Sherpath Chapter 25 Male genitourinary system
Which instructions would the nurse include in patient medication teaching regarding nocturia from diuretics? Select all that apply. "Avoid drinking alcohol at night." "Wear an adult diaper during the night." "Restrict fluid intake 3 hours before bedtime." "Use scrotal support during the night." "Drink a small cup of coffee before going to bed."
"Avoid drinking alcohol at night." "Restrict fluid intake 3 hours before bedtime." The nurse would instruct the patient to do the following: avoid drinking alcohol at night and restrict fluid intake 3 hours before bedtime. Nocturia refers to excessive urination during the night. It is characterized by frequent awakening and the urgency to void urine. The patient should avoid alcohol intake because alcohol has a diuretic effect, which may increase urine voiding. The patient should restrict fluid intake for 3 hours before bedtime, because increased fluid intake before bedtime may increase the frequency of voiding. The nurse would not tell the patient to wear adult diapers during the night. The excess moisture could lead to skin breakdown. The nurse would not instruct the patient to use scrotal support because this would be ineffective for nocturia. Scrotal support is used for a scrotum that is swollen. The nurse would not advise the patient to drink a cup of coffee before bedtime, because coffee contains caffeine, which has a diuretic effect. p.691
Which question would be most important for the nurse to ask a patient to assess for stress incontinence? "Are you urinating more often than usual?" "Are you having any difficulty controlling your urine?" "Do you have any trouble starting the urine stream?" "Do you accidentally urinate when you laugh or bear down?"
"Do you accidentally urinate when you laugh or bear down?" The nurse would ask, "Do you accidentally urinate when you laugh or bear down?" Stress incontinence refers to the involuntary loss of urine during physical strain (bear down) or laughing. The nurse would also ask about sneezing and coughing, which can lead to a loss of urine during stress incontinence. Stress incontinence is caused by weakness of the pelvic floor muscles. Although the nurse could ask about urinating more often than usual for stress incontinence, it is not the most important because this question is more specific for polyuria or oliguria. Asking about any difficulty controlling urine would help assess for stress incontinence, but it is not the most important because incontinence and urge incontinence can be identified with this question; it is not specific for stress incontinence like the question that asks about laughing or bearing down. Trouble starting the urine stream assesses for hesitancy, which is a reflection of possible obstruction; it is not an important question to ask for stress incontinence. p. 689
Which question would the nurse ask to determine hesitancy during urination? "How often do you awaken in the night to urinate?" "Are you urinating more often than usual?" "Is there any pain when you urinate?" "Do you have any trouble starting the urine stream?"
"Do you have any trouble starting the urine stream?" Any trouble starting the urine stream will help determine hesitancy during urination. Nocturia indicates the patient is awakening at night to urinate. Asking the patient about urinating more often than usual would establish urinary frequency, not hesitancy. Dysuria indicates pain or burning upon urination. p. 688
Which statement would the nurse make while instructing the patient about testicular self-examination? "Examine your testicles every month." "Perform testicular self-examination under cold water." "Report immediately if the testicle feels rubbery." "Use a thumb and first two fingers to hold the scrotum tightly."
"Examine your testicles every month." The nurse instructs the patient to perform a testicular self-examination monthly to detect any abnormal lumps or lesions. The use of cold water will stimulate a muscle reflex and retract the scrotal contents. Therefore the nurse would instruct the patient to perform the testicular self-examination in the shower with warm water. Normal testicles feel rubbery and have a smooth surface. Therefore it is not necessary to report this finding to the health care provider. The nurse would instruct the patient to hold the scrotum gently in the palm, because too much pressure will cause pain. The patient uses the thumb and first two fingers to feel each testicle.
Which statement would be typical from a patient with urge incontinence? "Whenever I sneeze or cough, I leak some urine." "Lately, I seem to be going in very large amounts." "I accidentally pass a small amount of urine every day." "It has started to burn when I go to the bathroom."
"I accidentally pass a small amount of urine every day." A patient with urge incontinence will state that there is an involuntary loss of urine ("I accidentally pass a small amount of urine every day"). Urge incontinence is involuntary urine loss from an overactive detrusor muscle in the bladder. The signs and symptoms of stress incontinence include leakage of urine when a patient sneezes, laughs, and coughs. Polyuria is the elimination of an excessive quantity of urine. Urinary tract infection refers to the invasion of a pathogen into the urinary tract, and it is characterized by a burning sensation upon urination. p. 689
Which statement might be made by a transgender patient? "Even though I am female, I prefer sex with females." "I know deep down that I am a male, not a female." "I enjoy sex with both males and females." "Even though I like vaginal sex, I prefer anal intercourse."
"I know deep down that I am a male, not a female." A transgender man may state that "deep down I am a male, not a female." Transgender individuals have an innate, deep-seated knowledge that their own orientation differs from their birth assignment. A lesbian female is sexually attracted to other females. A bisexual individual is sexually attracted to both males and females. Sexual preferences between vaginal or anal intercourse are not specific to any particular gender or sexual orientation. p. 685
Which information would the nurse include in a teaching session regarding testicular self-examinations? "Testicular cancer usually affects men after 50 years of age." "Avoid self-examination because lesions are difficult to detect." "The cure rate of testicular cancer is almost 100% when detected early." "There is no need to worry if any hard lumps on the testicles are painless."
