Chapter 55: Caring for Clients with Disorders of the Male Reproductive System

A patient experiences hypotension, lethargy, and muscle spasms while receiving bladder irrigations after a transurethral resection of the prostate (TURP). What is the first action the nurse should take? a. Discontinue the irrigations. b. Increase the rate of the IV fluids. c. Administer a unit of packed red blood cells. d. Prepare the patient for an ECG.

a Transurethral resection syndrome is a rare but potentially serious complication of TURP. Symptoms include lethargy, hypotension, and muscle spasms. The first action the nurse should take is to discontinue irrigation. The other interventions listed are not appropriate.

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? a. Using a bearing down motion to promote complete bladder emptying when voiding b. Performing perineal exercises frequently throughout the day c. Engaging in strenuous exercise to strengthen abdominal muscles d. Waiting to urinate for 5 to 10 minutes after feeling the initial urge

b 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.

A client with erectile dysfunction is prescribed sildenafil (Viagra). Which of the following would the nurse include in the teaching plan for this client? a. "You need to take this medication throughout the day to be effective." b. "The effects of this medication usually last for up to 48 hours." c. "You may experience headache and some flushing with this drug." d. "Your blood glucose level might increase when you take this drug."

c 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.

Which statement is accurate regarding sildenafil? a. It can be taken twice daily for increased effect. b. The medication should be taken right before intercourse. c. Its side effects include headache, flushing, and dizziness. d. Sexual stimulation is not needed to produce an erection.

c 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.

A client has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The client's interdisciplinary plan of care should prioritize which of the following interventions? a. Penile implant b. PDE-5 inhibitors c. Physical therapy d. Psychotherapy

d Clients with erectile dysfunction from psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction. Because of the absence of an organic cause, medications and penile implants are not first-line treatments. Physical therapy is not normally effective in the treatment of ED.

A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)? a. "I've had a fever and noticed I've been running to the bathroom more often." b. "I'm waking up at night to urinate and I've noticed some burning, too." c. "I've had trouble getting started when I urinate, often straining to do so." d. "I've had some pain in my lower abdomen lately and felt a bit sick to my stomach."

c 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.

A client has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe? a. circumcision b. narcotic analgesics c. increased hygienic measures d. scrotal support

a Circumcision is recommended to relieve phimosis and paraphimosis permanently.

Which of the following is the most common organism implicated in prostatitis? a. Escherichia coli b. Staphylococcus aureus c. Streptococcus d. Methicillin-resistant Staphylococcus aureus

a Escherichia coli is the most commonly isolated organism implicated in prostatitis. Microorganisms are usually carried to the prostate from the urethra. Staphylococcus aureus, Streptococcus, and methicillin-resistant Staphylococcus aureus are not the most common organism implications in prostatitis.

Which of the following patient populations have the highest risk for developing testicular cancer? a. European American b. African American c. Asian American d. Hispanic American

a European American men have a five times greater risk than that of African American men and more than double the risk of Asian American men.

Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer? a. Hormone therapy b. Brachytherapy c. Teletherapy d. Chemotherapy

b 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 presents to the emergency department with paraphimosis. The health care provider is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, the nurse should prepare the client for what intervention? a. Needle aspiration of the corpus cavernosum b. Circumcision c. Abstinence from sexual activity for 6 weeks d. Administration of vardenafil

b Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated. Vardenafil is used for erectile dysfunction and would not be used for paraphimosis.

The nurse is providing preoperative care to a client who is to undergo a radical prostatectomy for prostate cancer. The client's plan of care includes the nursing diagnosis of "anxiety related to surgery and its outcome." Which of the following would be most appropriate for the nurse to do? a. Tell the client that prostate cancer is very curable if caught early. b. Inform the client that risk of recurrence is decreased with this type of surgery. c. Ensure privacy when discussing sensitive or embarrassing sexual issues. d. Allow the client to assume a passive role in the preparation.

c To help reduce anxiety, the nurse should provide clear explanations about the events before, during, and after surgery, reinforcing information already provided by the surgeon. In addition, the nurse should establish a trusting relationship and allow the client to ask questions and verbalize his feelings related to the diagnosis, surgery, and outcomes. Because the surgery involves reproductive issues that the client may find sensitive or embarrassing, the nurse needs to ensure the client's privacy when discussing any of these issues. Telling the client that the cancer is very curable and informing him of a lower risk of recurrence would give the client false reassurance. In addition, anxiety could be increased, especially if the client's cancer is not at an early stage. Regardless of the diagnosis, clients need to participate in their care to foster autonomy and feelings of control over the situation.

