Chapter 26: Assessing Male Genitalia and Rectum Combined (Final)
What information should nurse include in the teaching plan for a client considering a vasectomy?
offers permanent birth control Explanation: Vasectomy is a method of permanent birth control which results in decreased, not increased, amounts of ejaculate. Vasectomy offers no protection from sexually transmitted infections (STIs). Prostatectomy, not vasectomy, causes urinary incontinence.
When palpating the rectal mucosa, how does the nurse rotate the examining hand?
Clockwise, then counterclockwise Explanation: To palpate the rectal mucosa, the nurse rotates the hand clockwise to palpate the right side of the client's rectal mucosa, then counterclockwise to palpate the surface posteriorly and on the client's left side.
The nurse is assessing male genitalia and finds clusters of pimple-like clear vesicles. The nurse recognizes this as what?
Herpes Explanation: Herpes is associated with clusters of pimple-like clear vesicles. Gonorrhea has drainage. Syphilis has a chancre. Chlamydia is asymptomatic.
An adult male client comes to the clinic for his annual physical examination. During the nursing assessment, the nurse asks, "Do you have any current or chronic illnesses such as diabetes, hypertension, respiratory problems, or cardiovascular disease?" Why does the nurse ask this question?
To assess risk for erectile dysfunction Explanation: Men with diabetes, hypertension, neurologic respiratory problems, or cardiovascular disease are at increased risk for erectile dysfunction. The other options are not related to health related issues.
A nurse observes that the mucosa of the rectum and the rectal wall of a female client protrudes out through the anal opening. It appears as a red, doughnut-like mass with radiating folds. How should the nurse document this condition of the rectum?
prolapse Explanation: The nurse should document this condition as rectal prolapse. Soft structures like nodules that may be present in the muscular anal ring are called rectal polyps. They are rather common and occur in varying size and number. If cancer metastasizes to the peritoneal cavity, it may be felt as a nodular, hard, shelf-like structure called rectal shelf that protrudes onto the anterior surface of the rectum in the area of the rectouterine pouch in women. Rectal cancer may feel like a firm nodule, an ulcerated nodule with rolled edges, or, as it grows, a large, irregularly shaped, fixed, hard nodule.
Prostate cancer is the leading cancer diagnosed in men in the United States. To increase knowledge of risk factors, the nurse would teach men that (Select all that apply.)
-each decade after age 50 increases the risk -it occurs earlier and is more advanced in African American men -15% have an affected first-degree relative
Important techniques in performing the rectal examination include which of the following?
All of the above Explanation: Lubricating the entire finger while removing excess lubricant, waiting for the client's anal sphincter to relax, and preparing the client for each step, are key parts of a good rectal examination. The examination itself, while it may be awkward for a client, should never cause pain in a normal person.
Important techniques in performing the rectal examination include which of the following? Lubrication Waiting for the sphincter to relax Explaining what the client should expect with each step before it occurs All of the above
All of the above Explanation: Lubricating the entire finger while removing excess lubricant, waiting for the client's anal sphincter to relax, and preparing the client for each step, are key parts of a good rectal examination. The examination itself, while it may be awkward for a client, should never cause pain in a normal person.
Which client should a nurse recognize has the highest risk to develop prostate cancer?
65-year-old Caucasian male whose father had prostate cancer at age 55 Explanation: Age, African American race, and having a bother or father who was diagnosed with prostate cancer before the age of 60 are the greatest risk factors. Therefore, the older male with a first-degree relative has the highest risk.
Which of the following recommendations should the nurse provide to clients in an effort to reduce their risk of developing colorectal cancer?
A high-fiber diet coupled with regular exercise Explanation: High fiber intake, exercise, moderate alcohol use, smoking cessation, low fat intake, and maintaining a healthy body weight can prevent colon cancer.
What ethnic group has a significantly higher incidence rate of prostate cancer?
African American Explanation: For undetermined reasons, incidence rates are significantly higher in African American men than in Caucasian men: 232 cases per 100,000 compared with 146 cases per 100,000, even after adjustments for access to care. Prostate cancer occurs at an earlier age and more advanced stage in African American men.
Which of the following groups has the highest incidence of prostate cancer?