"The cure rate of testicular cancer is almost 100% when detected early." The cure rate of testicular cancer is almost 100% if the treatment begins before metastasis. Testicular cancer usually occurs in males between 15 and 35 years of age. The nurse would teach testicular self-examination to the patient, because the patient can detect any lumps and report immediately. The nurse would instruct the patient to report any painless hard lumps on the testicles, because some tumors are painless. p. 697
Which male patient would the nurse ask about receiving the Gardasil vaccine? 5-year-old 10-year-old 50-year-old 65-year-old
10-year-old The nurse would ask the 10-year-old patient about Gardasil. Gardasil is a vaccine used for preventing infections caused by the human papillomavirus for boys and men ages 9 to 26 years of age. A 5-year-old is too young. The 50- and 65-year-olds are older than the recommended age (9 to 26). p. 691
Which patient would be at risk for developing bladder cancer? A 64-year-old Caucasian patient who smokes and works in a textile factory A 70-year-old Asian patient with a history of hypertension and diabetes A 45-year-old Hispanic patient with a decreased glomerular filtration rate (GFR) A 28-year-old African-American patient who had an undescended testicle surgically corrected
A 64-year-old Caucasian patient who smokes and works in a textile factory The 64-year-old Caucasian patient who smokes and works in a textile factory is at risk for bladder cancer. Risk factors for developing bladder cancer include being Caucasian, smoking, and working with aniline dyes and other chemicals used in the textile, paint, plastic, printing, and rubber industries. A history of hypertension and diabetes are risk factors for chronic kidney disease and end-stage renal disease, not for bladder cancer. A patient with a decreased GFR is at risk for renal and kidney problems, but GFR is not a recommended indicator for bladder cancer. A patient with an undescended testicle that was surgically corrected is at risk for testicular cancer, not bladder cancer. Caucasians are more susceptible to testicular cancer than African Americans. p. 687
At which time would the nurse obtain a patient's sexual history in relation to the genital examination? Before During After Does not matter
After
Which item in a patient's diet would cause the urine to turn blue? Beets Berries Asparagus Vitamin supplements
Asparagus Asparagus can turn the urine blue. Beets and berries turn the urine pink. Vitamin supplements can turn the urine bright neon yellow. p. 703
A patient with orchitis reports an enlarged scrotum with acute testicular pain. Which additional assessment finding would the nurse monitor for upon palpation? Cannot distinguish testis from epididymis Nontender swelling of testis Feels like a third testis Inability to feel scrotal contents Confident
Cannot distinguish testis from epididymis In orchitis the nurse cannot distinguish the epididymis from the testicles. A tender (not nontender) and swollen testis and acute pain in the scrotal area indicate that the patient has orchitis. A nontender swelling of the testis occurs with a hydrocele. Clinical findings of spermatocele include a painless cystic mass on the epididymis that feels like a third testis upon palpation. Inability to feel scrotal contents occurs with scrotal edema that accompanies marked edema in the lower half of the body (congestive heart failure, renal failure). p. 710
A patient with a urinary tract infection reports painful urination. Which additional urine sample finding would the nurse monitor for in the patient? Cloudiness of urine 3 red blood cells (RBCs) 2 white blood cells (WBCs) Amber-colored urine
Cloudiness of urine Cloudy urine indicates the presence of a urinary tract infection. Painful urination indicates dysuria, which is a symptom of urinary tract infection. Increased RBCs and WBCs indicate urinary tract infection. However, fewer than 5 RBCs and WBCs are normal findings and do not indicate a urinary tract infection. In this situation, the patient's RBCs are 3 and the WBCs are 2, making these both normal because both are below 5. The normal color of the urine ranges from yellow to deep amber color and should be clear. Amber urine does not indicate a urinary tract infection. p. 688
Which structure would be considered erectile tissue in males? Epididymis Scrotum Corpora cavernosa Cremaster muscle
Corpora cavernosa The erectile tissue of the penis is located in the corpora cavernosa. The epididymis is a coiled duct system that stores the sperm. The scrotum is a loose, protective sac that contains the testicles. The cremaster muscle does not contain the erectile tissue; it covers the testes and controls the size of the scrotum. The cremaster muscle is considered contractile tissue, not erectile tissue. p. 683
Which structure controls the size of the scrotum? Frenulum Epididymis Inguinal canal Cremaster muscle
Cremaster muscle The cremaster muscle is located in the wall of the scrotal sac and controls the size of the scrotum by responding to the surrounding temperature. The frenulum is a fold of the foreskin extending from the urethral meatus ventrally; it does not control the size of the scrotum. The epididymis is a comma-shaped structure, curved over the top and the posterior surface of the testis. The epididymis stores sperm; it does not control the size of the scrotum. The inguinal canal is a narrow tunnel passing obliquely between the layers of the abdominal muscle and does not control the size of the scrotum. p. 683
Which conditions would the nurse assess for in a patient whose blood urea nitrogen (BUN) level is 40 mg/dL? Select all that apply. Dehydration High protein intake Overhydration Undescended testes Malnutrition
Dehydration High protein intake The nurse would assess for dehydration and a high protein intake. BUN measures urea, which is the end product of protein metabolism in the body. The normal range of BUN is 10 to 20 mg/dL. The BUN level may rise because of a decrease in fluid volume, which may occur as a result of dehydration. High protein intake results in increased protein metabolism, which may also contribute to increased BUN levels. Overhydration would produce a low BUN level. Cryptorchidism is undescended testicles in the scrotal sac and would not cause BUN to elevate. Malnutrition (lack of nutrients and protein) would cause the BUN to decrease. pg. 698
An older adult male patient with bladder outlet obstruction presents with hesitancy and straining. Which additional signs and symptoms would the nurse monitor for? Select all that apply. Dribbling Sense of residual urine Weaker force of urine stream Palpable scrotal "bag of worms" Recurrent episodes of acute cystitis
