Chapter 53: Assessment and Management of Patients with Male Reproductive Disorders
A client being discharged after having an acute myocardial infarction asks why the health care provider omitted a prescription for sildenafil. Which response will the nurse make? "The medication cannot be taken for at least 6 months." "You can ask for the prescription when you have your follow-up appointment." "I will ask for the prescription before you leave the hospital." "It must have been accidentally omitted."
"The medication cannot be taken for at least 6 months." Sildenafil is a medication used to treat erectile dysfunction. It is contraindicated if the client has had a myocardial infarction within the past 6 months. The prescription was not accidentally omitted and the nurse will not be able to get the prescription for the client before leaving the hospital. The client will not be given the prescription if the appointment is within 6 months following the myocardial infarction.
A 55-year-old client has a PSA level of 4.8 ng/mL. Based on the client's PSA level, which assessment question does the nurse need to ask? "Will you remember to schedule your next PSA test in 1 year?" "How often do you include foods high in purines in your diet?" "Do you wear boxers or briefs?" "When was the last time you experienced ejaculation?"
"When was the last time you experienced ejaculation?" Values of PSA may increase after ejaculation. PSA levels are measured in nanograms per milliliter. In most laboratories, values less than 4.0 ng/mL are generally considered normal, and values greater than 4.0 ng/mL are considered elevated. Foods high in purines place individuals at risk for gout, but purines do not increase PSA levels. Because the client's PSA level is elevated, further assessment is indicated. Type of underwear affects how close the testes are held to the body and may affect male fertility; type of underwear does not affect PSA levels. Asking whether the client will remember to schedule another test in a year is not as important as asking when the client last experienced ejaculation.
Medical management of BPH includes pharmacologic therapy. Which of the following medications would the nurse expect the health care provider to prescribe for this diagnosis? Alpha-adrenergic blocker Analgesic Antispasmodic Diuretic
Alpha-adrenergic blocker Alpha-adrenergic blockers relax the smooth muscle of the bladder neck and prostate, improving urine flow and relieving BPH symptoms.
Which of the following is the most immediate danger after prostate surgery? Infection Obstructed urine flow Deep vein thrombosis Bleeding
Bleeding The immediate danger after prostate surgery is bleeding and hemorrhagic shock. If, after 20 minutes, the bleeding is not controlled, surgical exploration may be considered. Since bleeding is increased in the sitting position, which increases bladder and venous pressure, the patient is encouraged to rest in bed with the head of the bed slightly elevated.
Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer? Hormone therapy Brachytherapy Teletherapy Chemotherapy
Brachytherapy Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. Hormone therapy for advanced prostate cancer suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of DHT. Teletherapy involves 6 to 7 weeks of daily radiation treatments. High-dose ketoconazole (HDK) lowers testosterone through its abilities to decrease both testicular and endocrine production of androgen.
Which term refers to a failure of one or both or both of the testes to descend into the scrotum? Phimosis Cryptorchidism Varicocele Hydrocele
Cryptorchidism Cryptorchidism is the failure of one or both of the testes to descend into the scrotum. Hydrocele is a collection of fluid, generally in the tunica vaginalis of the testes. Varicocele is an abnormal dilation of the veins of the pampiniform venous plexus in the scrotum. Phimosis is a condition in which the foreskin is constricted so that is cannot be retracted over the glans.
A patient experiences hypotension, lethargy, and muscle spasms while receiving bladder irrigations after a transurethral resection of the prostate (TURP). What is the first action the nurse should take? Prepare the patient for an ECG. Discontinue the irrigations. Administer a unit of packed red blood cells. Increase the rate of the IV fluids.
Discontinue the irrigations. Transurethral resection syndrome is a rare but potentially serious complication of TURP. Symptoms include lethargy, hypotension, and muscle spasms. The first action the nurse should take is to discontinue irrigation. The other interventions listed are not appropriate.
Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis? Urge the limited intake of foods and fluids containing caffeine. Ensure immunizations against infectious diseases such as mumps. Engage in activities and exercises that minimize heavy lifting. Encourage the consumption of foods that are rich in fat and starch.
