BPH

A client with benign prostatic hyperplasia (BPH) exhibits decreased bladder capability and bladder instability. Which should the nurse recognize as the cause of this condition? A. Hypertrophic detrusor muscle B. Increased intra-abdominal pressure C. Development of bladder diverticula D. Increased prostate sensitivity to dihydrotestosterone

A Rationale: Hypertrophy of the detrusor muscle of the bladder to compensate for increased resistance eventually results in bladder instability and decreased bladder capability. Increased intra-abdominal pressure, bladder diverticula, and increased prostate sensitivity to dihydrotestosterone are all factors in the development of BPH but are not the response to increased resistance to urinary flow that results in decreased bladder capability and bladder instability

A client has been prescribed a 5-alpha reductase inhibitor, dutasteride (Avodart), for benign prostatic hyperplasia (BPH). Which potential adverse effect should the nurse include in the teaching for this medication? (Select all that apply.) A. Impotence B. Gynecomastia C. Decreased libido D. Renal insufficiency E. Decreased volume of ejaculate

A, C, E Rationale: Side effects of 5-alpha reductase inhibitors such as dutasteride (Avodart) and finasteride (Proscar) may include impotence, decreased libido, and decreased volume of ejaculate. Gynecomastia and renal insufficiency are not side effects for these medications

Which risk factors should the nurse assess when performing a health history on a client for benign prostatic hyperplasia (BPH) screening? (Select all that apply.) A. Age B. Vasectomy C. Racial background D. Sexual promiscuity E. The presence of testes

A, C, E Rationale: The risk of developing BPH increases with age, generally after the age of 40. Men who had their testes removed before puberty are not at risk for BPH. Race may be a factor in BPH: African American and Hispanic males tend to develop BPH earlier than Caucasian American males, while Asian American males develop symptoms later. Having had a vasectomy and sexual promiscuity are not risk factors for BPH

Which clinical manifestations should the nurse expect to observe when assessing a client with benign prostatic hyperplasia (BPH)? (Select all that apply.) A. Hesitancy B. Frequency C. Incontinence D. Incomplete emptying E. Weak or intermittent urinary stream

A, D, E Rationale: Symptoms of voiding BPH include hesitancy, incomplete emptying, weak or intermittent urinary stream, dribbling at the end of urination, and straining during urination. Frequency and incontinence are clinical manifestations of storage BPH, not benign BPH

A client presents to the urologist with complaints of getting up to urinate several times a night and difficulty starting a stream of urine. After medical testing is completed, a diagnosis of BPH is made. After conducting teaching regarding BPH, which statement by the client indicates the need for further education? A. "Alpha blockers can be used to control my symptoms." B. "I know I will get cancer of the prostate because of this." C. "As my condition progresses, I may need to consider surgical management." D. "There are nonsurgical treatment options available."

B) "I know I will get cancer of the prostate because of this." Rationale: BPH is a benign condition that is not considered a precursor to cancer. It is caused by an increase in size of the prostate gland and is seen in older males. Alpha blockers will help control the symptoms. There are nonsurgical treatments available, such as medication to shrink the gland along with surgical management, such as resection.

A client with benign prostatic hyperplasia is noted to have a smaller prostate in his physical examination. He states he is planning on having surgery that will minimize the risk of postoperative retrograde ejaculation, but he cannot remember what it is called. Which procedure should the nurse suspect? A. Transurethral needle ablation B. Prostatic urethral lift C. Transurethral incision of the prostate D. Laser surgery

C Rationale: Transurethral incision of the prostate has a lower risk of postoperative retrograde ejaculation than a transurethral resection of the prostate and other prostatectomy procedures

The nurse is providing care to a client diagnosed with BPH. The client's primary concern is burning and difficulty when urinating. Based on this data, which nursing diagnosis is the priority for this client? A. Fluid volume overload B. Fluid volume deficit C. Acute Pain D. Deficient knowledge

C) Acute Pain Rationale: The client is experiencing burning and other difficulties during urination. The burning indicates the client is experiencing pain and would indicate a priority nursing diagnosis of acute pain. There is no evidence of fluid volume overload, fluid volume deficit, or knowledge deficit.

