Lewis Chapter 54 – Flashcards
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A 73-year-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give the patient anticipatory guidance that what condition may be developing? A. A tumor of the prostate B. Benign prostatic hyperplasia C. Bladder atony because of age D. Age-related altered innervation of the bladder
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B. Benign prostatic hyperplasia Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men over age 50 and 80% of men over age 80. Only about 16% of men develop prostate cancer. Bladder atony and age-related altered innervations of the bladder do not lead to a weakened stream.
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To accurately monitor progression of a symptom of decreased urinary stream, the nurse should encourage the patient to have which primary screening measure done on a regular basis? A. Uroflowmetry B. Transrectal ultrasound C. Digital rectal examination (DRE) D. Prostate-specific antigen (PSA) monitoring
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C. Digital rectal examination (DRE) Digital rectal examination is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia in men over 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.
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A patient is one day postoperative following a transurethral resection of the prostate (TURP). Which event is not an expected normal finding in the care of this patient? A. The patient requires two tablets of Tylenol #3 during the night. B. The patient complains of fatigue and claims to have minimal appetite. C. The patient has continuous bladder irrigation (CBI) infusing, but output has decreased. D. The patient has expressed anxiety about his planned discharge home the following day.
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C. The patient has continuous bladder irrigation (CBI) infusing, but output has decreased. A decrease or cessation of output in a patient with CBI requires immediate intervention. The nurse should temporarily stop the CBI and attempt to resume output by repositioning the patient or irrigating the catheter. Complaints of pain, fatigue, and low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient's CBI.
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A 71-year-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a contact laser technique. What is the primary goal of this intervention? A. Resumption of normal urinary drainage B. Maintenance of normal sexual functioning C. Prevention of acute or chronic renal failure D. Prevention of fluid and electrolyte imbalances
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A. Resumption of normal urinary drainage The most significant signs and symptoms of BPH relate to the disruption of normal urinary drainage and consequent urine retention, incontinence, and pain. A laser technique vaporizes prostate tissue and cauterizes blood vessels and is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.
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Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy? A. Assessing the patient's incision B. Irrigating the patient's Foley catheter C. Assessing the patient's pain and selecting analgesia D. Performing cleansing of the meatus and perineal region
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D. Performing cleansing of the meatus and perineal region Performing perineal care is an appropriate task for delegation. Selecting analgesia, irrigating the patient's catheter, and assessing his incision are not appropriate skills or tasks for unlicensed personnel.
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The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations now indicate that the prostate cancer may be growing and he needs a change in his care (select all that apply)? A. Casts in his urine B. Presence of α-fetoprotein C. Serum PSA level 10 ng/mL D. Onset of erectile dysfunction E. Nodularity of the prostate gland
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C. Serum PSA level 10 ng/mL E. Nodularity of the prostate gland The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth.
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A 33-year-old patient noticed a painless lump in his scrotum on self-examination of his testicles and a feeling of heaviness. The nurse should first teach him about what diagnostic test? A. Ultrasound B. Cremasteric reflex C. Doppler ultrasound D. Transillumination with a flashlight
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A. Ultrasound When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.
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A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? A. E. coli bacteria in his urine B. A very tender prostate gland C. Complaints of chills and rectal pain D. Complaints of urgency and frequency
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B. A very tender prostate gland A tender and swollen prostate is indicative of prostatis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatis.
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After a vasectomy, what teaching should be included in the discharge teaching? A. "You will want to use an alternative form of contraception for 6 weeks." B. "You may lose some secondary sexual characteristics after this surgery." C. "You may have erectile dysfunction for several months after this surgery." D. "You will be uncomfortable, but you may safely have sexual intercourse today."
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A. "You will want to use an alternative form of contraception for 6 weeks." As vasectomies are usually done for sterilization purposes, to safely have sexual intercourse, the patient will need to use an alternative form of contraception until semen examination reveals no sperm, usually at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site. Hormones are not affected, so there is no loss of secondary sexual characteristics or erectile function. Most men experience too much pain to have sexual intercourse on the day of their surgery, so this is not an appropriate comment by the nurse.
