Green Chapter 53: Male Reproductive
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
c. Ibuprofen Explanation: 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.
A patient is suspected to have prostate cancer related to observed clinical symptoms. What definitive test can the nurse assist with to confirm a diagnosis of prostate cancer? a. DRE b, PSA c. Prostate biopsy d. Cystoscopy
c. Prostate biopsy Explanation: If prostate cancer is detected early, the likelihood of cure is high (Eggert, 2010). It can be diagnosed through an abnormal finding with the digital rectal examination (DRE), serum prostate-specific antigen (PSA), and ultrasound-guided transrectal ultrasound (TRUS) with biopsy. Detection is more likely with the use of combined diagnostic procedures. The diagnosis of prostate cancer is confirmed by a histologic examination of tissue removed surgically by transurethral resection of the prostate (TURP), open prostatectomy, or ultrasound-guided transrectal needle biopsy.
What is the potentially life-threatening effect of androgen that has been documented? A. Renal failure B. Abdominal aortic aneurysm C. Hepatocellular cancer D. Prostate cancer
A. Renal failure This action allows filling of the corpus cavernosum, causing penile erection.
The nurse is aware that the following laboratory values support a diagnosis of pyelonephritis? A. Myoglobinuria B. Ketonuria C. Pyuria D. Low white blood cell (WBC) count
Answer: C. Pyuria Explanation: Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. On urinalysis, one should look for pyuria as it is the most common finding in patients with acute pyelonephritis. Proteinuria and microscopic hematuria may be present as well on urinalysis. Blood work such as a complete blood cell count (CBC) is sent to look for an elevation in white blood cells.
A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure? A. Phosphate binders B. Insulin C. Antibiotics D. Cardiac glycosides
Answer: D. Cardiac glycosides Explanation: Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Hyperkalemia can be a marker of severe toxicity in acute poisoning. The role of potassium is less clear in chronic toxicity, although it has been linked to higher mortality despite traditional teaching that hypokalemia worsens the dysfunction at the Na-K transporter.
A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make? a. Testicular cancer is a highly curable type of cancer. b. Testicular cancer is very difficult to diagnose. c. Testicular cancer is the number one cause of cancer deaths in males. d. Testicular cancer is more common in older men.
a. Testicular cancer is a highly curable type of cancer. Explanation: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in younger, not older, men.
A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? a. Transurethral resection of the prostate (TURP) b. Suprapubic prostatectomy c. Retropubic prostatectomy d. Transurethral laser incision of the prostate
a. Transurethral resection of the prostate (TURP)
Which procedure is noninvasive, and best for minor prostatic enlargements? a. Transurethral resection of the prostate (TURP) b. Suprapubic prostatectomy c. Retropubic prostatectomy d. Transurethral laser incision of the prostate
a. Transurethral resection of the prostate (TURP)
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 urine in the drainage bag appears red to pink. b. The client reports bladder spasms and the urge to void. c. The normal saline irrigant is infusing at a rate of 50 drops/minute. 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. Explanation: 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 male client has undergone a semen analysis for evaluation of fertility. The nurse understands that a sperm count of which of the following would suggest infertility? a. 100 million /mL b. 75 million/mL c. 50 million/mL d. 18 million/mL
d. 18 million/mL Explanation: A sperm count of fewer than 20 million spermatozoa per milliliter results in infertility. Normal sperm count ranges on average from 60 to 100 million /mL.
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
d. How to perform a testicular self-examination Explanation: 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 is inconsistent with a digital rectal examination (DRE)? a. Recommended for men older than 50 years of age b. Assists in screening for cancer of prostate gland c. Enables examiner to assess size, shape, and consistency of prostate gland d. Can reveal a hydrocele
d. Can reveal a hydrocele Explanation: 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 triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the nurse is aware that the functions of the three lumens include: A. Continuous inflow and outflow of irrigation solution. B. Intermittent inflow and continuous outflow of irrigation solution. C. Continuous inflow and intermittent outflow of irrigation solution. D. Intermittent flow of irrigation solution and prevention of hemorrhage.
Answer: A. Explanation: Continuous inflow and outflow of irrigation solution. 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 male client is scheduled for a renal clearance test. Nurse Sheldon should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: A. 1 minute. B. 30 minutes. C. 1 hour. D. 24 hours.
Answer: A. 1 minute. Explanation: The renal clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period. The glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidneys. The gold standard measurement of GFR involves the injection of inulin and its clearance by the kidneys.
A female client is admitted for treatment of chronic renal failure (CRF). Nurse Julian knows that this disorder increases the client's risk of: A. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate. B. A decreased serum phosphate level secondary to kidney failure. C. An increased serum calcium level secondary to kidney failure. D. Metabolic alkalosis secondary to retention of hydrogen ions.
