Chapter 54 Male Reproductive and Genital Problems PDF

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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter54:MaleReproductiveandGenitalProblems TestBank MULTIPLECHOICE 1.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. DIF:CognitiveLevel:Apply(application)REF:1269 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 2.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. DIF:CognitiveLevel:Apply(application)REF:1272 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 3.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

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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.

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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. DIF:CognitiveLevel:Apply(application)REF:1271 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 4.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fo 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. DIF:CognitiveLevel:Apply(application)REF:1270 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 5.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.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

d.

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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. DIF:CognitiveLevel:Understand(comprehension)REF:1274 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 6.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. DIF:CognitiveLevel:Apply(application)REF:1272 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 7.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. DIF:CognitiveLevel:Apply(application)REF:1277

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 8.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. DIF:CognitiveLevel:Apply(application)REF:1275 TOP:NursingProcess:DiagnosisMSC:NCLEX:PhysiologicalIntegrity 9.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. DIF:CognitiveLevel:Apply(application)REF:1279 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 10.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.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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.

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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. DIF:CognitiveLevel:Apply(application)REF:1274 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 11.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. DIF:CognitiveLevel:Understand(comprehension)REF:1274 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 12.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.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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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. DIF:CognitiveLevel:Apply(application)REF:1283 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 13.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. DIF:CognitiveLevel:Understand(comprehension)REF:1286 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 14.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. DIF:CognitiveLevel:Understand(comprehension)REF:1286 TOP:NursingProcess:PlanningMSC:NCLEX:HealthPromotionandMaintenance 15.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.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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.

705

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. DIF:CognitiveLevel:Apply(application)REF:1290 TOP:NursingProcess:ImplementationMSC:NCLEX:PsychosocialIntegrity 16.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. DIF:CognitiveLevel:Understand(comprehension)REF:1287 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 17.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.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

706

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. DIF:CognitiveLevel:Apply(application)REF:1288 TOP:NursingProcess:DiagnosisMSC:NCLEX:PsychosocialIntegrity 18.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fo thesuddensymptomchangeisamoreappropriatefirstresponsebythenurse.PSAtestingisdoneto differentiateBPHfromprostaticcancer. DIF:CognitiveLevel:Apply(application)REF:1274 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 19.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. DIF:CognitiveLevel:Understand(comprehension)REF:1285

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

707

TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 20.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. DIF:CognitiveLevel:Apply(application)REF:1285 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 21.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re...