chapter 43

  1. The nurse is caring for a man diagnosed with prostatitis. What symptom should the nurse expect when collecting data from the patient?

    a.

    Polyuria

    b.

    Dysuria

    c.

    Glycosuria

    d.

    Hematuria
    ANS:     B

    The most common symptoms are the same ones that occur with any urinary tract infection (UTI): complaints of urgency, frequency, hesitancy, and dysuria. Because of the location and role of the prostate gland, the patient may complain of low back, perineal, and postejaculation pain; he may also have a fever and chills. Polyuria and glycosuria are symptoms of diabetes mellitus. Hematuria is not common with prostatitis but may signal a more serious disorder.
  2. The nurse is assisting with teaching a 56-year-old office manager who reports engaging in all of the following activities. Which one should the nurse explain most likely increased his risk for developing prostatitis?

    a.

    Drinking three to four martinis each night after work

    b.

    Having sexual intercourse with his wife once a week

    c.

    Sitting for long periods in his office

    d.

    Bowling once a week with the office team
    ANS:    A

    Ways to avert prostatitis are regular and complete emptying of the bladder to prevent urinary tract infection, avoiding excess alcohol (more than 2 to 3 ounces per day—alcohol is a bladder irritant), and avoiding certain high-risk sexual practices. Sitting may play a role in infertility but not necessarily prostatitis. Sexual intercourse with a spouse is not high risk. Bowling and other exercise are not risk factors.
  3. The nurse is caring for a patient with prostatitis who is exhibiting all of the following signs and symptoms. Which should the nurse attend to immediately?

    a.

    Fever 101°F (38.3°C)

    b.

    Low back pain rated 9 on a 0-to-10 scale

    c.

    Inability to urinate

    d.

    Shaking chills
    ANS:     C

    All of the symptoms provided are physiological, so the nurse needs to look at which could be life or health threatening. Inability to urinate could lead to a ruptured bladder or other serious complications and must be attended to first. Priorities after urination would include pain, fever, and chills.
  4. A patient diagnosed with benign prostatic hyperplasia is prescribed an alpha-blocking medication (terazosin [Hytrin]) to reduce symptoms. What side effect should the nurse be most alert for?

    a.

    Headaches

    b.

    Hypotension

    c.

    Dry mouth

    d.

    Urinary frequency
    ANS:     B

    Alpha-blocking medications dilate vessels, so the nurse should be alert for hypotension. Headache, dry mouth, and urinary frequency are also possible but are not life or health threatening as hypotension can be, so they take lower priority.
  5. A 70-year-old man arrives in the emergency department and says, “I haven’t urinated in 24 hours. I feel like I have to go, but I can’t.” What care should the nurse anticipate providing first?

    a.

    Emergency preparation for an intravenous pyelogram (IVP)

    b.

    Emergency preparation for a cystoscopy

    c.

    STAT insertion of an indwelling catheter

    d.

    STAT administration of IV fluids
    ANS:     C

    First, the man must be assisted to empty his bladder to avoid rupture or other complications. IV fluids will further add to his need to urinate. Preparation for tests would wait until he is safe from immediate harm.
  6. The nurse is providing pre-operative care for an 80-year-old patient who is scheduled to have prostate surgery. The patient says, “I know a man who was impotent after this surgery. Will that happen to me?” Which response by the nurse is most appropriate?

    a.

    “Impotence should not be a problem; sperm production is not affected by this surgery.”

    b.

    “There are many treatments available if it does occur.”

    c.

    “This type of surgery rarely causes erectile dysfunction. I’ll ask your surgeon to explain the risks to you.”

    d.

    “Most men your age learn to deal with erectile dysfunction if it does occur.”
    ANS:     C

    Some types of prostate procedures can lead to erectile dysfunction. The physician needs to address this risk with the patient. It is inappropriate for the nurse to talk about treatments, because it is not known from the information given if the patient is having a high-risk procedure. There is no reason to alarm the patient unnecessarily.
  7. A patient who has just returned from a transurethral resection of the prostate (TURP) asks the nurse why he needs a urinary catheter. What is the correct explanation?

    a.

    “We can take the catheter out when you are able to urinate on your own. I’ll ask the physician if we can remove it later today.”

    b.

    “The catheter is being used to irrigate your bladder with antibiotics. It is important to continue this until you can take antibiotics orally.”

    c.

    “The catheter keeps your bladder empty to reduce risk for infection. It is important to leave it in for at least 72 hours.”

    d.

