PrepU Patho Ch 39

The parents of a baby born with hypospadias ask the nurse if the baby can be circumcised. Which response by the nurse is most accurate?

"The circumcision will not be done now; the foreskin is needed for surgical repair." Surgery is the treatment of choice for hypospadias. Circumcision is avoided because the foreskin is used for surgical repair. Factors that influence the timing of surgical repair include anesthetic risk, penile size, and the psychological effects of the surgery on the child.

A male client is diagnosed with an inguinal hernia. Which statement by the client indicates that the nurse's teaching about the hernia has been effective?

"The hernia is a loop of bowel protruding through a weak spot in my abdominal muscles." An inguinal hernia or "rupture" is a protrusion of the parietal peritoneum and part of the intestine through an abnormal opening from the abdominal cavity. A loop of small bowel may become incarcerated in an inguinal hernia (strangulated hernia), in which case its lumen may become obstructed and its vascular supply compromised.

When caring for the client with acute bacterial prostatitis, the nurse plans for which intervention?

Antibiotics Acute prostatitis usually responds to appropriate anti-microbial therapy based on the sensitivity of the causative agents in the urethral discharge.

The anatomy of the prostate gland is made up of three concentric areas surrounding the prostatic urethra, into which they open. The nurse understands that an overgrowth of the mucosal glands can cause which disorder in older men?

Benign prostatic hyperplasia The prostate gland is made up of many secretory glands arranged in three concentric areas surrounding the prostatic urethra, into which they open. The component glands of the prostate include the small mucosal glands associated with the urethral mucosa, the intermediate submucosal glands that lie peripheral to the mucosal glands, and the large main prostatic glands that are situated toward the outside of the gland. It is the overgrowth of the mucosal glands that causes benign prostatic hyperplasia (BPH) in older men.

The nurse in the urology office recognizes screening men at risk for prostate cancer includes which diagnostic measures?

Blood level of prostate-specific antigen (PSA) and digital rectal exam The tests currently available to screen for prostate cancer include digital rectal examination, PSA testing, and transrectal ultrasonography. Prostate biopsy and tissue cytology are not screening measures but tests to confirm the cancer. Pelvic ultrasound and x-ray of kidneys, ureter, and bladder are used for detection of kidney stones. Alpha fetoprotein and HCG serum blood levels are used to predict an increased risk for subsequent miscarriage in women.

A client asks, "What gland is responsible for urethral lubrication during male sexual stimulation?" Which response by the health care provider would be the best reply?

Bulbourethral glands The bulbourethral glands are peanut-sized glands located next to the membranous urethra. Sexual stimulation causes a release of a clear mucous-like secretion that constitutes the major portion of the preseminal fluid and serves to lubricate the penile urethra. The other glands are not involved in the function.

Epididymitis can be sexually transmitted, or it can be caused by a variety of other reasons, including abnormalities in the genitourinary tract. What are the most common causes of epididymitis in young men without underlying genitourinary disease?

Chlamydia trachomatis and Neisseria gonorrhoeae Sexually transmitted acute epididymitis occurs mainly in young men without underlying genitourinary disease and is most commonly caused by Chlamydia trachomatis and Neisseria gonorrhoeae. Candida albicans and Escherichia coli are not the most common causes of epididymitis in young men without underlying genitourinary disease.

A client arrives in the emergency department complaining of severe pain in the left testicular area with nausea and vomiting for 2 hours. The left testicle is large and tender to palpation and radiating to the inguinal area. Which of the following reflexes can the nurse assess the absence of in order to indicate testicular torsion?

Cremasteric reflex When assessing the client for testicular torsion, the cremasteric reflex is frequently absent. To elicit the cremasteric reflex, the medial aspect of the thigh is stroked and testicular retraction is observed. The other reflexes do not indicate testicular torsion.

A 60-year-old man comes to the clinic and has been found to have a history of type 2 diabetes mellitus and cardiovascular disease. The manifestations of these diseases will warrant the nurse to assess the client for which problem?

Erectile dysfunction Erectile dysfunction is commonly seen in older men with type 2 DM, cardiovascular disease, and hyperlipidemia. Erectile dysfunction has largely replaced the term impotence.

A client comes to the clinic and informs the nurse that he was playing soccer and was kicked in the scrotal area on the right side. The nurse observes that the scrotal skin on the right side is dark red. What should the nurse suspect this client may have?

Hematocele A hematocele is an accumulation of blood in the tunica vaginalis, which causes the scrotal skin to become dark red or purple. It may develop as a result of an abdominal surgical procedure, scrotal trauma, a bleeding disorder, or a testicular tumor. This client sustained an injury to the scrotal area that created the hematocele. A spermatocele is a painless, sperm-containing cyst that forms at the end of the epididymis. Spermatoceles are freely movable and transilluminate. A varicocele is characterized by varicosities of the pampiniform plexus, a network of veins supplying the testes. The left side of the scrotum is more commonly affected. A hydrocele forms when excess fluid collecting between the layers of the tunica vaginalis.

