chapter 59 prepU
Finasteride
A 48-year-old man recently diagnosed with benign prostatic hyperplasia (BPH) reports consuming <i>Serenoa repens</i> (saw palmetto berry). The nurse needs to intervene if the physician orders which treatment?
frequency Explanation: Obstructive and irritative symptoms may include urinary frequency, urgency, nocturia, hesitancy in starting urination, decreased and intermittent force of stream and the sensation of incomplete bladder emptying, abdominal straining with urination, a decrease in the volume and force of the urinary stream, dribbling (urine dribbles out after urination), and complications of acute urinary retention and recurrent UTIs.
In a client with benign prostatic hyperplasia, which assessment finding provides the best indication of urinary retention?
-diabetes -testosterone deficiency -Parkinsonism Explanation: Organic causes of ED include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic renal failure, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to be psychogenic causes.
The nurse is leading a workshop on sexual health for men. The nurse should describe what organic causes of erectile dysfunction? Select all that apply
Finasteride (Proscar)
The client with benign prostatic hyperplasia (BPH) is considering use of medication in the management of symptoms. Which of the following drugs reduces the size of the prostate without lowering circulating levels of testosterone?
Alprostadil
The client with erectile dysfunction has opted to self administer a urethral suppository as a means of produce an erection. Which of the following agents would most likely be used?
hypotension with nitrate use
The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history?
ibuprofen
The nurse is obtaining a medication history from a client who is reporting erectile dysfunction. Which medication with the nurse identify as being least likely to contribute to the clients condition?
new onset of anemia being treated with iron supplements
The nurse is reviewing the history of client with a rectal dysfunction. Which of the following was a nurse least likely identify as contributing to the clients condition?
prostatism
The obstructive and irritative symptom complex caused by benign prostatic hypertrophy is called
increased effort to void
When assessing a client with benign prostatic hyperplasia, which of the following with the nurse expect the client to report as the initial complaint?
A 56-year-old African American man Rationale: Age over 40 and African American race are both risk factors for prostate cancer. Age younger than 40 and Asian heritage reduce the risk of prostate cancer
Which client is most likely to develop prostate cancer according to a nurse working at a health screening at the local mall?
transurethral needle ablation (TUNA) explanation: Other minimally invasive treatment options include (transurethral needle ablation [TUNA]) by radiofrequency energy and the UroLume stent. 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. The body then reabsorbs the dead tissue.
Which therapy uses low-level radio frequencies to produce localize heat that destroys prostate tissue?
Transurethral needle ablation (TUNA) Rationale: Transurethral needle ablation uses low-level radiofrequencies to produce localized heat that destroys prostate tissue while sparing the urethra, nerves, muscles, and membranes. Sal palmetto is a herbal product used to treat the symptoms associated with benign prostatic hyperplasia. Microwave thermotherapy involves the application of heat to the prostatic tissue. Resection of the prostate can be performed with ultrasound guidance.
Which therapy uses low-level radiofrequencies to produce localized heat that destroys prostate tissue?
"What concerns you most about having surgery?" Rationale: Being sympathetic and encouraging the client to express his concerns is a therapeutic response. This client may have concerns about the complications associated with the surgery and/or need additional information on newest techniques that improve outcomes. Explaining that the surgeon is competent does not address the concerns of this client. Family feelings are secondary to the concerns or the client. A cure of cancer is never a guarantee with any surgery.
A 50-year-old is diagnosed with stage II prostate cancer. The client is upset and verbalizes that he would rather die than have any surgery. Which is the best response by the nurse?
retinopathy Explanation:
A 55-year-old client with a history of type one diabetes presents at the clinic reporting erectile dysfunction. The physician prescribes tadalafil to be taken one hour before sexual intercourse. The nurse reviews the clients history prior to instructing a client on the use of this medication. What disorder will contradict the use of tadalafil?
Prostatism Rationale: Symptoms of prostatism include increased frequency of urination, nocturia, urgency, dribbling, hematuria, and a sensation that the bladder has not completely emptied. PSA and WBC levels are within expected ranges. Prostatitis is an inflammation of the prostate gland. Prostaglandins are physiologically active substances present in tissues with vasodilator properties. Prostatectomy refers to the surgical removal of the prostate gland.
A 57-year-old man is being treated in the outpatient community center. The client reports that most nights he wakes up twice to urinate. In addition, he reports occasional blood in his urine. The client's laboratory tests reveal a PSA level of 3.8 ng/mL and a white blood cell (WBC) count of 6,000 mm3. The nurse most likely suspects that the client is experiencing which condition?
