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The Client with Reproductive Health Problems TEST■ The Client with Uterine Fibroids■ The Client with Breast Disease■ The Client with Benign Prostatic Hypertrophy■ The Client with a Sexually Transmitted Disease■ The Client with Cancer of the Cervix■ The Client with Cancer of the Ovaries■ The Client Having Gynecological Surgery■ The Client with Testicular Disease■ The Client with Cancer of the Prostate■ The Client with Erectile Dysfunction■ Managing Care Quality and Safety■ Answers, Rationales, and Test Taking StrategiesThe Client with Breast Disease23. A postmenopausal woman is worried aboutpain in the upper outer quadrant of her left breast.The nurse’s fi rst course of action is to:■ 1. Do a breast examination and report the resultsto the physician.■ 2. Explain that pain is caused by hormonal fl uctuations.■ 3. Reassure the client that pain is not a symptomof breast cancer.■ 4. Teach the client the correct procedure forbreast self-examination (BSE).24. The nurse teaches a female client that thebest time in the menstrual cycle to examine thebreasts is during the:■ 1. Week that ovulation occurs.■ 2. Week that menstruation occurs.■ 3. First week after menstruation.■ 4. Week before menstruation occurs.The Client with Breast Disease23. A postmenopausal woman is worried aboutpain in the upper outer quadrant of her left breast.The nurse’s fi rst course of action is to:■ 1. Do a breast examination and report the resultsto the physician.■ 2. Explain that pain is caused by hormonal fl uctuations.■ 3. Reassure the client that pain is not a symptomof breast cancer.■ 4. Teach the client the correct procedure forbreast self-examination (BSE).24. The nurse teaches a female client that thebest time in the menstrual cycle to examine thebreasts is during the:■ 1. Week that ovulation occurs.■ 2. Week that menstruation occurs.■ 3. First week after menstruation.■ 4. Week before menstruation occurs.29. During the admission workup for a modifi edradical mastectomy, the client is extremely anxiousand asks many questions. Which of the followingapproaches would offer the best guide for the nurseto answer questions raised by this apprehensivepreoperative client?■ 1. Tell the client as much as she wants to knowand is able to understand.■ 2. Delay discussing the client’s questions withher until she is convalescing.■ 3. Delay discussing the client’s questions withher until her apprehension subsides.■ 4. Explain to the client that she should discussher questions fi rst with the physician.30. A client asks the nurse, “Where is cancerusually found in the breast?” When responding tothe client, the nurse uses a diagram of a left breastand indicates that most malignant tumors occur inwhich quadrant of the breast?■ 1. Upper outer quadrant.■ 2. Upper inner quadrant.■ 3. Lower outer quadrant.■ 4. Lower inner quadrant.31. Atropine sulfate is included in the preoperativeorders for a client undergoing a modifi ed radicalmastectomy. The expected outcome is to:■ 1. promote general muscular relaxation.■ 2. decrease pulse and respiratory rates.■ 3. decrease nausea.■ 4. inhibit oral and respiratory secretions.32. During the postoperative period after a modified radical mastectomy, the client confi des in thenurse that she thinks she got breast cancer becauseshe had an abortion and she did not tell her husband.The best response by the nurse is which of thefollowing?■ 1. “Cancer is not a punishment; it is a disease.”■ 2. “You might feel better if you confi ded in yourhusband.”■ 3. “Tell me more about your feelings on this.”■ 4. “I can have the social worker talk to you ifyou would like.”33. Postoperatively after a modifi ed radicalmastectomy, a client has an incisional drainage tubeattached to Hemovac suction. The nurse determinesthe suction is effective when:■ 1. The intrathoracic pressure is decreased andthe client breathes easier.■ 2. There is an increased collateral lymphaticfl ow toward the operative area.■ 3. Accumulated serum and blood in the operativearea are removed.■ 4. No adhesions are formed between the skinand chest wall in the operative area.34. Which of the following positions would bebest for a client’s right arm when she returns to herroom after a right modifi ed radical mastectomy withmultiple lymph node excisions?■ 1. Across her chest wall.■ 2. At her side at the same level as her body.■ 3. In the position that affords her the greatest comfortwithout placing pressure on the incision.■ 4. On pillows, with her hand higher than herelbow and her elbow higher than her shoulder.35. The client with breast cancer is prescribedtamoxifen (Nolvadex) 20 mg daily. The client statesshe does not like taking medicine and asks the nurseif the tamoxifen is really worth taking. The nurse’sbest response is which of the following?■ 1. “This drug is part of your chemotherapy program.”■ 2. “This drug has been found to decrease metastaticbreast cancer.”■ 3. “This drug will act as an estrogen in yourbreast tissue.”■ 4. “This drug will prevent hot fl ashes since youcannot take hormone replacement.”36. A client undergoing chemotherapy after amodifi ed radical mastectomy asks the nurse questionsabout a breast prosthesis and wigs. After answeringthe questions directly, the nurse should also:■ 1. Provide a list of resources, including the localbreast cancer support group.■ 2. Offer a referral to the social worker.■ 3. Call the home health care agency.