Ensure immunizations against infectious diseases such as mumps. Nurses should advocate for infant and childhood immunizations against infectious diseases such as mumps to reduce potential adult complications such as orchitis. Minimizing activities involving heavy lifting or urging limited intake of caffeine have no effect on the potential for adult complications such as orchitis. The nurse should encourage foods that are low in fat and starch; however, this also would have no effect on the potential for orchitis.
The nurse is providing preoperative care to a client who is to undergo a radical prostatectomy for prostate cancer. The client's plan of care includes the nursing diagnosis of "anxiety related to surgery and its outcome." Which of the following would be most appropriate for the nurse to do? Inform the client that risk of recurrence is decreased with this type of surgery. Tell the client that prostate cancer is very curable if caught early. Allow the client to assume a passive role in the preparation. Ensure privacy when discussing sensitive or embarrassing sexual issues.
Ensure privacy when discussing sensitive or embarrassing sexual issues. To help reduce anxiety, the nurse should provide clear explanations about the events before, during, and after surgery, reinforcing information already provided by the surgeon. In addition, the nurse should establish a trusting relationship and allow the client to ask questions and verbalize his feelings related to the diagnosis, surgery, and outcomes. Because the surgery involves reproductive issues that the client may find sensitive or embarrassing, the nurse needs to ensure the client's privacy when discussing any of these issues. Telling the client that the cancer is very curable and informing him of a lower risk of recurrence would give the client false reassurance. In addition, anxiety could be increased, especially if the client's cancer is not at an early stage. Regardless of the diagnosis, clients need to participate in their care to foster autonomy and feelings of control over the situation.
A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged IV pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow? Collecting a urine specimen before beginning irrigation Counter-balancing the I.V. pole Attaching the infusion set to an infusion pump Evaluating patency of the drainage lumen
Evaluating patency of the drainage lumen The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.
Which of the following is an immediate danger after a prostate surgery? Deep vein thrombosis Hemorrhagic shock Catheter obstruction Sexual dysfunction
Hemorrhagic shock The immediate dangers after prostate surgery are bleeding and hemorrhagic shock. The patient is monitored for major complications such as hemorrhage, infection, deep vein thrombosis, catheter obstruction, and sexual dysfunction.
A 65-year-old client complains to his health care provider that, when he urinates, he has to start and stop several times over a period of minutes in order to fully empty his bladder. The nurse is aware that this is not uncommon in men over the age of 60. This "double voiding" is directly related to which of the following? Thickening of the seminiferous tubules Hypogonadism Hyperplasia of the prostate gland Fibrotic changes of the corpora cavernosa
Hyperplasia of the prostate gland Urination, without bladder emptying, is an indication that the prostate gland is enlarged. It causes an increased sense of urgency to void, as well as a decreased force of the urine stream. Enlargement of the prostate gland is associated with weakening of prostatic contractions and lower urinary tract obstruction.
A nurse is reviewing the history of a client who is experiencing difficulty sustaining an erection. Which of the following might the nurse suspect as a possible contributing factor? Hypertension Asthma Sinus infections Lower back pain
Hypertension Hypertension may be a contributing factor because some types of antihypertensive agents can reduce a male's ability to achieve or sustain an erection. A history of lower back pain, sinus infections, or asthma is unrelated to erectile dysfunction.
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? Arthritis with corticosteroid use Asthma with beta-adrenergic inhaler use Chronic pain with narcotic use Hypotension with nitrate use
Hypotension with nitrate use 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.
Which statement is accurate regarding sildenafil? It can be taken twice daily for increased effect. Its side effects include headache, flushing, and dizziness. The medication should be taken right before intercourse. Sexual stimulation is not needed to produce an erection.
Its side effects include headache, flushing, and dizziness. Side effects of sildenafil include headache, flushing, and dizziness. Is should be taken 30 minutes to 4 hours before intercourse. Taking this medication more than once a day will not have an increased effect. The client will have no erection if stimulation does not occur.
After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first? Artificial sphincter use Fluid restriction Self-catheterization Kegel exercises
Kegel exercises Kegel exercises are noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for the client with increased detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for post-prostatectomy incontinence. Self-catheterization may be used as a temporary measure but isn't a primary intervention.
The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following? Dark amber with copious mucous Light pink with few red streaks Reddish-pink with numerous clots Light yellow and clear
Light yellow and clear Typically a three-way catheter drainage system is removed when the urine appears clear and amber (light yellow). Reddish-pink urine with clots usually occurs in the immediate postoperative period. Eventually the urine becomes light pink within 24 hours after surgery. Dark amber urine suggests concentrated urine commonly associated with dehydration.
Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? Undescended testicle Sexual history Medication use Age
Medication use Certain medications such as antihypertensive drugs, antidepressants, narcotics, etc. can cause sexual dysfunction in men. Impotence is not a normal part of aging. Undescended testicle is not indicative of ED. Sexual history is not indicative of ED.
The nurse is preparing a presentation for a men's community group about health promotion. Which of the following would the nurse include as a current recommendation for screening? Monthly testicular self-examination (TSE) Transrectal ultrasound every 5 years after age 50 years Annual digital rectal examination (DRE) after age 35 years Annual prostate-specific antigen (PSA) testing after age 40 years
Monthly testicular self-examination (TSE) Screening typically includes monthly TSE starting in adolescence and annual DRE for men older than 50 years. PSA testing along with DRE are used to screen for prostate cancer in men with at least a 10-year life expectancy and for men at high risk, including those with a strong family history of prostate cancer and of African-American ethnicity. Transrectal ultrasound is performed in clients with abnormalities detected by DRE and in those with elevated PSA levels.
Which term refers to the surgical removal of one or both testes? Hydrocelectomy Vasectomy Orchiectomy Circumcision
Orchiectomy Orchiectomy is required when the testicle(s) has been damaged. Circumcision is excision of the foreskin, or prepuce, of the glans penis. Vasectomy is ligation and transection of part of the vas deferens to prevent the passage of sperm from the testes. Hydrocelectomy describes the surgical repair of a hydrocele, a collection of fluid in the tunica vaginalis.
Following morning hygiene of an older adult client, the nurse is unable to replace the retracted foreskin of the penis. Which is the most likely outcome? Nausea and vomiting Unclean glans Painful swelling Erection of the penis
Painful swelling Paraphimosis results in strangulation of the glans penis from inability to replace the retracted foreskin. The strangulation results in painful swelling of the glans. Erection of the penis in the presence of phimosis can cause pain but is not a result of retracted foreskin. Nausea and vomiting are not indicated with retraction of foreskin.
The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? Palpate each testicle separately, following a warm shower. Palpate the front of the testicle first, where most tumors are found. Palpate both testicles simultaneously for comparison. Palpate for a soft, round shape with normal ridges on the testicles.
Palpate each testicle separately, following a warm shower. It is best to examine and palpate each testicle following a warm shower, when the testes are relaxed and not retracted. Because one testicle is normally larger and hangs lower, comparing the two sides is not indicated. Both testes should be oval in shape, smooth, and firm without masses or tenderness. Most tumors are located on the lateral aspect of the testicles.
Which condition is associated with buildup of fibrous plaques in the sheath of the corpus cavernosum, causing curvature of the penis when it is erect? Phimosis Bowen's disease Priapism Peyronie's disease
Peyronie's disease Peyronie's disease may require surgical removal of the plaques when the disease makes sexual intercourse painful, difficult, or impossible. Bowen's disease refers to a form of squamous cell carcinoma in situ of the penile shaft. Phimosis refers to the condition in which the foreskin is constricted so that it cannot be retracted over the glans. Priapism refers to an uncontrolled, persistent erection of the penis occurring from either neural or vascular causes.
Nursing students are reviewing information about the reproductive system and normal age-related changes. They demonstrate understanding of the topic when they identify which of the following as occurring? Secretions of the prostate gland increase. Plasma testosterone levels decrease. Spermatogenesis drops significantly Testes become heavier in weight.
Plasma testosterone levels decrease. With aging, plasma testosterone levels decrease, prostatic secretions increase, testes decrease in weight, and spermatogenesis continues.
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? Prostate biopsy Cystoscopy DRE PSA
Prostate biopsy 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.
A patient is scheduled for a transurethral resection (TUR). The nurse is aware that a disadvantage of this surgical approach is: Increased hemorrhage from the prostatic venous plexus. A high incidence of impotence. Possible damage to the external sphincter. Recurrent urethral obstruction.
Recurrent urethral obstruction. There are six operative procedures for prostatic disorders. Recurrent urethral obstruction is a disadvantage of a TUR or TURP. The other disadvantages refer to other surgeries. Refer to Table 34-4 in the text.
