Male Genitalia and Rectum

Which of the following groups has the highest incidence of prostate cancer? African American men Caucasian men Native American men Asian American men

African American men

During a prostate examination, the prostate is noted to have a rubbery or boggy glandular consistency. The nurse recognizes that this is what?

BPH

Which of the following unexpected findings of the testes is most likely to result in painful palpation of the testes? Testicular tumor Klinefelter's syndrome Orchitis Cryptorchidism

Orchitis Explanation: Acute orchitis results in inflamed, painful testes. Cryptorchidism, Klinefelter's syndrome, and testicular tumors are all disorders that are usually painless.

Mr. Jackson, 50 years old, has had discomfort between his scrotum and anus. He also has had some fevers and dysuria. Rectal examination is halted by tenderness anteriorly, but no frank mass is palpable. What is the most likely diagnosis? Prostatitis Colon cancer Prostate cancer Colonic polyp

Prostatitis Explanation: This examination, associated with a history of dysuria, frequency, and incomplete voiding, should lead to a suspicion of acute prostatitis. Prostate cancer, colon cancer, and polyps should not ordinarily cause systemic symptoms such as fever.

The client received in the ICU was shot in the lower abdomen, suffered bladder trauma, and now has a urinary catheter. With these risk factors, what would be an appropriate nursing diagnosis for this client? Risk for infection Risk for urinary retention Ineffective sexuality pattern Risk for urge incontinence

Risk for infection Explanation: Risk for infection is related to inadequate knowledge, urinary reflux, recent trauma, and urinary catheter placement. The other answers are distracters for the question.

The corpora spongiosum extends distally to form the acorn-shaped corona. frenulum. scrotum. glans.

glans.

The nurse is reviewing lifestyle changes with a client who is attempting to reduce the risk for colon and prostate cancer. Which statement by the client requires further follow-up by the nurse? "I am on a high-protein diet that includes red meats." "I have been increasing the fiber in my diet." "I am now abstaining from alcohol." "I have started to finally get my weight under control."

"I am on a high-protein diet that includes red meats." Explanation: The statement, "I am on a high-protein diet that includes red meats," requires further follow-up by the nurse, because a diet high in red meat increases the risk for prostate cancer. The statements, "I have been increasing the fiber in my diet," "I have started to finally get my weight under control," and "I am now abstaining from alcohol," all reflect lifestyle changes that reduce the risk of prostate and colon cancer.

The nurse is assessing a male client complaining of testicular pain. Which symptom helps the nurse determine that the client does not need immediate surgical intervention? Denies urethral irritation. Absence of nausea and vomiting. Temperature 100.4 degrees Fahrenheit. Elevation of affected testicle does not lessen pain.

Absence of nausea and vomiting. Explanation: Testicular torsion requires immediate surgical intervention. The signs of testicular torsion include: acute pain; nausea and vomiting in 50% of clients (nausea and vomiting are rare in epididymitis); rare fever; and urethral irritation. Epididymitis by contrast is characterized by gradual onset of pain; urethral discharge, and fever occurring in 50% of clients.

The nurse is preparing an instructional session for male clients about preventing penile cancer. Which non-modifiable risk factor should the nurse include in the teaching? Sexual promiscuity History of human papilloma virus Age 60 years or older Poor personal hygiene

Age 60 years or older

The exact cause of benign prostatic hypertrophy (BPH) is unknown, but the condition is believed to be associated with what factors? Lifestyle Age-related hormonal changes Environmental factors Diet

Age-related hormonal changes

How should a nurse proceed with palpation of the anus to best facilitate the exam without causing the client undo discomfort? Ask the client to bear down and place the lubricated finger on the anal opening Spread the gluteal folds with the hands and attempt to visualize the anal opening Use the fingertips of one hand because they are the smallest part of the finger Use gentle but firm force to push past the sphincter into the anal canal

Ask the client to bear down and place the lubricated finger on the anal opening Explanation: The nurse should lubricate the index finger of the gloved hand and ask the client to bear down. As the client bears down, place the pad of the index finger on the anal opening. When the sphincter relaxes, insert the finger with the pad facing down. Do not use the fingertip because this may cause the sphincter to tighten and this will cause pain when placed into the rectum. Spread the gluteal folds with the hands and attempt to visualize the anal opening is necessary if the client reports severe pain in order to see if there is a lesion present.

