NURS 317 Unit 4 Chapter 43 Path Point Questions Flashcards
What late complications of a transurethral prostatectomy (TURP) will the nurse address with the client as a part of discharge teaching?
A) Incontinence
B) Increased clotting
C) Increased hemorrhage
D) Inability to urinate
A) Incontinence
Rationale:Late complications of a TURP include erectile or sexual dysfunction, incontinence, and bladder neck constriction. Immediate complications of TURP include the inability to urinate, postoperative hemorrhage or clot retention, and urinary tract infection.
A 69-year-old client presents with urinary urgency and nocturia. After testing he has been diagnosed with benign prostatic hyperplasia (BPH). When describing the etiology and prognosis of BPH, what should the nurse explain to the client?
A) Surgery can often be avoided if pharmacologic interventions are successful.
B) BPH is an independent risk factor for the development of prostate cancer.
C) BPH results from a combination of risk factors, most of which are modifiable.
D) The etiology of BPH can usually be traced to long-term overdistention of the bladder.
A) Surgery can often be avoided if pharmacologic interventions are successful.
Rationale:BPH often necessitates surgery, but this can be avoided if drug therapy is effective. Bladder distention is a result of BPH, not a cause. Many risk factors are nonmodifiable and it does not cause prostate cancer
Which statements are true regarding priapism? Select all that apply.
A) It can be triggered by sickle cell disease.
B) It is rarely observed in men younger than 20 years of age.
C) It is not always related to sexual stimulation.
D) It can result in ischemia of the erectile tissue of the penis.
E) It involves an erection that lasts longer than 2 hours.
A) It can be triggered by sickle cell disease.
C) It is not always related to sexual stimulation.
D) It can result in ischemia of the erectile tissue of the penis.
Rationale:Priapism is an involuntary, prolonged (>4 hours), abnormal and painful erection that continues beyond, or is unrelated to, sexual stimulation. Priapism is a true urologic emergency because the prolonged erection can result in ischemia and fibrosis of the erectile tissue. Priapism can occur at any age. Sickle cell disease or neoplasms are the most common cause in boys between 5 and 10 years of age.
Which disorder of the male genitourinary system creates the most urgent need for prompt and aggressive surgical treatment?
A) Benign prostatic hyperplasia (BPH)
B) Erectile dysfunction
C) Intravaginal testicular torsion
D) Spermatocele
C) Intravaginal testicular torsion
Rationale:Although all of the noted health problems warrant monitoring and possible treatment, intravaginal testicular torsion is an emergency that requires prompt surgery to save the torsed testicle.
After seeking care due to recent history of testicular enlargement and scrotal pain, a 22-year-old college student has been diagnosed with testicular cancer. Which statement by the client indicates the need for further teaching?
A) “I have to admit that the prospect of losing a testicle is a bit overwhelming.”
B) “I can’t shake this feeling like I’ve received a death sentence.”
C) “I guess there’s some solace in the fact that this cancer wasn’t a result of an unhealthy lifestyle.”
D) “I really hope the cancer hasn’t spread anywhere, because I’ve read that it’s a possibility.”
B) “I can’t shake this feeling like I’ve received a death sentence.”
Rationale:Testicular cancer has the potential for metastasis, but outcomes are positive for most clients and survival rates are high. With appropriate treatment, the prognosis for men with testicular cancer is excellent. Orchiectomy remains the standard treatment, and the pathogenesis of testicular cancer is not thought to be related to lifestyle factors.
A client is concerned about having mumps orchitis and asks the nurse about the symptoms. What is the nurse’s best response?
A) Painful urination with the presence of urethral discharge
B) Purplish or red-colored scrotum after an abdominal procedure
C) Abnormal increase in sexual drive
D) Painful enlargement of the testes with fever 3 days after infection
D) Painful enlargement of the testes with fever 3 days after infection
Rationale:Onset of mumps orchitis is sudden—approximately 3 to 4 days after the onset of the infection. Symptoms include fever, painful enlargement of the testes, and small hemorrhages into the tunica albuginea. Urinary symptoms are absent. Sexual drive is not increased. Androgenic hormone function is usually maintained in these cases.
The community health nurse is providing men’s health education on prostate cancer. Which risk factors for prostate cancer should the nurse include in the discussion? Select all that apply.
A) Native American/First Nations descent
B) High fat diet from processed meat
C) High intake of green tea
D) Consuming high fat dairy items
E) Father-in-law treated for prostate cancer
B) High fat diet from processed meat
D) Consuming high fat dairy items
Rationale:While the precise cause of prostate cancer is unclear, the incidence of prostate cancer appears to be higher in relatives of men with prostate cancer. Men who have an affected first degree relative (e.g., father, brother) and an affected second-degree relative (e.g., grandfather, uncle) have an increase in risk. It has been suggested that increased intake of dietary fats may alter increase the risk of prostate cancer.
Which statements regarding prostate cancer are true? Select all that apply.
A) Age is a risk factor of this cancer.
B) Black males are at highest risk for developing the disease.
C) Screening for prostate cancer should begin at age 60.
D) Prostate cancer is the leading cause of cancer-related deaths in men.
E) Prognosis has improved because of PSA diagnostic screenings.
A) Age is a risk factor of this cancer.
B) Black males are at highest risk for developing the disease.
E) Prognosis has improved because of PSA diagnostic screenings.
Rationale:A recent increase in diagnosed cases is thought to reflect earlier diagnosis because of widespread use of PSA testing. The incidence of prostate cancer increases with age and is greater in black men of all ages. Prostate cancer is third to lung cancer and colorectal cancer as a cause of cancer-related death in men. The American Cancer Society suggests that every man 50 years of age or older should have a digital rectal examination and PSA test done as part of his annual physical examination.