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The patient has had cardiovascular disease for some time and has now developed erectile dysfunction. He is frustrated because he cannot take erectogenic medications because he takes nitrates for his cardiac disease. What should the nurse do first to help this patient? A. Give the patient choices for penile implant surgery. B. Recommend counseling for the patient and his partner. C. Obtain a thorough sexual, health, and psychosocial history. D. Assess levels of testosterone, prolactin, LH, and thyroid hormones.
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C. Obtain a thorough sexual, health, and psychosocial history. The nurse's first action to help this patient is to obtain a thorough sexual, health, and psychosocial history. Alternative treatments for the cardiac disease would then be explored if that had not already been done. Further examination or diagnostic testing would be based on the history and physical assessment, including hormone levels, counseling, or penile implant options.
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The nurse is caring for a 62-year-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? A. Avoid straining during defecation. B. Restrict fluids to prevent incontinence. C. Sexual functioning will not be affected. D. Prostate exams are not needed after surgery.
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A. Avoid straining during defecation. Activities that increase abdominal pressure, such as sitting or walking for prolonged periods and straining to have a bowel movement (Valsalva maneuver), should be avoided in the postoperative recovery period to prevent a postoperative hemorrhage. Instruct the patient to drink at least 2 L of fluid every day. Digital rectal examinations should be performed yearly. The prostate gland is not totally removed and may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, and decreased orgasmic sensation.
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The nurse coordinates postoperative care for a 70-year-old man with osteoarthritis after prostate surgery. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN)? A. Teach the patient how to perform Kegel exercises. B. Provide instructions to the patient on catheter care. C. Administer oxybutynin (Ditropan) for bladder spasms. D. Manually irrigate the urinary catheter to determine patency.
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D. Manually irrigate the urinary catheter to determine patency. The nurse may delegate the following to an LPN/LVN: monitor catheter drainage for increased blood or clots, increase flow of irrigating solution to maintain light pink color in outflow, administer antispasmodics and analgesics as needed. A registered nurse may not delegate teaching, assessments, or clinical judgments to a LPN/LVN.
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The nurse teaches a 30-year-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? A. Grilled steak, French fries, and vanilla shake B. Hamburger with cheese, pudding, and coffee C. Baked chicken, peas, apple slices, and skim milk D. Grilled cheese sandwich, onion rings, and hot tea
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C. Baked chicken, peas, apple slices, and skim milk A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.
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The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer? A. A 30-year-old white male with a history of cryptorchidism B. A 48-year-old African American male with erectile dysfunction C. A 19-year-old Asian male who had surgery for testicular torsion D. A 28-year-old Hispanic male with infertility caused by a varicocele
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A. A 30-year-old white male with a history of cryptorchidism The incidence of testicular cancer is four times higher in white males than in African American males. Testicular tumors are also more common in males who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to DES, and testicular cancer in the contralateral testis.
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A 45-year-old man reports having recent problems attaining an erection. Which medication will the nurse further explore as the possible etiology of this patient's sexual dysfunction? A. Furosemide (Lasix) B. Fluoxetine (Prozac) C. Clopidogrel (Plavix) D. Nitroglycerin (Nitrostat)
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B. Fluoxetine (Prozac) Fluoxetine is a selective serotonin reuptake inhibitor used in the treatment of depression. A common adverse effect of this medication is sexual problems (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest) in nearly 70% of men and women.
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An elderly male patient is experiencing difficulty in initiating voiding and a feeling of incomplete bladder emptying. What causes these symptoms in benign prostatic hyperplasia (BPH)? A. Obstruction of the urethra B. Untreated chronic prostatitis C. Decreased bladder compliance D. Excessive secretion of testosterone
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Answer: A BPH is a benign enlargement of the prostate gland. The enlargement of the prostate gradually compresses the urethra, eventually causing partial or complete obstruction. Compression of the urethra ultimately leads to the development of clinical symptoms.
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A patient with benign prostatic hyperplasia is scheduled for TURP. After you assess the patient's knowledge of the procedure and its effects on reproductive function, you determine a need for further teaching when the patient says, A. "It is possible that I'll be sterile after this procedure." B. "I understand that some retrograde ejaculation may occur." C. "I will have a catheter for several days to keep my urinary system open." D. "It is unlikely that I would become impotent from this procedure."