A client is recovering from prostate surgery on a med-surg unit. The client will be ready for discharge within the next few days. Which teaching point is appropriate for this client? A. The client shouldn't drive for 6 weeks after surgery B. The client should call the healthcare provider immediately for any bleeding C. The client should incorporate fruit juice in his diet D. The client should avoid heavy lifting for 2 weeks post-op

C) The client should incorporate fruit juice in his diet Rationale: The client should be encouraged to incorporate fruit juice in his diet to help keep bowel movements regular and soft, as straining for bowel movements after surgery can cause increased pressure in the prostate area. The client may not drive for 2 weeks after surgery. The client is taught to avoid heavy lifting for 4-8 weeks after discharge and to call the doctor for heavy bleeding, though minor bleeding when defecating, coughing, or exercising is normal.

The nurse is providing care to a client who is diagnosed with mild BPH. Which lifestyle change is appropriate for this client? A. Increasing caffeine intake B. Increasing alcohol intake C. Urinating at first urge D. Using OTC anti-histamines

C) Urinating at first urge Rationale: A client who is diagnosed with mild BPH is often treated with lifestyle changes and a "watchful waiting" approach. Urinating at first urge is a lifestyle change that is appropriate for this client. The client should also eliminate caffeine and alcohol from the diet. It is also important for this client to avoid using over-the-counter antihistamines.

The nurse is preparing a client for a transurethral needle ablation (TUNA) for benign prostatic hyperplasia (BPH). For which reason should the nurse expect that the client has selected this surgical procedure? (Select all that apply.) A. It is not expensive. B. It is easy to perform. C. It is minimally invasive. D. It does not cause impotence. E. It does not cause incontinence.

C, D, E) Rationale: The TUNA is a minimally invasive surgery that uses low-level radio frequency through twin needles to burn away a region of the enlarged prostate. The urethra is protected by a shield. This procedure improves urine flow through the urethra without causing impotence or incontinence. It is not necessarily easier to perform or less expensive than other procedures

The nurse is conducting a seminar on benign prostatic hyperplasia (BPH) for older men. Which statement is accurate in describing the pathophysiologic change of the aging prostate that contributes to the development of BPH? A. "The prostate increases the production of dihydrotestosterone." B. "Testosterone levels decrease, thereby decreasing inhibition of prostate growth." C. "Estrogen levels decrease, contributing to prostatic hyperplasia." D. "The prostate becomes more sensitive to available dihydrotestosterone."

D Rationale: Dihydrotestosterone (DHT) mediates prostatic growth. Estrogen appears to sensitize the aging prostate to available DHT, ultimately contributing to prostatic hyperplasia. Increasing estrogen levels, not decreasing levels, contribute to prostatic hyperplasia. The prostate becomes more sensitive to DHT, DHT production is not increased. The statement concerning testosterone levels is not a valid statement

Key term: Dihydrotestosterone (DHT)

Hormone responsible for mediating prostate growth

Key term: Hyperplasia

Increase in the NUMBER of cells (this is how BPH begins)

Key term: Hypertrophy

Increase in the SIZE of individual cells (contributes to BPH)

The nurse is providing care to a client who is diagnosed with BPH. Which items in the client's health history indicate a risk factor for this diagnosis? SATA A. Excessive exercise B. Decreased fluid intake C. Diet high in milk D. Age 70 E. African American ethnicity

*Note this rationale doesn't explain why African American ethnicity is a correct answer?* D, E Age 70 African American ethnicity Rationale: Although the exact cause is unknown, risk factors associated with BPH include increasing age. No link has been made to fluid intake, milk, or exercise.

