Ch 26: Assessing Male Genitalia and Rectum

A 17-year-old male client expresses concern about feeling lumps on his testicles. What response by the nurse would best address the client's concerns? "Do you think you have malformed testicles?" "Don't worry, that is the way normal testicles feel." "Lumpy testicles are not going to cause a problem with sexual performance." "The normal testicle contains internal structures that cause lumps on the surface."

"The normal testicle contains internal structures that cause lumps on the surface." Each normal testicle has a small, coiled tube (epididymis) that can feel like a small bump on the upper or middle outer side of the testicle. Normal testicles also have blood vessels, supporting tissues, and tubes that carry sperm. Asking for the client's opinion on whether or not the testicles are malformed does not yield assessment data or address the client's need for more information. Telling the client not to worry and describing the testicles as normal provides incomplete information to the client. Because the client's given concern is not regarding sexual performance, this is not a statement that the nurse should use; additionally, describing the testicles as lumpy is an inaccurate way to refer to an expected assessment finding.

Which of the following groups has the highest incidence of prostate cancer? Caucasian men Native American men African American men Asian American men

African American men African American men have the highest incidence of prostate cancer—two to three times higher than Caucasian men.

During assessment of the inguinal regions for herniating masses, the nurse instructs the standing male client do which of the following? Bear down. Exhale fully. Bend over and bear down. Hold breath to the count of 10.

Bear down. Asking the standing client to bear down while standing may facilitate detection of a herniating mass. Exhaling, bending over, and holding one's breath are not clinically useful techniques for assessing a potential herniating mass.

Upon inspection and palpation of the front of the client's thigh, the nurse discovers a bulge that appears when the client coughs. The nurse should document this finding as which type of hernia? Scrotal Incarcerated Strangulated Femoral

Femoral A bulge or mass on the front of the thigh in the femoral canal area is a femoral hernia. A hernia is strangulated if the blood supply is cut off. In this case, the client typically complains of extreme tenderness and nausea. A scrotal mass that remains when the client lies down and over which bowel sounds can be auscultated is a scrotal hernia. If the mass in the scrotum cannot be pushed into the abdomen, it could be an incarcerated hernia.

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? Apply scrotal support. Prepare the client for surgery. Apply a dressing over the scrotum. Prepare the client for circumcision.

Prepare the client for surgery. 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.

The nurse is teaching a group of student nurses in the lab about male anatomical differences and assessment. Which of the following should be included in the teaching? The assessment should be completed in a warm room. The scrotum should be covered with non-elastic taut skin. The client should raise their arms when assessing the scrotal sac. The prepuce should not be retracted.

The assessment should be completed in a warm room. Scrotal examination should occur in a warm room as the sac rises towards the body in colder temperatures. The arms do not need to be raised for the assessment. The client should be standing or lying comfortably. The skin on the scrotal sac should be loose and wrinkled. If the client is circumcised, the prepuce should be gently retracted for inspection. The prepuce should not be forcibly retracted.

The nurse has assessed a male client and determines that one of the testes is absent. The nurse should explain to the client that this condition is termed hypospadias. hematocele. cryptorchidism. orchitis.

cryptorchidism. Absence of a testis suggests cryptorchidism (an undescended testicle).

The corpora spongiosum extends distally to form the acorn-shaped glans. frenulum. corona. scrotum.

glans. The corpus spongiosum extends distally to form the acorn-shaped glans.

The prostate gland consists of two lobes separated by the median sulcus. rectovesical pouch. anorectal junction. valves of Houston.

median sulcus. The prostate gland consists of two lobes separated by a shallow groove called the median sulcus.

During assessment of an elderly male client, the client tells the nurse that he has had difficulty urinating for the past few weeks. The nurse should refer the client to the physician for possible inguinal hernia. sexually transmitted disease. impotence. prostate enlargement.

prostate enlargement. Difficulty urinating may indicate an infection or blockage, including prostatic enlargement.

A 60-year-old coach comes to the clinic complaining of difficulty starting to urinate for the last several months. He believes the problem is steadily getting worse. When asked he says he has a very weak stream, and it feels like it takes 10 minutes to empty his bladder. He also has the urge to go to the bathroom more often than he used to. He denies any blood or sediment in his urine and any pain with urination. Visualization of the anus shows no inflammation, masses, or fissures. Digital rectal examination reveals a smooth, enlarged prostate. No discrete masses are felt. There is no blood on the glove. An analysis of the urine shows no red blood cells, white blood cells, or bacteria. What disorder of the anus, rectum, or prostate is most likely?

Benign prostatic hyperplasia (BPH) BPH becomes more prevalent during the fifth decade and is often associated with hesitancy in starting a stream, decreased strength of stream, nocturia, and leaking of urine. On examination an enlarged, symmetrical, firm prostate is palpated. The anterior lobe cannot be felt. These clients may also develop UTIs secondary to their obstruction.

When palpating the rectal mucosa, how does the nurse rotate the examining hand? From the nurse's left, then to the right Anteriorly, then posteriorly Counterclockwise, then clockwise Clockwise, then counterclockwise

Clockwise, then counterclockwise To palpate the rectal mucosa, the nurse rotates the hand clockwise to palpate the right side of the client's rectal mucosa, then counterclockwise to palpate the surface posteriorly and on the client's left side.

