Male Reproductive Problems - Lippincotts

The nurse is performing a digital rectal examination. Which of the following finding is a key sign for prostate cancer? 1. A hard prostate, localized or diffuse. 2. Abdominal pain. 3. A boggy, tender prostate. 4. A nonindurated prostate.

1. On digital rectal examination, key signs of prostate cancer are a hard prostate, induration of the prostate, and an irregular, hard nodule. Accompanying symptoms of prostate cancer can include constipation, weight loss, and lymphadenopathy. Abdominal pain usually does not accompany prostate cancer. A boggy, tender prostate is found with infection (e.g., acute or chronic prostatitis).

A physician has ordered amoxicillin 100 P.O. BID (Ampicillin). The nurse should teach the client to: Select all that apply. 1. Drink 2,500 mL of fluids daily. 2. Void frequently, at least every 2 to 3 hours. 3. Take time to empty the bladder completely. 4. Take the last dose of the antibiotic for the day at bedtime. 5. Take the antibiotic with food.

1, 2, 3, 4. Ampicillin may be given with or without food, but the nurse should instruct the client to obtain an adequate fluid intake (2,500 mL) to promote urinary output and to flush out bacteria from the urinary tract. The nurse should also encourage the client to void frequently (every 2 to 3 hours) and empty the bladder completely. Taking the antibiotic at bedtime, after emptying the bladder, helps to ensure an adequate concentration of the drug during the overnight period.

The nurse is teaching a client newly diagnosed with prostate cancer. Which of the following points should be included in the instruction? Select all that apply. 1. Prostate cancer is usually multifocal and slow-growing. 2. Most prostate cancers are adenocarcinoma. 3. The incidence of prostate cancer is higher in African American men, and the onset is earlier. 4. A prostate specific antigen (PSA) lab test greater than 4 ng/mg will need to be monitored. 5. Cancer cells are detectable in the urine.

1, 2, 3, 4. Cancer of the prostate gland is the second-leading cause of cancer death among American men and is the most common carcinoma in men older than age 65. Incidence of prostate cancer is higher in African American men, and onset is earlier. Most prostate cancers are adenocarcinoma. Prostate cancer is usually multifocal, slow-growing, and can spread by local extension, by lymphatics, or through the bloodstream. Prostate-specific antigen (PSA) greater than 4 ng/mg is diagnostic; a free PSA level can help stratify the risk of elevated PSA levels. Metastatic workup may include skeletal x-ray, bone scan, and CT or MRI to detect local extension, bone, and lymph node involvement. The urine does not have prostate cancer cells.

When caring for a client with a history of benign prostatic hypertrophy (BPH), the nurse should do which of the following? Select all that apply. 1. Provide privacy and time for the client to void. 2. Monitor intake and output. 3. Catheterize the client for post void residual urine. 4. Ask the client if he has urinary retention. 5. Test the urine for hematuria.

1, 2, 4, 5. Because of the history of benign prostatic hypertrophy (BPH), the nurse should provide privacy and time for the client to void. The nurse should also monitor intake and output, assess the client for urinary retention, and test the urine for hematuria. It is not necessary to catheterize the client.

The nurse should teach the client with erectile dysfunction (ED) to alter his lifestyle to: 1. Avoid alcohol. 2. Follow a low-salt diet. 3. Decrease smoking. 4. Increase attempts at sexual intercourse.

1. Avoidance of alcohol can improve the out-come of therapy. Alcohol and smoking can affect a man's ability to have and maintain an erection. The client should be encouraged to follow a healthy diet, but no specific diet is associated with improvement of sexual function. The client should cease smoking, not just decrease smoking. Increasing attempts at intercourse without treatment will not facilitate improvement. The client should be reassured that ED is a common problem and that help is available.

A 65-year-old client has been told by the physician that his prostate cancer was graded at stage IIB. The client inquires if this means he is going to die soon. The best response by the nurse is which of the following? 1. "Prostate cancer at this stage is very slow growing." 2. "Prostate cancer at this stage is very fast growing." 3. "Prostate cancer at this stage has spread to the bone." 4. "Prostate cancer at this stage is difficult to predict."