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Answer: A The patient will not be sterile; he may experience retrograde ejaculation and some erectile dysfunction. It is unlikely he will become impotent. He will need a catheter.
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You expect which finding in a patient as a complication of prostatic hyperplasia? A. Dysuria B. Hematuria C. Urinary retention D. Urinary frequency
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Answer: C Obstructive symptoms caused by prostate enlargement include a decrease in the caliber and force of the urinary stream, difficulty in initiating voiding, intermittency (stopping and starting stream several times while voiding), and dribbling at the end of urination. These symptoms result from urinary retention.
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What is the primary purpose of a three-way urinary catheter after a transurethral resection of the prostate (TURP)? A. Promote hemostasis and drainage of clots B. Relieve bladder spasms C. Reduce edema D. Increase bladder tone
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Answer: A A large three-way indwelling catheter with a 30-mL balloon is inserted into the bladder after the procedure to provide hemostasis and to facilitate urinary drainage. The bladder is irrigated, either continuously or intermittently, usually for the first 24 hours to prevent obstruction from mucus and blood clots.
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What is the most significant factor in the development of clinical symptoms associated with BPH? A. Size of the prostate B. Location of the enlargement C. Age of the patient D. Length of the urethra
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Answer: B There is no direct relationship between the size of the prostate and degree of obstruction. The location of the enlargement significantly affects development of obstructive symptoms. For example, it is possible for mild hyperplasia to cause severe obstruction, and it is possible for extreme hyperplasia to cause few obstructive symptoms.
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You are teaching the patient with BPH about interventions that can assist in alleviating symptoms. Which behavior in the patient indicates successful teaching? A. The patient increases use of decongestants. B. The patient decreases intake of caffeinated beverages and artificial sweeteners. C. The patient increases activities such as walking. D. The patient voids every 30 minutes.
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Answer: B In some patients who have symptoms that appear and then disappear, a conservative treatment approach has value. Dietary changes (decreasing intake of caffeine and artificial sweeteners, limiting spicy or acidic foods), avoiding medications such as decongestants and anticholinergics, and restricting evening fluid intake may result in improvement of symptoms. A timed voiding schedule may reduce or eliminate symptoms, negating the need for further intervention, but 30 minutes is too frequent.
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When providing patient teaching about medication therapy for BPH with 5α-reductase inhibitors such as finasteride (Proscar), what information should you include? A. Ninety percent of patients show improvement with the drug. B. The drug can be taken periodically as symptoms occur. C. Women who are pregnant should not handle the drug. D. Effects are seen in 1 week.
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Answer: C Although more than 50% of men who are treated with the drug show symptom improvement, it takes about 6 months to be effective. The drug must be taken on a continuous basis to maintain therapeutic results. Women who may be or are pregnant should not handle tablets.
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You notice that the patient's urinary drainage 4 hours after TURP is redder than 1 hour ago. What is your priority intervention? A. To increase the rate of bladder irrigation B. To manually irrigate the urinary catheter C. To notify the physician D. To obtain vital signs
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Answer: A With CBI, irrigating solution is continuously infused and drained from the bladder. The rate of infusion is based on the color of drainage. Ideally, urine drainage should be light pink without clots. Continuously monitor the inflow and outflow of the irrigant.
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During the first 4 hours after TURP, the patient receives 1200 mL of bladder irrigation solution, and his urine output is 1000 mL. What is your priority intervention? A. Slowing the rate of bladder irrigation B. Continuing to observe the patient C. Checking catheter patency D. Encouraging oral fluids
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Answer: C You should continuously monitor the inflow and outflow of the irrigant. If outflow is less than inflow, assess the catheter for kinks or clots. If the outflow is blocked and patency cannot be reestablished by manual irrigation, stop the CBI and notify the physician.
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A 73-year-old man admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." You would give the patient anticipatory guidance that which condition is likely to be developing? A. A tumor of the prostate B. Benign prostatic hyperplasia C. Bladder atony because of age D. Age-related altered innervation of the bladder
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Answer: B BPH is an enlarged prostate gland caused by an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men older than 50 years and 80% of men older than 80 years.
