Chapter 54: Male Reproductive Problems

To determine the severity of the symptoms for a 68-year-old patient with benign prostatic hyperplasia (BPH) the nurse will ask the patient about

a. blood in the urine.

b. lower back or hip pain.

c. erectile dysfunction (ED).

d. force of the urinary stream

ANS: D

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 of BPH

A 58-year-old patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because it might affect his

ability to maintain an erection during intercourse. Which action should the nurse take?

a. Provide teaching about medications for erectile dysfunction (ED).

b. Discuss that TURP does not commonly affect erectile function.

c. Offer reassurance that sperm production is not affected by TURP.

d. Discuss alternative methods of sexual expression besides intercourse.

ANS: B

ED is not a concern with TURP, although retrograde ejaculation is likely and the nurse should discuss this with

the patient. 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

The health care provider prescribes finasteride (Proscar) for a 67-year-old patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that

a. he should change position from lying to standing slowly to avoid dizziness.

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

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.

ANS: B

A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the

drug. Although orthostatic hypotension may occur if the patient is also taking a medication for erectile dysfunction (ED), it should not occur with finasteride alone. Improvement in symptoms of obstruction takes

about 6 months. The medication does not cause hypertension.

The nurse will anticipate that a 61-year-old patient who has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level will need teaching about

a. cystourethroscopy.

b. uroflowmetry studies.

c. magnetic resonance imaging (MRI).

d. transrectal ultrasonography (TRUS).

ANS: D

In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to visualize the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be used before prostatectomy but will not be

done until after the TRUS and biopsy. MRI is used to determine whether prostatic cancer has metastasized but

would not be ordered at this stage of the diagnostic process.

Which information about continuous bladder irrigation will the nurse teach to a patient who is being admitted for a transurethral resection of the prostate (TURP)?

a. Bladder irrigation decreases the risk of postoperative bleeding.

b. Hydration and urine output are maintained by bladder irrigation.

c. Antibiotics are infused continuously through the bladder irrigation.

d. Bladder irrigation prevents obstruction of the catheter after surgery.

ANS: D

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 improve hydration. Antibiotics are given by the IV route,

not through the bladder irrigation.

The nurse will plan to teach the patient scheduled for photovaporization of the prostate (PVP)

a. that urine will appear bloody for several days.

b. how to care for an indwelling urinary catheter.

c. that symptom improvement takes 2 to 3 weeks.

d. about complications associated with urethral stenting.

ANS: B

The patient will have an indwelling catheter for 24 to 48 hours and will need teaching about catheter care.

There is minimal bleeding with this procedure. Symptom improvement is almost immediate after PVP. Stent

placement is not included in the procedure.

A 53-year-old man is scheduled for an annual physical exam. The nurse will plan to teach the patient about the purpose of

a. urinalysis collection.

b. uroflowmetry studies.

c. prostate specific antigen (PSA) testing.

d. transrectal ultrasound scanning (TRUS).

ANS: C

An annual digital rectal exam (DRE) and PSA are usually recommended starting at age 50 for men who have

an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of

urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA is abnormal.

A patient returning from surgery for a perineal radical prostatectomy will have a nursing diagnosis of risk for infection related to

a. urinary incontinence.

b. prolonged urinary stasis.

c. possible fecal wound contamination.

d. placement of a suprapubic bladder catheter.

ANS: C

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.

A 57-year-old patient is incontinent of urine following a radical retropubic prostatectomy. The nurse will plan to teach the patient

a. to restrict oral fluid intake.

b. pelvic floor muscle exercises.

c. to perform intermittent self-catheterization.

d. the use of belladonna and opium suppositories.

ANS: B

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.

A 70-year-old patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) is being discharged from the hospital today, The nurse determines that additional

instruction is needed when the patient says which of the following?

a. I should call the doctor if I have incontinence at home.

b. I will avoid driving until I get approval from my doctor.

c. I will increase fiber and fluids in my diet to prevent constipation.

d. I should continue to schedule yearly appointments for prostate exams

ANS: A

Because incontinence is common for several weeks after a TURP, the patient does not need to call the health care provider if this occurs. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.