    “The catheter is keeping pressure on the area to prevent bleeding. We will remove it when the risk for bleeding has passed.”
    ANS:    D

    As the tissue is removed during TURP, bleeding occurs. A Foley catheter is left in place with 30 to 60 mL of sterile water inflating the balloon. The balloon is overfilled and may be secured tightly to the leg or abdomen to tamponade (compress) the prostate area and stop the bleeding. Irrigation solution generally flows continuously; manual irrigation may be done for the first 24 hours to help maintain catheter patency by removing clots and chips. The health-care provider will remove the Foley catheter after the danger of hemorrhage has passed. Antibiotics are not routine.
  8. The nurse is caring for a patient with continuous bladder irrigation after a transurethral resection of the prostate (TURP). Which assessment finding should take priority?

    a.

    Patient report of bladder spasms

    b.

    Pink-tinged urine

    c.

    Leakage of small amounts of urine around the catheter

    d.

    10-mL urine output in an hour
    ANS:    D

    10 mL in an hour is not normal and signifies either a kidney problem or, more likely, an obstructed catheter. A, B, and C are all common after TURP and are easily treated.
  9. The nurse has just removed an indwelling catheter from a patient following transurethral resection of the prostate. What action by the nurse is most important?

    a.

    Monitor vital signs.

    b.

    Watch for bladder spasms.

    c.

    Offer the urinal every 15 minutes.

    d.

    Collect serial samples of urine to monitor for color.
    ANS:    D

    Serial urine samples may be collected after the Foley catheter has been removed. To do this, each time the patient urinates, save some of the urine in a transparent cup, and make sure to line up the cups in order (usually on a shelf in the bathroom). This way the nurse or physician can see whether the urine is becoming progressively less bloody and clearer with each void. Vital signs are always important but are not specific to removing a catheter. Bladder spasms are more likely early while the catheter is in place. Offering the urinal every 15 minutes is not necessary.
  10. A patient is discharged home after a prostatectomy. Two days later, he calls the nurse and says his bleeding has increased. The nurse asks what he has been doing since discharge. Which of the following activities reported by the patient indicates the need for teaching by the nurse?

    a.

    The patient has been sitting in a recliner watching television.

    b.

    The patient raked leaves in the yard.

    c.

    The patient took an opioid for pain.

    d.

    The patient took a walk around the block.
    ANS:     B

    Activity can increase bleeding, and raking is strenuous. Sitting, walking, and taking an opioid should not increase bleeding.
  11. The nurse is assisting with teaching a patient who will be discharged with a catheter after a prostatectomy. Which of the following statements indicates the need for further teaching?

    a.

    “I should keep the drainage bag below the level of my bladder at all times.”

    b.

    “I should call you if the bleeding increases.”

    c.

    “I need to wash around the meatus with soap and water each day.”

    d.

    “Applying antibiotic ointment to the meatus twice a day will prevent skin breakdown.”
    ANS:    D

    The meatus should be washed with soap and water, but antibiotic ointment is usually not necessary. The bag must be kept below the level of the bladder to prevent return of urine to the bladder, which may increase risk of infection. Bleeding should be reported.
  12. What term describes a painful, prolonged erection?

    a.

    Peyronie’s disease

    b.

    Priapism

    c.

    Paraphimosis

    d.

    Orchitis
    ANS:     B

    Priapism is a painful erection that lasts too long. Peyronie’s disease often gives the penis a curved or crooked look when it is erect. Paraphimosis occurs when the uncircumcised foreskin is pulled back, during intercourse or bathing, and not immediately replaced in a forward position. This causes constriction of the dorsal veins, which leads to edema and pain. Orchitis is a rare inflammation or infection of the testes.
  13. The nurse is bathing an elderly male patient who has never been circumcised. What is proper care of the uncircumcised penis?

    a.

    Retract the foreskin, wash with soap and water, and leave the foreskin retracted to prevent collection of debris.

    b.

    Do not retract the foreskin; leave it in its natural position at all times.

    c.

    Retract the foreskin, wash with soap and water, and replace the foreskin to its original position.

    d.

    Use alcohol and a cotton swab to clean gently underneath the foreskin.
    ANS:     C

    Phimosis is generally prevented by teaching uncircumcised males to pull the foreskin back carefully, wash with mild soap and water daily, and replace the foreskin to its normal position. Leaving the foreskin retracted can impair circulation. It must be retracted for adequate hygiene and then replaced. Alcohol is not necessary and may be irritating.
  14. What term describes a condition in which there is excessive fluid in the scrotal sac?

    a.

