MALE REPRO Lewis Ch 54: Male Reproductive Problems

Question 1

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What will the nurse will ask the patient about to determine the severity of benign prostatic hyperplasia (BPH) symptoms?

a. Blood in the urine
b. Lower back or hip pain
c. Force of urinary stream
d. Erectile dysfunction (ED)

Answer 1

c. Force of urinary stream

The American Urological Association Symptom Index for a patient with BPH asks questions such as the force and frequency of urination and nocturia. Blood in the urine, ED, and back or hip pain are not typical symptoms of BPH.

Question 2

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A patient who was recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because it might affect his ability to have sexual intercourse. Which action should the nurse take?

a. Discuss alternative methods of sexual expression.
b. Teach about medication for erectile dysfunction (ED).
c. Clarify that TURP does not commonly affect erection.
d. Offer reassurance that fertility is not affected by TURP

Answer 2

c. Clarify that TURP does not commonly affect erection.

ED is not a concern with TURP, although retrograde ejaculation is likely, and the nurse should discuss this with the patient. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about fertility does not address his concerns.

Question 3

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The health care provider prescribes finasteride (Proscar) for a patient who has benign prostatic hyperplasia (BPH). What information should the nurse provide when teaching the patient about the drug?

a. He should change position from lying to standing slowly to avoid dizziness.
b. His interest in sexual activity may decrease while he is taking the medication.
c. Improvement in the obstructive symptoms should occur within about 2 weeks.
d. He will need to monitor his blood pressure frequently to assess for hypertension.

Answer 3

b. His interest in sexual activity may decrease while he is taking the medication.

A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient is also taking a medication for erectile dysfunction, it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension.

Question 4

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What test will the nurse plan to explain to a 61-yr-old patient who has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate-specific antigen (PSA) level?

a. Cystourethroscopy
b. Uroflowmetry studies
c. Magnetic resonance imaging (MRI)
d. Transrectal ultrasonography (TRUS)

Answer 4

d. Transrectal ultrasonography (TRUS)

In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to visualize the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be used before prostatectomy but will not be done until after the TRUS and biopsy. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process.

Question 5

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Which information about continuous bladder irrigation will the nurse teach to a patient who is being admitted for a transurethral resection of the prostate (TURP)?

a. Bladder irrigation decreases the risk of postoperative bleeding.
b. Hydration and urine output are maintained by bladder irrigation.
c. Antibiotics are infused continuously through the bladder irrigation.
d. Bladder irrigation prevents obstruction of the catheter after surgery.

Answer 5

d. Bladder irrigation prevents obstruction of the catheter after surgery.

The purpose of bladder irrigation is to remove clots from the bladder and prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or improve hydration. Antibiotics are given by the IV route, not through the bladder irrigation.

Question 6

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A 53-yr-old patient is scheduled for an annual physical examination. What diagnostic test will the nurse plan to explain to the patient?

a. Urinalysis collection
b. Uroflowmetry studies
c. Prostate-specific antigen (PSA)
d. Transrectal ultrasound scanning (TRUS)

Answer 6

c. Prostate-specific antigen (PSA)

An annual digital rectal exam (DRE) and PSA are usually recommended starting at age 50 years for men who have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA results are abnormal.

Question 7

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What potential cause of infection will the nurse consider in the plan of care for a patient immediately after a perineal radical prostatectomy?

a. Urinary incontinence
b. Prolonged urinary stasis
c. Fecal wound contamination
d. Suprapubic catheter placement

Answer 7

c. Fecal wound contamination

The perineal approach increases the risk for infection because the incision is located close to the anus, and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery.

Question 8

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What will the nurse plan to teach the patient who is incontinent of urine following a radical retropubic prostatectomy?

a. Restrict oral fluid intake.
b. Do pelvic muscle exercises.
c. Perform intermittent self-catheterization.
d. Use belladonna and opium suppositories.