An adult male reports discomfort in the groin. If the client has metastatic testicular cancer, for what other clinical manifestations should the nurse assess? Select all that apply.

Hemoptysis Back pain Neck mass Signs of metastatic spread include swelling of the lower extremities, back pain, neck mass, cough, hemoptysis, or dizziness. Gynecomastia (breast enlargement) may result from human chorionic gonadotropin-producing tumors and occurs in about 5% of men with germ cell tumors. The other answers are not signs of metastatic spread of a testicular cancer.

A male client reports sudden pain and a bulging in the scrotal sac after lifting a heavy object. The swelling does not reduce when the client is supine and he begins to sweat profusely. What condition is the likely cause of these manifestations?

Inguinal hernia An inguinal hernia is when a loop of small bowel slips into the inguinal canal. A strangulated hernia occurs when the bowel becomes trapped and blood supply to the bowel is compromised. Phimosis is when the foreskin is constricted and cannot be easily retracted. Human papillomavirus (HPV) is a sexually transmitted infection which can cause genital warts, and cervical and penile cancers.

Which of these complications does the nurse recognize may occur after illness with parotitis (mumps) in young men?

Orchitis with residual sterility The residual effects seen after the acute phase of the mumps infection include hyalinization of the seminiferous tubules and atrophy of the testes (seen in half of affected men). Spermatogenesis is irreversibly impaired in approximately 30% of testes damaged by mumps orchitis. If both testes are involved, permanent sterility can result. Androgenic hormone function is usually maintained.

When assessing the client with chronic inflammatory bacterial prostatitis, the nurse recognizes which findings are typically present? Select all that apply.

Painful urination Frequency of urination Low back pain Bacteriuria Men with chronic bacterial prostatitis have urinary tract infections with the same strain of pathogenic bacteria in prostatic fluid and urine. Other symptoms include frequent and urgent urination, dysuria, perineal discomfort, and low back pain. Men with nonbacterial prostatitis often have inflammation of the prostate with an elevated leukocyte count and abnormal inflammatory cells in their prostatic secretions without presence of pathogens in the urine.

A nurse is performing a genital examination on a male client who develops an erection. What is the nurse's most appropriate intervention?

Reassure the client that this is a normal response and continue with the examination Emission and ejaculation, which constitute the culmination of the male sexual act, are a function of the sympathetic nervous system. Genital stimulation can produce erection. In the flaccid or detumescent state, sympathetic discharge through alpha-adrenergic receptors maintains contraction of the arteries that supply the penis and vascular sinuses of the corpora cavernosa and corpus spongiosum. Parasympathetic stimulation produces erection by inhibiting sympathetic neurons that cause detumescence and by stimulating the release of nitric oxide to effect a rapid relaxation of the smooth muscle in the sinusoidal spaces of the corpus cavernosum.

The nurse conducting a health promotion class for teenage boys on human reproduction determines that the participants are understanding the information when they state:

Spermatogenesis continues throughout a man's reproductive years. Spermatogenesis typically begins around 13 years of age and continues throughout the reproductive years of a man's life. Spermatogenesis occurs in the seminiferous tubules of the testes. Sperm in various stages of development are embedded in the Sertoli cells.

An obstetrician is explaining the differentiation of embryonic tissue into a fetus to an aspiring class of nursing students. Which hormone is primarily responsible for the development of male sex characteristics?

Testosterone Testosterone is the most abundant and most active of these hormones. In the male embryo, testosterone is essential for the appropriate differentiation of the internal and external genitalia. Testosterone also is the precursor of dihydrotestosterone (DHT), which functions in the formation of the male urethra, prostate, and external genitalia. Androstenedione and DHEA exert only weak androgenic activity, but their main purpose is to act as a key precursor for testosterone after peripheral conversion.

A male client is being prepared for a physical examination of his prostate gland. How will the nurse explain the location of the prostate gland?

The prostate gland is located in the pelvis, inferior to the bladder. The prostate is a fibromuscular and glandular organ lying just inferior to the bladder.

A nurse educator is explaining male reproductive physiology during grand rounds and is referring to the process of spermatogenesis. Where does spermatogenesis occur?

The seminiferous tubules Spermatogenesis occurs in the seminiferous tubules of the testes. The spermatogonia and Sertoli cells are parts of the seminiferous tubules, but they do not contain the entire process of spermatogenesis. The epididymis is a series of conducting tubules.

The nurse is caring for a baby with phimosis. Which of these does the nurse explain to the mother is the key feature of this disorder?

Tightening of the foreskin preventing full retraction over the penis Phimosis refers to a tightening of the prepuce or penile foreskin that prevents its retraction over the glans penis; as the child grows, retraction becomes possible in most cases.