase in sperm and testosterone production. d. The volume and viscosity of seminal fluid increase with age.
b. Men retain the ability to fertilize ova irrespective of age. Rationale: As men age, they retain the ability to fertilize ova even though there is a gradual decrease in sperm and testosterone production. Along with decreased sperm production, the volume and viscosity of seminal fluid decrease with age. A loss of muscular tone causes the scrotum to become more pendulous.
Following morning hygiene of an elderly client, the nurse is unable to replace the retracted foreskin of the penis. Which is the most likely outcome? a. Erection of the penis b. Painful swelling c. Unclean glans d. Nausea and vomiting
b. Painful swelling Rationale: Paraphimosis results in strangulation of the glans penis from inability to replace the retracted foreskin. The strangulation results in painful swelling of the glans. Erection of the penis in the presence of phimosis can cause pain but is not a result of retracted foreskin. Nausea and vomiting are not indicated with retraction of foreskin.
The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? a. Palpate for a soft, round shape with normal ridges on the testicles. b. Palpate each testicle separately, following a warm shower. c. Palpate the front of the testicle first, where most tumors are found. d. Palpate both testicles simultaneously for comparison.
b. Palpate each testicle separately, following a warm shower. Rationale: It is best to examine and palpate each testicle following a warm shower, when the testes are relaxed and not retracted. Because one testicle is normally larger and hangs lower, comparing the two sides is not indicated. Both testes should be oval in shape, smooth, and firm without masses or tenderness. Most tumors are located on the lateral aspect of the testicles.
Which instruction regarding future sexual activity should a nurse give a client with a vasectomy? a. Administer a mild analgesic before any sexual activity. b. Use a reliable method of contraception until the physician ensures that sperm are no longer present. c. Sexual activity can resume after 3 weeks. d. Expect some bruising and incisional soreness after every sexual activity for the first 2 days.
b. Use a reliable method of contraception until the physician ensures that sperm are no longer present. Rationale: For a client with a vasectomy, the nurse advises the client to use a reliable method of contraception until the physician ensures that sperm are no longer present, which may be determined after 10 or more ejaculations. The client should resume sexual activity when comfort allows, usually in 1 week. Administer a mild analgesic, such as aspirin or acetaminophen, for discomfort, not before the sexual activity. The client should expect some bruising and incisional soreness after the local anesthetic wears off.
Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BPH)? a. Serum testosterone level b. Voiding pattern c. Size of the prostate d. Creatinine clearance
b. Voiding pattern Rationale: The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.
After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first? a. Fluid restriction b. Artificial sphincter use c. Kegel exercises d. Self-catheterization
c. Kegel exercises Rationale: Kegel exercises are noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for the client with increased detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for post-prostatectomy incontinence. Self-catheterization may be used as a temporary measure but isn't a primary intervention.
A client has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe? a. scrotal support b. narcotic analgesics c. circumcision d. increased hygienic measures
c. circumcision Rationale: Circumcision is recommended to relieve phimosis and paraphimosis permanently.
A client is prescribed dutasteride (Avodart) as part of treatment for benign prostatic hyperplasia (BPH). When teaching the client about this drug, the nurse integrates knowledge of the drug's action. Which statement best reflects this? a. "The drug causes nitrous oxide to be released, leading to increased blood flow and urination." b. "The drug restores the balance of the normal microorganisms found in the bladder to improve urine flow." c. "The drug causes the smooth muscles of the bladder to relax so urine will flow more easily." d. "The drug interferes with testosterone, which causes the prostate to shrink in size."
d. "The drug interferes with testosterone, which causes the prostate to shrink in size." Rationale: Dutasteride is a 5-alpha-reductase inhibitor that prevents the conversion of testosterone to DHT, thereby causing a decrease in prostate size. Alpha-adrenergic blockers such as alfuzosin, terazosin, doxazosin, and tamsulosin relax the smooth muscle of the bladder neck and prostate. Nitrous oxide is released in the vasculature of the penis during sexual stimulation, leading to smooth muscle relaxation in blood vessels and resulting in increased blood flow and an erection. Phosphodiesterase-5 inhibitors increase blood flow to the penis and are used to treat erectile dysfunction. Dutasteride does not restore the normal flora of the bladder. The contents of the bladder are sterile.