Answer 8

b. Do pelvic muscle exercises.

Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L.

Question 9

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A 70-yr-old patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) is being discharged from the hospital today. Which patient statement indicates a need for the nurse to provide additional instruction?

a. “I should call the doctor if I have incontinence at home.”
b. “I will avoid driving until I get approval from my doctor.”
c. “I should schedule yearly appointments for prostate examinations.”
d. “I will increase fiber and fluids in my diet to prevent constipation.”

Answer 9

a. “I should call the doctor if I have incontinence at home.”

Because incontinence is common for several weeks after a TURP, the patient does not need to call the health care provider if this occurs. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.

Question 10

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What side effect of leuprolide (Lupron) should the nurse plan to discuss with a patient who has cancer of the prostate?

a. Flushing
b. Dizziness
c. Infection
d. Incontinence

Answer 10

a. Flushing

Hot flashes may occur with decreased testosterone production. Dizziness may occur with the -blockers used for benign prostatic hyperplasia. Urinary incontinence may occur after prostate surgery, but it is not an expected side effect of medication. Risk for infection is increased in patients receiving chemotherapy

Question 11

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Which information will the nurse plan to include when teaching a young adult who has a family history of testicular cancer about testicular self-examination?

a. Testicular self-examination should be done at least weekly.
b. Testicular self-examination should be done in a warm room.
c. The only structure normally felt in the scrotal sac is the testis.
d. Call the health care provider if one testis is larger than the other.

Answer 11

b. Testicular self-examination should be done in a warm room.

The testes will hang lower in the scrotum when the temperature is warm (e.g., during a shower), and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One testis is normally larger. Men at high risk should perform testicular self-examination monthly.

Question 12

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A 27-yr-old patient who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is appropriate for the nurse to take?

a. Teach the patient and the wife that impotence is unlikely after unilateral orchiectomy.
b. Ask the patient if he has any questions or concerns about the diagnosis and treatment.
c. Inform the patient’s wife that concerns about sexual function are common with this diagnosis.
d. Document the patient’s lack of communication on the health record and continue preoperative care.

Answer 12

b. Ask the patient if he has any questions or concerns about the diagnosis and treatment.

The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer teaching about complications after orchiectomy. Documentation of the patient’s lack of interaction is not an adequate nursing action in this situation.

Question 13

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A patient with urinary obstruction from benign prostatic hyperplasia (BPH) tells the nurse, “My symptoms are much worse this week.” Which response by the nurse is appropriate?

a. “Have you taken any over-the-counter (OTC) medications recently?”
b. “I will talk to the doctor about a prostate-specific antigen (PSA) test.”
c. “Have you talked to the doctor about surgery such as transurethral resection of the prostate (TURP)?”
d. “The prostate gland changes in size from day to day, and this may be making your symptoms worse.”

Answer 13

a. “Have you taken any over-the-counter (OTC) medications recently?”

Because the patient’s increase in symptoms has occurred abruptly, the nurse should ask about OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer.

Question 14

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What health history information should the nurse obtain from the patient who has possible testicular cancer?

a. Testicular torsion
b. Testicular trauma
c. Undescended testicles
d. Sexually transmitted infection (STI)

Answer 14

c. Undescended testicles

Cryptorchidism, or undescended testicles, is a risk factor for testicular cancer if it is not corrected before puberty. STI, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer.

Question 15

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A patient who has benign prostatic hyperplasia (BPH) with urinary retention is admitted to the hospital with elevated blood urea nitrogen (BUN) and creatinine. Which prescribed therapy should the nurse implement first?

a. Infuse normal saline at 50 mL/hr.
b. Insert a urinary retention catheter.
c. Draw blood for a complete blood count.
d. Schedule pelvic magnetic resonance imaging

Answer 15

b. Insert a urinary retention catheter.

The patient data indicate that the patient may have acute kidney injury caused by the BPH. The initial therapy will be to insert a catheter. The other actions are also appropriate, but they can be implemented after the acute urinary retention is resolved.

