1/7/24, 12:25 AM ATI Exam 4 - MED-SURG
CHAPTER 65
UNIT 9 REPRODUCTIVE DISORDERS INDICATIONS
SECTION: MALE REPRODUCTIVE DISORDERS ● Male clients should be given the opportunity to make
an informed decision with their provider after receiving
CHAPTER 65 Diagnostic information about the benefits, risks, and uncertainty
related to prostate screening. The discussion with their
Procedures for provider about screening should occur at 50 years of age
for males who have average risks, 45 years of age for
Male Reproductive males who have high risk, and 40 years of age for males
who have higher risks.
Disorders ● Because the EPCA-2 is highly sensitive in detecting
prostate cancer, some providers are using this test in
place of a biopsy. The EPCA-2 is also used to monitor
the client’s response to treatment for prostate cancer.
Changes to the prostate gland are common as
● For additional information regarding screening for and
males age, and routine diagnostic procedures treatment of prostate cancer, see www.cdc.gov.
are recommended to evaluate these changes. CLIENT PRESENTATION: As the prostate gland enlarges, it
encroaches on the urethra and causes diminished flow and
Enlargement of the prostate gland is usually retention of urine. Blood can also be found in the urine.
These findings can indicate BPH or prostate cancer.
benign and is called benign prostatic
hyperplasia (BPH). Prostate cancer is one of the
INTERPRETATION OF FINDINGS
most common forms of cancer in males.
PSA: An increase can indicate that a client has
Diagnostic procedures for male reproductive prostatic cancer or prostatitis.
● PSA levels increase with age. For a male younger than
disorders include prostate-specific 50 years of age, a PSA level of 2.5 ng/mL is within the
expected range.
antigen(PSA), early prostate cancer antigen ● The client can have an elevated PSA level for up to
(EPCA-2), digitalrectal exam (DRE), Doppler 6 weeks following a urinary tract infection.
● A PSA value greater than 4 ng/mL requires further
ultrasonography, urinalysis/urine culture, complete evaluation. An elevated PSA is an indication of a number
blood count, and transrectal ultrasound (TRUS). of conditions, including prostate cancer, BPH, and
acute prostatitis.
EPCA-2: A value of 30 ng/mL or greater is highly
suggestive of prostate cancer.
Prostate-specific antigen, DRE: Abnormal findings during the DRE include an
early prostate cancer antigen, abnormally large and hard prostate with an irregular
shape or lumps.
and digital rectal exam
PSA measures the amount of a protein produced by the
prostate gland in the bloodstream. It is performed prior Transrectal ultrasound
to the DRE because a rise in PSA can occur due to the ● With the client in a left, side-lying position, a probe
irritation that occurs upon palpation of the gland. A is inserted into the client’s rectum, and sound waves
sample of blood is used to determine the PSA level. are bounced off the surface of the prostate gland to
provide an image.
EPCA-2 measures the amount of protein in the blood that ● The provider can prescribe an enema prior to the procedure.
is only produced by abnormal prostate cells. ● The procedure is contraindicated for clients who have a
DRE is done in an office or clinic. latex allergy. The rectal ultrasound probe is covered by a
latex sac. Therefore, it is important to check the client for
● With the client leaning over the examination table, the
a latex allergy prior to the procedure.
provider places a gloved, lubricated finger in the client’s
anus and palpates the posterior portion of the prostate
gland through the rectal wall. The client also can be
INDICATIONS
placed on one side or in the lithotomy position for
the exam. A TRUS is done if a client’s PSA is elevated or the DRE
reveals a possible abnormality.
● If the DRE reveals an abnormality, the location of the
potentially cancerous prostate lesion is determined by
ultrasonography and confirmed by a biopsy.
INTERPRETATION OF FINDINGS
If an irregularity is found, the image is used to guide a
needle biopsy.
RN ADULT MEDICAL SURGICAL NURSING CHAPTER 65 DIAGNOSTIC PROCEDURES FOR MALE REPRODUCTIVE DISORDERS 435
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,1/7/24, 12:26 AM ATI Exam 4 - MED-SURG
Penile Doppler Application Exercises
ultrasonography 1. A nurse at a provider’s office is caring for an older
● This diagnostic test is used to determine the normal adult client who is having an annual physical
anatomy and blood flow of the penis. exam. Which of the following findings indicates
● This test identifies many conditions of the penis, additional follow-up is needed in regard to
including erectile dysfunction. the prostate gland? (Select all that apply.)
