Men's Health + STI

Question 1

A male patient who has a profuse, purulent urethral discharge with painful urination is seen at the clinic. Which information will be most important for the nurse to obtain?

a. Sexual orientation c. Recent sexual contacts
b. Immunization history d. Contraceptive preference

Answer 1

ANS: C
Information about sexual contacts is needed to help establish whether the patient has been exposed to a sexually transmitted infection and because sexual contacts also will need treatment. The other information also may be gathered but is not as important in determining the plan of care for the patient’s current symptoms.

Question 2

A 20-yr-old female patient who is being seen in the family medicine clinic for an annual physical examination reports being sexually active. The nurse will plan to teach the patient about

a. testing for Chlamydia infection.
b. immunization for herpes simplex.
c. infertility associated with the human papillomavirus (HPV).
d. the relationship between the herpes virus and cervical cancer.

Answer 2

ANS: A
Testing for Chlamydia is recommended by the Centers for Disease Control and Prevention for all sexually active women younger than age 25 years. HPV infection does not cause infertility. There is no vaccine available for herpes simplex, and herpes simplex infection does not cause cervical cancer.

Question 3

A patient with gonorrhea is treated with a single IM dose of ceftriaxone (Rocephin) and is given a prescription for doxycycline (Vibramycin) 100 mg bid for 7 days. The nurse explains to the patient that this combination is prescribed to

a. prevent reinfection during treatment.
b. treat any coexisting chlamydial infection.
c. eradicate resistant strains of N. gonorrhoeae.
d. prevent the development of resistant organisms.

Answer 3

ANS: B
Because there is a high incidence of co-infection with gonorrhea and Chlamydia, patients are usually treated for both. The other explanations about the purpose of the antibiotic combination are not accurate.

Question 4

A 46-yr-old patient who has had blood drawn for an insurance screening has a positive Venereal Disease Research Laboratory (VDRL) test. Which action should the nurse take next?

a. Ask the patient about past treatment for syphilis.
b. Explain the need for blood and spinal fluid cultures.
c. Schedule fluorescent treponemal antibody absorption (FAT-Abs) testing.
d. Assess for the presence of chancres, flulike symptoms, or a rash on the trunk.

Answer 4

ANS: A
When antibody testing is positive for syphilis, the antibodies remain present for an indefinite period of time even after successful treatment, so the nurse should inquire about previous treatment before doing other assessments or testing. Culture, FAT-Abs testing, and assessment for symptoms may be appropriate based on whether the patient has been previously treated for syphilis.

Question 5

A 48-yr-old male patient who has been diagnosed with gonococcal urethritis tells the nurse he had recent sexual contact with a woman but says she did not appear to have any disease. In responding to the patient, the nurse explains that

a. women do not develop gonorrhea infections but can serve as carriers to spread the disease to men.
b. women may not be aware they have gonorrhea because they often do not have symptoms of infection.
c. women develop subclinical cases of gonorrhea that do not cause tissue damage or clinical manifestations.
d. when gonorrhea infections occur in women, the disease affects only the ovaries and not the genital organs.

Answer 5

ANS: B
Many women with gonorrhea are asymptomatic or have minor symptoms that are overlooked. The disease may affect both the genitals and the other reproductive organs and cause complications such as pelvic inflammatory disease. Women who can transmit the disease have active infections.

Question 6

A patient admitted with chest pain is also found to have positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FAT-Abs) tests, rashes on the palms and the soles of the feet, and moist papules in the anal and vulvar area. Which action will the nurse include in the plan of care?

a. Assess for arterial aneurysms.
b. Wear gloves for patient contact.
c. Place the patient in a private room.
d. Apply antibiotic ointment to the perineum.

Answer 6

ANS: B
Exudate from any lesions with syphilis is highly contagious. Systemic antibiotics, rather than local treatment of lesions, are used to treat syphilis. The patient does not require a private room because the disease is spread through contact with the lesions. This patient has clinical manifestations of secondary syphilis and does not need to be monitored for manifestations of tertiary syphilis.

