Deck 55: Nursing Management: Male Reproductive Problems

Question 1

In teaching a male patient to perform testicular self-examination, the nurse includes the information that

A) the only structure normally felt in the scrotal sac is the testis.
B) the examination should be done when the scrotum is warm.
C) an appointment with the health care provider is needed if one testis is larger than the other.
D) an examination should be performed whenever the patient showers or bathes.

Answer 1

the examination should be done when the scrotum is warm.

Question 2

The health care provider prescribes finasteride (Proscar) for a 56-year-old male patient who has a BPH symptom score of 12 on the AUA Symptom Index. When teaching the patient about the drug, the nurse informs him that

A) his interest in sexual activity may decrease while he is taking the medication.
B) he should change position from lying to standing slowly to avoid dizziness.
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 2

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

Question 3

A patient with symptomatic BPH is scheduled for visual laser ablation of the prostate (VLAP) at an outpatient surgical center. The nurse will plan to teach the patient

A) how to care for an indwelling urinary catheter.
B) that the urine will appear bloody for several days.
C) to expect an immediate improvement in urinary force.
D) that an intraprostatic urethral stent will be placed.

Answer 3

how to care for an indwelling urinary catheter.

Question 4

When performing discharge teaching for a patient who has undergone a vasectomy in the health care provider's office, the nurse instructs the patient that

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

Question 5

A 41-year-old man asks the nurse what he can do to decrease the risk of BPH. The nurse explains that

A) riding a bicycle raises prostate specific antigen levels and may increase BPH risk.
B) prevention is not possible because prostatic enlargement occurs with normal aging.
C) decreasing butter and margarine and increasing fruits in the diet may help.
D) taking a daily vitamin E supplement has reduced prostate size in some men.

Question 6

The health care provider orders a blood test for prostate-specific antigen (PSA) when an enlarged prostate is palpated during a routine examination of a 56-year-old man. When the patient asks the nurse the purpose of the test, the nurse's response is based on the knowledge that

A) elevated levels of PSA are indicative of metastatic cancer of the prostate.
B) PSA testing is the "gold standard" for making a diagnosis of prostate cancer.
C) baseline PSA levels are necessary to determine whether treatment is effective.
D) PSA levels are usually elevated in patients with cancer of the prostate.

Question 7

A 22-year-old man tells the nurse at the health clinic that he has recently become unable to achieve an erection. When assessing for possible etiologic factors, which question should the nurse ask first?

A) "Have you been experiencing an unusual amount of stress?"
B) "Do you have any history of an erection that lasted for 6 hours or more?"
C) "Are you using any recreational drugs or drinking a lot of alcohol?"
D) "Do you have any chronic diseases, such as diabetes mellitus?"

Question 8

The nurse will teach the patient with chronic bacterial prostatitis that

A) PSA elevation indicates that he has concurrent prostate cancer.
B) Nonsteroidal antiinflammatory drugs (NSAIDs) usually provide adequate pain control.
C) sexual intercourse and masturbation will relieve symptoms.
D) antibiotics should be taken for 7 to 10 days.

Question 9

A 32-year-old man scheduled for a unilateral orchiectomy for testicular cancer is admitted to the hospital the morning of surgery. He is accompanied by his wife but does not talk to her and does not initiate interaction with the nurse. The most appropriate action by the nurse is to

A) ask the patient if he has any questions or concerns about the diagnosis and treatment.
B) tell the patient's wife that concerns about sexual function are common with this diagnosis.
C) teach the patient that impotence is rarely a problem after unilateral orchiectomy.
D) document the patient's lack of communication on the chart and continue preoperative care.

Question 10

Leuprolide (Lupron) and bicalutamide (Casodex) are prescribed for a patient with cancer of the prostate. In teaching the patient about these drugs, the nurse informs the patient that side effects may include

A) low blood pressure.
B) decreased sexual drive.
C) urinary incontinence.
D) frequent infections.

Question 11

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

A) the presence of blood in the urine.
B) any erectile dysfunction (ED).
C) occurrence of a weak urinary stream.
D) lower back and hip pain.

Question 12

A patient undergoing a TURP returns from surgery with a three-way urinary catheter with continuous bladder irrigation in place. The nurse observes that the urine output has decreased and the urine is clear red with multiple clots. The patient is complaining of painful bladder spasms. The most appropriate action by the nurse is to

A) administer the ordered IV morphine sulfate, 4 mg.
B) increase the flow rate of the continuous bladder irrigation.
C) give the ordered the belladonna and opium suppository.
D) manually instill 50 ml of saline and try to remove the clots.

Question 13

Following discharge teaching for a patient who has had a transurethral prostatectomy for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says,

A) "I will increase fiber and fluids in my diet to prevent constipation."
B) "I should call the doctor if I have any incontinence at home."
C) "I will avoid heavy lifting or driving until I get approval from my health care provider."
D) "I should continue to schedule yearly appointments for prostate exams."