1. Clients who have stage IA or IIB prostate cancer have an excellent survival rate. Prostate cancer is usually slow growing, and many men who have prostate cancer do not die from it. A stage I or II tumor is confined to the prostate gland and has not spread to the extrapelvic region or bone

Although the cause of testicular cancer is unknown, it is associated with a history of: 1. Undescended testes. 2. Sexual relations at an early age. 3. Seminal vesiculitis. 4. Epididymitis.

1. Cryptorchidism (undescended testes) carries a greatly increased risk for testicular cancer. Undescended testes occurs in about 3% of male infants, with an increased incidence in premature infants. Other possible causes of malignancy include chemical carcinogens, trauma, orchitis, and environmental factors. Testicular cancer is not associated with early sexual relations in men, even though cervical cancer is associated with early sexual relations in women. Testicular cancer is not associated with seminal vesiculitis or epididymitis.

A priority nursing diagnosis for the client who is being discharged to home 3 days after transurethral resection of the prostate (TURP) is: 1. Deficient fluid volume. 2. Imbalanced nutrition: Less than body requirements. 3. Impaired tissue integrity. 4. Ineffective airway clearance.

1. Deficient fluid volume is a priority diagnosis because the client needs to drink a large amount of fluids to keep the urine clear. The urine should be almost without color. About 2 weeks after TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the emergency department if at any time the urine turns bright red. The client is not specifically at risk for nutritional problems after TURP. The client is not specifically at risk for impaired tissue integrity because there is no external incision, and the client is not specifically at risk for airway problems because the procedure is done under spinal anesthesia.

CLIENT WITH BENIGN PROSTATIC HYPERTROPHY A 72-year-old male is in the emergency department because he has been unable to void for the past 12 hours. The best method for the nurse to use when assessing for bladder distention in a male client is to check for: 1. A rounded swelling above the pubis. 2. Dullness in the lower left quadrant. 3. Rebound tenderness below the symphysis. 4. Urine discharge from the urethral meatus.

1. The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. This swelling represents the distended bladder rising above the pubis into the abdominal cavity. Dullness does not indicate a distended bladder. The client might experience tenderness or pressure above the symphysis. No urine discharge is expected; the urine flow is blocked by the enlarged prostate.

The primary reason for taping an indwelling catheter laterally to the thigh of a male client is to: 1. Eliminate pressure at the penoscrotal angle. 2. Prevent the catheter from kinking in the urethra. 3. Prevent accidental catheter removal. 4. Allow the client to turn without kinking the catheter.

1. The primary reason for taping an indwelling catheter to a male client so that the penis is held in a lateral position is to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula.

A male client complains of impotence. The nurse examines the client's medication regimen and is aware that a contributing factor to impotence could be: 1. Aspirin. 2. Antihypertensives. 3. Nonsteroidal anti-inflammatory drugs. 4. Anticoagulants.

2. Antihypertensives, especially beta blockers such as propranolol (Inderal), can cause impotence. When a male client complains of impotence, the nurse should always examine his medication regimen as a potential contributing factor. Aspirin,nonsteroidal anti-inflammatory drugs, and anticoagulants do not cause erectile dysfunction.

A client with prostate cancer is treated with hormone therapy consisting of diethylstilbestrol (DES; Stilphostrol), 2 mg daily. The nurse should instruct the client to expect to have: 1. Tenderness of the scrotum. 2. Tenderness of the breasts. 3. Loss of pubic hair. 4. Decreased blood pressure

2. Diethylstilbestrol causes engorgement and tenderness of the breasts (gynecomastia). Stilbestrol is prescribed as palliative therapy for men with androgen-dependent prostatic carcinoma. An increase in blood pressure can occur. Tenderness of the scrotum and dramatic changes in secondary sexual characteristics should not occur.

In discussing home care with a client after transurethral resection of the prostate (TURP), the nurse should teach the male client that dribbling of urine: 1. Can be a chronic problem. 2. Can persist for several months. 3. Is an abnormal sign that requires intervention. 4. Is a sign of healing within the prostate.

2. Dribbling of urine can occur for several months after TURP. The client should be informed that this is expected and is not an abnormal sign. The nurse should teach the client perineal exercises to strengthen sphincter tone. The client may need to use pads for temporary incontinence. The client few months and will not be a chronic problem. Dribbling is not a sign of healing, but is related to the trauma of surgery.

