ATI Rectum and Genitourinary + Male genitourinary

Health Assessment ATI practice

Which of the following organs filters liquid waste products from the blood?

kidney

Which of the following subjective questions assesses the need for STI evaluation and education?

“ how many sexual partners have you had over the past 3 months “

which are the following are unexpected findings of a genitourinary assessment

malodorous vaginal discharge and itching near the vulva, cervix that appears at the vaginal opening, red fluid pocket on the inner labia

which are the following are expected findings of a genitourinary assessment in males

glans visible at the tip of the penis, scrotal skin is darker, visible vein along the shaft of the penis

Place the steps of the assessment of the anal and perianal area in order.

what is the expected urinary output

30 ml/hr

Which of the following conditions present with manifestations of genital lesions?

syphilis, genital herpes, HPV

what prevents STIs

vaccine, condoms

For which of the following client ages would the human papilloma virus (HPV) vaccine be recommended?

12 years old ; The HPV vaccine is recommended for healthy, previously unvaccinated preteens, prior to their first sexual encounter.

A nurse is collecting a health history from a client. Which of the following client statements requires further investigation?

i hav I noticed it burns when I urinate

A nurse is preparing to assess a client for the presence of a hernia in a client who is assigned male at birth. Which of the following areas should the nurse plan to inspect? 

femoral area, inguinal area; a hernia occurs when loops of bowel descent through the femoral or inguinal canals

A nurse is inspecting the genitalia of an older adult female client. For which of the following findings should the nurse notify the provider?

labial ulceration

A nurse is preparing to assess the genitalia of a female client. Which of the following actions should the nurse plan to take?

ensure the room temp is warm, apply clean gloves, and maintain privacy, have them empty bladder

A nurse is caring for a client who is assigned male at birth and reports the presence of yellow discharge from the meatus and burning with urination. Which of the following infections should the nurse suspect?

gonorrhea ; The reported manifestation of a yellow discharge from the meatus and dysuria are associated with a gonorrhea infection. The edges of the meatus can also appear inflamed and edematous.

A nurse is preparing to assist with a prostate examination. Which of the following actions should the nurse plan to take?

position the client standing facing the exam table, ensure adequate lighting, clean gloves and lube

A nurse is inserting a urinary catheter for a female adolescent. Which of the following findings should the nurse report to the provider?

An area of tenderness on the labia majora;
A palpable, fluid-filled area with redness, swelling, or tenderness on the labia majora might be a Bartholin gland abscess and should be reported to the provider.

A nurse is providing education to a young adult client about the human papillomavirus (HPV) vaccine. Which of the following information should the nurse include in the teaching?

HPV infections are associated with the development of genital, rectal, and oropharyngeal cancers.

A nurse is conducting a health history interview with a client about their urinary system. The nurse should recognize that which of the following client reports could indicate the presence of declining kidney function? (Select all that apply.)

recent weight gain, S.O.B, sweling in the ankles

A nurse is inspecting a client's rectal area and notes the presence of bulging red tissue that encompasses the entire anal opening. Which of the following should the nurse suspect?

rectal prolapse L mosit red, circular protrusion of the rectal mucus membranes

A nurse is providing a bed bath for an older adult client who is immobile. Which of the following findings should the nurse report to the provider?

an inability to retract the foreskin

A nurse is caring for an adult client who has an enlarged prostate and reports difficulty voiding. Which of the following actions should the nurse take? (Select all that apply.)

inspect the suprapubic area for distention, notify the provider if the bladder scan residual volume is greater than 100 ml, ask the client if they are experiencing pain or a burning sensation when voiding

A nurse is providing education to a client who is assigned female at birth and has expressed a desire to use a natural method of contraception. Which of the following methods should the nurse recommend? (Select all that apply withdrawal, fertility tracking with periodic abstinence,

fertility tracking, and withdrawl

A nurse is providing teaching about the prevention of sexually transmitted infections (STIs) to a 19-year-old client, assigned female at birth, who is sexually active and reports having multiple partners. Which of the following client responses demonstrates an understanding of the teaching

"I should plan on getting tested each year for sexually transmitted infections."

A nurse is inspecting the genitals of an adult client assigned male at birth. Which of the following should the nurse identify as expected findings? (Select all that apply.)

visible dorsal vein on the underside of the penile shaft, absence of pubic hair on the penile shaft , testes are easily moveable

A nurse is providing education to a client assigned male at birth about health promotion screenings. Which of the following information should the nurse include in the teaching?

A digital rectal examination can detect enlargement of the prostate gland.

A nurse is preparing to assist the provider with an assessment of the genitourinary system of a client who is assigned female at birth. Which of the following actions should the nurse plan to take?

The client should be positioned supine with the head of the bed elevated 45° or with their head on a pillow so that the provider can maintain eye contact with the client throughout the examination.

developmental competence : males sexual orientation

• Sexual and gender Minority ( SGM ) encompasses sexual orientation and gender identity

• provide an accepting attitude and identify and provide supportive resources

adults an aging adults

• around 40, production of sperm begins to decrease, although it continues to 80-90s

• testosterone production declines after age 30 but continues very gradually resulting in physical changes that are not evident until later

  • pubic hair decrease and penis size decreases

  • due to decrease tone of dartos muscle, scrotal contents hang lowr, rugae decreases and scrotum becomes pendulous

  • testes decrease in size and less firm to palpation

  • increased connective tissue is present in tubules and thickened = less sperm

genetic and environment : circumcision

• American Academy of Pediatrics AAP health benefits outright risks

• lower risk of

  • STIs such as HPV, herpes simplex virus, genital ulcer disease in men, and decreased risk for bacterial vaginosis and trichomoniasis in females

