Health Assessment Chapter 23

Is preadolescent. The hair present is no different from that on the abdomen. The testes, scrotum, and penis are the same size and shape as those of a young child.

In Stage I

Is the adult stage of development. Hair spreads to the medial surface of the thighs in an adult distribution. The scrotum is adult size, and the penis reaches nearly to the bottom of the scrotum.

In Stage V

An adult male tells the nurse, "I have a good wife, but I'm just not interested in sex anymore." What would be an appropriate response by the nurse? Hint: Special Considerations; Psychosocial Considerations a. "How does your wife feel about this?" b. "Have you noticed a change in your ability to obtain an erection?" c. "Do you have pain with intercourse?" d. "Have you been under a lot of stress recently?"

"Have you been under a lot of stress recently?"

In the United States

Penile cancer is rare

A condition in which the foreskin is so tight that it cannot be retracted

Phimosis

The most appropriate response to lack of sex drive would be for the nurse to ask the client about

Stress

Asking how the client's wife feels about this may be done

later in the conversation

Which statements should the nurse include when providing client education regarding testicular self-examination? Select all that apply. a. "The testicle should feel smooth, rounded, and firm." b. "Apply gentle pressure with your thumb, index, and middle fingers. Your testicle should hurt when you feel it." c. "The best time to perform the exam is in the shower or bath." d. "If your testicle has any lumps or is enlarged, call your healthcare provider." e. "It is normal to feel the epididymis on top of and behind each testicle."

"The testicle should feel smooth, rounded, and firm." "The best time to perform the exam is in the shower or bath." "If your testicle has any lumps or is enlarged, call your healthcare provider." "It is normal to feel the epididymis on top of and behind each testicle."

The mother of a full-term, 2-month-old male infant says to the nurse, "I think there's something wrong. His scrotum looks so big compared to his penis." How should the nurse respond to this mother? Hint: Special Considerations; Infants and Children a. "This is called cryptorchidism and is a common finding in baby boys." b. "This is normal. As your baby grows, his scrotum will be more in proportion with his penis." c. "The enlargement could indicate the presence of a hydrocele, which is normal at this age." d. "Have you noticed any redness or drainage from the area?"

"This is normal. As your baby grows, his scrotum will be more in proportion with his penis."

What statement should the nurse include when educating an older adult male on prostate health? Hint: Cultural and Environmental Considerations a. "Men your age should have the prostate-specific antigen (PSA) screening every year." b. "You should receive an annual prostate examination." c. "The symptoms of prostate cancer occur early in the disease." d. "Risk factors for prostate cancer include a family history of testicular cancer and a personal history of a vasectomy."

"You should receive an annual prostate examination." Men over the age of 50 should receive an annual prostate examination (digital rectal examination). The United States Preventive Services Task Force (USPSTF, 2008) recommends against PSA screening in males 75 years of age and older. Signs of prostate cancer are not usually noticeable until the prostatic cancer is advanced. The signs are usually confounding because benign prostatic disease presents with similar symptoms such as dribbling, retention of urine, difficulty initiating the urinary stream, and cystitis. Risk factors include a family history of prostatic cancer and smoking.

Identifying and considering risk factors for prostate cancer, which client should the nurse refer to the healthcare provider? Hint: Patient Education; Cultural Considerations a. 40-year-old White uncircumcised male b. 60-year-old Black male with an elevated PSA c. 25-year-old White male with testicular pain d. 65-year-old Hispanic male with difficulty starting and stopping urination

60-year-old Black male with an elevated PSA Prostate cancer occurs more frequently in Black males than in other ethnic groups. The client's age and his race raise his risk for prostate cancer. While an elevated PSA is not specific for prostate cancer, the nurse should refer this client to the healthcare provider for evaluation. The incidence of prostate cancer increases as men age; unless there are increased risk factors, prostate screening typically begins at the age of 50. An uncircumcised male may be at increased risk for penile cancer, not prostate cancer. A 25-year-old White male with a testicular mass is at risk for testicular cancer, not prostate cancer. A 65-year-old Hispanic male with difficulty starting and stopping urination may be experiencing prostatic hypertrophy. As men age, it is common for the prostate gland to enlarge causing urinary symptoms that may include, frequency, urinary retention, difficulty starting and stopping the urinary stream, and dysuria.

Penile cancer accounts for almost 10% of male cancers in

Africa and South America

Prostate cancer occurs more frequently in

Caucasians than in African Americans

The rates for STIs are higher in African American and Hispanic populations than in

Caucasians.

The condition in which the urinary meatus is located on the dorsal side of the glans

Epispadias

The pubic hair is slightly pigmented, longer, straight hair, often still downy and usually at the base of the penis, sometimes on the scrotum. There is enlargement of the scrotum and testes.

