Chapter 38: Management of Men with Reproductive Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 38: Management of Men with Reproductive Disorders

MULTIPLE CHOICE

1. A client is admitted to the hospital for a transurethral resection of the prostate (TURP). To learn more about the clients concerns regarding this surgery and his sexual functioning, the nurse might say

a.

Did you talk to anyone about how this surgery will affect your sex life?

b.

It is not unusual for a man to worry about how this surgery will affect his sex life. What are some of your concerns?

c.

This surgery may affect your sex life. Would you like to talk about this?

d.

You may have heard about some side effects of surgery. Are you worried about how this surgery will affect your sex life?

ANS: B

Giving men permission to express their feelings and health-related concerns draws them and their significant others into the process of health care. This option is better than the others. Option a is a yes/no question and is rather abrupt; it also sounds like there will definitely be some effect on sexuality. In reality, erectile dysfunction occurs in only 5-10% of clients and only when nerves are damaged during the operation. Options c and d are also yes/no questions. Yes/no questions are considered a barrier to therapeutic communication because the client can simply answer yes or no without elaborating.

DIF: Application/Applying REF: pp. 873, 882 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Communication

2. For a client with mild benign prostatic hypertrophy (BPH) who will be treated conservatively, the nurse would advise the client to

a.

avoid alcoholic beverages.

b.

limit fluid intake.

c.

limit sexual intercourse.

d.

void every couple of hours.

ANS: A

The nurse should advise the client to (a) void whenever the urge is felt (do not put it off), (b) avoid taking large quantities of fluid over a short period, and (3) avoid alcohol, because its diuretic effect, with the volume of fluid, increases bladder distention.

DIF: Comprehension/Understanding REF: p. 878 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

3. To provide protection against development of BPH, the nurse would encourage men in a community health education class to increase their intake of

a.

citrus juices.

b.

dairy products.

c.

red meat.

d.

yellow vegetables.

ANS: D

Dietary factors have been examined, and it has been concluded that yellow vegetables appear to provide some protection against BPH.

DIF: Comprehension/Understanding REF: p. 874 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

4. The statement by the client scheduled for TURP that would indicate the need for further preoperative teaching is

a.

I will have a catheter after surgery.

b.

I will need to drink a lot after surgery.

c.

My incision will probably be painful.

d.

My urine will be red after surgery.

ANS: C

TURP is performed by inserting a resectoscope through the urethra. No incision is made.

DIF: Evaluation/Evaluating REF: p. 879 OBJ: Evaluation

MSC: Physiological Integrity Physiological Adaptation-Illness Management

5. A client developed retrograde ejaculation after prostate surgery. In responding to the clients questions regarding this complication, the nurse would be aware that

a.

the client will not be able to experience orgasm.

b.

the problem can be repaired surgically.

c.

this condition is a risk of surgery.

d.

this condition is usually temporary.

ANS: C

Complications of prostate surgery include sexual dysfunction, such as erectile dysfunction, retrograde ejaculation, and infertility.

DIF: Comprehension/Understanding REF: p. 882 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

6. After a transurethral resection, the nurse notices that the clients urine in the Foley catheter bag is bright red, has numerous clots, and is viscous. The priority nursing action at this time is to

a.

add fluid to the balloon end of the catheter.

b.

call the physician immediately.

c.

force fluids for the next 8 hours.

d.

irrigate the catheter with sterile saline.

ANS: B

Arterial bleeding is bright red, has numerous clots, and is viscous. Blood pressure may fall, and emergency surgical intervention may become necessary.

DIF: Application/Applying REF: p. 884 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

7. After a transurethral resection, the nurse notes that the clients urinary catheter is blocked and his bladder is overdistended. The initial nursing action should be to

a.

change the catheter.

b.

irrigate the catheter.

c.

milk the catheter tubing.

d.

notify the physician.

ANS: C

If obstruction is suspected, manual (hand) irrigation may be necessary. After prostatectomy for BPH, at least 60 ml of irrigant must be used, with some force, to dislodge and evacuate blood clots and other debris.

DIF: Application/Applying REF: p. 883 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Managing Equipment

8. After the urinary catheter is removed on the fourth day following a transurethral resection, the client is upset because he is dribbling urine. The most appropriate nursing intervention in this situation is to

a.

help keep the client dry, explaining that it may take some time to clear up.

b.

obtain urine for culture, because he may have a urinary tract infection.

c.

remind him to void every hour to prevent dribbling.

d.

tell him the problem will clear up in a few days.