A client receiving an alpha-adrenergic blocker, doxazosin, for treatment of the symptoms of benign prostatic hyperplasia (BPH) calls the nurse complaining of severe dizziness. How should the nurse respond to this information? A. Inform the client that these are common adverse effects and review precautions to take while on this drug. B. Tell the client that it is likely that he will need to switch to a different drug to treat the BPH symptoms. C. Inform the client that he needs to immediately quit taking the drug and see the healthcare provider. D. Ask the client to continue taking the drug, but make an appointment with the provider for follow-up.

A Rationale: Alpha-adrenergic blockers such as doxazosin can cause orthostatic hypotension, dizziness, and headaches. Thus, the client should be reminded that these are common adverse effects and that there are certain precautions such as making position changes slowly, taking and recording blood pressures daily, and checking with the healthcare provider before taking any medications for coughs, colds, or allergies. The client does not need to make an appointment with the healthcare provider for follow-up, quit taking the drug, or switch to a different medication unless the adverse effects become intolerable at which time the benefits and risks would need to be weighed

The client admitted with BPH is prescribed an alpha-adrenergic blocker, prazosin (Minipress), for the treatment of BPH. When providing care to this client, which assessment is a priority related to this medication? A. Blood Pressure B. Pain rating C. Respiratory Rate D. Temperature

A) Blood Pressure Rationale: The medication prazosin (Minipress) is an alpha-adrenergic blocker that may cause first-dose phenomenon (severe hypotension and syncope) and tachycardia. When administering this medication to a client diagnosed with BPH, the priority assessment is the client's blood pressure.

A client with BPH is experiencing urinary retention and bladder distention. The nurse understands that, without proper treatment, the client is at risk for complications such as diverticula, hydroureter, and hydronephrosis. Which issue related to the client's condition is most important to address in order to reduce the risk for these complications? A. The enlarging mass of prostatic tissues must be reduced B. Straining during urination must be avoided C. Bladder pain must be managed D. The weak urinary stream must be strength.

A) The enlarging mass of prostatic tissues must be reduced Rationale: The enlarging mass contributes to distention of the bladder, so this is the most important issue to address to avoid diverticula, hydroureter, and hydronephrosis. Straining during urination and weak stream are associated with voiding rather than urinary retention and are less critical to avoiding complications. Bladder pain is associated with storage rather than retention and should be addressed but is not critical to avoiding complications.

A client with mild benign prostatic hyperplasia (BPH) tells the nurse that he prefers to do things "naturally" and doesn't want to take medication for his condition. Which lifestyle change should the nurse recommend? (Select all that apply.) A. Reducing stress B. Avoiding alcohol and caffeine C. Avoiding drinking fluids within 2 hours of bedtime D. Exercising regularly, including pelvic floor exercises E. Increasing dietary intake of foods high in potassium

A, B, C, D Rationale: Lifestyle changes that may help clients with mild BPH include avoiding alcohol and caffeine, exercising regularly, including Kegel exercises, avoiding drinking fluids within 2 hours of bedtime, and reducing stress. Dietary intake of potassium is not related to BPH symptoms

Which information should the nurse include in the discharge instructions for a client who has undergone prostate surgery? (Select all that apply.) A. Activity B. Bleeding C. Bowel movements D. Sexual intercourse E. Clothing restrictions

A, B, C, D Rationale: The nurse should include information about activitylong dash the healing period lasts 4dash 8 weeks. The client should be informed when to report bleeding to the healthcare provider. Teaching the client how to keep bowel movements regular and soft is important in keeping pressure off the prostate area. The client should be informed to abstain from sexual intercourse for 6 weeks after surgery. There is no specific clothing restriction for the client who has undergone prostate surgery

A client is diagnosed with BPH. Which topics are appropriate for the nurse to include in the teaching session related to the client's condition? SATA A. Self-care B. Nutrition C. Surgical approaches to treatment D. Pharmacologic approaches to treatment E. Permanent urinary catheterization

A, B, C, D) Self-care, Nutrition, Surgical approaches to treatment, Pharmacologic approaches to treatment. Rationale: When conducting teaching for a client who is diagnosed with BPH, the nurse will include information regarding self-care, nutrition, surgical approaches for treatment, and pharmacologic approaches for treatment. Permanent urinary catheterization is not an appropriate topic to include in the teaching session.