When assessing a client during the physical examination of the genitalia, the nurse palpates the scrotal contents. Which finding should the nurse recognize as an indication that an infection or cysts are present? Beaded or thickened cord Left testicle is slightly lower than the right Smooth, nontender cord Palpable and tortuous veins

Beaded or thickened cord Explanation: A beaded or thickened cord indicates infection or cysts. The presence of palpable and tortuous veins indicates varicocele. A smooth, nontender, and rope-like cord is a normal finding. In most men, one testicle hangs lower than the other; in 65% of males, the left hangs lower than the right.

A 60-year-old coach comes to the clinic complaining of difficulty starting to urinate for the last several months. He believes the problem is steadily getting worse. When asked he says he has a very weak stream, and it feels like it takes 10 minutes to empty his bladder. He also has the urge to go to the bathroom more often than he used to. He denies any blood or sediment in his urine and any pain with urination. He has had no fever, weight gain, weight loss, or night sweats. His medical history includes type 2 diabetes and high blood pressure treated with medications. He does not smoke but drinks a six pack of beer weekly. He has been married for 35 years. His mother died of a myocardial infarction in her 70s, and the client's father is currently in his 80s with high blood pressure and arthritis. Examination reveals a mildly obese alert and cooperative man. His blood pressure is 130/70 with a heart rate of 80. He is afebrile, and his cardiac, lung, and abdominal examinations are normal. Visualization of the anus shows no inflammation, masses, or fissures. Digital rectal examination reveals a smooth, enlarged prostate. No discrete masses are felt. There is no blood on the glove. An analysis of the urine shows no red blood cells, white blood cells, or bacteria. What disorder of the anus, rectum, or prostate is most likely? Prostate cancer Benign prostatic hyperplasia (BPH) Prostatitis Anorectal cancer

Benign prostatic hyperplasia (BPH) Explanation: BPH becomes more prevalent during the fifth decade and is often associated with hesitancy in starting a stream, decreased strength of stream, nocturia, and leaking of urine. On examination an enlarged, symmetrical, firm prostate is palpated. The anterior lobe cannot be felt. These clients may also develop UTIs secondary to their obstruction.

The nurse is palpating the prostate of a 55-year-old client and finds it to be enlarged, smooth, firm, and slightly elastic, without a median sulcus. Which condition should the nurse most suspect? Benign prostatic hypertrophy Prostate cancer Hydrocele Acute prostatitis

Benign prostatic hypertrophy

A nurse examining a client's external genitalia notices that his scrotum and testes draw up and he shivers. This phenomenon is known as which of the following? Cremasteric reflex Vasovagal reflex Patellar reflex Rooting reflex

Cremasteric reflex Explanation: The scrotum can maintain temperature control because the cremaster muscle is sensitive to changes in temperature. The muscle contracts when too cold, raising the scrotum and testes upward toward the body for warmth (cremasteric reflex). This accounts for the wrinkled appearance of the scrotal skin.

When examining a newborn male infant, the nurse notes that neither testicle is descended. How would the nurse document this finding? Epididymitis Cryptorchidism Orchitis Varicocele

Cryptorchidism Explanation: Absence of a testis in the scrotum suggests cryptorchidism. Epididymitis is an infection of the epididymis. Orchitis is an inflammation of the testes. Varicocele is an abnormal dilation of veins in the spermatic cord.

