Chapter 26: Male Genitalia and rectum PrepU

After positioning a 34-year-old client for examination of the anal region, the nurse notes a small opening above the gluteal crease that contains a tuft of hair. How should the nurse interpret this assessment finding?

The pilonidal cyst and sinus are usually benign, but can occasionally become infected or develop further sinuses. Explanation: A pilonidal cyst is a congenital, and usually asymptomatic, tract that can become a problem if infection or sinus formation results. It alone does not indicate infection.

The nurse is teaching a client about medications used for erectile dysfunction. Teaching was effective when the client makes which of the following statements?

"This medication will cause more blood to flow to the penis." Explanation:Medications used for erectile dysfunction facilitate smooth muscle relaxation and increase blood flow to the penis. The efficacy of erectile dysfunction medication is not altered by circumcision or lack of circumcision. Similarly, the efficacy of the medication is not improved by being taken with a full bladder. The prepuce, also called the foreskin of the penis, does not dilate when taking erectile dysfunction medication.

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.

What information should nurse include in the teaching plan for a client considering a vasectomy?

offers permanent birth control Ex: 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.

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 Ex: Pimple-like lesions from herpes are sometimes detected on the glans.

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.

When assessing a client with benign prostatic hypertrophy, 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.

A client presents to the health care clinic with reports of clay-colored stool. The nurse recognizes that this finding is most likely a result of which of the following?

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

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.

During DRE, a 46-year-old client cries out in pain as the nurse palpates his swollen, firm prostate. Which of the following problems should the nurse first suspect?

Prostatitis Explanation: The hallmarks of prostatitis are a tender, swollen, firm prostate. Tenderness is not normally present in cases of BPH or prostate cancer.

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.

The nurse is beginning the physical exam of a male client's genitals. The nurse is sitting on a stool in front of the client. In which position would be best to place the client?

Standing Explanation: When beginning the exam, the nurse sits on a stool in front of the client while the client assumes a standing position. This allows the nurse to inspect the genitalia.

On inspection of a client's penis, the nurse observes a small, silvery-white papule. Which of the following conditions should the nurse suspect in this client?

Syphilitic chancre Explanation: Syphilitic chancre initially is a small, silvery-white papule that develops a red, oval ulceration. Herpes progenitalis is characterized by clusters of pimple-like, clear vesicles that erupt and become ulcers. Cancer of the glans penis appears as a hardened nodule or ulcer on the glans. Hypospadias is a condition in which the urethral meatus is located underneath the glans (ventral side).

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 nurse is performing palpation of a client's prostate gland. Which of the following indicates proper procedure?

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.

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.

The nurse notes that a client has a small red papule that is clean, smooth, and glistening on the penis. What should the nurse suspect is causing this lesion?

primary syphilis Explanation: Manifestations of primary syphilis include a small red papule that is clean, smooth, and glistening. Manifestations of gonorrhea include a penile discharge and not skin changes. Manifestations of genital herpes include small scattered or grouped vesicles on the penis. Manifestations of genital warts include single or multiple papules or plaques of variable shapes.

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.

A nurse is assessing a client who is uncircumcised. The nurse understands that this client is at greater risk for which of the following conditions? Select all that apply.

Cancer of the glans penis occurs primarily in uncircumcised men. Also, being uncircumcised is a risk factor for HIV/AIDS in sexually active men. There is no association between lack of circumcision and prostate, testicular, or colorectal cancers.

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.

A nurse is caring for a client with prostatitis. The nurse knows that what nursing care measure will be employed when caring for this client?

Administer the prescribed dose of antibiotics Ex: The nurse should administer the prescribed dose of antibiotics when caring for the client. Sitz bath procedures can be provided to relieve the condition. The nurse should encourage the client to increase his fluid intake to flush bacteria out of the bladder. The client can use the prescribed dose of stool softeners to prevent constipation.

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.

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.

During assessment of the inguinal regions for herniating masses, the nurse instructs the standing male client do which of the following?

Bear down. Explanation: Asking the standing client to bear down while standing may facilitate detection of a herniating mass. Exhaling, bending over, and holding one's breath are not clinically useful techniques for assessing a potential herniating mass.

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.

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.

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.

An Advanced Practice Nurse is preparing to do a rectal examination on a 77-year-old client. The client complains of pain as soon as the examination begins. What might this client have?

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

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.