  • reduced risk of contracting HIV infection through heterosexual contact

G & E - Kidney disease and Bladder cancer

Chronic kidney disease ( CKD)

• 2 leading causes of ESRD(end-stage renal disease); our kidneys can’t filter anymore and toxins accumulating in the blood - HTN and diabetes

• prevalence of diverts and HTN is higher in some racial groups - African, Indian, Hispanics

Bladder Cancer

• 4th most common cancer in men with ethnic differences

• smoking is the most common risk factor along with occupational exposure to chemical

• assess for hematuiria

G & E sexually transmitted dinfection

• STIs increasing #s each year

• Types: chlamydia, gonorrhea, syphilis, HPV, HIV and Hep B

• Many are asymptomatic - increased transmission

• all sexually active individuals should have behavioral counseling to help decrease risk

objective data

• use firm deliberate touch

• use gloves, may use a glass slide, light, material for cytology

inspect and palpate the penis

• skin is normally wrinkled, hairless, and w/o lessons; dorsal vein may be apparent

• glans look smooth and w/o lesions; ask uncircumcised male to retract foreskin

  • some cheesy smegma may have collected under the foreskin after inspection, slide the foreskin back to its original position

• urethral meatus positioned just about centrally

• Compress glans anteroposteriorly between your thumb and forefinger; meatus edge should appear pink, smooth, and w/o discharge

inspect and palpate the scrotum

• hold penis away

• palpate gently each scrotal half between your thumb and 1st 2 fingers

• palpate spermatic cord between you thumb and forefinger along its length from epididymis up to external inguinal ring

• if you find a mass, provide additional specific information relative to location, size, shape and ability to reduce

inspect and palpate; hernia

• inspect inguinal region for bulge as a person stands and sots normally

• palpate inguinal canal

  • right side ask a male to shift his weight to the left

  • use technique; navel ( Nerve, artery, vein, space, lymphatics)

• palpate femoral area for bulge

  • usually, you feel none

palpate lymph nodes

• palpate horizontal chain along going inferior to inguinal ligament and vertical chain along the upper inner thigh

• normal to palpate an isolated node on occasion it then feels small, 1cm soft, discrete, and movable

  • enlarged, hard, matted, fixed nodes

Testicular Seld- Exam ( TSE )

Encourage self-care by teaching every male from 13 to 14 years old through
adulthood how to examine his testicles

• Early detection of cancer is enhanced if the male is familiar with his normal
  consistency

• A good time to assess is during a shower or bath

• Consider risk factors/monthly exams as needed

• Points to include during health teaching are:

  • T—timing, once a month

  • S—shower, warm water relaxes the scrotal sac

  • E—examine, check for, and report changes immediately

assessing urinary function

Observe urine color

note ph (4.5 and 8.0), and specific gravity (between 1.005 and 1.030)

• Serum analysis of kidney function correlates with creatinine level which is relatively stable ( an end production of muscle metabolism)

• blood urea nitrogen ( BUN ) measures urea which can vary based on several factors- impacted by dehydration or in increase in protein intake

Anormal Findings: Urinary Problems and Male Genital Lesions

Urinary problems
◦ Urethritis (Urethral Discharge and Dysuria)
◦ Renal Calculi
◦ Acute Urinary Retention and Urinary Tract Infection
◦ Urethral Stricture

Male genital lesions
- Tinea Cruris
◦ Genital Herpes—HSV-2 Infection
◦ Genital Warts
◦ Syphilitic Chancre
◦ Carcinoma

abnormal findings : penis

• hypospadias

• priapism

• phimosis

• paraphimosis

• epispadias

• peyronie’s disease

scrotum abnormalities

• Absent testis, Cryptorchidism

• Small Testis

• Testicular Torsion

• Epididymitis

• Varicocele

• Spermatocele

• Early Testicular Tumor

• Diffuse Tumor

• Hydrocele

• Scrotal Hernia

• Orchitis

• Scrotal Edema

inguinal

Review of Inguinal Hernia

• Course: An inguinal hernia occurs when abdominal contents, such as intestines or fat, protrude through a weakened area of the abdominal wall in the inguinal region. It may be reducible (can be pushed back in) or incarcerated/strangulated (trapped, cutting off blood supply—medical emergency).

• Clinical Signs & Symptoms:

  • Bulge in the groin, especially when standing or straining

  • Heaviness or discomfort in the groin

  • Pain with lifting, coughing, or bending

  • If strangulated: severe pain, nausea, vomiting, and redness over the hernia

• Frequency & Cause:

  • More common in men than women due to anatomical differences.

  • Causes: Increased intra-abdominal pressure (heavy lifting, chronic cough, obesity, pregnancy, straining during bowel movements).

Types of Inguinal Hernias

1. Indirect Inguinal Hernia

   • Pathway: Passes through the inguinal canal and may reach the scrotum.

   • Cause: Congenital (failure of the processus vaginalis to close).

   • Common in: Infants and young males.

2. Direct Inguinal Hernia

   • Pathway: Pushes through a weakened Hesselbach’s triangle (medial to the inferior epigastric vessels).

   • Cause: Acquired due to muscle weakness, often in older adults.

   • Common in: Middle-aged and elderly men.

3. Femoral Hernia

   • Pathway: Passes through the femoral canal, below the inguinal ligament.

   • Cause: Increased intra-abdominal pressure and weak abdominal wall.

   • Common in: Women, especially after pregnancy.

   • Risk: Highest risk for strangulation due to the narrow femoral ring.

Key Differentiation in inguinal henrias

• Indirect: Lateral to inferior epigastric vessels, congenital, common in younger males.

• Direct: Medial to inferior epigastric vessels, acquired, common in older males.

• Femoral: Below inguinal ligament, more common in women, high risk of strangulation.