ANS: A

Temporary urinary frequency, urgency, leakage, and dysuria are normal until complete healing occurs. The nurse should remind the client and his significant others that these problems are temporary but may take time to resolve.

DIF: Application/Applying REF: p. 884 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

9. Because a client is receiving antispasmodics for bladder spasms, the nurse should be sure that the client

a.

increases fluid intake.

b.

is assessed frequently for bleeding.

c.

receives stool softeners.

d.

remains on bed rest.

ANS: C

Because antispasmodic drugs can cause constipation and straining at stool can precipitate bleeding from the operative site, stool softeners such as docusate sodium (Colace) are often given.

DIF: Analysis/Analyzing REF: p. 884 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

10. On the first day after prostatectomy, a client complains of pain that is caused by bladder spasm. The priority action by the nurse is to

a.

administer antispasmodic drugs as ordered.

b.

administer pain medication as ordered.

c.

assess urethral catheter for patency.

d.

encourage the client to use relaxation techniques.

ANS: C

Bladder spasms frequently occur after prostate procedures. The nurse should be sure that the drainage system is not obstructed, because obstruction and bladder irritation can cause bladder spasms. Once the nurse is assured that the catheter system is patent, then he/she can administer an antispasmodic medication.

DIF: Application/Applying REF: p. 884 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

11. A client tells the nurse that on discharge following the clients transurethral resection, his wife is going to drive him to his daughters house 3 hours away to recuperate. The nurses most appropriate response would be

a.

During the drive, be sure to stop every hour to void.

b.

Im glad you have someone to help you after your operation.

c.

Try to limit fluid intake before the drive to avoid problems.

d.

You need to avoid prolonged sitting for 2 weeks; can you plan something else?

ANS: D

Prolonged sitting increases intra-abdominal pressure and may precipitate bleeding. After the client leaves the health care facility, driving an automobile or taking prolonged automobile rides should be avoided until at least 2 weeks after surgery, when the risk of bleeding decreases. In fact, the man should not sit at all except for meals during this time.

DIF: Application/Applying REF: p. 885 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

12. The nurse preparing health teaching information about the etiology of prostate cancer would omit factors related to

a.

diet.

b.

heredity.

c.

race.

d.

vasectomies.

ANS: D

There are proven factors related to race, heredity, and diet. Factors that may be related to vasectomies and BPH are not conclusive.

DIF: Comprehension/Understanding REF: p. 890 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

13. For a client with radioactive iodine seeds implanted for local control of a prostate tumor, the nurse would address radiation precautions by

a.

isolating the client while the implants are intact.

b.

limiting time spent with the client.

c.

not allowing children to sit on his lap.

d.

treating all urine as radioactive.

ANS: D

The long half-life of these seeds allows delivery of an effective radiation dose for 1 year. The client should avoid intercourse for the first 1-2 months after implantation and intercourse for procreation is not allowed unless specifically cleared by the urologist or radiation oncologist. The nurse should also teach the client not to allow childrenor anyone elseto sit on his lap for a prolonged period of time during the first 1-2 months after implantation. Otherwise, no specific radiation precautions are needed.

DIF: Application/Applying REF: p. 895 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Handling Hazardous and Infectious Materials

14. Considering the potential long-term side effects of a radical prostectomy, the nurse would make the nursing diagnosis of

a.

Deficient Fluid Volume

b.

Impaired Urinary Elimination

c.

Risk for Sexual Dysfunction

d.

Social Isolation

ANS: C

Although various surgical approaches can be used, permanent erectile dysfunction and incontinence are possible risks of surgery.

DIF: Application/Applying REF: p. 892 OBJ: Diagnosis

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Human Sexuality

15. Nursing management of a client with acute bacterial prostatitis would include

a.

catheterizing as needed.

b.

encouraging ambulation.

c.

limiting fluid intake.

d.

providing fiber and fluid intake.

ANS: D

Rest, increased fluids, and analgesics are important in all clients with prostatitis. Because constipation can be a painful problem with prostatitis, the nurse should encourage the client to manage this with a high-fiber diet and increased fluids along with regular exercise.

DIF: Application/Applying REF: p. 897 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

16. Because a clients mother took diethylstilbestrol (DES) during pregnancy, a nurse should advise a client to maintain screening practices for which associated health risk?

a.

Decreased sperm count

b.

High risk of erectile dysfunction

c.

Increased chance of bladder cancer

d.

