Question 1

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

Accepted Answer

The testes will hang lower in the scrotum when the temperature is warm, and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One testis is normally larger. The patient should perform testicular self-examination (TSE) monthly.

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

Accepted Answer

A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Orthostatic hypotension is a side effect of the a-blocking agents. Improvement in symptoms of obstruction takes 3 to 6 months. The medication does not cause hypertension.

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

Accepted Answer

The patient will have indwelling catheter for up to a week and will need to be instructed on catheter care to avoid problems such as infection. There is minimal bleeding with this procedure. It will take several weeks before the full benefits of the procedure take effect. Stent placement is not included in the procedure.

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

Accepted Answer

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

Question 5

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

Accepted Answer

A diet high in saturated fats, found in foods like butter, is associated with an increased risk for BPH. Individuals who eat more fruits and vegetables may be at lower risk. Riding a bicycle does increase prostate-specific antigen (PSA) levels, but this is not associated with development of BPH. Dietary changes and increased exercise do appear to help prevent BPH. Vitamin E supplements do not decrease prostate size.

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

Accepted Answer

PSA levels are usually elevated above the normal in patients with prostate cancer. PSA testing does not determine whether metastasis has occurred. A biopsy of the prostate is needed for a definitive diagnosis of prostate cancer. Success of treatment is determined by a fall in PSA to an undetectable level; the patient's baseline PSA is not needed to determine the success of treatment.

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?

Accepted Answer

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

Question 8

The nurse will teach the patient with chronic bacterial prostatitis that

Accepted Answer

Ejaculation helps drain the prostate and relieve pain. PSA elevation may be due to the prostatitis. NSAIDs are prescribed, but are often inadequate to control pain. Antibiotics should be continued for 4 to 16 weeks.

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

Accepted Answer

The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, it is inappropriate for the nurse to initiate teaching. It would be inappropriate for the nurse to provide patient teaching without further assessment of the patient's teaching needs and concerns. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.

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

Accepted Answer

Hormonal therapy blocks the effects of testosterone and decreases libido. Hypotension is associated with the a-blockers used for BPH. Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy.

Question 11

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

Accepted Answer

The American Urological Association (AUA) Symptom Index for a patient with BPH asks questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and back or hip pain are not typical symptoms with BPH.

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

Accepted Answer

The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.

Question 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,

Accepted Answer

Incontinence is common for several weeks after a TURP. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.

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

Accepted Answer

In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to help differentiate BPH from prostatic cancer. Uroflowmetry studies will help determine the extent of urine blockage and treatment, but a differential diagnosis will be obtained first. Cystourethroscopy may be used after TRUS if the diagnosis is still uncertain. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process.

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?

Accepted Answer

The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or maintain urine production. Antibiotics are given by the IV route, not through the bladder irrigation.

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

Accepted Answer

Erectile problems are rare, but retrograde ejaculation may occur after TURP. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns.

Question 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

Accepted Answer

The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery.

Question 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

Accepted Answer

Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L.

Question 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

Accepted Answer

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

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

Accepted Answer

Because some medications can cause ED and patients using nitrates should not take Viagra, the nurse should ask about prescription drug use. Viagra is a helpful therapy for most types of ED. Hydrocele is not a risk factor for ED or a contraindication to erectogenic drugs. Severe ED is not a normal consequence of aging in a 53-year-old patient.

Quiz 55: Nursing Management: Male Reproductive Problems