Dribbling Sense of residual urine Weaker force of urine stream Recurrent episodes of acute cystitis Signs and symptoms of a bladder outlet obstruction include the following: dribbling, sense of residual urine, weaker force of urine stream, and recurrent episodes of acute cystitis. Bladder outlet obstruction usually occurs in older males with benign prostatic hyperplasia (BPH). The prostate gland surrounding the upper urethra undergoes an expected tissue hyperplasia in about 80% of men over 60 years. This is not cancer, but BPH can lead to bladder outlet obstruction. Varicocele feels like a "bag of worms" upon palpation and is not associated with bladder outlet obstruction. p. 688
Which symptom would the nurse expect patients having acute cystitis, prostatitis, or urethritis to have in common? Dysuria Polyuria Nocturia Oliguria
Dysuria In conditions such as acute cystitis, prostatitis, and urethritis, there is inflammation of the urinary tract that results in dysuria. Thus the nurse would expect dysuria to be common among patients with acute cystitis, prostatitis, or urethritis. Dysuria refers to pain, burning, and discomfort during urination. Polyuria refers to an increased frequency of urination because of the excessive production of urine, which may occur in patients with diabetes mellitus. Nocturia is not a common symptom among patients with acute cystitis, prostatitis, or urethritis. Nocturia refers to the urgency and increased frequency of urination during night hours from diuretic medication, certain urinary tract disorders, and cardiovascular diseases. Oliguria is not a common symptom among patients with acute cystitis, prostatitis, or urethritis. Oliguria refers to a diminished quantity of urine because of decreased fluid intake or renal failure. p. 688
Which information would the nurse include in a teaching session about male genital structures? Testes store sperm. Epididymis produces the sperm. Ejaculatory duct empties into the urethra. Seminal vesicles form the spermatic cord.
Ejaculatory duct empties into the urethra. The nurse would include the information that the ejaculatory duct empties into the urethra. The testes that lie in each scrotal half produce sperm; they do not store the sperm. The epididymis is a coiled duct system and stores the sperm; it does not produce the sperm. The vas deferens, a muscular duct, joins the duct of the seminal vesicle to form the ejaculatory duct, not the spermatic cord. The vas deferens approximates with other vessels (arteries and veins, lymphatics, nerves) to form the spermatic cord. p. 683
Which developmental changes would the nurse be able to observe in a male preadolescent during physical examination? Select all that apply. Enlargement of the testis Increase in the penis size Appearance of pubic hair Pendulous appearance of the scrotum Migration of the testis along the inguinal canal
Enlargement of the testis Increase in the penis size Appearance of pubic hair The nurse would look for enlargement of the testis, increase in penis size, and appearance of pubic hair. The nurse can observe the signs of puberty during physical examination in preadolescents. Enlargement of the testis is the first sign of puberty, which starts around 9─10 years of age. Next pubic hair appears, and then penis size increases. The appearance of a pendulous scrotum occurs because of decreased tone of muscle mass and decreased rugae; it is seen in older adult males. Migration of the testis along the inguinal canal occurs before birth. p. 690
Which condition would the nurse be monitoring for by asking the older adult patient about any difficulty in urination, any dribbling, incomplete emptying, and straining during urination? Nocturia Paraphimosis Urinary incontinence Enlarging prostate
Enlarging prostate The nurse would ask about these findings during history collection to determine whether the older adult patient has prostate enlargement. An increase in prostate size may block the passage of urine and cause incomplete emptying of the bladder, dribbling, and difficulty in urination. Nocturia refers to excessive urination during the night and is characterized by the urgency to urinate. Paraphimosis is an abnormal finding of the penis in which the foreskin on the glans cannot be reduced. Urinary incontinence is the involuntary leaking of urine, which occurs because of weakness of the pelvic floor muscles or overactivity of the detrusor muscle. p. 691
Which structure would be the storage site of sperm? Frenulum Epididymis Vas deferens Corona
Epididymis The epididymis is a coiled duct system and is the main storage site of sperm. The frenulum is a fold of the foreskin extending from the urethral meatus ventrally; it does not store sperm. The vas deferens is a muscular duct that transports sperm from the epididymis to the ejaculatory ducts by forming a union with the seminal vesicles; it does not store the sperm. The shoulder where the glans penis joins the shaft is called the corona; the corona does not store the sperm. p. 683
A patient with a diffuse testicular tumor reports having a hard nodule in the left scrotum. Which additional finding would the nurse monitor for in the patient? Testis transilluminates Misshapen testis Tender swelling of testis Firm palpation does not produce discomfort
Firm palpation does not produce discomfort Firm palpation does not cause usual sickening discomfort as with normal testis in a patient with a diffuse testicular tumor. In a diffuse testicular tumor, the testis does not transilluminate. The diffuse tumor maintains the shape of the testis, and it is not misshapen. Nontender swelling of the testis occurs with a diffuse testicular tumor. p. 709
A patient with a urinary tract infection (UTI) presents with dysuria. Which additional assessment findings would the nurse monitor for in the patient? Select all that apply. Pinpoint, constricted meatus opening Frequency Urgency Suprapubic pain Penile shaft indurated along ventral side
Frequency Urgency Suprapubic pain The nurse would assess for frequency, urgency, and suprapubic pain. UTI presents with dysuria, frequency, urgency, suprapubic pain, nocturia, occasionally gross hematuria, and possibly fever. A pinpoint, constricted opening at meatus indicates a urethral stricture, not a UTI. With a urethral stricture the penile shaft feels indurated along the ventral aspect at the site of the stricture. p. 704
Which infection would be prevented by administering the Gardasil vaccine to a male patient? Tinea cruris Genital warts Genital herpes Syphilitic chancre
