Jarvis ch. 26 - Male Genitourinary System

Question 1

When performing a genital examination on a 25-year-old man, the nurse notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information, the nurse would:

a. Squeeze the glans to check for the presence of discharge
b. Consider this finding as normal and proceed with the examination
c. Assess the testicles for the presence of masses or painless lumps
d. Obtain a more detailed history, focusing on any scrotal abnormalities the patient has noticed

Answer 1

ANS: B

After adolescence, the scrotal skin is deeply pigmented, has large sebaceous follicles, and appears corrugated.

Question 2

During the health history interview with an 18 year-old male patient, the patient expresses concern that his “private parts seem to move closer to his body when it is cold out.” The nurse explains that:

a. The lymphatic vessels of the testes drain into the abdominal lymph nodes
b. The vas deferens is located along the inferior portion of each testis
c. The right testis is lower than the left one because the right spermatic cord is longer
d. The cremaster muscle contracts in response to cold and draws the testicles closer to the body

Answer 2

ANS: D
When it is cold, the cremaster muscle contracts, which raises the scrotal sac and brings the testes closer to the body to absorb heat necessary for sperm viability. The lymphatic vessels of the testes drain into the inguinal lymph nodes. The vas deferens is located along the upper portion of each testis. The left testis is lower than the right because the left spermatic cord is longer

Question 3

A 62-year-old man states that his physician told him that he has an “inguinal hernia.” He asks the nurse to explain what a hernia is. The nurse should:

a. Tell him not to worry and that most men his age have hernias
b. Explain that a hernia is often the result of prenatal growth abnormalities
c. Refer him to his physician for additional consultation because the physician made the initial diagnosis
d. Explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles

Answer 3

ANS: D

A hernia is a loop of bowel protruding through a weak spot in the musculature.

Question 4

The mother of a 10-year-old boy asks the nurse to explain the onset of puberty. The nurse should reply by saying:

a. “Puberty usually begins around 15 years of age.”
b. “The first sign of puberty is an enlargement of the testes.”
c. “The penis size does not increase until about 16 years of age.”
d. “The development of pubic hair precedes enlargement of the testicles or penis.”

Answer 4

ANS: B
Puberty begins sometime between ages 9.5 and 13.5 years. The first sign is enlargement of the testes. Next, pubic hair appears, and then penis size increases

Question 5

During an examination of a 70-year-old male patient, the nurse recognizes that normal changes to expect would be:

a. Enlarged scrotal sac
b. Increased pubic hair
c. Decreased penis size
d. Increased rugae over the scrotum

Answer 5

ANS: C
In the aging man, the amount of pubic hair decreases, the penis size decreases, and the rugae over the scrotal sac decreases. The scrotal sac does not enlarge. Because of decreased tone of the dartos muscle, the scrotal contents hang lower, the rugae decrease, and the scrotum looks pendulous

Question 6

An older man is concerned about his sexual performance. The nurse knows that in the absence of disease, a man may withdraw from sexual activity later in life because of:

a. Side effects of medications
b. Decreased libido with aging
c. Decreased sperm production
d. Decreased pleasure from sexual intercourse

Answer 6

ANS: A
In the absence of disease, a withdrawal from sexual activity could be attributed to the side effects of medications, such as antihypertensives, antidepressants, sedatives, psychotropics, antispasmotics, tranquilizers or narcotics, and hormone therapy. The other options are not correct

Question 7

When the nurse is conducting sexual history interview with a male adolescent, which statement would be most appropriate to use at the beginning of the interview?

a. “Do you use condoms?”
b. “You don’t masturbate, do you?”
c. “Have you had sex in the past 6 months?”
d. “Often adolescents your age have questions about sexual activity.”

Answer 7

ANS: D
The interview should begin with a permission statement, which conveys that it is normal and acceptable to think or feel a certain way. The nurse should avoid sounding judgemental

Question 8

When the nurse is performing a genital examination on a male patient, the patient has an erection. The nurse’s most appropriate action or response is to:

a. Ask the patient if he would like someone else to examine him
b. Continue with the examination as though nothing has happened
c. Stop the examination and leave the room after stating that the examination will be resumed at a later time
d. Reassure the patient that this is a normal physiological response and continue with the examination

Answer 8

ANS: D
When the male patient has an erection, the nurse should reassure the patient that this is a normal physiological response to touch and proceed with the rest of the examination. The other responses are not correct and may be perceived as judgemental