In stage II

The pubic hair is dark and curly around the base of the penis. There is enlargement of the penis, especially in length, with enlargement of the testes and descent of the scrotum.

In stage III

Redness and drainage might indicate

Inflammation or infection, not the normal scrotum of an infant.

The nurse is planning an educational session on cancers of the male reproductive system. Which statements should the nurse include? Select all that apply. Hint: Cultural and Environmental Considerations a. Penile cancer is rare in the United States. b. Prostate cancer occurs more frequently in Caucasians than in African Americans. c. Testicular cancer occurs more frequently in Caucasians than in any other ethnic group. d. The rates for sexually transmitted infections (STIs) are higher in Caucasians than in other ethnic groups. e. Bladder cancer is more common in Caucasians.

Penile cancer is rare in the United States. Testicular cancer occurs more frequently in Caucasians than in any other ethnic group. Bladder cancer is more common in Caucasians.

Cryptorchidism, undescended testicles, is more common in

Preterm infants.

When performing a genital assessment on a young teenage boy, the nurse notes that the pubic hair is slightly pigmented, longer, straight, downy, and at the base of the penis. There is enlargement of the scrotum and testes but not the penis. The nurse documents that the client is in which stage of maturation? a. Stage I b. Stage II c. Stage III d. Stage V

Stage II

The nurse is having difficulty during the focused interview obtaining information from a 16-year-old male client regarding his sexual history and activity. How should the nurse proceed with this assessment? Select all that apply. Hint: Questions Regarding Infants and Children a. Tell the client that the information he shares with you is confidential and will not be discussed with his parents, unless he is in an abusive situation. b. Offer information on pregnancy, birth control, and STDs. c. Ask the adolescent's parents to talk with him. d. Screen the adolescent for sexually transmitted infections (STIs). e. Wait until the next appointment and bring up the subject again when he may feel more comfortable.

Tell the client that the information he shares with you is confidential and will not be discussed with his parents, unless he is in an abusive situation. Offer information on pregnancy, birth control, and STDs. • Tell the client that the information he shares with you is confidential and will not be discussed with his parents, unless he is in an abusive situation. Some teenagers may be fearful that the nurse will relay this information to their parents. The nurse should reinforce that all information is confidential except in situations of sexual abuse. • Offer information on pregnancy, birth control, and STIs. Whether or not a male adolescent admits to being sexually active, the nurse should offer information on teenage pregnancy, birth control, and protection against STIs. • Ask the adolescent's parents to talk with him. It is the nurse's responsibility to discuss this information with the client. • Screen the adolescent for sexually transmitted infections (STIs). The nurse needs more information and client consent to screen for STIs. • Wait until the next appointment and bring up the subject again when he may feel more comfortable. The nurse needs to make the most of each client encounter. Waiting until another time or avoiding the discussion is not appropriate. He may not return for another appointment.

Because the spermatic cord is longer.

The scrotum is visibly asymmetrical with the left side extending lower than the right

A variety of factors including disease, medication, loss of significant other, loss of privacy, depression, fatigue, stress, or use of alcohol or illicit drugs can influence

The sex drive

A teenage boy reports sudden, severe pain in the testicles with no precipitating event. The nurse notes edema of the testicles. The nurse is concerned that this teen may be experiencing: Hint: Abnormalities of the Scrotum a. testicular tumor b. scrotal hernia c. scrotal edema d. torsion of the spermatic cord

torsion of the spermatic cord Torsion of the spermatic cord occurs with greatest frequency in adolescents. The twisting of the testicle or the spermatic cord creates edema and pain. This condition is a surgical emergency. Testicular tumors typically present as a painless nodule on the testes. Scrotal hernias are commonly an indirect inguinal hernia located within the scrotum and don't present with sudden, severe pain and edema of the area. Scrotal edema is seen in conditions causing edema of the lower body including renal disease and heart failure.

When you feel it.

Your testicle should not hurt

When assessing the genitals of a male client, the nurse notes normal findings that include: Select all that apply. a. The left testicle hangs lower than the right. b. The skin on the scrotum is shiny and smooth. c. The scrotum is a darker color than the general skin color. d. The testes move closer to the body in response to cooler temperatures. e. The urethral meatus is positioned on the ventral surface of the penis.

a. The left testicle hangs lower than the right. c. The scrotum is a darker color than the general skin color. d. The testes move closer to the body in response to cooler temperatures.

