Med Surg Ch. 59 Male Reproductive Disorders
A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:
continuous inflow and outflow of irrigation solution. When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.
A male client has undergone a semen analysis for evaluation of fertility. The nurse understands that a sperm count of which of the following would suggest infertility?
18 million/mL A sperm count of fewer than 20 million spermatozoa per milliliter results in infertility. Normal sperm count ranges on average from 60 to 100 million /mL.
A client is having prostate-specific antigen (PSA) testing done. Which result would the nurse identify as abnormal?
4.6 nanograms/milliliter Normal prostate-specific antigen (PSA) levels are less than 4.0 nanograms/milliliter (ng/mL). A level of 4.6 ng/mL would be considered abnormal.
As treatment of erectile dysfunction, Viagra is taken how many minutes before intercourse to be effective?
60 Viagra needs to be taken orally 1 hour before intercourse. Stimulation is required to achieve erection.
The nurse is reviewing the medical record of a client who has been diagnosed with prostate cancer. The nurse notes that the Gleason score was used to grade the cancer. Which total score would the nurse interpret as indicating a highly aggressive cancer?
9 The Gleason score is the most commonly used tumor grading system which assigns two scores with a combined value ranging from 2 to 10. With each increase in Gleason score, there is an increase in tumor aggressiveness. High Gleason scores indicate more aggressive cancer. A total score of 8 to 10 indicate a high-grade cancer.
A client comes to the emergency department complaining of moderate to severe testicular pain and tenderness. Both testicles are swollen and a penile discharge is present. The client is diagnosed with viral orchitis. Which of the following would the nurse include in this client's plan of care?
Aplying ice to the scrotum Care for the client with viral orchitis includes elevating the scrotum and applying ice to it, promoting rest, and using analgesics and anti-inflammatory agents for pain relief. Antibiotics would be used if the orchitis was bacterial. Incision and drainage are not performed.
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?
Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. 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 of the following may result if prostate cancer invades the urethra or bladder?
Hematuria 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 nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make?
Testicular cancer is a highly curable type of cancer. 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 in men with lung cancer. Testicular cancer is found more commonly in younger, not older, men.
A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?
Transurethral resection of the prostate (TURP) TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; each requires an incision.
The nurse is preparing a presentation for a local community group about prostate cancer and possible dietary risk factors. Which of the following would the nurse most likely include?
High-fat diet Although the cause of prostatic cancer is unknown, there seems to be a relationship with increased testosterone levels and a diet high in fat. No other dietary links have been suggested.
The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history?
Hypotension with nitrate use Due to the action of the medication on the smooth muscles and blood vessels, clients are advised not to take medications to treat erectile dysfunction when also prescribed a nitrate drug for chest pain or heart problems. Combining medication could result in a serious drop in blood pressure. Although all disease processes and medication therapy should be screened for interactions, hypotension with nitrate use the most serious side effects.
Following a vasectomy, which is the most important instruction to provide to the client?
Use another form of birth control until further notice. It may take up to 10 ejaculations to clear sperm and prevent impregnation. The client should be instructed to use another form of reliable birth control until a sperm count proves sterility has occurred. Use of Tylenol, scrotal support, and rest are all helpful during the initial recovery period.
Which of the following should be included when teaching a client about the management of benign prostatic hyperplasia (BPH)? Select all that apply.
-Do not delay the urge to void. -Schedule digital rectal exams. The client should be instructed to void promptly when the urge to empty the bladder is signaled by the stretch receptors in the bladder. Voiding promptly will decrease the risk for urinary retention. Digital rectal exams should be monitored to detect further enlargement of the gland and/or presence of prostatic nodules. Alcohol and antihistamines (e.g., Benadryl) should be avoided in the management of BPH. Exposure to heat and painless hematuria are not significant in the management of BPH. Alcohol and antihistamines interact with many BPH drugs.
A 48-year-old man recently diagnosed with benign prostatic hyperplasia (BPH) reports consuming <i>Serenoa repens</i> (saw palmetto berry). The nurse needs to intervene if the physician orders which treatment?
