Chapter 55 Clients W/Male Reproductive Disorders

A client with erectile dysfunction has opted to self-administer a urethral suppository as a means to produce an erection. Which of the following agents would most likely be used? A) Sildenafil B) Vardenafil C) Alprostadil D) Papaverine

Ans: C Feedback: Alprostadil is the drug used for self-administration via a urethral suppository. Sildenafil and vardenafil are examples of phosphodiesterase inhibitors that are taken orally. Papaverine with phentolamine is used for self-injection into the corpora cavernosa to achieve an erection.

A client is receiving chemotherapy as adjuvant therapy in the management of testicular cancer. The nurse also notes that the client is ordered filgrastim (Neupogen) and knows that the client is at greatest risk for which assessment finding? A) Increased bruising B) Fever C) Pale color D) Decreased energy

Ans: B Feedback: Filgrastim (Neupogen) is used in the management of clients with low WBC count, which places them at greatest risk for infection. Symptom of fever would alert the nurse to infection. Increased bruising would be significant with low platelet count. Pale color and decreased energy are associated with lower RBC count.

A client with history of type 2 diabetes mellitus and coronary artery disease has been diagnosed with stage III prostate cancer and opts for treatment with diethylstilbestrol (DES). Which is the most important nursing assessment finding in this client? A) Nausea and vomiting B) Progression of the malignancy C) Breast enlargement D) Elevated blood sugar

Ans: D Feedback: DES is a hormone and can interfere with blood sugar control in clients with diabetes mellitus. Blood glucose levels should be monitored frequently to prevent ketoacidosis. DES does not cure the prostate cancer but rather retards the progression of the malignancy with hopes of prolonging period of palliation. Nausea, vomiting, and breast enlargement are all common side effects of DES.

A client is diagnosed with prostatitis. Which of the following is the most important teaching point for the management of this disorder? A) Avoid tub baths. B) Avoid sexual activity. C) Limit fluid intake. D) Avoid prolonged sitting.

Ans: D Feedback: Prolonged sitting can aggravate the condition of prostatitis and should be avoided. Warm tub baths and/or sitz baths can provide comfort. Increasing fluid intake can also flush the urethra of microorganisms and decrease risk of bacterial infection. Regularly draining the prostate gland through masturbation or intercourse can be helpful.

Which of the following nursing assessment findings would be most significant in determining sterility in a male client? A) Uncircumcised penis B) Recurrent urinary tract infections (UTI) C) Multiple sex partners D) Mumps at age 15 years

Ans: D Feedback: Viral mumps infection that occurs after puberty can be the cause of orchitis, which may result in testicular atrophy and sterility. Uncircumcised penis, UTIs, and number of sex partners are not indicated with sterility

Which assessment finding is most important in determining which client has a higher risk for developing testicular cancer? A) Previous sexually transmitted infection (STI) B) Low sperm count C) Cryptorchidism as an infant D) Family history of cancer

Ans: C Feedback: Caucasian men who have had cryptorchidism as an infant, regardless of whether an orchiopexy was performed, are at higher risk for incidence of testicular cancer. STIs, low sperm count, and family history of general cancers are not indicative of testicular cancer risk.

In a client with benign prostatic hyperplasia (BPH), which assessment finding provides the best indication of urinary retention? A) Frequency B) Urgency C) Hesitancy D) Dribbling

Ans: A Feedback: As residual urine accumulates, the client has an urge to void more often. Urgency, hesitancy, and dribbling are all urinary symptoms associated with BPH but not specific to urinary retention.

Which pharmacologic agents pose the greatest risk for urinary retention in a client with benign prostatic hyperplasia (BPH)? A) Muscle relaxers B) Antihypertensives C) Nitrates D) Antihistamines

Ans: D Feedback: Antihistamines and over-the-counter cold medications should be avoided in clients with BPH due to the increase in urinary retention properties. Muscle relaxers are commonly prescribed for treatment of urinary retention. Nitrates and antihypertensive medications do not cause significant risk in the management of BPH.

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

Ans: D Feedback: 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 would a nurse include in a teaching plan for a client with benign prostatic hyperplasia who is not yet a candidate for surgery? A) Maintaining optimal bladder emptying B) Using appropriate coping to allay anxiety C) Performing deep breathing exercises periodically D) Doing leg exercises at least daily

Ans: A Feedback: 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.

