CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition) // CHAPTER 54 Male Reproductive and Gential Problems (10th Edition)

Question 1

*** 1. An older male patient is experiencing difficulty in initiating voiding and a feeling of incomplete bladder emptying. These symptoms of BPH are primarily caused by

a. obstruction of the urethra.
b. untreated chronic prostatitis.
c. decreased bladder compliance.
d. excessive secretion of testosterone.

Answer 1

a. obstruction of the urethra.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 2

2. Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a three-way urinary catheter with a 30-mL balloon. When he complains of bladder spasms with the catheter in place, the nurse should
   a. deflate the catheter balloon to 10 mL to decrease bulk in the bladder.
   b. deflate the catheter balloon and then reinflate to ensure that it is patent.
   c. encourage the patient to try to have a bowel movement to relieve colon pressure.
   d. explain that this feeling is normal and that he should not try to urinate around the catheter.

Answer 2

d. explain that this feeling is normal and that he should not try to urinate around the catheter.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 3

3. Which factors would place a patient at higher risk for prostate cancer (select all that apply)?
   a. Older than 65 years
   b. Asian or Native American
   c. Long-term use of an indwelling urethral catheter
   d. Father diagnosed and treated for early stage prostate cancer
   e. Previous history of undescended testicle and testicular cancer

Answer 3

a. Older than 65 years
d. Father diagnosed and treated for early stage prostate cancer

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 4

4. A patient scheduled for a prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. In responding to this patient, the nurse should keep in mind that
   a. erectile dysfunction can occur even with a nerve-sparing procedure.
   b. retrograde ejaculation affects sexual function more frequently than erectile dysfunction.
   c. the most common complication of this surgery is postoperative bowel incontinence.
   d. preoperative sexual function is the most important factor in determining postoperative erectile dysfunction.

Answer 4

a. erectile dysfunction can occur even with a nerve-sparing procedure.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 5

5. The nurse explains to the patient with chronic bacterial prostatitis who is undergoing antibiotic therapy that (select all that apply)
   a. all patients require hospitalization.
   b. pain will lessen once treatment has ended.
   c. course of treatment is generally 2 to 4 weeks.
   d. long-term therapy may be indicated in immunocompromised patient.
   e. if the condition is unresolved and untreated, he is at risk for prostate cancer.

Answer 5

b. pain will lessen once treatment has ended.
d. long-term therapy may be indicated in immunocompromised patient.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 6

6. In assessing a patient for testicular cancer, the nurse understands that the manifestations of this disease often include
   a. acute back spasms and testicular pain.
   b. rapid onset of scrotal swelling and fever.
   c. fertility problems and bilateral scrotal tenderness.
   d. painless mass and heaviness sensation in the scrotal area.

Answer 6

d. painless mass and heaviness sensation in the scrotal area.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 7

7. The nurse should explain to the patient who has had a vasectomy that
   a. the procedure blocks the production of sperm.
   b. erectile dysfunction is temporary and will return with sexual activity.
   c. the ejaculate will be about half the volume it was before the procedure.
   d. an alternative form of contraception will be necessary for 6 to 8 weeks.

Answer 7

d. an alternative form of contraception will be necessary for 6 to 8 weeks.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 8

8. To decrease the patient’s discomfort over care related to his reproductive organs, the nurse should
   a. relate his sexual concerns to his sexual partner.
   b. arrange to have male nurses care for the patient.
   c. maintain a nonjudgmental attitude toward his sexual practices.
   d. use technical terminology when discussing reproductive function.

Answer 8

c. maintain a nonjudgmental attitude toward his sexual practices.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 9

1. The nurse coordinates postoperative care for a 70-year-old man with osteoarthritis after prostate surgery. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN)?
   a. Teach the patient how to perform Kegel exercises.
   b. Provide instructions to the patient on catheter care.
   c. Administer oxybutynin (Ditropan) for bladder spasms.
   d. Manually irrigate the urinary catheter to determine patency.