African American men Explanation: African American men have the highest incidence of prostate cancer—two to three times higher than Caucasian men.
A client has undergone a digital rectal examination. This assessment will allow the clinician to diagnose which of the following?
BPH Explanation: A rubbery or boggy glandular consistency may indicate BPH, a common finding in men older than 60 years of age. The gland may feel soft, tender, and boggy from infection.
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 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 72-year-old male presents at a local clinic and states: "I have to urinate all the time, and I never feel like my bladder is emptied. It really bothers me at night." What condition might the nurse suspect related to this chief complaint?
Benign prostatic hyperplasia (BPH) Explanation: Initial symptoms of BPH may be urinary difficulties. The client does not empty his bladder completely when he voids and finds that he must void frequently, often during the night. He may also find starting to void increasingly difficult or painful and may notice traces of blood in his urine. Cystitis may result. The client with chronic prostatitis is usually asymptomatic, but he may complain of back or perineal pain. Symptoms of orchitis include pain and swelling in the scrotum and sometimes urethral irritation. Symptoms of epididymitis include redness, pain, and various degrees of scrotal swelling.
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 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. The patellar reflex occurs when a physician strikes the patellar tendon of the knee and the leg jerks. The rooting reflex occurs in infants when they turn their heads toward anything that strokes the cheek or mouth. The vasovagal reflex is a contraction of muscles in the gastrointestinal tract in response to distension of the tract following consumption of food and drink.
The nurse is asked to prepare material on erectile dysfunction to be placed in a urologist's office waiting room. What should the nurse include as reasons for the development of this disorder? Select all that apply.
Diabetes Depression Alcohol use Antihypertensive medications
Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis?
Ensure immunizations against infectious diseases such as mumps. Explanation: Nurses should advocate for infant and childhood immunizations against infectious diseases such as mumps to reduce potential adult complications such as orchitis. Minimizing activities involving heavy lifting or urging limited intake of caffeine have no effect on the potential for adult complications such as orchitis. The nurse should encourage foods that are low in fat and starch; however, this also would have no effect on the potential for orchitis.
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 prostate cancer.
Upon observation, the nurse documents that a male child's urethral meatus is located on the underside of his penis. What is the term for this structural abnormality?
Hypospadias Explanation: A urethral meatus located on the underside of the penis is called hypospadias. A meatus located on the upper surface is called epispadias. These congenital conditions are usually repaired surgically at a young age if they are severe. Cryptorchidism is an undescended testicle, and with phimosis, the foreskin becomes so tight that it will not retract over the glans penis.
The nurse educates the client that what condition may be associated with a varicocele?
Infertility Explanation: Infertility is may be associated with a varicocele. Klinefelter's syndrome is related to small testes. Circulatory obstruction is associated with orchitis. Ischemia may be occur with torsion.
On inspection and palpation, the nurse finds that a client's testes are small, probably less than 2 cm, and firm. Which of the following conditions should the nurse most suspect in this situation?
Klinefelter's syndrome Explanation: Testes that are less than 2 cm long and firm may indicate Klinefelter's syndrome. Testes that are less than 3.5 cm long and soft indicate atrophy. Atrophy may result from cirrhosis, hypopituitarism, estrogen administration, extended illness, or the disorder may occur after orchitis. Orchitis is inflammation of the testes, associated frequently with mumps, and in which the testes are tender on palpation. Epididymitis is infection of the epididymis and is characterized by an enlarged, reddened, and swollen scrotum.
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 Explanation: Signs of testicular torsion include acute pain that is not relieved by elevating the testicle, nausea, and vomiting. Epididymitis usually presents in adult males. The client presents with unilateral pain to one testis, but fever, dysuria, and possibly urethral discharge. Hydrocele is the accumulation of fluid around a testicle. This condition usually presents as a non-tender and soft testicle. Often testicular cancer presents lump or swelling, which may or may not be painful. The condition could also present with pain in the abdomen or low back.
Which of the following unexpected findings of the testes is most likely to result in painful palpation of the testes?
Orchitis Explanation: Acute orchitis results in inflamed, painful testes. Cryptorchidism, Klinefelter's syndrome, and testicular tumors are all disorders that are usually painless.