Question 14

A patient with irritative and obstructive bladder symptoms has an enlarged prostate on digital rectal examination (DRE) and an elevated PSA level. The nurse will anticipate that the patient will need teaching about

A) uroflometry studies.
B) cystourethroscopy.
C) transrectal ultrasonography (TRUS).
D) magnetic resonance imaging (MRI).

Question 15

The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate?

A) "The bladder irrigation is needed to stop the postoperative bleeding in the bladder."
B) "The irrigation is needed to keep the catheter from being occluded by blood clots."
C) "Normal production of urine is maintained with the irrigations until healing occurs."
D) "Antibiotics are being administered into the bladder with the irrigation solution."

Question 16

A patient scheduled for a transurethral resection of the prostate (TURP) for BPH tells the nurse that he has delayed having surgery because he is afraid it will affect his sexual function. When responding to his concern, the nurse explains that

A) with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur.
B) information about penile implants used for ED is available if he is interested.
C) there are many methods of sexual expression that can be alternatives to sexual intercourse.
D) sterility will not be a problem after surgery because sperm production will not be affected.

Question 17

A 64-year-old man undergoes a perineal radical prostatectomy for stage C prostatic cancer. Postoperatively, the nurse establishes the nursing diagnosis of risk for infection related to

A) urinary stasis.
B) urinary incontinence.
C) possible fecal contamination of the surgical wound.
D) placement of a suprapubic catheter into the bladder.

Question 18

Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of urine. An appropriate nursing intervention for this patient is to teach the patient

A) pelvic floor muscle training.
B) the use of belladonna and opium suppositories.
C) how to perform intermittent self-catheterization.
D) to restrict oral fluid intake.

Question 19

A couple is seen at the infertility clinic because they have not been able to conceive. When performing a focused examination to determine any possible causes for infertility, the nurse will check the man for the presence of

A) hydrocele.
B) varicocele.
C) epididymitis.
D) paraphimosis.

Question 20

A 53-year-old man tells the nurse he has not been able to function sexually for several years but is now interested in using Viagra (sildenafil). In responding to the patient's interest, the nurse

A) questions the patient about any prescription drugs he is taking.
B) tells the patient that Viagra is an appropriate treatment for only a few types of ED.
C) asks the patient about any previous treatment for hydrocele.
D) reassures the patient that a gradual decline in erectile function is common with aging.

Question 21

A patient with benign prostatic hyperplasia (BPH) with mild obstruction tells the nurse, "My symptoms have gotten a lot worse this week." Which response by the nurse is most appropriate?

A) "The prostate gland normally changes slightly in size from day to day, and this may be making your symptoms worse."
B) "Have you been taking any over-the-counter (OTC) medications recently?"
C) "Have you talked to the doctor about surgical procedures such as transurethral resection of the prostate?"
D) "I will talk to the doctor about ordering a prostate specific antigen test."

Question 22

When planning teaching for a patient who has had a unilateral orchiectomy and chemotherapy for testicular cancer, the nurse will include information about the need for

A) regular follow-up appointments to detect other types of malignancies.
B) aspiration of sperm from the remaining testis if infertility occurs.
C) testosterone supplements to help maintain erectile function.
D) application of ice to the scrotum to minimize pain and swelling.

Question 23

A patient with acute urinary retention associated with BPH is admitted to the emergency department. The patient has had no urine output for 16 hours, and the laboratory work shows a blood urea nitrogen (BUN) level of 50 mg/dl and a creatinine of 3.0 mg/dl. The nurse will anticipate a health care provider order to

A) schedule the patient for inpatient hemodialysis.
B) insert a retention catheter.
C) start an IV line for fluid administration.
D) administer furosemide (Lasix).

Question 24

The nurse working in a health clinic receives calls from all these patients. Which patient should be seen by the doctor first?

A) A 23-year-old man who states he had difficulty maintaining an erection last night
B) A 44-year-old man who has perineal pain and a temperature of 100.4° F
C) A 62-year-old man who has light pink urine after having a TURP 3 days ago
D) A 66-year-old man who has a painful erection that has lasted over 9 hours

Question 25

A 46-year-old man has had erectile dysfunction (ED) for about 3 years when he finally seeks help for the problem. He tells the nurse that he decided to seek help because his wife "is losing patience with the situation." The most appropriate nursing diagnosis for the patient is

A) risk for anxiety related to inability to perform sexually.
B) situational low self-esteem related to loss of satisfying sexual activity.
C) ineffective sexuality patterns related to ED.
D) ineffective role performance related to effects of ED.

Question 26

When obtaining a focused health history for a patient with possible testicular cancer, the nurse will ask the patient about any history of

A) testicular torsion.
B) STD infection.
C) undescended testicles.
D) testicular trauma.

Question 27

The doctor is considering whether to prescribe testosterone replacement therapy for a 62-year-old man who is concerned about a gradual decrease in sexual performance. Which information obtained by the nurse is most important to communicate to the doctor?

A) The patient states that he has noticed a decrease in energy level for a few years.
B) The patient has had a gradual decrease in the force of his urinary stream.
C) The patient has been using sildenafil (Viagra) several times every week.
D) The patient's symptoms have increased steadily over the last few years.