● An injection is given to increase blood flow to the penis, A. Prostate-specific antigen (P SA) is 7.1 ng/mL.
causing an erection. B. A digital rectal exam (DRE) reveals an
● The procedure measures penile arterial blood flow. enlarged and nodular prostate.
NURSING ACTIONS: Place the client in the supine position C. The client reports a weak urine stream.
with the penis in correct anatomical position against D. The client reports urinating once during the night.
the abdomen. E. Smegma is present below the glans of the penis.
CLIENT EDUCATION: No erectile dysfunction medications
should be taken for 2 days prior to the test. 2. A nurse is providing information to a client who is
scheduled for a transrectal ultrasound (TRUS). Which
Culture and sensitivity of prostatic fluid of the following information should the nurse include?
A. “This procedure will determine whether
If infection is suspected, as with prostatitis, expressed
you have prostate cancer.”
prostatic fluid can be tested for culture and sensitivity to
B. “The procedure is contraindicated if
identify the causative organism (bacteria) and determine
you have an allergy to eggs.”
the type of antibiotic to treat the infection.
C. “S ound waves will be used to create
Complete blood count (CBC): To evaluate any evidence of a picture of your prostate.”
systemic infection or anemia from hematuria
D. “You should avoid having a bowel movement
for 1 hr prior to the procedure.”
Active Learning Scenario
A nurse in a provider’s office is providing information
to an older adult client who is scheduled for a
prostate-specific antigen (PSA ) test and a digital rectal
exam (DRE ). Use the ATI Act ive Learning Template:
Diagnostic Procedure to complete this item.
DESCRIPTION OF PROCEDURE: I nclude the
order in which they are performed.
INDICATIONS: Identify two factors that the
nurse should discuss with the client that place
the client at risk for prostate cancer.
436 CHAPTER 65 DIAGNOSTIC PROCEDURES FOR MALE REPRODUCTIVE DISORDERS CONTENT MASTERY SERIES
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,1/7/24, 12:26 AM ATI Exam 4 - MED-SURG
Application Exercises Key Active Learning Scenario Key
1. A. CORRECT: Although the PSA level is typically Using the ATI Active Learning Template: Diagnostic Procedure
elevated in an older adult male, a PSA level greater DESCRIPTION OF PROCEDURE
than 4ng/mL warrants additional follow-up.
B. CORRECT: An enlarged and nodular prostate is a possible PSA: A blood sample is taken to measure a specific protein
indication of prostate cancer and requires further evaluation. produced by the prostate gland that is present in the bloodstream.
C. CORRECT: A weak urine stream is a manifestation of The PSA is performed first because examination of the prostate
benign prostatic hyperplasia and warrants follow-up. irritates the prostate and can cause the PSA to rise.
D. Urinating once during the night is an expected DRE: With the client either leaning over the exam table, placed on
finding for an older adult male. one side, or in the lithotomy position, the examiner uses a gloved,
E. Smegma is a normal secretion that can lubricated finger to palpate the prostate through the rectal wall
accumulate beneath the glans penis. to identify any abnormalities in size, shape, and consistency.
NCLEX® Connection: Health Promotion and Maintenance,
Health Screening INDICATIONS
●
Age greater than 50 years old
●
African American descent
2. A. A biopsy or EPC A-2 is used to make the ●
Family history of prostate cancer
diagnosis of prostate cancer.
NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests
B. A TRUS is contraindicated if the client has an allergy to latex.
C. CORRECT: A transrectal ultrasound creates an
image of the prostate using sound waves.
D. The provider may prescribe an enema prior to
the procedure to decrease the interference of
feces with obtaining accurate test results.