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

Infertility Explanation: A varicocele is an abnormal dilatation of the testicular veins in the scrotum, causing a reflux of blood down to the scrotum when standing or straining. The scrotal temperature is higher than normal because of the blood pooling in the area. Heat impairs spermatogenesis and sperm storage, resulting in a low sperm count and infertility. Thyroid disorder may cause erectile dysfunction and undescended testicle is a risk factor for testicular cancer. Epididymitis is inflammation of the epididymis. In adults younger than 40 years, Chlamydia trachomatis is often the causative organism, and the condition manifests as a burning sensation and/or penile discharge.

A nurse recognizes that which finding is normal upon palpation of the prostate?

Nontender and rubbery Ex: 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.

During palpation of the male genitalia, which of the following is an expected finding?

Palpable spermatic cord Explanation: While the spermatic cord is expected to be palpable, beading of the vas deferens suggests infection and testicular nodules, even if painless, are associated with testicular cancer. Tortuous veins suggest the presence of a varicocele.

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 Explanation: 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.

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.

The nurse is teaching a class of senior citizens about the risk factors for prostate cancer. Which of the following would the nurse mention? Select all that apply.

Risk factors for prostate cancer include: age older than 50 years, African American heritage, diet high in animal fats, family history of prostate cancer, excessive alcohol consumption, environmental exposure, and PSA elevation.

A male client is assessed for suspected benign prostatic hypertrophy (BPH). The nurse expects the client to suffer from which symptoms? (Select all that apply.)

Signs and symptoms of BPH include: Unable to empty bladder, frequent urination, weak stream, dribbling after urination, and nocturia. Bleeding and spotting may occur with the passing of kidney stones.

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 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.

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.

During a focused genital assessment of an older adult client, the nurse observes a skin tag that protrudes through the rectum. How should the nurse document this finding?

a previously thrombosed hemorrhoid Explanation: A previously thrombosed hemorrhoid appears as a skin tag. Redness, itchiness, and signs of scratching could indicate pinworm or fungi; the client is not exhibiting these signs or symptoms. A perianal abscess presents as hardened and red. An external hemorrhoid is itchy, painful, and swollen.

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 Ex: 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?

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 and internal sphincter of the rectum are divided by the

intersphincteric groove. Explanation: Within the anus are the two sphincters that normally hold the anal canal closed except when passing gas and feces. Dividing the two sphincters is the palpable intersphincteric groove.

Which of the following would the nurse expect to be done to assess the size of the prostate?

digital rectal examination Ex: 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.

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 Ex: Nurses should advocate for infant and childhood immunizations against infectious diseases such as mumps to reduce potential adult complications such as orchitis.

The corpora spongiosum extends distally to form the acorn-shaped

glans. Explanation: The corpus spongiosum extends distally to form the acorn-shaped glans.

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 Ex: 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.

A male client comes to the clinic reporting a painless red, oval ulceration on his penis that had started out as a small silvery-white bump. Which of the following disorders would the nurse suspect?

primary sign of syphilis Explanation: Syphilis presents with a small silvery-white papule that is painless and that later develops into a red oval ulceration that is also painless. Human immunodeficiency virus (HIV) presents with flu symptoms that resolve; the client may not experience any other symptoms for a long period of time (latent period) before developing symptoms leading to autoimmune disorder (AIDS) if not treated. Herpes progenitalis presents as painful clusters of pustules on the genitals. Phimosis is the inability to retract the foreskin.

A male client tells the nurse that he has received a diagnosis of hernia. He visits the clinic because he is nauseated and has extreme tenderness on the left side. The nurse should

refer the client to an emergency room. Explanation: A hernia is strangulated when its blood supply is cut off. The client typically complains of extreme tenderness and nausea. If you suspect that the client has a strangulated hernia, refer the client immediately to the physician and prepare him for surgery.

The nurse identifies a cheesy white material that has accumulated under a male client's foreskin of the penis. What does this finding suggest to the nurse?

smegma Explanation: A cheesy white material may accumulate under the foreskin of a client. This is smegma and is considered normal. Balanitis refers to inflammation of the glans, not the expected secretions of the glans that cause smegma to accumulate. The accumulation of secretions from the glans (smegma) does not indicate that a sexually transmitted infection is present. Hypospadias refers to a congenital condition that involves ventral displacement of the meatus on the penis.

A client reports the new onset of mucous in the stool. How should the nurse document this in the client's history?

steatorrhea Ex: 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.

A client presents at the clinic with severe scrotal pain. What is the presumptive diagnosis?

testicular torsion Ex: Any client with scrotal pain should be presumed to have testicular torsion until another diagnosis can be proven.

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 Ex: Men with diabetes, hypertension, neurologic respiratory problems, or cardiovascular disease are at increased risk for erectile dysfunction.