MALE REPRO: Brunner's Ch 59: Assessment and Management of Patients With Male Reproductive Disorders Flashcards
(40 cards)
An adolescent is identified as having a collection of fluid in the tunica vaginalis of his testes. The nurse knows that this adolescent will receive what medical diagnosis? A) Cryptorchidism B) Orchitis C) Hydrocele D) Prostatism
C) Hydrocele
A hydrocele refers to a collection of fluid in the tunica vaginalis of the testes. Cryptorchidism is the most common congenital defect in males, characterized by failure of one or both of the testes to descend into the scrotum. Orchitis is an inflammation of the testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical, or unknown factors. Prostatism is an obstructive and irritative symptom complex that includes increased frequency and hesitancy in starting urination, a decrease in the volume and force of the urinary stream, acute urinary retention, and recurrent urinary tract infections.
An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem? A) Bowens disease B) Peyronies disease C) Phimosis D) Priapism
C) Phimosis
Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans. Bowens disease is an in situ carcinoma of the penis. Peyronies disease is an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels.
A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort, burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient is exhibiting symptoms of what? A) V aricocele B) Epididymitis C) Prostatitis D) Hydrocele
C) Prostatitis
Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation is indicative of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele is a collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the spermatic cord.
A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication?
A) Sexual stimulation is not needed to obtain an erection.
B) The drug should be taken 1 hour prior to intercourse.
C) Facial flushing or headache should be reported to the physician immediately.
D) The drug has the potential to cause permanent visual changes.
B) The drug should be taken 1 hour prior to intercourse.
The patient must have sexual stimulation to create the erection, and the drug should be taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side effects of Viagra and do not normally warrant reporting to the physician. Some visual disturbances may occur, but these are transient.
A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? A) Red wine colored B) Tea colored C) Amber D) Light pink
D) Light pink
The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.
A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer?
A) It is most common among men over 55.
B) It is one of the least curable solid tumors.
C) It typically does not metastasize.
D) It is highly responsive to treatment.
D) It is highly responsive to treatment.
Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.
A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively? A) Fowlers position B) Prone position C) Supine position D) Lithotomy position
D) Lithotomy position
Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the patient is placed in a lithotomy position during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or Fowlers position.
A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family?
A) The patient should not be in contact with the baby after delivery.
B) The patients treatment poses no risk to his daughter or her infant.
C) The patients brachytherapy may be contraindicated for safety reasons.
D) The patient should avoid close contact with his daughter for 2 months.
D) The patient should avoid close contact with his daughter for 2 months.
Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient returns home after the procedure. Exposure of others to radiation is minimal, but the patient should avoid close contact with pregnant women and infants for up to 2 months.
A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this patient has chronic urinary retention? A) Hypertension B) Peripheral edema C) Tachycardia and other dysrhythmias D) Increased blood urea nitrogen (BUN)
D) Increased blood urea nitrogen (BUN)
Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur with chronic urinary retention and large residual volumes.
A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patients history prior to instructing the patient on the use of this medication. What disorder will contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Retinopathy C) Hypotension D) Diabetic nephropathy
B) Retinopathy
Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil (Cialis) and sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil (Viagra) are usually contraindicated with diabetic retinopathy.
A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer?
A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
B) Have a transrectal ultrasound every 5 years.
C) Perform monthly testicular self-examinations, especially after age 60.
D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.
A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations wont identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.
A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize?
A) Testicular cancer is a highly curable type of cancer.
B) Testicular cancer is very difficult to diagnose.
C) Testicular cancer is the number one cause of cancer deaths in males.
D) Testicular cancer is more common in older men.
A) Testicular cancer is a highly curable type of cancer.
Testicular cancer is highly curable, particularly when its treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.
A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens?
A) Continuous inflow and outflow of irrigation solution
B) Intermittent inflow and continuous outflow of irrigation solution
C) Continuous inflow and intermittent outflow of irrigation solution
D) Intermittent flow of irrigation solution and prevention of hemorrhage
A) Continuous inflow and outflow of irrigation solution
For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.
A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? A) Urinary tract infection B) Chronic pain C) Permanent vascular damage D) Future erectile dysfunction
C) Permanent vascular damage
The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or erectile dysfunction.
A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the patients history, what might the nurse note that contributes to erectile dysfunction?
A) The patient has been treated for a UTI twice in the past year.
B) The patient has a history of hypertension.
C) The patient is 66 years old.
D) The patient leads a sedentary lifestyle.