A client presents at the clinic with severe scrotal pain. What is the presumptive diagnosis?
Testicular torsion Explanation: Any client with scrotal pain should be presumed to have testicular torsion until another diagnosis can be proven.
The nurse suspects that a male client may have a hernia. The nurse should further assess the client for
bowel sounds at the bulge. Explanation: Bowel sounds auscultated over the mass indicate the presence of bowel and thus a scrotal hernia.
The external sphincter of the anus is
composed of skeletal muscle. Explanation: The external anal sphincter is composed of skeletal muscle and is under voluntary control.
The nurse has assessed a male client and determines that one of the testes is absent. The nurse should explain to the client that this condition is termed
cryptorchidism. Explanation: Absence of a testis suggests cryptorchidism (an undescended testicle).
The prostate functions to
secrete a milky substance that neutralizes female acidic secretions. Explanation: The prostate secretes a thin, milky substance that promotes sperm motility and neutralizes female acidic vaginal secretions.
An adolescent male client is diagnosed with testicular torsion. The nurse should prepare the client for which treatment?
Emergency surgery Explanation: Testicular torsion is a sudden twisting of the spermatic cord typically occurs on the left side because the left cord is longer. Most common in late childhood or early adolescence, it is rare after 20 years of age. 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 23 year old male comes to the clinic complaining of sudden and severe pain in his scrotum. The nurse would suspect what?
Torsion of the spermatic cord Explanation: Torsion of the spermatic cord is usually accompanied by a sudden, severe pain of the scrotum and is a urological emergency. A spermatocele is a sperm-filled cystic mass located on the epididymis. Orchitis is inflammation of the testes. A varicocele is an abnormal dilation of veins in the spermatic cord.
Before beginning the examination of the genitalia of an adult male client, the nurse should
ask the client to empty his bladder. Explanation: Before the examination, instruct the client to empty his bladder so that he will be comfortable.
While reviewing the medical record before examining a male clinic client, the nurse notes that the urinary meatus is located on the top of the glans of the penis. The nurse understands the correct term for this congenital defect is
epispadias
A client visits the clinic and tells the nurse that her stools have been black for the past 3 days. The nurse should assess the client for
gastrointestinal bleeding. Explanation: Black stools may indicate gastrointestinal bleeding.
The corpora spongiosum extends distally to form the acorn-shaped
glans. Explanation: The corpus spongiosum extends distally to form the acorn-shaped glans.
During assessment of an adult client, which of the following lifestyle practices would indicate to the nurse that the client may be at high risk for HIV/AIDS? A client who
has anal intercourse with other males. Explanation: Because HIV is preventable, knowing risks and practicing risk-reducing behaviors will help to stem the epidemic of this infection. Risks include having unprotected sex (especially male-on-male anal intercourse).
The rectum is lined with folds of mucosa, and each fold contains a network of arteries, veins, and visceral nerves. When these veins undergo chronic pressure, the result may be
hemorrhoids. Explanation: The anorectal junction is not palpable, but may be visualized during internal examination. The folds contain a network of arteries, veins, and visceral nerves. If the veins in these folds undergo chronic pressure, they may become engorged with blood, forming hemorrhoids.
A male client has a distinctive bulge in the right inguinal area when standing. What should the nurse suspect is occurring with this client?
hernia Explanation: A noticeable bulge in the inguinal area when standing strongly suggests that the male client has a hernia. Hypospadias is a displacement of the urinary meatus. Testicular torsion would be suspected if the scrotum were edematous and painful. An epidermoid cyst is a painless mobile mass in the scrotum. It would not be observed while the client is standing.
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
herpes infection. Explanation: Pimple-like lesions from herpes are sometimes detected on the glans.
The prostate gland consists of two lobes separated by the
median sulcus. Explanation: The prostate gland consists of two lobes separated by a shallow groove called the median sulcus.
Which of the following would lead the nurse to suspect a hydrocele versus other causes of scrotal swelling?
A positive transillumination test Explanation: A cystic structure will often transilluminate well. While a transilluminator head for the battery handle is ideal, it is possible to use an otoscope to transilluminate the scrotum. The examiner should be able to get above the mass on palpation, and bowel sounds should not be present. If they are, it should lead the examiner to consider an inguinal hernia. Scrotal edema involves thickened skin, which can be measured by gently pinching a section of the scrotum itself.