NCLEX® Connection: Reduction of Risk Potential,
Diagnostic Tests
RN ADULT MEDICAL SURGICAL NURSING CHAPTER 65 DIAGNOSTIC PROCEDURES FOR MALE REPRODUCTIVE DISORDERS 437
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, 1/7/24, 12:26 AM ATI Exam 4 - MED-SURG
438 CHAPTER 65 DIAGNOSTIC PROCEDURES FOR MALE REPRODUCTIVE DISORDERS CONTENT MASTERY SERIES
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CHAPTER 65
UNIT 9 REPRODUCTIVE DISORDERS INDICATIONS
SECTION: MALE REPRODUCTIVE DISORDERS ● Male clients should be given the opportunity to make
an informed decision with their provider after receiving
CHAPTER 65 Diagnostic information about the benefits, risks, and uncertainty
related to prostate screening. The discussion with their
Procedures for provider about screening should occur at 50 years of age
for males who have average risks, 45 years of age for
Male Reproductive males who have high risk, and 40 years of age for males
who have higher risks.
Disorders ● Because the EPCA-2 is highly sensitive in detecting
prostate cancer, some providers are using this test in
place of a biopsy. The EPCA-2 is also used to monitor
the client’s response to treatment for prostate cancer.
Changes to the prostate gland are common as
● For additional information regarding screening for and
males age, and routine diagnostic procedures treatment of prostate cancer, see www.cdc.gov.
are recommended to evaluate these changes. CLIENT PRESENTATION: As the prostate gland enlarges, it
encroaches on the urethra and causes diminished flow and
Enlargement of the prostate gland is usually retention of urine. Blood can also be found in the urine.
These findings can indicate BPH or prostate cancer.
benign and is called benign prostatic
hyperplasia (BPH). Prostate cancer is one of the
INTERPRETATION OF FINDINGS
most common forms of cancer in males.
PSA: An increase can indicate that a client has
Diagnostic procedures for male reproductive prostatic cancer or prostatitis.
● PSA levels increase with age. For a male younger than
disorders include prostate-specific 50 years of age, a PSA level of 2.5 ng/mL is within the
expected range.
antigen(PSA), early prostate cancer antigen ● The client can have an elevated PSA level for up to
(EPCA-2), digitalrectal exam (DRE), Doppler 6 weeks following a urinary tract infection.
● A PSA value greater than 4 ng/mL requires further
ultrasonography, urinalysis/urine culture, complete evaluation. An elevated PSA is an indication of a number
blood count, and transrectal ultrasound (TRUS). of conditions, including prostate cancer, BPH, and
acute prostatitis.
EPCA-2: A value of 30 ng/mL or greater is highly
suggestive of prostate cancer.
Prostate-specific antigen, DRE: Abnormal findings during the DRE include an
early prostate cancer antigen, abnormally large and hard prostate with an irregular
shape or lumps.
and digital rectal exam
PSA measures the amount of a protein produced by the
prostate gland in the bloodstream. It is performed prior Transrectal ultrasound
to the DRE because a rise in PSA can occur due to the ● With the client in a left, side-lying position, a probe
irritation that occurs upon palpation of the gland. A is inserted into the client’s rectum, and sound waves
sample of blood is used to determine the PSA level. are bounced off the surface of the prostate gland to
provide an image.
EPCA-2 measures the amount of protein in the blood that ● The provider can prescribe an enema prior to the procedure.
is only produced by abnormal prostate cells. ● The procedure is contraindicated for clients who have a
DRE is done in an office or clinic. latex allergy. The rectal ultrasound probe is covered by a
latex sac. Therefore, it is important to check the client for
● With the client leaning over the examination table, the
a latex allergy prior to the procedure.
provider places a gloved, lubricated finger in the client’s
anus and palpates the posterior portion of the prostate
gland through the rectal wall. The client also can be
INDICATIONS
placed on one side or in the lithotomy position for
the exam. A TRUS is done if a client’s PSA is elevated or the DRE
reveals a possible abnormality.
● If the DRE reveals an abnormality, the location of the
potentially cancerous prostate lesion is determined by
ultrasonography and confirmed by a biopsy.
INTERPRETATION OF FINDINGS
If an irregularity is found, the image is used to guide a
needle biopsy.
RN ADULT MEDICAL SURGICAL NURSING CHAPTER 65 DIAGNOSTIC PROCEDURES FOR MALE REPRODUCTIVE DISORDERS 435
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,1/7/24, 12:26 AM ATI Exam 4 - MED-SURG
Penile Doppler Application Exercises
ultrasonography 1. A nurse at a provider’s office is caring for an older
● This diagnostic test is used to determine the normal adult client who is having an annual physical
anatomy and blood flow of the penis. exam. Which of the following findings indicates
● This test identifies many conditions of the penis, additional follow-up is needed in regard to
including erectile dysfunction. the prostate gland? (Select all that apply.)