Which of the following herbal remedies is used to treat symptoms of benign prostatic hypertrophy (BPH)? Ginkgo Green tea Garlic Saw palmetto
Saw palmetto Saw palmetto is an herbal product used to treat symptoms associated with BPH.
A patient comes to the emergency department and tells the nurse, "I took a pill to help me perform and then passed out." The nurse is assessing the patient and finds a nitroglycerin patch on his back. What is the first intervention the nurse must perform? Start an IV. Administer atropine 0.5 mg. Ask the patient to obtain a urine specimen. Take the patient's blood pressure.
Take the patient's blood pressure. Based on the patient's comments, he is most likely taking a phosphodiesterase type 5 (PDE-5) inhibitor, which is an oral medication used to treat erectile dysfunction. The most common side effects of this medication include headache, flushing, dyspepsia, diarrhea, nasal congestion, and lightheadedness. These agents are contraindicated in men who take organic nitrates (e.g., isosorbide [Isordil], nitroglycerin), because taken together, these medications can cause side effects such as severe hypotension.
Students preparing for a test are reviewing the structure and function of the reproductive system. They demonstrate understanding of the material when they identify which of the following as the site of spermatogenesis? Vas deferens Prostate gland Seminal vesicles Testes
Testes The testes are responsible for producing sperm (spermatogenesis). The vas deferens are the tubes that carry the sperm from the testicles and epididymis to the seminal vesicles, which acts as the reservoir for testicular secretions. The prostate gland produces a secretion that is chemically and physiologically suitable to the needs of the sperm in their passage from the testes.
A client comes to the emergency department reporting severe testicular pain that started about 1 hour ago. Examination reveals a thickened spermatic cord, an elevated testis, and testicular tenderness. The nurse would interpret these findings to suggest which of the following? Epididymitis Testicular torsion Orchitis Testicular cancer
Testicular torsion Testicular torsion is manifested by student pain in the testicle, usually developing over 1 to 2 hours, accompanied by swelling of the scrotum, testicular tenderness, elevated testis, thickened spermatic cord, and a swollen, painful scrotum. Epididymitis is manifested by low-grade fever, chills, and heaviness in the affected testicle developing over 1 to 2 days. Orchitis is manifested by fever, pain, tenderness in one or both testicles, testicular swelling, penile discharge, blood in the semen, and leukocytosis. It is common after an episode of mumps. Testicular cancer is manifested by a lump or mass on the testicle and usually painless enlargement of the testis that appears gradually.
When developing an educational program for a group of adolescents about sexually transmitted infections (STIs), what should the nurse inform the group about the single greatest risk factor for contracting an STI? The type of contraception used The number of times the person has contact with a partner The number of sexual partners Where the patient lives
The number of sexual partners The single greatest risk factor for contracting an STI is the number of sexual partners. As the number of partners increases, so does the risk of exposure to a person infected with an STI.
Which therapy uses low-level radiofrequencies to produce localized heat that destroys prostate tissue? Microwave thermotherapy Resection Saw palmetto Transurethral needle ablation
Transurethral needle ablation Transurethral needle ablation uses low-level radiofrequencies to produce localized heat that destroys prostate tissue while sparing the urethra, nerves, muscles, and membranes. Sal palmetto is a herbal product used to treat the symptoms associated with benign prostatic hyperplasia. Microwave thermotherapy involves the application of heat to the prostatic tissue. Resection of the prostate can be performed with ultrasound guidance.
A client is to undergo a TURP for BPH. Which statement is accurate with regard to a TURP? It is done on an outpatient basis. Urethral strictures are more frequent for TURP than for nontransurethral procedures. There is no danger of retrograde ejaculation. A TURP causes erectile dysfunction.
Urethral strictures are more frequent for TURP than for nontransurethral procedures. Urethral strictures are more frequent for TURP than with nontransurethral procedures. TURP rarely causes erectile dysfunction. It requires an overnight stay. There is danger of retrograde ejaculation.
The nurse is reviewing a client's medication and health history. Which assessment finding would cause the nurse to question the client's new prescription for the phosphodiesterase inhibitor sildenafil? Use of nitrates Type 2 diabetes Use of diuretics History of hypertension
Use of nitrates PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa via vasodilation of the blood vessels. If a client is using nitrates (which also exhibit vasodilation) hypotension is likely to occur. History of hypertension and diabetes does not interfere with the administration of PDE5 inhibitors. Use of diuretics is not significant.
