MedSurg Quiz 6
The nurse is caring for a client who has just returned to the surgical unit after a transurethral resection of the prostate (TURP). Which assessment finding will require the most immediate action?
Catheter that is draining deep red blood
Which nursing action can best prevent infection from a urinary retention catheter?
Cleansing around the meatus routinely
A client with benign prostatic hyperplasia has a new prescription for tamsulosin. Which statement about tamsulosin is most important to include when teaching this client?
"You should avoid sitting up or standing up too quickly"
A client has had a needle biopsy of the prostate gland using the transrectal approach. Which statement is most important to include in the client teaching plan?
"You will need to call the HCP if you develop fever or chills"
The nurse is talking to a 35-year-old African American man about prostate-specific antigen (PSA) testing. The patient tells the nurse that his father was diagnosed with prostate cancer in his 50s. What should the nurse tell the patient?
"Your genetic and racial risk factors suggest testing should begin at age 45."
The nurse is interviewing a patient to determine the presence of lower urinary tract symptoms associated with benign prostatic hyperplasia. Which questions would the nurse ask? Select all that apply.
-"Do you have difficulty starting and continuing urination?" -"Do you have reduced force and size of the urinary stream?" -"Have you noticed dribbling or leaking after urinating?" -"How many times do you have to get up during the night to urinate?" -"Have you noticed blood at the start or at the end of urinating?"
Which conditions meet the criteria for a patient having a surgical intervention for benign prostatic hyperplasia? Select all that apply.
-Acute urinary retention -Hydronephrosis -Hematuria -Chronic urinary tract infections secondary to residual urine in the bladder
The nurse teaches a patient with benign prostatic hyperplasia to follow which instructions? Select all that apply.
-Avoid antihistamine -Avoid caffeine -Avoid drinking large amounts of fluid in a short time -Void when the urge occurs
What are common sites of metastasis for prostate cancer? Select all that apply.
-Bones of the pelvis -Liver -Lumbar Spine -Lungs
The nurse is teaching a patient who had an open retroperitoneal lymph node dissection. What instructions does the nurse give to the patient? Select all that apply.
-Do not lift anything over 15 lb -Do not drive a car for several weeks -Perform monthly testicular self-examination on the remaining tests -Have follow-up diagnostic testing for at least 3 years after the surgery -Report fever, drainage, or increasing tenderness or pain around the incision
The nurse is taking a health history on a patient with organic erectile dysfunction. What are possible causes of this condition? Select all that apply.
-Medications for hypertension -Thyroid disorders -Diabetes mellitus -Smoking and alcohol
The nurse is teaching a patient about self-care following an open radical prostatectomy. What does the nurse include in the health teaching? Select all that apply.
-Teach how to care for the indwelling catheter and manifestations of infection -Instruct to walk short distances -Advise to maintain an upright position and not walk bent or flexed -Advise to shower rather than soak in a bathtub for the first 2-3 weeks
The nurse is caring for a patient who had minimally invasive surgery for testicular cancer. The nurse is also caring for a patient who had an open radical retroperitoneal lymph node dissection for testicular cancer. The nurse anticipates that the second patient has greater risk for which conditions?
Paralytic ileus
The patient had a transurethral resection of the prostate (TURP) several days ago, and the urinary catheter was removed 6 hours ago. Which sign/symptom must be resolved before the patient is discharged?
Patient has not voided since the catheter was removed
The nurse is reviewing the laboratory results from a patient being evaluated for lower urinary tract symptoms. What does an elevated prostate specific antigen level and serum acid phosphate level in this patient indicate?
Prostate cancer
A nurse is caring for a client with a diagnosis of cancer of the prostate. Which serum level should the nurse teach the client to have monitored to follow the course of the disease?
Prostate-specific antigen
The health care provider tells the nurse that the patient needs testing for prostatitis. Which specimen needs to be obtained and sent to the laboratory?
Prostatic fluid for culture and sensitivity
The nurse is giving discharge instructions to a patient who had a transurethral resection of the prostate. What does the nurse include in the instructions?
