Question 1

During a health history, a patient tells the nurse that he has trouble in starting his urine stream. How should the nurse document this finding?

Accepted Answer

Hesitancy is trouble in starting the urine stream. Urgency is the feeling that one cannot wait to urinate. Dribbling is the last of the urine before or after the main act of urination. Frequency is urinating more often than usual.

Question 2

A 16-year-old boy is brought to the clinic for a problem that he refused to let his mother see. The nurse examines him, and finds that he has scrotal swelling on the left side. He had the mumps the previous week, and the nurse suspects that he has orchitis. Which of the following assessment findings support this diagnosis? (Select all that apply.)

Accepted Answer

With orchitis, the testis is swollen, with a feeling of weight, and is tender or painful. The mass does not transilluminate, and the scrotal skin is reddened. Transillumination of a mass occurs with a hydrocele, not orchitis.

Question 3

The nurse is performing a genitourinary assessment on a 50-year-old obese male laborer. On examination, the nurse notices a painless round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. What type of hernia do these findings suggest?

Accepted Answer

Direct inguinal hernias occur most often in men over the age of 40 years. It is an acquired weakness brought on by heavy lifting, obesity, chronic cough, or ascites. The direct inguinal hernia is usually a painless, round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. A scrotal hernia appears with an enlarged testis that does not transilluminate and may reduce when supine. It may be painful with straining. Upon palpation a soft, mushy mass which is distinct from the normal testis can be palpated and the palpating fingers cannot get above the mass. A femoral hernia usually presents with pain that is constant and may be severe and become strangulated. With indirect inguinal hernias, pain occurs with straining and a soft swelling increases with increased intra-abdominal pressure, which may decrease when the patient lies down.

Question 4

The nurse is inspecting the scrotum and testes of a 43-year-old man. Which finding would require additional follow-up and evaluation?

Accepted Answer

Scrotal swelling may cause the skin to be taut and to display pitting edema. Normal scrotal skin is rugae, and asymmetry is normal with the left scrotal half usually lower than the right. The testes may move closer to the body in response to cold temperatures.

Question 5

The nurse is describing how to perform a testicular self-examination to a patient. Which statement is most appropriate?

Accepted Answer

If the patient notices a firm painless lump, a hard area, or an overall enlarged testicle, then he should call his health care provider for further evaluation. The testicle normally feels rubbery with a smooth surface. A good time to examine the testicles is during the shower or bath, when one's hands are warm and soapy and the scrotum is warm. Testicular self-examination should be performed once a month.

Question 6

A 2-year-old boy has been diagnosed with physiologic cryptorchidism. Considering this diagnosis, what will the nurse most likely observe during the assessment?

Accepted Answer

Migratory testes (physiologic cryptorchidism) are common because of the strength of the cremasteric reflex and the small mass of the prepubertal testes. The affected side has a normally developed scrotum and the testis can be milked down. The other responses are not correct.

Question 7

When the nurse is performing a testicular examination on a 25-year-old man, which finding is considered normal?

Accepted Answer

Testes normally feel oval, firm and rubbery, smooth, and bilaterally equal and are freely movable and slightly tender to moderate pressure. The scrotal skin should not be dry, scaly, or nodular or contain subcutaneous plaques. Any mass would be an abnormal finding.

Question 8

During an examination of an aging man, what finding would the nurse expect?

Accepted Answer

When assessing the genitals of an older man, the nurse may notice thinner, graying pubic hair and a decrease in the size of the penis. The size of the testes may be decreased, they may feel less firm, and the scrotal sac is pendulous with less rugae. No change in scrotal color is observed.

Question 9

A 2-month-old uncircumcised infant has been brought to the clinic for a well-baby checkup. How would the nurse proceed with the genital examination?

Accepted Answer

If uncircumcised, then the foreskin is normally tight during the first 3 months and should not be retracted because of the risk for tearing the membrane attaching the foreskin to the shaft. The cremasteric reflex (retracting the scrotal contents) is strong in infants and care should be taken not to elicit it. Since retracting the foreskin on an uncircumcised infant is not recommended until the infant is 3 months old, the glans and dirt and smegma under the foreskin cannot be assessed.

Question 10

When performing a genital assessment on a middle-aged man, the nurse notices multiple soft, moist, painless papules in the shape of cauliflower-like patches scattered across the shaft of the penis. What does this finding suggest?

Accepted Answer

The lesions of genital warts are soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch. They occur on the shaft of the penis, behind the corona, or around the anus, where they may grow into large grapelike clusters. Genital carcinoma begins as red, raised, warty growth or as an ulcer with watery discharge which almost always occur on the glans or inner lip of foreskin. Genital herpes (HSV-2 infection) appears as clusters of small vesicles with surrounding erythema which are often painful and erupt on the glans, foreskin, or anus. Syphilitic chancres begin within 2 to 4 weeks of infection as a small, solitary, silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. The symptoms this patient is experiencing are those of genital warts.

Question 11

When performing a genitourinary assessment on a 16-year-old male adolescent, the nurse notices a swelling in the scrotum that increases with increased intra-abdominal pressure and decreases when he is lying down. The patient reports pain when straining. What do these findings indicate?

Accepted Answer

With indirect inguinal hernias, pain occurs with straining and a soft swelling increases with increased intra-abdominal pressure, which may decrease when the patient lies down. A femoral hernia usually presents with pain that is constant and may be severe and become strangulated. An incisional, or ventral, hernia occurs at the site of a previous surgical incision in either the groin or abdominal area. A direct hernia is usually painless and is easily reduced when supine. The symptoms this patient is experiencing are those of an indirect hernia.