A young client who awoke with sudden, severe testicular pain with edema arrives at the ED unable to walk and nauseated. After examination, what treatment would the physician likely order? a. surgery b. oral anti-inflammatory medications c. application of heat d. elevation of testes

a In spermatic cord torsion, immediate surgery is necessary to prevent atrophy of the spermatic cord and preserve fertility.

A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? a. It is most common among men over 55. b. It is one of the least curable solid tumors. c. It typically does not metastasize. d. It is highly responsive to treatment.

d Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

When developing an educational program for a group of adolescents about sexually transmitted infections (STIs), what should the nurse inform the group about the single greatest risk factor for contracting an STI? a. The type of contraception used b. The number of times the person has contact with a partner c. The number of sexual partners d. Where the patient lives

c The single greatest risk factor for contracting an STI is the number of sexual partners. As the number of partners increases, so does the risk of exposure to a person infected with an STI.

A client is being seen by an urologist for perineal pain, low back pain, fever lasting 5 days, and painful urination. The physician confirms a diagnosis of prostatitis and orders treatment. During client education, which recommendation does the nurse make? a. All options are correct. b. Avoid caffeine. c. Regularly drain the gland. d. Complete the prescribed antibiotic treatment.

a The nurse instructs the client to avoid caffeine, prolonged sitting, and constipation and regularly to drain the prostate gland through masturbation or intercourse. The nurse instructs the client to comply with antibiotic therapy and use a mild analgesic for pain.

A client with erectile dysfunction has been prescribed a PDE5 inhibitor. What would the nurse include in the client education? a. Depending on the drug, most are taken "on demand" 15 minutes, 1/2 hour, to 1 hour before sexual activity. b. The PDE5 inhibitors facilitate penile erection by producing smooth muscle contraction in the corpora cavernosa, facilitating an inflow of blood. c. These drugs have erectile effect without sexual stimulation. d. Currently, sildenafil is the only PDE5 inhibitor that can be taken either "on demand" or on a daily basis.

a Depending on the drug, most are taken "on demand" 15 minutes, 1/2 hour, to 1 hour before sexual activity. The PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa, facilitating an inflow of blood. These drugs have no erectile effect without sexual stimulation. Tadalafil is the only PDE5 inhibitor that can be taken either "on demand" or on a daily basis.

What is included in the home care instructions for a client with epididymitis and orchitis? a. All options are correct. b. Take prescribed antibiotics. c. Take sitz baths. d. Avoid sexual intercourse until symptoms are relieved.

a 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, and avoid lifting and straining (e.g., sexual intercourse) until symptoms are relieved.

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? a. Suggest donor insemination or adoption b. Undertake herbal alternatives c. Suggest the use of sildenafil d. Reverse the surgery

a 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 59-year-old African American man has opted for hormonal androgen deprivation therapy (ADT) to treat his prostate cancer. Which surgical procedures is the client most likely to undergo? a. Orchiectomy b. Circumcision c. Vasectomy d. Hydrocelectomy

a ADT is commonly used to suppress androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of dihydrotestosterone (DHT). As a result, the prostatic epithelium atrophies (decreases in size). This effect is accomplished by an orchiectomy (removal of the testes). Circumcision is excision of the foreskin, or prepuce, of the glans penis. Vasectomy is the ligation and transection of part of the vas deferens to prevent the passage of the sperm from the testes. Hydrocelectomy describes the surgical repair of a hydrocele, a collection of fluid in the tunica vaginalis.

Which term refers to a failure of one or both or both of the testes to descend into the scrotum? a. Cryptorchidism b. Hydrocele c. Varicocele d. Phimosis

a 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.

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? a. Have regular prostate-specific antigen (PSA) levels tested and repeat lymph node biopsies. b. Avoid sexual intercourse for at least 2 years. c. Undertake pelvic floor retraining exercises. d. Avoid strenuous exercises, especially lifting.

a 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.