An adolescent male client is diagnosed with testicular torsion. The nurse should prepare the client for which treatment? Emergency surgery Antibiotic therapy Prostate specific antigen lab work Schedule routine follow-up appointment

Emergency surgery Explanation: Testicular torsion results from faulty anchoring of the testis on the scrotal wall, which enables rotation. The anterior part of the testes rotates medially toward the other testes. Blood supply is impaired, resulting in ischemia and venous engorgement. Because the testis can become gangrenous within a few hours, testicular torsion is considered a surgical emergency.

A client complains of scrotal pain, and the nurse elicits a positive Prehn sign. The nurse would refer the client for treatment of what condition? Epididymitis Scrotal mass Strangulated hernia Tortuous varicocele

Epididymitis Explanation: Passive elevation of the testes with relief of scrotal pain is a positive Prehn's sign indicating epididymitis. Painless nodules may indicate a scrotal mass or tumor. Tenderness and swelling may indicate a strangulated hernia. Palpable tortuous veins suggest a varicocele.

A male in college presents to the health clinic with complaints of fever, malaise, and swelling of the sides of the neck. A blood test confirms the presence of mumps. The nurse should educate the client to report which changes of his genitalia to the health care provider? Clear vesicles that erupt from ulcers Feelings of heaviness and pain in the scrotum Silvery lesion on the glans Red rash on the penis

Feelings of heaviness and pain in the scrotum Explanation: Mumps may cause the onset of orchitis in males, which presents as a heaviness and swelling of the scrotum

A client presents to the health care clinic with reports of black stool. The client denies the ingestion of iron supplements or taking Pepto-Bismol. The nurse recognizes that the black stools could be an indication of what disease process? Lack of bile pigment Cancer of the colon Increased fat content Gastrointestinal bleeding

Gastrointestinal bleeding Explanation: Black stools may indicate gastrointestinal bleeding in this client who has not been receiving iron supplements or taking Pepto-Bismol. Clay-colored stool results from the lack of bile pigment. Yellow stool suggests increased fat content or steatorrhea. Cancer of the rectum or colon may be indicated by blood detected in the stool.

What documentation in a client's history should a nurse recognize as an indication that the client has a normal prostate? Nontender, firm, and slightly tender to palpation Heart shaped, smooth with two distinct lobes Rubbery with two lobes, left slightly larger than the right Slightly tender to palpation but smooth and rubbery

Heart shaped, smooth with two distinct lobes

An adolescent present at the free clinic with a collection of fluid in the tunica vaginalis of the testes. The nurse knows that the term that defines this condition is what? Prostatism Orchitis Cryptorchidism Hydrocele

Hydrocele Explanation: A hydrocele refers to a collection of fluid in the tunica vaginalis of the testes.

During a client's genitourinary exam, the nurse notes that the client's scrotum is enlarged and easily transilluminates. What should the nurse suspect? Hydrocele Hernia Tumor Varicocele

Hydrocele Explanation: Swelling or masses that contain serous fluid, such as hydrocele or spermatocele, light up with a red glow with transillumination. Swellings or masses that are solid, or filled with blood, such as tumors, hernias, or varicocele, do not transilluminate.

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? Sinus infections Hypertension Asthma Lower back pain

Hypertension Explanation: Hypertension may be a contributing factor because some types of antihypertensive agents can reduce a male's ability to achieve or sustain an erection

The nurse caring for a client with a varicocele explains the side effects of this condition. With what disorder is this condition associated? Infertility Epididymitis Undescended testicle Thyroid disorder

Infertility Explanation: A varicocele is an abnormal dilatation of the testicular veins in the scrotum, causing a reflux of blood down to the scrotum when standing or straining. The scrotal temperature is higher than normal because of the blood pooling in the area. Heat impairs spermatogenesis and sperm storage, resulting in a low sperm count and infertility.