Answer 9

d. Manually irrigate the urinary catheter to determine patency.

The nurse may delegate the following to an LPN/LVN: monitor catheter drainage for increased blood or clots, increase flow of irrigating solution to maintain light pink color in outflow, administer antispasmodics and analgesics as needed. A registered nurse may not delegate teaching, assessments, or clinical judgments to a LPN/LVN.

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Question 10

2. The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer?
   a. A 30-year-old white male with a history of cryptorchidism
   b. A 48-year-old African American male with erectile dysfunction

A 19-year-old Asian male who had surgery for testicular torsion

A 28-year-old Hispanic male with infertility caused by a varicocele

Answer 10

a. A 30-year-old white male with a history of cryptorchidism

The incidence of testicular cancer is four times higher in white males than in African American males. Testicular tumors are also more common in males who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to DES, and testicular cancer in the contralateral testis.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 11

*** 3. A 45-year-old man reports having recent problems attaining an erection. Which medication will the nurse further explore as the possible etiology of this patient’s sexual dysfunction?

a. Furosemide (Lasix)
b. Fluoxetine (Prozac)
c. Clopidogrel (Plavix)
d. Nitroglycerin (Nitrostat)

Answer 11

b. Fluoxetine (Prozac)

Fluoxetine is a selective serotonin reuptake inhibitor used in the treatment of depression. A common adverse effect of this medication is sexual problems (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest) in nearly 70% of men and women.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Jeff E.

Question 12

*** 4. The nurse teaches a 30-year-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu?

a. Grilled steak, French fries, and vanilla shake
b. Hamburger with cheese, pudding, and coffee
c. Baked chicken, peas, apple slices, and skim milk
d. Grilled cheese sandwich, onion rings, and hot tea

Answer 12

c. Baked chicken, peas, apple slices, and skim milk

A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 13

*** 5. The nurse is caring for a 62-year-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan?

a. Avoid straining during defecation.
b. Restrict fluids to prevent incontinence.
c. Sexual functioning will not be affected.
d. Prostate exams are not needed after surgery.

Answer 13

a. Avoid straining during defecation.

Activities that increase abdominal pressure, such as sitting or walking for prolonged periods and straining to have a bowel movement (Valsalva maneuver), should be avoided in the postoperative recovery period to prevent a postoperative hemorrhage. Instruct the patient to drink at least 2 L of fluid every day. Digital rectal examinations should be performed yearly. The prostate gland is not totally removed and may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, and decreased orgasmic sensation.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 14

1. A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)?
   a. E. coli bacteria in his urine
   b. A very tender prostate gland
   c. Complaints of chills and rectal pain
   d. Complaints of urgency and frequency

Answer 14

b. A very tender prostate gland

A tender and swollen prostate is indicative of prostatis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatis.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 15

2. A 71-year-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a contact laser technique. What is the primary goal of this intervention?
   a. Resumption of normal urinary drainage
   b. Maintenance of normal sexual functioning
   c. Prevention of acute or chronic renal failure
   d. Prevention of fluid and electrolyte imbalances

Answer 15

a. Resumption of normal urinary drainage

The most significant signs and symptoms of BPH relate to the disruption of normal urinary drainage and consequent urine retention, incontinence, and pain. A laser technique vaporizes prostate tissue and cauterizes blood vessels and is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 16

3. Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy?
   a. Assessing the patient’s incision
   b. Irrigating the patient’s Foley catheter
   c. Assessing the patient’s pain and selecting analgesia
   d. Performing cleansing of the meatus and perineal region

Answer 16

d. Performing cleansing of the meatus and perineal region

Performing perineal care is an appropriate task for delegation. Selecting analgesia, irrigating the patient’s catheter, and assessing his incision are not appropriate skills or tasks for unlicensed personnel.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 17

4. To accurately monitor progression of a symptom of decreased urinary stream, the nurse should encourage the patient to have which primary screening measure done on a regular basis?
   a. Uroflowmetry
   b. Transrectal ultrasound
   c. Digital rectal examination (DRE)
   d. Prostate-specific antigen (PSA) monitoring

