Male Genitourinary System

11. A baby boy is about to have a circumcision. The nurse knows that the reasons for circumcision include: a. Cultural and religious beliefs b. Prevention of testicular cancer c. Improving the sperm count later in life d. Prevention of dysuria

A

12. A 59-year-old patient has been diagnosed with prostatitis and is being seen at the clinic for complaints of burning and pain during urination. He is experiencing: a. Dysuria b. Nocturia c. Polyuria d. Hematuria

A Dysuria (burning with urination) is common with acute cystitis, prostatitis, and urethritis. Nocturia is voiding during the night. Polyuria is voiding in excessive quantities. Hematuria is blood in urine.

10. An older man is concerned about his sexual performance. The nurse knows that in the absence of disease, a man may withdraw from sexual activity later in life because of: a. Side effects of medications b. Decreased libido with aging c. Decreased sperm production d. Decreased pleasure from sexual intercourse

A In the absence of disease, a withdrawal from sexual activity could be attributed to the side effects of medications, such as antihypertensives, antidepressants, sedatives, psychotropics, antispasmodics, tranquilizers or narcotics, and hormone therapy. The other options are not correct.

18. When performing a genitourinary assessment, the nurse notices that the urethral meatus is ventrally positioned. This finding is: a. Known as hypospadias b. A result of phimosis c. Probably caused by a stricture d. Often associated with aging

A Normally, the urethral meatus is positioned just about centrally. Hypospadias is the ventral location of the urethral meatus. The position of the meatus does not change with aging. Phimosis is the inability to retract the foreskin. A stricture is a narrow opening of the meatus.

33. The nurse is inspecting the scrotum and testes of a 43-year-old man. Which finding would require additional follow-up and evaluation? a. Skin on the scrotum is taut. b. Left testicle hangs lower than the right testicle. c. Scrotal skin has yellowish, 1-cm nodules that are firm and nontender. d. Testes move closer to the body in response to cold temperatures.

A Scrotal swelling may cause the skin to be taut and to display pitting edema. Normal scrotal skin is rugae, and asymmetry is normal with the left scrotal half usually lower than the right. The testes may move closer to the body in response to cold temperatures.

6. A male patient with possible fertility problems asks the nurse where sperm is produced. The nurse knows that sperm production occurs in the: a. Testes b. Prostate c. Epididymis d. Vas deferens

A Sperm production occurs in the testes, not in the other structures listed.

15. Which of these questions is most appropriate when the nurse is obtaining a genitourinary history from an older adult male? a. "Do you need to get up at night to urinate?" b. "Do you experience nocturnal emissions, or 'wet dreams'?" c. "Do you know how to perform a testicular self-examination (TSE)?" d. "Has anyone ever touched your genitals when you did not want them to?"

A The older adult male patient should be asked about the presence of nocturia. Awaking at night to urinate may be attributable to a diuretic medication, fluid retention from mild heart failure or varicose veins, or fluid ingestion 3 hours before bedtime, especially coffee and alcohol. The other questions are more appropriate for younger men.

40. During a physical examination, the nurse finds that a male patient's foreskin is fixed and tight and will not retract over the glans. The nurse recognizes that this condition is: a. Phimosis b. Epispadias c. Urethral stricture d. Peyronie's disease

A With phimosis, the foreskin is nonretractable, forming a pointy tip of the penis with a tiny orifice at the end of the glans. The foreskin is advanced and so tight that it is impossible to retract it over the glans. This condition may be congenital or acquired from adhesions related to infection. (See Table 26-5 for information on urethral stricture.

1. A 70-year-old man is in for his annual checkup. He has noticed some changes he is concerned about as he is aging. The nurse explains what normal changes he should expect including: (Select all that apply.) a. Scrotum hanging lower b. Decrease in the size of the testes c. Increase in the amount of pubic hair d. Decrease in the size of the penis e. Scrotum shrinking in size

A, B, D After ages 55 to 60 years, testosterone production declines very gradually so that resulting physical changes are not evident until later in life. Aging changes also result from decreased muscle tone, decreased subcutaneous fat, and decreased cellular metabolism. In older men, the amount of pubic hair decreases, and the remaining hair turns grey. Penis size decreases. Because of decreased tone of the dartos muscle, the scrotal contents hang lower, the rugae decrease, and the scrotum looks pendulous. The testes decrease in size and are less firm to palpation.