A teenage male client comes to the ED with severe left testicular pain and vomiting. Elevation of his left testicle does not lessen the pain. What could these symptoms indicate for this client? Left testicular torsion Testicular cancer Epididymitis Hydrocele

Left testicular torsion

The nurse is presenting a program about sexually transmitted infections, including HIV, to a group of young men. The nurse would include who as the having the highest incidence of HIV infection in the United States? Bisexual individuals Intravenous drug users Men having sex with men Heterosexual partners

Men having sex with men

A nurse teaches a male client how to perform testicular self-examination. The nurse should instruct the client to perform the self-examination at which frequency? Quarterly Weekly Bimonthly Monthly

Monthly

When palpating the prostate, the nurse detects a nontender, rubbery prostate with lateral lobes that are 2.5 cm and heart-shaped. The nurse would interpret this finding as indicating which of the following? Prostatitis Benign hypertrophy Normal prostate Cancer

Normal prostate Explanation: The prostate is normally nontender and rubbery with two lateral lobes that are smooth, 2.5 cm long, and heart shaped. Swelling and tenderness suggest prostatitis. Enlargement of a smooth, firm, slightly elastic prostate suggests benign hypertrophy. A hardened area on the prostate or hard fixed irregular nodules suggest prostate cancer.

A client with which of the following cancers is prone to developing phimosis? Leukemia Testicular Penile Prostate

Penile Explanation: In penile cancer the client is prone to developing phimosis (the foreskin of the penis cannot be pulled back over the glans).

When performing the physical assessment of a client, the nurse notes the presence of a small cyst that contains hair, which is located midline in the sacrococcygeal area and has a palpable sinus tract. How should the nurse document this finding? Pilonidal cyst Anal fissure Perianal abscess External hemorrhoid

Pilonidal cyst Explanation: A pilonidal cyst is a congenital disorder characterized by a small dimple or cyst/sinus that contains hair. External hemorrhoids are usually painless papules below the anorectal junction, caused by varicose veins. Anal fissures are splits in the tissue of the anal canal caused by trauma. Perianal abscess is a cavity of pus, caused by infection in the skin around the anal opening.

A nurse is a preparing to assess a male client's anus and rectum. How should the nurse best prepare the client for this assessment? Position the client in a left side-lying position. Assist the client into the supine position. Ask the client if he is feeling anxious or fearful about the exam. Administer a dose of analgesia 15 minutes before the exam.

Position the client in a left side-lying position. Explanation: The most frequently used position for inspection and palpation of the anus, rectum, and prostate is the left lateral position. This position allows adequate inspection and palpation of the anus, rectum, and prostate (in men) and is usually more comfortable for the client. Pain control should not be necessary. Some men may be anxious or fearful during this exam, but the nurse would not normally raise this possibility unless he or she had reason to believe that the client felt this way.

A nurse prepares a male client for a physical assessment of the external genitalia. Which instruction is appropriate for the nurse to inform the client of before the examination? Ask the client to avoid emptying the bladder Explain that he may need to lie supine Reassure him that it is not unusual to have an erection Request that the client avoid talking

Reassure him that it is not unusual to have an erection

A female nurse is performing a comprehensive assessment on a male client. During assessment of the client's anus, rectum, and prostate gland, the client develops an erection. The client becomes embarrassed and apologizes to the nurse. Reassure the client that this is not an unusual occurrence and continue with the assessment. Inform the client that this kind of behavior is unacceptable. Discontinue the assessment and ask a male nurse to assess the client. Ignore the situation and continue with the assessment.

Reassure the client that this is not an unusual occurrence and continue with the assessment.

Upon examination of the rectum, the nurse notes a red, doughnut-like mass with radiating folds. The nurse suspects which of the following? Rectal prolapse Anorectal fistula Rectal polyp External hemorrhoid

Rectal prolapse Explanation: Bulges of red mucous membrane or red doughnut like mass with radiation folds suggests a rectal prolapse. A small opening in the skin surrounding the anal opening suggests an anorectal fistula. A thrombosed swollen area would suggest an external hemorrhoid. Soft nodules inside the rectum may suggest polyps.