A 65-year-old male client with erectile dysfunction (ED) asks the nurse, "Is all this just in my head? Am I crazy?" The best response by the nurse is based on the knowledge that: 1. ED is believed to be psychogenic in most cases. 2. More than 50% of the cases are attributed to organic causes. 3. Evaluation of nocturnal erections does not help differentiate psychogenic or organic causes. 4. ED is an uncommon problem among men older than age 65.

2. ED is multifactorial in origin, and more than 50% of the cases can be attributed to organic causes, which include alteration in vascular supply, hormonal changes, neurologic dysfunction, medications, and associated systemic diseases, such as diabetes mellitus or alcoholism. The presence of nocturnal erections is the first evaluation to differentiate between organic and psychogenic causes. ED is a common problem among men older than age 65.

CLIENT WITH TESTICULAR DISEASE A 28-year-old male is diagnosed with acute epididymitis. The nurse should assess the client for: 1. Burning and pain on urination. 2. Severe tenderness and swelling in the scrotum. 3. Foul-smelling ejaculate. 4. Foul-smelling urine.

2. Epididymitis causes acute tenderness and pronounced swelling of the scrotum. Gradual onset of unilateral scrotal pain, urethral discharge, and fever are other key signs. Epididymitis is occasionally, but not routinely, associated with urinary tract infection. Burning and pain on urination and foul smelling ejaculate or urine are not classic symptoms of epididymitis.

The primary reason for lubricating the urinary catheter generously before inserting it into a male client is that this technique helps reduce: 1. Spasms at the orifice of the bladder. 2. Friction along the urethra when the catheter is being inserted. 3. The number of organisms gaining entrance to the bladder. 4. The formation of encrustations that may occur at the end of the catheter.

2. Liberal lubrication of the catheter before catheterization of a male reduces friction along the urethra and irritation and trauma to urethral tissues. Because the male urethra is tortuous, a liberal amount of lubrication is advised to ease catheter passage. The female urethra is not tortuous, and, although the catheter should be lubricated before insertion, less lubricant is necessary. Lubrication of the catheter will not decrease spasms. The nurse should use sterile technique to prevent introducing organisms. Crusts will not form immediately. Irrigating the catheter as needed will prevent clot and crust formation.

A client is undergoing a total prostatectomy for prostate cancer. The client asks questions about his sexual function. The best response by the nurse is which of the following? 1. "Loss of the prostate gland means that you will be impotent." 2. "Loss of the prostate gland means that you will be infertile and there will be no ejaculation. You can still experience the sensations of orgasm." 3. "Loss of the prostate gland means that you will have no loss of sexual function and drive." 4. "Loss of the prostate gland means that your erectile capability will return immediately after surgery."

2. Loss of the prostate gland interrupts the flow of semen, so there will be no ejaculation fluid. The sensations of orgasm remain intact. The client needs to be advised that return of erectile capability is often disrupted after surgery, but within 1 year 95% of men have returned to normal erectile function with sexual intercourse.

CLIENT WITH CANCER OF THE PROSTATE The nurse is developing a program about prostate cancer for a health fair. The nurse should provide information about which of the following topics? 1. The Prostate-Specific Antigen (PSA) test is reliable for detecting the presence of prostate cancer. 2. For all men, age 50 and older, the American Cancer Society recommends an annual rectal examination. 3. Avoid lifting more than 20 lb aids in prevention of prostate cancer. 4. Regular sexual activity promotes health of the prostate gland to prevent cancer.

2. Most prostate cancer is adenocarcinoma and is palpable on rectal examination because it arises from the posterior portion of the gland. Although the PSA is not a perfect screening test, the American Cancer Society recommends an annual rectal examination and blood PSA level for all men age 50 and older, or starting at age 40 if African American or if there is family history of prostate cancer. To help achieve optimal sexual function, give the client the opportunity to communicate his concerns and sexual needs. Regular sexual activity does not prevent cancer.

The nurse is assessing a client's testes. Which of the following findings indicate the testes are normal? 1. Soft. 2. Egg-shaped. 3. Spongy. 4. Lumpy.

2. Normal testes feel smooth, egg-shaped, and firm to the touch, without lumps. The surface should feel smooth and rubbery. The testes should not be soft or spongy to the touch. Testicular malignancies are usually nontender, nonpainful hard lumps. Lumps, swelling, nodules, or signs of inflammation should be reported to the physician.