■ 4. Contact the plastic surgeon.37. A client is to have radiation therapy aftera modifi ed radical mastectomy. The nurse shouldteach the client to care for the skin at the site oftherapy by:■ 1. Washing the area with water.■ 2. Exposing the area to dry heat.■ 3. Applying an ointment to the area.■ 4. Using talcum powder on the area.38. The nurse should teach a client that a normallocal tissue response to radiation is:■ 1. Atrophy of the skin.■ 2. Scattered pustule formation.■ 3. Redness of the surface tissue.■ 4. Sloughing of two layers of skin.39. The nurse refers a client who had a mastectomyto “Reach to Recovery.” The primary purposeof the American Cancer Society’s Reach to Recoveryprogram is to:■ 1. Foster rehabilitation in women who have hadmastectomies.■ 2. Raise funds to support early breast cancerdetection programs.■ 3. Provide free dressings for women who havehad radical mastectomies.■ 4. Collect statistics for research from womenwho have had mastectomies.The Client with Benign ProstaticHypertrophy40. A 72-year-old male is in the emergencydepartment because he has been unable to void forthe past 12 hours. The best method for the nurse touse when assessing for bladder distention in a maleclient is to check for:■ 1. A rounded swelling above the pubis.■ 2. Dullness in the lower left quadrant.■ 3. Rebound tenderness below the symphysis.■ 4. Urine discharge from the urethral meatus.41. During a client’s urinary bladder catheterization,the nurse ensures that the bladder is emptiedgradually. The best rationale for the nurse’s action isthat completely emptying an overdistended bladderat one time tends to cause:■ 1. Renal failure.■ 2. Abdominal cramping.■ 3. Possible shock.■ 4. Atrophy of bladder musculature.42. The primary reason for lubricating the urinarycatheter generously before inserting it into amale client is that this technique helps reduce:■ 1. Spasms at the orifi ce of the bladder.■ 2. Friction along the urethra when the catheteris being inserted.■ 3. The number of organisms gaining entrance tothe bladder.■ 4. The formation of encrustations that mayoccur at the end of the catheter.43. The primary reason for taping an indwellingcatheter laterally to the thigh of a male clientis to:■ 1. Eliminate pressure at the penoscrotal angle.■ 2. Prevent the catheter from kinking in the urethra.■ 3. Prevent accidental catheter removal.■ 4. Allow the client to turn without kinking thecatheter.44. Many older men with prostatic hypertrophydo not seek medical attention until urinary obstructionis almost complete. One reason for this delay inseeking attention is that these men may:■ 1. Feel too self-conscious to seek help whenreproductive organs are involved.■ 2. Expect that it is normal to have to livewith some urinary problems as they growolder.■ 3. Fear that sexual indiscretions in earlier lifemay be the cause of their problem.■ 4. Have little discomfort in relation to theamount of pathology because responses topain stimuli fade with age.45. When caring for a client with a history ofbenign prostatic hypertrophy (BPH), the nurseshould do which of the following? Select all thatapply.■ 1. Provide privacy and time for the client to void.■ 2. Monitor intake and output.■ 3. Catheterize the client for post void residualurine.■ 4. Ask the client if he has urinary retention.■ 5. Test the urine for hematuria.46. The nurse should specifi cally assess a clientwith prostatic hypertrophy for which of the following ?■ 1. Voiding at less frequent intervals.■ 2. Diffi culty starting the fl ow of urine.■ 3. Painful urination.■ 4. Increased force of the urine stream.47. The nurse is reviewing the medication historyof a client with benign prostatic hypertrophy(BPH). Which medication will likely aggravate BPH?■ 1. Metformin (Glucophage).■ 2. Buspirone (BuSpar).■ 3. Inhaled ipratropium (Atrovent).■ 4. Ophthalmic timolol (Timoptic).48. A client is scheduled to undergo transurethralresection of the prostate. The procedure is tobe done under spinal anesthesia. Postoperatively,the nurse should assess the client for:■ 1. Seizures.■ 2. Cardiac arrest.■ 3. Renal shutdown.■ 4. Respiratory paralysis.49. A client with benign prostatic hypertrophy(BPH) is being treated with terazosin (Hytrin) 2 mgat bedtime. The nurse should monitor the client’s:■ 1. Urine nitrites.■ 2. White blood cell count.■ 3. Blood pressure.■ 4. Pulse.50. A client underwent transurethral resection ofthe prostate (TURP), and a large three-way indwellingurinary catheter was inserted in the bladderwith continuous bladder irrigation. In which of thefollowing circumstances should the nurse increasethe fl ow rate of the continuous bladder irrigation?■ 1. When drainage is continuous but slow.■ 2. When drainage appears cloudy and dark yellow.■ 3. When drainage becomes bright red.■ 4. When there is no drainage of urine and irrigatingsolution.51. A client is to receive belladonna and opiumsuppositories, as needed, postoperatively aftertransurethral resection of the prostate (TURP). Thenurse should give the client these drugs when hedemonstrates signs of:■ 1. A urinary tract infection.■ 2. Urine retention.■ 3. Frequent urination.■ 4. Pain from bladder spasms.52. A nursing assistant tells the nurse, “I thinkthe client is confused. He keeps telling me he has tovoid, but that isn’t possible because he has a catheterin place that is draining well.” Which of thefollowing responses would be most appropriate forthe nurse to make?