Chapter 59: Assessment and Management of Problems Related to Male Reproductive Processes

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? DRE PSA Prostate biopsy Cystoscopy

Correct response: 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.

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.

Correct response: 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.

Which of the following is the only definitive way to diagnose testicular cancer? Tissue biopsy Computed tomography of abdomen Ultrasound Lactate dehydrogenase levels

Correct response: Tissue biopsy Explanation: Tissue biopsy is the only definitive way to determine whether cancer is present, and is performed at the time of surgery rather than as a part of the diagnostic workup, to reduce the risk of promoting spread of cancer. A computed tomography scan of the abdomen and pelvis is performed to determine the extent of the disease in the retroperitoneum and pelvis. Lactate dehydrogenase levels and ultrasound examination to determine the presence and size of the testicular mass may also be done.

Which of the following herbal remedies is used to treat symptoms of benign prostatic hypertrophy (BPH)? Saw palmetto Garlic Gingko Green tea

Correct response: Saw palmetto Explanation: Saw palmetto is an herbal product used to treat symptoms associated with BPH.

Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? Age Medication use Sexual history Undescended testicle

Correct response: Medication use Explanation: 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.

Which of the following terms refers to the surgical removal of one of the testes? Orchiectomy Circumcision Vasectomy Hydrocelectomy

Correct response: Orchiectomy Explanation: Orchiectomy is required when the testicle has been damaged. Circumcision is excision of the foreskin, or prepuce, of the glans penis. Vasectomy is the ligation and transection of part of the vas deferens to prevent the passage of the sperm from the testes. Hydrocelectomy describes the surgical repair of a hydrocele, a collection of fluid in the tunica vaginalis.

A client is scheduled for a transurethral rescection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met? A. "I'll have to stay in the hospital for about 3 to 4 days after the surgery." B. "I'll have a small incision on my lower abdomen after the procedure." C. "The surgeon is going to remove the entire prostate gland." D. "The surgeon is going to insert a scope through my urethra to remove a portion of the gland."

Correct response: "The surgeon is going to insert a scope through my urethra to remove a portion of the gland." Explanation: TURP involves the surgical removal of the inner portion of the gland through an endoscope inserted through the urethra. There is no external skin incision. Typically, the procedure is performed in an outpatient setting but may require an overnight hospital stay.

A client is having prostate-specific antigen (PSA) testing done. Which result would the nurse identify as abnormal? 2.7 nanograms/milliliter 3.2 nanograms/milliliter 3.8 nanograms/milliliter 4.6 nanograms/milliliter

Correct response: 4.6 nanograms/milliliter Explanation: Normal prostate-specific antigen (PSA) levels are less than 4.0 nanograms/milliliter (ng/mL). A level of 4.6 ng/mL would be considered abnormal.

Which of the following is inconsistent with a digital rectal examination (DRE)? A. Recommended for men older than 40 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

Correct response: Can reveal a hydrocele Explanation: The 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 health care provider prescribes ketoconazole (Nizoral), a second-line hormonal agent for the treatment of prostatic cancer. The nurse explained to the patient that this drug acts by: A. Decreasing the level of circulating plasma testosterone. B.Interrupting the conversion of dihydrotestosterone (DHT). C. Decreasing the endocrine production of androgen. D. Suppressing androgenic stimuli to the prostate.

Correct response: Decreasing the endocrine production of androgen. Explanation: Nizoral is an adrenal-ablating drug that inhibits enzymes required for the synthesis of androgens.

Which of the following would the nurse expect to find when assessing a client with phimosis? A. Severe edema accompanied by chronic inflammation at the glans penis B. Difficulty cleaning under the foreskin C. Painful swelling of the glans penis and prepuce D. Urinary retention accompanied by burning sensations in the urinary tract

Correct response: Difficulty cleaning under the foreskin Explanation: Clients with phimosis report pain with erection and intercourse and difficulty cleaning under the foreskin. Clients with paraphimosis experience painful swelling of the glans. If the condition continues, severe edema and urinary retention may occur.

A nurse is caring for a client admitted to the unit with a seizure disorder. The client seems upset and asks the nurse, "What will they do to me? I'm scared of the tests and of what they'll find out." The nurse should focus her teaching plans on which diagnostic tests? A. Transesophageal echocardiogram (TEE), troponin levels, and a complete blood count B. EEG, blood cultures, and neuroimaging studies C. X-ray of the brain, bone marrow aspiration, and EEG D.. Electrocardiography, TEE, prothrombin time (PT), and International Normalized Ratio (INR)

Correct response: EEG, blood cultures, and neuroimaging studies Explanation: Physicians use EEG and neuroimaging studies to diagnose neurologic problems. Blood cultures can identify infection that can cause seizures. Electrocardiography, TEE, and troponin levels are cardiac-specific diagnostic tests. X-ray of the brain reveals skeletal condition. Bone marrow aspiration isn't indicated for seizure disorder. PT and INR reflect blood coagulation.

What should a male client older than age 50 do to help ensure early identification of prostate cancer? A. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B. Have a transrectal ultrasound every 5 years. C. Perform monthly testicular self-examinations, especially after age 50. D. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels checked yearly.

Correct response: Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. Explanation: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland because of its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastasis.

When assessing a client with benign prostatic hypertrophy, which of the following would the nurse expect the client to report as the initial complaint? Dark brown urine Increased effort to void Narrowing of urinary stream Nocturia

Correct response: Increased effort to void Explanation: The symptoms of BPH appear gradually. At first, the client notices that it takes more effort to void. Eventually, the urinary stream narrows and has decreased force. The bladder empties incompletely. As residual urine accumulates, the client has an urge to void more often and nocturia occurs.

A client diagnosed with prostate cancer is to receive brachytherapy. Which of the following would the nurse include when discussing this therapy with the client? A. Need for daily treatments over a 7- to 8-week period B. Use of radioactive seeds implanted into the prostate C. Surgical castration to decrease the level of circulating testosterone D. Use of probes inserted using ultrasound to freeze the tissue

Correct response: Use of radioactive seeds implanted into the prostate Explanation: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. External beam radiation therapy (teletherapy) involves the use of radiation treatments, usually 5 days/week over 7 to 8 weeks. Surgical castration is a type of androgen-deprivation therapy. Cryosurgery invovles the insertion of transperineal probes into the prostate to freeze the tissue directly.

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 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.

Correct response: continuous inflow and outflow of irrigation solution. Explanation: 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.