Preview Extract
Chapter 50
1. A patient reports to the emergency department with complaints of scrotal swelling. During
the nursing assessment, the patient reports his pain level at “2.” When asked to discuss the
characteristics of his pain, he reports feeling a dull ache associated with prolonged standing
or walking. The physical assessment reveals a “bag of worms” appearance to the scrotum.
Which of the following disorders is likely presented?
1. Varicocele
2. Hydrocele
3. Prostatitis
4. Testicular torsion
Answer: Varicocele
Rationale: The varicocele is an enlargement of the veins in the scrotum. It is associated with a
swelling and dull ache in the scrotum. The hydrocele is also associated with a dull ache, but
placing a light source behind the swollen scrotum will cause a glow as the fluid is penetrated
by the light. Patients experiencing prostatitis will report problems with urinary elimination.
Testicular torsion will present with pain and discomfort.
2. A student nurse is preparing a presentation on reproductive cancers of the male. Which of
the following concepts should be included in the presentation?
1. Farmers may have a higher incidence for the development of testicular cancer than whitecollar workers.
2. African American men have the highest rate of testicular cancer.
3. The development of testicular cancer is most common in men over the age of 40.
4. The mortality rate for men diagnosed with testicular cancer is approximately 10%.
Answer: Farmers may have a higher incidence for the development of testicular cancer than
white-collar workers.
Rationale: The development of testicular cancer is associated to exposure to insecticides. The
work activities of a farmer will promote a greater exposure to these chemicals than to
someone performing office-related duties. The highest rate for the development of testicular
cancer is in men of Scandinavian descent. Testicular cancer is highest in men ages 20 to 39.
The mortality rate is just under 5%.
3. An 86-year-old patient has just been diagnosed with benign prostatic hyperplasia (BPH).
While discussing the condition with the nurse, the patient shakes his head and states, “I
thought this disease was more common in middle-aged men.” What response by the nurse is
most appropriate?
1. “This condition is seen in about 90% of men your age.”
2. “This disease is most common in men between the ages of 40 and 55.”
3. “No one really knows why this happens in older men.”
4. “I understand how you feel.”
Answer: “This condition is seen in about 90% of men your age.”
Rationale: The occurrence of BPH increases with aging. The disorder is seen in up to 90% of
men age 85 and older. The disease is the result of an overgrowth of prostatic tissue. Telling
the patient about understanding he is upset does not meet the needs of the interaction and
lacks empathy.
4. After experiencing increasing difficulty with urination, a 55-year-old patient has been
diagnosed with benign prostatic hyperplasia (BPH). The patient reports a desire to avoid
surgical intervention at this time. The health care provider prescribes a pharmacological
therapy and encourages the patient to consider an herbal remedy as well. Based upon your
understanding, which of the following will likely be recommended?
1. African star grass
2. St. John’s wort
3. Dill weed
4. Oil of primrose
Answer: African star grass
Rationale: African star grass is used to prevent or decrease the symptoms of BPH. St. John’s
wort is used to manage depression. Oil of primrose is used in the management of
premenstrual syndrome. Dill weed is used in food preparations.
5. A 44-year-old man has sought treatment for erectile dysfunction. The patient asks
specifically to be considered for sildenafil (Viagra) therapy. Which of the following factors in
the patient’s medical history must be taken into consideration for this particular medication?
Select all that apply.
1. The patient reports a history of hypotension.
2. The patient has angina.
3. The patient has a history of glaucoma.
4. The patient was recently hospitalized to regulate his insulin therapy.
5. The patient has a history of type 2 diabetes managed by oral hypoglycemic medications.
Answer:
1. The patient reports a history of hypotension.
2. The patient has angina.
Rationale: The patient reports a history of hypotension. Sildenafil (Viagra) will cause
coronary vasodilation and hypotension. A patient having a history of hypotension may face
excessively low blood pressure readings as a result of this therapy. The patient has angina.
Nitroglycerine is used to manage angina. The use of nitrates contradicts the use of sildenafil
(Viagra). The patient has a history of glaucoma. Glaucoma is not an indication to limit the use
of sildenafil (Viagra). The patient was recently hospitalized to regulate his insulin therapy.
Diabetes is not an indication to limit the use of sildenafil (Viagra). The patient has a history
of type 2 diabetes managed by oral hypoglycemic. Neither type 2 diabetes nor the use of oral
hypoglycemic medications will negatively impact the use of sildenafil (Viagra).
6. A patient is preparing to undergo an invasive procedure to manage his benign prostatic
hyperplasia (BPH). The patient and health care provider have selected transurethral needle
ablation (TUNA) as the preferred procedure. Which of the following statements by the
patient indicates an accurate understanding of the procedure?