■ 1. “His catheter is probably plugged. I’ll irrigateit in a few minutes.”■ 2. “That’s a common complaint after prostatesurgery. The client only imagines the urge tovoid.”■ 3. “The urge to void is usually created by thelarge catheter, and he may be having somebladder spasms.”■ 4. “I think he may be somewhat confused.”53. A physician has ordered amoxicillin 100P.O. BID (Ampicillin). The nurse should teach theclient to: Select all that apply.■ 1. Drink 2,500 mL of fl uids daily.■ 2. Void frequently, at least every 2 to 3 hours.■ 3. Take time to empty the bladder completely.■ 4. Take the last dose of the antibiotic for the dayat bedtime.■ 5. Take the antibiotic with food.54. In discussing home care with a client aftertransurethral resection of the prostate (TURP), thenurse should teach the male client that dribbling ofurine:■ 1. Can be a chronic problem.■ 2. Can persist for several months.■ 3. Is an abnormal sign that requires intervention.■ 4. Is a sign of healing within the prostate.55. A priority nursing diagnosis for the clientwho is being discharged to home 3 days after transurethralresection of the prostate (TURP) is:■ 1. Defi cient fl uid volume.■ 2. Imbalanced nutrition: Less than body requirements.■ 3. Impaired tissue integrity.■ 4. Ineffective airway clearance.56. A client with benign prostatic hypertrophy(BPH) has an elevated prostate-specifi c antigen(PSA) level. The nurse should?■ 1. Instruct the client to have a colonoscopybefore coming to conclusions about the PSAresults.■ 2. Instruct the client that a urologist will monitorthe PSA level biannually when elevated.■ 3. Determine if the prostatic palpation was donebefore or after the blood sample was drawn.■ 4. Ask the client if he emptied his bladderbefore the blood sample was obtained.The Client with Testicular Disease98. A 28-year-old male is diagnosed with acuteepididymitis. The nurse should assess the client for:■ 1. Burning and pain on urination.■ 2. Severe tenderness and swelling in the scrotum.■ 3. Foul-smelling ejaculate.■ 4. Foul-smelling urine.99. A 20-year-old client is being treated forepididymitis. Teaching for this client should includethe fact that epididymitis is commonly a result of a:■ 1. Virus.■ 2. Parasite.■ 3. Sexually transmitted infection.■ 4. Protozoon.100. When teaching a client to perform testicularself-examination, the nurse explains that the examinationshould be performed:■ 1. After intercourse.■ 2. At the end of the day.■ 3. After a warm bath or shower.■ 4. After exercise.101. The nurse is assessing a client’s testes. Whichof the following fi ndings indicate the testes arenormal?■ 1. Soft.■ 2. Egg-shaped.■ 3. Spongy.■ 4. Lumpy.102. A client has a testicular nodule that is highlysuspicious for testicular cancer. A laboratory testthat supports this diagnosis is:■ 1. Decreased alpha fetoprotein (AFP).■ 2. Decreased beta–human chorionic gonadotropin(hCG).■ 3. Increased testosterone.■ 4. Increased AFP.103. Although the cause of testicular cancer isunknown, it is associated with a history of:■ 1. Undescended testes.■ 2. Sexual relations at an early age.■ 3. Seminal vesiculitis.■ 4. Epididymitis.104. Risk factors associated with testicular malignanciesinclude:■ 1. African-American race.■ 2. Residing in a rural area.■ 3. Lower socioeconomic status.■ 4. Age older than 40 years.105. A client with a testicular malignancy undergoesa radical orchiectomy. In the immediate postoperativeperiod the nurse should particularlyassess the client for:■ 1. Bladder spasms.■ 2. Urine output.■ 3. Pain.■ 4. Nausea.106. A right orchiectomy is performed on a clientwith a testicular malignancy. The client expressesconcerns regarding his sexuality. The nurse shouldbase the response on the knowledge that the client:■ 1. Is not a candidate for sperm banking.■ 2. Should retain normal sexual drive and function.■ 3. Will be impotent.■ 4. Will have a change in secondary sexual characteristics.107. A client diagnosed with seminomatous testicularcancer expresses fear and questions the nurseabout his prognosis. The nurse should base theresponse on the knowledge that:■ 1. Testicular cancer is almost always fatal.■ 2. Testicular cancer has a cure rate of 90% whendiagnosed early.■ 3. Surgery is the treatment of choice for testicularcancer.■ 4. Testicular cancer has a 50% cure rate whendiagnosed early.The Client with Cancerof the Prostate108. The nurse is developing a program aboutprostate cancer for a health fair. The nurse shouldprovide information about which of the followingtopics?■ 1. The Prostate-Specifi c Antigen (PSA) test is reliablefor detecting the presence of prostate cancer.■ 2. For all men, age 50 and older, the AmericanCancer Society recommends an annual rectalexamination.■ 3. Avoid lifting more than 20 lb aids in preventionof prostate cancer.■ 4. Regular sexual activity promotes health of theprostate gland to prevent cancer.109. The nurse is caring for a client who willhave a bilateral orchiectomy. The client asks whatis involved with this procedure. The nurse’s mostappropriate response would be? “The surgery:■ 1. Removes the entire prostate gland, prostaticcapsule, and seminal vesicles.”■ 2. Tends to cause urinary incontinence andimpotence.”■ 3. Freezes prostate tissue, killing cells.”■ 4. Results in reduction of the major circulatingandrogen, testosterone.”110. The nurse is teaching a client newly diagnosedwith prostate cancer. Which of the following pointsshould be included in the instruction? Select all thatapply.