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 Explanation: The prostate is normally nontender and rubbery. A swollen and tender prostate may indicate acute prostatitis. An enlarged smooth, firm, slightly elastic prostate that may not have a median sulcus suggests benign prostatic hypertrophy. This condition is common in men older than 50 years. A hard area on the prostate or hard, fixed, irregular nodules on the prostate suggest cancer. Hydrocele is a painless swelling of the scrotum.
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 nurse examines the external genitalia of a client and observes that the scrotum is underdeveloped and the testis cannot be palpated. How should the nurse document this condition?
Cryptorchidism Explanation: The nurse should document this condition as cryptorchidism, a condition in which the scrotum appears underdeveloped and the testis cannot be palpated. Cryptorchidism is the failure of one or both testicles to descend into the scrotum. Orchitis is the inflammation of the testes, associated frequently with mumps; the scrotum appears enlarged and reddened. Epididymitis is an infection of the epididymis; the scrotum appears enlarged, reddened, and swollen, and a tender epididymis is palpated. Hydrocele appears as a swelling in the scrotum and is usually painless.
Which of the following would the nurse expect to be done to assess the size of the prostate?
Digital rectal examination Explanation: A digital rectal examination is performed to assess the prostate for size as well as evidence of tumor. Transillumination is used to determine the density of scrotal tissue. Pelvic examination is performed to evaluate female reproductive structures. Bladder percussion reveals information about the status of the bladder.
Upon inspection of the glans, a nurse observes the urethral opening present on the dorsal side of the penis. How should the nurse document this finding?
Epispadias Explanation: Epispadias is the displacement of the urinary meatus to the dorsal (top) of the glans penis. Hypospadias is the displacement of the urinary meatus to the ventral (bottom) of the glans penis. A hydrocele is a collection of fluid in the scrotum, outside the tunica vaginalis.
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?
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. The other symptoms listed are not associated with mumps, but with other conditions.
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?
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.
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 case 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.
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?
Hydrocele Explanation: A hydrocele refers to a collection of fluid in the tunica vaginalis of the testes. Cryptorchidism is the most common congenital defect in males; characterized by failure of one or both of the testes to descend into the scrotum. Orchitis is an inflammation of the testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical, or unknown factors. Prostatism is an obstructive and irritative symptom complex that includes increased frequency and hesitancy in starting urination, a decrease in the volume and force of the urinary stream, acute urinary retention, and recurrent urinary tract infections.
A male infant is born with the urethral meatus opening on the underside of the penis. When providing information to the parents, what is the correct terminology to use for this condition?
Hypospadias Explanation: With hypospadias, the urethral meatus opens on the ventral side of the penis. The deviation of the meatus makes it difficult to urinate when standing. The physical appearance of the penis is altered, sometimes causing body image disturbances. Phimosis is when the prepuce cannot be retracted over the glans. Paraphimosis occurs when the retracted prepuce cannot be placed back over the glans. Epispadias occurs when the urethral meatus opens on the dorsal surface of the penis.
Upon inspection and palpation of the scrotum, the nurse discovers a mass. The nurse finds that the mass cannot be pushed back into the abdomen. The nurse should document this finding as which type of hernia?
Incarcerated Explanation: The nurse should document this finding as scrotal hernia if the bulge remains when the client lies down and bowel sounds can be auscultated over it. If the mass in the scrotum cannot be pushed into the abdomen, it could be an incarcerated hernia. A hernia is strangulated if the blood supply is cut off. A bulge or mass on the front of the thigh in the femoral canal area is a femoral hernia.
Which of the following is a sign or symptom of benign prostatic hypertrophy (BPH)?
Nocturia Explanation: BPH is usually not associated with systemic symptoms such as weight loss or fever. Bone pain is associated with prostate cancer, which often metastasizes to the lower axial skeleton. Nocturia, sensation of incomplete voiding, weak stream, and difficulty initiating urination are also common symptoms.
A nurse recognizes that which finding is normal upon palpation of the prostate?