The client with prostatitis presents with low back pain, dysuria, and unusual sensation following ejaculation. Which of the following treatments will the nurse anticipate being ordered for this client? A) Analgesics B) Sitz baths C) Antibiotics D) Abstinence

Ans: C Feedback: Prostatitis is an inflammation of the prostate gland that is most often caused by microorganisms. Treatment consists of up to 30 days of antibiotic therapy. Mild analgesics and warm sitz baths may be ordered for discomfort but not a primary action. Regular drainage of the prostate gland through masturbation or intercourse can be helpful in decreasing the inflammation and discomfort.

30. A 50-year-old is diagnosed with stage II prostate cancer. The client is upset and verbalizes that he would rather die than have any surgery. Which is the best response by the nurse? A) "What concerns you most about having surgery?" B) "Your surgeon has performed this surgery many times." C) "How does your family feel about this decision?" D) "This surgery can cure you of cancer."

Ans: A Feedback: Being sympathetic and encouraging the client to express his concerns is a therapeutic response. This client may have concerns about the complications associated with the surgery and/or need additional information on newest techniques that improve outcomes. Explaining that the surgeon is competent does not address the concerns of this client. Family feelings are secondary to the concerns or the client. A cure of cancer is never a guarantee with any surgery.

The client with benign prostatic hyperplasia (BPH) is considering use of medication in the management of symptoms. Which of the following drugs reduces the size of the prostate without lowering circulating levels of testosterone? A) Finasteride (Proscar) B) Tamsulosin (Flomax) C) Terazosin (Hytrin) D) Oxybutynin chloride (Ditropan)

Ans: A Feedback: Finasteride (Proscar) inhibits the conversion of testosterone depriving the gland of dihydrotestosterone (more potent type of testosterone), which stimulates prostatic growth. Tamsulosin (Flomax) and terazosin (Hytrin) work by reducing the tone of smooth muscle in the bladder neck and prostate gland but have little effect on reducing prostate size. Oxybutynin chloride (Ditropan) is antimuscarinic, antispasmodic drug used for treatment of overactive bladder.

Which of the following would be most important to include in a teaching plan for a client who has had a vasectomy? A) Using a reliable method of contraception for several weeks B) Applying warm compresses to the scrotum for the first 24 hours C) Taking a prescribed opioid analgesic for pain relief D) Resuming sexual activity in 24 to 48 hours

Ans: A Feedback: It may take several weeks or more after surgery before the ejaculatory fluid is free of sperm, and the client is informed to use a reliable method of contraception until sperm no longer are present. The client should apply ice packs to the scrotum to reduce swelling and use a mild analgesic such as aspirin or acetaminophen for pain relief. The client typically can resume sexual activity when comfortable, usually in 1 week.

Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis? A) Ensure immunizations against infectious diseases such as mumps. B) Engage in activities and exercises that minimize heavy lifting. C) Encourage the consumption of foods that are rich in fat and starch. D) Urge the limited intake of foods and fluids containing caffeine.

Ans: A Feedback: 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.

A hydrocele is suspected in a client with scrotal edema. Which assessment technique would the nurse anticipate to be done first? A) Transillumination of the scrotum B) Palpate for presence of testicle C) Examine for soft tissue swelling D) Assess for collect-on of blood in the scrotum

Ans: A Feedback: Transillumination, shining a light through the scrotum, will determine if the swelling in the scrotum is caused by serous fluid versus a solid mass. Palpation for testicle is not indicated with a hydrocele. Soft-tissue swelling and/or collection of blood in the scrotum is not indicated with hydrocele.

The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? A) Palpate both testicles simultaneously for comparison. B) Palpate each testicle separately, following a warm shower. C) Palpate the front of the testicle first, where most tumors are found. D) Palpate for a soft, round shape with normal ridges on the testicles.

Ans: B Feedback: 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.

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) Erosion of penile or urethral tissue B) Underinflation or bulging of the cylinders during inflation C) Erosion of scrotal, bowel, or bladder tissue D) Migration of the cylinders, pump, or reservoir from their intended location

Ans: B Feedback: 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 midsized 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 client who is diagnosed with stage II prostate cancer asks the nurse if a transurethral resection of the prostate (TURP) can be done for this disorder. Which is the best response by the nurse? A) "A TURP is a viable option. Let's talk to the surgeon." B) "Stage II means the cancer has already spread from the prostate gland." C) "A TURP is a removal of only a portion of the prostate gland." D) "You have the right to choose which ever surgery you feel is best for you."

