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Exam #5
Advanced Med Surg
1. need to know what phimosis is? “turtleneck” Chapter: 59 – Assessment and Management of Patients with Male
Reproductive Disorders.
An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On
examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem?
A) Bowens disease
B) Peyronies disease
C) Phimosis
D) Priapism
R: Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans.
A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so
low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation?
Select all that apply.
A) Phimosis
B) Priapism
C) Herpes simplex infection
D) Increasing age
E) Lack of circumcision
R: Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV,
smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two-thirds of cases occur in men older than 65 years of
age), lichen sclerosis, and balanitis xerotica obliterans.
A 75-year-old male patient is being treated for phimosis. When planning this patient care, what health promotion activity is most
directly related to the etiology of the patients health problem?
A) Teaching the patient about safer sexual practices
B) Teaching the patient about the importance of hygiene
C) Teaching the patient about the safe use of PDE-5 inhibitors
D) Teaching the patient to perform testicular self-examination
R: Poor hygiene often contributes to cases of phimosis.
A patient presents to the emergency department with paraphimosis. The physician is able to compress the glans and manually reduce
the edema. Once the inflammation and edema subside, what is usually indicated?
A) Needle aspiration of the corpus cavernosum
B) Circumcision
C) Abstinence from sexual activity for 6 weeks
D) Administration of vardenafil
R: Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the
corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated.
Vardenafil is Levitra and would not be used for paraphimosis.
A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic
findings would suggest that this patient has chronic urinary retention.
A) Hypertension
B) Peripheral edema
C) Tachycardia and other dysrhythmias
D) Increased blood urea nitrogen (BUN)
R: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic
hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur
with chronic urinary retention and large residual volumes.
2. patient has pain with urination, frequency, pain with ejaculation, what is that? Versicle? Ependymitis? Prostatitis?
Hydrocele?
A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort,
burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient
is exhibiting symptoms of what?
A) Varicocele
B) Epididymitis
C) Prostatitis
D) Hydrocele
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R: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation is indicative
of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal
spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute
part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an
infected prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele is a
collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the
spermatic cord.
3. know what drug sildenafil is used for? Know about the drug? When do you take it?
A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication?
A) Sexual stimulation is not needed to obtain an erection.
B) The drug should be taken 1 hour prior to intercourse.
C) Facial flushing or headache should be reported to the physician immediately.
D) The drug has the potential to cause permanent visual changes.
R: The patient must have sexual stimulation to create the erection, and the drug should be taken 1 hour
before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side
effects of Viagra and do not normally warrant reporting to the physician. Some visual disturbances may
occur, but these are transient.
A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of
diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse
reviews the patient’s history prior to instructing the patient on the use of this medication. What disorder
will contraindicate the use of tadalafil (Cialis)?
A) Cataracts
B) Retinopathy
C) Hypotension
D) Diabetic nephropathy
R: Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil (Cialis) and
sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil (Viagra) are usually
contraindicated with diabetic retinopathy.
4. patient is having prostatectomy, continuous bladder irrigation, in 24 hours what should output look like? Clear? No.
A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color
of output should the nurse expect to find in the drainage bag?
A) Red wine colored
B) Tea colored
C) Amber
D) Light pink
R: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.
A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen
indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to
balloon inflation, are the functions of the three lumens?
A) Continuous inflow and outflow of irrigation solution
B) Intermittent inflow and continuous outflow of irrigation solution
C) Continuous inflow and intermittent outflow of irrigation solution
D) Intermittent flow of irrigation solution and prevention of hemorrhage
Feedback: For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three
lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.
A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The
patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing
bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the
discomfort of the patient?
A) Apply a cold compress to the pubic area.
B) Notify the urologist promptly.
C) Irrigate the catheter with 30 to 50 mL of normal saline as ordered.
D) Administer a smooth-muscle relaxant as ordered.
Feedback: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold
compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be
relieved without the involvement of the urologist, who will normally order medications on a PRN basis.