Nontender and rubbery Explanation: The prostate is normally nontender and rubbery. A swollen and tender prostate may indicate acute prostatitis. An enlarged smooth, firm, slightly elastic prostate that may not have a median sulcus suggests benign prostatic hypertrophy. A hard area on the prostate or hard, fixed, irregular nodules on the prostate suggest cancer.
A nurse examines the external genitalia of a client who has been diagnosed with the mumps. The scrotum appears enlarged and reddened. How should the nurse document this condition?
Orchitis Explanation: The nurse should document this condition as orchitis, which is the inflammation of the testes, associated frequently with mumps; the scrotum appears enlarged and reddened. Cryptorchidism is the failure of one or both testicles to descend into the scrotum, resulting in a condition in which the scrotum appears underdeveloped and the testis cannot be palpated. Epididymitis is an infection of the epididymis; the scrotum appears enlarged, reddened, and swollen, and a tender epididymis is palpated. Hydrocele appears as a swelling in the scrotum and is usually painless.
An uncircumcised, 78 year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination it is noted that the foreskin is very constricted. What is this condition called?
Phimosis is the term used to describe a condition in which the foreskin is constricted so it cannot be retracted over the glans. Bowen's disease is an in situ carcinoma of the penis. Peyronie's disease is an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels.
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 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 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.
On inspecting a client's external genitalia, a nurse notes that he is uncircumcised. This means that which of the following covers the glans of the penis?
Prepuce Explanation: If the man has not been circumcised, a hood-like fold of skin called the foreskin, or prepuce, covers the glans. In the center of the corpus spongiosum is the urethra, which travels through the shaft and opens as a slit at the tip of the glans as the urethral meatus. The shaft of the penis is composed of three cylindrical masses of vascular erectile tissue that are bound together by fibrous tissue—two corpora cavernosa on the dorsal side and the corpus spongiosum on the ventral side.
On palpation of a client's prostate, a nurse detects hard, fixed, and irregular nodules on the prostate. Which condition should the nurse most suspect in this client?
Prostate cancer Explanation: The prostate is normally nontender and rubbery. A swollen and tender prostate may indicate acute prostatitis. An enlarged smooth, firm, slightly elastic prostate that may not have a median sulcus suggests benign prostatic hypertrophy. A hard area on the prostate or hard, fixed, irregular nodules on the prostate suggest cancer. Hydrocele is a painless swelling of the scrotum.
A nurse prepares a male client for a physical assessment of the external genitalia. Which instruction is appropriate for the nurse to give the client before the examination?
Reassure him that it is not unusual to have an erection during the examination Explanation: The nurse should reassure the client that it is not unusual to have an erection during the examination; this will avoid unnecessary embarrassment in the client. The nurse should ask the client to empty the bladder before the examination so that he will be comfortable during the examination. The client should be informed that he may need to stand for most of the examination. The nurse should encourage the client to ask questions during the examination, and, at the same time, ease the client's anxiety by explaining in detail the significance of each portion of the examination.
Dawn, 55 years old, comes in today for her yearly well-woman examination. The nurse performs a careful rectal examination with the client in the lithotomy position, and feels a firm and nodular mass against the bowel wall. Which of the following is most likely?
Rectal cancer Explanation: This finding should lead to a suspicion of rectal cancer, because the mass is firm, nodular, and nontender. Hemorrhoids are not firm and are frequently visible externally, although some are internal as well. An anal fissure would be a palpable linear lesion in the anal canal, and may be tender. Valves of Houston are sometimes palpable, but are not firm.
A 50-year-old truck driver comes to the clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system complaints. Past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different company. He smokes one pack of cigarettes a day, drinks fewer than six beers a week, and denies any illegal drugs. His mother has high blood pressure and arthritis; his father died of lung cancer in his 60s. On examination, the client's blood pressure is 130/80 and pulse is 80. Cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but digital rectal examination reveals a soft, smooth, nontender, pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation?
Rectal polyp Explanation: Polyps are generally symptom free and can be found on routine rectal examinations. Proctoscopy with biopsy is necessary to see if the polyp has any potential to become cancerous. Anyone with a rectal polyp needs a colonoscopy.
An adult male client comes to the clinic complaining of awakening at night to void and voiding more than once in a 2-hour time period. The client has a history of bladder irritation. What would be an appropriate nursing diagnosis for this client?
