Chap 53: Assessment and Management of Clients with Male Reproductive Disorders

Transurethral resection of the prostate (TURP): explanation of triple lumen indwelling catheter A client 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? 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

A. Continuous inflow and outflow of irrigation solution Rationale: 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.

Organic causes of erectile dysfunction; select all that apply The nurse is leading a workshop on sexual health for men. The nurse should describe what organic causes of erectile dysfunction? Select all that apply. A. Diabetes B. Testosterone deficiency C. Anxiety D. Depression E. Parkinsonism

A. Diabetes B. Testosterone deficiency E. Parkinsonism Rationale: Organic causes of ED include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic kidney disease, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to be psychogenic causes.

Nursing diagnosis for patient with newly diagnosed testicular cancer A 29-year-old client has just been told that they have testicular cancer and needs to have surgery. During a presurgical appointment, the client admits to feeling devastated that they require surgery, stating that it will leave them "emasculated" and "a shell of a man." The nurse should identify what nursing diagnosis when planning the client's subsequent care? A. Disturbed body image related to effects of surgery B. Spiritual distress related to effects of cancer surgery C. Social isolation related to effects of surgery D. Risk for loneliness related to change in self-concept

A. Disturbed body image related to effects of surgery Rationale: The client's statements specifically address the perception of the body as it relates to the client's identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This client is at risk for social isolation and loneliness, but there's no indication in this scenario that these diagnoses are present. There is no indication of a spiritual element to the client's concerns.

Side effects of laparoscopic prostatectomy A client who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that the client is experiencing occasional "dribbling" of urine. How should the nurse best respond to this client's concern? A. Inform the client that urinary control is likely to return gradually. B. Arrange for the client to be assessed by the urologist. C. Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D. Teach the client to perform intermittent self-catheterization.

A. Inform the client that urinary control is likely to return gradually. Rationale: It is important that the client know that regaining urinary control is a gradual process; the client may continue to "dribble" after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

Intervention for paraphimosis A client presents to the emergency department with paraphimosis. The health care provider is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, the nurse should prepare the client for what intervention? A. Needle aspiration of the corpus cavernosum B. Circumcision C. Abstinence from sexual activity for 6 weeks D. Administration of vardenafil

B. Circumcision Rationale: Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated. Vardenafil is used for erectile dysfunction and would not be used for paraphimosis.

Sildenafil: patient education A client has been prescribed sildenafil (Viagra). What should the nurse teach the client about this medication? A. Sexual stimulation is not needed to obtain an erection. B. The drug should be taken 1 hour prior to intercourse. C. Facial flushing or headache should be reported to the health care provider. D. The drug has the potential to cause permanent visual changes.

B. The drug should be taken 1 hour prior to intercourse. Rationale: The client must have sexual stimulation to create the erection, and the drug should be taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side effects of Viagra and do not normally warrant reporting. Some visual disturbances may occur, but these are transient.

Vasectomy: changes to seminal fluid as a result A 35-year-old father of three tells the nurse that they want information on a vasectomy. What would the nurse tell the client about ejaculate after a vasectomy? A. There will be no ejaculate after a vasectomy, though the client's potential for orgasm is unaffected. B. There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. C. There is a marked decrease in the amount of ejaculate after vasectomy, though this does not affect sexual satisfaction. D. There is no change in the quantity of ejaculate after vasectomy, but the viscosity is somewhat increased.

B. There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. Rationale: Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland, which are unaffected by vasectomy, thus no noticeable decrease in the amount of ejaculate occurs (volume decreases approximately 3%), even though it contains no spermatozoa. The viscosity of ejaculate does not change.

Adverse effects of priapism A nurse is assessing a client 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 issue? A. Urinary tract infection B. Chronic pain C. Permanent vascular damage D. Future erectile dysfunction

C. Permanent vascular damage Rationale: The ischemic form of priapism, which is described as a nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been implicated in the development of UTIs, chronic pain, or erectile dysfunction.

PSA level: who, when, why A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on the right knee. While taking the client's family history, the client states, "My father died of prostate cancer at age 48." The nurse should instruct the client on which of the following health promotion activities? A. The client will need PSA levels drawn starting at age 55. B. The client should have testing for presence of the CDH1 and STK11 genes. C. The client should have PSA levels drawn regularly. D. The client should limit alcohol use due to the risk of malignancy.

C. The client should have PSA levels drawn regularly. Rationale: PSA screening is warranted by the client's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the client should be limited. However, this is not the most important health promotion intervention.

Symptoms of prostatitis A nurse practitioner is assessing a 55-year-old male client who reports perineal discomfort, burning, urgency, and frequency with urination. The client states that he has pain with ejaculation. The nurse knows that the client is exhibiting symptoms of: A. varicocele. B. epididymitis. C. prostatitis. D. hydrocele.

C. prostatitis. Rationale: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation are indicative of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract; it may also develop as a complication of gonorrhea. A hydrocele is a collection of fluid, generally in the tunica vaginalis of the testis, although it may also collect within the spermatic cord.

Treatment for psychogenic erectile dysfunction A client has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The client's interdisciplinary plan of care should prioritize which of the following interventions? A. Penile implant B. PDE-5 inhibitors C. Physical therapy D. Psychotherapy

D. Psychotherapy Rationale: Clients with erectile dysfunction from psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction. Because of the absence of an organic cause, medications and penile implants are not first-line treatments. Physical therapy is not normally effective in the treatment of ED.