Ans: C Feedback: A TURP is not a viable option for treatment of prostate cancer and will only scrape or remove the portion of the gland that is causing obstruction of the urethra. Stage II cancer is a tumor that is still confined to the prostate gland and has not metastasized. The surgical treatment of choice is determined by the surgeon and client together and is not based on feelings but rather evidence-based practice and best prognosis and outcome.

The nurse knows that the safest treatment for erectile dysfunction in a client with coronary artery disease (CAD) includes which of the following medications? A) Sildenafil (Viagra) B) Tadalafil (Cialis) C) Apomorphine (Uprima) D) Vardenafil (Levitra)

Ans: C Feedback: Apomorphine (Uprima), a dopamine agonist, is a possible alternative to phosphodiesterase (PDE5) inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) for the treatment of ED. Uprima is safer for men with CAD and does not cause mass vasodilation of the blood vessels such as the PDE5 inhibitors.

After examination, a client is found to have a prostatic nodule and is scheduled for prostatic-specific antigen (PSA) testing. When reviewing the results, which of the following would indicate that the nodule is malignant? A) 4 ng/mL B) 7 ng/mL C) 9 ng/mL D) 12 ng/mL

Ans: D Feedback: After a prostatic nodule is detected, prostate-specific antigen testing may be done. A PSA greater than 4 ng/mL is the basis for performing more definitive diagnostic procedures, and a PSA greater than 10 ng/mL indicates a prostatic malignancy. A PSA greater than 80 ng/mL indicates advanced metastatic disease.

A client comes to the outpatient clinic for information on a vasectomy. Which instruction should be included by the nurse? A) Vasectomies should be considered a permanent means of birth control. B) Following surgery, sexual intercourse should be avoided for 3 months. C) Postoperative discomfort can be relieved with use of warm sitz baths. D) Vasectomy can result in permanent impotence.

Ans: A Feedback: 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.

Which assessment finding would create the greatest risk to a client ordered a phosphodiesterase (PDE5) inhibitor such as sildenafil (Viagra)? A) Use of nitrates B) History of hypertension C) Type 2 diabetes D) Use of diuretics

Ans: A Feedback: PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa via vasodilation of the blood vessels. If a client is using nitrates (which also exhibit vasodilation) hypotension is likely to occur. History of hypertension and diabetes does not interfere with the administration of PDE5 inhibitors. Use of diuretics is not significant.

The nurse is obtaining a medication history from a client who is reporting erectile dysfunction. Which medication would the nurse identify as being least likely to contribute to the client's condition? A) Spironolactone B) Cimetidine C) Ibuprofen D) Methyldopa

Ans: C Feedback: Certain medications, such as antihypertensive agents (e.g., methyldopa and spironolactone), antidepressants, narcotics, and cimetidine cause sexual dysfunction in men. Ibuprofen is not associated with causing erectile dysfunction. Cimetidine is a histamine2-receptor antagonist used for gastric ulcers.

A young client is admitted with torsion of the spermatic cord. Which is the most appropriate action to be taken by the nurse? A) Elevate the scrotum. B) Keep the client NPO. C) Monitor vital signs for cardiac changes. D) Avoid the use of analgesics.

Ans: B Feedback: With torsion of the spermatic cord, immediate surgery is necessary to prevent atrophy of the cord and preserve fertility. The client should be placed on NPO status in preparation for surgery. Elevating the scrotum intensifies the pain by increasing the degree of twist. Analgesics are prescribed preoperatively to control pain. Cardiac changes are not indicated unless client history warrants assessment.

Following a vasectomy, which is the most important instruction to provide to the client? A) Wear a scrotal support until swelling is resolved. B) Use a Tylenol as needed for discomfort. C) Use another form a birth control until further notice. D) Take a day or two to rest and recuperate from the procedure.

Ans: C Feedback: It may take up to 10 ejaculations to clear sperm and prevent impregnation. The client should be instructed to use another form of reliable birth control until a sperm count proves sterility has occurred. Use of Tylenol, scrotal support, and rest are all helpful during the initial recovery period.

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) Unclean glans C) Painful swelling D) Nausea and vomiting

Ans: C Feedback: 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.

A client with a normal prostate-specific antigen (PSA) level is reporting painful urination and the presence of blood in urine and semen. The nurse understands that the best option for management of this client includes which of the following? A) Wait-and-see approach B) Continue to monitor PSA levels. C) Further evaluation D) Treat the symptoms.