Risk for urge incontinence Explanation: The most appropriate nursing diagnosis is risk for urge incontinence related to irritation of bladder. Risk factors for this diagnosis are voiding more than once every 2 hours and awakening at night. urinary retention would be a concern if the client was unable to urinate, or urinated frequently with only small amounts of urine voided. Frequent urination at night is not a risk for infection. The symptoms noted are not related to ineffective sexuality pattern.
Upon inspection and palpation of the scrotum, the nurse discovers a mass. The nurse asks the client to lie down, and the bulge remains. On auscultation, the nurse finds bowel sounds. The nurse should document this finding as which type of hernia?
Scrotal Explanation: The nurse should document this finding as scrotal hernia if the bulge remains when the client lies down and bowel sounds can be auscultated over it. If the mass in the scrotum cannot be pushed into the abdomen, it could be an incarcerated hernia. A hernia is strangulated if the blood supply is cut off. A bulge or mass on the front of the thigh in the femoral canal area is a femoral hernia.
A 29-year-old married computer programmer comes to the clinic complaining of "something strange" going on in his scrotum. Last month while he was doing his self-testicular examination he felt a lump in his left testis. He waited a month and felt the area again but the lump was still there. He has had some aching in his left testis but denies any pain with urination or sexual intercourse. He denies any fever, malaise, or night sweats. His past medical history consists of groin surgery when he was a baby and a tonsillectomy as a teenager. He eats a healthy diet and works out at the gym five times a week. He denies any tobacco or illegal drugs and drinks alcohol occasionally. His parents are both healthy. Examination shows a muscular healthy young man with unremarkable vital signs. On visualization the penis is circumcised with no lesions; there is a scar in his right inguinal region. There is no lymphadenopathy. Palpation of his scrotum is unremarkable on the right but has a large mass on the left. While placing a finger through the inguinal ring on the right, the examiner asks the client to bear down. Nothing is felt. The examiner attempts to place a finger through the left inguinal ring but cannot get above the mass. On rectal examination the client's prostate is unremarkable. What disorder of the testes is most likely?
Scrotal hernia Explanation: Scrotal hernias occur when the small intestine passes through a weak spot of the inguinal ring. The examiner cannot get a finger above the hernia into the ring. Hernias are often caused by increased abdominal pressure such as in weight lifting. Clients who have a hernia on one side often have another hernia on the opposite side.
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?
Side effects of medications Explanation: Lack of libido may arise from psychogenic causes such as depression, endocrine dysfunction, or side effects of medications.
During a physical examination, the nurse inspects the eternal 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.
During the physical assessment of a client's genitalia, the nurse notes an abnormal mass or swelling. The nurse performs transillumination by shining a light from the back of the scrotum through the mass. In which condition should the nurse see a red glow?
Spermatocele Explanation: When transilluminating the scrotal contents, a red glow is seen in swellings or masses that contain serous fluid such as spermatocele and hydrocele. Swellings or masses such as tumors, hernias, and varicocele that are solid or filled with blood do not light up with a red glow.
When assessing for an inguinal hernia, the nurse asks the client to assume what position?
Standing, facing the examiner Explanation: Palpation for an inguinal hernia is best performed with the client standing upright.
A client reports the new onset of mucous in the stool. How should the nurse document this in the client's history?
Steatorrhea Explanation: The proper term for mucus in the stool is steatorrhea, which indicates the presence of excessive fat in the stool. Diarrhea is an increase in the frequency of loose stool. Change in bowel habits is not specific to the problem the client reported. Fecal incontinence is the inappropriate release or inability to control the bowels.
During the assessment of a client, the nurse recognizes that which of the client's lifestyle practices may predispose to the development of an inguinal hernia?
Strenuous activity Explanation: Strenuous activity and heavy lifting may predispose a client to the development of an inguinal hernia. Exposure to radiation and certain chemicals increases the risk of developing cancer. Erectile dysfunction occurs frequently in adult males and may be attributed to various factors, some of which include the use of alcohol, diabetes, or depression. Fear can cause stress and inhibition and decrease sexual satisfaction.
