Chapter 59: Assessment and Management of Problems Related to Male Reproductive Processes

Lithotomy position

A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively?

Pelvic floor exercises

A patient has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following?

Surgery

A 57-year-old male comes to the clinic complaining that when he has an erection his penis curves and becomes painful. The patient's diagnosis is identified as severe Peyronie's disease. The nurse should be aware of what likely treatment modality?

Teaching the patient about the importance of hygiene

A 75-year-old male patient is being treated for phimosis. When planning this patient's care, what health promotion activity is most directly related to the etiology of the patient's health problem?

-Wearing a scrotal support garment -Using sitz baths

A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply.

The patient should avoid close contact with his daughter for 2 months.

A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family?

Continuous inflow and outflow of irrigation solution

A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens?

Increased blood urea nitrogen (BUN)

A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this patient has chronic urinary retention?

Administer a smooth-muscle relaxant as ordered.

A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient?

Inform the urologist of this finding.

A patient has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action?

Light pink

A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag?

Circumcision

A patient presents to the emergency department with paraphimosis. The physician is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, what is usually indicated?

Inform the patient that urinary control is likely to return gradually.

A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional "dribbling" of urine. How should the nurse best respond to this patient's concern?

Phimosis

An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem?

Hydrocele

An adolescent is identified as having a collection of fluid in the tunica vaginalis of his testes. The nurse knows that this adolescent will receive what medical diagnosis?

-Diabetes -Testosterone deficiency -Parkinsonism

The nurse is leading a workshop on sexual health for men. The nurse should teach participants that organic causes of erectile dysfunction include what? Select all that apply.

Report the planned use of dietary supplements to the physician.

To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what?

The drug should be taken 1 hour prior to intercourse.

A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication?

African Americans

A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group?

Closely monitoring the input and output of the bladder irrigation system

A nurse is providing care for a patient who has recently been admitted to the postsurgical unit from PACU following a transuretheral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action?

Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.

A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer?

Prostatitis

A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort, burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient is exhibiting symptoms of what?

Asking the patient if he is willing to discuss sexual functioning

A nursing student is learning how to perform sexual assessments using the PLISSIT model. According to this model, the student should begin an assessment by doing which of the following?

Nocturnal penile tumescence tests

A patient confides to the nurse that he cannot engage in sexual activity. The patient is 27 years old and has no apparent history of chronic illness that would contribute to erectile dysfunction. What does the nurse know will be ordered for this patient to assess his sexual functioning?

Evidence of a more advanced lesion

A nurse is caring for a 33-year-old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in 5 years. During the examination, the physician finds that digital rectal examination (DRE) reveals "stoney" hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what?

Psychotherapy

A patient has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The patient's interdisciplinary plan of care should prioritize which of the following interventions?

The patient should have PSA levels drawn regularly.

A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patient's family history, he states, "My father died of prostate cancer at age 48." The nurse should instruct him on which of the following health promotion activities?

Provide empathy and encouragement in an effort to foster a positive outlook.

A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time?

Disturbed Body Image Related to Effects of Surgery

A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him "emasculated" and "a shell of a man." The nurse should identify what nursing diagnosis when planning the patient's subsequent care?

There is no noticeable decrease in the amount of ejaculate even though it contains no sperm.

A 35-year-old father of three tells the nurse that he wants information on a vasectomy. What would the nurse tell him about ejaculate after a vasectomy?

Chronic bacterial prostatitis

A 35-year-old man is seen in the clinic because he is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem?

Retinopathy

A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history prior to instructing the patient on the use of this medication. What disorder will contraindicate the use of tadalafil (Cialis)?

-Phimosis -Increasing age -Lack of circumcision

A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply.

The patient has a history of hypertension.

A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the patient's history, what might the nurse note that contributes to erectile dysfunction?

A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer.

A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response?

Permanent vascular damage

A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what?

All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction.

A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurse's response?

Below the prostate, within the posterior aspect of the urethra

A physician explains to the patient that he has an inflammation of the Cowper glands. Where are the Cowper glands located?

It is highly responsive to treatment

A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer?

Testicular cancer is a highly curable type of cancer.

A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize?