CH 59

An client with a history of hypertension is being seen by the urologist due to erectile dysfunction. Results from the client's nocturnal penile tumescence test measured several spontaneous erections while the client slept. What does this indicate?

psychological etiology Explanation: Evidence of spontaneous erections during sleep but erectile dysfunction in a waking state suggests a psychological etiology.

A nurse is instructing a client in testicular self-examination. Which client statement indicates the need for additional teaching?

"I should do this exam at least once a week." Explanation: Testicular self-examination is performed monthly, preferably when warm, such as in the shower. The client should place his thumb on top and his middle and index fingers under the testis. It is normal for one testis to be larger than the other.

A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)?

"I've had trouble getting started when I urinate, often straining to do so." Explanation: Symptoms that might alert the nurse to BPH include difficulty initiating urination and abdominal straining with urination. Although fever, urinary frequency, nocturia, pelvic pain, nausea, vomiting, and fatigue may be noted, they also may suggest other conditions such as urinary tract infection. Fever, nausea, vomiting, and fatigue are general symptoms that can accompany many conditions.

The nurse is demonstrating the technique for performing a testicular self examination (TSE) to a group of men for a company health fair. One of the men asks the nurse at what age a man should begin performing TSE. What is the best answer by the nurse?

"It should begin in adolescence." Explanation: TSE should begin during adolescence.

The nurse is teaching a young adult male how to perform testicular self-examination (TSE). The nurse determines that the client has understood the instructions when he states which of the following?

"The best time to do it is once a month after I take my warm morning shower." Explanation: TSE is to be performed monthly, usually after a warm bath or shower when the scrotum is more relaxed. Both hands are used to palpate the testis. The index and middle fingers are placed under the testis and the thumb is placed on top. The testis is rolled gently in a horizontal plane between the thumb and fingers. A cordlike structure on the top and back of the testicle is the epididymis. This is normal and does not need to be reported.

A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met?

"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 with erectile dysfunction is prescribed sildenafil (Viagra). Which of the following would the nurse include in the teaching plan for this client?

"You may experience headache and some flushing with this drug." Explanation: Sildenafil (Viagra) may cause headache, flushing, dyspepsia, diarrhea, nasal congestion, and lightheadedness. It is taken 30 minutes to 4 hours before sexual activity. It can be taken more than once a day, but doing so will not increase its effect. It should be taken only when the client wants to have intercourse, to a maximal dose of 100 mg/24 hours. The drug may cause low blood glucose levels and abnormal liver function tests.

Several male clients are scheduled to come to the clinic for an annual physical examination. The nurse would expect to prepare which client for a digital rectal examination (DRE)?

A 52-year-old man in good health Explanation: DRE is used to screen for prostate cancer and is recommended annually for every man older than 50 years or those 45 years old at high risk (African-American men and men with a strong family history of prostate cancer). Therefore, a DRE would be most likely for the 52-year-old client. A DRE would not necessarily be done for the other clients, even with their history of other underlying conditions.

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 Explanation: Alpha-adrenergic blockers relax the smooth muscle of the bladder neck and prostate, improving urine flow and relieving BPH symptoms.

Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer?

Brachytherapy Explanation: 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.

A client with Stage IV prostate cancer is to receive hormone therapy. The nurse would inform the client about possible adverse effects including which of the following?

Breast tenderness Explanation: Feminizing side effects occur with hormone therapy. The client's voice may become higher, hair and fat distribution may change, and breasts may become tender and enlarged. Libido and potency also are diminished.

Which age-related change affects the male reproductive system?

Decreased plasma testosterone levels Explanation: Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.

Which component of client teaching helps the nurse assist a client following treatment for cancer of the prostate gland to manage and minimize the possibility of a recurrence of the primary cancer or metastasis?

Have regular prostate-specific antigen (PSA) levels tested and repeat lymph node biopsies. Explanation: Regular monitoring of PSA levels after treatment aids in the early detection of cancer recurrence or metastasis. Repeat lymph node biopsies may be part of the surgical follow-up. Cancer cells are spread via the lymphatic system. Exercise routines and avoiding sexual intercourse are not known to have any role in recurrence of the primary cancer or metastasis.

Which of the following may result if prostate cancer invades the urethra or bladder?