Question 9

When performing a genitourinary assessment, the nurse notices that the urethral meatus is ventrally positioned. This finding is:

a. Known as hypospadias
b. A result of phimosis
c. Probably caused by a stricture
d. Often associated with aging

Answer 9

ANS: A
Normally, the urethral meatus is positioned just about centrally. Hypospadias is the ventral location of the urethral meatus. The position of the meatus does not change with aging. Phimosis is the inability to retract the foreskin. A stricture is a narrow opening of the meatus

Question 10

The nurse is performing a genital examination on a male patient and notices urethral drainage. When collecting urethral discharge for microscopic examination and culture, the nurse should:

a. Ask the patient to urinate into a sterile cup
b. Ask the patient for a specimen of semen
c. Insert a cotton-tipped applicator into the urethra to collect a specimen
d. Compress the glans between thumb and forefinger to obtain a specimen of the discharge

Answer 10

ANS: D
If urethral discharge is noticed, then the examiner should obtain a smear for microscopic examination and culture by compressing the glans anteroposteriorly with the thumb and forefinger

Question 11

When assessing the scrotum of a male patient, the nurse notices the presence of multiple firm, nontender, yellow, 1-cm nodules. The nurse knows that these nodules are most likely:

a. Caused by urethritis
b. Sebaceous cysts
c. Subcutaneous plaques
d. From an inflammation of the epididymis

Answer 11

ANS: B

Sebaceous cysts are commonly found on the scrotum. These yellowish, 1-cm nodules are firm, nontender, and often multiple

Question 12

During a scrotal assessment, the nurse palpates a mass and notices that the scrotal contents show a red glow with transillumination. On the basis of these findings, the nurse would:

a. Assess the patient for the presence of a hernia
b. Suspect the presence of serous fluid in the scrotum
c. Consider this finding normal and proceed with the examination
d. Refer the patient for evaluation of the mass in the scrotum

Answer 12

ANS: B
Perform transillumination only if you notice a swelling or mass. Darken the room. Shine a strong flashlight from behind the scrotal contents. Normal scrotal contents do not allow light to pass through the scrotum. However, serous fluid is transilluminated and shows as a red glow. Neither a mass nor a hernia would be transilluminated

Question 13

When the nurse is performing a genital examination on a male patient, which action is correct?

a. Auscultating for the presence of a bruit over the scrotum
b. Palpating for the vertical chain of lymph nodes along the groin, inferior to the inguinal ligament
c. Palpating the inguinal canal only if a bulge is present in the inguinal region during inspection
d. Having the patient shift his weight onto the left (unexamined) leg when palpating the right inguinal canal for a mass

Answer 13

ANS: D
When palpating for the presence of a herniating mass on the right side, the male patient is asked to shift his weight onto the left (unexamined) leg. Auscultating for a bruit over the scrotum is not appropriate. When palpating for lymph nodes, the horizontal chain is palpated. The inguinal canal should be palpated whether a bulge is present or not

Question 14

During the health history interview with a 40-year-old male patient who was raised in South Korea, the patient mentions that he has undescended testes that had not been corrected in his childhood and is concerned about getting cancer. The nurse informs the patient that:

a. Testicular cancer is the most common cancer in men 30 to 50 years of age
b. The early symptoms of testicular cancer are pain and induration
c. Men with a history of cryptorchidism are at risk for the development of testicular cancer
d. The cure rate for testicular cancer is low

Answer 14

ANS: C
The overall incidence is rare, but testicular cancer occurs most commonly in men 15 to 29 years of age. Other risk factors include delayed descent of the testicles (if not corrected early), family or personal history of testicular cancer, and abnormal development of the testicle. True cryptorchidism occurs when the testes have never descended. Men with undescended testicles (cryptorchidism) are therefore at risk for the development of testicular cancer. The overall incidence of testicular cancer is rare. Although testicular cancer has no early symptoms, if detected early through palpation and treated before it metastasizes, the cure rate is almost 100%

Question 15

The nurse is describing to a patient how to perform TSE. Which statement is most appropriate?

a. “A good time to examine your testicles is just before you take a shower.”
b. “An enlarged testicle or a painless lump is not unusual.”
c. “The healthy testicle is egg shaped and movable. It should feel firm and have a lumpy consistency.”
d. “Perform TSE at least once a week to detect testicular cancer in the early stage.”

