Chapter 72: Care of Patients with Male Reproductive Problems

Question 1

The nurse is conducting a history on a male client to determine the severity of symptoms associated with prostate enlargement. Which finding is cause for prompt action by the nurse?

Answer 1

Cloudy urine
Hematuria

Cloudy urine and hematuria could indicate infection due to possible urine retention and should be a priority action.

Question 2

A client is diagnosed with benign prostatic hyperplasia and seems sad and irritable. After assessing the clients behavior, which statement by the nurse would be the most appropriate?

Answer 2

Nocturia could cause interruption of your sleep and cause changes in mood

Frequent visits to the bathroom during the night could cause sleep interruptions and affect the clients mood and mental status. Incontinence could cause the client to feel embarrassment and cause him to limit his activities outside the home.

Question 3

A 55-year-old African-American client is having a visit with his health care provider. What test should the nurse discuss with the client as an option to screen for prostate cancer, even though screening is not routinely recommended?

Answer 3

Prostate-specific antigen

The prostate-specific antigen test should be discussed as an option for prostate cancer screening.

Question 4

The nurse is teaching a client with benign prostatic hyperplasia (BPH). What statement indicates a lack of understanding by the client(needs further information)?

Answer 4

There should be no problem with a glass of wine with dinner each night

This client did not associate wine with the avoidance of alcohol, and requires additional teaching. The nurse must teach a client with BPH to avoid alcohol, caffeine, and large quantities of fluid in a short amount of time to prevent overdistention of the bladder.

Question 5

A client has returned from a transurethral resection of the prostate with a continuous bladder irrigation. Which action by the nurse is a priority if bright red urinary drainage and clots are noted 5 hours after the surgery?

Answer 5

Take vital signs and notify the surgeon immediately

Bright red urinary drainage with clots may indicate arterial bleeding. Vital signs should be taken and the surgeon notified.

Question 6

A nurse and an unlicensed assistive personnel (UAP) are caring for a client with an open radical
prostatectomy. Which comfort measure could the nurse delegate to the UAP?

Answer 6

Helping the client transfer from the bed to the chair

The UAP could aid the client in transferring from the bed to the chair and with ambulation

Question 7

A client is diagnosed with metastatic prostate cancer. The client asks the nurse the purpose of his treatment with the luteinizing hormonereleasing hormone (LH-RH) agonist leuprolide (Lupron) and the bisphosphonate pamidronate (Aredia). Which statement by the nurse is most appropriate?

Answer 7

The treatment reduces testosterone and prevents bone fractures.

Lupron, an LH-RH agonist, stimulates the pituitary gland to release luteinizing hormone (LH) to the point that the gland is depleted of LH and testosterone production is lessened. This may decrease the prostate cancer since it is hormone dependent. Lupron can cause osteoporosis, which results in the need for Aredia to prevent bone loss.

Question 8

The nurse is administering sulfamethoxazole-trimethoprim (Bactrim) to a client diagnosed with bacterial prostatitis. Which finding causes the nurse to question this medication for this client?

Answer 8

Allergy to sulfa medications

Before administering sulfamethoxazole-trimethoprim, the nurse must assess if the client is allergic to sulfa drugs.

Question 9

A 55-year-old male client is admitted to the emergency department with symptoms of a myocardial infarction. Which question by the nurse is the most appropriate before administering nitroglycerin?

Answer 9

Have you taken any drugs like Viagra recently?

Phosphodiesterase-5 inhibitors such as sildenafil (Viagra) relax smooth muscles to increase blood flow to the penis for treatment of erectile dysfunction. In combination with nitroglycerin, there can be extreme hypotension with reduction of blood flow to vital organs.

Question 10

A 34-year-old client comes to the clinic with concerns about an enlarged left testicle and heaviness in his lower abdomen. Which diagnostic test would the nurse expect to be ordered to confirm testicular cancer?

Answer 10

Alpha-fetoprotein (AFP)

AFP is a glycoprotein that is elevated in testicular cancer. PSA and PAP testing is used in the screening of prostate cancer

Question 11

A 25-year-old client has recently been diagnosed with testicular cancer and is scheduled for radiation therapy. Which intervention by the nurse is best?

Answer 11

Explore with the client the possibility of sperm collection

Sperm collection is a viable option for a client diagnosed with testicular cancer and should be completed before radiation therapy, chemotherapy, or radical lymph node dissection

Question 12

A 70-year-old client returned from a transurethral resection of the prostate 8 hours ago with a continuous bladder irrigation. The nurse reviews his laboratory results as follows:
Sodium 128
mEq/L
Hemoglobin 14
g/dL
Hematocrit 42%
Red blood
cell count
4.5
What action by the nurse is the most appropriate?

Answer 12

Slow down the bladder irrigation if the urine is pink.

The serum sodium is decreased due to large-volume bladder irrigation (normal is 136 to 145 mEq/L). By slowing the irrigation, there will be less fluid overload and sodium dilution.

Question 13

The nurse is teaching an uncircumcised 65-year-old client about self-management of a urinary catheter in preparation for discharge to his home. What statement indicates a lack of understanding by the client (needs
more information)?