Reassurance that loss of control of urination or dribbling of urine is temporary
After a radical prostatectomy, a client is ready to be discharged. Which nursing action included in the discharge plan should be assigned to an experienced LPN/LVN?
Reinforcing the client's need to check his temperature daily
The nurse is giving instructions to unlicensed assistive personnel (UAP) about hygienic care for an older adult patient who is uncircumcised. What does the nurse instruct the UAP to do?
Replace the foreskin over the penis after bathing
A patient had a transrectal ultrasound with biopsy. After this procedure, what does the nurse instruct the patient to do?
Report fever, chills, bloody urine, and any difficulty voiding
A client with cancer of the prostate requests the urinal at frequent intervals but either does not void or voids in very small amounts. What does the nurse conclude is most likely the causative factor?
Retention
A patient tells the nurse that he was diagnosed with benign prostatic hyperplasia. Based on this diagnosis, which symptom is the patient most likely to report?
Trouble passing urine
The nurse obtains the following assessment data about a client who has had a transurethral resection of the prostate (TURP) and has continuous bladder irrigation. Which finding indicates the most immediate need for nursing intervention?
The client reports painful bladder spasms
The advanced practice nurse is preparing to examine a patient's prostate gland. Before the exam, what does the nurse tell the patient?
The gland will be massaged to obtain a fluid sample for possible prostatitis
A client is admitted to the hospital with a tentative diagnosis of urinary retention related to benign prostatic hyperplasia. There is a secondary diagnosis of delirium related to urosepsis. The health care provider prescribes the insertion of an indwelling urinary retention catheter. What nursing action is most important for the client's safety?
Determine if any unsafe behavior patterns exist
The nurse is using the International Prostate Symptom score to assess the patient. Which data does the nurse intend to obtain through the use of this assessment tool?
Effect of urinary symptoms on the quality of life
The nurse is caring for a patient who had an open radical prostatectomy. During the assessment, the nurse notes that the penis and scrotum are swollen. What does the nurse do next?
Elevate the scrotum and penis; apply ice intermittently to the area for 24-48 hours
The nurse is reviewing the laboratory results for a patient with prostate cancer. Which laboratory result suggests metastasis to the bone
Elevated serum alkaline phosphatase
The patient had several diagnostic tests to evaluate lower urinary tract symptoms. Which finding suggests that the patient may have a kidney disease?
Elevated serum creatinine
Which is the most important for the nurse to do when providing care to a client who had a transurethral resection of the prostate?
Ensure patency of the indwelling catheter
A patient is prescribed leuprolide, a luteinizing hormone-releasing hormone agonist, for treatment of a prostate tumor. What possible side effect of this medication does the nurse advise the patient about?
Erectile dysfunction
What is the major advantage to tadalafil compared to other medications or treatments for erectile dysfunction?
Erection occurs more naturally
The nurse is preparing to assess an obese patient who reports subjective symptoms and urinary patterns associated with benign prostatic hyperplasia. Which technique does the nurse use to perform the physical assessment?
Instruct the patient to void and then use the bedside ultrasound bladder scanner
The nurse notes bright red blood with numerous clots in the urinary drainage bag for a patient who had a transurethral resection of the prostate. Besides notifying the surgeon, what is the nurse's best action?
Irrigate the catheter with normal saline per protocol
A nurse is caring for a client with a diagnosis of benign prostatic hyperplasia (BPH). Which information about this condition is important for the nurse to consider when caring for the client?
It predisposes to hydronephrosis
A patient had a trasurethral resection of the prostate and has a three-way urinary catheter taped to the left thigh. What does the nurse instruct about the position of the left leg?
Keep the leg straight
A patient had a transrectal ultrasound with biopsy earlier in the day. What urine characteristics does the nurse expect to see?
Light pink urine
The patient has an indwelling catheter in place following a transurethral resection of the prostate. What instructions will the nurse give to the unlicensed assistive personnel regarding the catheter?