Hematuria Explanation: Hematuria may result if the cancer invades the urethra or bladder. Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, and oliguria.

The nurse is preparing a presentation for a local community group about prostate cancer and possible dietary risk factors. Which of the following would the nurse most likely include?

High-fat diet Explanation: Although the cause of prostatic cancer is unknown, there seems to be a relationship with increased testosterone levels and a diet high in fat. No other dietary links have been suggested.

Which statement is accurate regarding sildenafil?

Its side effects include headache, flushing, and dizziness. Explanation: 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.

Which of the following should nurses teach all men, especially those who have had cryptorchidism?

How to perform a testicular self-examination. Explanation: The nurses should teach all men, especially those who have had cryptorchidism, to perform testicular self-examination to detect any abnormal mass in the scrotum. The nurse instructs the clients to examine the testicles monthly, preferably when warm, such as in the shower. Having regular PSA levels, lymph node biopsies, and blood tests for measuring serum acid phosphatase are for the clients who are treated for prostrate cancer.

A health care provider prescribed a luteinizing hormone-releasing hormone (LHRH) agonist to suppress testicular androgen and treat prostate cancer. Which medication is the primary drug of choice?

Lupron Explanation: Lupon is an LHRH agonist. The other three choices are antiandrogen receptor antagonists.

Which term refers to the surgical removal of one or both testes?

Orchiectomy Explanation: 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 elderly client, the nurse is unable to replace the retracted foreskin of the penis. Which is the most likely outcome?

Painful swelling Explanation: 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 preparing a discharge teaching plan for a client who has had a prostatectomy. Which of the following would be appropriate to include?

Performing perineal exercises frequently throughout the day Explanation: After a prostatectomy, the client should be instructed in how to perform perineal exercises and to perform them hourly throughout the day, each day. In addition, the client should avoid bearing down (straining) to urinate because of the increased risk for hematuria. He should also avoid strenuous exercise, which increases the tendency to rebleed. The client should be instructed to urinate as soon as he feels the first urge to do so.

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?

Peyronie's disease Explanation: 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.

Which is an age-related change affecting the male reproductive system?

Plasma testosterone levels decrease. Explanation: Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.

A nurse is teaching a client about a circumcision. Which external reproductive structure is removed by circumcision?

Prepuce Explanation: In an uncircumcised male, the prepuce, sometimes referred to as the foreskin, that covers the glans is removed by circumcision. The glans is the rounded head of the penis. The corpora cavernosa is erectile tissue. The mons pubis is fatty tissue near the pubic bones.

A client expresses concerns about future reproduction after a surgery to correct the cancer of the testes. For this client, treatment proceeded without first collecting and storing sperm. Which alternative should the nurse suggest to the client?

Suggest donor insemination or adoption Explanation: For a client after a surgery to correct cancer of the testes and for whom treatment had proceeded without first collecting and storing sperm, the nurse explains other pregnancy options, such as donor insemination or adoption. Reversal of surgery is not possible for testicular cancer. In addition, undertaking herbal alternatives should not be advised by the nurse. Sildenafil would not enhance that chance of that this client could cause a woman to become pregnant.

A patient is having a DRE in the physician's office and the nurse is to assist in the examination. What can the nurse instruct the client to do to decrease the discomfort from the exam?

Take a deep breath and exhale when the physician inserts a gloved finger into the rectum. Explanation: To minimize discomfort and relax the anal sphincter during the digital rectal examination, the patient is instructed to take a deep breath and exhale slowly as the practitioner inserts a finger. If possible, he should turn his feet inward so his toes are touching.

Which instruction regarding future sexual activity should a nurse give a client with a vasectomy?

Use a reliable method of contraception until the physician ensures that sperm are no longer present. Explanation: For a client with a vasectomy, the nurse advises the client to use a reliable method of contraception until the physician ensures that sperm are no longer present, which may be determined after 10 or more ejaculations. The client should resume sexual activity when comfort allows, usually in 1 week. Administer a mild analgesic, such as aspirin or acetaminophen, for discomfort, not before the sexual activity. The client should expect some bruising and incisional soreness after the local anesthetic wears off.

Following a vasectomy, which is the most important instruction to provide to the client?