Genital warts The vaccine Gardasil is indicated for prevention of genital warts. Gardasil is a vaccine used to prevent human papillomavirus (HPV) infections. Genital warts are caused by HPV and therefore can be prevented by using the HPV vaccine. Tinea cruris is a fungal infection and is commonly referred to as "jock itch." Tinea cruris cannot be prevented with Gardasil. Genital herpes is a viral infection that can be treated by administering oral antiviral agents but not prevented with Gardasil. Syphilis, a characteristic of which is a chancre, is a sexually transmitted infection that is usually treated with penicillin G, not prevented with Gardasil. p. 705
Which condition would the nurse be assessing for when examining an infant for a bulge in the inguinal area? Tumor Hernia Chancre Infection
Hernia The nurse would be assessing for a hernia. Hernia is the protrusion of the abdominal contents through a canal. While examining an infant, the nurse would assess for inguinal hernia, because it is the most common type of hernia that occurs in infants. It is not required to assess for the presence of tumors in an infant, because most testicular or diffused tumors occur in patients between 18 and 35 years of age. A chancre is a painless ulcer formed during the primary stage of syphilis and usually occurs on the penis; it does not produce a bulge in the inguinal area. An infection would not cause a bulge in the inguinal area but could cause a fever and an open lesion in the inguinal area. p. 700
Which medical condition would cause a patient's scrotum to have a red glow of serous fluid upon transillumination? Hernia Hydrocele Orchitis Testicular tumor
Hydrocele If the serous fluid transilluminates and shows a red glow, it indicates the patient has a hydrocele. Transillumination is performed by shining a strong flashlight from behind the scrotal contents. The absence of transillumination of the scrotal contents is normal. Blood and solid tissue do not transilluminate. Therefore transillumination does not occur in other conditions such as hernia, orchitis, and testicular tumor. p. 710
The infant's urethral meatus is located ventrally. Which penis abnormality would the infant have? Phimosis Epispadias Hypospadias Paraphimosis
Hypospadias Hypospadias is a congenital birth defect in which the infant's urinary meatus is located ventrally. The urethral meatus is generally positioned at the center of the penis. Phimosis is a condition in which the foreskin cannot be retracted because of a narrowed opening of the prepuce. If the urethral meatus is located dorsally, it indicates that the infant has epispadias. Painful constriction of the glans by a retracted, fixed foreskin is referred to as paraphimosis. pp. 693, 698
Which examples would be objective assessment findings recorded by the nurse after examining a male patient's genitourinary system? Select all that apply. Left testis larger than the right Pain while passing urine Reports voiding 5 times/day Edematous glans penis Presence of white discharge from the penis
Left testis larger than the right Edematous glans penis Presence of white discharge from the penis Objective assessment findings include left testis larger than the right, edematous glans penis, and presence of white discharge from the penis. After an assessment of the genitourinary system, the nurse documents the findings as subjective and objective. Objective findings are collected by the nurse through the skills of physical examination such as inspection and palpation. Subjective data include the data that are obtained from the history given by the patient. Pain while passing urine and reports of voiding 5 times/day are subjective data, not objective. pp. 693-694
Which characteristic accurately describes the inguinal lymph nodes? Receive drainage from the testes Lie along the groin inferior to the inguinal ligament Receive drainage from the superficial knee region Lie below the junction of the lower outer thigh
Lie along the groin inferior to the inguinal ligament The inguinal lymph nodes horizontal chain lies along the groin inferior to the inguinal ligament. The inguinal lymph nodes receive drainage from the lymphatics of the penis and the scrotal surface. The lymphatics of the testes drain into the abdomen. The inguinal lymph nodes do not receive drainage from the superficial knee region; the inguinal lymph nodes receive drainage from the penis and scrotal surfaces. The inguinal lymph nodes vertical chain lies along the upper inner thigh, not below the junction of the lower outer thigh. p. 684
Which drug classification would the nurse administer to a patient who presents with clusters of painful vesicles and eruptions on the glans and foreskin of the penis? Antifungal Antibiotic Oral antiviral Local anesthetic
Oral antiviral The initial infection of genital herpes, a viral infection, is treated with oral antivirals. Clusters of painful vesicles and eruptions on the glans and foreskin indicate the patient has genital herpes. Genital herpes is a sexually transmitted infection, the acute stage of which lasts for 7 to 10 days. Antifungals are used to treat tinea cruris. Antibiotics, like Penicillin G, are effective against some sexually transmitted infections, such as syphilis. Lidocaine-prilocaine cream (EMLA) is a local anesthetic used during minor invasive procedures such as circumcision. p. 705
Which color of urine would alert the nurse to a side effect of rifampin? Orange Pale yellow Red Dark gray
Orange Orange-colored urine is a side effect of rifampin. Orange-colored urine can also occur from other medications (Pyridium, warfarin), dehydration, and jaundice. A pale yellow color indicates excess liquids, acute viral hepatitis, or cirrhosis. Red indicates blood in the urine and occurs with nephritis, cystitis, prostate cancer, bladder cancer, and postoperatively after prostate surgery. Dark gray indicates that the urine contains melanin (melanuria). p. 703
Which finding would the nurse observe when transilluminating a normal adult scrotal sac? Faint pink glow Red glow No glow Coral glow
No glow A normal finding is no glow. Normal scrotal contents will not transilluminate and will not produce a glow. Hydrocele may transilluminate as a faint pink glow or red. There is no condition, normal or abnormal, that causes a coral glow upon transillumination. p. 695
Which term would the nurse use in a report to describe a patient's urinary output that is 200 mL per day? Dysuria Oliguria Polyuria Hematuria
Oliguria Because the patient's urinary output is 200 mL per day, the nurse reports that the patient has oliguria. If urine output is less than 400 mL per day, it indicates that the patient has oliguria, or diminished urine output. Any pain or burning sensation with urination indicates dysuria. Excessive production of urine indicates polyuria. The presence of blood in the urine indicates hematuria.