Which elements of a health history for a client with benign prostatic hyperplasia (BPH) should be documented? (Select all that apply.) A. Pain B. Hematuria C. Risk factors D. Sexual orientation E. Urinary elimination patterns

A, B, C, E Rationale: The health history should include risk factors, urinary elimination patterns and manifestations, hematuria, and pain. Sexual orientation is not a relevant part of the health history for BPH

Which instruction should the nurse include to promote healing for a client being discharged postdash prostate surgery? (Select all that apply.) A. Avoid strenuous activity and heavy lifting. B. Drink fruit juices and take stool softeners as ordered. C. Use NSAIDs for pain relief every 4-6 hours as needed. D. Avoid sexual activity for at least 6 weeks after surgery. E. Restrict driving time to less than half an hour at a time.

A, B, D Rationale: Upon discharge, the client should be instructed to avoid strenuous activity and heavy lifting, drink fruit juices, and take stool softeners as ordered, and to avoid sexual activity for at least 6 weeks after surgery. The client should be told not to drive for at least 2 weeks, thus indicating that it is okay to drive for short time frames is not appropriate. Additionally, NSAIDs should not be used for at least 2 weeks after surgery or as instructed by the healthcare provider

The nurse is providing discharge instructions to a postoperative client who is being discharged home with an indwelling urinary catheter. Which information should the nurse include in discharge teaching? (Select all that apply.) A. Empty the leg bag every 3-4 hours. B. Avoid strapping on the leg bag too tightly. C. Place powder around the bag to prevent odor. D. Place a soft cloth between the leg bag and thigh. E. Change from a daytime leg bag to a larger drainage bag at night.

A, B, D, E Rationale: Changing to a larger bag at night permits gravity drainage and keeps urine from backing up in the bladder. If the leg bag is strapped on too tightly, it can impede venous return in the leg. Placing a soft cloth between the bag and the thigh protects the skin and absorbs any wetness. Emptying the leg bag every 3-4 hours prevents overfilling. Powder is not indicated. If there is a strong urine smell, this should be reported to the urologist, along with changes in urine color, urine consistency and amount, hematuria, frank bleeding, or large blood clots

The nurse caring for a client 24-hours post-transurethral resection of the prostate (TURP) should assess for which complication? (Select all that apply.) A. Hemorrhage B. Hypotension C. Hypertension D. Large blood clots E. Decreased urinary output

A, B, D, E Rationale: During the first 24-48 hours after a TURP, the client should be monitored closely for hemorrhage (frank bloody urine output), the presence of large blood clots, decreased urinary output, increased bladder spasms, decreased hemoglobin and hematocrit, tachycardia, and hypotension. Hypertension would not be an expected complication

The nurse is teaching a community-based group about reproductive health. Which information should the nurse include when discussing benign prostatic hyperplasia (BPH)? (Select all that apply.) A. BPH is the most common benign tumor in men. B. BPH is considered a precursor to prostate cancer. C. Almost all men will develop BPH if they live long enough. D. Caucasian American men develop symptoms of BPH later than all other races. E. Antioxidant and anti-inflammatory supplements can reduce the risk of BPH.

A, C Rationale: BPH is the most common benign tumor in men and almost all men will develop BPH if they live long enough. Therefore, the nurse would include these statements in the teaching session. BPH is not considered a precursor to prostate cancer. There is no evidence to support the use of antioxidant or anti-inflammatory supplements to reduce the risk of BPH. Caucasian American men do not develop symptoms of BPH later than all other races. Asian American men develop symptoms later than Caucasian American men

A client who has just undergone transurethral resection of the prostate (TURP) has developed TURP syndrome. Which finding during the nursing assessment support this diagnosis? (Select all that apply.) A. Confusion B. Hypotension C. Hypertension D. Hyponatremia E. Decreased hematocrit