1. “The TUNA procedure will not require a hospital admission.”
2. “The extra money this procedure will cost over the TURP will be well worth the reduced
complications.”
3. “I can anticipate needing to have this procedure repeated in about 5 to 7 years.”
4. “Bleeding is a serious complication associated with the TUNA procedure.”
Answer: “The TUNA procedure will not require a hospital admission.”
Rationale: The transurethral needle ablation (TUNA) is an outpatient procedure. It is more
economical and has fewer problems with bleeding and complications than many other
procedures. A downside to the procedure is the need to repeat it in 1 to 2 years.
7. Laboratory testing is ordered for a 61-year-old patient suspected of having prostatitis.
Which of the following procedures will likely be included?
1. Urinalysis
2. CT scan
3. IVP
4. Digital rectal examination
Answer: Urinalysis
Rationale: The patient being tested for prostatitis will have a series of urine specimens
collected. A CT exam and IVP will not be included in the assessment. The digital rectal
examination is performed but is not a laboratory assessment.
8. A patient who is suspected of having prostate cancer has had laboratory tests completed.
The PSA result is 3ng/mL. Which of the following inferences can be made about this
information?
1. The patient’s PSA results are within normal limits.
2. The patient does not have prostate cancer.
3. The patient’s PSA results are elevated, signaling likely prostate cancer.
4. The patient’s PSA results are inconclusive, signaling the need for additional testing.
Answer: The patient’s PSA results are within normal limits.
Rationale: PSA levels less than 4 ng/mL are considered within normal limits. The PSA is a
screening tool. It not an absolute test for the presence of cancer. Results greater than 10
ng/mL are indicative of cancer in 67% of patients.
9. A 19-year-old patient presents to the emergency department with complaints of testicular
inflammation and pain. Laboratory tests are performed. Which of the following results is
consistent with the suspected diagnosis of orchitis?
1. WBC: 14,500/mm3
2. PSA: 12ng/mL
3. Urinalysis: no red blood cells noted
4. Platelet count: 250,000
Answer: WBC: 14,500/mm3
Rationale: An elevation in the white blood cells is consistent with the presence of an
infection. The PSA is a screening tool used to assess for the likelihood of prostate cancer. The
urinalysis and platelet results are within normal limits.
10. A 62-year-old patient has been diagnosed with bacterial epididymitis. The nurse has
provided education relating to the management of the disorder. Which of the following
statements by the patient indicates understanding of the teaching provided?
1. “These problems may be a result of my prostate problems.”
2. “This condition will spontaneously go away.”
3. “I must be on bed rest during the acute phase of this disorder.”
4. “I should go home and apply moist heat to my scrotum.”
Answer: “These problems may be a result of my prostate problems.”
Rationale: The older man with epididymitis may have gotten the condition as a result of
prostatitis, instrumentation, or a structural lesion. The condition must be treated with
antibiotics. Bedrest is not a requirement of condition management. Cold applications should
be used during the acute phase.
11. A nurse has been assigned to a patient who has just had surgery to manage testicular
cancer. When preparing the plan of care, which of the following problems will be of the
highest priority?
1. Pain management
2. Anxiety and fear
3. Potential for nausea
4. Knowledge deficit related to radiation therapy
Answer: Pain management
Rationale: The problems listed will all need to be incorporated in the patient’s plan of care,
but assessing the patient’s level of pain and providing interventions to address the complaints
will be of the highest priority. Until the pain is at an acceptable level, the patient will be
unable to meet other postoperative challenges.
12. The nurse is caring for a man diagnosed with testicular cancer. Surgery is scheduled in 1
week. Which of the following statements indicates the patient understands the education
provided?
1. “I will likely be given an enema in the hours preceding my surgery.”
2. “I may use aspirin during the period leading up to my surgery.”
3. “I should not take my insulin in the days leading up to surgery.”
4. “Ibuprofen is an acceptable over-the-counter preparation to take in the days before my
surgery if I need it.”
Answer: “I will likely be given an enema in the hours preceding my surgery.”
Rationale: Because an abdominal inguinal incision will be used to perform the orchiectomy, a
bowel preparation will be indicated. Aspirin is not an accepted medication in the days prior to
surgery, as it may cause increased bleeding. The patient will need to maintain glucose control
in the days leading up to the surgical procedure and will need to continue his scheduled
insulin therapy. Ibuprofen is an NSAID and is associated with an increase in bleeding risk
and should be avoided for the week prior to surgery.