A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met? a. "I'll have to stay in the hospital for about 3 to 4 days after the surgery." b. "I'll have a small incision on my lower abdomen after the procedure." c. "The surgeon is going to remove the entire prostate gland." d. "The surgeon is going to insert a scope through my urethra to remove a portion of the gland."
d. "The surgeon is going to insert a scope through my urethra to remove a portion of the gland." Rationale: TURP involves the surgical removal of the inner portion of the gland through an endoscope inserted through the urethra. There is no external skin incision. Typically, the procedure is performed in an outpatient setting but may require an overnight hospital stay.
The nurse is reviewing the medical record of a client who has been diagnosed with prostate cancer. The nurse notes that the Gleason score was used to grade the cancer. Which total score would the nurse interpret as indicating a highly aggressive cancer? a. 3 b. 7 c. 5 d. 9
d. 9 Rationale: The Gleason score is the most commonly used tumor grading system which assigns two scores with a combined value ranging from 2 to 10. With each increase in Gleason score, there is an increase in tumor aggressiveness. High Gleason scores indicate more aggressive cancer. A total score of 8 to 10 indicate a high-grade cancer.
Medical management of BPH includes pharmacologic therapy. Which of the following medications would the nurse expect the health care provider to prescribe for this diagnosis? a. Analgesic b. Diuretic c. Antispasmodic d. Alpha-adrenergic blocker
d. Alpha-adrenergic blocker Rationale: Alpha-adrenergic blockers relax the smooth muscle of the bladder neck and prostate, improving urine flow and relieving BPH symptoms. Reference:
Bright red bleeding following prostate surgery indicates which of the following? a. Disseminated intravascular coagulation b. Venous bleed c. Thrombocytopenia d. Arterial bleed
d. Arterial bleed Rationale: Bright red bleeding with increased viscosity and numerous clots usually indicates arterial bleeding, and requires surgical intervention. Venous bleeding, which is dark red in color, may be controlled by the provider via "overinflating" the urinary catheter balloon and applying traction to the catheter so that the balloon holding the urinary catheter in place applies pressure to the prostatic fossa. It does not represent disseminated intravascular coagulation or thrombocytopenia.
The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following? a. Light pink with few red streaks b. Reddish-pink with numerous clots c. Dark amber with copious mucous d. Light yellow and clear
d. Light yellow and clear Rationale: Typically a three-way catheter drainage system is removed when the urine appears clear and amber (light yellow). Reddish-pink urine with clots usually occurs in the immediate postoperative period. Eventually the urine becomes light pink within 24 hours after surgery. Dark amber urine suggests concentrated urine commonly associated with dehydration.
Which of the following would a nurse include in a teaching plan for a client with benign prostatic hyperplasia who is not yet a candidate for surgery? a. Performing deep breathing exercises periodically b. Using appropriate coping to allay anxiety c. Doing leg exercises at least daily d. Maintaining optimal bladder emptying
d. Maintaining optimal bladder emptying Rationale: For the client with benign prostatic hyperplasia who is not yet a candidate for surgery, the nurse would teach a client how to maintain optimal bladder emptying. The surgical client requires support and information to allay anxiety. The nurse teaches deep breathing and leg exercises for the client who is to have surgery.
Which of the following herbal remedies is used to treat symptoms of benign prostatic hypertrophy (BPH)? a. Garlic b. Ginkgo c. Green tea d. Saw palmetto
d. Saw palmetto Rationale: Saw palmetto is an herbal product used to treat symptoms associated with BPH.
A patient informs the nurse that his father died of prostate cancer, so he wants to know ways in which to reduce his risk factors for developing it. What education can the nurse give to the patient to decrease modifiable risk factors? a. Limit red meat and dairy products high in fat. b. Quit smoking. c. Avoid wearing tight pants and underwear. d. Monitor blood pressure.
a. Limit red meat and dairy products high in fat. Rationale: The risk of prostate cancer is greater in men whose diet contains excessive amounts of red meat or dairy products that are high in fat.