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Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a three-way urinary catheter with a 30-mL balloon. When he complains of bladder spasms with the catheter in place, you should A. deflate the catheter balloon to 10 mL to decrease bulk in the bladder. B. deflate the catheter balloon and then reinflate it to ensure that it is patent. C. encourage the patient to try to have a bowel movement to relieve colon pressure. D. explain that this feeling is normal and that he should not try to urinate around the catheter.
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Answer: D Bladder spasms occur as a result of irritation of the bladder mucosa from the insertion of the resectoscope, presence of a catheter, or clots leading to obstruction of the catheter. Instruct the patient not to urinate around the catheter because this increases the likelihood of spasm.
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A 45-year-old man asks you if it is advisable to have his prostate-specific antigen (PSA) level tested, because his father and brother have prostate cancer. What is your response? A. "You should wait until you are age 50." B. "You should have a transurethral resection of the prostate as a preventive measure." C. "You should have a voiding cystourethrogram yearly." D. "You should have annual PSA levels assessed and a digital examination of the prostate."
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Answer: D The American Cancer Society recommends an annual digital rectal examination (DRE) and a blood test for PSA beginning at age 50 for men who are at average risk for prostate cancer. During DRE, an abnormal prostate may feel hard, nodular, and asymmetric.
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Which ethnic group has the highest incidence of prostate cancer? A. African Americans B. Asians C. Whites D. Hispanics
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Answer: A The incidence of prostate cancer worldwide is higher among African Americans than in any other ethnic group. The reasons for the higher rate are unknown.
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A patient asks you, "How can I decrease my risk of prostate cancer?" You teach the patient to avoid which foods (select all that apply)? A. Red meat B. High-fat dairy products C. Fruits D. Vegetables E. Chicken
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Answer: A, B Dietary factors may be associated with prostate cancer. A diet high in red meat and high-fat dairy products, along with a low intake of vegetables and fruits, may increase the risk of prostate cancer.
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Which best indicates that treatment for cancer of the prostate is effective? A. Increase in urinary stream B. Decrease of PSA to 2 ng/mL C. Decreased blood in the urine D. White blood cell (WBC) count of 10,000/μL
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Answer: B The PSA value is used to detect prostate cancer and to monitor the success of treatment. When treatment has been successful in removing prostate cancer, PSA levels should decrease and reach normal levels (less than 4 ng/mL). The regular measurement of PSA levels after treatment is important to evaluate the effectiveness of treatment and possible recurrence of prostate cancer.
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For the patient with inoperable prostate cancer, you expect the physician to order which type of hormone? A. Gonadotropin-releasing hormone B. Androgen deprivation C. Luteinizing hormone D. Estrogen
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Answer: B Prostate cancer growth largely depends on androgens, and androgen deprivation is a primary therapeutic approach for some men with prostatic cancer. Hormone therapy, also known as androgen-deprivation therapy (ADT), focuses on reducing the levels of circulating androgens to diminish tumor growth.
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When providing teaching regarding potential complications after perineal resection of the prostate, what should you include? A. Deep vein thrombosis B. Pulmonary embolism C. Colonic constipation D. Urinary incontinence
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Answer: D The two major complications after a radical prostatectomy are erectile dysfunction and urinary incontinence.
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Which factors place a patient at high risk for prostate cancer (select all that apply)? A. Age older than 65 years B. Asian or Native American ethnicity C. Personal history of BPH D. Brother diagnosed and treated for prostate cancer E. History of undescended testicle and testicular cancer
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Answer: A,D Age, ethnicity, and family history are known risk factors for prostate cancer. The incidence of prostate cancer rises markedly after age 50, and more than 66% of men diagnosed are older than 65 years. The incidence of prostate cancer worldwide is higher among African Americans than in any other ethnic group. A family history of prostate cancer, especially first-degree relatives (fathers, brothers), is associated with an increased risk.