Answer 13

I only have to wash the outside of the catheter once a week.

The first few inches of the catheter must be washed daily starting at the penis and washing outward with soap and water.

Question 14

The nurse is administering finasteride (Proscar) and doxazosin (Cardura) to a 67-year-old client with benign
prostatic hyperplasia. What precautions are related to the side effects of these medications? (Select all that apply.)

Answer 14

Assessing for blood pressure changes when lying, sitting, and arising from the bed
Immediately reporting any change in the alanine aminotransferase laboratory test
Asking the client to report any weakness, light-headedness, or dizziness

Both the 5-alpha-reductase inhibitor (5-ARI) and the alpha1-selective blocking agents can cause orthostatic (postural) hypotension and liver dysfunction.

Question 15

A client is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? (Select all that apply.)

Answer 15

Family history of prostate cancer/ First-degree relative with prostate cance
Advanced age
Eating too much red meat
Race

Advanced family history of prostate cancer, age, a diet high in animal fat, and race are all risk factors for prostate cancer.

Question 16

A client came to the clinic with erectile dysfunction. What are some possible causes of this condition that the nurse could discuss with the client during history taking? (Select all that apply.)

Answer 16

Recent prostatectomy
Long-term hypertension
Diabetes mellitus
Consumption of beer each night

Organic erectile dysfunction can be caused by surgical procedures, hypertension and its treatment, diabetes mellitus, and alcohol consumption.

Question 17

A nurse is providing education to a new 55-year-old African-American client about screening for prostate cancer. What action by the nurse is most appropriate?

Answer 17

Teach the client that he is in a high risk group and should discuss screening.

Clients in certain high risk groups should discuss screening for prostate cancer with their rprimary health care providers at age 45. High risk groups include African Americans and men with a first-degree relative who was diagnosed with prostate cancer before the age of 65. This new client will be encouraged to discuss

Question 18

A new nurse care for several client after radical prostatectomies for prostate cancer. What action by the nurse indicates a need to review care measures for this type of client?

Answer 18

Administers a suppository to the client who reports constipation.

After a radical prostatectomy, the nurse would not provide a rectal suppository for constipation. All rectal treatments are contraindicated.

Question 19

A client with metastatic prostate cancer has been prescribed leuprolide, a bisphosphonate, and flutamide. Which statement by the client warrants further investigation by the nurse?

Answer 19

“My wife has noticed my eyes looking a little yellow.

Flutamide is an antiandrogen drug that can cause liver toxicity. The nurse would follow up on the statement that the client’s eyes may be looking a little yellow which could indicate the onset of this adverse effect.

Question 20

The nurse is providing preoperative education to a client prior to having an orchiectomy for testicular cancer. What statement by the client indicates the need to review the information?

Answer 20

“There should be no effect on my ability to reproduce.”

Oligospermia and azoospermia are common in clients with testicular function and can affect reproduction. The statement that there will be no effect on reproduction requires the nurse to review the information with the client. Sperm banking is an option prior to treatment to store sperm for future use

Question 21

The nurse has provided postvasectomy discharge instructions to the client. What statement by the client demonstrates good understanding?

Answer 21

“An ice pack to my scrotum will help with the swelling.”

After vasectomy, clients are instructed to use birth control until the 3-month semen analysis shows that the procedure has worked, to use an ice pack intermittently for 24 to 48 hours, that swelling and bruising are normal, and the bandage can be removed in 48 hours.

Question 22

A client presents to the emergency department reporting vomiting, severe lower abdominal
pain, and a tender mass above one testis. What action by the nurse is most important?

Answer 22

Determine when he last ate or drank anything.

This client has signs and symptoms of testicular torsion, which is a surgical emergency. For client safety, the nurse assesses last oral intake. Rating the pain is an important intervention too but is not related to safety

Question 23

A client returned from a transurethral resection of the prostate 8 hours ago with a continuous bladder irrigation. The client reports headache and dizziness. What action by the nurse is most appropriate

Answer 23

Report the findings to the surgeon immediately

Headache, dizziness, and shortness of breath are symptoms of possible TURP syndrome in which the irrigation fluid is absorbed, putting strain on the client’s heart. The nurse notifies the primary health care provider immediately as the client may need intensive care monitoring.

Question 24

The nurse is teaching a client about side effects and adverse reactions of a PDE5 inhibitor. What information does the nurse include? (Select all that apply.)

Answer 24

Stop using this drug if your primary health care provider prescribes a nitrate.
Do not drink alcohol before having sexual intercourse.
Muscle cramps, nausea, and vomiting are possible if you take more than 1 pill a day.
Change positions slowly especially if you also take an anti-hypertensive

A PDE5 inhibitor is used to treat erectile dysfunction. The client should avoid grapefruit or grapefruit juice while taking these drugs. Taking a PDE5 inhibitor along with a nitrate can cause a profound drop in blood pressure. Alcohol may interfere with the ability to have an erection. Muscle cramps, nausea, and vomiting are possible side effects if more than 1 pill a day are taken. Each medication has its own directions for how soon to take it before intercourse, from 15 minutes to 2 hours. Any PDE5 drug can lower blood pressure so the nurse alerts the client of safety precautions