    Epididymitis

    b.

    Varicocele

    c.

    Hydrocele

    d.

    Orchitis
    ANS:     C

    A hydrocele is a collection of fluid in the scrotal sac. Epididymitis is inflammation or infection of the epididymis that may be caused by bacteria, viruses, parasites, chemicals, or trauma. A varicocele is a condition sometimes called varicose veins of the scrotum. Orchitis is a rare inflammation or infection of the testes.
  15. The nurse is providing care for a patient admitted with epididymitis. Which of the following interventions is most appropriate?

    a.

    Warm packs to the scrotum

    b.

    Pressure to the scrotum

    c.

    Frequent ambulation

    d.

    Elevation of the scrotum
    ANS:    D

    Depending on the severity of the pain, the patient may be placed on bedrest with the scrotum elevated, possibly on ice packs, and also given analgesics. Pressure would increase pain.
  16. A 30-year-old male patient has just received a diagnosis of testicular cancer. He appears sad and states, “I always wanted to have children. Now it will be impossible.” What nursing intervention would be most helpful?

    a.

    Tell the patient that it may be possible to deposit sperm in a sperm bank before treatment is begun.

    b.

    Inform the patient that there is no reason he cannot have children after he has completed treatment.

    c.

    Contact pastoral care to counsel the patient.

    d.

    Provide the patient with literature about adoption.
    ANS:    A

    If a diagnosis of cancer has been made, provide emotional support for the patient. If the patient wants to have children, he should be encouraged to make deposits in a sperm bank before any surgery or treatment is started. Pastoral care may be helpful if the patient wishes, but they will not be able to inform the patient about sperm bank donations. Providing adoption literature is inappropriate at this time.
  17. The nurse is teaching a male patient how to perform a testicular self-examination. Which description of how the testes should feel is correct?

    a.

    Round, with an occasional surface irregularity

    b.

    Round, with a granular surface

    c.

    Hard and marble-like

    d.

    Smooth and egg-shaped
    ANS:    D

    The testes should be smooth, firm, and egg shaped. An irregular surface and hardness are variations from normal.
  18. What drug class is most likely to cause erectile dysfunction?

    a.

    Antibiotics

    b.

    Antidiabetics

    c.

    Antihypertensives

    d.

    NSAIDs
    ANS:     C

    Antihypertensive agents often affect the autonomic nervous system and affect erection. Antibiotics, antidiabetics, and NSAIDs are not common offenders.
  19. The nurse is working in a urology clinic, where a patient has just received a new prescription for a transurethral suppository for erectile dysfunction. What instructions should the nurse provide?

    a.

    “Urinate before you insert the suppository into your urethra.”

    b.

    “Insert the suppository into the urethra at least 2 hours before anticipated intercourse.”

    c.

    “Lubricate the suppository well, and insert it into your rectum before intercourse.”

    d.

    “Remove the suppository after you are finished having intercourse.”
    ANS:    AThe patient is instructed to urinate before use of the suppository. A tiny pellet (microsuppository) is inserted into the urethra using a specialized single-dose applicator. The medication usually begins to work in 5 to 10 minutes, and the effects last for approximately 30 to 60 minutes; therefore, 2 hours is too long. The suppository will be absorbed and is not removable.
  20. A patient is using a suction device and penile ring to treat erectile dysfunction. What instructions must the patient receive to prevent tissue damage?

    a.

    “Remove the penile ring as soon as an erection occurs.”

    b.

    “Remove the penile ring within 15 to 20 minutes of putting it on.”

    c.

    “Leave the penile ring on no more than an hour after intercourse.”

    d.

    “Loosen the penile ring before having intercourse.”
    ANS:     B

    Suction devices are another nonsurgical treatment option. This is an external cylinder vacuum device that fits over the penis and draws the blood up into the corporeal bodies, causing an erection. A penile ring is then slipped onto the base of the penis. Once the cylinder is removed, sexual intercourse can begin. Special care must be taken to remove the penile ring within 15 to 20 minutes to prevent tissue damage. Removing or loosening the ring as soon as the erection occurs risks losing the erection. An hour can cause circulatory impairment and tissue damage.
  21. The nurse is assisting with a urology clinic intake assessment on a patient who reports erectile dysfunction. He has tried several treatments without success. He states, “I’m pretty useless to my wife now. I might as well become a monk.” Which nursing diagnosis should take priority in guiding the nurse’s care?

    a.

    Knowledge Deficit related to lack of knowledge about treatments for erectile dysfunction

    b.