Maintain traction on the catheter
The day after a radical prostatectomy, a client has blood clots in the urinary catheter and reports bladder spasms. The client says that his right calf is sore and that he feels short of breath. Which action will the nurse take first?
Measure oxygen saturation using pulse oximetry
A patient reports having erectile dysfunction and is seeking a prescription for sildenafil. Because of the potential for dangerous drug-drug interactions, the nurse asks the patient specifically if he takes which type of medication?
Nitrates
The patient is prescribed a broad-spectrum antibiotic for prostatitis. Which laboratory result indicates that the medication is having the desired therapeutic effect?
Normalization of white cell count
The nurse is caring for a patient who is taking finasteride, a 5 alpha reductase inhibitor. What questions would the nurse ask to determine if the medication is having the desired therapeutic effect?
"Are you having any problems with urination?"
The nurse sees that the patient is taking tamsulosin. Which question would the nurse ask to determine if the medication is achieving the desired therapeutic effect?
"Are you still having trouble passing urine?"
What are common serum tumor markers that confirm a diagnosis of testicular cancer? Select all that apply.
-Lactate dehydrogenase -Alpha-fetoprotein -Beta human chorionic gonadotropin
A client had a suprapubic prostatectomy. Which type of tube can the nurse expect the client to have when he returns to his room from the postanesthesia care unit?
Cystostomy
During the first 24 hours after prostatectomy, what is the priority concern?
Hemorrhage
An older patient reports that he has an enlarged prostate with chronic urinary retention but declines to seek treatment because "its been that way for a long time." The nurse would encourage a follow-up appointment to prevent which complication of this chronic condition?
Hydronephrosis
A client who had a suprapubic prostatectomy returns from the postanesthesia care unit and accidently pulls out the urethral catheter. What should the nurse do first?
Notify the health care provider
An older patient is scheduled for an annual physical including a prostate-specific antigen (PSA) and a digital rectal examination (DRE). How are these two tests scheduled for the patient?
PSA is drawn before the DRE is performed
An older adult patient had a transurethral resection of the prostate at 8:00 AM. At 3:00 PM, the nurse assesses the patient. Which finding does the nurse report to the health care provider?
Patient keeps moving and ketchup-like urine output is noted
Which sign/symptom is associated with advanced prostate cancer?
Swollen lymph nodes
The nurse is designing a teaching plan for a patient with an enlarged prostate with obstructive symptoms. What action could the patient perform that might help to relive the obstruction?
Increase frequency of sexual intercourse
A patient needs surgical intervention for an enlarged prostate but also needs to maintain his anticoagulant therapy. Which brochure would be the most appropriate to prepare for the patient?
"Talking to Your Doctor About Holmium Laser Enucleation of the Prostate"
An older patient's wife is very upset because "my husband was just told he had prostate cancer. He feels fine now, but the doctor told him to watch and wait. Why are we just watching? What are we supposed to do?" What is the nurse's best response?
"Prostate cancer is slow growing. Your husband needs regular prostate specific antigen testing; I'll give you a list of symptoms to watch for."
The nurse is interviewing a patient with erectile dysfunction. Which question would the nurse ask to assist the health care provider in differentiating the etiology as organic versus functional?
"Do you ever have nocturnal emissions or morning erections?"
The nurse reads in the patient's chart that the patient had a transurethral needle ablation. Which question would the nurse ask the patient to determine if the procedure achieved the intended therapeutic goal?
"Have your problems with urination been resolved?"
The nurse is talking to a patient who had the relatively new procedure, prostate artery embolization. Which patient report indicates that the intended goal of therapy has been met?
"I am not having any more urinary symptoms"
The nurse is talking with an older patient who has benign prostatic hyperplasia. Which report by the patient requires emergent care?
"I can't pass my urine today."
The patient has a continuous bladder irrigation via a three-way urinary catheter. At 0700, the urine drainage bag was emptied and 1,000 mL of irrigation fluid was hung. At 1100, 350 mL of irrigation fluid has been administered through the catheter. The urinary drainage bag now contains 600 mL. How many mL of urine has the patient produced in the past 4 hours? ________ mL
250 mL
The emergency department nurse receives change-of-shift report about four clients. Which one should be assessed first?