Answer 15

ANS: B
If the patient notices a firm, painless lump; a hard area; or an overall enlarged testicle, then he should contact his health care provider for further evaluation. The testicle normally feels rubbery and has a smooth surface. A good time to examine the testicles is just after a warm bath or shower. The heat from the water relaxes the scrotum and makes the testicles descend. TSE should be performed once a month

Question 16

A 2-month-old uncircumcised infant has been brought to the clinic for a well-baby checkup. How would the nurse proceed with the genital examination?

a. Eliciting the cremasteric reflex is recommended.
b. The glans is assessed for redness or lesions.
c. Retracting the foreskin should be avoided until the infant is 3 months old.
d. Any dirt or smegma that has collected under the foreskin should be noted

Answer 16

ANS: C
If the baby is uncircumcised, then the foreskin is normally tight during the first 3 months and should not be retracted because of the risk for tearing the membrane attaching the foreskin to the shaft

Question 17

A 2-year-old boy has been diagnosed with physiological cryptorchidism. Considering this diagnosis, during assessment the nurse will most likely observe:

a. Testes that are hard and painful to palpation
b. Atrophic scrotum and a bilateral absence of the testis
c. Absence of the testis in the scrotum, but the testis can be milked down
d. Testes that migrate into the abdomen when the child squats or sits cross-legged

Answer 17

ANS:  C 
Migratory testes (physiological cryptorchidism) are common because of the strength of the cremasteric reflex and the small mass of the prepubertal testes. The affected side has a normally developed scrotum and the testis can be milked down. The other responses are not correct

Question 18

The nurse knows that a common assessment finding in a boy younger than 2 years of age is:

a. Inflamed and tender spermatic cord
b. Presence of a hernia in the scrotum
c. Penis that looks large in relation to the scrotum
d. Presence of a hydrocele, or fluid in the scrotum

Answer 18

ANS: D

A common scrotal finding in boys younger than 2 years of age is a hydrocele, or fluid in the scrotum

Question 19

When performing a genital assessment on a middle-aged man, the nurse notices multiple soft, moist, painless papules in the shape of cauliflower-like patches scattered across the shaft of the penis. These lesions are characteristic of:

a. Carcinoma
b. Syphilitic chancres
c. Genital herpes
d. Genital warts

Answer 19

ANS: D
The lesions of genital warts are soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch. They occur on the shaft of the penis, behind the corona, or around the anus, where they may grow into large grapelike clusters

Question 20

A 15-year-old boy is seen in the clinic for complaints of “dull pain and pulling” in the scrotal area. On examination, the nurse palpates a soft, irregular mass posterior to and above the testis on the left. This mass collapses when the patient is supine and refills when he is upright. This description is consistent with:

a. Epididymitis
b. Spermatocele
c. Testicular torsion
d. Varicocele

Answer 20

ANS: D
A varicocele consists of dilated, tortuous varicose veins in the spermatic cord caused by incompetent valves within the vein. Symptoms include dull pain or a constant pulling or dragging feeling, or the individual may be asymptomatic. When palpating the mass, the examiner will feel a soft, irregular mass posterior to and above the testis that collapses when the individual is supine and refills when the individual is upright

Question 21

When performing a genitourinary assessment on a 16-year-old male adolescent, the nurse notices a swelling in the scrotum that increases with increased intra-abdominal pressure and decreases when he is lying down. The patient complains of pain when straining. The nurse knows that this description is most consistent with a(n) __________ hernia.

a. Femoral
b. Incisional
c. Direct inguinal
d. Indirect inguinal

Answer 21

ANS: D
With indirect inguinal hernias, pain occurs with straining and a soft swelling increases with increased intra-abdominal pressure, which may decrease when the patient lies down. These findings do not describe the other hernias

Question 22

The nurse is inspecting the scrotum and testes of a 43-year-old man. Which finding would require additional follow-up and evaluation?

a. Skin on the scrotum is taut.
b. Left testicle hangs lower than the right testicle.
c. Scrotal skin has yellowish, 1-cm nodules that are firm and nontender.
d. Testes move closer to the body in response to cold temperatures.