Students preparing for a test are reviewing the structure and function of the male reproductive system. They demonstrate understanding of the material when they identify which of the following as the site of spermatogenesis? a. Testes b. Vas deferens c. Prostate gland d. Seminal vesicles
a. Testes Rationale: The testes are responsible for producing sperm (spermatogenesis). The vas deferens are the tubes that carry the sperm from the testicles and epididymis to the seminal vesicles, which acts as the reservoir for testicular secretions. The prostate gland produces a secretion that is chemically and physiologically suitable to the needs of the sperm in their passage from the testes.
Which is the most common type of prostate surgery? a. Transurethral resection of the prostate b. Retropubic prostatectomy c. Perineal prostatectomy d. Suprapubic prostatectomy
a. Transurethral resection of the prostate Rationale: Transurethral resection of the prostate, or TURP, is the most common procedure used and can be carried out through endoscopy. Suprapubic, perineal, and retropubic prostatectomies are surgical procedures for the prostate, but they are not the most common.
A clinical manifestation related to metastasis from prostate cancer is a. hip pain. b. weight gain. c. thrombocytopenia. d. polyuria.
a. hip pain. Rationale: Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, oliguria (decreased urine output), and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.
Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically address testicular cancer risk, a nurse should modify client teaching for male clients to include: a. physician visits. b. family history. c. testicular self-examination. d. risk factors.
c. testicular self-examination. Rationale: Testicular self-examination is a relatively simple technique that's extremely useful in detecting cancer-related testicular changes. Physician visits, risk factors, and family history are important to all clients, regardless of gender, and don't specifically address risk factors associated with testicular cancer.
After teaching a group of student about structural abnormalities of the male reproductive system, the instructor determines that the teaching was successful when the students identify which of the following as an example? a. Prostatitis b. Erectile dysfunction c. Priapism d. Cryptorchidism
d. Cryptorchidism Rationale: Structural abnormalities include cryptorchidism, torsion of the spermatic cord, phimosis, paraphimosis, hydrocele, spermatocele, and varicocele. Erectile dysfunction and priapism are erection disorders. Prostatitis is an infectious disorder.
The nurse is preparing a discharge teaching plan for a client who has had a prostatectomy. Which of the following would be appropriate to include? a. Engaging in strenuous exercise to strengthen abdominal muscles b. Waiting to urinate for 5 to 10 minutes after feeling the initial urge c. Using a bearing down motion to promote complete bladder emptying when voiding d. Performing perineal exercises frequently throughout the day
d. Performing perineal exercises frequently throughout the day Rationale: After a prostatectomy, the client should be instructed in how to perform perineal exercises and to perform them hourly throughout the day, each day. In addition, the client should avoid bearing down (straining) to urinate because of the increased risk for hematuria. He should also avoid strenuous exercise, which increases the tendency to rebleed. The client should be instructed to urinate as soon as he feels the first urge to do so.
Which condition is associated with buildup of fibrous plaques in the sheath of the corpus cavernosum, causing curvature of the penis when it is erect? a. Priapism b. Phimosis c. Bowen's disease d. Peyronie's disease
d. Peyronie's disease Rationale: Peyronie's disease may require surgical removal of the plaques when the disease makes sexual intercourse painful, difficult, or impossible. Bowen's disease refers to a form of squamous cell carcinoma in situ of the penile shaft. Phimosis refers to the condition in which the foreskin is constricted so that it cannot be retracted over the glans. Priapism refers to an uncontrolled, persistent erection of the penis occurring from either neural or vascular causes.
A client with Stage IV prostate cancer is to receive hormone therapy. The nurse would inform the client about possible adverse effects including which of the following? a. Deepening of voice b. Enhanced potency c. Increased libido d. Breast tenderness
d. Breast tenderness Rationale: Feminizing side effects occur with hormone therapy. The client's voice may become higher, hair and fat distribution may change, and breasts may become tender and enlarged. Libido and potency also are diminished.