A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what group? a. Native Americans b. European Americans c. African Americans d. Asian Americans

c African American men have a higher risk of prostate cancer.

A patient is diagnosed with prostatitis. Which of the following is the most commonly isolated organism that will be present in this patient's laboratory results? a. Staphylococcus aureus b. Proteus c. Escherichia coli d. Pseudomonas

c E. coli is the most commonly isolated organism with prostatitis. Microorganisms are usually carried to the prostate from the urethra.

Which of the following herbal remedies is used to treat symptoms of benign prostatic hypertrophy (BPH)? a. Saw palmetto b. Garlic c. Ginkgo d. Green tea

a Saw palmetto is an herbal product used to treat symptoms associated with BPH.

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: a. testosterone therapy during childhood. b. sexually transmitted disease. c. early onset of puberty. d. cryptorchidism.

d 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 just been diagnosed with prostate cancer and is scheduled for brachytherapy the following week. The client and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family? a. The client should not be in contact with the baby after delivery. b. The client's treatment poses no risk to his daughter or her infant. c. The client's brachytherapy may be contraindicated for safety reasons. d. The client should avoid close contact with his daughter for 2 months.

d Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the client returns home after the procedure. Exposure of others to radiation is minimal, but the client should avoid close contact with pregnant women and infants for up to 2 months.

A client has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this client has chronic urinary retention? a. Hypertension b. Peripheral edema c. Tachycardia and other dysrhythmias d. Increased blood urea nitrogen (BUN)

d Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and kidney injury can occur with chronic urinary retention and large residual volumes.

How many men, 75 years of age and older, have chronic erectile dysfunction? a. more than half b. 15% to 25% c. 10% d. 65%

a More than half of all men 75 years of age or older are chronically impotent.

A client has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following? a. Pelvic floor exercises b. Intermittent urinary catheterization c. Reduced physical activity d. Active range of motion exercises

a Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

A nurse is teaching a male client who is older than 50 years about prostate cancer. What teaching should be included by the nurse? a. Have a digital rectal examination. b. Have a transrectal ultrasound every 5 years. c. Perform monthly testicular self-examinations, especially after age 50. d. Have a complete blood count, blood urea nitrogen, and creatinine levels checked yearly.

a A serum prostate-specific antigen level test and a digital rectal exam, which are recommended by the American Cancer Society, are used to screen for prostate cancer in men with at least a 10-year life expectancy and for men at high risk, including those with a strong family history of prostate cancer and those of African American ethnicity. Testicular self-examinations won't identify changes in the prostate gland because of its location in the body. A transrectal ultrasound, complete blood count, blood urea nitrogen, and creatinine level test are usually done after diagnosis to identify the extent of the disease and potential metastasis.

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? a. Take the patient's blood pressure. b. Ask the patient to obtain a urine specimen. c. Start an IV. d. Administer atropine 0.5 mg.

a 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.

A client with a history of hypertension and heart disease is being seen by the urologist because of erectile dysfunction. What would be the most likely cause of the client's erectile dysfunction? a. All options are correct. b. hypertension medication c. atherosclerosis d. depression

a Common causes of ED include neurologic disorder such as spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy, atherosclerosis, hypertension, and complications of diabetes mellitus. Certain medications such as antihypertensive drugs (e.g., methyldopa, spironolactone), antidepressants, narcotics, and cimetidine can cause sexual dysfunction in men. Atherosclerosis is a common cause of ED. ED may be related to anxiety or depression.

A 22-year-old male is being discharged home after surgery for testicular cancer. The client is scheduled to begin chemotherapy in 2 weeks. The client tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this client at this time? a. Provide empathy and encouragement in an effort to foster a positive outlook. b. Tell the client it is his decision whether to accept or reject chemotherapy. c. Report the client's statement to members of his support system. d. Refer the client to social work.

a Clients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the client's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the client's statement to members of his support system and there is no obvious need for a social work referral.

A nurse is providing care for a client who has recently been admitted to the postsurgical unit from PACU following a transurethral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action? a. Closely monitoring the input and output of the bladder irrigation system b. Administering parenteral nutrition and fluids as prescribed c. Monitoring the client's level of consciousness and skin turgor d. Scanning the client's bladder for retention every 2 hours

a Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.