2. A 16-year-old boy is brought to the clinic for a problem that he refused to let his mother see. The nurse examines him and finds that he has scrotal swelling on the left side. He had had the mumps the previous week, and the nurse suspects that he has orchitis. Which of the following assessment findings support this diagnosis? (Select all that apply.) a. Swollen testis b. Mass that is transilluminated c. Mass that is not transilluminated d. Scrotum that is nontender on palpation e. Scrotum that is tender on palpation f. Scrotal skin that is reddened

A, C, E, F With orchitis, the testis is swollen, with a feeling of weight, and is tender or painful. The mass is not transilluminated, and the scrotal skin is reddened. Transillumination of a mass occurs with a hydrocele, not orchitis. (Table 26-6)

4. When performing a genital examination on a 25-year-old man, the nurse notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information, the nurse would: a. Squeeze the glans to check for the presence of discharge b. Consider this finding as normal and proceed with the examination c. Assess the testicles for the presence of masses or painless lumps d. Obtain a more detailed history, focusing on any scrotal abnormalities the patient has noticed

B After adolescence, the scrotal skin is deeply pigmented, has large sebaceous follicles, and appears corrugated.

24. The nurse is describing to a patient how to perform TSE. Which statement is most appropriate? a. "A good time to examine your testicles is just before you take a shower." b. "An enlarged testicle or a painless lump is not unusual." c. "The healthy testicle is egg shaped and movable. It should feel firm and have a lumpy consistency." d. "Perform TSE at least once a week to detect testicular cancer in the early stage."

B If the patient notices a firm, painless lump

21. During a scrotal assessment, the nurse palpates a mass and notices that the scrotal contents show a red glow with transillumination. On the basis of these findings, the nurse would: a. Assess the patient for the presence of a hernia b. Suspect the presence of serous fluid in the scrotum c. Consider this finding normal and proceed with the examination d. Refer the patient for evaluation of the mass in the scrotum

B Perform transillumination only if you notice a swelling or mass. Darken the room. Shine a strong flashlight from behind the scrotal contents. Normal scrotal contents do not allow light to pass through the scrotum. However, serous fluid is transilluminated and shows as a red glow. Neither a mass nor a hernia would be transilluminated.

8. The mother of a 10-year-old boy asks the nurse to explain the onset of puberty. The nurse should reply by saying: a. "Puberty usually begins around 15 years of age." b. "The first sign of puberty is an enlargement of the testes." c. "The penis size does not increase until about 16 years of age." d. "The development of pubic hair precedes enlargement of the testicles or penis."

B Puberty begins sometime between ages 9 and 13 years. The first sign is enlargement of the testes. Next, pubic hair appears, and then penis size increases.

20. When assessing the scrotum of a male patient, the nurse notices the presence of multiple firm, nontender, yellow, 1-cm nodules. The nurse knows that these nodules are most likely: a. Caused by urethritis b. Sebaceous cysts c. Subcutaneous plaques d. From an inflammation of the epididymis

B Sebaceous cysts are commonly found on the scrotum. These yellowish, 1-cm nodules are firm, nontender, and often multiple. The other options are not correct.

1. The nurse is teaching a class of 5-year-olds the correct terminology for male genitalia and explains that the external structures include the: a. Testis b. Scrotum c. Epididymis d. Vas deferens

B The external male genital structures include the penis and the scrotum. The testis, epididymis, and vas deferens are internal structures.

28. During an examination of an older adult male, the nurse recognizes that normal changes to expect would be: a. Change in scrotal colour b. Decrease in the size of the penis c. Enlargement of the testesNandRscrIotuGm B.C M d. Increase in the number of rugae over the scrotal sac

B When assessing the genitals of an older adult male, the nurse may notice thinner, greying pubic hair and a decrease in the size of the penis. The size of the testes may be decreased, they may feel less firm, and the scrotal sac is pendulous with less rugae. No change in scrotal color is observed.

34. A 55-year-old man is experiencing severe pain of sudden onset in the scrotal area. It is somewhat relieved by elevation. On examination the nurse notices an enlarged, red scrotum that is very tender to palpation. Distinguishing the epididymis from the testis is difficult, and the scrotal skin is thick and edematous. This description is consistent with which of these? a. Varicocele b. Epididymitis c. Spermatocele d. Testicular torsion

B Epididymitis presents as severe pain of sudden onset in the scrotum that is somewhat relieved by elevation. On examination, the scrotum is enlarged, reddened, and exquisitely tender. The epididymis is enlarged and indurated and may be hard to distinguish from the testis. The overlying scrotal skin may be thick and edematous.