Answer 17

c. Digital rectal examination (DRE)

Digital rectal examination is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia in men over 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 18

5. A patient is one day postoperative following a transurethral resection of the prostate (TURP). Which event is not an expected normal finding in the care of this patient?
   a. The patient requires two tablets of Tylenol #3 during the night.
   b. The patient complains of fatigue and claims to have minimal appetite.
   c. The patient has continuous bladder irrigation (CBI) infusing, but output has decreased.
   d. The patient has expressed anxiety about his planned discharge home the following day.

Answer 18

c. The patient has continuous bladder irrigation (CBI) infusing, but output has decreased.

A decrease or cessation of output in a patient with CBI requires immediate intervention. The nurse should temporarily stop the CBI and attempt to resume output by repositioning the patient or irrigating the catheter. Complaints of pain, fatigue, and low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient’s CBI.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 19

6. The patient has had cardiovascular disease for some time and has now developed erectile dysfunction. He is frustrated because he cannot take erectogenic medications because he takes nitrates for his cardiac disease. What should the nurse do first to help this patient?
   a. Give the patient choices for penile implant surgery.
   b. Recommend counseling for the patient and his partner.
   c. Obtain a thorough sexual, health, and psychosocial history.
   d. Assess levels of testosterone, prolactin, LH, and thyroid hormones.

Answer 19

c. Obtain a thorough sexual, health, and psychosocial history.

The nurse’s first action to help this patient is to obtain a thorough sexual, health, and psychosocial history. Alternative treatments for the cardiac disease would then be explored if that had not already been done. Further examination or diagnostic testing would be based on the history and physical assessment, including hormone levels, counseling, or penile implant options.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 20

7. After a vasectomy, what teaching should be included in the discharge teaching?
   a. “You will want to use an alternative form of contraception for 6 weeks.”
   b. “You may lose some secondary sexual characteristics after this surgery.”
   c. “You may have erectile dysfunction for several months after this surgery.”
   d. “You will be uncomfortable, but you may safely have sexual intercourse today.”

Answer 20

a. “You will want to use an alternative form of contraception for 6 weeks.”

As vasectomies are usually done for sterilization purposes, to safely have sexual intercourse, the patient will need to use an alternative form of contraception until semen examination reveals no sperm, usually at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site. Hormones are not affected, so there is no loss of secondary sexual characteristics or erectile function. Most men experience too much pain to have sexual intercourse on the day of their surgery, so this is not an appropriate comment by the nurse.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 21

8. A 73-year-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the “stream is less than it used to be.” The nurse should give the patient anticipatory guidance that what condition may be developing?
   a. A tumor of the prostate
   b. Benign prostatic hyperplasia
   c. Bladder atony because of age
   d. Age-related altered innervation of the bladder

Answer 21

b. Benign prostatic hyperplasia

Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men over age 50 and 80% of men over age 80. Only about 16% of men develop prostate cancer. Bladder atony and age-related altered innervations of the bladder do not lead to a weakened stream.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 22

9. A 33-year-old patient noticed a painless lump in his scrotum on self-examination of his testicles and a feeling of heaviness. The nurse should first teach him about what diagnostic test?
   a. Ultrasound
   b. Cremasteric reflex
   c. Doppler ultrasound
   d. Transillumination with a flashlight

Answer 22

a. Ultrasound

When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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Question 23

10. The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on “watchful waiting” status for 5 years. Six months ago his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations now indicate that the prostate cancer may be growing and he needs a change in his care (select all that apply)?

a. Casts in his urine
b. Presence of α-fetoprotein
c. Serum PSA level 10 ng/mL
d. Onset of erectile dysfunction
e. Nodularity of the prostate gland

Answer 23

c. Serum PSA level 10 ng/mL
d. Nodularity of the prostate gland

The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth.

CHAPTER 55 Nursing Management: Male Reproductive Problems (9th Edition)
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