LEWIS CH. 59 or 54 - MALE REPRODUCTIVE PROBLEMS
A 22-yr-old patient tells the nurse at the health clinic that he has recently had problems with erectile dysfunction. Which question should the nurse ask to assess for possible etiologic factors in this age group? a. "Do you use recreational drugs or drink alcohol?" b. "Do you experience an unusual amount of stress?" c. "Do you have cardiovascular or peripheral vascular disease?" d. "Do you have a history of an erection that lasted for 6 hours or more?"
a. "Do you use recreational drugs or drink alcohol?"
A patient with urinary obstruction from benign prostatic hyperplasia (BPH) tells the nurse, "My symptoms are much worse this week." Which response by the nurse is appropriate? a. "Have you taken any over-the-counter (OTC) medications recently?" b. "I will talk to the doctor about a prostate-specific antigen (PSA) test." c. "Have you talked to the doctor about surgery such as transurethral resection of the prostate (TURP)?" d. "The prostate gland changes in size from day to day, and this may be making your symptoms worse."
a. "Have you taken any over-the-counter (OTC) medications recently?"
A 70-yr-old patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) is being discharged from the hospital today. Which patient statement indicates a need for the nurse to provide additional instruction? a. "I should call the doctor if I have incontinence at home." b. "I will avoid driving until I get approval from my doctor." c. "I should schedule yearly appointments for prostate examinations." d. "I will increase fiber and fluids in my diet to prevent constipation."
a. "I should call the doctor if I have incontinence at home."
The following male patients recently arrived in the emergency department. Which one should the nurse assess first? a. A 19-yr-old patient who is reporting severe scrotal pain b. A 60-yr-old patient with a nontender ulceration of the glans penis c. A 64-yr-old patient who has dysuria after brachytherapy for prostate cancer d. A 22-yr-old patient who has purulent urethral drainage and severe back pain
a. A 19-yr-old patient who is reporting severe scrotal pain
Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first? a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum b. A 35-yr-old patient who is concerned that his scrotum "feels like a bag of worms" c. A 40-yr-old patient who has pelvic pain while being treated for chronic prostatitis d. A 70-yr-old patient who is reporting frequent urinary dribbling after a prostatectomy
a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum
What is the effect of finasteride (Proscar) in the treatment of BPH? a. A reduction in the size of the prostate gland b. Relaxation of the smooth muscle of the urethra c. Increased bladder tone that promotes bladder emptying d. Relaxation of the bladder detrusor muscle promoting urine flow
a. A reduction in the size of the prostate gland
What information will the nurse plan to teach the patient scheduled for photovaporization of the prostate (PVP)? a. Care of an indwelling urinary catheter. b. Urine will appear bloody for several days. c. Symptom improvement takes 2 to 3 weeks. d. Complications associated with urethral stenting.
a. Care of an indwelling urinary catheter.
What side effect of leuprolide (Lupron) should the nurse plan to discuss with a patient who has cancer of the prostate? a. Flushing b. Dizziness c. Infection d. Incontinence
a. Flushing
What information should the nurse include when performing discharge teaching for a patient after a vasectomy? a. He should continue to use other methods of birth control for 6 weeks. b. He should not have sexual intercourse until his 6-week follow-up visit. c. He may have temporary erectile dysfunction (ED) because of swelling. d. He will notice a decrease in the appearance and volume of his ejaculate.
a. He should continue to use other methods of birth control for 6 weeks.
A patient is seeking medical intervention for ED. Why should he be thoroughly evaluated? a. It is important to determine if ED is reversible before treatment is started. b. Psychologic counseling can reverse the problem in 80% to 90% of the cases. c. Most treatments for ED are contraindicated in patients with systemic diseases. d. New invasive and experimental techniques currently used have unknown risks.
a. It is important to determine if ED is reversible before treatment is started.
What should the nurse plan to teach a 67-yr-old patient who has been diagnosed with orchitis? a. Pain management b. Emergency surgery c. Scrotal sac fluid aspiration d. Applying heat to the scrotum
a. Pain management
What accurately describes prostate cancer detection and/or treatment (select all that apply)? a. The symptoms of lumbosacral pain and lower urinary tract symptoms may be present. b. Orchiectomy is a treatment option for all patients with prostatic cancer except those with stage IV tumors. c. Palpation of the prostate reveals hard and asymmetric enlargement with areas of induration or nodules. d. The preferred hormonal therapy for treatment of prostate cancer includes estrogen and androgen receptor blockers. e. Early detection of prostate cancer is increased with annual rectal examinations and serum prostatic acid phosphatase (PAP) measurements. f. An annual prostate examination is recommended starting at age 45 years for black men with a first-degree relative with prostate cancer at an early age.
a. The symptoms of lumbosacral pain and lower urinary tract symptoms may be present. c. Palpation of the prostate reveals hard and asymmetric enlargement with areas of induration or nodules. f. An annual prostate examination is recommended starting at age 45 years for black men with a first-degree relative with prostate cancer at an early age.