Finasteride Serenoa repens (saw palmetto berry) should not be used with finasteride. Terazosin is an alpha-adrenergic blocker and can be taken with Serenoa repens. Sipuleucel-T is a therapeutic cancer vaccine. Ketoconazole is an adrenal-ablating drug used to inhibit cytochrome P450 enzymes.
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?
Use sterile technique when irrigating the catheter. If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.
After teaching a group of student about structural abnormalities of the male reproductive system, the instructor determines that the teaching was successful when the students identify which of the following as an example?
Cryptorchidism Structural abnormalities include cryptorchidism, torsion of the spermatic cord, phimosis, paraphimosis, hydrocele, spermatocele, and varicocele. Erectile dysfunction and priaprism are erection disorders. Prostatitis is an infectious disorder.
Which age-related change affects the male reproductive system?
Decreased plasma testosterone levels Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.
What should a male client older than age 50 do to help ensure early identification of prostate cancer?
Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland because of its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastasis.
A nurse is reviewing the history of a client who is experiencing difficulty sustaining an erection. Which of the following might the nurse suspect as a possible contributing factor?
Hypertension Hypertension may be a contributing factor because some types of antihypertensive agents can reduce a male's ability to achieve or sustain an erection. A history of lower back pain, sinus infections, or asthma is unrelated to erectile dysfunction.
A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)?
"I've had trouble getting started when I urinate, often straining to do so." 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.
Which client would the nurse identify as having the greatest risk for testicular cancer?
A 36-year-old Caucasian American who is HIV positive The client who is 36 years old, Caucasian 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. Caucasian 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 diethylstilbesterol. 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 Caucasian 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.
Medical management of BPH includes pharmacologic therapy. Which of the following medications would the nurse expect the health care provider to prescribe for this diagnosis?
Alpha-adrenergic blocker Alpha-adrenergic blockers relax the smooth muscle of the bladder neck and prostate, improving urine flow and relieving BPH symptoms.
A client is undergoing treatment for prostate cancer. He has chemotherapy sessions regularly. However, of late he is showing symptoms of food allergy and loss of appetite. He has lost considerable weight as a result. Which is an appropriate nursing task in this situation?
Ask the client to keep a diet diary. The appropriate nursing task in this situation is to assess the amount of food eaten. This assessment will help determine nutrient intake. The nurse should ensure adequate fluid hydration before, during, and after drug administration when the client has side effects of nausea and vomiting. Administration of fruits is not recommended when the client is at risk of infection, such as during chemotherapy. Serotonin blockers are administered to control nausea and vomiting.
Which is inconsistent with a digital rectal examination (DRE)?
Can reveal a hydrocele DRE is recommended as part of the regular health checkup for every man older than 50 years of age. It is a screening for cancer of the prostate gland. It enables the examiner to assess the size, shape, and consistency of the prostate gland.
A health care provider prescribes ketoconazole (Nizoral), a second-line hormonal agent for the treatment of prostatic cancer. The nurse explained to the patient that this drug acts by:
Decreasing the endocrine production of androgen. Nizoral is an adrenal-ablating drug that inhibits enzymes required for the synthesis of androgens.
A nurse is caring for a client admitted to the unit with a seizure disorder. The client seems upset and asks the nurse, "What will they do to me? I'm scared of the tests and of what they'll find out." The nurse should focus her teaching plans on which diagnostic tests?
EEG, blood cultures, and neuroimaging studies Physicians use EEG and neuroimaging studies to diagnose neurologic problems. Blood cultures can identify infection that can cause seizures. Electrocardiography, TEE, and troponin levels are cardiac-specific diagnostic tests. X-ray of the brain reveals skeletal condition. Bone marrow aspiration isn't indicated for seizure disorder. PT and INR reflect blood coagulation.
After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true?
Erectile dysfunction may be due to testosterone insufficiency. Common causes of erectile dysfunction include neurologic disorder like spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy such as antihypertensives or antidepressants, atherosclerosis, hypertension, and complications of diabetes mellitus. Erectile dysfunction may be related to anxiety or depression. It is not a normal aspect of aging.