35. The nurse is performing a genitourinary assessment on a 50-year-old male labourer, who is obese. On examination, the nurse notices a painless round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. These findings are most consistent with a(n) hernia. a. Scrotal b. Femoral c. Direct inguinal d. Indirect inguinal

C Direct inguinal hernias occur most often in men over age 40 years. It is an acquired weakness brought on by heavy lifting, obesity, chronic cough, or ascites. The direct inguinal hernia is usually a painless, round swelling close to the pubis in the area of the internal inguinal ring

39. During a genital examination, the nurse notices that a male patient has clusters of small vesicles on the glans, surrounded by erythema. The nurse recognizes that these lesions are: a. Peyronie's disease b. Genital warts c. Genital herpes d. Syphilitic cancer

C Genital herpes, or herpes simplex virus 2 (HSV-2), infections are indicated with clusters of small vesicles with surrounding erythema, which are often painful and erupt on the glans or foreskin. (See Table 26-4 for the descriptions of the other options.)

2. An accessory glandular structure for the male genital organs is the: a. Testis b. Scrotum c. Prostate d. Vas deferens

C Glandular structures accessory to the male genital organs are the prostate, seminal vesicles, and bulbourethral glands.

25. A 2-month-old uncircumcised infant has been brought to the clinic for a well-baby checkup. How would the nurse proceed with the genital examination? a. Eliciting the cremasteric reflex is recommended. b. The glans is assessed for redness or lesions. c. Retracting the foreskin should be avoided until the infant is 3 months old. d. Any dirt or smegma that has collected under the foreskin should be noted.

C If the baby is uncircumcised, then the foreskin is normally tight during the first 3 months and should not be retracted because of the risk for tearing the membrane attaching the foreskin to the shaft. The other options are not correct.

9. During an examination of a 70-year-old male patient, the nurse recognizes that normal changes to expect would be: a. Enlarged scrotal sac b. Increased pubic hair c. Decreased penis size d. Increased rugae over the Necrotomy

C In the aging man, the amount of pubic hair decreases, the penis size decreases, and the rugae over the scrotal sac decreases. The scrotal sac does not enlarge. Because of decreased tone of the dartos muscle, the scrotal contents hang lower, the rugae decrease, and the scrotum looks pendulous.

26. A 2-year-old boy has been diagnosed with physiological cryptorchidism. Considering this diagnosis, during assessment the nurse will most likely observe: a. Testes that are hard and painful to palpation b. Atrophic scrotum and a bilateral absence of the testis c. Absence of the testis in the scrotum, but the testis can be milked down d. Testes that migrate into the abdomen when the child squats or sits cross-legged

C Migratory testes (physiological cryptorchidism) are common because of the strength of the cremasteric reflex and the small mass of the prepubertal testes. The affected side has a normally developed scrotum and the testis can be milked down. The other responses are not correct.

13. During a follow-up appointment with a 68-year-old male patient who had surgery for prostate cancer, he tells the nurse that he is concerned because "every time I sneeze some urine leaks out." The nurse will document that he is experiencing: a. Urinary frequency b. Enuresis c. Stress incontinence d. Urge incontinence

C Stress incontinence is involuntary urine loss with physical strain, sneezing, or coughing, and it occurs as a result to weakness of the pelvic floor. Urinary frequency is urinating more often than usual (more than five to six times per day). Enuresis is involuntary passage of urine at night after age 5 to 6 years (bed wetting). Urge incontinence is involuntary urine loss from overactive detrusor muscle in the bladder. It contracts, causing an urgent need to void.

32. When the nurse is performing a testicular examination on a 25-year-old man, which finding is considered normal? a. Nontender subcutaneous plaques b. Scrotal area that is dry, scaly, and nodular c. Testes that feel oval and movable and are slightly sensitive to compression d. Single, hard, circumscribed, movable mass, less than 1 cm under the surface of the testes

C Testes normally feel oval, firm and rubbery, smooth, and bilaterally equal and are freely movable and slightly tender to moderate pressure. The scrotal skin should not be dry, scaly, or nodular or contain subcutaneous plaques. Any mass would be an abnormal finding.