Which interventions would the nurse perform to prevent eliciting the cremasteric reflex in an infant during palpation of the inguinal region? Select all that apply. Palpate down from the external inguinal ring. Block the inguinal canals with the thumb and forefinger. Warm hands before starting the palpation technique. Compress the glans anteroposteriorly between the thumb and forefinger. Palpate the shaft of the penis between the thumb and the first two fingers.
Palpate down from the external inguinal ring. Block the inguinal canals with the thumb and forefinger. Warm hands before starting the palpation technique. To not elicit the cremasteric reflex: (1) palpate down from the external inguinal ring, (2) block the inguinal canals with the thumb and forefinger of the other hand to prevent the testes from retracting, and (3) warm hands before starting the palpation technique. The cremasteric reflex is a superficial reflex in which the testis of a male is retracted in response to cold, touch, exercise, or emotion. This reflex is strong in infants. The nurse would palpate from the external inguinal ring down to prevent eliciting the reflex. The nurse would block the inguinal canals with the thumb and the forefinger of other hand to prevent the testes from retracting. The cremasteric reflex is initiated by cold; therefore the nurse would warm hands before palpating. Compressing the glans anteroposteriorly between the thumb and the forefinger helps detect the presence of any meatus problems such as stricture, which is a narrowed opening. The nurse would palpate the shaft of the penis between the thumb and the first two fingers to check for the presence of nodules or induration and tenderness of the penis. p. 699
Which medication would the nurse administer to a patient who has syphilitic chancre? Gardasil Testosterone Penicillin G Lidocaine-prilocaine cream
Penicillin G Syphilis is a sexually transmitted infection and can be easily treated using antibiotics such as penicillin G. A small, round, solitary, silvery papule with yellowish discharge and nontender lymph nodes indicate that the patient may have a syphilitic chancre. Gardasil is an HPV vaccine used in the treatment of genital warts. Testosterone is administered for male hypogonadism, low testosterone. Lidocaine-prilocaine cream (EMLA) is used to prevent pain during the circumcision procedure. p. 706
Which area would the nurse observe to assess for hypospadias? Testes Scrotum Groin Penis
Penis The nurse would assess the penis to determine hypospadias. Hypospadias is a congenital defect in which the urethral meatus opens on the ventral side of the penis. Assessment of the testes will help determine the presence of testes or absence of testes (cryptorchidism), but will not assess for hypospadias. The scrotum is assessed to help determine a hydrocele. The groin is assessed to help determine a hernia, not hypospadias. p. 706
Which conditions would be examples of penile abnormalities? Select all that apply. Phimosis Epididymitis Hypospadias Diffuse tumor Spermatocele Peyronie disease
Phimosis Hypospadias Peyronie disease Phimosis, hypospadias, and Peyronie disease are examples of abnormalities of the penis. Phimosis is a condition in males in which the foreskin is advanced, extremely tight, and cannot be retracted over the glans penis. Hypospadias refers to the presence of urethral meatus on the ventral side of the glans penis. Peyronie disease is the presence of hard, nontender, subcutaneous palpable plaques on the dorsal or lateral surface of the penis. Epididymitis, diffuse tumor, and spermatocele are examples of scrotal abnormalities. Epididymitis is the acute infection and inflammation of epididymis. Diffuse tumor is the nontender enlargement of a cancerous testis. Spermatocele is the presence of a fluid cyst in the epididymis. pp. 706-707
After reviewing the results of a male genitourinary assessment, which findings would the nurse consider normal? Select all that apply. Presence of pubic hair at the base of the penis Narrow prepuce opening Hard and enlarged lymph nodes Left scrotal sac is lower than right Central urethral meatus
Presence of pubic hair at the base of the penis Left scrotal sac is lower than right Central urethral meatus The normal findings include presence of pubic hair at the base of the penis; left scrotal sac is lower than right; and central urethral meatus. Pubic hair is normally located at the base of the penis. The left scrotal sac appears low because the left testis has a longer spermatic cord when compared with the right testis. The urethral meatus is normally centrally located. Normally the scrotal sac is nontender, not tender. A tender scrotal sac is abnormal and is indicative of inflammation of the scrotal contents. A narrowed opening of the prepuce indicates phimosis, which is an abnormal finding. Hard and enlarged nodes in the inguinal area are abnormal. Normally lymph nodes may not be palpable but may feel small, soft, discrete, and movable. pp. 693-694
Which information would the nurse include in a staff teaching session about the developmental changes in the male genitourinary system? Slow detumescence occurs, especially after 60 years. Older men experience a definite end to fertility. Production of sperm begins to decrease around 40 years of age. Increased tone of the dartos muscle causes scrotal rugae to decrease.