Question 7

Which statement by a 24-yr-old patient indicates that the nurse’s teaching about management of primary genital herpes has been effective?

a. “I will use acyclovir ointment on the area to relieve the discomfort.”
b. “I will use condoms for intercourse until the medication is all gone.”
c. “I will take the acyclovir (Zovirax) every 8 hours for the next week.”
d. “I will need to take all of the medication to be sure the infection is cured.”

Answer 7

ANS: C
The treatment regimen for primary genital herpes infections includes acyclovir 400 mg 3 times daily for 7 to 10 days. The patient is taught to abstain from intercourse until the lesions are gone. (Condoms should be used even when the patient is asymptomatic.) Acyclovir ointment is not effective in treating lesions or reducing pain. Herpes infection is chronic and recurrent.

Question 8

Which infection, reported in the health history of a female patient who is having difficulty conceiving, will the nurse identify as a risk factor for infertility?

a. N. gonorrhoeae c. Condyloma acuminatum
b. Treponema pallidum d. Herpes simplex virus type 2

Answer 8

ANS: A
Complications of gonorrhea include scarring of the fallopian tubes, which can lead to tubal pregnancies and infertility. Syphilis, genital warts, and genital herpes do not lead to problems with conceiving, although transmission to the fetus (syphilis) or newborn (genital warts or genital herpes) is a concern.

Question 9

A patient is diagnosed with primary syphilis during her eighth week of pregnancy. The nurse will plan to teach the patient about the

a. likelihood of a stillbirth.
b. plans for cesarean section
c. intramuscular injection of penicillin.
d. antibiotic eye drops for the newborn.

Answer 9

ANS: C
A single injection of penicillin is recommended to treat primary syphilis. This will treat the mother and prevent transmission of the disease to the fetus. Instillation of erythromycin into the eyes of the newborn is used to prevent gonorrheal eye infections. C-section is used to prevent the transmission of herpes to the newborn. Although stillbirth can occur if the fetus is infected with syphilis, treatment before the 10th week of gestation will eliminate in utero transmission to the fetus.

Question 10

A 19-yr-old patient has genital warts around her external genitalia and perianal area. She tells the nurse that she has not sought treatment until now because “the warts are so disgusting.” Which nursing diagnosis is consistent with these data?

a. Disturbed body image related to feelings about the genital warts
b. Ineffective coping related to denial of increased risk for infection
c. Risk for infection related to lack of knowledge about transmission
d. Anxiety related to impact of condition on interpersonal relationships

Answer 10

ANS: A
The patient’s statement that her lesions are disgusting suggests that disturbed body image is the major concern. There is no evidence to indicate ineffective coping or lack of knowledge about mode of transmission. The patient may be experiencing anxiety, but there is nothing in the data indicating that the genital warts are impacting interpersonal relationships.

Question 11

When a 31-yr-old male patient returns to the clinic for follow-up after treatment for gonococcal urethritis, a purulent urethral discharge is still present. Which question will the nurse ask to identify a possible cause of recurrent infection?

a. “Did you take the prescribed antibiotic for a week?”
b. “Did you drink at least 3 quarts of fluids every day?”
c. “Were your sexual partners treated with antibiotics?”
d. “Do you wash your hands after using the bathroom?”

Answer 11

ANS: C
A common reason for recurrence of symptoms is reinfection because infected partners have not been simultaneously treated. Because gonorrhea is treated with one dose of antibiotic, antibiotic therapy for a week is not needed. An adequate fluid intake is important, but a low fluid intake is not a likely cause for failed treatment. Poor hygiene may cause complications such as ocular trachoma but will not cause a failure of treatment.

Question 12

A 29-yr-old female patient is diagnosed with Chlamydia during a routine pelvic examination. The nurse knows that teaching regarding the management of the condition has been effective when the patient says which of the following?

a. “My partner will need to take antibiotics at the same time I do.”
b. “Go ahead and give me the antibiotic injection, so I will be cured.”
c. “I will use condoms during sex until I finish taking all the antibiotics.”
d. “I do not plan on having children, so treating the infection is not important.”