Answer 22

ANS: A
Scrotal swelling may cause the skin to be taut and to display pitting edema. Normal scrotal skin is rugae, and asymmetry is normal with the left scrotal half usually lower than the right. The testes may move closer to the body in response to cold temperatures

Question 23

A 55-year-old man is experiencing severe pain of sudden onset in the scrotal area. It is somewhat relieved by elevation. On examination the nurse notices an enlarged, red scrotum that is very tender to palpation. Distinguishing the epididymis from the testis is difficult, and the scrotal skin is thick and edematous. This description is consistent with which of these?

a. Varicocele
b. Epididymitis
c. Spermatocele
d. Testicular torsion

Answer 23

ANS: B
Epididymitis presents as severe pain of sudden onset in the scrotum that is somewhat relieved by elevation. On examination, the scrotum is enlarged, reddened, and exquisitely tender. The epididymis is enlarged and indurated and may be hard to distinguish from the testis. The overlying scrotal skin may be thick and edematous

Question 24

The nurse is performing a genitourinary assessment on a 50-year-old male labourer, who is obese. On examination, the nurse notices a painless round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. These findings are most consistent with a(n) __________ hernia.

a. Scrotal
b. Femoral
c. Direct inguinal
d. Indirect inguinal

Answer 24

ANS: C
Direct inguinal hernias occur most often in men over age 40 years. It is an acquired weakness brought on by heavy lifting, obesity, chronic cough, or ascites. The direct inguinal hernia is usually a painless, round swelling close to the pubis in the area of the internal inguinal ring; the swelling is easily reduced when the individual is supine.

Question 25

The nurse is providing patient teaching about an erectile dysfunction drug. One of the drug’s potential side effects is prolonged, painful erection of the penis without sexual stimulation, which is known as:

a. Orchitis
b. Stricture
c. Phimosis
d. Priapism

Answer 25

ANS: D
Priapism is prolonged, painful erection of the penis without sexual desire. Orchitis is inflammation of the testes. Stricture is narrowing of the opening of the urethral meatus. Phimosis is the inability to retract the foreskin

Question 26

During an examination, the nurse notices that a male patient has a red, round, superficial ulcer with a yellowish serous discharge on his penis. On palpation, the nurse finds a nontender base that feels like a small button between the thumb and fingers. At this point the nurse suspects that this patient has:

a. Genital warts
b. Herpes infection
c. Syphilitic chancre
d. Carcinoma lesion

Answer 26

ANS: C

This lesion indicates syphilitic chancre, which begins within 2 to 4 weeks of infection

Question 27

During a genital examination, the nurse notices that a male patient has clusters of small vesicles on the glans, surrounded by erythema. The nurse recognizes that these lesions are:

a. Peyronie’s disease
b. Genital warts
c. Genital herpes
d. Syphilitic cancer

Answer 27

ANS: C
Genital herpes, or herpes simplex virus 2 (HSV-2), infections are indicated with clusters of small vesicles with surrounding erythema, which are often painful and erupt on the glans or foreskin

Question 28

During a physical examination, the nurse finds that a male patient’s foreskin is fixed and tight and will not retract over the glans. The nurse recognizes that this condition is:

a. Phimosis
b. Epispadias
c. Urethral stricture
d. Peyronie’s disease

Answer 28

ANS: A
With phimosis, the foreskin is nonretractable, forming a pointy tip of the penis with a tiny orifice at the end of the glans. The foreskin is advanced and so tight that it is impossible to retract it over the glans. This condition may be congenital or acquired from adhesions related to infection

Question 29

A 70-year-old man is in for his annual checkup. He has noticed some changes he is concerned about as he is aging. The nurse explains what normal changes he should expect including: (Select all that apply.)

a. Scrotum hanging lower
b. Decrease in the size of the testes
c. Increase in the amount of pubic hair
d. Decrease in the size of the penis
e. Scrotum shrinking in size

Answer 29

ANS: A, B, D
After ages 55 to 60 years, testosterone production declines very gradually so that resulting physical changes are not evident until later in life. Aging changes also result from decreased muscle tone, decreased subcutaneous fat, and decreased cellular metabolism. In older men, the amount of pubic hair decreases, and the remaining hair turns grey. Penis size decreases. Because of decreased tone of the dartos muscle, the scrotal contents hang lower, the rugae decrease, and the scrotum looks pendulous. The testes decrease in size and are less firm to palpation

Question 30

A 16-year-old boy is brought to the clinic for a problem that he refused to let his mother see. The nurse examines him and finds that he has scrotal swelling on the left side. He had had the mumps the previous week, and the nurse suspects that he has orchitis. Which of the following assessment findings support this diagnosis? (Select all that apply.)

a. Swollen testis
b. Mass that is transilluminated
c. Mass that is not transilluminated
d. Scrotum that is nontender on palpation
e. Scrotum that is tender on palpation
f. Scrotal skin that is reddened

Answer 30

ANS: A, C, E, F
With orchitis, the testis is swollen, with a feeling of weight, and is tender or painful. The mass is not transilluminated, and the scrotal skin is reddened. Transillumination of a mass occurs with a hydrocele, not orchitis