The nurse will inform a patient with cancer of the prostate that side effects of leuprolide (Lupron) may

include

a. flushing.

b. dizziness.

c. infection.

d. incontinence.

ANS: A

Hot flashes may occur with decreased testosterone production. Dizziness may occur with the alpha-blockers

used for benign prostatic hyperplasia (BPH). Urinary incontinence may occur after prostate surgery, but it is

not an expected side effect of medication. Risk for infection is increased in patients receiving chemotherapy.

Which information will the nurse teach a patient who has chronic prostatitis?

a. Ibuprofen (Motrin) should provide good pain control.

b. Prescribed antibiotics should be taken for 7 to 10 days.

c. Intercourse or masturbation will help relieve symptoms.

d. Cold packs used every 4 hours will decrease inflammation.

ANS: C

Ejaculation helps drain the prostate and relieve pain. Warm baths are recommended to reduce pain.

Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed but usually do not offer adequate pain relief. Antibiotics for chronic prostatitis are taken for 4 to 12 weeks.

The nurse performing a focused examination to determine possible causes of infertility will assess for

a. hydrocele.

b. varicocele.

c. epididymitis.

d. paraphimosis.

ANS: B

Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are

not risk factors for infertility

Which information will the nurse plan to include when teaching a community health group about testicular self-examination?

a. Testicular self-examination should be done in a warm room.

b. The only structure normally felt in the scrotal sac is the testis.

c. Testicular self-examination should be done at least every week.

d. Call the health care provider if one testis is larger than the other.

ANS: A

The testes will hang lower in the scrotum when the temperature is warm (e.g., during a shower), 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 monthly.

A 27-year-old man who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is best for the nurse to take?

a. Teach the patient and the wife that impotence is unlikely after unilateral orchiectomy.

b. Ask the patient if he has any questions or concerns about the diagnosis and treatment.

c. Document the patients lack of communication on the chart and continue preoperative care.

d. Inform the patients wife that concerns about sexual function are common with this diagnosis.

ANS: B

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, the nurse should not offer teaching about

complications after orchiectomy. Documentation of the patients lack of interaction is not an adequate nursing

action in this situation.

When performing discharge teaching for a patient after a vasectomy, the nurse instructs the patient that he

a. should continue to use other methods of birth control for 6 weeks.

b. should not have sexual intercourse until his 6-week follow-up visit.

c. may have temporary erectile dysfunction (ED) because of swelling.

d. will notice a decrease in the appearance and volume of his ejaculate.

ANS: A

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.

A 52-year-old man tells the nurse that he decided to seek treatment for erectile dysfunction (ED) because his wife is losing patience with the situation. The most appropriate nursing diagnosis for the patient is

a. situational low self-esteem related to effects of ED.

b. ineffective role performance related to effects of ED.

c. anxiety related to inability to have sexual intercourse.

d. ineffective sexuality patterns related to infrequent intercourse.

ANS: B

The patients statement indicates that the relationship with his wife is his primary concern. Although anxiety,

low self-esteem, and ineffective sexuality patterns may also be concerns, the patient information suggests that addressing the role performance problem will lead to the best outcome for this patient.

A patient with urinary obstruction from benign prostatic hyperplasia (BPH) tells the nurse, My symptoms are much worse this week. Which response by the nurse is most appropriate?

a. Have you been taking any over-the-counter (OTC) medications recently?

b. I will talk to the doctor about ordering a prostate specific antigen (PSA) test.

c. Have you talked to the doctor about surgery such as transurethral resection of the prostate (TURP)?

d. The prostate gland changes in size from day to day, and this may be making your symptoms worse.

ANS: A

Because the patients increase in symptoms has occurred abruptly, the nurse should ask about OTC medications

that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland

does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for

the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer.

The nurse taking a focused health history for a patient with possible testicular cancer will ask the patient about a history of

a. testicular torsion.

b. testicular trauma.

c. undescended testicles.

d. sexually transmitted infection (STI).