■ 1. Prostate cancer is usually multifocal andslow-growing.■ 2. Most prostate cancers are adenocarcinoma.■ 3. The incidence of prostate cancer is higherin African American men, and the onset isearlier.■ 4. A prostate specifi c antigen (PSA) labtest greater than 4 ng/mg will need to bemonitored.■ 5. Cancer cells are detectable in the urine.111. When a client is receiving hormone replacementfor prostate cancer, the nurse should do whichof the following? Select all that apply.■ 1. Inform the client that increased libido isexpected with hormone therapy.■ 2. Reassure the client and his signifi cant otherthat erectile dysfunction will not occur as aconsequence of hormone therapy.■ 3. Provide the client the opportunity to communicateconcerns and needs.■ 4. Utilize communication strategies thatenable the client to gain some feeling ofcontrol.■ 5. Suggest that an appointment be made to see apsychiatrist.112. A client asks the nurse why the prostatespecifi c antigen (PSA) level is determined before thedigital rectal examination. The nurse’s best responseis which of the following?■ 1. “It is easier for the client.”■ 2. “A prostate examination can possiblydecrease the PSA.”■ 3. “A prostate examination can possiblyincrease the PSA.”■ 4. “If the PSA is normal, the client will not haveto undergo the rectal examination.”113. The nurse is performing a digital rectalexamination. Which of the following fi nding is akey sign for prostate cancer?■ 1. A hard prostate, localized or diffuse.■ 2. Abdominal pain.■ 3. A boggy, tender prostate.■ 4. A nonindurated prostate.114. A client is undergoing a total prostatectomyfor prostate cancer. The client asks questions abouthis sexual function. The best response by the nurseis which of the following?■ 1. “Loss of the prostate gland means that youwill be impotent.”■ 2. “Loss of the prostate gland means that youwill be infertile and there will be no ejaculation.You can still experience the sensationsof orgasm.”■ 3. “Loss of the prostate gland means that youwill have no loss of sexual function anddrive.”■ 4. “Loss of the prostate gland means that yourerectile capability will return immediatelyafter surgery.”115. A 65-year-old client has been told by the physicianthat his prostate cancer was graded at stageIIB. The client inquires if this means he is going todie soon. The best response by the nurse is which ofthe following?■ 1. “Prostate cancer at this stage is very slowgrowing.”■ 2. “Prostate cancer at this stage is very fastgrowing.”■ 3. “Prostate cancer at this stage has spread to thebone.”■ 4. “Prostate cancer at this stage is diffi cult topredict.”116. A client with prostate cancer is treated withhormone therapy consisting of diethylstilbestrol(DES; Stilphostrol), 2 mg daily. The nurse shouldinstruct the client to expect to have:■ 1. Tenderness of the scrotum.■ 2. Tenderness of the breasts.■ 3. Loss of pubic hair.■ 4. Decreased blood pressure.Answers The Client with Breast Disease23. 1. This complaint warrants the nurse’s performingan examination and reporting the results tothe physician. Hormone fl uctuations do cause breastdiscomfort, but an examination must be done atthis time to assess the breast. Although pain is notcommon with breast cancer, it can be a symptom.Teaching the client to perform BSE is important, butit is not the priority action in this : Physiological adaptation;CL: Synthesize24. 3. It is generally recommended that thebreasts be examined during the fi rst week aftermenstruation. During this time, the breasts are leastlikely to be tender or swollen because estrogen isat its lowest level. Therefore, the examination willbe more comfortable for the client. The examinationmay also be more accurate because the client ismore likely to notice an actual change in her breastthat is not simply related to hormonal : Health promotion and maintenance;CL: Apply25. 2. The client needs to become more confi dentand knowledgeable about the normal feel of theimplants and her breast tissue. The best technique isfor the nurse to demonstrate breast self-examination(BSE) to the client as the nurse conducts the clinicalbreast examination. Implant surgery does notexclude the need for monthly BSE. A mammogramis not a substitute for monthly : Health promotion and maintenance;CL: Synthesize26. 2. The breasts may vary in size before menstruationbecause of breast engorgement caused byhormonal changes. A woman may then note thather bra fi ts more tightly than usual. Benign cysts donot cause variation in breast size. A change in breastsize that does not follow hormonal changes couldwarrant further assessment. The breasts normallyare about the same size, although some women haveone breast slightly larger than the : Health promotion and maintenance;CL: Apply27. 2. Advancing age in postmenopausal womenhas been identifi ed as a risk factor for breast cancer.A 76-year-old client needs monthly breast selfexaminationand a yearly clinical breast examinationand mammogram to comply with the screeningschedule. While mammograms are less painful asbreast tissue becomes softer, the nurse should advisethe woman to have the mammogram. Family historyis important, but only about 5% of breast cancersare : Health promotion and maintenance;CL: Synthesize28. 