B) The patient has a history of hypertension.
Past history of infection and lack of exercise do not contribute to impotence. With advancing age, sexual function and libido and potency decrease somewhat, but this is not the primary reason for impotence. Vascular problems cause about half the cases of impotence in men older than 50 years; hypertension is a major cause of such problems.
A 35-year-old man is seen in the clinic because he is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem? A) Chronic bacterial prostatitis B) Orchitis C) Benign prostatic hyperplasia D) Urolithiasis
A) Chronic bacterial prostatitis
Prostatitis is an inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. Symptoms are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge. Urinary incontinence and retention occur with benign prostatic hyperplasia or hypertrophy. The patient may experience nocturia, urgency, decrease in volume and force of urinary stream. Urolithiasis is characterized by excruciating pain. Orchitis does not cause urinary symptoms.
To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what?
a. Report the planned use of dietary supplements to the physician.
b. Decrease the intake of fluids to prevent urinary retention.
c. Abstain from sexual activity for 2 weeks following the initiation of treatment.
d. Anticipate a temporary worsening of urinary retention before symptoms subside.
a. Report the planned use of dietary supplements to the physician.
Some herbal supplements are contraindicated with Proscar, thus their planned use should be discussed with the physician or pharmacist. The patient should maintain normal fluid intake. There is no need to abstain from sexual activity and a worsening of urinary retention is not anticipated.
A nurse is providing an educational event to a local mens group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group?
a. Native Americans
b. Caucasian Americans
c. African Americans
d. Asian Americans
c. African Americans
African American men have a high risk of prostate cancer; furthermore, they are more than twice as likely to die from prostate cancer as men of other racial or ethnic groups.
A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurses response?
A) A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer.
B) HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant.
C) Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer.
D) Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.
A) A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer.
A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is associated with breast cancer.
A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patients family history, he states, My father died of prostate cancer at age 48. The nurse should instruct him on which of the following health promotion activities?
A) The patient will need PSA levels drawn starting at age 55.
B) The patient should have testing for presence of the CDH1 and STK11 genes.
C) The patient should have PSA levels drawn regularly.
D) The patient should limit alcohol use due to the risk of malignancy.
C) The patient should have PSA levels drawn regularly.
PSA screening is warranted by the patients family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the patient should be limited. However, this is not the most important health promotion intervention.
A 35-year-old father of three tells the nurse that he wants information on a vasectomy. What would the nurse tell him about ejaculate after a vasectomy?
A) There will be no ejaculate after a vasectomy, though the patients potential for orgasm is unaffected.
B) There is no noticeable decrease in the amount of ejaculate even though it contains no sperm.
C) There is a marked decrease in the amount of ejaculate after vasectomy, though this does not affect sexual satisfaction.
D) There is no change in the quantity of ejaculate after vasectomy, but the viscosity is somewhat increased.
B) There is no noticeable decrease in the amount of ejaculate even though it contains no sperm.
Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland, which are unaffected by vasectomy, thus no noticeable decrease in the amount of ejaculate occurs (volume decreases approximately 3%), even though it contains no spermatozoa. The viscosity of ejaculate does not change.
A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply. A) Phimosis B) Priapism C) Herpes simplex infection D) Increasing age E) Lack of circumcision
A) Phimosis
D) Increasing age
E) Lack of circumcision
Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV, smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two-thirds of cases occur in men older than 65 years of age), lichen sclerosus, and balanitis xerotica obliterans. Priapism and HSV are not known risk factors.
A 75-year-old male patient is being treated for phimosis. When planning this patients care, what health promotion activity is most directly related to the etiology of the patients health problem?
A) Teaching the patient about safer sexual practices
B) Teaching the patient about the importance of hygiene
C) Teaching the patient about the safe use of PDE-5 inhibitors
D) Teaching the patient to perform testicular self-examination
B) Teaching the patient about the importance of hygiene
Poor hygiene often contributes to cases of phimosis. This health problem is unrelated to sexual practices, the use of PDE-5 inhibitors, or testicular self-examination.
A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional dribbling of urine. How should the nurse best respond to this patients concern?
A) Inform the patient that urinary control is likely to return gradually.
B) Arrange for the patient to be assessed by his urologist.
C) Facilitate the insertion of an indwelling urinary catheter by the home care nurse.
D) Teach the patient to perform intermittent self-catheterization.
A) Inform the patient that urinary control is likely to return gradually.
It is important that the patient know that regaining urinary control is a gradual process; he may continue to dribble after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.