Production of sperm begins to decrease around 40 years of age. The production of sperm begins to decrease around 40 years, although it continues into the 80s and 90s. Rapid, not slow, detumescence (return to the flaccid state) occurs, especially after 60 years of age because of less forceful and shorter sperm ejaculation and from a less firm erection. Because of decreased (not increased) tone of the dartos muscle, the scrotal rugae decrease. p. 685
Which condition would be a common cause of epididymitis? Varicocele Prostatitis Hypospadias Cryptorchidism
Prostatitis Prostatitis is a condition that involves inflammation of the prostate and the area around it and commonly causes an acute infection to the epididymis, which is called epididymitis. Other conditions such as varicocele, hypospadias, and cryptorchidism do not cause epididymitis. Varicocele refers to the presence of tortuous dilated veins in the spermatic cord. Hypospadias is a birth defect in which the urinary meatus is present on the ventral side of the penis. Cryptorchidism is also a birth defect, in which a patient has an undescended testis or testes. Cryptorchidism increases the risk for testicular cancer, but it does not cause epididymitis. p. 708
Which genitourinary assessment would the nurse observe in a patient who has urethritis? Red edematous meatus with purulent discharge Unretractable foreskin Circumscribed collection of serous fluid around testis Undescended testes
Red edematous meatus with purulent discharge If the meatus is red in color and edematous, with purulent discharge, it indicates the patient has urethritis. The urethral meatus is located centrally at the tip of the glans. Normally, the edge of the meatus appears pink and smooth, without any discharge. If the patient is unable to retract the foreskin, it indicates that the patient has phimosis, not urethritis. A cystic, circumscribed collection of serous fluid in the tunica vaginalis surrounding the testis is known as hydrocele, not urethritis. Undescended testes indicate cryptorchidism, not urethritis. p. 704
Which benefits would the nurse include in the teaching session about infant circumcision? Select all that apply. Protection against chronic kidney disease Protection against bladder cancer Reduced decision making for young males Reduced heterosexual HIV risk Protection against urinary tract infections
Reduced heterosexual HIV risk Protection against urinary tract infections Reduced risk of acquiring HIV infection through heterosexual contact and protection against urinary tract infections are benefits the nurse would include in the teaching session about infant circumcision. Circumcision does not protect against chronic kidney disease. Hypertension and diabetes are the main causes of chronic kidney disease. Circumcision does not protect against bladder cancer; not smoking can protect against bladder cancer. Reduced decision making for young males is one of the costs of circumcision, not a benefit. Some feel there are not enough compelling reasons for surgery before boys are old enough to decide for themselves. p. 687
A patient with benign prostatic hyperplasia (BPH) presents with a smooth, enlarged prostate. Which other assessment finding would the nurse monitor for in the patient? Genital warts Thick gray-brown discharge Painless hard testicle Reports of difficulty voiding
Reports of difficulty voiding An enlarged prostate that is smooth and difficulty in voiding are symptoms of BPH. Papillomavirus is a virus that may cause genital warts but does not occur with BPH. Thick gray-brown discharge occurs with gonorrhea, not BPH. A painless hard testicle occurs with testicular tumor, not BPH. p. 686
Which assessment finding would be abnormal in a male patient? Scrotal contents do not transilluminate. Right side of scrotum is lower than the left side. Testes feel smooth, movable, and slightly sensitive to compression. Skin of the glans penis folds in and back on itself, forming a hood or flap.
Right side of scrotum is lower than the left side. Right side of the scrotum is lower than the left is an abnormal finding. The left scrotal half is normally lower than the right because of a longer left spermatic cord. Normal scrotal contents do not transilluminate. Testes normally feel smooth and are freely movable. They are also slightly tender to moderate pressure. Although all men may not be circumcised, uncircumcised is a normal finding. Over the glans, the skin folds in and back on itself, forming a hood or flap. This is the foreskin, or prepuce, and is a normal finding. p. 694
A patient with a varicocele reports a dragging sensation in the scrotal area. Which additional assessment finding would the nurse monitor for upon palpation? Solitary nodule on testicle Scrotal "bag of worms" Extremely tender scrotum Absence of testis
Scrotal "bag of worms" Varicocele refers to the dilation of the varicose veins in the spermatic cord, which feels like a "bag of worms" on palpation. A solitary nodule on a testicle is testicular cancer, not a varicocele. An extremely tender scrotum occurs in epididymitis, not varicocele. Absence of testis is cryptorchidism, not varicocele. p. 709
Which laboratory result would the nurse monitor to best determine a patient's kidney function? Presence of urine glucose Blood urea nitrogen (BUN) Serum creatinine White blood cells in urine
Serum creatinine Serum creatinine is the best measurement of kidney function because its levels are fairly constant from day to day, and it is a reflection of the glomerular filtration rate. The presence of urine glucose indicates glycosuria, suggesting hyperglycemia occurring with diabetes, but it is not as specific for detecting kidney functioning. BUN is not as specific as creatinine for kidney functioning because BUN rises with dehydration or an increase in protein intake. White blood cells in urine are not as specific to indicate kidney functioning but can suggest a urinary tract infection. A high count of white blood cells in the urine is associated with urinary tract infections. p. 698
Which genital assessment findings would the nurse observe for a patient with genital warts? Select all that apply. Soft, pointed painless papules around the anus Red-colored painless ulcers with watery discharge Multiple moist and fleshy papules behind the corona A small, solitary, silvery papule with serous discharge Erythematous, painful, and superficial ulcers on glans
Soft, pointed painless papules around the anus Multiple moist and fleshy papules behind the corona The nurse would find soft, pointed painless papules around the anus and multiple moist, fleshy papules behind the corona in a patient with genital warts. Genital warts are characterized by soft, moist, fleshy, and pointed papules that are usually formed on the shaft of the penis, around the anus, and behind the corona. Warts occur in multiple forms or singly, and are usually painless. Carcinoma is characterized by red-colored painless ulcers with watery discharge. Syphilis is characterized by chancres, which are small, solitary, silvery papules with serous discharge. Genital herpes is a herpes simplex virus (HSV-2) infection characterized by erythematous and painful superficial ulcers on the glans, foreskin, or anus. p. 705