ANS: C

Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STI, testicular torsion,

and testicular trauma are risk factors for other testicular conditions but not for testicular cancer

The nurse will plan to provide teaching for a 67-year-old patient who has been diagnosed with orchitis about

a. pain management.

b. emergency surgical repair.

c. application of heat to the scrotum.

d. aspiration of fluid from the scrotal sac.

ANS: A

Orchitis is very painful, and effective pain management will be needed. Heat, aspiration, and surgery are not

used to treat orchitis.

A 71-year-old patient who has benign prostatic hyperplasia (BPH) with urinary retention is admitted to the hospital with elevated blood urea nitrogen (BUN) and creatinine. Which prescribed therapy should the nurse

implement first?

a. Infuse normal saline at 50 mL/hr.

b. Insert a urinary retention catheter.

c. Draw blood for a complete blood count.

d. Schedule a pelvic computed tomography (CT) scan.

ANS: B

The patient data indicate that the patient may have acute kidney injury caused by the BPH. The initial therapy

will be to insert a catheter. The other actions are also appropriate, but they can be implemented after the acute

urinary retention is resolved.

The nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the laboratory results of these patients. Which patients PSA result is most important to report to the health care provider?

a. A 38-year-old who is being treated for acute prostatitis

b. A 48-year-old whose father died of metastatic prostate cancer

c. A 52-year-old who goes on long bicycle rides every weekend

d. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH)

ANS: B

The family history of prostate cancer and elevation of PSA indicate that further evaluation of the patient for prostate cancer is needed. Elevations in PSA for the other patients are not unusual.

After a transurethral resection of the prostate (TURP), a 64-year-old patient with continuous bladder

irrigation complains of painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take first?

a. Increase the flow rate of the bladder irrigation.

b. Administer the prescribed IV morphine sulfate.

c. Give the patient the prescribed belladonna and opium suppository.

d. Manually instill and then withdraw 50 mL of saline into the catheter.

ANS: D

The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurses 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.

A 22-year-old man tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. Which question should the nurse ask first to assess for possible etiologic factors?

a. Do you experience an unusual amount of stress?

b. Do you use any recreational drugs or drink alcohol?

c. Do you have chronic cardiovascular or peripheral vascular disease?

d. Do you have a history of an erection that lasted for 6 hours or more?

ANS: B

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

factors in younger men.

A 58-year-old man with erectile dysfunction (ED) tells the nurse he is interested in using sildenafil

(Viagra). Which action should the nurse take first?

a. Assure the patient that ED is common with aging.

b. Ask the patient about any prescription drugs he is taking.

c. Tell the patient that Viagra does not always work for ED.

d. Discuss the common adverse effects of erectogenic drugs

ANS: B

Because some medications can cause ED and patients using nitrates should not take sildenafil, the nurse should

first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of sildenafil therapy, but this should not be the first action. Although ED does increase with

aging, it may be secondary to medication use or cardiovascular disease.

The nurse in a health clinic receives requests for appointments from several patients. Which patient should

be seen by the health care provider first?

a. A 48-year-old man who has perineal pain and a temperature of 100.4 F

b. A 58-year-old man who has a painful erection that has lasted over 6 hours

c. A 38-year-old man who states he had difficulty maintaining an erection last night

d. A 68-year-old man who has pink urine after a transurethral resection of the prostate (TURP) 3 days

ago

ANS: B

Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications.

Which assessment information is most important for the nurse to report to the health care provider when a patient asks for a prescription for testosterone replacement therapy (TRT)?

a. The patient has noticed a decrease in energy level for a few years.

b. The patients symptoms have increased steadily over the last few years.

c. The patient has been using sildenafil (Viagra) several times every week.

d. The patient has had a gradual decrease in the force of his urinary stream.

ANS: D

The decrease in urinary stream may indicate benign prostatic hyperplasia (BPH) or prostate cancer, which are

contraindications to the use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient

A 76-year-old patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. The nurse will plan to

a. vaccinate the patient with sipuleucel-T ( Provenge).

b. provide the patient with information about cryotherapy.

c. teach the patient about placement of intraurethral stents.

d. schedule the patient for annual prostate-specific antigen testing.