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A patient scheduled for a prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. In responding to the patient, you should keep in mind that A. erectile dysfunction can occur even with a nerve-sparing procedure. B. retrograde ejaculation affects sexual functioning more frequently than erectile dysfunction. C. the most common complication of this surgery is postoperative bowel incontinence. D. preoperative sexual functioning is the most important factor in determining postoperative erectile dysfunction.
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Answer: A A major complication after a prostatectomy (even with nerve-sparing procedures) is erectile dysfunction
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You should encourage a patient with bacterial prostatitis to A. remain on bed rest until antibiotic therapy has been in place for 72 hours. B. significantly increase fluid intake of noncaffeinated beverages. C. empty the bladder every hour with a straight catheter. D. weigh daily before the first voiding of the morning.
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Answer: B Because the prostate can serve as a source of bacteria, fluid intake should be kept at a high level for all patients experiencing prostatitis. Nursing interventions are aimed at encouraging the patient to drink plenty of fluids. This is especially important for those with acute bacterial prostatitis because of the increased fluid needs associated with fever and infection. Bed rest is not indicated, and activity should be encouraged. The bladder should be emptied, although not with a catheter, and it is not necessary to do so every hour. Weight gain should be reported, but the patient does not need to weigh before voiding.
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A priority nursing diagnosis for the patient with bacterial prostatitis is A. activity intolerance related to fatigue. B. sexual dysfunction related to painful ejaculation. C. deficient fluid volume related to decreased fluid intake. D. impaired urinary elimination related to urethral compression.
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Answer: D Acute urinary retention can develop in acute prostatitis, and it requires bladder drainage with suprapubic catheterization. The patient may experience fatigue, but this is not the priority. Sexual dysfunction can occur, but the pain occurs after ejaculation. Fluid volume should be increased.
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A complication of prostatitis is A. prostatic cancer. B. benign prostatic hyperplasia. C. acute urinary retention. D. hydrocele.
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Answer: C Acute urinary retention can develop in acute prostatitis, and it requires bladder drainage with suprapubic catheterization. Passage of a catheter through an inflamed urethra is contraindicated in acute prostatitis.
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What do you tell the patient with chronic bacterial prostatitis who is undergoing antibiotic therapy (select all that apply)? A. Hospitalization is required of all patients. B. Pain will lessen after treatment has ended. C. The course of treatment usually is 2 to 4 weeks. D. Long-term therapy may be indicated for immunocompromised patients. E. If the condition is unresolved and untreated, the patient is at risk for prostate cancer.
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answer: B, D Patients with chronic bacterial prostatitis are usually given antibiotics for 4 to 12 weeks. However, antibiotics may be given for a lifetime if the patient is immunocompromised. Although patients with chronic bacterial prostatitis tend to experience a great amount of discomfort, the pain resolves as the infection is treated. If the patient with acute bacterial prostatitis has high fever or other signs of impending sepsis, hospitalization and intravenous antibiotics are prescribed.
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Where is the urethra opening located in cases of hypospadias? A. On the ventral surface of the penis B. On the dorsal surface of the penis C. At the upper portion of the testicular vault D. Within a bladder extrophy
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Answer: A Hypospadias is a urologic abnormality in which the urethral opening is located on the ventral surface of the penis anywhere from the corona to the perineum. Hormonal influences in utero, environmental factors, and genetic factors are possible causes.
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During the bath of a male patient, the nursing assistive personnel reports to you that the patient's foreskin cannot be retracted over the head of the penis. You recognize this condition as A. phimosis. B. prostatitis. C. priapism. D. epispadias.
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Answer: A Phimosis is tightness or constriction of the foreskin around the head of the penis, which makes retraction difficult. Paraphimosis is tightness of the foreskin resulting in the inability to pull it forward from a retracted position and preventing normal return over the glans. Prostatitis is inflammation of the prostate, and epispadias occurs when the urethral opening is on the dorsal surface of the penis.
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Which instructions should you include in the discharge instructions for a patient with epididymitis? A. Refrain from sexual intercourse. B. Continue to participate in liberal exercise. C. Take frequent sitz baths. D. Eat a low-salt diet.