A, C, D, E Rationale: TURP syndrome occurs when the client absorbs the irrigation fluids during and after surgery. Clinical manifestations are hyponatremia, decreased hematocrit, hypertension, bradycardia, nausea, and confusion. If not treated promptly, TURP syndrome may result in dysrhythmias and/or seizures. Hypotension is not a manifestation of this syndrome

Which diagnostic tests should the nurse expect to be prescribed for a client with symptoms of benign prostatic hyperplasia (BPH)? (Select all that apply.) A. Urinalysis B. Urine specific gravity test C. Digital rectal examination D. Prostate-specific antigen (PSA) level E. Ultrasound or postvoid catheterization

A, C, D, E Rationale: Urinalysis is done to identify the presence of white and red blood cells or bacteria in the urine. An ultrasound or postvoid catheterization is performed to determine residual urine volume. A PSA test screens for prostate cancer, and a digital rectal exam assesses the external surface of the prostate. A urine specific gravity test is not a part of the diagnostic screening for BPH

Which statement most accurately describes why BPH is more common in older men than in younger men? A. An increase in androgen production occurs with age, and increased androgens trigger prostatic growth. B. Hyperplasia of stromal and epithelial cells in the prostate gland occurs over a long period of time. C. A decrease in estrogen levels occurs over time and results in an increase in the size of the individual cells within the prostate. D. Frequency of UTIs increases with age, and frequent UTIs contribute to changes in the prostate.

B) Hyperplasia of stromal and epithelial cells in the prostate gland occurs over a long period of time. Rationale: Hyperplasia is an increase in the number of cells; in the case of BPH, hyperplasia occurs in the cells of the prostate over a long period of time. As men age, androgen production decreases rather than increases. Estrogen levels increase with age rather than decreasing. UTIs are often a result rather than a cause of BPH.

The nurse is provididng follow-up care for a client recently diagnosed with BPH. Which nursing diagnosis is the priority for the nurse to include in the client's plan of care? A. Chronic Pain B. Impaired Urinary Elimination C. Constipation D. Diarrhea

B) Impaired Urinary Elimination Rationale: The priority diagnosis for a client diagnoses with BPH is Impaired Urinary Elimination. Acute pain, not chronic pain, is also an appropriate diagnosis. Clients with BPH have problems associated with urinary elimination, not bowel elimination. Constipation and Diarrhea are not appropriate nursing diagnoses for this client.

The nurse is providing care to a client in the healthcare clinic. The client's brother was recently diagnosed with BPH, and the client wants to know if he is also at risk. Which item in the client's history increases the risk for BPH? A. Decreased levels of progesterone B. Increased levels of estrogen C. 35 years old D. Testicle removal due to cancer

B) Increased levels of estrogen Rationale: Clients with increased levels of estrogen are at an increased risk for developing BPH. Clients younger than 40 years of age are at a decreased risk for BPH. Having testicles removed prior to puberty due to cancer also decreases the risk of BPH.

The nurse is providing care to a client who is diagnosed with mild BPH who is experiencing urinary retention. Which goal is the most appropriate for this client? A. The client will increase fluid intake to at least 2-3 liter/day B. The client lists OTC meds to be avoided C. The client will voice understanding of the importance of the use of compression stockings and devices D. The client will use a T-binder or scrotal support properly

B) The client lists OTC meds to be avoided Rationale: Avoiding over-the-counter medications can lessen or prevent the symptoms associated with mild benign prostatic hyperplasia (BPH). An increased fluid intake can assist in preventing burning on urination after catheter removal and reduces the risk of a urinary tract infection. There is no indication that this client had surgery or had a catheter placed. The use of antiembolic stockings and compression devices reduces the risk of developing a thromboembolism. There is no indication that this client had surgery or is at risk for developing a thromboembolism. The use of a T-binder or scrotal support is for those clients that have undergone surgery and are in need of scrotal support and support of the surgical dressing. There is no indication that this client had surgery or had a catheter placed.

