Chapter 72: Care of Patients with Male Reproductive Problems Nursing School Test Banks

Chapter 72: Care of Patients with Male Reproductive Problems

Ignatavicius: Medical-Surgical Nursing, 8th Edition

MULTIPLE CHOICE

1. The nurse is conducting a history on a male client to determine the severity of symptoms associated with prostate enlargement. Which finding is cause for prompt action by the nurse?

a.

Cloudy urine

b.

Urinary hesitancy

c.

Post-void dribbling

d.

Weak urinary stream

ANS: A

Cloudy urine could indicate infection due to possible urine retention and should be a priority action. Common symptoms of benign prostatic hyperplasia are urinary hesitancy, post-void dribbling, and a weak urinary stream due to the enlarged prostate causing bladder outlet obstruction.

DIF: Applying/Application REF: 1500

KEY: Reproductive problems| pathophysiology| nursing assessment

MSC: Integrated Process: Nursing Process: Assessment

NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

2. A client is diagnosed with benign prostatic hyperplasia and seems sad and irritable. After assessing the clients behavior, which statement by the nurse would be the most appropriate?

a.

The urine incontinence should not prevent you from socializing.

b.

You seem depressed and should seek more pleasant things to do.

c.

It is common for men at your age to have changes in mood.

d.

Nocturia could cause interruption of your sleep and cause changes in mood.

ANS: D

Frequent visits to the bathroom during the night could cause sleep interruptions and affect the clients mood and mental status. Incontinence could cause the client to feel embarrassment and cause him to limit his activities outside the home. The social isolation could lead to clinical depression and should be treated professionally. The nurse should not give advice before exploring the clients response to his change in behavior. The statement about age has no validity.

DIF: Applying/Application REF: 1500

KEY: Reproductive problems| caring| support

MSC: Integrated Process: Communication and Documentation

NOT: Client Needs Category: Psychosocial Integrity

3. A 55-year-old African-American client is having a visit with his health care provider. What test should the nurse discuss with the client as an option to screen for prostate cancer, even though screening is not routinely recommended?

a.

Complete blood count

b.

Culture and sensitivity

c.

Prostate-specific antigen

d.

Cystoscopy

ANS: C

The prostate-specific antigen test should be discussed as an option for prostate cancer screening. A complete blood count and culture and sensitivity laboratory test will be ordered if infection is suspected. A cystoscopy would be performed to assess the effect of a bladder neck obstruction.

DIF: Understanding/Comprehension REF: 1507

KEY: Reproductive problems| diversity| diagnostic examination

MSC: Integrated Process: Teaching/Learning

NOT: Client Needs Category: Health Promotion and Maintenance

4. The nurse is teaching a client with benign prostatic hyperplasia (BPH). What statement indicates a lack of understanding by the client?

a.

There should be no problem with a glass of wine with dinner each night.

b.

I am so glad that I weaned myself off of coffee about a year ago.

c.

I need to inform my allergist that I cannot take my normal decongestant.

d.

My normal routine of drinking a quart of water during exercise needs to change.

ANS: A

This client did not associate wine with the avoidance of alcohol, and requires additional teaching. The nurse must teach a client with BPH to avoid alcohol, caffeine, and large quantities of fluid in a short amount of time to prevent overdistention of the bladder. Decongestants also need to be avoided to lower the chance for urinary retention.

DIF: Applying/Application REF: 1503

KEY: Reproductive problems| patient education

MSC: Integrated Process: Teaching/Learning

NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

5. A client has returned from a transurethral resection of the prostate with a continuous bladder irrigation. Which action by the nurse is a priority if bright red urinary drainage and clots are noted 5 hours after the surgery?

a.

Review the hemoglobin and hematocrit as ordered.

b.

Take vital signs and notify the surgeon immediately.

c.

Release the traction on the three-way catheter.

d.

Remind the client not to pull on the catheter.

ANS: B

Bright red urinary drainage with clots may indicate arterial bleeding. Vital signs should be taken and the surgeon notified. The traction on the three-way catheter should not be released since it places pressure at the surgical site to avoid bleeding. The nurses review of hemoglobin and hematocrit and reminding the client not to pull on the catheter are good choices, but not the priority at this time.

DIF: Applying/Application REF: 1505

KEY: Reproductive problems| postoperative nursing| client safety

MSC: Integrated Process: Nursing Process: Implementation

NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

6. A nurse and an unlicensed assistive personnel (UAP) are caring for a client with an open radical prostatectomy. Which comfort measure could the nurse delegate to the UAP?

a.

Administering an antispasmodic for bladder spasms

b.

Managing pain through patient-controlled analgesia

c.

Applying ice to a swollen scrotum and penis

d.

Helping the client transfer from the bed to the chair

ANS: D

The UAP could aid the client in transferring from the bed to the chair and with ambulation. The nurse would be responsible for medication administration, assessment of swelling, and the application of ice if needed.