1. If a client has questions the nurse cannotanswer, it is best to delay the signing of the consentuntil the questions are clarifi ed for the client. Thesurgeon should be notifi ed, and the appropriateinformation or collaboration should be providedfor the client before she signs the surgical consent.Telling her she should concentrate on recovery fi rstignores the client’s questions and concerns. Frequentlythe plastic surgeon needs to be consulted atthe beginning of the treatment because various surgicaldecisions depend on the future plans for : Management of care;CL: Synthesize29. 1. An important nursing responsibility ispreoperative teaching, and the most frequentlyrecommended guide for teaching is to tell the clientas much as she wants to know and is able to understand.Delaying discussion of issues about which the client has concerns is likely to aggravate thesituation and cause the client to feel distrust. As ageneral guide, the client would not ask the questionif she were not ready to discuss her situation. Thenurse is available to answer the client’s questionsand concerns and should not delay discussing thesewith the : Psychosocial adaptation;CL: Synthesize30. 1. About half of malignant breast tumorsoccur in the upper outer quadrant of the breast. Forno known reason, cancer appears in the left breastmore often than in the right breast. The upper outerquadrants of the breast, and especially the axillaryarea, should be covered thoroughly in the clinicalbreast examination and breast self-: Physiological adaptation;CL: Apply31. 4. Atropine sulfate, a cholinergic blockingagent, is given preoperatively to reduce secretionsin the mouth and respiratory tract, which assists inmaintaining the integrity of the respiratory systemduring general anesthesia. Atropine is not used topromote muscle relaxation, decrease nausea andvomiting, or decrease pulse and respiratory rates. Itcauses the pulse to : Pharmacological and parenteraltherapies; CL: Evaluate32. 3. The nurse should respond with an openendedstatement that elicits further exploration ofthe client’s feelings. Women with cancer may feelguilt or shame. Previous life decisions, sexuality,and religious beliefs may infl uence a client’s adjustmentto a diagnosis of cancer. The nurse shouldnot contradict the client’s feelings of punishmentor offer advice such as confi ding in the husband.A social worker referral may be benefi cial in thefuture, but is not the fi rst response needed to elicitexploration of the client’s : Psychosocial adaptation;CL: Synthesize33. 3. A drainage tube is placed in the woundafter a modifi ed radical mastectomy to help removeaccumulated blood and fl uid in the area. Removalof the drainage fl uids assists in wound healing andis intended to decrease the incidence of hematoma,abscess formation, and infection. Drainage tubesplaced in a wound do not decrease intrathoracicpressure, increase collateral lymphatic fl ow, or preventadhesion : Reduction of risk potential;CL: Evaluate34. 4. Lymph nodes can be removed from theaxillary area when a modifi ed radical mastectomy isdone, and each of the nodes is biopsied. To facilitatedrainage from the arm on the affected side, theclient’s arm should be elevated on pillows with herhand higher than her elbow and her elbow higherthan her shoulder. A sentinel node biopsy procedureis associated with a decreased risk of lymphedemabecause fewer nodes are : Physiological adaptation;CL: Synthesize35. 2. Tamoxifen is an antiestrogen drug that hasbeen found to be effective against metastatic breastcancer and to improve the survival rate. The drugcauses hot fl ashes as an adverse : Pharmacological and parenteraltherapies; CL: Synthesize36. 1. Giving the client a list of communityresources that could provide support and guidanceassists the client to maintain her self-image andindependence. The support group will include otherwomen who have undergone similar therapies andcan offer suggestions for breast products and wigs.Because the client is asking about specifi c resources,she does not need a referral to a social worker, homehealth agency, or plastic : Management of care; CL: Synthesize37. 1. A client receiving radiation therapy shouldavoid lotions, ointments, and anything that maycause irritation to the skin, such as exposure to sunlight,heat, or talcum powder. The area may safelybe washed with water if it is done gently and if careis taken not to injure the : Reduction of risk potential;CL: Synthesize38. 3. The most common reaction of the skin toradiation therapy is redness of the surface tissues.Dryness, tanning, and capillary dilation are alsocommon. Atrophy of the skin, pustules, and sloughingof two layers would not be expected and shouldbe reported to the : Reduction of risk potential;CL: Apply39. 1. The American Cancer Society’s Reach toRecovery is a rehabilitation program for womenwho have had breast surgery. It is designed to meettheir physical, psychological, and emotional needs.The Reach to Recovery program is implementedby women who have had breast cancer themselves.Many women benefi t from this peer information : Psychosocial adaptation; CL: ApplyThe Client with Benign ProstaticHypertrophy40. 1. The best way to assess for a distendedbladder in either a male or female client is to checkfor a rounded swelling above the pubis. This swellingrepresents the distended bladder rising abovethe pubis into the abdominal cavity. Dullness doesnot indicate a distended bladder. The client mightexperience tenderness or pressure above the symphysis.No urine discharge is expected; the urine fl owis blocked by the enlarged : Reduction of risk potential;CL: Analyze41. 