Question 12

What is a common assessment finding in a boy younger than 2 years old?

Accepted Answer

A common scrotal finding in boys younger than 2 years of age is a hydrocele, or fluid in the scrotum. The other options are not correct.

Question 13

The nurse is aware that which statement is true regarding the incidence of testicular cancer?

Accepted Answer

Men with undescended testicles (cryptorchidism) are at the greatest risk for the development of testicular cancer. The overall incidence of testicular cancer is rare. Although testicular cancer has no early symptoms, when detected early and treated before metastasizing, the cure rate is almost 100%.

Question 14

During a genital examination, the nurse notices that a male patient has clusters of small vesicles on the glans, surrounded by erythema. What does this finding suggest?

Accepted Answer

Genital herpes, or herpes simplex virus 2 (HSV-2), infections present as clusters of small vesicles with surrounding erythema, which are often painful and erupt on the glans or foreskin. The lesions of genital warts are soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch. They occur on the shaft of the penis, behind the corona, or around the anus, where they may grow into large grapelike clusters. Peyronie disease presents as subcutaneous plaques on the penis and is associated with painful bending of the penis during erection. Its cause is trauma to the penis with resulting scar, deformity, and often erectile dysfunction. Syphilitic chancres begin within 2 to 4 weeks of infection as a small, solitary, silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. The symptoms this patient is presenting with are those of genital herpes.

Question 15

The nurse is providing patient teaching about an erectile dysfunction drug. One of the drug's potential side effects is prolonged, painful erection of the penis without sexual stimulation. What is the medical term for this condition?

Accepted Answer

Priapism is prolonged, painful erection of the penis without sexual desire. Orchitis is inflammation of the testes. Stricture is a narrowing of the opening of the urethral meatus. Phimosis is the inability to retract the foreskin.

Question 16

During a physical examination, the nurse finds that a male patient's foreskin is fixed and tight and will not retract over the glans. What is this condition called?

Accepted Answer

With phimosis, the foreskin is nonretractable, forming a pointy tip of the penis with a tiny orifice at the end of the glans. The foreskin is advanced and so tight that it is impossible to retract over the glans. This condition may be congenital or acquired from adhesions related to infection. Epispadias is when the meatus opens on the dorsal (upper) side of glans or shaft above a broad, spadelike penis. It is rare but more disabling than hypospadias because of associated urinary incontinence and separation of pubic bones. A urethral stricture is a narrowing of the urethra which appears as a pinpoint, constricted opening at the meatus or inside along the urethra. A gradual decrease in force and caliber of urine stream is the most common symptom. Peyronie disease presents as subcutaneous plaques on the penis and is associated with painful bending of the penis during erection. Its cause is trauma to the penis with resulting scar, deformity, and often erectile dysfunction. The physical findings from this patient's examination indicate phimosis.

Question 17

During an examination, the nurse notices that a male patient has a red, round, superficial ulcer with a yellowish serous discharge on his penis. On palpation, the nurse finds a nontender base that feels like a small button between the thumb and fingers. What do these findings indicate?

Accepted Answer

Syphilitic chancres begin as a small, solitary, silvery papule within 2 to 4 weeks of infection which then erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. The lesions of genital warts are soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch. They occur on the shaft of the penis, behind the corona, or around the anus, where they may grow into large grapelike clusters. Genital herpes (HSV-2 infection) appears as clusters of small vesicles with surrounding erythema which are often painful and erupt on the glans, foreskin, or anus. Genital carcinoma begins as red, raised, warty growth or as an ulcer with watery discharge which almost always occur on the glans or inner lip of foreskin. The symptoms this patient is experiencing are those of syphilitic chancre.

Question 18

A 55-year-old man is in the clinic for a yearly checkup. He is worried because his father died of prostate cancer. The nurse knows which tests should be performed at this time? (Select all that apply.)

Accepted Answer

Prostate cancer is typically detected by testing the blood for PSA or by a DRE. It is recommended that both PSA and DRE be offered to men annually, beginning at age 50 years. If PSA is elevated, then further laboratory work or a transrectal ultrasound (TRUS) and biopsy may be recommended.

Question 19

A 55-year-old man is experiencing severe pain of sudden onset in the scrotal area. It is somewhat relieved by elevation. On examination the nurse notices an enlarged, red scrotum that is very tender to palpation. Distinguishing the epididymis from the testis is difficult, and the scrotal skin is thick and edematous. What do these findings suggest?

Accepted Answer

Epididymitis presents as severe pain of sudden onset in the scrotum that is somewhat relieved by elevation. On examination, the scrotum is enlarged, reddened, and exquisitely tender. The epididymis is enlarged and indurated and may be hard to distinguish from the testis. The overlying scrotal skin may be thick and edematous. A varicocele can present with either a dull pain, constant pulling or dragging sensation, or be asymptomatic. Appearance upon inspection may be normal or the lighter scrotal skin may have a bluish color and the testis on side of varicocele may be smaller due to impaired circulation. When standing a soft irregular mass posterior to and above testis which feels like a "bag of worms" may be palpable and collapses when supine and then refills when upright. A spermatocele is usually a painless, round, freely movable mass lying above and behind testis and if large may feel like a third testis. Testicular torsion presents with sudden onset of excruciating unilateral pain in testicle; red, swollen scrotum with one testes (usually the left) higher owing to rotation of shortening; and extremely tender to palpation and difficult to distinguish epididymis from testis.

Quiz 25: Male Genitourinary System