    Anxiety related to uncertain future

    c.

    Powerlessness related to inability to fulfill role functions

    d.

    Noncompliance related to use of treatments for erectile dysfunction
    ANS:     C

    The patient’s comment shows powerlessness. There is no evidence of knowledge deficit, anxiety, or noncompliance in the data provided.
  22. If an endocrine problem is the cause of male infertility, which type of problem is it considered?

    a.

    Pretesticular

    b.

    Testicular

    c.

    Post-testicular
    ANS:    A

    Endocrine problems are pretesticular, because hormones affect testicular function. Testicular problems occur in the testes, and post-testicular problems are usually the result of surgery or injury along the pathway from the testes to the outside of the man’s body.
  23. The nurse is assisting a 28-year-old man who is undergoing testing for infertility. He says, “I can’t believe I have to stop wearing tight jeans. What on earth could that have to do with anything?” Which response by the nurse is best?

    a.

    “The pressure on your scrotum from tight jeans can damage your testes.”

    b.

    “Tight jeans hold your scrotum too close to your body, where the heat can inhibit sperm production.”

    c.

    “It’s not the tight jeans, but the way they make you sit that causes the problem.”

    d.

    “Tight jeans do not cause infertility. That is an old wives’ tale.”
    ANS:     B

    Excessive use of hot tubs and saunas, wearing tight jeans, and long-haul truck driving have all been identified as raising the temperature level in the scrotum to the extent that sperm production is decreased.
  24. For how long must a couple attempt to conceive unsuccessfully before they are considered infertile?

    a.

    3 months

    b.

    6 months

    c.

    1 year

    d.

    2 years
    ANS:     C

    A couple is considered infertile if they have been unsuccessful at becoming pregnant after at least 1 year of unprotected intercourse.
  25. The nurse is caring for a patient in the emergency department in a hypertensive crisis. He states he stopped taking his blood pressure medicine because it made him impotent. What should be the nurse’s first response?

    a.

    “You are right; blood pressure medications can cause erectile dysfunction. You should consider seeing a urologist for treatment.”

    b.

    “Yes, blood pressure medications can cause erectile dysfunction, but there are many different classes of drugs for high blood pressure. Let’s ask your physician what might work better for you.”

    c.

    “No, it is a myth that blood pressure medications cause erectile dysfunction. You should see a urologist to look for other causes.”

    d.

    “No, blood pressure medications do not usually cause erectile dysfunction; it is the high blood pressure that can cause the problem. You need to be careful to take your medications to keep it under control.”
    ANS:     B

    Some classes of medications for hypertension can cause erectile dysfunction. Some men have been known to stop taking their blood pressure medication and risk a stroke or heart attack because the medication interfered with their sexual activity. Talking with the physician about other options should take place first. If a change in medication does not help, then a referral to a urologist might be in order.
  26. What is the term for the condition in which the penis is curved?

    a.

    Priapism

    b.

    Phimosis

    c.

    Peyronie’s disease

    d.

    Paraphimosis
    ANS:     C

    Peyronie’s disease often gives the penis a curved or crooked look when it is erect. Priapism is a painful erection that lasts too long. Phimosis is the term used to describe a condition in which the foreskin of an uncircumcised male becomes so tight it is difficult or impossible to pull back, away from the head of the penis. Paraphimosis occurs when the uncircumcised foreskin is pulled back, during intercourse or bathing, and not immediately replaced in a forward position. This causes constriction of the dorsal veins, which leads to edema and pain.
  27. What instructions should the nurse provide to a patient being treated for prostatitis? (Select all that apply.)

    a.

    “Take your antibiotics until your symptoms have completely resolved.”

    b.

    “Avoid products that contain caffeine.”

    c.

    “Try to increase the amount of fiber in your diet.”

    d.

    “Empty your bladder frequently.”

    e.

    “Increase your fluid intake to nearly 3,000 mL/day.”

    f.

    “Avoid tub baths.”
    ANS: B, D, E

    Encourage the patient to empty his bladder every 2 to 3 hours even if he does not feel the urge to urinate. Sitz baths should be encouraged, not avoided. Fluids such as water and cranberry juice should be encouraged up to 2,500 to 3,000 mL per day unless contraindicated by heart failure or other chronic illness. Bladder irritants in the form of caffeine products (e.g., coffee, tea, cola, and chocolate), citrus juices, and alcohol should be taken in very limited amounts. Fiber does not affect urinary elimination. Antibiotics should always be taken until they are gone unless otherwise instructed by the physician.
  28. The nurse is collecting admission data from a patient recently diagnosed with benign prostatic hyperplasia. Which of the following symptoms would the nurse expect the patient to report? (Select all that apply.)

    a.