Many older men with prostatic hypertrophy do not seek medical attention until urinary obstruction is almost complete. One reason for this delay in seeking attention is that these men may: 1. Feel too self-conscious to seek help when reproductive organs are involved. 2. Expect that it is normal to have to live with some urinary problems as they grow older. 3. Fear that sexual indiscretions in earlier life may be the cause of their problem. 4. Have little discomfort in relation to the amount of pathology because responses to pain stimuli fade with age.

2. Research shows that older men tend to believe it is normal to live with some urinary problems. As a result, these men often overlook symptoms and simply attribute them to aging. As part of preventive care for men older than age 40, the yearly physical examination should include palpation of the prostate via rectal examination. Prostate specific antigen screening also is done annually to determine elevations or increasing trends in elevations. The nurse should teach male clients the value of early detection and adequate follow-up for the prostate.

The nurse should specifically assess a client with prostatic hypertrophy for which of the following ? 1. Voiding at less frequent intervals. 2. Difficulty starting the flow of urine. 3. Painful urination. 4. Increased force of the urine stream.

2. Signs and symptoms of prostatic hypertrophy include difficulty starting the flow of urine, urinary frequency and hesitancy, decreased force of the urine stream, interruptions in the urine stream when voiding, and nocturia. The prostate gland surrounds the urethra, and these symptoms are all attributed to obstruction of the urethra resulting from prostatic hypertrophy. Nocturia from incomplete emptying of the bladder is common. Straining and urine retention are usually the symptoms that prompt the client to seek care. Painful urination is generally not a symptom of prostatic hypertrophy.

CLIENT WITH ERECTILE DYSFUNCTION The client is taking sildenafil (Viagra) P.O. for erectile dysfunction. The nurse should instruct the client about which of the following? 1. Sildenafil (Viagra) may be taken more than one time per day. 2. The health care provider should be notified promptly if the client experiences sudden or diminished vision. 3. Sildenafil (Viagra) offers protection against some sexually transmitted diseases (STDs). 4. Sildenafil (Viagra) does not require sexual stimulation to work.

2. Sildenafil (Viagra) should not be taken more than once per day. Viagra offers no protection against sexually transmitted diseases. Viagra has no effect in the absence of sexual stimulation. The client should notify his health care provider promptly if he experiences sudden or decreased vision loss in one or both eyes.

Risk factors associated with testicular malignancies include: 1. African-American race. 2. Residing in a rural area. 3. Lower socioeconomic status. 4. Age older than 40 years.

2. The incidence of testicular cancer is higher in men who live in rural rather than suburban areas. Testicular cancer is more common in white than black men. Men with higher socioeconomic status seem to have a greater incidence of testicular cancer. The exact cause of testicular cancer is unknown. Cancer of the testes is the leading cause of death from cancer in the 15- to 35-year-old age group.

A right orchiectomy is performed on a client with a testicular malignancy. The client expresses concerns regarding his sexuality. The nurse should base the response on the knowledge that the client: 1. Is not a candidate for sperm banking. 2. Should retain normal sexual drive and function. 3. Will be impotent. 4. Will have a change in secondary sexual characteristics.

2. Unilateral orchiectomy alone does not result in impotence if the other testis is normal. The other testis should produce enough testosterone to maintain normal sexual drive, functioning, and characteristics. Sperm banking before treatment is commonly recommended because radiation or chemotherapy can affect fertility.

A client diagnosed with seminomatous testicular cancer expresses fear and questions the nurse about his prognosis. The nurse should base the response on the knowledge that: 1. Testicular cancer is almost always fatal. 2. Testicular cancer has a cure rate of 90% when diagnosed early. 3. Surgery is the treatment of choice for testicular cancer. 4. Testicular cancer has a 50% cure rate when diagnosed early.

2. When diagnosed early and treated aggressively, testicular cancer has a cure rate of about 90%. Treatment of testicular cancer is based on tumor type, and seminoma cancer has the best prognosis. Modes of treatment include combinations of orchiectomy, radiation therapy, and chemotherapy. The chemotherapeutic regimen used currently is responsible for the successful treatment of testicular cancer.