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate? Use sterile technique when irrigating the catheter. Prepare to remove the catheter. Restrict fluids to prevent the client's bladder from becoming distended. Tell the client to try to urinate around the catheter to remove blood clots.
Use sterile technique when irrigating the catheter. If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.
The nurse is caring for client who has had a vasectomy. Which would be most important to include in a teaching plan for this client? Resuming sexual activity in 24 to 48 hours Taking a prescribed opioid analgesic for pain relief Applying warm compresses to the scrotum for the first 24 hours Using a reliable method of contraception for several weeks.
Using a reliable method of contraception for several weeks. It may take several weeks or more after surgery before the ejaculatory fluid is free of sperm, and the client is informed to use a reliable method of contraception until sperm no longer are present. The client should apply ice packs to the scrotum to reduce swelling and use a mild analgesic such as aspirin or acetaminophen for pain relief. The client typically can resume sexual activity when comfortable, usually in 1 week.
Which of the following would be most important to include in a teaching plan for a client who has had a vasectomy? Taking a prescribed opioid analgesic for pain relief. Applying warm compresses to the scrotum for the first 24 hours. Using a reliable method of contraception for several weeks. Resuming sexual activity in 24 to 48 hours.
Using a reliable method of contraception for several weeks. It may take several weeks or more after surgery before the ejaculatory fluid is free of sperm, and the client is informed to use a reliable method of contraception until sperm no longer are present. The client should apply ice packs to the scrotum to reduce swelling and use a mild analgesic such as aspirin or acetaminophen for pain relief. The client typically can resume sexual activity when comfortable, usually in 1 week.
A client comes to the outpatient clinic for information on a vasectomy. Which instruction should be included by the nurse? Following surgery, sexual intercourse should be avoided for 3 months. Vasectomy can result in permanent impotence. Vasectomies should be considered a permanent means of birth control. Postoperative discomfort can be relieved with use of warm sitz baths.
Vasectomies should be considered a permanent means of birth control. Although attempts to reverse a vasectomy have proven successful, a vasectomy should be considered a permanent means of birth control. Scar formation and/or sperm leakage can interfere with restoration of reproductive effectiveness. Sexual intercourse can be resumed when it is comfortable to do so, usually in about 1 week. Postoperative discomfort should be controlled with application of cold to reduce swelling or use of mild analgesics. On occasion, clients have complained of impotence, but vasectomies have no effect on erection or ejaculation.
The nurse monitors a client for symptoms of urethral strictures following a transurethral resection of the prostate (TURP) for the treatment of prostate cancer. Drag words from the choices below to fill in each blank in the following sentence. Client symptoms indicative of this complication that the nurse monitors for following a TURP include ______, _________, and _________.
a weak urinary stream straining dysuria Urethral strictures is a complication that is associated with a transurethral resection of the prostate (TURP) when implemented for the treatment of prostate cancer. Dysuria, which is painful or difficult urination, is a symptom associated with urethral stricture, a complication associated with TURP. Straining to urinate is a symptom associated with urethral stricture, a complication associated with TURP. A weak urine stream is a symptom associated with urethral stricture, a complication associated with TURP. Fever is a symptom indicative of infection, not urethral stricture after a TURP. Although all postoperative clients are at risk for infection, the risk is significantly decreased with this procedure because there is no abdominal incision. Erectile dysfunction is a complication associated with a TURP and many other surgical procedures for prostate cancer; however, this finding is not a symptom of urethral stricture.
A client has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe? narcotic analgesics increased hygienic measures circumcision scrotal support
circumcision Circumcision is recommended to relieve phimosis and paraphimosis permanently.
A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to: sexually transmitted disease. testosterone therapy during childhood. cryptorchidism. early onset of puberty.
cryptorchidism Cryptorchidism (failure of one or both testes to descend into the scrotum) appears to play a role in testicular cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early onset of puberty aren't risk factors for testicular cancer.
A clinical manifestation related to metastasis from prostate cancer is thrombocytopenia. hip pain. weight gain. polyuria.
hip pain. Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, oliguria (decreased urine output), and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.