The extent of urinary obstruction caused by BPH can be determined by which diagnostic study? a. Uroflowmetry b. A cystometrogram c. Transrectal ultrasound d. Postvoiding catheterization
a. Uroflowmetry
A 47-year-old patient who has hypogonadism has decided to try the testosterone gel Testim. What should the nurse teach the patient and his wife about this gel? a. Wash the hands with soap and water after applying it. b. His wife should apply it to help him feel better about using it. c. Do not wear clothing over the area until it has been absorbed. d. The gel may be taken buccally if it is not effective on the abdomen.
a. Wash the hands with soap and water after applying it.
The nurse provides discharge teaching to a patient after a TURP and determines that the patient understands the instructions when he makes which statement? a. "I should use daily enemas to avoid straining until healing is complete." b. "I will avoid heavy lifting, climbing, and driving until my follow-up visit." c. "At least I don't have to worry about developing cancer of the prostate now." d. "Every day I should drink 10 to 12 glasses of liquids, such as coffee, tea, or soft drinks."
b. "I will avoid heavy lifting, climbing, and driving until my follow-up visit."
The nurse in a health clinic receives requests for appointments from several patients. Which patient should be seen by the health care provider first? a. A 48-yr-old patient who has perineal pain and a temperature of 100.4° F b. A 58-yr-old patient who has a painful erection that has lasted more than 6 hours c. A 38-yr-old patient who reports that he had difficulty maintaining an erection twice last week d. A 68-yr-old patient who has pink urine after a transurethral resection of the prostate (TURP) 3 days ago
b. A 58-yr-old patient who has a painful erection that has lasted more than 6 hours
A 58-yr-old patient with erectile dysfunction (ED) tells the nurse he is interested in using sildenafil (Viagra). Which action should the nurse take first? a. Assure the patient that ED is common with aging. b. Ask the patient about any prescription drugs he is taking. c. Tell the patient that Viagra does not always work for ED. d. Discuss the common adverse effects of erectogenic drugs.
b. Ask the patient about any prescription drugs he is taking.
A 27-yr-old patient who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is appropriate for the nurse to take? a. Teach the patient and the wife that impotence is unlikely after unilateral orchiectomy. b. Ask the patient if he has any questions or concerns about the diagnosis and treatment. c. Inform the patient's wife that concerns about sexual function are common with this diagnosis. d. Document the patient's lack of communication on the health record and continue preoperative care.
b. Ask the patient if he has any questions or concerns about the diagnosis and treatment.
A patient with continuous bladder irrigation after a prostatectomy tells the nurse that he has bladder spasms and leaking of urine around the catheter. What should the nurse do first? a. Slow the rate of the irrigation. b. Assess the patency of the catheter. c. Encourage the patient to try to urinate around the catheter. d. Administer a belladonna and opium (B&O) suppository as prescribed.
b. Assess the patency of the catheter.
What will the nurse plan to teach the patient who is incontinent of urine following a radical retropubic prostatectomy? a. Restrict oral fluid intake. b. Do pelvic muscle exercises. c. Perform intermittent self-catheterization. d. Use belladonna and opium suppositories.
b. Do pelvic muscle exercises.
The health care provider prescribes finasteride (Proscar) for a patient who has benign prostatic hyperplasia (BPH). What information should the nurse provide when teaching the patient about the drug? a. He should change position from lying to standing slowly to avoid dizziness. b. His interest in sexual activity may decrease while he is taking the medication. c. Improvement in the obstructive symptoms should occur within about 2 weeks. d. He will need to monitor his blood pressure frequently to assess for hypertension.
b. His interest in sexual activity may decrease while he is taking the medication.
A patient who has benign prostatic hyperplasia (BPH) with urinary retention is admitted to the hospital with elevated blood urea nitrogen (BUN) and creatinine. Which prescribed therapy should the nurse implement first? a. Infuse normal saline at 50 mL/hr. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Schedule pelvic magnetic resonance imaging
b. Insert a urinary retention catheter.