A 28-year-old musician comes to the clinic complaining of a "spot" on his penis. He states his partner noticed it 2 days ago and it hasn't gone away. He says it doesn't hurt. He has had no burning with urination and no pain during intercourse. He has had several partners in the last year and uses condoms occasionally. His past medical history consists of nongonococcal urethritis from Chlamydia and prostatitis. He denies any surgeries. He smokes two packs of cigarettes a day, drinks a case of beer a week, and smokes marijuana and occasionally crack. He has injected IV drugs before but not in the last few years. His mother has rheumatoid arthritis; he doesn't know anything about his father. Examination shows a young man appearing deconditioned but pleasant. His vital signs are unremarkable. Visualization of his penis reveals a 6-mm red, oval ulcer with an indurated base just proximal to the corona. There is no prepuce because of neonatal circumcision. On palpation the ulcer is nontender. In the inguinal region there is nontender lymphadenopathy. What disorder of the penis is most likely?
Syphilitic chancre Explanation: Primary syphilis causes a large ulcer that is firm and initially painless. Syphilis is fairly uncommon but does occur in the highly promiscuous population, especially when coupled with illegal drug use. The nurse should consider further questions and workup regarding HIV status.
An uncircumcised male client has just come to the recovery room following a 4-hour back surgery. Before surgery a urinary catheter was placed. During the postoperative assessment, the recovery nurse discovers that the client has developed paraphimosis. What might have happened to the client to cause this?
The foreskin was not pulled back over the head of the penis after catheter placement Explanation: Paraphimosis occurs when the retracted prepuce cannot be placed back over the glans. Paraphimosis may be severe enough to restrict circulation to the glans. An uncircumcised male should always have the foreskin pulled toward the urethral opening. The other options are distracters to the question.
A teenager presents at the ER with severe scrotal and abdominal pain, vomiting, and nausea. He tells the nurse that he participated in a polar bear plunge in his community (jumping into cold water off-season). What conditions would the nurse suspect?
Torsion of the spermatic cord Explanation: Symptoms of torsion of the spermatic cord include an acute onset of sudden severe scrotal pain, vomiting, abdominal pain, and nausea. Extreme cold, such as with jumping into very cold water, may cause torsion. With hydrocele, the scrotum enlarges; pain and swelling may be present. However, the client with a hydrocele is often asymptomatic. In a client with phimosis, the foreskin becomes so tight that it will not retract over the glans penis. Varicocele can cause pain in the testicle or pain radiating to the other side. Symptoms of varicocele include swelling and a nagging dull pain in the scrotum.
A 15-year-old high school football player comes to the office with his mother. He complains of severe testicular pain since 8:00 this morning. He denies any sexual activity and states that it hurts so bad he can't even urinate. He is nauseated and vomiting. He denies any recent illness or fever. Past medical history is unremarkable. He denies any tobacco, alcohol, or drug use. His parents are both in good health. Examination shows a young teenager lying on the bed with an emesis basin. He is very uncomfortable and keeps shifting his position. Blood pressure is 150/100, pulse is 110, and respirations are 24. On visualization of the penis he is circumcised; there are no lesions or discharge from the meatus. Scrotal skin is tense and red. Palpation of the left testicle causes severe pain and causes the client to cry. His prostate examination is unremarkable. His cremasteric reflex on the left is absent but normal on the right. Catheterization is necessary to get a urine sample, the analysis of which is unremarkable. The boy is admitted to the emergency department of a nearby hospital for further workup. What is the most likely cause of this young man's symptoms?
Torsion of the spermatic cord Explanation: Torsion is caused by twisting of the testicle on its spermatic cord and blood vessels, leading to severe pain. The scrotum becomes red and tense. Torsion is usually seen in adolescents and is a true surgical emergency. If not quickly surgically repaired, the testicle's function is lost and it has to be removed. Presence of a cremasteric reflex is reassuring, but in this case a thorough evaluation must take place as soon as possible.
A nurse is performing palpation of a client's prostate gland. Which of the following indicates proper procedure?
Turn the hand fully counterclockwise so that the pad of the index finger faces the client's umbilicus Explanation: The prostate can be palpated on the anterior surface of the rectum by turning the hand fully counterclockwise so that the pad of the index finger faces toward the client's umbilicus.