3. Rapid emptying of an overdistended bladdermay cause hypotension and shock due to thesudden change of pressure within the abdominalviscera. Previously, removing no more than 1,000mL at one time was the standard of practice, but thisis no longer thought to be necessary as long as theoverdistended bladder is emptied : Reduction of risk potential;CL: Apply42. 2. Liberal lubrication of the catheter beforecatheterization of a male reduces friction along theurethra and irritation and trauma to urethral tissues.Because the male urethra is tortuous, a liberalamount of lubrication is advised to ease catheterpassage. The female urethra is not tortuous, and,although the catheter should be lubricated beforeinsertion, less lubricant is necessary. Lubricationof the catheter will not decrease spasms. The nurseshould use sterile technique to prevent introducingorganisms. Crusts will not form immediately. Irrigatingthe catheter as needed will prevent clot andcrust : Reduction of risk potential;CL: Apply43. 1. The primary reason for taping an indwellingcatheter to a male client so that the penis is heldin a lateral position is to prevent pressure at thepenoscrotal angle. Prolonged pressure at the penoscrotalangle can cause a ureterocutaneous fi : Reduction of risk potential;CL: Apply44. 2. Research shows that older men tend tobelieve it is normal to live with some urinary problems.As a result, these men often overlook symptomsand simply attribute them to aging. As partof preventive care for men older than age 40, theyearly physical examination should include palpationof the prostate via rectal examination. Prostatespecific antigen screening also is done annuallyto determine elevations or increasing trends in elevations. The nurse should teach male clients thevalue of early detection and adequate follow-up forthe : Reduction of risk potential;CL: Apply45. 1, 2, 4, 5. Because of the history of benignprostatic hypertrophy (BPH), the nurse shouldprovide privacy and time for the client to void. Thenurse should also monitor intake and output, assessthe client for urinary retention, and test the urinefor hematuria. It is not necessary to catheterize : Physiological adaptation;CL: Synthesize46. 2. Signs and symptoms of prostatic hypertrophyinclude diffi culty starting the fl ow of urine, urinaryfrequency and hesitancy, decreased force of theurine stream, interruptions in the urine stream whenvoiding, and nocturia. The prostate gland surroundsthe urethra, and these symptoms are all attributedto obstruction of the urethra resulting from prostatichypertrophy. Nocturia from incomplete emptyingof the bladder is common. Straining and urineretention are usually the symptoms that prompt theclient to seek care. Painful urination is generally nota symptom of prostatic : Physiological adaptation;CL: Analyze47. 3. Ipratropium is a bronchodilator, and itsanticholinergic effects can aggravate urine retention.Metformin and buspirone do not affect the urinarysystem; timolol does not have a systemic : Pharmacological and parenteraltherapies; CL: Apply48. 4. If paralysis of vasomotor nerves in theupper spinal cord occurs when spinal anesthesiais used, the client is likely to develop respiratoryparalysis. Artifi cial ventilation is required until theeffects of the anesthesia subside. Seizures, cardiacarrest, and renal shutdown are not likely results ofspinal : Physiological adaptation;CL: Analyze49. 3. Terazosin is an antihypertensive drug thatis also used in the treatment of BPH. Blood pressuremust be monitored to ensure that the client doesnot develop hypotension, syncope, or orthostatichypotension. The client should be instructed tochange positions slowly. Urine nitrates, white bloodcell count, and pulse rate are not affected by : Pharmacological and parenteraltherapies; CL: Analyze50. 3. The decision by the surgeon to insert acatheter after TURP or prostatectomy depends onthe amount of bleeding that is expected after theprocedure. During continuous bladder irrigationafter a TURP or prostatectomy, the rate at whichthe solution enters the bladder should be increasedwhen the drainage becomes brighter red. The colorindicates the presence of blood. Increasing the fl owof irrigating solution helps fl ush the catheter well sothat clots do not plug it. There would be no reasonto increase the fl ow rate when the return is continuousor when the return appears cloudy and darkyellow. Increasing the fl ow would be contraindicatedwhen there is no return of urine and : Pharmacological and parenteraltherapies; CL: Synthesize51. 4. Belladonna and opium suppositories areprescribed and administered to reduce bladderspasms that cause pain after TURP. Bladder spasmsfrequently accompany urologic procedures. Antispasmodicsoffer relief by eliminating or reducingspasms. Antimicrobial drugs are used to treat aninfection. Belladonna and opium do not relieveurine retention or urinary : Pharmacological and parenteraltherapies; CL: Synthesize52. 3. The indwelling urinary catheter creates theurge to void and can also cause bladder spasms. Thenurse should ensure adequate bladder emptying bymonitoring urine output and characteristics. Urineoutput should be at least 50 mL/hour. A pluggedcatheter, imagining the urge to void, and confusionare less likely reasons for the client’s : Reduction of risk potential;CL: Synthesize53. 