Which is an age-related change affecting the male reproductive system? a. Patency increases. b. Testes become soft. c. Prostate secretion increases. d. Plasma testosterone levels decrease.
d. Plasma testosterone levels decrease. Rationale: Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.
A 48-year-old man recently diagnosed with benign prostatic hyperplasia (BPH) reports consuming <i>Serenoa repens</i> (saw palmetto berry). The nurse needs to intervene if the physician orders which treatment? a. Terazosin b. Finasteride c. Ketoconazole d. Sipuleucel-T
b. Finasteride Rationale: Serenoa repens (saw palmetto berry) should not be used with finasteride. Terazosin is an alpha-adrenergic blocker and can be taken with Serenoa repens. Sipuleucel-T is a therapeutic cancer vaccine. Ketoconazole is an adrenal-ablating drug used to inhibit cytochrome P450 enzymes.
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate? a. Restrict fluids to prevent the client's bladder from becoming distended. b. Tell the client to try to urinate around the catheter to remove blood clots. c. Prepare to remove the catheter. d. Use sterile technique when irrigating the catheter.
d. Use sterile technique when irrigating the catheter. Rationale: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.
Which statement is accurate regarding sildenafil? a. Sexual stimulation is not needed to produce an erection. b. Its side effects include headache, flushing, and dizziness. c. It can be taken twice daily for increased effect. d. The medication should be taken right before intercourse.
b. Its side effects include headache, flushing, and dizziness. Rationale: Side effects of sildenafil include headache, flushing, and dizziness. Is should be taken 30 minutes to 4 hours before intercourse. Taking this medication more than once a day will not have an increased effect. The client will have no erection if stimulation does not occur.
A patient experiences hypotension, lethargy, and muscle spasms while receiving bladder irrigations after a transurethral resection of the prostate (TURP). What is the first action the nurse should take? a. Increase the rate of the IV fluids. b. Prepare the patient for an ECG. c. Administer a unit of packed red blood cells. d. Discontinue the irrigations.
d. Discontinue the irrigations. Rationale: Transurethral resection syndrome is a rare but potentially serious complication of TURP. Symptoms include lethargy, hypotension, and muscle spasms. The first action the nurse should take is to discontinue irrigation. The other interventions listed are not appropriate.
A client is receiving leuprolide as part of his treatment for prostate cancer. The nurse would be alert for which of the following as a possible adverse effect? a. Nipple retraction b. Muscle overgrowth c. Reports of increased libido d. Gynecomastia
d. Gynecomastia Rationale: Adverse effects associated with leuprolide, a luteinizing hormone-releasing hormone agonist, are related to hypogonadism and include vasomotor flushing, loss of libido, decreased bone density, anemia, fatigue, increased fat mass, decreased muscle mass, gynecomastia, and mastodynia (breast/nipple tenderness).
A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include: a. continuous inflow and outflow of irrigation solution. b. continuous inflow and intermittent outflow of irrigation solution. c. intermittent flow of irrigation solution and prevention of hemorrhage. d. intermittent inflow and continuous outflow of irrigation solution.
a. continuous inflow and outflow of irrigation solution. Rationale: When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.
A 59-year-old African American man has opted for hormonal androgen deprivation therapy (ADT) to treat his prostate cancer. Which surgical procedures is the client most likely to undergo? a. Circumcision b. Hydrocelectomy c. Orchiectomy d. Vasectomy
c. Orchiectomy Rationale: ADT is commonly used to suppress androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of dihydrotestosterone (DHT). As a result, the prostatic epithelium atrophies (decreases in size). This effect is accomplished by an orchiectomy (removal of the testes). Circumcision is excision of the foreskin, or prepuce, of the glans penis. Vasectomy is the ligation and transection of part of the vas deferens to prevent the passage of the sperm from the testes. Hydrocelectomy describes the surgical repair of a hydrocele, a collection of fluid in the tunica vaginalis.