An adult client has sought care because he has a two-day history of stool that is "black like road tar." How should the nurse best respond to this aspect of the client's history? Refer the client to a dietitian for treatment of a possible vitamin deficiency. Refer the client for treatment of a possible gastrointestinal bleed. Encourage the client to increase his intake of fluids and soluble fiber. Tell the client to use an over-the-counter laxative for the next 2 to 3 days.

Refer the client for treatment of a possible gastrointestinal bleed.

The nurse is aware of the heightened risk of urinary tract infections in older males. In order to reduce this risk, the nurse should prioritize which of the following interventions? Encourage the use of intravenous fluids to ensure hydration. Remove urinary catheters as soon as possible. Promote physical activity among older males. Encourage older men to avoid low-pH foods and beverages.

Remove urinary catheters as soon as possible. Explanation: Urinary tract infection (UTI), a type of HAI, accounts for more than 30% of infections reported by acute care hospitals in the United States. Virtually all hospital-associated UTIs are caused by instrumentation of the urinary tract, mainly from indwelling urinary catheters. Prevention of a catheter-acquired urinary tract infection (CAUTI) is a key component of an acute-care hospital's client safety and quality improvement program.

How should the testis feel to the nurse's fingers when performing palpation of the scrotal contents? Select all that apply. Smooth Hard Soft Left larger than right Rubbery Firm

Smooth Firm Rubbery Explanation: The testis should feel smooth, firm, rubbery, mobile, free of nodules, and rather tender to palpation. A hard testicle may be a sign of testicular cancer. The left side of the scrotal sac hangs lower than the right, but the testicles are equal in size.

A nurse is beginning the physical exam of a male client's genitals. The nurse is sitting on a stool in front of the client. Which position would be best to place the client in? Lying supine Sitting Kneeling Standing

Standing

The nurse is assessing the genitalia of an older adult client. What would the nurse document as a normal finding? Testes hanging lower in the scrotum Bulging in the inguinal area Abundant pubic hair Decrease in size of the testes

Testes hanging lower in the scrotum Explanation: In the older adult male, the testes hang lower in the scrotum, the penis becomes smaller, and pubic hair may be gray and sparse

The nurse is teaching a group of student nurses in the lab about male anatomical differences and assessment. Which of the following should be included in the teaching? The prepuce should not be retracted. The scrotum should be covered with non-elastic taut skin. The assessment should be completed in a warm room. The client should raise their arms when assessing the scrotal sac.

The assessment should be completed in a warm room. Explanation: Scrotal examination should occur in a warm room as the sac rises towards the body in colder temperatures.

An older adult client comes to the ED bleeding from the rectum. The client has a history of atrial fibrillation and has had two small strokes. The client is currently taking blood pressure medication and anticoagulation therapy at home. Why might this client need to be hospitalized? All rectal bleeding requires immediate hospitalization The client has had a stroke in the past The client is an older adult The client is on anticoagulation medication

The client is on anticoagulation medication Explanation: The client with rectal bleeding needs rapid assessment. Bleeding associated with anorectal problems can resolve spontaneously or with local pressure. The client undergoing anticoagulation therapy, however, may need hospitalization. The client's history of stroke or being an older adult would not be the deciding factor in hospitalization.

The nurse suspects that a male client may have a hernia. The nurse should further assess the client for bruising at the site. urinary tract infection. bowel sounds at the bulge. cysts at the spermatic cord.

bowel sounds at the bulge. Explanation: Bowel sounds auscultated over the mass indicate the presence of bowel and thus a scrotal hernia.

The prostate gland consists of two lobes separated by the rectovesical pouch. valves of Houston. anorectal junction. median sulcus.

median sulcus. Explanation: The prostate gland consists of two lobes separated by a shallow groove called the median sulcus.

During assessment of an elderly male client, the client tells the nurse that he has had difficulty urinating for the past few weeks. The nurse should refer the client to the physician for possible impotence. prostate enlargement. inguinal hernia. sexually transmitted disease.

prostate enlargement. Explanation: Difficulty urinating may indicate an infection or blockage, including prostatic enlargement.