13. A 45-year-old patient is undergoing treatment for testicular cancer. Cisplatin (PlatinolAQ) is the medication being used. The nurse has completed the shift assessment and has
reviewed the day’s laboratory results. Which of the following developments will require the
nurse to notify the health care provider?
1. The patient has voided 500 cc in the past 24 hours.
2. The patient complains of nausea 2 hours after the medication is administered.
3. The patient reports noticing an increase in hair loss over the past 2 days.
4. The patient’s white blood cell count is 7,000.
Answer: The patient has voided 500 cc in the past 24 hours.
Rationale: Cisplatin (Platinol-AQ) may be accompanied with an impairment in renal
function. Urinary output of 500 cc for a 24-hour period is inadequate and may signal a
reduction in renal function. The use of chemotherapy medications may have side effects
including nausea, vomiting, and alopecia. These are not life threatening at this time. The
white blood cell count is within normal limits.
14. The nurse is planning care for the patient who has just been diagnosed with testicular
cancer. Surgery is planned. Which if the following patient problems should be included in the
plan of care?
1. Altered body image
2. Erectile dysfunction
3. Urinary incontinence
4. Bowel incontinence
Answer: Altered body image
Rationale: An orchiectomy is the surgical procedure used for testicular cancer. Men
undergoing the procedure will be faced with a potential change in body image. The procedure
is not associated with erectile dysfunction or incontinence.
15. The wife of a man diagnosed with prostate cancer appears disheveled and anxious during
her visit to her husband. When the patient leaves the floor for testing, the nurse uses the
opportunity to approach her. Which of the following approaches by the nurse is most
therapeutic?
1. “Would you like to talk about your concerns?”
2. “What is wrong?”
3. “I can see that you are having a difficult time.”
4. “You must be having problems with all of this.”
Answer: “Would you like to talk about your concerns?”
Rationale: The spouse of a man diagnosed with prostate cancer can experience stress and
anxiety. It is important for the nurse to include her in the plan of care. Asking her to share
feelings is a good starting point to assess for her specific needs. Simply asking “what is
wrong” may indicate to her that she has made an error or is presenting herself in a negative
manner. Expressing to her that you are able to see that she is having difficulties is making a
judgment about her coping abilities and does little to open the dialogue. Advising her that she
“must” be having problems is a closed statement and does not promote communication.
16. A nurse is planning a community outreach program to discuss the prevention of prostate
cancer. When developing the program, which of the following should be included in the
information provided to participants?
1. The digital rectal examination should be incorporated into the annual physical exams of
men beginning at age 50.
2. Men over the age of 50 should have a CT scan every other year to assess for prostatic
changes.
3. PSA testing should begin annually for men at the age of 45.
4. Men who have a positive family history for prostate cancer should have a digital rectal
examination at the age of 30 to provide baseline information.
Answer: The digital rectal examination should be incorporated into the annual physical
exams of men beginning at age 50.
Rationale: Annual digital rectal examination and PSA testing should begin for men at the age
of 50. A CT scan is an expensive diagnostic test. It may be utilized to more definitively
diagnose a suspected problem with the prostate gland. There is no available information
about the use of a baseline digital rectal examination for men at the age of 30.
17. During a routine physical examination, a 49-year-old patient voices concerns about
developing BPH. He is interested in actions he can take to promote prostate health and
potentially avoid the development of the disorder. What information can be provided to the
patient?
1. Encourage the patient to limit alcohol intake.
2. There is nothing that can be done to avoid the onset of BPH.
3. Advise the patient to increase the amount of caffeine in his diet.
4. Encourage the patient to use vitamin E preparations weekly.
Answer: Encourage the patient to limit alcohol intake.
Rationale: Avoidance of bladder/renal irritants will aid in the promotion of healthy urinary
functioning. Caffeine is a bladder irritant and its use should be limited. Vitamin E does not
have an impact on prostate functioning.
18. A 35-year-old man voices questions during a routine physical examination about
nonpharmacological interventions available to promote his sexuality. The nursing assessment
reveals there are not significant problems with the patient’s performance. The focus of the
patient appears to be related to prevention of future problems. What information can be
provided?
1. The implementation of a diet and exercise program should be considered.
2. The use of sildenafil (Viagra) is primary treatment available to promote male sexuality.
3. The patient should investigate the use of saw palmetto.
4. The use of cactus flower has been promoted to improve sexual functioning.
Answer: The implementation of a diet and exercise program should be considered
Rationale: Studies continue to support the use of diet and exercise to promote overall health
status, including sexual health. The use of sildenafil (Viagra) is limited to erectile
dysfunction. Saw palmetto has been investigated, but reviews do not support its use for
sexual health over diet and exercise. Cactus flower is an alternative therapy used for men
experiencing BPH.