Answer: A. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate. Explanation: A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2, persisting for 3 months or more, irrespective of the cause.
Dr. Grey prescribes norfloxacin (Noroxin), 400 mg P.O. twice daily, for a client with a urinary tract infection (UTI). The client asks the nurse how long to continue taking the drug. For an uncomplicated UTI, the usual duration of norfloxacin therapy is: A. 3 to 5 days. B. 7 to 10 days. C. 12 to 14 days. D. 10 to 21 days.
Answer: B. 7 to 10 days. Explanation: For an uncomplicated UTI, norfloxacin therapy usually lasts 7 to 10 days. Oral quinolones are rapidly absorbed in the gastrointestinal tract and possess a high oral bioavailability, allowing the oral and IV routes of administration to be used interchangeably for certain quinolones. Though quinolones are widely distributed throughout the body, the degree of penetration into tissues and bodily fluids depends on the individual quinolone.
A male client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region, which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnosed renal calculi and ordered flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? A. Kidney B. Ureter C. Bladder D. Urethra
Correct Answer: A. Kidney Explanation: The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and may lodge anywhere along the tract or may stay within the kidney. Renal calculi are a common cause of blood in the urine (hematuria) and pain in the abdomen, flank, or groin. They occur in one in 11 people at some time in their lifetimes with men affected 2 to 1 over women.
Nurse Pippy is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way? A. Fluid intake should double the urine output. B. Fluid intake should be approximately equal to the urine output. C. Fluid intake should be half the urine output. D. Fluid intake should be inversely proportional to the urine output.
Answer: B. Fluid intake should be approximately equal to the urine output. Explanation: Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. The core principle of fluid balance is that the amount of water lost from the body must equal the amount of water taken in; for example, in humans, the output (via respiration, perspiration, urination, defecation, and expectoration) must equal the input (via eating and drinking, or by parenteral intake).
A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should Nurse Kaye conclude? A. The skin wasn't lubricated before the pouch was applied. B. The pouch faceplate doesn't fit the stoma. C. A skin barrier was applied properly. D. Stoma dilation wasn't performed.
Answer: B. The pouch faceplate doesn't fit the stoma. Explanation: The pouch faceplate doesn't fit the stoma. If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. The hole should fit snugly around the stoma without any gaps. Make sure that the hole is not too small either so that it doesn't dig into the stoma and cause any cuts or abrasions that could bleed.
The nurse is aware that the following findings would be further evidence of a urethral injury in a male client during rectal examination? A. A low-riding prostate B. The presence of a boggy mass. C. Absent sphincter tone D. A positive Hemoccult
Answer: B. The presence of a boggy mass. Rationale: The presence of a boggy mass. When the urethra is ruptured, a hematoma or collection of blood separates the two sections of the urethra. This may feel like a boggy mass on rectal examination. Rupture of the urethra is an uncommon result of penile injury, incorrect catheter insertion, straddle injury, or pelvic girdle fracture. The urethra, the muscular tube that allows for urination, may be damaged by trauma. When urethral rupture occurs, urine may extravasate (escape) into the surrounding tissues.
8. Question Nurse Pete is reviewing the report of a client's routine urinalysis. Which value should the nurse consider abnormal? A. Specific gravity of 1.03 B. Urine pH of 3.0 C. Absence of protein D. Absence of glucose
Answer: B. Urine pH of 3.0 Explanation: Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine-specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, its color ranging from pale yellow to deep amber.
A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: A. Hematuria. B. Weight loss. C. Increased urine output. D. Increased blood pressure.
Answer: B. Weight loss. Explanation: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. The client's normal weight without any extra fluid in the body is called "dry weight." Extra fluid can be dangerous and cause extra strain on the body, including the heart and lungs. When the client has kidney failure, her body depends on dialysis to get rid of the extra fluid and wastes that build up in her body between treatments.
A male client with acute pyelonephritis receives a prescription for co-trimoxazole (Septra) P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen? A. Urine output increases to 2,000 ml/day. B. Flank and abdominal discomfort decrease. C. Bacteria are absent in urine culture. D. The red blood cell (RBC) count is normal.
Answer: C. Bacteria are absent on urine culture. Explanation: Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore, the absence of bacteria on urine culture indicates that the drug has achieved its desired effect. The initial selection of antibiotics will be empiric and should be based on the local antibiotic resistance. Antibiotic therapy should then be adjusted based on the results of the urine culture.
A male client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing post-procedure care, the nurse should: A. Keep the client's knee on the affected side bent for 6 hours. B. Apply pressure to the puncture site for 30 minutes. C. Check the client's pedal pulses frequently. D. Remove the dressing on the puncture site after vital signs stabilize.