Increased risk of testicular cancer

ANS: D

The male offspring of women who used estrogen during the first trimester of pregnancy (called DES sons), or who were exposed to estrogen-progestin combinations frequently used in diagnostic tests to confirm pregnancy, are at greater risk of developing testicular cancer.

DIF: Application/Applying REF: p. 898 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health Screening

17. In counseling a couple who want to conceive, the appropriate recommendation that the nurse would make to the man is

a.

avoid using recreational drugs and alcohol.

b.

have intercourse every 24 hours during ovulation.

c.

take hot, soaking baths several times a week.

d.

wear jockey shorts instead of boxer type.

ANS: A

Clients who want to conceive can try to prevent infertility by reducing exposure to gonadotoxins (marijuana, other recreational drugs, and possibly tobacco) and keeping the scrotum cool (avoiding excessive heat, hot baths, and tight clothing). Couples are advised to have intercourse only once every 36 hours during the womans periovulatory period because it takes 24 hours for a normal sperm count to be generated after ejaculation.

DIF: Comprehension/Understanding REF: pp. 903-904 OBJ: Intervention

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Family Planning

18. A nurse counsels a client who smokes cigarettes and uses alcohol daily that he should be aware that these substances have been known to cause

a.

decreased erectile ability.

b.

decreased sperm count.

c.

gynecomastia.

d.

increased ejaculatory ability.

ANS: A

Recreational drugs, alcohol, and smoking cause erectile dysfunction. They are not related to the other three problems.

DIF: Comprehension/Understanding REF: p. 906 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

19. A 45-year-old client says to the nurse, Im really worried about occasional impotence. The most appropriate response by the nurse would be

a.

Do you feel you should see a sex therapist?

b.

Impotence is usually caused by psychogenic causes.

c.

This is not unusual after age 40.

d.

You should see your doctor to determine if the cause is physical.

ANS: D

There are multiple medical problems and medications that can cause erectile dysfunction (ED), so the client should be encouraged to seek medical attention to rule out or treat serious physiologic causes, such as hypertension and diabetes. A sex therapist would not be a first-line referral before a medical evaluation. Many older men continue to enjoy satisfactory erections and sex lives. Although psychogenic causes can lead to ED, again the client should seek medical attention. The nurse, while he/she may need to explain to the client that psychogenic causes may be a problem, should not do so in a way that makes the man feel like it is all in his head.

DIF: Application/Applying REF: p. 906 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health and Wellness

20. A nurse teaches a client who underwent insertion of a prostatic stent 5 weeks ago to be sure to tell all care providers about this procedure. When the client asks about the reason for this instruction, the nurse would reply that

a.

increased frequency of assessment for prostatic cancer is needed.

b.

ongoing antibiotic therapy will be needed for 1 year.

c.

the client should not be catheterized through the stent for at least 3 months.

d.

the client should not undergo magnetic resonance imaging.

ANS: C

To prevent complications, clients should be cautioned not to be catheterized through the stent for 3 months after stent placement. None of the other options is related.

DIF: Comprehension/Understanding REF: p. 882 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

21. A client who had prostate surgery asks the nurse when the suprapubic catheter will be removed. The nurse would reply that it will be left in place until

a.

about 2 weeks after the surgery.

b.

antibiotic therapy is completed.

c.

no pain medication is necessary.

d.

the client is voiding well.

ANS: D

The suprapubic catheter is left in place until voiding function has returned. When the client is voiding well, the suprapubic catheter can be removed.

DIF: Comprehension/Understanding REF: p. 884 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

22. The nurse providing client teaching about prostate cancer would tell a group of male clients 52 to 67 years old that screening includes

a.

colonoscopy.

b.

cystoscopy.

c.

digital rectal exam.

d.

monthly self-examination.

ANS: C

Men with prostate cancer typically have no manifestations. Early diagnosis through prostate-specific antigen (PSA) measurement and digital rectal examination is essential. The American Cancer Society and American Urological Association recommend regular testing on all men between 50 and 70 years of age and routine testing beginning at age 40 for African-American males and men with first-degree relatives with prostate cancer.

DIF: Comprehension/Understanding REF: pp. 890-891 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health Screening

23. A nurse is collecting a history on a young client being treated for epididymitis. For which past medical condition should the nurse ask if the client has received treatment?

a.

Frequent urinary tract infections

b.

History of testicular torsion at puberty

c.

Problems with erectile dysfunction

d.

Sexually transmitted diseases

ANS: D

In young men, STDs are a common cause of epididymitis. In older men, urinary pathogens are a common cause. Erectile dysfunction and testicular torsion are not related.