Answer 12

ANS: A
Sex partners should be treated simultaneously to prevent reinfection. Chlamydia is treated with oral antibiotics. Abstinence from sexual intercourse is recommended for 7 days after treatment, and condoms should be recommended during all sexual contacts to prevent infection. Chronic pelvic pain, as well as infertility, can result from untreated Chlamydia.

Question 13

A patient in the sexually transmitted infection (STI) clinic tells the nurse that she is concerned she may have been exposed to gonorrhea. To determine whether the patient has gonorrhea, the nurse will plan to

a. interview the patient about symptoms of gonorrhea.
b. take a sample of cervical discharge for Gram staining.
c. draw a blood specimen or rapid plasma reagin (RPR) testing.
d. obtain secretions for a nucleic acid amplification test (NAAT).

Answer 13

ANS: D
NAAT has a high sensitivity (similar to a culture) for gonorrhea. Because women have few symptoms of gonorrhea, asking the patient about symptoms may not be helpful in making a diagnosis. Smears and Gram staining are not useful because the female genitourinary tract has many normal flora that resemble Neisseria gonorrhoeae. RPR testing is used to detect syphilis.

Question 14

A 32-yr-old patient who is diagnosed with Chlamydia tells the nurse that she is very angry because her husband is her only sexual partner. Which response should the nurse make first?

a. “You may need professional counseling to help resolve your anger.”
b. “It is understandable that you feel angry about contracting an infection.”
c. “Your feelings are justified and you should share them with your husband.”
d. “It is important that both you and your husband be treated for the infection.”

Answer 14

ANS: B
This response expresses the nurse’s acceptance of the patient’s feelings and encourages further discussion and problem solving. The patient may need professional counseling, but more assessment of the patient is needed before making this judgment. The nurse should also assess further before suggesting that the patient share her feelings with the husband because problems such as abuse might be present in the relationship. Although it is important that both partners be treated, the patient’s anger suggests that the feelings need to be acknowledged first.

Question 15

Which patient will the nurse plan on teaching about the Gardasil vaccine?

a. A 24-yr-old female patient who has not been sexually active
b. A 34-yr-old female patient who has multiple sexual partners
c. A 24-yr-old female patient who is pregnant for the first time
d. A 34-yr-old female patient who is in a monogamous relationship

Answer 15

ANS: A
Gardasil is recommended for female patients ages 9 through 26 years, preferably those who have never been sexually active. It is not recommended for women during pregnancy or for older women.

Question 16

After the nurse has taught a patient with a newly diagnosed sexually transmitted infection (STI) about expedited partner therapy, which patient statement indicates that the teaching has been effective?

a. “I will tell my partner that it is important to be examined at the clinic.”
b. “I will have my partner take the antibiotics if any STI symptoms occur.”
c. “I will make sure that my partner takes all of the prescribed medication.”
d. “I will have my partner use a condom until I have finished the antibiotics.”

Answer 16

ANS: C
With expedited partner therapy, the patient is given a prescription or medications for the partner. The partner does not need to be evaluated by the health care provider but is presumed to be infected and should be treated concurrently with the patient. Use of a condom will not treat the presumed STI in the partner.

Question 17

A 39-yr-old patient with a history of IV drug use is seen at a community clinic. The patient reports difficulty walking, stating, “I don’t know where my feet are.” Diagnostic screening reveals positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-Abs) test results. Based on the patient history, what will the nurse assess (select all that apply)?

a. Heart sounds
b. Genitalia for lesions
c. Joints for swelling and inflammation
d. Mental state for judgment and orientation
e. Skin and mucous membranes for gummas

Answer 17

ANS: A, D, E
The patient’s clinical manifestations and laboratory tests are consistent with tertiary syphilis. Valvular insufficiency, gummas, and changes in mentation are other clinical manifestations of this stage.