The nurse is preparing a client for surgery for benign prostatic hyperplasia (BPH). Which clinical manifestations should the nurse expect in the client's history and physical that would support the need for surgery? (Select all that apply.) A. Nocturia B. Hematuria C. Bladder stones D. Urinary retention E. Renal insufficiency secondary to BPH

B, C, D, E Rationale: Candidates for prostate surgery are clients who have urinary retention, hematuria, bladder stones, and renal insufficiency secondary to BPH. Nocturia alone is not a reason to undergo surgery

A client with benign prostatic hyperplasia (BPH) asks the nurse if there are medications that can be used to prevent the need for surgery. Which response by the nurse is accurate? A. "There are two classes of medications available for BPH, but they only address lower urinary tract symptoms and do not shrink the prostate." B. "There are medications, but most of them have serious adverse effects." C. "Yes, there are medications that can help control BPH symptoms and reduce the need for surgery." D. "There are some medications available, but ultimately they just delay the need for surgery for a short time."

C Rationale: Medications such as alpha-blockers and 5-alpha reductase inhibitors have significantly reduced the need for surgery to control symptoms of BPH. The medications do have several side effects, none of which would likely be considered terrible, in particular, finasteride has no serious adverse effects. The statement that they only delay the need for surgery for a short bit is not a valid statement. Finasteride and dutasteride both cause the enlarged prostate to shrink, thus the statement that they only address lower urinary tract symptoms is not valid

The nurse is caring for a client diagnosed with BPH who is experiencing an increase in symptoms. Which statement by the client would best explain the source of the increased symptoms? A. "I have decreased oral intake at night." B. "I recently had a vasectomy." C. "I am using an OTC cough medication for a cold." D. "I am drinking very little caffeine."

C) "I am using an OTC cough medication for a cold." Rationale: Use of cold medications can increase symptoms because of their anticholinergic properties. Avoiding caffeine and decreasing oral intake at night may resolve symptoms. A vasectomy does not affect the symptoms of BPH.

The nurse is caring for a middle-aged male who is experiencing urinary retention. The client asks the nurse if it's possible that he's experiencing BPH. During the client history, the client reports that he is of Japanese descent. Which response by the nurse is the most appropriate? A. "No, you're not old enough to have BPH." B. "Your symptoms are not consistent with BPH." C. "You are considered low-risk for BPH." D. "Where did you get an idea that you might have BPH?"

C) "You are considered low-risk for BPH." Rationale: The nurse must always provide honest responses to client questions. The nurse should tell the client that due to his ethnicity, he is considered low-risk for developing BPH. While age does increase the risk of BPH, it is not the only factor to consider. The client is experiencing urinary retention, which is consistent with BPH. Asking a client where he got that idea is demeaning.

The home care nurse is making an initial follow-up visit to a client discharged Post-perineal prostatectomy. Which behavior reported by the client post-suture removal should be a cause for concern? A. Fluid intake of 2000-3000 mL per day B. Perineal irrigations with sterile normal saline after bowel movements C. Daily sitz baths D. Use of enemas to address constipation

D Rationale: Due to the proximity of the incision to the anus, there is a high risk of infection. The client should not use enemas or take the temperature rectally. Sitz baths can be used to promote healing. A fluid intake of 2-3 L per day is recommended to prevent urinary tract infection. Perineal irrigations with sterile normal saline should be done after each bowel movement to help prevent infection

A client is recovering from minimally invasive surgery due to a diagnosis of BPH. After assessing the client, the nurse expects which outcome for this client? A. Bowel continence B. Absence of pain C. No post-op treatment D. Urinary Continence

D) Urinary Continence Rationale: After surgery and removal of the catheter, the client should return to urinary continence as expected. The client will need postoperative teaching and will experience some amount of discomfort. Most clients, due to pain and swelling in the area, may have problems with constipation immediately following the surgical intervention.