A nurse examining a client's external genitalia notices that his scrotum and testes draw up and he shivers. This phenomenon is known as which of the following? Patellar reflex Rooting reflex Cremasteric reflex Vasovagal reflex

Cremasteric reflex The scrotum can maintain temperature control because the cremaster muscle is sensitive to changes in temperature. The muscle contracts when too cold, raising the scrotum and testes upward toward the body for warmth (cremasteric reflex). This accounts for the wrinkled appearance of the scrotal skin. The patellar reflex occurs when a physician strikes the patellar tendon of the knee and the leg jerks. The rooting reflex occurs in infants when they turn their heads toward anything that strokes the cheek or mouth. The vasovagal reflex is a contraction of muscles in the gastrointestinal tract in response to distension of the tract following consumption of food and drink.

A nurse examines the anal area of a client and observes the presence of a varicose vein. How should the nurse document this finding? Perianal abscess Anal fissure Anorectal fistula External hemorrhoid

External hemorrhoid Hemorrhoids are usually painless papules caused by varicose veins, either external or internal. If the hemorrhoid becomes thrombosed is can become painful and swollen. A perianal abscess is a cavity of pus caused by infection in the skin around the anal opening. An anal fissure is a split in the tissue of the anal canal caused by trauma. An anorectal fistula is a small, round opening in the skin that surrounds the anal opening. It suggests an inflammatory tract from the anus or rectum out to the skin.

A client asks the nurse for suggestions about what to eat to reduce the risk of colon cancer. The nurse would suggest that the client eat which of the following types of food? Low in calcium High in fiber High in animal protein Low in folic acid

High in fiber The client should be instructed to eat a diet high in fiber, fruit, and vegetables and low in fat and animal protein; a half cup of raisins or three-quarters of a cup of grapes daily (tartaric acid and fiber reduce bile acids and speed food through system); and foods with adequate calcium, folic acid, vitamin D, and possibly magnesium.

A 68-year-old man comes to the clinic reporting that he is having difficulty obtaining an erection. When reviewing the client's history what might the nurse note that contributes to impotence? Past history of infection History of hypertension Use of multivitamins Lack of exercise

History of hypertension Past history of infection, lack of exercise, and use of vitamins do not contribute to impotence. Vascular problems cause about half the cases of impotence in men older than 50 years.

Which of the following should nurses teach all men, especially those who have had cryptorchidism? Need for blood tests to measure serum acid phosphate levels. Importance of regular monitoring of prostate-specific antigen (PSA) levels. Need to undergo a baseline and follow up lymph node biopsies. How to perform a testicular self-examination.

How to perform a testicular self-examination. 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.

Which of the following is a sign or symptom of benign prostatic hypertrophy (BPH)? Weight loss Bone pain Fever Nocturia

Nocturia BPH is usually not associated with systemic symptoms such as weight loss or fever. Bone pain is associated with prostate cancer, which often metastasizes to the lower axial skeleton. Nocturia, sensation of incomplete voiding, weak stream, and difficulty initiating urination are also common symptoms.

A nurse recognizes that which finding is normal upon palpation of the prostate? Swollen and tender Enlarged, smooth, firm, slightly elastic Hard, fixed, irregular nodules Nontender and rubbery

Nontender and rubbery The prostate is normally nontender and rubbery. A swollen and tender prostate may indicate acute prostatitis. An enlarged smooth, firm, slightly elastic prostate that may not have a median sulcus suggests benign prostatic hypertrophy. A hard area on the prostate or hard, fixed, irregular nodules on the prostate suggest cancer.

The nurse notes that a male client's scrotal sac is documented as being "normal." What should the nurse expect to assess in this client? Select all that apply. Rugated Thin skin Scattered lesions Few strands of hair Color darker than the penis

Rugated Thin skin Few strands of hair Color darker than the penis For a scrotal sac to be considered "normal," the skin should appear thin and rugated. There will be few strands of hair and the color of the skin is darker than the penis. Lesions on the scrotal sac indicate an infection and would not be considered "normal."

A 23 year old male comes to the clinic complaining of sudden and severe pain in his scrotum. The nurse would suspect what? Torsion of the spermatic cord Spermatocele Orchitis Varicocele

Torsion of the spermatic cord Torsion of the spermatic cord is usually accompanied by a sudden, severe pain of the scrotum and is a urological emergency. A spermatocele is a sperm-filled cystic mass located on the epididymis. Orchitis is inflammation of the testes. A varicocele is an abnormal dilation of veins in the spermatic cord.

The nurse suspects that a male client may have a hernia. The nurse should further assess the client for bruising at the site. urinary tract infection. cysts at the spermatic cord. bowel sounds at the bulge.

bowel sounds at the bulge. Bowel sounds auscultated over the mass indicate the presence of bowel and thus a scrotal hernia.

What information should nurse include in the teaching plan for a client considering a vasectomy? offers permanent birth control increases the amount of ejaculate protects from sexually transmitted infection May causes urinary incontinence

offers permanent birth control Vasectomy is a method of permanent birth control which results in decreased, not increased, amounts of ejaculate. Vasectomy offers no protection from sexually transmitted infections (STIs). Prostatectomy, not vasectomy, causes urinary incontinence.

The nurse identifies a cheesy white material that has accumulated under a male client's foreskin of the penis. What does this finding suggest to the nurse? balanitis hypospadias sexually transmitted infection smegma

smegma A cheesy white material may accumulate under the foreskin of a client. This is smegma and is considered normal. Balanitis refers to inflammation of the glans, not the expected secretions of the glans that cause smegma to accumulate. The accumulation of secretions from the glans (smegma) does not indicate that a sexually transmitted infection is present. Hypospadias refers to a congenital condition that involves ventral displacement of the meatus on the penis.