A patient tells the nurse that he decided to seek treatment for erectile dysfunction (ED) because his partner "is losing patience with the situation." Which patient concern should be the focus of the nurse's follow-up questions? a. Low self-esteem b. Role performance c. Increased anxiety. d. Infrequent intercourse.
b. Role performance
Which therapies for BPH are done on an outpatient basis (select all that apply)? a. Intraprostatic urethral stents b. TUNA c. Photovaporization of the prostate (PVP) d. Transurethral incision of prostate (TUIP) e. TUMT
b. TUNA c. Photovaporization of the prostate (PVP) d. Transurethral incision of prostate (TUIP) e. TUMT
Which information will the nurse plan to include when teaching a young adult who has a family history of testicular cancer about testicular self-examination? a. Testicular self-examination should be done at least weekly. b. Testicular self-examination should be done in a warm room. c. The only structure normally felt in the scrotal sac is the testis. d. Call the health care provider if one testis is larger than the other.
b. Testicular self-examination should be done in a warm room.
Which treatment for BPH uses a low-wave radiofrequency to precisely destroy prostate tissue? a. Laser prostatectomy b. Transurethral needle ablation (TUNA) c. Transurethral microwave thermotherapy (TUMT) d. Transurethral electrovaporization of prostate (TUVP)
b. Transurethral needle ablation (TUNA)
What should the nurse assess for when performing a focused examination to determine possible causes of infertility? a. Hydrocele b. Varicocele c. Epididymitis d. Paraphimosis
b. Varicocele
Serum tumor markers that may be elevated on diagnosis of testicular cancer and used to monitor the response to therapy include a. tumor necrosis factor (TNF) and C-reactive protein (CRP). b. α-fetoprotein (AFP) and human chorionic gonadotropin (hCG). c. PSA and PAP. d. carcinoembryonic antigen (CEA), antinuclear antibody (ANA) and human epidermal growth factor receptor 2 (HER-2).
b. α-fetoprotein (AFP) and human chorionic gonadotropin (hCG).
The nurse is obtaining the pertinent health history for a man who is being evaluated for infertility. Which question focuses on a possible cause of infertility? a. "Are you circumcised?" b. "Have you had surgery for phimosis?" c. "Do you use medications to improve muscle mass?" d. "Is there a history of prostate cancer in your family?"
c. "Do you use medications to improve muscle mass?"
The nurse in the clinic notes elevated prostate-specific antigen (PSA) levels in the laboratory results of these patients. Which patient's elevated PSA result requires further evaluation? a. A 38-yr-old patient who is being treated for acute prostatitis b. A 52-yr-old patient who goes on long bicycle rides every weekend c. A 48-yr-old patient whose father died of metastatic prostate cancer d. A 75-yr-old patient who uses saw palmetto to treat benign prostatic hyperplasia (BPH)
c. A 48-yr-old patient whose father died of metastatic prostate cancer
A patient who was recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because it might affect his ability to have sexual intercourse. Which action should the nurse take? a. Discuss alternative methods of sexual expression. b. Teach about medication for erectile dysfunction (ED). c. Clarify that TURP does not commonly affect erection. d. Offer reassurance that fertility is not affected by TURP.
c. Clarify that TURP does not commonly affect erection.
What potential cause of infection will the nurse consider in the plan of care for a patient immediately after a perineal radical prostatectomy? a. Urinary incontinence b. Prolonged urinary stasis c. Fecal wound contamination d. Suprapubic catheter placement
c. Fecal wound contamination
What will the nurse will ask the patient about to determine the severity of benign prostatic hyperplasia (BPH) symptoms? a. Blood in the urine b. Lower back or hip pain c. Force of urinary stream d. Erectile dysfunction (ED)
c. Force of urinary stream
On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need to know what? a. The effects of general anesthesia b. The possibility of short-term incontinence c. Home management of an indwelling catheter d. Monitoring for postoperative urinary retention
c. Home management of an indwelling catheter
Which information will the nurse teach a patient who has chronic prostatitis? a. Ibuprofen (Motrin) should provide good pain control. b. Prescribed antibiotics should be taken for 7 to 10 days. c. Intercourse or masturbation will help relieve symptoms. d. Cold packs used every 4 hours will decrease inflammation.
c. Intercourse or masturbation will help relieve symptoms.
