[Osborn] chapter 50

Learning Outcomes [Number and Title ]

Learning Outcome 1
Identify the most common male reproductive disorders.
Learning Outcome 2
Discuss the etiology, pathophysiology, clinical manifestations,
and treatments of testicular, penile, and prostatic disorders
Learning Outcome 3
Interpret diagnostic test results for male reproductive disorders.
Learning Outcome 4
Identify nursing management goals when caring for males with
reproductive disorders.
Learning Outcome 5
Apply nursing diagnoses and nursing process to the care of the
male patient with testicular and prostatic cancer.
Learning Outcome 6
Discuss health education, health promotion, and disease
prevention specific for male health.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Varicocele
Hydrocele
Prostatitis
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.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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%.
Cognitive Level: Application
Nursing Process: Diagnosis
Client Need: Physiological Integrity
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
Cognitive Level: Analysis
Nursing Process: Implementation
Client Need: Psychosocial Integrity
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

African star grass

St. Johns wort
Dill weed
Oil of primrose

Answer: African star grass

Rationale: African star grass is used to prevent or decrease the symptoms of BPH. St. Johns wort
is used to manage depression. Oil of primrose is used in the management of premenstrual
syndrome. Dill weed is used in food preparations.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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 patients
medical history must be taken into consideration for this particular medication?
Select all that apply.
1.
2.
3.
4.
5.

The patient reports a history of hypotension.

The patient has angina.
The patient has a history of glaucoma.
The patient was recently hospitalized to regulate his insulin therapy.
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).

Cognitive Level: Application

Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
Cognitive Level: Analysis
Nursing Process: Evaluation
Client Need: Physiological Integrity
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Urinalysis
CT scan
IVP
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.
Cognitive Level: Application
Nursing Process: Diagnosis
Client Need: Health Promotion and Maintenance
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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 patients PSA results are within normal limits.
2. The patient does not have prostate cancer.
3. The patients PSA results are elevated, signaling likely prostate cancer.
4. The patients PSA results are inconclusive, signaling the need for additional testing.
Answer: The patients 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.
Cognitive Level: Analysis
Nursing Process: Diagnosis
Client Need: Health Promotion and Maintenance
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
Cognitive Level: Analysis
Nursing Process: Diagnosis
Client Need: Health Promotion and Maintenance
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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 patients plan of care, but
assessing the patients 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.
Cognitive Level: Analysis
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
Cognitive Level: Analysis
Nursing Process: Evaluation
Client Need: Physiological Integrity
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

13. A 45-year-old patient is undergoing treatment for testicular cancer. Cisplatin (Platinol-AQ) is
the medication being used. The nurse has completed the shift assessment and has reviewed the
days 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 patients 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.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
Cognitive Level: Application
Nursing Process: Planning
Client Need: Psychosocial Integrity
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Psychosocial Integrity
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

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 patients 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.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.