Answer: C. Check the client's pedal pulses frequently. Explanation: Check the client's pedal pulses frequently. After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding
Which of the following is the action of alprostadil? A. Locally relaxes vascular smooth muscles B. Blocks cyclic guanosine monophosphate (cGMP) to increase the blood flow C. Increases nitrous oxide levels in the corpus cavernosum D. Fills the corpus cavernosum with blood
Answer: C. Increases nitrous oxide levels in the corpus cavernosum. Sildenafil is a PDE5 receptor inhibitor. Nitrous oxide then activates cGMP to cause smooth muscle relaxation and increase the flow of blood to the corpus cavernosum.
For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? A. Encouraging coughing and deep breathing. B. Promoting carbohydrate intake. C. Limiting fluid intake. D. Providing pain-relief measures.
Answer: C. Limiting fluid intake. Explanation: During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Scatter desired beverages throughout the 24-hour period and give various offerings (hot, cold, frozen). Help avoid periods without fluids, minimizes boredom of limited choices, and reduces sense of deprivation and thirst.
After trying to conceive for a year, a couple consults an infertility specialist. When obtaining a history from the husband, Nurse Jessica inquires about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility? A. Chickenpox B. Measles C. Mumps D. Scarlet fever
Answer: C. Mumps Mumps is the most significant childhood infectious disease affecting male fertility. Chickenpox, measles, and scarlet fever don't affect male fertility. Orchitis caused due to mumps becomes noticeable in the first week of contracting the disease. The scrotum swells up causing intense pain and the scrotal skin turns red in color indicating infection. Pain usually disappears within 5 days but there could be testicular shrinkage. Studies suggest that anti-sperm antibodies may be the factor that negatively impacts male fertility in such cases.
A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should Nurse Ginny include in a bladder retraining program? A. Establishing a predetermined fluid intake pattern for the client. B. Encouraging the client to increase the time between voidings. C. Restricting fluid intake to reduce the need to void. D. Assessing present elimination patterns.
Answer: D. Assessing present elimination patterns Explanation: he guidelines for initiating bladder retraining include assessing the client's intake patterns, voiding patterns, and reasons for each accidental voiding. Bladder training is an important form of behavior therapy that can be effective in treating urinary incontinence. The goals are to increase the amount of time between emptying the bladder and the amount of fluids the bladder can hold. It also can diminish leakage and the sense of urgency associated with the problem.
Which is true about androgens? A. It is produced together with testosterone in the testes. B. It can be used in treatment of breast cancer in men. C. Client taking androgens must increase their dietary intake of potassium. D. Caution is advised for clients with high blood pressure.
Answer: D. Caution is advised for clients with high blood pressure. Explanation Androgens, specifically Danazol, can increase risk for thromboembolic events. Androgens are produced in the adrenal gland and it can't be used in treating breast cancers in men because testosterone in the drug can aggravate it. Patients taking this drug should reduce their dietary potassium intake because androgens increase its retention.
Nurse Lily is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? A. Rashes on the palms of the hands and soles of the feet. B. Cauliflower-like warts on the penis. C. Painful red papules on the shaft of the penis. D. Foul-smelling discharge from the penis.
Answer: D. Foul-smelling discharge from the penis. Explamation: Foul-smelling discharge from the penis Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. The most common clinical manifestations of gonococcal disease in males include penile purulent discharge, dysuria, and testicular discomfort. Although many females, more than 50%, will not manifest symptoms of their gonococcal cervix infections, most males, more than 90%, will manifest urogenital gonorrhea symptomatically.
The most widely used procedure for prostate gland removal is a. Transurethral resection of the prostate (TURP) b. Suprapubic prostatectomy c. Retropubic prostatectomy d. Transurethral laser incision of the prostate
a. Transurethral resection of the prostate (TURP) Explanation: TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; each requires an incision.
The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history? a. Asthma with beta-adrenergic inhaler use b. Hypotension with nitrate use c. Chronic pain with narcotic use d. Arthritis with corticosteroid use
b. Hypotension with nitrate use Explanation: Due to the action of the medication on the smooth muscles and blood vessels, clients are advised not to take medications to treat erectile dysfunction when also prescribed a nitrate drug for chest pain or heart problems. Combining medication could result in a serious drop in blood pressure. Although all disease processes and medication therapy should be screened for interactions, hypotension with nitrate use the most serious side effects.
Having regular PSA levels, lymph node biopsies, and blood tests for measuring serum acid phosphatase are for which clients? a. The clients who received a vasectomy. b. The clients who have mildly enlarged prostate. c. The clients who are treated for prostate cancer. d. The clients who are treated for cryptorchidism
c. The clients who are treated for prostate cancer.