● An injection is given to increase blood flow to the penis, A. Prostate-specific antigen (P SA) is 7.1 ng/mL.
causing an erection. B. A digital rectal exam (DRE) reveals an
● The procedure measures penile arterial blood flow. enlarged and nodular prostate.
NURSING ACTIONS: Place the client in the supine position C. The client reports a weak urine stream.
with the penis in correct anatomical position against D. The client reports urinating once during the night.
the abdomen. E. Smegma is present below the glans of the penis.
CLIENT EDUCATION: No erectile dysfunction medications
should be taken for 2 days prior to the test. 2. A nurse is providing information to a client who is
scheduled for a transrectal ultrasound (TRUS). Which
Culture and sensitivity of prostatic fluid of the following information should the nurse include?
A. “This procedure will determine whether
If infection is suspected, as with prostatitis, expressed
you have prostate cancer.”
prostatic fluid can be tested for culture and sensitivity to
B. “The procedure is contraindicated if
identify the causative organism (bacteria) and determine
you have an allergy to eggs.”
the type of antibiotic to treat the infection.
C. “S ound waves will be used to create
Complete blood count (CBC): To evaluate any evidence of a picture of your prostate.”
systemic infection or anemia from hematuria
D. “You should avoid having a bowel movement
for 1 hr prior to the procedure.”
Active Learning Scenario
A nurse in a provider’s office is providing information
to an older adult client who is scheduled for a
prostate-specific antigen (PSA ) test and a digital rectal
exam (DRE ). Use the ATI Act ive Learning Template:
Diagnostic Procedure to complete this item.
DESCRIPTION OF PROCEDURE: I nclude the
order in which they are performed.
INDICATIONS: Identify two factors that the
nurse should discuss with the client that place
the client at risk for prostate cancer.
436 CHAPTER 65 DIAGNOSTIC PROCEDURES FOR MALE REPRODUCTIVE DISORDERS CONTENT MASTERY SERIES
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,1/7/24, 12:26 AM ATI Exam 4 - MED-SURG
Application Exercises Key Active Learning Scenario Key
1. A. CORRECT: Although the PSA level is typically Using the ATI Active Learning Template: Diagnostic Procedure
elevated in an older adult male, a PSA level greater DESCRIPTION OF PROCEDURE
than 4ng/mL warrants additional follow-up.
B. CORRECT: An enlarged and nodular prostate is a possible PSA: A blood sample is taken to measure a specific protein
indication of prostate cancer and requires further evaluation. produced by the prostate gland that is present in the bloodstream.
C. CORRECT: A weak urine stream is a manifestation of The PSA is performed first because examination of the prostate
benign prostatic hyperplasia and warrants follow-up. irritates the prostate and can cause the PSA to rise.
D. Urinating once during the night is an expected DRE: With the client either leaning over the exam table, placed on
finding for an older adult male. one side, or in the lithotomy position, the examiner uses a gloved,
E. Smegma is a normal secretion that can lubricated finger to palpate the prostate through the rectal wall
accumulate beneath the glans penis. to identify any abnormalities in size, shape, and consistency.
NCLEX® Connection: Health Promotion and Maintenance,
Health Screening INDICATIONS
●
Age greater than 50 years old
●
African American descent
2. A. A biopsy or EPC A-2 is used to make the ●
Family history of prostate cancer
diagnosis of prostate cancer.
NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests
B. A TRUS is contraindicated if the client has an allergy to latex.
C. CORRECT: A transrectal ultrasound creates an
image of the prostate using sound waves.
D. The provider may prescribe an enema prior to
the procedure to decrease the interference of
feces with obtaining accurate test results.
NCLEX® Connection: Reduction of Risk Potential,
Diagnostic Tests
RN ADULT MEDICAL SURGICAL NURSING CHAPTER 65 DIAGNOSTIC PROCEDURES FOR MALE REPRODUCTIVE DISORDERS 437
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, 1/7/24, 12:26 AM ATI Exam 4 - MED-SURG
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