1, 2, 3, 4. Ampicillin may be given with orwithout food, but the nurse should instruct the clientto obtain an adequate fl uid intake (2,500 mL)to promote urinary output and to fl ush out bacteriafrom the urinary tract. The nurse should alsoencourage the client to void frequently (every 2 to3 hours) and empty the bladder completely. Takingthe antibiotic at bedtime, after emptying the bladder,helps to ensure an adequate concentration of thedrug during the overnight : Physiological adaptation;CL: Synthesize54. 2. Dribbling of urine can occur for severalmonths after TURP. The client should be informedthat this is expected and is not an abnormal sign.The nurse should teach the client perineal exercisesto strengthen sphincter tone. The client may needto use pads for temporary incontinence. The client few months and will not be a chronic problem. Dribblingis not a sign of healing, but is related to thetrauma of : Basic care and comfort;CL: Synthesize55. 1. Defi cient fl uid volume is a priority diagnosisbecause the client needs to drink a large amountof fl uids to keep the urine clear. The urine shouldbe almost without color. About 2 weeks after TURP,when desiccated tissue is sloughed out, a secondaryhemorrhage could occur. The client should beinstructed to call the surgeon or go to the emergencydepartment if at any time the urine turns bright red.The client is not specifi cally at risk for nutritionalproblems after TURP. The client is not specifi cally atrisk for impaired tissue integrity because there is noexternal incision, and the client is not specifi callyat risk for airway problems because the procedure isdone under spinal : Basic care and comfort; CL: Analyze56. 3. Rectal and prostate examinations canincrease serum PSA levels; therefore, instruct theclient that a manual rectal examination is usuallypart of the test regimen to determine prostatechanges. The prostatic palpation should be doneafter the blood sample is drawn. The PSA level mustbe monitored more often than biannually when it iselevated. Having a colonoscopy is not related to thefi ndings of the PSA test. It is not necessary to voidprior to having PSA blood levels : Health promotion and maintenance;CL: SynthesizeThe Client with Testicular Disease98. 2. Epididymitis causes acute tenderness andpronounced swelling of the scrotum. Gradual onsetof unilateral scrotal pain, urethral discharge, andfever are other key signs. Epididymitis is occasionally,but not routinely, associated with urinary tractinfection. Burning and pain on urination and foulsmellingejaculate or urine are not classic symptomsof : Physiological adaptation;CL: Analyze99. 3. Among men younger than age 35,epididymitis is most frequently caused by a sexuallytransmitted infection. Causative organisms are usuallychlamydia or Neisseria gonorrhoeae. The othermajor form of epididymitis is bacterial, caused bythe Escherichia coli or Pseudomonas organisms. Thenurse should always include safe sex teaching for aclient with epididymitis. The client should also be is a mode of transmission of gram-negative rods tothe : Reduction of risk potential;CL: Apply100. 3. After a warm bath or shower, the testeshang lower and are both relaxed and in the idealposition for manual evaluation and : Health promotion and maintenance;CL: Apply101. 2. Normal testes feel smooth, egg-shaped,and fi rm to the touch, without lumps. The surfaceshould feel smooth and rubbery. The testes shouldnot be soft or spongy to the touch. Testicular malignanciesare usually nontender, nonpainful hardlumps. Lumps, swelling, nodules, or signs of infl ammationshould be reported to the : Health promotion and maintenance;CL: Analyze102. 4. AFP and hCG are considered markers thatindicate the presence of testicular disease. ElevatedAFP and hCG and decreased testosterone are markersfor testicular disease. Measurements of AFP,hCG, and testosterone are also obtained throughoutthe course of therapy to help measure the effectivenessof : Physiological adaptation;CL: Apply103. 1. Cryptorchidism (undescended testes) carriesa greatly increased risk for testicular cancer.Undescended testes occurs in about 3% of maleinfants, with an increased incidence in prematureinfants. Other possible causes of malignancy includechemical carcinogens, trauma, orchitis, and environmentalfactors. Testicular cancer is not associatedwith early sexual relations in men, even though cervicalcancer is associated with early sexual relationsin women. Testicular cancer is not associated withseminal vesiculitis or : Health promotion and maintenance;CL: Apply104. 2. The incidence of testicular cancer is higherin men who live in rural rather than suburbanareas. Testicular cancer is more common in whitethan black men. Men with higher socioeconomicstatus seem to have a greater incidence of testicularcancer. The exact cause of testicular cancer isunknown. Cancer of the testes is the leading causeof death from cancer in the 15- to 35-year-old : Health promotion and maintenance;CL: Analyze105. 3. Because of the location of the incisionin the high inguinal area, pain is a major problemduring the immediate postoperative period. Theincisional area and discomfort caused by movementcontribute to increased pain. Bladder spasms andelimination problems are more commonly associatedwith prostate surgery. Nausea is not a : Physiological adaptation;CL: Synthesize106. 