A client who comes to the clinic complaining of perineal pain, dysuria, and fever is diagnosed with prostatitis. The nurse understands that which of the following organisms would be the most likely cause?
Escherichia coli Prostatitis is an inflammation of the prostate gland and is most often caused by microorganisms that reach the prostate by way of the urethra. Escherichia coli and microbes that cause sexually transmitted infections often are responsible. Staphylococcus and Streptococcus are not typically a cause of prostatitis. Paramyxovirus is the cause of mumps.
Which statement is accurate regarding sildenafil?
Its side effects include headache, flushing, and dizziness. 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.
Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction?
Medication use Certain medications such as antihypertensive drugs, antidepressants, narcotics, etc. can cause sexual dysfunction in men. Impotence is not a normal part of aging. Undescended testicle is not indicative of ED. Sexual history is not indicative of ED.
The nurse is preparing a presentation for a men's community group about health promotion. Which of the following would the nurse include as a current recommendation for screening?
Monthly testicular self-examination (TSE) Screening typically includes monthly TSE starting in adolescence and annual DRE for men older than 50 years. PSA testing along with DRE 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 storng family history of prostate cancer and of African-American ethnicity. Transrectal ultrasound is performed in clients with abnormalities detected by DRE and in those with elevated PSA levels.
Which term refers to the surgical removal of one or both testes?
Orchiectomy Orchiectomy is required when the testicle(s) has been damaged. Circumcision is excision of the foreskin, or prepuce, of the glans penis. Vasectomy is ligation and transection of part of the vas deferens to prevent the passage of sperm from the testes. Hydrocelectomy describes the surgical repair of a hydrocele, a collection of fluid in the tunica vaginalis.
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?
Performing perineal exercises frequently throughout the day 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 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?
Suggest donor insemination or adoption 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.
Students preparing for a test are reviewing the structure and function of the male reproductive system. They demonstrate understading of the material when they identify which of the following as the site of spermatogenesis?
Testes The testes are responsible for producing sperm (spermatogenesis). The vas deferens are the tubes that carry the sperm from the testicles and epididymis to the seminal vesicles, which acts as the reservoir for testicular secretions. The prostate gland produces a secretion that is chemically and physiologically suitable to the needs of the sperm in their passage from the testes.
The client states to the nurse that he is very anxious about having prostate cancer ever since his prostate-specific antigen (PSA) test came back elevated. The client asks, "Which diagnostic test produces definitive results if cancer is present?" The nurse is most correct to state which of the following?
Tissue biopsy Obtaining an actual piece of the tissue and analyzing it for cancer is a definitive test when cancer is found. A transrectal ultrasonography is a test to view the prostate gland from different angles. This test provides additional data on the status of the prostate gland. The tumor marker studies include the prostate-specific antigen (PSA) level. This antigen indicates a potential problem but is not definitive. PSA elevations have been noted for reasons other than cancer. A digital rectal exam provided data on the shape, size, and texture of the prostate gland.
A client with erectile dysfunction who had a penile implant inserted has been taught how to identify malfunction of the device. Which of the following if stated by the client as indicative of malfunction would indicate to the nurse that the client has understood the teaching?
Underinflation or bulging of the cylinders during inflation Malfunction of the device is characterized by the underinflation, bulging of the cylinders during inflation, and a loss of fluid from the implant. Erosion of penile or urethral tissue occurs due to a mis-sized implant, pressure, or friction of the implanted cylinders. Erosion of scrotal, bowel, or bladder tissue occurs if an implant with a fluid reservoir is used. Migration of the cylinders, pump, or reservoir from their intended location is accompanied by pain, tenderness, and dysfunction of components that are part of the device.
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:
cryptorchidism. 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 reports experiencing nocturia. The nurse obtains a thorough history including current signs and symptoms. What would the client likely include when describing the symptoms?
decrease in the force of urinary stream The symptoms of benign prostatic hyperplasia (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. Changes in sexual function would not be consistent with BPH.