A client with a penile implant is to be informed about the possible complications after discharge. Which complication occurs due to a midsized implant, pressure, or friction of the implanted cylinders? a. erosion of penile or urethral tissue b. migration of the cylinders, pump, and reservoir c. erosion of scrotal, bowel, or bladder tissue d. malfunction of the device

a Erosion of penile or urethral tissue may occur from a midsized implant, pressure, and friction of the implanted cylinders, which is evidenced by seeing the implant through the skin. Migration of the cylinders, pump, and reservoir is a possible complication but not due to a midsized implant, pressure, or friction of the implanted cylinders. Erosion of scrotal, bowel, or bladder tissue can occur when an implant with a fluid reservoir is used. Malfunction of the device can occur with migration, accidental trauma such as a fall, or aggressive or improper use of the device.

Which of the following may result if prostate cancer invades the urethra or bladder? a. Hematuria b. Backache c. Hip pain d. Rectal discomfort

a 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.

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? a. Lupron b. Eulexin c. Casodex d. Nilandron

a Lupon is an LHRH agonist. The other three choices are antiandrogen receptor antagonists.

Which cancer ranks second as the cause of death in American men? a. prostate b. testicular c. skin d. penis

a Prostatic cancer is second to skin cancer in frequency among American men. It ranks second as the cause of deaths from cancer. Cancer of the testes is a malignancy seen in men between 18 and 40 years of age. Although this cancer is relatively rare, accounting for approximately 1% of cancers in men, it is the most common type in men between 15 and 34 years of age and is the leading cause of cancer deaths in men between 25 and 34 years of age. Skin cancer ranks first in frequency among American men. Penile cancer is rare and occurs more often in men who are uncircumcised.

A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? a. Testicular cancer is a highly curable type of cancer. b. Testicular cancer is very difficult to diagnose. c. Testicular cancer is the number one cause of cancer deaths in males. d. Testicular cancer is more common in older men.

a 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 with lung cancer. Testicular cancer is found more commonly in younger men.

A 29-year-old client has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the client admits to feeling devastated that he requires surgery, stating that it will leave him "emasculated" and "a shell of a man." The nurse should identify what nursing diagnosis when planning the client's subsequent care? a. Disturbed Body Image Related to Effects of Surgery b. Spiritual Distress Related to Effects of Cancer Surgery c. Social Isolation Related to Effects of Surgery d. Risk for Loneliness Related to Change in Self-Concept

a The client's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This client is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the client's concerns.

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BPH)? a. Voiding pattern b. Size of the prostate c. Creatinine clearance d. Serum testosterone level

a 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 nurse is teaching a 53-year-old man about prostate cancer, given the fact that he has a family history of the disease. What information should the nurse provide to best facilitate the early identification of prostate cancer? a. Have a digital rectal examination and prostate-specific antigen (PSA) test done as recommended. b. Have a transrectal ultrasound every 5 years. c. Perform monthly testicular self-examinations, especially after age 60. d. Have a complete blood count (CBC), blood urea nitrogen (BUN), and creatinine assessment performed annually.

a The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that are especially relevant when a client has a family history. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

A client who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional "dribbling" of urine. How should the nurse best respond to this client's concern? a. Inform the client that urinary control is likely to return gradually. b. Arrange for the client to be assessed by his urologist. c. Facilitate the insertion of an indwelling urinary catheter by the home care nurse. d. Teach the client to perform intermittent self-catheterization.

a The physician should be informed if there is significant leakage around a suprapubic catheter. Some leakage is expected, but larger amounts should be communicated to the care team. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

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? a. Hyperplasia of the prostate gland b. Thickening of the seminiferous tubules c. Fibrotic changes of the corpora cavernosa d. Hypogonadism

a 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.

Which discharge instructions would be provided to a client following a vasectomy? Select all that apply. a. Apply ice packs to the scrotum to reduce swelling. b. Resume usual activities in 2 to 3 days. c. Wear an athletic support once swelling has resolved. d. Expect swelling at the top of the testes for the first 2 to 3 days.

a, b Apply ice for 20-minute increments, remove and replace again after the tissue rewarms. Activities are resumed in 2 to 3 days, with the avoidance of strenuous exercise for up to 5 days. Wear an athletic support for several days for comfort. Report severe pain, fever, or swelling at the top of the testes.