    Difficulty starting the urine stream

    b.

    Difficulty initiating an erection

    c.

    Dribbling after urination

    d.

    Low back pain

    e.

    Difficulty maintaining an erection
    ANS: A, C

    Symptoms related to obstruction include decrease in the size or force of the urinary stream, difficulty in starting a stream, dribbling after urination is thought to be completed, urinary retention, and a feeling that the bladder is not empty. The patient may also experience overflow incontinence or an interrupted stream, where the urine stops midstream and then starts again. Pain may be related to cancer. Prostate hyperplasia does not affect erections.
  29. The nurse is collecting a medication history from a man with erectile dysfunction. What medication classes should the nurse be aware of that commonly contribute to erectile dysfunction? (Select all that apply.)

    a.

    Beta-blocking agents

    b.

    Alcohol

    c.

    Antibiotics

    d.

    Antihistamines

    e.

    Oral hypoglycemic agents

    f.

    Caffeine
    ANS: A, B, D, F

    Beta blockers, alcohol, antihistamines, and caffeine can all contribute to erectile dysfunction. Antibiotics and oral hypoglycemics do not; however, diabetes can contribute.
  30. What instructions should be included for a patient prescribed tamsulosin (Flomax) for benign prostatic hypertrophy? (Select all that apply.)

    a.

    Dizziness may occur.

    b.

    Avoid unnecessary sunlight.

    c.

    Dry mouth and gastrointestinal upset may occur.

    d.

    Chew or crush tablets.

    e.

    Be careful when going from a sitting to a standing position.

    f.

    Avoid the use of heavy machinery.
    ANS: A, C, E, F

    Warn patients that dizziness may occur with onset of use, so be careful when moving to a standing position. Monitor blood pressure and pulse. Do not crush or chew tablets. Use caution with driving or use of heavy machinery. Dry mouth may occur. Sunlight does not affect tamsulosin.
  31. Which medications are used to treat cancer by suppressing or blocking testosterone? (Select all that apply.)

    a.

    Leuprolide (Lupron)

    b.

    Finasteride (Proscar)

    c.

    Dutasteride (Avodart)

    d.

    Diethylstilbesterol (DES)

    e.

    Goserelin (Zoladex)
    ANS: A, D, E

    Finasteride and dutasteride are alpha-reductase inhibitors that inhibit the enzyme responsible for formation of potent androgen from testosterone. Leuprolide, finasteride, and DES suppress hormone function.
  32. The nurse is providing care for a patient diagnosed with bacterial prostatitis who is being treated on an outpatient basis with oral antibiotic therapy. In addition to the medication, which of the following interventions should the nurse include in discharge teaching? (Select all that apply.)

    a.

    Warm sitz baths

    b.

    Stool softeners

    c.

    Bedrest

    d.

    Anti-inflammatory agents

    e.

    Self-catheterization every 2 hours
    ANS: A, B, D

    Acute bacterial prostatitis is usually treated medically with antibiotic therapy. Other forms of treatment may include anti-inflammatory agents, stool softeners, warm sitz baths, prostatic massage, and dietary changes, such as decreasing spicy foods and alcohol. Bedrest and self-catheterization are not necessary.
  33. For normal conception to occur, there must be a concentration of greater than ____________________ million sperm per milliliter of semen.
    ANS:      

    20

    Semen volume of 1.5 to 5 mL, a concentration of more than 20 million sperm per milliliter, 50% to 60% of the sperm classified as grade 2 mobility, 60% to 80% of sperm with a normal shape, pH between 7.2 and 7.8, a small amount of fructose (sugar, a food supply), and sperm (semen) that first coagulate and then liquefy are factors necessary for normal conception.
  34. After age 70, ____________________% of men have benign prostatic hypertrophy.
    ANS:      

    75

    Enlargement of the prostate gland is a normal process in older men. It begins at about age 50 and happens in 75% of men older than age 70.
  35. If undescended testes do not descend into the scrotum by age ____________________ years, surgery may be necessary to correct the problem.
    ANS:      

    2

    Many times, the testes descend into the scrotum on their own by 2 years of age. If they do not descend by the age of 2, surgery should be done to correct the problem.
Author
mayjher
ID
344431
Card Set
chapter 43
Description
male disorders
Updated