Use another form of birth control until further notice. Explanation: It may take up to 10 ejaculations to clear sperm and prevent impregnation. The client should be instructed to use another form of reliable birth control until a sperm count proves sterility has occurred. Use of Tylenol, scrotal support, and rest are all helpful during the initial recovery period.

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BPH)?

Voiding pattern Explanation: The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.

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:

cryptorchidism. Explanation: 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 client has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe?

circumcision Explanation: Circumcision is recommended to relieve phimosis and paraphimosis permanently.

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:

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.

Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically address testicular cancer risk, a nurse should modify client teaching for male clients to include:

testicular self-examination. Explanation: Testicular self-examination is a relatively simple technique that's extremely useful in detecting cancer-related testicular changes. Physician visits, risk factors, and family history are important to all clients, regardless of gender, and don't specifically address risk factors associated with testicular cancer.

A patient is having brachytherapy for the treatment of prostate cancer and asks the nurse if he can have sexual intercourse after radiation therapy is completed. What is the best response by the nurse?

"You must be sure to use a condom for 2 weeks after implantation and then it will no longer be necessary." Explanation: Two major forms of radiation therapy are used to treat cancer of the prostate: teletherapy (external) and brachytherapy (internal). Brachytherapy (internal implants) involves the implantation of interstitial radioactive seeds under anesthesia. Radiation safety guidelines include straining urine for seeds and using a condom during sexual intercourse for 2 weeks after implantation to catch any seeds that pass through the urethra.

A patient is scheduled for a transurethral resection (TUR). The nurse is aware that a disadvantage of this surgical approach is:

Recurrent urethral obstruction. Explanation: 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.

The nurse is reviewing the medical record of a client who has been diagnosed with prostate cancer. The nurse notes that the Gleason score was used to grade the cancer. Which total score would the nurse interpret as indicating a highly aggressive cancer?

9 Explanation: The Gleason score is the most commonly used tumor grading system which assigns two scores with a combined value ranging from 2 to 10. With each increase in Gleason score, there is an increase in tumor aggressiveness. High Gleason scores indicate more aggressive cancer. A total score of 8 to 10 indicate a high-grade cancer.

After teaching a group of student about structural abnormalities of the male reproductive system, the instructor determines that the teaching was successful when the students identify which of the following as an example?

Cryptorchidism Explanation: Structural abnormalities include cryptorchidism, torsion of the spermatic cord, phimosis, paraphimosis, hydrocele, spermatocele, and varicocele. Erectile dysfunction and priapism are erection disorders. Prostatitis is an infectious disorder.

A patient is planning to use a negative-pressure (vacuum) device to maintain and sustain an erection. What should the nurse caution the patient about with the use of this device?

Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. Explanation: Negative-pressure (vacuum) devices may also be used to induce an erection. A plastic cylinder is placed over the flaccid penis, and negative pressure is applied. When an erection is attained, a constriction band is placed around the base of the penis to maintain the erection. To avoid penile injury, the patient is instructed not to leave the constricting band in place for longer than 1 hour.

A client is receiving leuprolide as part of his treatment for prostate cancer. The nurse would be alert for which of the following as a possible adverse effect?

Gynecomastia Explanation: Adverse effects associated with leuprolide, a luteinizing hormone-releasing hormone agonist, are related to hypogonadism and include vasomotor flushing, loss of libido, decreased bone density, anemia, fatigue, increased fat mass, decreased muscle mass, gynecomastia, and mastodynia (breast/nipple tenderness).

A 65-year-old man 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?

Hyperplasia of the prostate gland Explanation: 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.

When assessing a client with benign prostatic hyperplasia, which of the following would the nurse expect the client to report as the initial complaint?

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.

Nursing students are reviewing information about the male reproductive system and normal age-related changes. They demonstrate understanding of the topic when they identify which of the following as occurring?

Plasma testosterone levels decrease. Explanation: With aging, plasma testosterone levels decrease, prostatic secretions increase, testes decrease in weight, and spermatogenesis continues.

A client comes to the emergency department complaining of sudden, sharp testicular pain. Further examination reveals torsion of the spermatic cord. Which of the following would the nurse expect to do next?

Prepare the client for surgery Explanation: For the client with torsion, immediate surgery is necessary to prevent atrophy of the spermatic cord and preserve fertility. Analgesics would be given preoperatively. Postoperatively, a scrotal support is applied and dressings are inspected for drainage. Circumcision is done to relieve phimosis or paraphimosis.