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Answer: A Patients with epididymitis should be encouraged to refrain from sexual intercourse during the acute phase. Conservative treatment consists of bed rest with elevation of the scrotum, use of ice packs, and analgesics. Ambulation places the scrotum in a dependent position and increases pain. Salt does not affect epididymitis recovery.
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The patient with epididymitis asks you when he can resume his exercise routine. You should respond with which piece of information? A. When there is no evidence of urethral discharge B. After 1 week of antibiotic therapy C. When scrotal pain has subsided D. As soon as he feels able
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Answer: C Most tenderness subsides within 1 week, although swelling may last for weeks or months. One week of antibiotic therapy may not relieve pain and swelling. "When the patient feels able" is a vague response, and the patient should remain on rest until scrotal swelling has subsided. There may be no urethral discharge in epididymitis.
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Which childhood disease is often associated with orchitis? A. Measles B. Mumps C. Strep throat D. Chickenpox
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Answer: B Orchitis refers to an acute inflammation of the testis. In orchitis, the testis is painful, tender, and swollen. It usually occurs after an episode of bacterial or viral infection, such as mumps. The other disorders are not associated with mumps.
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When working in the emergency department you recognize the need for immediate diagnosis and treatment of the patient with A. orchitis. B. phimosis. C. epididymitis. D. testicular torsion.
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Answer: D Torsion constitutes a surgical emergency. If the blood supply to the affected testicle is not restored within 4 to 6 hours, testicular ischemia will occur, leading to necrosis and possible removal.
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Which diagnostic evaluation is used for a patient with a suspected testicular cancer? A. Prostate-specific antigen (PSA) B. α-Fetoprotein (AFP) C. Complete blood cell count D. Urine and semen analyses
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Answer: B Palpation of the scrotal contents is the first step in diagnosing testicular cancer. A cancerous mass is firm and does not transilluminate. Ultrasound of the testes is indicated when testicular cancer (e.g., palpable mass) is suspected or when persistent or painful testicular swelling is present. If testicular cancer is suspected, blood is obtained to determine the serum levels of AFP, lactate dehydrogenase (LDH), and human chorionic gonadotropin (hCG).
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Which fact in the patient's history could be related to the presence of testicular cancer? A. Epispadias B. Cryptorchidism C. Hernia repair D. Uncircumcised penis
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Answer: B The incidence of testicular cancer is four times higher among white men (especially those of Scandinavian descent) than African American males. It occurs more commonly in the right testicle than the left. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or have a family history of testicular cancer or anomalies. Epispadias and lack of circumcision are not related to testicular cancer. Hernia repair is related to future hernias, but not testicular cancer.
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In assessing a patient for testicular cancer, you understand that the manifestations of this disease often include A. acute back spasms and testicular pain. B. rapid onset of scrotal swelling and fever. C. fertility problems and bilateral scrotal tenderness. D. painless mass and heaviness sensation in the scrotal area.
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Answer: D Clinical manifestations of testicular cancer include a painless lump in the scrotum, scrotal swelling, and a feeling of heaviness. The scrotal mass usually is not tender and is very firm. Some patients complain of a dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum.
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Six weeks after a vasectomy, the patient has a sperm-free semen analysis result. What should the couple conclude? A. The patient is sterile. B. One additional semen free test is required. C. Alternative contraception is still required. D. Intercourse should be avoided for 2 more weeks.
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Answer: A After vasectomy, the patient should not notice any difference in the look or feel of the ejaculate because its major component is seminal and prostatic fluid. The patient should use an alternative form of contraception until semen examination reveals no sperm. This usually requires at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site.
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You have provided teaching to the male patient regarding a vasectomy procedure. Which statement by the patient indicates the teaching has been successful? A. "I will need to not eat or drink anything for 24 hours before the procedure." B. "The physician will use local anesthetic, and I will be awake." C. "I will be able to have unprotected intercourse in 3 weeks." D. "I acknowledge there is a risk of impotence."
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Answer: B The procedure requires only 15 to 30 minutes and is usually performed with the patient under local anesthesia on an outpatient basis. Vasectomy is considered a permanent form of sterilization but does not affect the ability to achieve an erection. After vasectomy, the patient should not notice any difference in the look or feel of the ejaculate because its major component is seminal and prostatic fluid. The patient should use an alternative form of contraception until semen examination reveals no sperm. This usually requires at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site.