Which nursing diagnoses may be appropriate for a client with prostate cancer? Select all that apply. a. Sexual dysfunction b. Anxiety c. Readiness for enhanced knowledge d. Spiritual distress e. Imbalanced nutrition, more than body requirements

a, b, c 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.

A health care provider has explained to the client that he has an inflammation of the Cowper glands. Where are the Cowper glands located? a. Within the epididymis b. Below the prostate, within the posterior aspect of the urethra c. On the inner epithelium lining the scrotum, lateral to the testes d. Medial to the vas deferens

b Cowper glands lie below the prostate, within the posterior aspect of the urethra. This gland empties its secretions into the urethra during ejaculation, providing lubrication. The Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas deferens.

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? a. Do not use the device while taking nitrates. b. Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. c. Watch for erosion of the prosthesis through the skin. d. Watch for the development of infection.

b 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.

Which client would the nurse identify as having the greatest risk for testicular cancer? a. A 20-year-old African American who was exposed to diethylstilbestrol prenatally b. A 36-year-old European American who is HIV positive c. A 50-year-old Hispanic American who works in a textile factory d. A 45-year-old Asian American with an enlarged prostate

b The client who is 36 years old, European American, and HIV-positive would have the greatest risk. Testicular cancer is the most common cancer diagnosed in men 15 to 35 years old and the second most common malignancy in those 35 to 39 years old. European Americans have a five times greater risk than African Americans and more than two to three times greater risk than Asian, Native American, and Hispanic men. The risk of developing testicular cancer is higher in HIV-positive men. Occupational hazards such as exposure to chemicals in mining, oil, and gas production, and leather processing have been suggested as possible risk factors. No evidence has linked testicular cancer to prenatal exposure to diethylstilbestrol. The client who is 20 years old is in the appropriate age group, but his ethnicity poses a lower risk than that of the 36-year-old European American. Both the 50-year-old Hispanic American and 45-year-old Asian American are at lower risk based on their ethnic group. Additionally, both these clients are not in the typical age group affected. Working in a textile factory and having an enlarged prostate are not risk factors associated with testicular cancer.

A client has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action? a. Cleanse the skin surrounding the suprapubic tube. b. Inform the urologist of this finding. c. Remove the suprapubic tube and apply a wet to dry dressing. d. Administer antispasmodic drugs as prescribed.

b The physician should be informed if there is significant leakage around a suprapubic catheter. Some leakage is expected, but larger amounts should be communicated to the care team. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

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? a. DRE b. PSA c. Prostate biopsy d. Cystoscopy

c 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.

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. The nurse should recognize the presence of what health problem? a. Bowen disease b. Peyronie's disease c. Phimosis d. Priapism

c Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans. Bowen 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.

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? a. "I'll have to stay in the hospital for about 3 to 4 days after the surgery." b. "I'll have a small incision on my lower abdomen after the procedure." c. "The surgeon is going to remove the entire prostate gland." d. "The surgeon is going to insert a scope through my urethra to remove a portion of the gland."

c 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.

Which of the following is the most immediate danger after prostate surgery? a. Obstructed urine flow b. Infection c. Bleeding d. Deep vein thrombosis

c The immediate danger after prostate surgery is bleeding and hemorrhagic shock. If, after 20 minutes, the bleeding is not controlled, surgical exploration may be considered. Since bleeding is increased in the sitting position, which increases bladder and venous pressure, the patient is encouraged to rest in bed with the head of the bed slightly elevated.

A client confides to the nurse that he cannot engage in sexual activity. The client is 27 years old and has no apparent history of chronic illness that would contribute to erectile dysfunction. What does the nurse know will be ordered for this client to assess his sexual functioning? a. Sperm count b. Ejaculation capacity tests c. Engorgement tests d. Nocturnal penile tumescence tests

d Nocturnal penile tumescence tests may be conducted in a sleep laboratory to monitor changes in penile circumference during sleep using various methods to determine number, duration, rigidity, and circumference of penile erections; the results help identify whether the erectile dysfunction is caused by physiologic and/or psychological factors. A sperm count would be done if the client was experiencing infertility. Ejaculation capacity tests and engorgement tests are not applicable for assessment in this circumstance.

A client is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? a. Red wine colored b. Tea colored c. Amber d. Light pink

d The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink color 24 hours after surgery.