When a client is receiving hormone replacement for prostate cancer, the nurse should do which of the following? Select all that apply. 1. Inform the client that increased libido is expected with hormone therapy. 2. Reassure the client and his significant other that erectile dysfunction will not occur as a consequence of hormone therapy. 3. Provide the client the opportunity to communicate concerns and needs. 4. Utilize communication strategies that enable the client to gain some feeling of control. 5. Suggest that an appointment be made to see a psychiatrist.

3, 4. Hormone manipulation deprives tumor cells of androgens or their by-products and, thereby, alleviates symptoms and retards disease progression. Complications of hormonal manipulation include: hot flashes, nausea and vomiting, gynecomastia, and sexual dysfunction. As part of supportive care, provide explanations of diagnostic tests and treatment options and help the client gain some feeling of control over his disease and decisions related to it. To help achieve optimal sexual function, give the client the opportunity to communicate his concerns and sexual needs. Inform the client that decreased libido is expected after hormonal manipulation therapy, and that impotence may result from some surgical procedures and radiation. A psychiatrist is not needed.

When teaching a client to perform testicular self-examination, the nurse explains that the examination should be performed: 1. After intercourse. 2. At the end of the day. 3. After a warm bath or shower. 4. After exercise.

3. After a warm bath or shower, the testes hang lower and are both relaxed and in the ideal position for manual evaluation and palpation.

A 20-year-old client is being treated for epididymitis. Teaching for this client should include the fact that epididymitis is commonly a result of a: 1. Virus. 2. Parasite. 3. Sexually transmitted infection. 4. Protozoon.

3. Among men younger than age 35, epididymitis is most frequently caused by a sexually transmitted infection. Causative organisms are usually chlamydia or Neisseria gonorrhoeae. The other major form of epididymitis is bacterial, caused by the Escherichia coli or Pseudomonas organisms. The nurse should always include safe sex teaching for a client with epididymitis. The client should also be is a mode of transmission of gram-negative rods to the epididymis.

A client with a testicular malignancy undergoes a radical orchiectomy. In the immediate postoperative period the nurse should particularly assess the client for: 1. Bladder spasms. 2. Urine output. 3. Pain. 4. Nausea.

3. Because of the location of the incision in the high inguinal area, pain is a major problem during the immediate postoperative period. The incisional area and discomfort caused by movement contribute to increased pain. Bladder spasms and elimination problems are more commonly associated with prostate surgery. Nausea is not a priority problem.

The nurse is reviewing the medication history of a client with benign prostatic hypertrophy (BPH). Which medication will likely aggravate BPH? 1. Metformin (Glucophage). 2. Buspirone (BuSpar). 3. Inhaled ipratropium (Atrovent). 4. Ophthalmic timolol (Timoptic).

3. Ipratropium is a bronchodilator, and its anticholinergic effects can aggravate urine retention. Metformin and buspirone do not affect the urinary system; timolol does not have a systemic effect.

A client asks the nurse why the prostate specific antigen (PSA) level is determined before the digital rectal examination. The nurse's best response is which of the following? 1. "It is easier for the client." 2. "A prostate examination can possibly decrease the PSA." 3. "A prostate examination can possibly increase the PSA." 4. "If the PSA is normal, the client will not have to undergo the rectal examination."

3. Manipulation of the prostate during the digital rectal examination may falsely increase the PSA levels. The PSA determination and the digital rectal examination are both necessary as screening tools for prostate cancer, and both are recommended for all men older than age 50. Prostate cancer is the most common cancer in men and the second leading killer from cancer among men in the United States. Incidence increases sharply with age, and the disease is predominant in the 60- to 70-year-old age-group.

During a client's urinary bladder catheterization, the nurse ensures that the bladder is emptied gradually. The best rationale for the nurse's action is that completely emptying an over-distended bladder at one time tends to cause: 1. Renal failure. 2. Abdominal cramping. 3. Possible shock. 4. Atrophy of bladder musculature.

3. Rapid emptying of an over-distended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000mL at one time was the standard of practice, but this is no longer thought to be necessary as long as the over-distended bladder is emptied slowly.

A client with benign prostatic hypertrophy (BPH) has an elevated prostate-specific antigen (PSA) level. The nurse should? 1. Instruct the client to have a colonoscopy before coming to conclusions about the PSA results. 2. Instruct the client that a urologist will monitor the PSA level biannually when elevated. 3. Determine if the prostatic palpation was done before or after the blood sample was drawn. 4. Ask the client if he emptied his bladder before the blood sample was obtained.