Upon palpation, how would a normal epididymis feel in a male patient? Rough Tender Firm and rubbery Softer than the testes
Softer than the testes A normal epididymis is softer than the testis and feels discrete. The epididymis is not rough but feels smooth on palpation. Although the testes may be slightly tender with palpation, the epididymis is nontender. The testes will feel firm and rubbery, but the epididymis will not. p. 694
In which position would the nurse place the adult male to assess for a hernia? Prone Sitting Supine Standing
Standing The presence of a hernia can be checked by instructing the adult male patient to stand. In this position, gravity assists the downward movement of the herniated content, which may help the nurse palpate the hernia with ease. The nurse cannot examine the male for a hernia in the prone position, because the groin area is not accessible in the prone position. The adult male cannot be in a sitting position because the genital region is not adequately exposed in this position. In the supine position, the hernia can retract into the abdominal cavity, causing an inaccurate result. p. 692
Which conditions would be medical emergencies? Select all that apply. Orchitis Hydrocele Genital herpes Testicular torsion Paraphimosis
Testicular torsion Paraphimosis Testicular torsion and paraphimosis are medical emergencies. Testicular torsion is a medical emergency because the blood supply is cut off, resulting in ischemia and engorgement. Torsion is an emergency situation requiring surgery because the testis can become gangrenous in a few hours. Paraphimosis is a medical emergency because the constricting band prevents venous and lymphatic return from the glans and compromises arterial circulation. Orchitis is an acute inflammation of the testis, and is characterized by moderate pain, sudden onset of fever, and swelling. Orchitis is not a medical emergency. Hydrocele is a condition in which serous fluid is accumulated in the tunica vaginalis around the testicles. The swelling is generally soft, nontender, and large in size and can disappear spontaneously, making it a nonemergency condition. Genital herpes is a chronic viral infection that can be treated with oral antivirals and is not considered a medical emergency. pp. 707-708
Which signs and symptoms would the nurse find in a young child who has an indirect inguinal hernia? Select all that apply. Stops crying after being laid down Has nausea, vomiting, and tenderness Whines because of pain while expelling stools Has swelling that increases with intra-abdominal pressure Has swelling close to pubis in area of internal inguinal ring
Stops crying after being laid down Whines because of pain while expelling stools Has swelling that increases with intra-abdominal pressure The following findings are consistent with indirect inguinal hernia: stops crying after being laid down, whines because of pain while expelling stools, and has swelling that increases with intra-abdominal pressure. Indirect inguinal hernia is the most common of all hernias. In indirect inguinal hernia, the sac of the peritoneum herniates through the internal inguinal ring and may pass into the scrotum. The child may have decreased pain while lying down, because this position may decrease intra-abdominal pressure. The child may report pain while expelling stools, because this activity exerts strain on the abdominal muscles. When there is an increase in the intra-abdominal pressure, the intestinal contents are pushed through the inguinal canal, producing swelling or a bulge. The child may have nausea, vomiting, and tenderness in the case of a strangulated femoral hernia. The child may have a swelling close to the pubis in the area of the internal inguinal ring in the case of a direct (not indirect) inguinal hernia. p.711
Which type of hernia in a patient would be the priority to assess first? Strangulated Incarcerated Reducible Direct inguinal
Strangulated The patient with a strangulated hernia would be seen first. Strangulated means that the blood supply to the tissue or small intestine trapped by the hernia is shut off and will die from the lack of blood supply. Although an incarcerated herniated bowel cannot be returned to the abdominal cavity, it is not as severe as a strangulated hernia because the blood supply is still intact in an incarcerated hernia. Reducible indicates that the hernia contents will return to the abdominal cavity by lying down or gentle pressure; a reducible hernia is not as critical as a strangulated hernia. A direct inguinal hernia is easily reduced when supine and is less of a priority when compared with a strangulated hernia. p. 711
Which assessment technique would the nurse use to check for Peyronie disease? Palpating the inguinal lymph nodes Transilluminating the scrotum Stretching the penis Observing urine color
Stretching the penis Hard, nontender, subcutaneous plaques, which cause painful bending of the penis during erections, are palpated by stretching the penis on the dorsal or lateral surfaces. Palpating the inguinal lymph nodes is ineffective for Peyronie disease, but it can help with determining some infections, such as syphilis, and penis carcinoma. Transillumination of the scrotum is ineffective for Peyronie disease because it is a solid tissue disorder. Transillumination occurs with a hydrocele or spermatocele. Urine color can help determine a urinary tract infection, liver disease, kidney stones, jaundice, nephritis, cystitis, certain drugs the patient is taking, or certain foods the patient has eaten, but it does not help determine Peyronie disease. p. 707
A patient with testicular torsion presents with lower abdominal pain, nausea, and vomiting. Which additional assessment finding would the nurse monitor for in the patient? Cremasteric reflex present on both sides Thin, nontender spermatic cord Sudden onset of excruciating unilateral pain Testes symmetrical in length
Sudden onset of excruciating unilateral pain Testicular torsion results in the sudden onset of excruciating unilateral pain in the testicle during sleep or trauma. Cremasteric reflex is absent on the side of the torsion; normally, it is present on both sides. The spermatic cord feels thick, swollen, and tender, not thin and nontender. One testis is higher, owing to rotation and shortening; the testes are not symmetrical in length. p.708
Which assessment finding would the nurse observe in a patient with priapism? Sustained, involuntary erection Foreskin cannot be retracted Painful bending of the penis Dorsal meatus opening
Sustained, involuntary erection Involuntary, sustained, and painful erection without any sexual stimulation is a condition referred to as priapism. Phimosis is a condition in which the foreskin cannot be retracted because of narrowed opening of the prepuce. Painful bending of the penis during erections is associated with Peyronie disease. If the urethral meatus is located dorsally, it indicates that the patient has epispadias. p. 706
Which initial finding indicates the male has entered puberty? Pubic hair appears. Penis size increases. Testes enlarge. Vellus hair grows.