The nurse is assessing a 12-year-old boy and finds the following: sparse growth of pubic hair, beginning penile enlargement, and beginning textural changes on the scrotum. The nurse would document which Tanner stage? 1 3 2 4

2 Explanation: Tanner stage 2 for males consists of sparse growth and slightly curly pubic hair, slight or no enlargement of the penis, and both the testes and scrotum larger, reddened, and beginning to exhibit textural changes. Tanner stage 1 is characterized by no pubic hair and a penis, testes, and scrotum of the same size and proportion as in childhood. Tanner stage 3 is characterized by darker, coarse curly sparse pubic hair over the symphysis pubis, a larger and longer penis, and continued enlargement of the testes and scrotum. Tanner stage 4 is characterized by coarse, curly pubic hair that does not extend to the medial thighs, increased penile length and width with development of the glans, and continued enlargement of the testes and scrotum with a darkening of the scrotal skin.

An Advanced Practice Nurse is preparing to do a rectal examination on a 77-year-old client. The client complains of pain as soon as the examination begins. What might this client have? Fissures Benign prostatic hyperplasia (BPH) Scrotal enlargement Constipation

Fissures Explanation: Anorectal fissure is a rip in the anal mucosa; it can occur midline or posterior or anterior to the anus. Usually, a fissure is caused by the passage of large hard stool. On observation, a sentinel skin tag may be seen at the lower end of the fissure. Ulcerations may appear at the site. The client has bleeding, pain, and itching. Because the internal sphincter is spastic, anesthesia of the site is necessary for examination.

Which of the following conditions consists of a tight prepuce that, once retracted, cannot be returned? Paraphimosis Balanoposthitis Balanitis Phimosis

Paraphimosis Explanation: This describes paraphimosis. Phimosis describes a foreskin that cannot be retracted. Balanitis involves an inflammation of the glans, whereas balanoposthitis involves inflammation of both the glans and prepuce.

A 45-year-old client with a family history of prostate cancer comes to the clinic for an annual physical examination. The nurse practitioner prepares to perform a focused assessment of the prostate gland to determine enlargement. The client asks the nurse, "What will be included in the prostate assessment?" What is the best response by the nurse? Select all that apply. Transilluminate the scrotum. Inspect stool. Palpate for inguinal and femoral hernia. Perform a digital rectum exam (DRE). Conduct a prostate specific antigen (PSA) test.

Perform a digital rectum exam (DRE). Transilluminate the scrotum. Conduct a prostate specific antigen (PSA) test.

A group of students is reviewing information about the male genitalia in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as external genitalia? Testis Scrotum Spermatic cord Vas deferens

Scrotum Explanation: The external genitalia include the penis and scrotum. The testis, vas deferens, and spermatic cord are internal genitalia

The client tells the nurse that he has little or no interest in sex. He says he is concerned and he knows his wife is unhappy with his lack of libido. What can the nurse tell the client often causes lack of libido? Mental illness Manic episodes Testosterone hypersecretion Side effects of medications

Side effects of medications Explanation: Lack of libido may arise from psychogenic causes such as depression, endocrine dysfunction, or side effects of medications.

Which of the following would be most important for the nurse to remember when performing the physical examination of the anus and rectum? (Select all that apply.) Explain all the steps before beginning. Use gentle finger movements. Perform the steps of the exam quickly. Use adequate lubrication. Watch for nonverbal signs of discomfort.

Use gentle finger movements. Use adequate lubrication. Watch for nonverbal signs of discomfort. Explanation: When performing the physical exam, the nurse should proceed slowly and explain all steps as the nurse proceeds through the exam. The nurse should use gentle movements of the finger and make sure to use adequate lubrication, listening and watching for signs of discomfort and tensing muscles.

While assessing an adult male client, the nurse detects pimple-like lesions on the client's glans. The nurse explains the need for a referral to the client. The nurse determines that the client has understood the instructions when the client says he may have venereal warts. syphilis. herpes infection. gonorrhea.

herpes infection.