Question 18

Which topics will the nurse include when preparing to teach a patient with recurrent genital herpes simplex (select all that apply)?

a. Infected areas should be kept moist to speed healing.
b. Sitz baths may be used to relieve discomfort caused by the lesions.
c. Genital herpes can be cured by consistent use of antiviral medications.
d. Recurrent genital herpes episodes usually are shorter than the first episode.
e. The virus can infect sexual partners even when you do not have symptoms.

Answer 18

ANS: B, D, E
Patients are taught that shedding of the virus and infection of sexual partners can occur even in asymptomatic periods, that recurrent episodes resolve more quickly, and that sitz baths can be used to relieve pain caused by the lesions. Antiviral medications decrease the number of outbreaks but do not cure herpes simplex infections. Infected areas may be kept dry if this decreases pain and itching.

Question 19

The nurse in the outpatient clinic notes that the following patients have not received the human papillomavirus (HPV) vaccine. Which patients should the nurse plan to teach about benefits of the vaccine (select all that apply)?

a. A 24-yr-old male patient who has a history of genital warts
b. An 18-yr-old male patient who has had one male sexual partner
c. A 38-yr-old female patient who has never been sexually active
d. A 20-yr-old female patient who has a newly diagnosed Chlamydia infection
e. A 30-yr-old female patient whose sexual partner has a history of genital warts

Answer 19

ANS: A, B, D
The HPV vaccines are recommended for male and female patients between ages 9 through 26 years. There are several types of HPV. Ideally, the vaccines are administered before patients are sexually active, but they offer benefit even to those who already have HPV infection because the vaccines protect against HPV types not already acquired.

Question 20

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about

a. blood in the urine. c. force of urinary stream.
b. lower back or hip pain. d. erectile dysfunction (ED).

Answer 20

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

Question 21

A patient who has been 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 21

ANS: C
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 sperm production does not address his concerns.

Question 22

The health care provider prescribes finasteride (Proscar) for a patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that

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 22

ANS: B
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 23

The nurse will anticipate that a 61-yr-old patient who has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level will need teaching about

a. cystourethroscopy.
b. uroflowmetry studies.
c. magnetic resonance imaging (MRI).
d. transrectal ultrasonography (TRUS).

Answer 23

ANS: D
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 24

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 24

ANS: D
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 25

The nurse will plan to teach the patient scheduled for photovaporization of the prostate (PVP)

a. that urine will appear bloody for several days.
b. how to care for an indwelling urinary catheter.
c. that symptom improvement takes 2 to 3 weeks.
d. about complications associated with urethral stenting.

Answer 25

ANS: B
The patient will have an indwelling catheter for 24 to 48 hours and will need teaching about catheter care. There is minimal bleeding with this procedure. Symptom improvement is almost immediate after PVP. Stent placement is not included in the procedure.

Question 26

A 53-yr-old patient is scheduled for an annual physical examination. The nurse will plan to teach the patient about the purpose of

a. urinalysis collection.
b. uroflowmetry studies.
c. prostate specific antigen (PSA) testing.
d. transrectal ultrasound scanning (TRUS).

Answer 26

ANS: C
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 27

The plan of care for a patient immediately after a perineal radical prostatectomy will include decreasing the risk for infection related to

a. urinary incontinence. c. fecal wound contamination.
b. prolonged urinary stasis. d. suprapubic catheter placement.

Answer 27

ANS: C
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 28

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

a. restrict oral fluid intake.
b. do pelvic muscle exercises.
c. perform intermittent self-catheterization.
d. use belladonna and opium suppositories.

Answer 28

ANS: B
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 29

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 29

ANS: A
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 30

The nurse will inform a patient with cancer of the prostate that side effects of leuprolide (Lupron) may include

a. flushing. c. infection.
b. dizziness. d. incontinence.

Answer 30

ANS: A
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 31

Which information will the nurse teach a patient who has chronic prostatitis?

a. Ibuprofen (Motrin) should provide good pain control.
b. Prescribed antibiotics should be taken for 7 to 10 days.
c. Intercourse or masturbation will help relieve symptoms.
d. Cold packs used every 4 hours will decrease inflammation.

