BPH & Medications
The client asks, "What does an elevated PSA test mean?" On which scientific rationale should the nurse base the response? 1.An elevated PSA can result from several different causes. 2.An elevated PSA can be only from prostate cancer. 3.An elevated PSA can be diagnostic for testicular cancer. 4.An elevated PSA is the only test used to diagnose BPH.
1.An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct.
The nurse is explaining to a client with benign prostatic hyperplasia (BPH) the diagnostic tests that are used to differentiate BPH from prostate cancer. Which would the nurse include in the explanation? (Select all that apply.) A Digital rectal examination B Pelvic ultrasound C PSA level D Blood chemistry E Sperm count
A, C(In a digital rectal examination for BPH, the prostate is asymmetrical and enlarged; in prostate cancer, the exam shows nodules and a fixed position. PSA is specific to the prostate and is released by both benign and malignant cells; however, in BPH the amounts of the free form of PSA and complex PSA would be different. The other tests are not helpful in distinguishing cancer from BPH.)
Which side effect is caused by selective alpha-1 blockers for benign prostatic hyperplasia? a.Low blood pressure b.Male-pattern baldness c.Erectile dysfunction d.Urinary retention
ANS: A Selective alpha-1 blockers can lower blood pressure, especially when changing positions (orthostatic hypotension), causing dizziness or light-headedness.
Which test or examination does a patient receive before taking any drug for benign prostate hypertrophy (BPH)? a.Digital rectal examination b.24-hour urinalysis c.Kidney function test d.Urine culture
ANS: A The signs and symptoms of BPH are the same as for prostate cancer. Before a drug for BPH is taken, the patient should have a digital rectal examination by his prescriber and have his blood tested for prostate-specific antigen levels to rule out prostate cancer.
Which individual should be cautioned to avoid handling a DHT inhibitor drug? a.55-year-old woman who is postmenopausal b.25-year-old woman who is 3 months pregnant c.35-year-old man whose sister is 5 months pregnant d.45-year-old man who has diabetes and hypertension
ANS: B DHT inhibitors are teratogens and can cause birth defects, especially in male fetuses. Women who are pregnant, may become pregnant, or are breastfeeding should not take these drugs or handle them if the tablet or capsule is crushed or broken.
What is the most common side effect of drugs used for benign prostate hypertrophy (BPH)? a.Low blood pressure b.Decreased libido c.Light-headedness d.Hair loss
ANS: B Side effects of drugs used for BPH also include erectile dysfunction, decreased seminal fluid, and reduced fertility. The most common side effect of these drugs is a decreased interest in sexual activity.
How do DHT inhibitors work to reduce benign prostatic hyperplasia? a.Relaxing the muscles of the bladder. b.Increasing urine production. c.Shrinking the prostate gland. d.Relaxing prostate smooth muscle.
ANS: C DHT inhibitors work directly on the prostate gland. They are a "counterfeit" drug that looks like testosterone and binds to the enzyme that normally converts testosterone to DHT, its most powerful form. This counterfeit drug cannot be converted to DHT; and, while it is bound to the enzyme, the enzyme is not available to convert the real testosterone to DHT. With much less DHT in the prostate, the cells in the prostate gland do not receive the signal to grow. As a result, the gland shrinks and puts less pressure on the urethra, allowing better urine flow.
Which drug belongs to the DHT inhibitor class? a.Alfuzosin b.Tamsulosin c.Silodosin d.Dutasteride
ANS: D Alfuzosin, tamsulosin, and silodosin are all selective alpha-1 blockers. Dutasteride and finasteride are DHT inhibitors.
A patient with acute urinary retention associated with BPH is admitted to the emergency department. The patient has had no urine output for 16 hours, and the laboratory work shows a blood urea nitrogen (BUN) level of 50 mg/dl and a creatinine of 3.0 mg/dl. The nurse will anticipate a health care provider order to a. schedule the patient for inpatient hemodialysis. b. insert a retention catheter. c. start an IV line for fluid administration. d. administer furosemide (Lasix).
Answer: B Rationale: The patient data indicate that the patient may have hydronephrosis and acute renal failure caused by the BPH; the initial therapy will be to insert a catheter. Hemodialysis may be needed if the elevation in BUN and creatinine persists, but it will not be ordered initially. Fluid administration and furosemide administration will increase the bladder distension.Cognitive Level: Application Text Reference: p. 1415Nursing Process: Planning NCLEX: Physiological Integrity
The health care provider prescribes finasteride (Proscar) for a 56-year-old male patient who has a BPH symptom score of 12 on the AUA Symptom Index. When teaching the patient about the drug, the nurse informs him that a. his interest in sexual activity may decrease while he is taking the medication. b. he should change position from lying to standing slowly to avoid dizziness. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.