Ans: C Feedback: Although PSA levels of 4 ng/mL or greater is a basis for performing more definitive diagnostic tests, screening measurements of PSA are becoming more controversial. The presence of dysuria, hematuria, and hemospermia are indicative of prostate tumor growth and should be receive further evaluation. The wait-and-see approach is not appropriate if the client is symptomatic. Treating the symptoms without diagnosis could place the client at greater risk for metastasis.

A client is diagnosed with stage II cancer of the prostate. The nurse interprets this as indicating which of the following? A) Cancer is small with no symptoms. B) Tumor is confined to the prostate gland. C) Tumor has spread beyond the prostrate. D) Tumor has expanded to the bladder.

Ans: B Feedback: Stage II cancer of the prostate involves a tumor that is larger than stage I but is still confined to the prostate gland; if left untreated, it is more likely to spread beyond the prostate and cause symptoms. Stage I cancer of the prostate involves a small, slow-growing cancer that may never cause symptoms or other health problems. Stage III involves a tumor that has spread beyond the prostate but has not reached the bladder, rectum, lymph nodes, or other organs. Stage IV involves a tumor that has spread to the bladder, rectum, lymph nodes, or distant organs such as the bones.

The surgeon has ordered belladonna and opium (B and O) suppositories for the management of a postoperative prostatectomy client who is receiving continuous bladder irrigation. Which of the following symptoms would indicate to the nurse the need for administration of this drug? Select all that apply. A) Increased blood in the catheter tubing B) Slowed or stopped infusion rate C) Increased bladder pressure and pain D) Increased speed of infusion rate E) Signs of urinary retention F) Increased force of urinary stream

Ans: B, C Feedback: Belladonna and opium suppositories are ordered to reduce bladder spasms that cause increased bladder pressure and pain following a prostatectomy. As spasms occur, the infusion of saline will slow or stop. Increased blood in the catheter tubing is a sign of active bleeding. With an indwelling three-way catheter, urinary retention and increased force of urinary stream are not present.

A client is scheduled for a pump-type implanted penile prosthesis. Which client statement would indicate the need for additional teaching? A) "The reservoir is filled with saline solution." B) "The penis will appear longer than usual." C) "Surgery is required for placing the implant." D) "The implant is pumped when sexual activity is desired."

Ans: B Feedback: When a pump-type implant is used, the erect penis tends to be shorter than usual because the saline filled cylinders do not fill the glans portion of the penis. This procedure is performed via surgical approach. The implant is pumped causing filling and erection when sexual activity is desired.

Immediately following a transurethral resection of the prostate (TURP), which is the best method to determine if active bleeding is occurring? A) Assess hemoglobin and hematocrit. B) Assess blood in catheter collection bag. C) Assess catheter tubing. D) Assess blood pressure and pulse.

Ans: C Feedback: Assessing the color of drainage in the catheter tubing will alert the nurse to active bleeding. If the bleeding is active, it will be bright red in color and may become increased enough to make reading newspaper print through the tubing impossible. Blood in the collection bag is expected and does not signify active bleeding. Assessment of vital signs is necessary to determine is excessive blood loss has occurred, resulting in symptoms of hypovolemia. Waiting for an H and H report is not the best method for determining active bleeding.

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) Staphylococcus B) Streptococcus C) Escherichia coli D) Paramyxovirus

Ans: C Feedback: 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 nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? A) Age B) Medication use C) Sexual history D) Undescended testicle

Ans: B Feedback: Certain medications such as antihypertensive drugs, antidepressants, narcotics, etc. can cause sexual dysfunction in men. Impotence is not a normal part of aging. Undescended testicle is not indicative of ED. Sexual history is not indicative of ED.

Which of the following should be included when teaching a client about the management of benign prostatic hyperplasia (BPH)? Select all that apply. A) Moderate use of alcohol is useful for bladder relaxation. B) Do not delay the urge to void. C) Low-dose Benadryl will promote restful sleep. D) Prolonged exposure to heat increases bladder spasms. E) Painless hematuria is a common symptom of BPH. F) Schedule digital rectal exams.

Ans: B, F Feedback: The client should be instructed to void promptly when the urge to empty the bladder is signaled by the stretch receptors in the bladder. Voiding promptly will decrease the risk for urinary retention. Digital rectal exams should be monitored to detect further enlargement of the gland and/or presence of prostatic nodules. Alcohol and antihistamines (e.g., Benadryl) should be avoided in the management of BPH. Exposure to heat and painless hematuria are not significant in the management of BPH. Alcohol and antihistamines interact with many BPH drugs.