2. Unilateral orchiectomy alone does notresult in impotence if the other testis is normal. Theother testis should produce enough testosteroneto maintain normal sexual drive, functioning, andcharacteristics. Sperm banking before treatment iscommonly recommended because radiation or chemotherapycan affect : Psychosocial adaptation;CL: Synthesize107. 2. When diagnosed early and treated aggressively,testicular cancer has a cure rate of about90%. Treatment of testicular cancer is based ontumor type, and seminoma cancer has the best prognosis.Modes of treatment include combinations oforchiectomy, radiation therapy, and chemotherapy.The chemotherapeutic regimen used currently isresponsible for the successful treatment of : Physiological adaptation; CL: ApplyThe Client with Cancerof the Prostate108. 2. Most prostate cancer is adenocarcinomaand is palpable on rectal examination becauseit arises from the posterior portion of the gland.Although the PSA is not a perfect screening test, theAmerican Cancer Society recommends an annualrectal examination and blood PSA level for all menage 50 and older, or starting at age 40 if AfricanAmerican or if there is family history of prostatecancer. To help achieve optimal sexual function,give the client the opportunity to communicate hisconcerns and sexual needs. Regular sexual activitydoes not prevent : Health promotion and maintenance;CL: Synthesize109. 4. Bilateral orchiectomy (removal of testes)results in reduction of the major circulating androgen,testosterone, as a palliative measure to reducesymptoms and progression of prostate cancer.A radical prostatectomy (removal of entire prostategland, prostatic capsule, and seminal vesicles) may include pelvic lymphadenectomy. Complicationsinclude urinary incontinence, impotence, and rectalinjury with the radical prostatectomy. Cryosurgeryfreezes prostate tissue, killing tumor cells : Health promotion and maintenance;CL: Apply110. 1, 2, 3, 4. Cancer of the prostate gland is thesecond-leading cause of cancer death among Americanmen and is the most common carcinoma inmen older than age 65. Incidence of prostate canceris higher in African American men, and onset isearlier. Most prostate cancers are adenocarcinoma.Prostate cancer is usually multifocal, slow-growing,and can spread by local extension, by lymphatics, orthrough the bloodstream. Prostate-specifi c antigen(PSA) greater than 4 ng/mg is diagnostic; a free PSAlevel can help stratify the risk of elevated PSA levels.Metastatic workup may include skeletal x-ray,bone scan, and CT or MRI to detect local extension,bone, and lymph node involvement. The urine doesnot have prostate cancer : Health promotion and maintenance;CL: Create111. 3, 4. Hormone manipulation deprives tumorcells of androgens or their by-products and, thereby,alleviates symptoms and retards disease plications of hormonal manipulationinclude: hot fl ashes, nausea and vomiting, gynecomastia,and sexual dysfunction. As part of supportivecare, provide explanations of diagnostic testsand treatment options and help the client gain somefeeling of control over his disease and decisionsrelated to it. To help achieve optimal sexual function,give the client the opportunity to communicatehis concerns and sexual needs. Inform the clientthat decreased libido is expected after hormonalmanipulation therapy, and that impotence mayresult from some surgical procedures and radiation.A psychiatrist is not : Psychosocial adaptation;CL: Synthesize112. 3. Manipulation of the prostate during thedigital rectal examination may falsely increase thePSA levels. The PSA determination and the digitalrectal examination are both necessary as screeningtools for prostate cancer, and both are recommendedfor all men older than age 50. Prostate cancer is themost common cancer in men and the second leadingkiller from cancer among men in the UnitedStates. Incidence increases sharply with age, andthe disease is predominant in the 60- to 70-year-oldage-: Health promotion and maintenance;CL: Apply113. 1. On digital rectal examination, key signsof prostate cancer are a hard prostate, induration ofthe prostate, and an irregular, hard nodule. Accompanyingsymptoms of prostate cancer can includeconstipation, weight loss, and lymphadenopathy.Abdominal pain usually does not accompany prostatecancer. A boggy, tender prostate is found withinfection (e.g., acute or chronic prostatitis).CN: Health promotion and maintenance;CL: Analyze114. 2. Loss of the prostate gland interrupts thefl ow of semen, so there will be no ejaculation fl uid.The sensations of orgasm remain intact. The clientneeds to be advised that return of erectile capabilityis often disrupted after surgery, but within 1 year95% of men have returned to normal erectile functionwith sexual : Physiological adaptation;CL: Synthesize115. 1. Clients who have stage IA or IIB prostatecancer have an excellent survival rate. Prostatecancer is usually slow growing, and many men whohave prostate cancer do not die from it. A stage I orII tumor is confi ned to the prostate gland and hasnot spread to the extrapelvic region or : Physiological adaptation;CL: Synthesize116. 2. Diethylstilbestrol causes engorgement andtenderness of the breasts (gynecomastia). Stilbestrolis prescribed as palliative therapy for menwith androgen-dependent prostatic carcinoma. Anincrease in blood pressure can occur. Tendernessof the scrotum and dramatic changes in secondarysexual characteristics should not : Pharmacological and parenteraltherapies; CL: Apply ................
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