Answer: A Rationale: A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Orthostatic hypotension is a side effect of the α-blocking agents. Improvement in symptoms of obstruction takes 3 to 6 months. The medication does not cause hypertension.Cognitive Level: Application Text Reference: p. 1417Nursing Process: Implementation NCLEX: Physiological Integrity
Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of urine. An appropriate nursing intervention for this patient is to teach the patient a. pelvic floor muscle training. b. the use of belladonna and opium suppositories. c. how to perform intermittent self-catheterization. d. to restrict oral fluid intake.
Answer: A Rationale: Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L.Cognitive Level: Application Text Reference: p. 1428Nursing Process: Planning NCLEX: Physiological Integrity
A patient with symptomatic BPH is scheduled for visual laser ablation of the prostate (VLAP) at an outpatient surgical center. The nurse will plan to teach the patient a. how to care for an indwelling urinary catheter. b. that the urine will appear bloody for several days. c. to expect an immediate improvement in urinary force. d. that an intraprostatic urethral stent will be placed.
Answer: A Rationale: The patient will have indwelling catheter for up to a week and will need to be instructed on catheter care to avoid problems such as infection. There is minimal bleeding with this procedure. It will take several weeks before the full benefits of the procedure take effect. Stent placement is not included in the procedure.Cognitive Level: Application Text Reference: pp. 1420-1422Nursing Process: Planning NCLEX: Physiological Integrity
A patient scheduled for a transurethral resection of the prostate (TURP) for BPH tells the nurse that he has delayed having surgery because he is afraid it will affect his sexual function. When responding to his concern, the nurse explains that a. with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur. b. information about penile implants used for ED is available if he is interested. c. there are many methods of sexual expression that can be alternatives to sexual intercourse. d. sterility will not be a problem after surgery because sperm production will not be affected.
Answer: ARationale: Erectile problems are rare, but retrograde ejaculation may occur after TURP. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns.Cognitive Level: Application Text Reference: p. 1418Nursing Process: Implementation NCLEX: Physiological Integrity
A patient with benign prostatic hyperplasia (BPH) with mild obstruction tells the nurse, "My symptoms have gotten a lot worse this week." Which response by the nurse is most appropriate? a. "The prostate gland normally changes slightly in size from day to day, and this may be making your symptoms worse." b. "Have you been taking any over-the-counter (OTC) medications recently?" c. "Have you talked to the doctor about surgical procedures such as transurethral resection of the prostate?" d. "I will talk to the doctor about ordering a prostate specific antigen test."
Answer: B Rationale: Because the patient's increase in symptoms has occurred abruptly, the nurse should ask about OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer and is not indicated in this patient, who has already been diagnosed with BPH.Cognitive Level: Application Text Reference: p. 1421Nursing Process: Assessment NCLEX: Physiological Integrity
Following discharge teaching for a patient who has had a transurethral prostatectomy for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, a. "I will increase fiber and fluids in my diet to prevent constipation." b. "I should call the doctor if I have any incontinence at home." c. "I will avoid heavy lifting or driving until I get approval from my health care provider." d. "I should continue to schedule yearly appointments for prostate exams."
Answer: B Rationale: Incontinence is common for several weeks after a TURP. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.Cognitive Level: Application Text Reference: p. 1422Nursing Process: Evaluation NCLEX: Physiological Integrity
The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate? a. "The bladder irrigation is needed to stop the postoperative bleeding in the bladder." b. "The irrigation is needed to keep the catheter from being occluded by blood clots." c. "Normal production of urine is maintained with the irrigations until healing occurs." d. "Antibiotics are being administered into the bladder with the irrigation solution."
Answer: B Rationale: The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or maintain urine production. Antibiotics are given by the IV route, not through the bladder irrigation.Cognitive Level: Comprehension Text Reference: pp. 1420-1421Nursing Process: Implementation NCLEX: Physiological Integrity
A 41-year-old man asks the nurse what he can do to decrease the risk of BPH. The nurse explains that a. riding a bicycle raises prostate specific antigen levels and may increase BPH risk. b. prevention is not possible because prostatic enlargement occurs with normal aging. c. decreasing butter and margarine and increasing fruits in the diet may help. d. taking a daily vitamin E supplement has reduced prostate size in some men.