A client comes to the emergency department complaining of sudden, sharp testicular pain. Further examination reveals torsion of the spermatic cord. Which of the following would the nurse expect to do next? a. Prepare the client for circumcision b. Apply a scrotal support c. Prepare the client for surgery d. Apply a dressing over the scrotum
c. Prepare the client for surgery Rationale: For the client with torsion, immediate surgery is necessary to prevent atrophy of the spermatic cord and preserve fertility. Analgesics would be given preoperatively. Postoperatively, a scrotal support is applied and dressings are inspected for drainage. Circumcision is done to relieve phimosis or paraphimosis.
A client who comes to the clinic complaining of perineal pain, dysuria, and fever is diagnosed with prostatitis. The nurse understands that which of the following organisms would be the most likely cause? a. Streptococcus b. Paramyxovirus c. Staphylococcus d. Escherichia coli
d. Escherichia coli Rationale: Prostatitis is an inflammation of the prostate gland and is most often caused by microorganisms that reach the prostate by way of the urethra. Escherichia coli and microbes that cause sexually transmitted infections often are responsible. Staphylococcus and Streptococcus are not typically a cause of prostatitis. Paramyxovirus is the cause of mumps.
Which of the following is an immediate danger after a prostate surgery? a. Sexual dysfunction b. Hemorrhagic shock c. Catheter obstruction d. Deep vein thrombosis
b. Hemorrhagic shock Rationale: The immediate dangers after prostate surgery are bleeding and hemorrhagic shock. The patient is monitored for major complications such as hemorrhage, infection, deep vein thrombosis, catheter obstruction, and sexual dysfunction.
Which should be included as part of the home care instructions for a client with epididymitis and orchitis? a. Apply ice to the area after scrotal swelling subsides b. Resume sexual intercourse c. Undertake lifting exercises d. Take prescribed antibiotics
d. Take prescribed antibiotics Rationale: Home care for a client with epididymitis and orchitis includes instructions to continue administering prescribed antibiotics and to take Sitz baths, apply local heat after scrotal swelling subsides, avoid lifting, and refrain from sexual intercourse until symptoms are relieved.
After teaching about self-care measures to a client who has been diagnosed with prostatitis, the nurse determines that the teaching was successful when the client states which of the following? a. "If I have discomfort, a cool shower will give me relief." b. "I should avoid fluids like coffee and tea." c. "I'll take the antibiotic until all the symptoms are gone." d. "I need to make sure that I drink lots of fluid."
b. "I should avoid fluids like coffee and tea." Rationale: With prostatitis, the client should avoid foods and liquids with diuretic action such as coffee and tea. He also needs to complete the full course of prescribed antibiotic therapy, not just until the symptoms are gone. Hot sitz baths may be used to promote relief. Fluids are encouraged to satisfy thirst but are not forced because an effective medication level must be maintained in the urine.
Which client would the nurse identify as being at highest risk for the development of testicular cancer? a. A 75-year-old White male with erectile dysfunction b. A 25-year-old male with a history of cryptorchidism c. A 39-year-old Black male who is HIV-negative d. A 45-year-old White male with a history of hypertension
b. A 25-year-old male with a history of cryptorchidism Rationale: Testicular cancer is most common in between 15 and 34 years of age and is the leading cause of cancer deaths in men between 25 to 34 years of age. Its incidence is higher in White men and men with a history of cryptorchidism. Other clients at risk are those with a family history of the disease, those who are HIV-positive or have developed AIDS, and those who already have had cancer in one testicle.
Several male clients are scheduled to come to the clinic for an annual physical examination. The nurse would expect to prepare which client for a digital rectal examination (DRE)? a. A 48-year-old man with a history of type 2 diabetes b. A 52-year-old man in good health c. A 40-year-old man with a history of asthma d. A 34-year-old man with a history of hypertension
b. A 52-year-old man in good health Rationale: DRE is used to screen for prostate cancer and is recommended annually for every man older than 50 years or those 45 years old at high risk (African-American men and men with a strong family history of prostate cancer). Therefore, a DRE would be most likely for the 52-year-old client. A DRE would not necessarily be done for the other clients, even with their history of other underlying conditions.
Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis? a. Engage in activities and exercises that minimize heavy lifting. b. Ensure immunizations against infectious diseases such as mumps. c. Urge the limited intake of foods and fluids containing caffeine. d. Encourage the consumption of foods that are rich in fat and starch.
b. Ensure immunizations against infectious diseases such as mumps. Rationale: Nurses should advocate for infant and childhood immunizations against infectious diseases such as mumps to reduce potential adult complications such as orchitis. Minimizing activities involving heavy lifting or urging limited intake of caffeine have no effect on the potential for adult complications such as orchitis. The nurse should encourage foods that are low in fat and starch; however, this also would have no effect on the potential for orchitis.
Which of the following is considered first-line treatment for prostate cancer? a. Cryosurgery b. Radical prostatectomy c. Radiation d. Hormonal therapy
b. Radical prostatectomy Rationale: Radical prostatectomy is the complete surgical removal of the prostate, seminal vesicles, and often the surrounding fat, nerves, lymph nodes and blood vessels. It is considered the standard first-line treatment for prostate cancer. If prostate cancer is detected in its early stage, the treatment may be curative radiation therapy. Hormonal therapy for advanced prostate cancer suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of dihydrotestosterone.
A young client who awoke with sudden, severe testicular pain with edema arrives at the ED unable to walk and nauseated. After examination, what treatment would the physician likely order? a. surgery b. application of heat c. oral anti-inflammatory medications d. elevation of testes
a. surgery Rationale: In spermatic cord torsion, immediate surgery is necessary to prevent atrophy of the spermatic cord and preserve fertility.
Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer? a. Hormone therapy b. Brachytherapy c. Teletherapy d. Chemotherapy
b. Brachytherapy Rationale: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. Hormone therapy for advanced prostate cancer suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of DHT. Teletherapy involves 6 to 7 weeks of daily radiation treatments. High-dose ketoconazole (HDK) lowers testosterone through its abilities to decrease both testicular and endocrine production of androgen.
. After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded? a. The normal saline irrigant is infusing at a rate of 50 drops/minute. b. The client reports bladder spasms and the urge to void. c. The urine in the drainage bag appears red to pink. d. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.
b. The client reports bladder spasms and the urge to void. Rationale: Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency.
A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to: a. sexually transmitted disease. b. cryptorchidism c. early onset of puberty. d. testosterone therapy during childhood.
b. cryptorchidism Rationale: Cryptorchidism (failure of one or both testes to descend into the scrotum) appears to play a role in testicular cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early onset of puberty aren't risk factors for testicular cancer.
The nurse is reviewing the history of a client with erectile dysfunction. Which of the following would the nurse least likely identify as contributing to the client's condition? a. Use of metoprolol for treating hypertension b. History of depression treated with fluoxetine c. New onset of anemia being treated with iron supplements d. History of type 2 diabetes mellitus for 10 years
c. New onset of anemia being treated with iron supplements Rationale: Anemia and iron supplements are not associated with erectile dysfunction. Diabetes, depression, and certain medications such as metoprolol and fluoxetine are associated with erectile dysfunction.
A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged IV pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow? a. Attaching the infusion set to an infusion pump b. Counter-balancing the I.V. pole c. Collecting a urine specimen before beginning irrigation d. Evaluating patency of the drainage lumen
d. Evaluating patency of the drainage lumen Rationale: The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.
A client comes to the outpatient clinic for information on a vasectomy. Which instruction should be included by the nurse? a. Vasectomy can result in permanent impotence. b. Following surgery, sexual intercourse should be avoided for 3 months. c. Vasectomies should be considered a permanent means of birth control. d. Postoperative discomfort can be relieved with use of warm sitz baths.
c. Vasectomies should be considered a permanent means of birth control. Rationale: Although attempts to reverse a vasectomy have proven successful, a vasectomy should be considered a permanent means of birth control. Scar formation and/or sperm leakage can interfere with restoration of reproductive effectiveness. Sexual intercourse can be resumed when it is comfortable to do so, usually in about 1 week. Postoperative discomfort should be controlled with application of cold to reduce swelling or use of mild analgesics. On occasion, clients have complained of impotence, but vasectomies have no effect on erection or ejaculation.