A 53-yr-old patient is scheduled for an annual physical examination. What diagnostic test will the nurse will plan to explain to the patient? a. Urinalysis collection b. Uroflowmetry studies c. Prostate-specific antigen (PSA) d. Transrectal ultrasound scanning (TRUS)
c. Prostate-specific antigen (PSA)
: When caring for a patient after a radical prostatectomy with a perineal approach, what is the priority nursing intervention the nurse should use to prevent complications? a. Use chemotherapy to prevent metastasis. b. Administer sildenafil (Viagra) as needed for erectile dysfunction (ED). c. Provide wound care after each bowel movement to prevent infection. d. Insert a smaller indwelling urinary catheter to prevent urinary retention.
c. Provide wound care after each bowel movement to prevent infection.
A 55-year-old man with a history of prostate cancer in his family asks the nurse what he can do to decrease his risk of prostate cancer. What should the nurse teach him about prostate cancer risks? a. Nothing can decrease the risk because prostate cancer is primarily a disease of aging. b. Treatment of any enlargement of the prostate gland will help prevent prostate cancer. c. Substituting fresh fruits and vegetables for high-fat foods in the diet may lower the risk of prostate cancer. d. Using a natural herb, such as saw palmetto, has been found to be an effective protection against prostate cancer.
c. Substituting fresh fruits and vegetables for high-fat foods in the diet may lower the risk of prostate cancer.
Which action by the unlicensed assistive personnel (UAP) who are assisting with the care of male patients with reproductive problems indicates that the nurse should provide more teaching? a. The UAP apply a cold pack to the scrotum for a patient with mumps orchitis. b. The UAP help a patient who has had a prostatectomy to put on antiembolism hose. c. The UAP leave the foreskin pulled back after cleaning the glans of a patient who has a retention catheter. d. The UAP encourage a high oral fluid intake for patient who had transurethral resection of the prostate yesterday.
c. The UAP leave the foreskin pulled back after cleaning the glans of a patient who has a retention catheter.
What health history information should the nurse obtain from the patient who has possible testicular cancer? a. Testicular torsion b. Testicular trauma c. Undescended testicles d. Sexually transmitted infection (STI)
c. Undescended testicles
What describes hypospadias? a. Scrotal lymphedema b. Undescended testicle c. Ventral urinary meatus d. Inflammation of the prepuce
c. Ventral urinary meatus
When taking a nursing history from a patient with BPH, the nurse would expect the patient to report a. nocturia, dysuria, and bladder spasms. b. urinary frequency, hematuria, and perineal pain. c. urinary hesitancy, postvoid dribbling, and weak urinary stream. d. urinary urgency with a forceful urinary stream and cloudy urine.
c. urinary hesitancy, postvoid dribbling, and weak urinary stream.
What should the nurse teach the patient about what occurs after having a vasectomy? a. The amount of ejaculate will be noticeably decreased. b. He may have difficulty maintaining an erection for several months. c. The testes will gradually decrease production of sperm and testosterone. d. An alternative form of contraception must be used until semen examination shows no sperm.
d. An alternative form of contraception must be used until semen examination shows no sperm.
Before undergoing a TURP, what should the patient be taught? a. This surgery requires an external incision. b. The procedure is done under local anesthesia. c. Recurrent urinary tract infections are likely to occur. d. An indwelling catheter will be used to maintain urinary output until healing is complete.
d. An indwelling catheter will be used to maintain urinary output until healing is complete.
A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. The best response by the nurse includes what information about BPH? a. BPH is a benign tumor that does not spread beyond the prostate gland. b. BPH is a precursor to prostate cancer but does not yet show any malignant changes. c. BPH is an enlargement of the gland caused by an increase in the size of existing cells. d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells.
d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells.
Which information about continuous bladder irrigation will the nurse teach to a patient who is being admitted for a transurethral resection of the prostate (TURP)? a. Bladder irrigation decreases the risk of postoperative bleeding. b. Hydration and urine output are maintained by bladder irrigation. c. Antibiotics are infused continuously through the bladder irrigation. d. Bladder irrigation prevents obstruction of the catheter after surgery.
d. Bladder irrigation prevents obstruction of the catheter after surgery.
The health care provider prescribes the following interventions for a patient with acute prostatitis caused by Escherichia coli. Which intervention should the nurse question? a. Give trimethoprim/sulfamethoxazole 1 tablet daily for 28 days. b. Administer ibuprofen 400 mg every 8 hours as needed for pain. c. Instruct patient to avoid sexual intercourse until treatment is complete. d. Catheterize the patient as needed if symptoms of urinary retention develop.
d. Catheterize the patient as needed if symptoms of urinary retention develop.