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What should you explain to the patient who has had a vasectomy? A. The procedure blocks the production of sperm B. Erectile dysfunction is temporary and will return with sexual activity. C. The ejaculate will be about half the volume it was before the procedure. D. An alternative form of contraception will be necessary for 6 to 8 weeks.
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Answer: D After a vasectomy, the patient should use an alternative form of contraception until semen examination reveals no sperm. This usually requires at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site.
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After you perform teaching regarding medication therapy for erectile dysfunction (ED), you know the teaching was successful when the patient states, A. "I will take the drug once each day about an hour before sexual activity." B. "I will take the drug two times each day but not more than three." C. "I can take the drug in the morning, and I will be able to have an erection anytime throughout the day." D. "There are no precautions to take while I am on this medication."
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Answer: A Medication is taken orally about 1 hour before sexual activity, but not more than once each day. These drugs have been found to be generally safe and effective for the treatment of most types of ED.
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A 62-year-old man is seen at the health clinic because he is concerned about a gradual decrease in sexual performance. The nursing history does not identify any specific risk factors related to erectile dysfunction. What is your priority at this time? A. Consult with the health care provider about testing the patient for hypogonadism. B. Refer the patient to a qualified therapist to explore possible psychologic causes of decreased function. C. Explain normal age-related changes in sexual performance to the patient. D. Discuss the variety of aids and devices available to increase sexual performance.
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Answer: C Normal physiologic age-related changes are associated with changes in erectile function and may be an underlying cause of ED for some men.
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What is the most common cause of erectile dysfunction? A. Aging B. Benign prostatic hyperplasia C. Vascular disease D. Psychological distress
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Answer: C Common causes of ED include diabetes, vascular disease, side effects from medications, results of surgery (e.g., prostatectomy), trauma, chronic illness, decreased gonadal hormone secretion, stress, difficulty in a relationship, or depression. The most common cause of ED is vascular disease.
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What is an erection lasting longer than 6 hours called? A. Priapism B. Peyronie's disease C. Hydrocele D. Hypospadias
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Answer: A Priapism is a painful erection lasting longer than 6 hours. It is caused by an obstruction of the venous outflow in the penis. The condition may constitute a medical emergency. Causes of priapism include thrombosis of the corpus cavernosal veins, leukemia, sickle cell anemia, diabetes mellitus, degenerative lesions of the spine, neoplasms of the brain or spinal cord, vasoactive medications injected into the corpus cavernosa, and medications (e.g., sildenafil, cocaine, trazodone).
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You recognize the need to begin testosterone therapy when testosterone levels drop below A. 750 ng/dL. B. 500 ng/dL. C. 400 ng/dL. D. 250 ng/dL.
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Answer: D Normal testosterone levels can range from 280 to 1100 ng/dL. Replacement therapy may be considered when levels are below 250 ng/dL.
question
What is the most common cause of male infertility? A. A hydrocele B. A varicocele C. Alcohol use D. Epididymitis.
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Answer: B The most common cause of male infertility is a varicocele, not a hydrocele. Other factors that influence the testes include infection such as epididymitis and alcohol use, but they are not the most common causes.
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What is the first step in the identification of the cause of male infertility? A. Estrogen levels B. Progesterone levels C. Semen analysis D. Time to ejaculation
answer
Answer: C The first test in an infertility study is a semen analysis. The test determines the sperm concentration, motility, and morphology
question
To decrease the patient's discomfort about care involving his reproductive organs, you should A. relate his sexual concerns to his sexual partner. B. arrange to have male nurses care for the patient. C. maintain a nonjudgmental attitude toward his sexual practices. D. use technical terminology when discussing reproductive function.
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Answer: C Conducting routine health assessments on men places you in a unique position. It provides an opportunity to ask the patient questions pertaining to general health and to sexual health and function. Given the opportunity, men are less hesitant to answer these questions when they know that someone cares and can provide them with answers. You must remain nonjudgmental about sexual practices.