23. During the health history interview with a 40-year-old male patient who was raised in South Korea, the patient mentions that he has undescended testes that had not been corrected in his childhood and is concerned about getting cancer. The nurse informs the patient that: a. Testicular cancer is the most common cancer in men 30 to 50 years of age b. The early symptoms of testicular cancer are pain and induration c. Men with a history of cryptorchidism are at risk for the development of testicular cancer d. The cure rate for testicular cancer is low

C The overall incidence is rare, but testicular cancer occurs most commonly in men 15 to 29 years of age. Other risk factors include delayed descent of the testicles (if not corrected early), family or personal history of testicular cancer, and abnormal development of the testicle. True cryptorchidism occurs when the testes have never descended. Men with undescended testicles (cryptorchidism) are therefore at risk for the development of testicular cancer. The overall incidence of testicular cancer is rare. Although testicular cancer has no early symptoms, if detected early through palpation and treated before it metastasizes, the cure rate is almost 100%.

37. During an examination, the nurse notices that a male patient has a red, round, superficial ulcer with a yellowish serous discharge on his penis. On palpation, the nurse finds a nontender base that feels like a small button between the thumb and fingers. At this point the nurse suspects that this patient has: a. Genital warts b. Herpes infection c. Syphilitic chancre d. Carcinoma lesion

C This lesion indicates syphilitic chancre, which begins within 2 to 4 weeks of infection.

27. The nurse knows that a common assessment finding in a boy younger than 2 years of age is: a. Inflamed and tender spermatic cord b. Presence of a hernia in the scrotum c. Penis that looks large in relation to the scrotum d. Presence of a hydrocele, or fluid in the scrotum

D A common scrotal finding in boys younger than 2 years of age is a hydrocele, or fluid in the scrotum. The other options are not correct.

7. A 62-year-old man states that his physician told him that he has an "inguinal hernia." He asks the nurse to explain what a hernia is. The nurse should: a. Tell him not to worry and that most men his age have hernias b. Explain that a hernia is often the result of prenatal growth abnormalities c. Refer him to his physician for additional consultation because the physician made the initial diagnosis d. Explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles

D A hernia is a loop of bowel protruding through a weak spot in the musculature. The other options are not correct responses to the patient's question.

30. A 15-year-old boy is seen in the clinic for complaints of "dull pain and pulling" in the scrotal area. On examination, the nurse palpates a soft, irregular mass posterior to and above the testis on the left. This mass collapses when the patient is supine and refills when he is upright. This description is consistent with: a. Epididymitis b. Spermatocele c. Testicular torsion d. Varicocele

D A varicocele consists of dilated, tortuous varicose veins in the spermatic cord caused by incompetent valves within the vein. Symptoms include dull pain or a constant pulling or dragging feeling, or the individual may be asymptomatic. When palpating the mass, the examiner will feel a soft, irregular mass posterior to and above the testis that collapses when the individual is supine and refills when the individual is upright. (See Table 26-6 for more information and for the descriptions of the other options.)

38. During a health history, a patient tells the nurse that he has trouble starting urination. This problem is known as: a. Urgency b. Dribbling c. Frequency d. Hesitancy

D Hesitancy is difficulty starting urination. Urgency is the feeling that one cannot wait to urinate. Dribbling is the leaking of the last drops of urine before or after the main act of urination. Frequency is urinating more often than usual.

36. The nurse is providing patient teaching about an erectile dysfunction drug. One of the drug's potential side effects is prolonged, painful erection of the penis without sexual stimulation, which is known as: a. Orchitis b. Stricture c. Phimosis d. Priapism

D Priapism is prolonged, painful erection of the penis without sexual desire. Orchitis is inflammation of the testes. Stricture is narrowing of the opening of the urethral meatus. Phimosis is the inability to retract the foreskin.

17. The nurse is examining the glans and knows which finding is normal for this area? a. The meatus may have a slight discharge when the glans is compressed. b. Hair is without any infestations. c. The skin is wrinkled and without lesions. d. Smegma may be present under the foreskin of an uncircumcised male.

D The glans looks smooth and without lesions and does not have hair. The meatus should not have any discharge when the glans is compressed. Some cheesy smegma may have collected under the foreskin of an uncircumcised male.

14. When the nurse is conducting sexual history interview with a male adolescent, which statement would be most appropriate to use at the beginning of the interview? a. "Do you use condoms?" b. "You don't masturbate, do you?" c. "Have you had sex in the past 6 months?" d. "Often adolescents your age have questions about sexual activity."