3. Rectal and prostate examinations can increase serum PSA levels; therefore, instruct the client that a manual rectal examination is usually part of the test regimen to determine prostate changes. The prostatic palpation should be done after the blood sample is drawn. The PSA level must be monitored more often than biannually when it is elevated. Having a colonoscopy is not related to the findings of the PSA test. It is not necessary to void prior to having PSA blood levels tested.

A client with benign prostatic hypertrophy (BPH) is being treated with terazosin (Hytrin) 2 mg at bedtime. The nurse should monitor the client's: 1. Urine nitrites. 2. White blood cell count. 3. Blood pressure. 4. Pulse.

3. Terazosin is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or orthostatic hypotension. The client should be instructed to change positions slowly. Urine nitrates, white blood cell count, and pulse rate are not affected by terazosin.

A client underwent transurethral resection of the prostate (TURP), and a large three-way indwelling urinary catheter was inserted in the bladder with continuous bladder irrigation. In which of the following circumstances should the nurse increase the flow rate of the continuous bladder irrigation? 1. When drainage is continuous but slow. 2. When drainage appears cloudy and dark yellow. 3. When drainage becomes bright red. 4. When there is no drainage of urine and irrigating solution.

3. The decision by the surgeon to insert a catheter after TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so that clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindicated when there is no return of urine and irrigating solution.

A nursing assistant tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that isn't possible because he has a catheter in place that is draining well." Which of the following responses would be most appropriate for the nurse to make? 1. "His catheter is probably plugged. I'll irrigate it in a few minutes." 2. "That's a common complaint after prostate surgery. The client only imagines the urge to void." 3. "The urge to void is usually created by the large catheter, and he may be having some bladder spasms." 4. "I think he may be somewhat confused."

3. The indwelling urinary catheter creates the urge to void and can also cause bladder spasms. The nurse should ensure adequate bladder emptying by monitoring urine output and characteristics. Urine output should be at least 50 mL/hour. A plugged catheter, imagining the urge to void, and confusion are less likely reasons for the client's complaint.

A client has a testicular nodule that is highly suspicious for testicular cancer. A laboratory test that supports this diagnosis is: 1. Decreased alpha fetoprotein (AFP). 2. Decreased beta-human chorionic gonadotropin (hCG). 3. Increased testosterone. 4. Increased AFP.

4. AFP and hCG are considered markers that indicate the presence of testicular disease. Elevated AFP and hCG and decreased testosterone are markers for testicular disease. Measurements of AFP, hCG, and testosterone are also obtained throughout the course of therapy to help measure the effectiveness of treatment.

A client is to receive belladonna and opium suppositories, as needed, postoperatively after transurethral resection of the prostate (TURP). The nurse should give the client these drugs when he demonstrates signs of: 1. A urinary tract infection. 2. Urine retention. 3. Frequent urination. 4. Pain from bladder spasms.

4. Belladonna and opium suppositories are prescribed and administered to reduce bladder spasms that cause pain after TURP. Bladder spasms frequently accompany urologic procedures. Antispasmodics offer relief by eliminating or reducing spasms. Antimicrobial drugs are used to treat an infection. Belladonna and opium do not relieve urine retention or urinary frequency.

The nurse is caring for a client who will have a bilateral orchiectomy. The client asks what is involved with this procedure. The nurse's most appropriate response would be? "The surgery: 1. Removes the entire prostate gland, prostatic capsule, and seminal vesicles." 2. Tends to cause urinary incontinence and impotence." 3. Freezes prostate tissue, killing cells." 4. Results in reduction of the major circulating androgen, testosterone."

4. Bilateral orchiectomy (removal of testes) results in reduction of the major circulating androgen, testosterone, as a palliative measure to reduce symptoms and progression of prostate cancer. A radical prostatectomy (removal of entire prostate gland, prostatic capsule, and seminal vesicles) may include pelvic lymphadenectomy. Complications include urinary incontinence, impotence, and rectal injury with the radical prostatectomy. Cryosurgery freezes prostate tissue, killing tumor cells without prostatectomy.

A client is scheduled to undergo transurethral resection of the prostate. The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should assess the client for: 1. Seizures. 2. Cardiac arrest. 3. Renal shutdown. 4. Respiratory paralysis.

4. If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Seizures, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.