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Exam #5
Advanced Med Surg
1. need to know what phimosis is? “turtleneck” Chapter: 59 – Assessment and Management of Patients with Male
Reproductive Disorders.
An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On
examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem?
A) Bowens disease
B) Peyronies disease
C) Phimosis
D) Priapism
R: Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans.
A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so
low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation?
Select all that apply.
A) Phimosis
B) Priapism
C) Herpes simplex infection
D) Increasing age
E) Lack of circumcision
R: Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV,
smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two-thirds of cases occur in men older than 65 years of
age), lichen sclerosis, and balanitis xerotica obliterans.
A 75-year-old male patient is being treated for phimosis. When planning this patient care, what health promotion activity is most
directly related to the etiology of the patients health problem?
A) Teaching the patient about safer sexual practices
B) Teaching the patient about the importance of hygiene
C) Teaching the patient about the safe use of PDE-5 inhibitors
D) Teaching the patient to perform testicular self-examination
R: Poor hygiene often contributes to cases of phimosis.
A patient presents to the emergency department with paraphimosis. The physician is able to compress the glans and manually reduce
the edema. Once the inflammation and edema subside, what is usually indicated?
A) Needle aspiration of the corpus cavernosum
B) Circumcision
C) Abstinence from sexual activity for 6 weeks
D) Administration of vardenafil
R: Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the
corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated.
Vardenafil is Levitra and would not be used for paraphimosis.
A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic
findings would suggest that this patient has chronic urinary retention.
A) Hypertension
B) Peripheral edema
C) Tachycardia and other dysrhythmias
D) Increased blood urea nitrogen (BUN)
R: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic
hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur
with chronic urinary retention and large residual volumes.
2. patient has pain with urination, frequency, pain with ejaculation, what is that? Versicle? Ependymitis? Prostatitis?
Hydrocele?
A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort,
burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient
is exhibiting symptoms of what?
A) Varicocele
B) Epididymitis
C) Prostatitis
D) Hydrocele
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R: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation is indicative
of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal
spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute
part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an
infected prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele is a
collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the
spermatic cord.
3. know what drug sildenafil is used for? Know about the drug? When do you take it?
A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication?
A) Sexual stimulation is not needed to obtain an erection.
B) The drug should be taken 1 hour prior to intercourse.
C) Facial flushing or headache should be reported to the physician immediately.
D) The drug has the potential to cause permanent visual changes.
R: The patient must have sexual stimulation to create the erection, and the drug should be taken 1 hour
before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side
effects of Viagra and do not normally warrant reporting to the physician. Some visual disturbances may
occur, but these are transient.
A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of
diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse
reviews the patient’s history prior to instructing the patient on the use of this medication. What disorder
will contraindicate the use of tadalafil (Cialis)?
A) Cataracts
B) Retinopathy
C) Hypotension
D) Diabetic nephropathy
R: Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil (Cialis) and
sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil (Viagra) are usually
contraindicated with diabetic retinopathy.
4. patient is having prostatectomy, continuous bladder irrigation, in 24 hours what should output look like? Clear? No.
A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color
of output should the nurse expect to find in the drainage bag?
A) Red wine colored
B) Tea colored
C) Amber
D) Light pink
R: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.
A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen
indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to
balloon inflation, are the functions of the three lumens?
A) Continuous inflow and outflow of irrigation solution
B) Intermittent inflow and continuous outflow of irrigation solution
C) Continuous inflow and intermittent outflow of irrigation solution
D) Intermittent flow of irrigation solution and prevention of hemorrhage
Feedback: For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three
lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.
A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The
patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing
bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the
discomfort of the patient?
A) Apply a cold compress to the pubic area.
B) Notify the urologist promptly.
C) Irrigate the catheter with 30 to 50 mL of normal saline as ordered.
D) Administer a smooth-muscle relaxant as ordered.
Feedback: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold
compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be
relieved without the involvement of the urologist, who will normally order medications on a PRN basis.
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