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make?

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 term refers to a failure of one or both or both of the testes to descend into the scrotum?

Cryptorchidism Explanation: 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 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?

Evaluating patency of the drainage lumen Explanation: 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.

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 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.

Which nursing diagnoses may be appropriate for a client with prostate cancer? Select all that apply.

Sexual dysfunction Anxiety Readiness for enhanced knowledge Explanation: Urinary retention, fear, anxiety, sexual dysfunction, pain, and readiness for enhanced knowledge are all nursing diagnoses that could be used for a client with prostate cancer. Some clients may experience spiritual distress; however, spiritual distress is not present in all clients with prostate cancer. Clients with prostate cancer may experience nutritional imbalance with less-than-body requirements.

During a physical examination, the nurse inspects the external genitalia of a male client. Which of the following would the nurse identify as an abnormality?

Skin lesions Explanation: During a physical examination, the nurse inspects the external genitalia, looking for abnormalities such as skin lesions and urethral discharge. Prepuce covering the glans penis is a normal finding in an uncircumcised male. The scrotum is normally pendulous, and with increasing age, it becomes more pendulous.

A client is undergoing treatment for prostate cancer. He has chemotherapy sessions regularly. However, of late he is showing symptoms of food allergy and loss of appetite. He has lost considerable weight as a result. Which is an appropriate nursing task in this situation?

Ask the client to keep a diet diary. Explanation: The appropriate nursing task in this situation is to assess the amount of food eaten. This assessment will help determine nutrient intake. The nurse should ensure adequate fluid hydration before, during, and after drug administration when the client has side effects of nausea and vomiting. Administration of fruits is not recommended when the client is at risk of infection, such as during chemotherapy. Serotonin blockers are administered to control nausea and vomiting.

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?

Take the patient's blood pressure. Explanation: 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.

Which should be included as part of the home care instructions for a client with epididymitis and orchitis?

Take prescribed antibiotics. Explanation: Home care for a client with epididymitis and orchitis includes instructions to continue administering prescribed antibiotics, take Sitz baths, apply local heat after scrotal swelling subsides, avoid lifting, and refrain from sexual intercourse until symptoms are relieved.

Which assessment finding is most important in determining which client has a higher risk for developing testicular cancer?

Cryptorchidism as an infant Explanation: Caucasian men who have had cryptorchidism as an infant, regardless of whether an orchiopexy was performed, are at higher risk for incidence of testicular cancer. STIs, low sperm count, and family history of general cancers are not indicative of testicular cancer risk.

The nurse working on the postoperative unit receives a report on various clients. Based on the information provided, whom should the nurse see first?

A 67-year-old male patient recovering from a prostatectomy, with a potassium level of 4.0 mEq/L and a serum sodium level of 130 mEq/L. Vital signs are temperature 99.2°F, pulse 88, respirations 22, and blood pressure 156/92. Explanation: This client's condition is consistent with hyponatremia and needs to be reported to the physician. Scrotal swelling, discomfort, and ecchymoses are expected findings following a vasectomy. Acute prostatitis is characterized by the sudden onset of fever, dysuria, perineal prostatic pain, and severe lower urinary tract symptoms (dysuria, frequency, urgency, hesitancy, and nocturia). The signs and symptoms listed are expected in a client with orchitis.

A client who has had a right orchiectomy is scheduled to undergo a retroperitoneal lymph node dissection. The client states, "I'm afraid I will have problems with impotency afterwards." Which of the following responses would be most appropriate?

"Since you only had one testis removed, your sex drive and ability to have an erection should be preserved." Explanation: Clients with nonseminomas usually undergo a radical, nerve-sparing, procedure known as retroperitoneal lymph node dissection (RPLND) within 6 weeks of an orchiectomy as well. RPLND decreases potential metastasis from the testis and the need for chemotherapy. If only one testis is removed, sexual activity, libido, and fertility usually are unaffected. After a radical lymph node dissection, libido and erections are preserved. Sperm banking is an option that needs to be addressed before medical or surgical treatment occurs. The client's ability to achieve an erection should be preserved. As a result, there shouldn't be a need for medications to help him achieve an erection.