Question 16

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The nurse in the clinic notes elevated prostate-specific antigen (PSA) levels in the laboratory results of these patients. Which patient’s elevated PSA result requires further evaluation?
a. A 38-yr-old patient who is being treated for acute prostatitis
b. A 52-yr-old patient who goes on long bicycle rides every weekend
c. A 48-yr-old patient whose father died of metastatic prostate cancer
d. A 75-yr-old patient who uses saw palmetto to treat benign prostatic hyperplasia
(BPH)

Answer 16

c. A 48-yr-old patient whose father died of metastatic prostate cancer

The family history of prostate cancer and elevation of PSA indicate that further evaluation of the patient for prostate cancer is needed. Elevations in PSA for the other patients are not unusual.

Question 17

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After a transurethral resection of the prostate (TURP), a 64-yr-old patient with continuous bladder irrigation reports painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take first?

a. Increase the flowrate of the bladder irrigation.
b. Administer the prescribed IV morphine sulfate.
c. Give the patient the prescribed belladonna and opium suppository.
d. Manually instill and then withdraw 50 mL of saline into the catheter.

Answer 17

d. Manually instill and then withdraw 50 mL of saline into the catheter.

The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse’s first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flowrate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.

Question 18

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A patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. What should the nurse plan to do?

a. Vaccinate the patient with sipuleucel-T (Provenge).
b. Provide the patient with information about cryotherapy.
c. Teach the patient about placement of intraurethral stents.
d. Schedule the patient for annual prostate-specific antigen testing.

Answer 18

d. Schedule the patient for annual prostate-specific antigen testing.

Patients who opt for active surveillance need to have annual digital rectal examinations and prostate-specific antigen testing. Vaccination with sipuleucel-T, cryotherapy, and stent placement are options for patients who choose to have active treatment for prostate cancer.

Question 19

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Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first?

a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum
b. A 35-yr-old patient who is concerned that his scrotum “feels like a bag of worms”
c. A 40-yr-old patient who has pelvic pain while being treated for chronic prostatitis
d. A 70-yr-old patient who is reporting frequent urinary dribbling after a prostatectomy

Answer 19

a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum

The patient’s age and symptoms suggest possible testicular cancer. Some forms of testicular cancer can be very aggressive, so the patient should be evaluated by the health care provider as soon as possible. Varicoceles do require treatment but not emergently. Ongoing pelvic pain is common with chronic prostatitis. Urinary dribbling is a common problem after prostatectomy.

Question 20

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When caring for a patient with continuous bladder irrigation after having transurethral resection of the prostate, which action could the nurse delegate to unlicensed assistive personnel (UAP)?

a. Teach the patient how to perform Kegel exercises.
b. Monitor for increases in bleeding or presence of clots.
c. Increase the flowrate of the irrigation if clots are noted.
d. Report any patient reports of pain or spasms to the nurse.

Answer 20

d. Report any patient reports of pain or spasms to the nurse.

UAP education and role includes reporting patient concerns to supervising nurses. Patient teaching, assessments for complications, and actions such as bladder irrigation require more education and should be done by licensed nursing staff.

Question 21

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After reviewing the electronic medical record shown in the accompanying figure for a patient who had transurethral resection of the prostate the previous day, which information requires the most rapid action by the nurse?

a. Elevated temperature and pulse
b. Bladder spasms and urine output
c. Respiratory rate and lung crackles
d. No prescription for antihypertensive drugs

Answer 21

b. Bladder spasms and urine output

Bladder spasms and lack of urine output indicate that the nurse needs to assess the continuous bladder irrigation for kinks and may need to manually irrigate the patient’s catheter. The other information will also require actions, such as having the patient take deep breaths and cough and discussing the need for antihypertensive medication prescriptions with the health care provider but the nurse’s first action should b e to address the problem with the urinary drainage system