Testes enlarge The first sign of puberty is enlargement of the testes. Next pubic hair appears, and then penis size increases. Vellus hair, the fine body hair on the abdomen, is a sign of prepuberty, not puberty. p. 685
Which condition would a 20-year-old Caucasian male with a history of cryptorchidism be at high risk for developing? Varicocele Bladder cancer Testicular cancer Sexually transmitted infections
Testicular cancer A history of undescended testes (cryptorchidism) is the most important risk factor for testicular cancer. Testicular cancer is also more common in Caucasian males between the ages of 18 and 35. Cryptorchidism is not a risk factor for a varicocele. A varicocele is a dilation of varicose veins in the spermatic cord, and occurs in 15% by age 15 years. Undescended testes are not a risk factor for bladder cancer; smoking and certain occupations are risk factors for bladder cancer. Sexually transmitted infections can occur in a sexually active patient who practices unsafe sex but is not associated with cryptorchidism. p. 709
Circumcision in males would cause a decreased risk for which medical conditions in their female sexual partners? Select all that apply. Genital ulcer disease Herpes simplex virus Trichomoniasis Bacterial vaginosis Human papillomavirus infection
Trichomoniasis Bacterial vaginosis There is a decreased risk for trichomoniasis and bacterial vaginosis in female partners of men who have had circumcisions. The area under the foreskin serves as a good breeding ground for bacteria and infection, but circumcision helps in preventing the growth and transmission of sexually transmitted infections. Circumcised males receive medical benefits such as a reduced risk of acquiring genital ulcer disease, herpes simplex virus, and human papillomavirus infection. p. 687
Which condition would be caused by hyperactivity of the detrusor muscle? Direct inguinal hernia Pendulous scrotum Urge incontinence Testicular torsion
Urge incontinence Urge incontinence is caused by a hyperactive detrusor muscle. The overactive detrusor muscle causes an urge to urinate, which may in turn result in the involuntary leakage of urine. This condition is referred to as urge incontinence. A direct inguinal hernia can be caused by muscle atrophy, not from a hyperactive detrusor muscle. A pendulous scrotum results in the older adult male because of decreased tone of the dartos muscle, not from an overactive detrusor muscle. Testicular torsion occurs from faulty anchoring of testis on the wall of the scrotum, not from a hyperactive detrusor muscle. p. 689
Which assessment finding would the nurse report as abnormal for a patient's urinalysis report? Urine pH 4 Absence of protein Absence of glucose Urine specific gravity 1.025
Urine pH 4 The normal pH of urine is 4.5 to 8.0; therefore a urine pH of 4.0 is abnormal. Normally, urine does not contain protein or glucose. Hence, the absence of protein and glucose is considered normal. The specific gravity of urine normally ranges from 1.003 to 1.030; therefore a specific gravity of 1.025 is a normal finding. p. 698
Which type of pain would be characteristic of a direct inguinal hernia? Severe Only with straining Usually painless Increases when supine
Usually painless A direct inguinal hernia is usually painless. Severe pain occurs with a femoral hernia. An indirect inguinal hernia has pain with straining. A direct inguinal hernia is easily reduced when supine so pain would not increase when supine. p. 711
Which conditions would be examples of scrotal abnormalities? Select all that apply. Varicocele Epididymitis Hypospadias Paraphimosis Spermatocele
Varicocele Epididymitis Spermatocele Varicocele, epididymitis, and spermatocele are abnormalities of the scrotum. Varicocele refers to dilated, tortuous varicose veins in the spermatic cord caused by incompetent valves within the vein that permit the reflux of blood. Acute infection to the epididymis is known as epididymitis. Spermatocele is a cyst in the epididymis that is filled with a thin, milky fluid that contains sperm. Hypospadias and paraphimosis are abnormalities of the penis. pp. 709-710
Which action would the female nurse take during a genitalia examination of a male patient? Engage in friendly talk and then proceed use a confidant, relaxed, business-like approach defer the physical assessment and record that the patient refused discuss genitourinary history while performing the examination
use a confidant, relaxed, business-like approach