What is the most common screening intervention for detecting BPH in men over age 50 years? a. Prostate-specific antigen (PSA) level b. Urinalysis c. Cystoscopy d. Digital rectal examination
d. Digital rectal examination
Following a TURP, a patient has continuous bladder irrigation. Four hours after surgery, the catheter is draining thick, bright red clots and tissue. What should the nurse do? a. Release the traction on the catheter. b. Clamp the drainage tube and notify the patient's health care provider (HCP). c. Manually irrigate the catheter until the drainage is clear. d. Increase the rate of the irrigation and take the patient's vital signs.
d. Increase the rate of the irrigation and take the patient's vital signs.
After a transurethral resection of the prostate (TURP), a 64-yr-old patient with continuous bladder irrigation reports painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take first? a. Increase the flowrate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter.
d. Manually instill and then withdraw 50 mL of saline into the catheter.
What differentiates chronic bacterial prostatitis from acute prostatitis? a. Postejaculatory pain b. Frequency, urgency, and dysuria c. Symptoms of a urinary tract infection (UTI) d. Most common reason for recurrent UTIs in adult men
d. Most common reason for recurrent UTIs in adult men
When caring for a patient with continuous bladder irrigation after having transurethral resection of the prostate, which action could the nurse delegate to unlicensed assistive personnel (UAP)? a. Teach the patient how to perform Kegel exercises. b. Monitor for increases in bleeding or presence of clots. c. Increase the flowrate of the irrigation if clots are noted. d. Report any patient reports of pain or spasms to the nurse.
d. Report any patient reports of pain or spasms to the nurse.
What is an explanation that the nurse should give to the wife of the patient who asks what her husband's diagnosis of paraphimosis means? a. Painful, prolonged erection b. Inflammation of the epididymis c. Painful downward curvature of an erect penis d. Retracted tight foreskin preventing return over the glans
d. Retracted tight foreskin preventing return over the glans
A patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. What should the nurse plan to do? a. Vaccinate the patient with sipuleucel-T (Provenge). b. Provide the patient with information about cryotherapy. c. Teach the patient about placement of intraurethral stents. d. Schedule the patient for annual prostate-specific antigen testing.
d. Schedule the patient for annual prostate-specific antigen testing.
The couple has not been able to become pregnant. The wife has not been diagnosed with any infertility problems. Which treatment will the nurse expect to teach the couple about if the problem is the most common testicular problem causing male infertility? a. Antibiotics b. Semen analysis c. Avoidance of scrotal heat d. Surgery to correct the problem
d. Surgery to correct the problem
The cremasteric reflex is absent in which problem of the scrotum and testes? a. Hydrocele b. Varicocele c. Spermatocele d. Testicular torsion
d. Testicular torsion
A 66-year-old male patient is experiencing ED. He and his wife have used tadalafil (Cialis), but because he had priapism, they decided to change treatment to an intraurethral device. How should the nurse explain how this device works? a. The device relaxes smooth muscle in the penis. b. Blood is drawn into corporeal bodies and held with a ring. c. The device is implanted into corporeal bodies to firm the penis. d. The device directly applies drugs that increase blood flow in the penis.
d. The device directly applies drugs that increase blood flow in the penis.
Which assessment information collected by the nurse may present a contraindication to a testosterone replacement therapy (TRT)? a. The patient has noticed a decrease in energy level for a few years. b. The patient's symptoms have increased steadily over the past few years. c. The patient has been using sildenafil (Viagra) several times every week. d. The patient has had a gradual decrease in the force of his urinary stream.
d. The patient has had a gradual decrease in the force of his urinary stream.
What test will the nurse plan to explain to a 61-yr-old patient who has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate-specific antigen (PSA) level? a. Cystourethroscopy b. Uroflowmetry studies c. Magnetic resonance imaging (MRI) d. Transrectal ultrasonography (TRUS)
d. Transrectal ultrasonography (TRUS)
Which characteristics describe transurethral resection of the prostate (TURP) (select all that apply)? a. Best used for a very large prostate gland b. Inappropriate for men with rectal problems c. Involves an external incision prostatectomy d. Uses transurethral incision into the prostate e. Most common surgical procedure to treat BPH f. Resectoscopic excision and cauterization of prostate tissue
e. Most common surgical procedure to treat BPH f. Resectoscopic excision and cauterization of prostate tissue