ANS: D

Patients who opt for active surveillance need to have annual digital rectal exams and prostate-specific antigen testing. Vaccination with sipuleucel-T, cryotherapy, and stent placement are options for patients who choose to

have active treatment for prostate cancer

The health care provider prescribes the following interventions for a patient with acute prostatitis caused by

E. coli. Which intervention should the nurse question?

a. Instruct patient to avoid sexual intercourse until treatment is complete.

b. Administer ibuprofen (Advil) 400 mg every 8 hours as needed for pain.

c. Catheterize the patient as needed if symptoms of urinary retention develop.

d. Give trimethoprim/sulfamethoxazole (Bactrim) DS 1 tablet daily for 28 days.

ANS: C

Although acute urinary retention may occur, insertion of a catheter through an inflamed urethra is

contraindicated and the nurse will anticipate that the health care provider will need to insert a suprapubic catheter. The other actions are appropriate.

Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first?

a. 22-year-old who has noticed a firm, nontender lump on his scrotum

b. 35-year-old who is concerned that his scrotum feels like a bag of worms

c. 40-year-old who has pelvic pain while being treated for chronic prostatitis

d. 70-year-old who is reporting frequent urinary dribbling after a prostatectomy

ANS: A

The patients age and symptoms suggest possible testicular cancer. Some forms of testicular cancer can be very

aggressive, so the patient should be evaluated by the health care provider as soon as possible. Varicoceles do

require treatment, but not emergently. Ongoing pelvic pain is common with chronic prostatitis. Urinary dribbling is a common problem after prostatectomy.

When obtaining the pertinent health history for a man who is being evaluated for infertility, which question is most important for the nurse to ask?

a. Are you circumcised?

b. Have you had surgery for phimosis?

c. Do you use medications to improve muscle mass?

d. Is there a history of prostate cancer in your family?

ANS: C

Testosterone or testosterone-like medications may adversely affect sperm count. The other information will be obtained in the health history but does not affect the patients fertility.

The following male patients recently arrived in the emergency department. Which one should the nurse assess first?

a. 19-year-old who is complaining of severe scrotal pain

b. 60-year-old with a nontender ulceration of the glans penis

c. 22-year-old who has purulent urethral drainage and back pain

d. 64-year-old who has dysuria after brachytherapy for prostate cancer

ANS: A

The patients age and symptoms suggest possible testicular torsion, which will require rapid treatment in order

to prevent testicular necrosis. The other patients also require assessment by the nurse, but their history and

symptoms indicate nonemergent problems (acute prostatitis, cancer of the penis, and radiation-associated

urinary tract irritation)

Which action by the unlicensed assistive personnel (UAP) who are assisting with the care of patients with male reproductive problems indicates that the nurse should provide more teaching?

a. The UAP apply a cold pack to the scrotum for a patient with mumps orchitis.

b. The UAP help a patient who has had a prostatectomy to put on antiembolism hose.

c. The UAP leave the foreskin pulled back after cleaning the glans of a patient who has a retention

catheter.

d. The UAP encourage a high oral fluid intake for patient who had transurethral resection of the

prostate yesterday.

ANS: C

Paraphimosis can be caused by failing to replace the foreskin back over the glans after cleaning. The other actions by UAP are appropriate.

When caring for a patient with continuous bladder irrigation after having transurethral resection of the prostate, which action could the nurse delegate to unlicensed assistive personnel (UAP)?

a. Teach the patient how to perform Kegel exercises.

b. Report any complaints of pain or spasms to the nurse.

c. Monitor for increases in bleeding or presence of clots.

d. Increase the flow rate of the irrigation if clots are noted.

ANS: B

UAP education and role includes reporting patient concerns to supervising nurses. Patient teaching,

assessments for complications, and actions such as bladder irrigation require more education and should be

done by licensed nursing staff.