A 19-year-old client with scrotal swelling and severe pain that has not decreased with elevation of scrotum
Which man has the highest risk for prostate cancer?
A 75-year-old African American man whose brother had prostate cancer
The nurse is caring for a 21-year-old client who had a left orchiectomy for testicular cancer on the previous day. Which nursing activity will be best to assign to an LPN/LVN?
Administering the prescribed "as needed" (PRN) oxycodone to the client
A young patient is diagnosed with testicular cancer. He and his wife have been trying to conceive a child for several months. What information does the nurse give the couple about sperm storage?
Arrangements for sperm storage should be made as soon as possible after diagnosis
A patient had undergone external beam radiation therapy (EBRT) for palliative treatment of prostate cancer. What suggestions does the nurse make to help the patient manage acute radiation cystitis secondary to ERBT?
Avoid consumption of caffeinated drinks
A patient who has testicular cancer is likely to have which common problem?
Azoospermia
A client who has just returned to the surgical unit after a transurethral resection of the prostate (TURP) reports acute bladder spasms. In which order will the nurse perform these prescribed actions? A. Administer acetaminophen/oxycodone 325 mg/5 mg B. Irrigate the retention catheter with 30 to 50 mL of sterile normal saline C. Infuse 500 mL of 5% dextrose in lactated Ringer's solution over 2 hours D. Offer the client oral fluids to at least 2500 to 3000 mL/day
B, A, C, D
The nurse is teaching a patient at risk for prostate cancer about food sources of omega-3 fatty acids. Which food does the nurse suggest?
Fish
The nurse is caring for an older patient who had an indwelling urinary catheter inserted after a transurethral resection of the prostate. The patient is intermittently confused, and picks at the IV tubing and the catheter. What should the nurse try first?
Give the patient a familiar object to hold, such as a family picture
The nurse notes that the patient has just started taking an alpha-blocker medication to treat benign prostatic hyperplasia. What instruction, related to the medication side effects, will the nurse give to unlicensed assistive personnel who will assist the patient with activities of daily living?
Have him sit up slowly and pause before standing
A patient reports having uncomfortable and unsettling episodes of "hot flashes" after receiving hormonal therapy for a prostate tumor. To alleviate this symptom, the nurse would obtain an order for which medication?
Hormonal inhibitor drug such as megestrol acetate
The nurse is teaching a patient who had an open radical prostatectomy about how to manage the common potential long-term complications. What does the nurse teach the patient?
How to perform Kegel perineal exercises
A patient is undergoing large-volume bladder irrigation. During and after the procedure, the nurse observes the patient for confusion, muscle weakness, and increased gastrointestinal motility related to which potentially adverse effect of large-volume irrigation?
Hyponatremia
What should the nurse do to obtain an accurate urine output for a client with a continuous bladder irrigation (CBI)?
Subtract the volume of irrigant from the total drainage
A nurse is caring for a client with a continuous bladder irrigation. Which is the most important nursing action?
Subtracting irrigant from output to determine urine volume
A patient is receiving internal radiation therapy (brachytherapy) and has had a low-dose radiation seed implanted directly into the prostate gland. What nursing implication is related to this therapy?
Teach the patient that fatigue is common but should pass after several months
The advanced practice nurse is performing a testicular exam on a young Caucasian male patient. The practitioner finds a hard, painless lump. This finding is considered the most common manifestation of which disease or disorder?
Testicular cancer
The nurse is reviewing prostate-specific antigen (PSA) results for a patient who had a prostatectomy for prostate cancer several months ago. The PSA level is 40 ng/mL. How does the nurse interpret this data?
The cancer is most likely recurring
A patient has an enlarged prostate. Which procedure does the nurse anticipate that the health care provider will order to test for bladder outlet obstruction?
Urodynamic pressure-flow study
A nurse is caring for a client with an indwelling urinary catheter. What is the most important action for the nurse to implement when irrigating the bladder?
Use sterile equipment