Answer: C Rationale: A diet high in saturated fats, found in foods like butter, is associated with an increased risk for BPH. Individuals who eat more fruits and vegetables may be at lower risk. Riding a bicycle does increase prostate-specific antigen (PSA) levels, but this is not associated with development of BPH. Dietary changes and increased exercise do appear to help prevent BPH. Vitamin E supplements do not decrease prostate size.Cognitive Level: Comprehension Text Reference: p. 1415Nursing Process: Implementation NCLEX: Physiological Integrity
A patient with irritative and obstructive bladder symptoms has an enlarged prostate on digital rectal examination (DRE) and an elevated PSA level. The nurse will anticipate that the patient will need teaching about a. uroflometry studies. b. cystourethroscopy. c. transrectal ultrasonography (TRUS). d. magnetic resonance imaging (MRI).
Answer: C Rationale: In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to help differentiate BPH from prostatic cancer. Uroflowmetry studies will help determine the extent of urine blockage and treatment, but a differential diagnosis will be obtained first. Cystourethroscopy may be used after TRUS if the diagnosis is still uncertain. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process.Cognitive Level: Application Text Reference: p. 1416Nursing Process: Planning NCLEX: Physiological Integrity
The health care provider orders a blood test for prostate-specific antigen (PSA) when an enlarged prostate is palpated during a routine examination of a 56-year-old man. When the patient asks the nurse the purpose of the test, the nurse's response is based on the knowledge that a. elevated levels of PSA are indicative of metastatic cancer of the prostate. b. PSA testing is the "gold standard" for making a diagnosis of prostate cancer. c. baseline PSA levels are necessary to determine whether treatment is effective. d. PSA levels are usually elevated in patients with cancer of the prostate.
Answer: D Rationale: PSA levels are usually elevated above the normal in patients with prostate cancer. PSA testing does not determine whether metastasis has occurred. A biopsy of the prostate is needed for a definitive diagnosis of prostate cancer. Success of treatment is determined by a fall in PSA to an undetectable level; the patient's baseline PSA is not needed to determine the success of treatment.Cognitive Level: Application Text Reference: p. 1423Nursing Process: Implementation NCLEX: Physiological Integrity
An older male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)? A. High-purine diet B. Sedentary lifestyle C. Benign prostatic hyperplasia (BPH) D. Recent use of broad-spectrum antibiotics
C. Benign prostatic hyperplasia (BPH)BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi.
A patient undergoing a TURP returns from surgery with a three-way urinary catheter with continuous bladder irrigation in place. The nurse observes that the urine output has decreased and the urine is clear red with multiple clots. The patient is complaining of painful bladder spasms. The most appropriate action by the nurse is to a. administer the ordered IV morphine sulfate, 4 mg. b. increase the flow rate of the continuous bladder irrigation. c. give the ordered the belladonna and opium suppository. d. manually instill 50 ml of saline and try to remove the clots.
D
A man whose BPH has been successfully managed through medical treatment visits the provider's office and reports he has suddenly had a return of symptoms including frequency, urgency, and a sensation of incomplete emptying after voiding. The nurse collects a thorough history and suspects the possible cause of the sudden exacerbation of the client's symptoms may be: A) increased sexual activity since his wife has retired. B) antihypertensive medications he was recently prescribed. C) increased levels of exercise as he trains for a marathon. D) over-the-counter medications he's been taking to treat cold symptoms.
D(Over-the-counter medications, such as antihistamines and decongestants, can exacerbate the symptoms of BPH because they contain alpha adrenergic agents or have anticholinergic effects. Antihypertensives do not affect BPH. Increased sexual activity and exercise will not aggravate symptoms of BPH.)
The nurse is assessing a client who is suspected of experiencing an enlarging prostate gland (BPH). The nurse expects the enlarging prostate in BPH to be manifested by which of the following symptoms? A) Bowel elimination B) Skin integrity C) Peripheral vascular function D) Urinary elimination
D(Rationale:As the prostate enlarges around the urethra, it begins to obstruct the outflow of urine from the bladder during urination causing problems with urinary retention, frequency, and urgency. The other systems are not affected
A result of the digital rectal examination in a patient with BPH includes what findings? A Enlarged, tender prostate. B Large, rubbery prostate. C Small, nontender prostate. D Pus-covered prostate.
Question 4 Explanation: B: BPH manifests a large, nontender, rubbery prostate when assessed through DRE. A: The prostate in BPH is not tender. C: The prostate in BPH is not small. D: The prostate in BPH is not covered in pus.
What is the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra? A Open prostatectomy. B TUNA. C DRE. D TURP.
Question 5 Explanation: D: TURP the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra. A: Open prostatectomy involves the surgical removal of the inner portion of the prostate via a suprapubic, retropubic, or perineal approach for large prostate glands. B: TUNA uses low-level radio frequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues. C: DRE is the manual palpation of the prostate via the rectum using the gloved fingers of the examiner.