A nurse is providing teaching to the parents of a child who has undergone corrective surgery for cryptorchidism. The most important information for the nurse to provide is:
A) Teaching should include methods to prevent recurrence of this problem.
B) Parents must understand that their child is at increased risk for sterility.
C) Parents should be taught that their child needs frequent follow-up visits.
D) Explanations that medication therapy needs to be administered until puberty.
C) Parents should be taught that their child needs frequent follow-up visits.
Rationale:Treatment of men with undescended testis should include lifelong follow-up, considering the sequelae of testicular cancer and infertility. Parents need to be aware of the potential issues of infertility and increased risk of testicular cancer. On reaching puberty, boys should be instructed in the necessity of testicular self-examination.
Which chronic health issues increase a man’s risk for developing erectile dysfunction? Select all that apply.
A) Asthma
B) Hypertension
C) Hyperlipidemia
D) Crohn disease
E) Diabetes mellitus
B) Hypertension
C) Hyperlipidemia
E) Diabetes mellitus
Rationale:Common risk factors for generalized penile arterial insufficiency (erectile dysfunction) include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation. Asthma and Crohn disease are not associated with erectile dysfunction.
A client calls the clinic and informs the nurse that he has sustained an erection for 3 hours and that it is extremely painful. The client has a history of sickle cell disease and this has not happened to him in the past. Which instruction should the nurse give to the client?
A) If the client does not seek medical attention, impotence may result.
B) The client should not be concerned; this often happens in male clients.
C) The client is having an increase in blood flow to the penis.
D) There are no long-term effects of this occurrence
A) If the client does not seek medical attention, impotence may result.
Rationale:Priapism is a true urologic emergency because the prolonged erection can result in ischemia and fibrosis of the erectile tissue with significant risk of subsequent impotence. It is caused by impaired blood flow in the corpora cavernosa of the penis.
A 52-year-old male diagnosed with erectile dysfunction (ED) asks the nurse what will be implemented as a first option for treatment. The best response would be:
A) Psychosexual counseling and PDE-5 inhibitor medications
B) Catheterization and increased fluids to increase vascular flow
C) Surgical placement of a penile prosthesis
D) Intravenous administration of a PDE-5 inhibitor
A) Psychosexual counseling and PDE-5 inhibitor medications
Rationale:Treatment methods include psychosexual counseling, androgen replacement therapy, oral and intravenous drug therapy, vacuum restriction devices, and surgery. Commonly prescribed drugs for ED are the selective inhibitors of phosphodiesterase-type 5 (PDE-5). The PDE-5 inhibitors are taken orally. Surgery would not be the initial therapy, and increasing fluids does not increase blood flow to the penis.
A client is admitted into the emergency department with a sustained erection lasting 4 hours. Which initial treatments does the nurse anticipate administering? Select all that apply.
A) Analgesics
B) Sedation
C) Hydrating measures
D) Insertion of a urinary catheter
E) Surgical shunt
A) Analgesics
B) Sedation
C) Hydrating measures
Rationale:Initial treatment measures for priapism would include analgesics, sedation, and hydration. Urinary retention may necessitate catheterization, but this client has not stated that he has urinary retention so this is not indicated at this time. Other local measures include ice packs and cold saline enemas, aspiration, and irrigation of the corpus cavernosum with plain or heparinized saline, or instillation of alpha adrenergic drugs. If less aggressive treatment does not produce detumescence, a temporary surgical shunt may be established between the corpus cavernosum and the corpus spongiosum.
While working with a client with a fairly recent spinal cord injury, the partner asks about the couple’s ability to maintain a sexual relationship. Which response by the nurse is most accurate?
A) “As long as you can stimulate each other in a meaningful way, then this will fulfill your need for sex.”
B) “It takes all components, neural, vascular, and chemical pathways to produce a satisfactory erection.”
C) “If the parasympathetic impulses can pass from the sacral segments of spinal cord through pelvic nerves, an erection should be possible.”
D) “It is highly doubtful since the majority of nerves in the lower back must function in order to obtain an erection and for ejaculation.”
C) “If the parasympathetic impulses can pass from the sacral segments of spinal cord through pelvic nerves, an erection should be possible.”
Rationale:Erection is mediated by parasympathetic nervous system (PSNS) impulses that pass from the sacral segments of the spinal cord through the pelvic nerves to the penis. PSNS stimulation results in release of the neurotransmitter nitric oxide, which causes relaxation of trabecular smooth muscle of the corpora cavernose. This relaxation permits inflow of blood into the sinuses. Therefore, PSNS innervation must be intact and nitric oxide synthesis must be active for erection to occur.
When assessing the client with chronic inflammatory bacterial prostatitis, the nurse recognizes which findings are typically present? Select all that apply.
A) Low back pain
B) Painful urination
C) Bacteriuria
D) Frequency of urination
E) Epigastric tenderness
A) Low back pain
B) Painful urination
C) Bacteriuria
D) Frequency of urination
Rationale:Men with chronic bacterial prostatitis have urinary tract infections with the same strain of pathogenic bacteria in prostatic fluid and urine. Other symptoms include frequent and urgent urination, dysuria, perineal discomfort, and low back pain. Men with nonbacterial prostatitis often have inflammation of the prostate with an elevated leukocyte count and abnormal inflammatory cells in their prostatic secretions without presence of pathogens in the urine.