DIF: Applying/Application REF: 1509

KEY: Reproductive problems| postoperative nursing| comfort measures| unlicensed assistive personnel (UAP)

MSC: Integrated Process: Nursing Process: Implementation

NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

7. A client is diagnosed with metastatic prostate cancer. The client asks the nurse the purpose of his treatment with the luteinizing hormonereleasing hormone (LH-RH) agonist leuprolide (Lupron) and the bisphosphonate pamidronate (Aredia). Which statement by the nurse is most appropriate?

a.

The treatment reduces testosterone and prevents bone fractures.

b.

The medications prevent erectile dysfunction and increase libido.

c.

There is less gynecomastia and osteoporosis with this drug regimen.

d.

These medications both inhibit tumor progression by blocking androgens.

ANS: A

Lupron, an LH-RH agonist, stimulates the pituitary gland to release luteinizing hormone (LH) to the point that the gland is depleted of LH and testosterone production is lessened. This may decrease the prostate cancer since it is hormone dependent. Lupron can cause osteoporosis, which results in the need for Aredia to prevent bone loss. Erectile dysfunction, decreased libido, and gynecomastia are side effects of the LH-RH medications. Antiandrogen drugs inhibit tumor progression by blocking androgens at the site of the prostate.

DIF: Applying/Application REF: 1510

KEY: Reproductive problems| cancer| bisphosphonates| hormone therapy

MSC: Integrated Process: Teaching/Learning

NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is administering sulfamethoxazole-trimethoprim (Bactrim) to a client diagnosed with bacterial prostatitis. Which finding causes the nurse to question this medication for this client?

a.

Urinary tract infection

b.

Allergy to sulfa medications

c.

Hematuria

d.

Elevated serum white blood cells

ANS: B

Before administering sulfamethoxazole-trimethoprim, the nurse must assess if the client is allergic to sulfa drugs. Urinary tract infection, hematuria, and elevated serum white blood cells are common problems associated with bacterial prostatitis that require long-term antibiotic therapy.

DIF: Applying/Application REF: 1512

KEY: Reproductive problems| patient safety| antibiotics

MSC: Integrated Process: Nursing Process: Analysis

NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

9. A 55-year-old male client is admitted to the emergency department with symptoms of a myocardial infarction. Which question by the nurse is the most appropriate before administering nitroglycerin?

a.

On a scale from 0 to 10, what is the rating of your chest pain?

b.

Are you allergic to any food or medications?

c.

Have you taken any drugs like Viagra recently?

d.

Are you light-headed or dizzy right now?

ANS: C

Phosphodiesterase-5 inhibitors such as sildenafil (Viagra) relax smooth muscles to increase blood flow to the penis for treatment of erectile dysfunction. In combination with nitroglycerin, there can be extreme hypotension with reduction of blood flow to vital organs. The other questions are appropriate but not the highest priority before administering nitroglycerin.

DIF: Applying/Application REF: 1512

KEY: Reproductive problems| medical emergencies| patient safety| nitroglycerin/nitrates

MSC: Integrated Process: Nursing Process: Assessment

NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

10. A 34-year-old client comes to the clinic with concerns about an enlarged left testicle and heaviness in his lower abdomen. Which diagnostic test would the nurse expect to be ordered to confirm testicular cancer?

a.

Alpha-fetoprotein (AFP)

b.

Prostate-specific antigen (PSA)

c.

Prostate acid phosphatase (PAP)

d.

C-reactive protein (CRP)

ANS: A

AFP is a glycoprotein that is elevated in testicular cancer. PSA and PAP testing is used in the screening of prostate cancer. CRP is diagnostic for inflammatory conditions.

DIF: Remembering/Knowledge REF: 1514

KEY: Reproductive problems| cancer| laboratory values

MSC: Integrated Process: Nursing Process: Analysis

NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

11. A 25-year-old client has recently been diagnosed with testicular cancer and is scheduled for radiation therapy. Which intervention by the nurse is best?

a.

Ask the client about his support system of friends and relatives.

b.

Encourage the client to verbalize his fears about sexual performance.

c.

Explore with the client the possibility of sperm collection.

d.

Provide privacy to allow time for reflection about the treatment.

ANS: C

Sperm collection is a viable option for a client diagnosed with testicular cancer and should be completed before radiation therapy, chemotherapy, or radical lymph node dissection. The other options would promote psychosocial support but are not the priority intervention.

DIF: Applying/Application REF: 1514

KEY: Reproductive problems| cancer| coping

MSC: Integrated Process: Nursing Process: Implementation

NOT: Client Needs Category: Psychosocial Integrity

12. A 70-year-old client returned from a transurethral resection of the prostate 8 hours ago with a continuous bladder irrigation. The nurse reviews his laboratory results as follows:

Sodium

128 mEq/L

Hemoglobin

14 g/dL

Hematocrit

42%

Red blood cell count

4.5

What action by the nurse is the most appropriate?

a.