D The interview should begin with a permission statement, which conveys that it is normal and acceptable to think or feel a certain way. The nurse should avoid sounding judgemental.

29. When performing a genital assessment on a middle-aged man, the nurse notices multiple soft, moist, painless papules in the shape of cauliflower-like patches scattered across the shaft of the penis. These lesions are characteristic of: a. Carcinoma b. Syphilitic chancres c. Genital herpes d. Genital warts

D The lesions of genital warts are soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch. They occur on the shaft of the penis, behind the corona, or around the anus, where they may grow into large grapelike clusters.

3. The nurse is teaching a sex education class for a group of 10-year-old boys, who are curious about why the penis looks different in some boys. The nurse explains that some boys are circumcised and that circumcision involves: a. The ventral placement of the urethral meatus b. The placement of the prepuce covering the shaft of the penis c. Surgery of the two cylindrical columns of erectile tissue d. The surgical removal of the foreskin shortly after birth

D The penis is made up of three cylindrical columns of erectile tissue. The skin that covers the glans of the penis is the prepuce. The urethral meatus forms at the tip of the glans. Over the glans, the skin folds in and back on itself, forming a hood or flap. This is the foreskin, or prepuce. Sometimes, it is surgically removed shortly after birth by circumcision.

5. During the health history interview with an 18 year-old male patient, the patient expresses concern that his "private parts seem to move closer to his body when it is cold out." The nurse explains that: a. The lymphatic vessels of the testes drain into the abdominal lymph nodes b. The vas deferens is located along the inferior portion of each testis c. The right testis is lower than the left one because the right spermatic cord is longer d. The cremaster muscle contracts in response to cold and draws the testicles closer to the body

D When it is cold, the cremaster muscle contracts, which raises the scrotal sac and brings the testes closer to the body to absorb heat necessary for sperm viability. The lymphatic vessels of the testes drain into the inguinal lymph nodes. The vas deferens is located along the upper portion of each testis. The left testis is lower than the right because the left spermatic cord is longer.

22. When the nurse is performing a genital examination on a male patient, which action is correct? a. Auscultating for the presence of a bruit over the scrotum b. Palpating for the vertical chain of lymph nodes along the groin, inferior to the inguinal ligament c. Palpating the inguinal canal only if a bulge is present in the inguinal region during inspection d. Having the patient shift his weight on(unexamined) leg when palpating the right inguinal canal for mass

D When palpating for the presence of a herniating mass on the right side, the male patient is asked to shift his weight onto the left (unexamined) leg. Auscultating for a bruit over the scrotum is not appropriate. When palpating for lymph nodes, the horizontal chain is palpated. The inguinal canal should be palpated whether a bulge is present or not.

16. When the nurse is performing a genital examination on a male patient, the patient has an erection. The nurse's most appropriate action or response is to: a. Ask the patient if he would like someone else to examine him b. Continue with the examination as though nothing has happened c. Stop the examination and leave the room after stating that the examination will be resumed at a later time d. Reassure the patient that this is a normal physiological response and continue with the examination

D When the male patient has an erection, the nurse should reassure the patient that this is a normal physiological response to touch and proceed with the rest of the examination. The other responses are not correct and may be perceived as judgemental.

31. When performing a genitourinary assessment on a 16-year-old male adolescent, the nurse notices a swelling in the scrotum that increases with increased intra-abdominal pressure and decreases when he is lying down. The patient complains of pain when straining. The nurse knows that this description is most consistent with a(n) hernia. a. Femoral b. Incisional c. Direct inguinal d. Indirect inguinal

D With indirect inguinal hernias, pain occurs with straining and a soft swelling increases with increased intra-abdominal pressure, which may decrease when the patient lies down. These findings do not describe the other hernias. (See Table 26-7 for the descriptions of femoral, direct inguinal, and indirect inguinal hernias.)

19. The nurse is performing a genital examination on a male patient and notices urethral drainage. When collecting urethral discharge for microscopic examination and culture, the nurse should: a. Ask the patient to urinate into a sterile cup b. Ask the patient for a specimen of semen c. Insert a cotton-tipped applicator into the urethra to collect a specimen d. Compress the glans between thumb and forefinger to obtain a specimen of the discharge

D If urethral discharge is noticed, then the examiner should obtain a smear for microscopic examination and culture by compressing the glans anteroposterior with the thumb and forefinger. The other options are not correct actions.