When performing an assessment of the genital and anal region of a male, the nurse notes the presence of tears around the anal opening. The client states that he has been more constipated than usual. The nurse documents the finding as: Hint: Abnormalities of the Perianal Area a. pilonidal cyst b. perianal or perirectal abscess c. anal fissures d. prolapse of the rectum

anal fissures Anal fissures are tears in the anal mucosa and are most frequently associated with passage of hard stools. Pilonidal cysts are seen as dimpling in the sacrococcygeal area at the midline. An opening is visible and may reveal a tuft of hair. They are typically asymptomatic; however, they may become abscessed. Perianal and perirectal abscesses are painful and tender with perianal erythema. They are generally caused by infection of an anal gland and can lead to the development of fistulas. Rectal prolapse occurs when the rectal mucosa protrudes through the anus. A round or oval pink protrusion is seen outside the anus.

Call your healthcare provider if your testicle has

any lumps or is enlarged,

The incidence of testicular cancer is higher in Caucasians than in

any other ethnic group

Caucasians are more likely to develop

bladder cancer.

Paraphimosis describes a condition in which the foreskin, once retracted, becomes so tight that it

cannot be moved back over the glans

If there are any distinct lumps, areas of hardness, or if the testicle is enlarged, the client should

contact their healthcare provider.

The testes move closer to the body in response to

cooler temperatures and stimulation.

With cryptorchidism, the scrotal sac would be

empty, not appear enlarged

A hydrocele may be present if the scrotum is

enlarged and filled with fluid, which is not considered a normal finding.

The epididymis often can be

felt during palpation.

The scrotum is a darker color than the

general skin color

When performing an assessment on a 3-year-old child, the nurse notes the presence of the cremasteric reflex. Before examining the testicles of the child, the nurse should: Hint: Palpate the testes a. wash his/her hands in cool water b. obtain a flashlight for transillumination of the scrotum c. have the child sit tailor style d. have the child cough or bear down

have the child sit tailor style The cremasteric reflex may cause the testicles to migrate upward temporarily. To prevent this reflexive action when examining a child, have him sit tailor style (cross-legged). Gentle pressure over the canal with the nondominant hand can also reduce this response. The nurse should have warm hands when performing this assessment. Cold hands, a cold room, or the stimulus of touch can stimulate the cremasteric reflex. Transillumination of the scrotum is done if a mass or edema is evident on assessment. Having the client cough or bear down is done when assessing for hernias.

The best time to perform the exam is

in the shower or bath

Hypospadias is the condition in which the urinary meatus is located on the

ventral side of the glans

During a shower or bath, the heat and steam will warm the hands, and the water will help

your hands glide over the surface of the skin.

The left testicle hangs

lower than the right

The urethral meatus should be positioned in the

midline.

The epididymis is positioned

on top of and behind each testicle

In comparison with the penis the male infant's scrotum should seem

oversized, this proportion changes as the infant grows

When examining an uncircumcised client, the nurse attempts to retract the foreskin. The foreskin is so tight that it cannot be retracted. The nurse documents the presence of: Hint: Assessment Techniques and Findings; Inspect the Penis a. phimosis b. paraphimosis c. epispadias d. hypospadias

phimosis

If the testicle hurts when palpating it, the client is

pressing too hard

The scrotum is darkly pigmented, wrinkled, and has a scant amount of

pubic hair

Based on the client's statement, more information would be obtained about the client's psychosocial status before

questions related to physical problems such as pain and erectile dysfunction

During the inspection of a male client's genitalia, the nurse notes a white cheesy substance on the glans penis. The nurse documents this finding as: Hint: Techniques and Normal Findings; Inspect the Penis a. purulent discharge on glans penis b. smegma present c. signs of urethritis present d. potential sexually transmitted infection

smegma present Smegma, a white cheesy substance on the glans penis, may be present and is considered a normal finding. Purulent discharge could be white or yellow in color. There are no other symptoms noted to make the nurse suspect that this is purulent drainage. Signs of urethritis (inflammation of the urethra) include redness and edema around the glans and foreskin, and discharge. The client would likely have pain on urination as well. Gonococcal infection is suspected if the drainage is profuse and thick, purulent, and greenish yellow.

When performing a prostate examination, the nurse knows that normal findings include: Select all that apply. Hint: Palpate the Bulbourethral Gland and Prostate Gland a. smooth surface b. firm consistency c. The gland extends about 2 centimeters into the rectal area. d. moderate tenderness to palpation e. small, discrete nodules

smooth surface firm consistency • Smooth surface: The surface of the prostate gland should be smooth. • Firm consistency: The prostate is smooth and firm, even somewhat rubbery. • The gland extends about 2 centimeters into the rectal area: The normal prostate gland extends out no more than 1 centimeter into the rectal area. • Moderate tenderness: The prostate should be nontender to palpation. • Small, discrete nodules: The surface is smooth. Nodules are characteristic of prostate cancer.

The contour of a normal testicle is

smooth, rounded, and firm

When assessing the testicle apply gentle pressure with your

thumb, index, and middle fingers