Consider starting a blood transfusion.

b.

Slow down the bladder irrigation if the urine is pink.

c.

Report the findings to the surgeon immediately.

d.

Take the vital signs every 15 minutes.

ANS: B

The serum sodium is decreased due to large-volume bladder irrigation (normal is 136 to 145 mEq/L). By slowing the irrigation, there will be less fluid overload and sodium dilution. The hemoglobin and hematocrit values are a low normal, with a slight decrease in the red blood cell count. Therefore, a blood transfusion or frequent vital signs should not be necessary. Immediate report to the surgeon is not necessary.

DIF: Analyzing/Analysis REF: 1505

KEY: Reproductive problems| fluid and electrolyte imbalance| postoperative nursing

MSC: Integrated Process: Nursing Process: Implementation

NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

13. The nurse is teaching an uncircumcised 65-year-old client about self-management of a urinary catheter in preparation for discharge to his home. What statement indicates a lack of understanding by the client?

a.

I only have to wash the outside of the catheter once a week.

b.

I should take extra time to clean the catheter site by pushing the foreskin back.

c.

The drainage bag needs to be changed at least once a week and as needed.

d.

I should pour a solution of vinegar and water through the tubing and bag.

ANS: A

The first few inches of the catheter must be washed daily starting at the penis and washing outward with soap and water. The other options are correct for self-management of a urinary catheter in the home setting.

DIF: Remembering/Knowledge REF: 1511

KEY: Reproductive problems| patient education

MSC: Integrated Process: Teaching/Learning

NOT: Client Needs Category: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. The nurse is administering finasteride (Proscar) and doxazosin (Cardura) to a 67-year-old client with benign prostatic hyperplasia. What precautions are related to the side effects of these medications? (Select all that apply.)

a.

Assessing for blood pressure changes when lying, sitting, and arising from the bed

b.

Immediately reporting any change in the alanine aminotransferase laboratory test

c.

Teaching the client about the possibility of increased libido with these medications

d.

Taking the clients pulse rate for a minute in anticipation of bradycardia

e.

Asking the client to report any weakness, light-headedness, or dizziness

ANS: A, B, E

Both the 5-alpha-reductase inhibitor (5-ARI) and the alpha1-selective blocking agents can cause orthostatic (postural) hypotension and liver dysfunction. The 5-ARI agent (Proscar) can cause a decreased libido rather than an increased sexual drive. The alpha-blocking drug (Cardura) can cause tachycardia rather than bradycardia.

DIF: Analyzing/Analysis REF: 1503

KEY: Reproductive problems| patient education| adverse effects

MSC: Integrated Process: Nursing Process: Implementation

NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A client is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? (Select all that apply.)

a.

Family history of prostate cancer

b.

Smoking

c.

Obesity

d.

Advanced age

e.

Eating too much red meat

f.

Race

ANS: A, D, E, F

Advanced family history of prostate cancer, age, a diet high in animal fat, and race are all risk factors for prostate cancer. Smoking and obesity are not known risk factors.

DIF: Remembering/Knowledge REF: 1507

KEY: Reproductive problems| lifestyle factors| patient education

MSC: Integrated Process: Teaching/Learning

NOT: Client Needs Category: Health Promotion and Maintenance

3. A client came to the clinic with erectile dysfunction. What are some possible causes of this condition that the nurse could discuss with the client during history taking? (Select all that apply.)

a.

Recent prostatectomy

b.

Long-term hypertension

c.

Diabetes mellitus

d.

Hour-long exercise sessions

e.

Consumption of beer each night

ANS: A, B, C, E

Organic erectile dysfunction can be caused by surgical procedures, hypertension and its treatment, diabetes mellitus, and alcohol consumption. There is no evidence that exercise is related to this problem.

DIF: Remembering/Knowledge REF: 1512

KEY: Reproductive problems| patient education| pathophysiology

MSC: Integrated Process: Nursing Process: Assessment

NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

SHORT ANSWER

1. Post transurethral resection of the prostate, a client has a three-way catheter with a continuous bladder irrigation. Over the last 12 hours, there has been 1400 mL of irrigation solution infused and 2000 mL measured in output from the drainage bag. What is the recording of the urinary output for the 12-hour period? (Record your answer using a whole number.) ____ mL

ANS:

600 mL

2000 mL from the drainage bag (including both the irrigation fluid and urine) minus the 1400 mL of irrigation fluid equals 600 mL of urine: 2000 mL 1400 mL = 600 mL.

DIF: Applying/Application REF: 1517

KEY: Reproductive problems| nursing intervention| fluid and electrolyte balance

MSC: Integrated Process: Nursing Process: Analysis

NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

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