Answer 31

ANS: C
Ejaculation helps drain the prostate and relieve pain. Warm baths are recommended to reduce pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed but usually do not offer adequate pain relief. Antibiotics for chronic prostatitis are taken for 4 to 12 weeks.

Question 32

The nurse performing a focused examination to determine possible causes of infertility will assess for

a. hydrocele. c. epididymitis.
b. varicocele. d. paraphimosis.

Answer 32

ANS: B
Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility.

Question 33

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 33

ANS: B
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 34

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 34

ANS: B
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 35

When performing discharge teaching for a patient after a vasectomy, the nurse instructs the patient that he

a. should continue to use other methods of birth control for 6 weeks.
b. should not have sexual intercourse until his 6-week follow-up visit.
c. may have temporary erectile dysfunction (ED) because of swelling.
d. will notice a decrease in the appearance and volume of his ejaculate.

Answer 35

ANS: A
Because it takes about 6 weeks to evacuate sperm that are distal to the vasectomy site, the patient should use contraception for 6 weeks. ED that occurs after vasectomy is psychologic in origin and not related to postoperative swelling. The patient does not need to abstain from intercourse. The appearance and volume of the ejaculate are not changed because sperm are a minor component of the ejaculate.

Question 36

A patient tells the nurse that he decided to seek treatment for erectile dysfunction (ED) because his wife “is losing patience with the situation.” The nurse’s follow-up questions should focus on the man’s identified concern with

a. low self-esteem. c. increased anxiety.
b. role performance. d. infrequent intercourse.

Answer 36

ANS: B
The patient’s statement indicates that the relationship with his wife is his primary concern. Although anxiety, low self-esteem, and ineffective sexuality patterns may also be concerns, the patient information suggests that addressing the role performance problem will lead to the best outcome for this patient.

Question 37

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 37

ANS: A
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 possible 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 38

The nurse taking a focused health history for a patient with possible testicular cancer will ask the patient about a history of

a. testicular torsion.
b. testicular trauma.
c. undescended testicles.
d. sexually transmitted infection (STI).

Answer 38

ANS: C
Cryptorchidism 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 39

The nurse will plan to teach a 67-yr-old patient who has been diagnosed with orchitis about

a. pain management.
b. emergency surgery.
c. application of heat to the scrotum.
d. aspiration of fluid from the scrotal sac.

Answer 39

ANS: A
Orchitis is very painful, and effective pain management will be needed. Heat, aspiration, and surgery are not used to treat orchitis.

Question 40

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 40

ANS: B
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 41

The nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the laboratory results of these patients. Which patient’s PSA result is not expected to be elevated?

a. A 38-yr-old patient who is being treated for acute prostatitis
b. A 48-yr-old patient whose father died of metastatic prostate cancer
c. A 52-yr-old patient who goes on long bicycle rides every weekend
d. A 75-yr-old patient who uses saw palmetto to treat benign prostatic hyperplasia (BPH)

Answer 41

ANS: B
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 42

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

a. Increase the flow rate 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 42

ANS: D
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 flow rate 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 43

A 22-yr-old patient tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. Which question should the nurse ask to assess for possible etiologic factors in this age group?

a. “Do you use recreational drugs or drink alcohol?”
b. “Do you experience an unusual amount of stress?”
c. “Do you have cardiovascular or peripheral vascular disease?”
d. “Do you have a history of an erection that lasted for 6 hours or more?”

Answer 43

ANS: A
A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are not common etiologic factors in younger men.

Question 44

A 58-yr-old patient with erectile dysfunction (ED) tells the nurse he is interested in using sildenafil (Viagra). Which action should the nurse take first?

a. Assure the patient that ED is common with aging.
b. Ask the patient about any prescription drugs he is taking.
c. Tell the patient that Viagra does not always work for ED.
d. Discuss the common adverse effects of erectogenic drugs.

Answer 44

ANS: B
Because some medications can cause ED and patients using nitrates should not take sildenafil, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of sildenafil therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease.