DIF: Application/Applying REF: p. 900 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

24. A young man presents to the emergency department with sudden onset of scrotal swelling and acute pain. The nurse would plan care suspecting treatment for this client will consist of

a.

admission and IV antibiotics.

b.

emergency surgery.

c.

ice, analgesics, and scrotal support.

d.

NSAIDs and local heat.

ANS: B

These manifestations and the clients age suggest that he may have testicular torsion, a surgical emergency. Once diagnosis is confirmed, treatment is emergency surgery.

DIF: Analysis REF: p. 900 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

25. A client is very upset that he recently had a vasectomy but his wife got pregnant anyway. When taking a history on this client, which question should the nurse specifically ask?

a.

After the operation, did you use ice for more than 2 days?

b.

Did you return for a follow-up sperm count?

c.

Have you considered paternity testing?

d.

Were you told about the lifting restrictions?

ANS: B

After a vasectomy, clients should use alternative forms of birth control until a follow-up sperm count shows azoospermia, because at the time of the procedure there are live sperm left in the vas deferens.

DIF: Application/Applying REF: p. 901 OBJ: Assessment

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Family Planning

26. A client is having a penile shaft resection for advanced penile cancer. Which nursing diagnosis would be most important for the nurse to consider when planning care?

a.

Altered Body Image

b.

Anxiety

c.

Risk for Incontinence

d.

Risk for Sexual Dysfunction

ANS: A

Many men are reluctant to seek help for medical conditions involving their genitals because they regard such problems as a potential threat to their sexuality or identity as a man. After delaying medical care for penile cancer, the man may present with ulcerated, complicated lesions that require extreme surgery such as penile shaft resection or penectomy. Such a radical procedure has dire psychosocial implications.

DIF: Analysis/Analyzing REF: p. 906 OBJ: Diagnosis

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

27. A client comes to the emergency department in obvious distress, holding his groin. He refuses to get undressed to be examined. Which statement or question by the nurse is most appropriate?

a.

Ill leave the room if that makes you feel better. When you are undressed, put on the call light.

b.

If you dont let us examine you to see what the problem is, you may lose blood supply to your genital area.

c.

No one can help you if we cant see whats going on. So please take off your clothes.

d.

Sometimes men get painful erections that wont go away or problems with their testicles. If thats the problem, we can help you.

ANS: D

Option d is the best example of therapeutic communication. From the presentation, this client may have a testicular torsion or priapism, both of which are emergencies. For the client to receive care, he must trust the health care providers to provide care in a sensitive manner, and using therapeutic communication is one way to win his trust. Such skillful, therapeutic interaction is essential.

DIF: Application/Applying REF: p. 873 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Communication

28. A client had a prostatectomy and is asking the nurse about the medications he is getting. He becomes alarmed when the nurse lists sildenafil (Viagra), saying But thats for ED! I was told I wouldnt have ED with this procedure! The best response by the nurse is

a.

ED is a possible complication after all types of prostatectomies.

b.

Its being prescribed during your recovery to keep the blood flow to the penis.

c.

Oh, I didnt realize you werent told about this. Ill call the doctor.

d.

Taking it regularly will help prevent ED after prostate surgery.

ANS: B

Sildenafil (Viagra) is sometimes prescribed in the postoperative recovery period after prostatectomy to maintain blood flow to the corpora cavernosa and to prevent or reverse apoptosis caused by prolonged disuse of the erectile mechanism. It is most beneficial for clients who have had radical prostatectomy.

DIF: Comprehension/Understanding REF: p. 885 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

29. A client has ED after a prostatectomy. Which of the following would be the most helpful statement by the nurse?

a.

Have you ever heard of vacuum erection devices?

b.

I can refer you to a qualified sex therapist who can be very helpful.

c.

Many men get ED after prostate surgery, but its really a shame.

d.

Well there are several medications made to treat these problems.

ANS: B

Referral to a qualified sex therapist can be invaluable in the multidisciplinary care of the client with ED. This option gives the client hope that his problem can be attended to and treats the client with respect and sensitivity.

DIF: Application/Applying REF: p. 885 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Referrals

MULTIPLE RESPONSE

1. The nurse explains that if left untreated, BPH could result in (Select all that apply).

a.

bladder cancer.

b.

prostatic cancer.

c.

renal failure.

d.

upper urinary tract infection.

ANS: C, D

The enlarged prostate may cause urinary back-pressure, leading to reflux and upper urinary tract infection.

DIF: Comprehension REF: pp. 874, 875 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

Leave a Reply