Question 45

The nurse in a health clinic receives requests for appointments from several patients. Which patient should be seen by the health care provider first?

a. A 48-yr-old patient who has perineal pain and a temperature of 100.4° F
b. A 58-yr-old patient who has a painful erection that has lasted more than 6 hours
c. A 38-yr-old patient who reports that he had difficulty maintaining an erection twice last week
d. A 68-yr-old patient who has pink urine after a transurethral resection of the prostate (TURP) 3 days ago

Answer 45

ANS: B
Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications.

Question 46

Which assessment information collected by the nurse may present a contraindication to a testosterone replacement therapy (TRT)?

a. The patient has noticed a decrease in energy level for a few years.
b. The patient’s symptoms have increased steadily over the past few years.
c. The patient has been using sildenafil (Viagra) several times every week.
d. The patient has had a gradual decrease in the force of his urinary stream.

Answer 46

ANS: D
The decrease in urinary stream may indicate benign prostatic hyperplasia (BPH) or prostate cancer, which are contraindications to the use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient.

Question 47

A patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. The nurse will plan to

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 47

ANS: D
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 48

The health care provider prescribes the following interventions for a patient with acute prostatitis caused by Escherichia coli. Which intervention should the nurse question?

a. Give trimethoprim/sulfamethoxazole 1 tablet daily for 28 days.
b. Administer ibuprofen 400 mg every 8 hours as needed for pain.
c. Instruct patient to avoid sexual intercourse until treatment is complete.
d. Catheterize the patient as needed if symptoms of urinary retention develop.

Answer 48

ANS: D
Although acute urinary retention may occur, insertion of a catheter through an inflamed urethra is contraindicated, and the nurse will anticipate that the health care provider will need to insert a suprapubic catheter. The other actions are appropriate.

Question 49

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 49

ANS: A
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 50

The nurse is obtaining the pertinent health history for a man who is being evaluated for infertility. Which question focuses on a possible cause of infertility?

a. “Are you circumcised?”
b. “Have you had surgery for phimosis?”
c. “Do you use medications to improve muscle mass?”
d. “Is there a history of prostate cancer in your family?”

Answer 50

ANS: C
Testosterone or testosterone-like medications may adversely affect sperm count. The other information will be obtained in the health history but does not affect the patient’s fertility.

Question 51

The following male patients recently arrived in the emergency department. Which one should the nurse assess first?

a. A 19-yr-old patient who is complaining of severe scrotal pain
b. A 60-yr-old patient with a nontender ulceration of the glans penis
c. A 64-yr-old patient who has dysuria after brachytherapy for prostate cancer
d. A 22-yr-old patient who has purulent urethral drainage and severe back pain

Answer 51

ANS: A
The patient’s age and symptoms suggest possible testicular torsion, which will require rapid treatment to prevent testicular necrosis. The other patients also require assessment by the nurse, but their history and symptoms indicate nonemergent problems (acute prostatitis, cancer of the penis, and radiation-associated urinary tract irritation).

Question 52

Which action by the unlicensed assistive personnel (UAP) who are assisting with the care of male patients with reproductive problems indicates that the nurse should provide more teaching?

a. The UAP apply a cold pack to the scrotum for a patient with mumps orchitis.
b. The UAP help a patient who has had a prostatectomy to put on antiembolism hose.
c. The UAP leave the foreskin pulled back after cleaning the glans of a patient who has a retention catheter.
d. The UAP encourage a high oral fluid intake for patient who had transurethral resection of the prostate yesterday.

Answer 52

ANS: C
Paraphimosis can be caused by failing to replace the foreskin back over the glans after cleaning. The other actions by UAP are appropriate.

Question 53

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. Report any complaints of pain or spasms to the nurse.
c. Monitor for increases in bleeding or presence of clots.
d. Increase the flow rate of the irrigation if clots are noted.

Answer 53

ANS: B
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 54

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 54

ANS: B
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 be to address the problem with the urinary drainage system.