-clonidine -lorazepam -nadolol -Fluoxetine
During a routine office visit, a client mentions difficulty maintaining an erection. While reviewing the clients medical history, the nurse notes the clients medication history. Which medication with the nurse interpret as a potential cause of erectile dysfunction? Select all that apply
Antifungals Antipsychotics Beta blockers Antiseizure agents Antispasmodics
Which of the following medication classifications are associated with erectile dysfunction? Select all that apply.
Light yellow and clear Rationale: Typically a three-way catheter drainage system is removed when the urine appears clear and amber (light yellow). Reddish-pink urine with clots usually occurs in the immediate postoperative period. Eventually the urine becomes light pink within 24 hours after surgery. Dark amber urine suggests concentrated urine commonly associated with dehydration.
The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following?
"The best time to do it is once a month after I take my warm morning shower." Rationale: TSE is to be performed monthly, usually after a warm bath or shower when the scrotum is more relaxed. Both hands are used to palpate the testis. The index and middle fingers are placed under the testis and the thumb is placed on top. The testis is rolled gently in a horizontal plane between the thumb and fingers. A cordlike structure on the top and back of the testicle is the epididymis. This is normal and does not need to be reported.
The nurse is teaching a young adult male how to perform testicular self-examination (TSE). The nurse determines that the client has understood the instructions when he states which of the following?
relieve urinary symptoms Explanation: Alpha-adrenergic blockers, which include alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cardura), and tamsulosin, relax the smooth muscle of the bladder neck and prostate. This improves urine flow and relieves symptoms of BPH.
The physician orders in Alpha adrenergic blocker for a client with the benign prostatic hyperplasia. The nurse understand that this drug acts to achieve which of the follow up?
-do not delay the urge to void -Schedule Digital rectal exams Explanation: The client should be instructed to void promptly when the urge to empty the bladder is signaled by the stretch receptors in the bladder. Voiding promptly will decrease the risk for urinary retention. Digital rectal exams should be monitored to detect further enlargement of the gland and /or presence of prostatic nodules. Alcohol and antihistamines should be avoided in the management of BPH. Exposure to heat and painless hematuria are not significant in the management of BPH. Alcohol and antihistamines interact with many BPH drugs.
Which of the following should be included when teaching a client about the management of benign prostatic hyperplasia? Select all that apply
Evaluating the patency of drainage lumen Explanation: Nursing interventions include closely monitoring vital signs; administering medications, IV fluids, and blood component therapy as prescribed; maintaining an accurate record of intake and output; and carefully monitoring drainage to ensure adequate urine flow and patency of the drainage system.
A client is ordered continuous bladder irrigation at a rate of 60 drops per minute. The nurse changes a 2 L bag of sterile solution with tubing on a three legged IV pole. She then attaches the tubing to the clients three-way urinary catheter, adjust the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow?
"I've had trouble getting started when I urinate, often straining to do so." Explanation: Obstructive and irritative symptoms of BPH may include urinary frequency, urgency, nocturia, hesitancy in starting urination, decreased and intermittent force of stream and the sensation of incomplete bladder emptying, abdominal straining with urination, a decrease in the volume and force of the urinary stream, dribbling (urine dribbles out after urination), and complications of acute urinary retention and recurrent UTIs.
A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia?
Applying ice to the scrotum
A client comes to the emergency department complaining of moderate to severe testicular pain and tenderness. Both testicles are swollen and a penile discharge is present. The client is diagnosed with viral orchitis. Which of the following would the nurse include in this client's plan of care?
Prepare the client for surgery Rationale: For the client with torsion, immediate surgery is necessary to prevent atrophy of the spermatic cord and preserve fertility. Analgesics would be given preoperatively. Postoperatively, a scrotal support is applied and dressings are inspected for drainage. Circumcision is done to relieve phimosis or paraphimosis.
A client comes to the emergency department complaining of sudden, sharp testicular pain. Further examination reveals torsion of the spermatic cord. Which of the following would the nurse expect to do next?
increased blood urea nitrogen (BUN)
A client has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this client has chronic urinary retention?
the client reports bladder spasms and the urge to void Explanation:
After having transurethral resection of the prostate, a client returns to the unit with three-way and rolling catheter and continuous close bladder irrigation. Which findings suggest that the clients catheter is occluded?
Cryptorchidism Rationale: Structural abnormalities include cryptorchidism, torsion of the spermatic cord, phimosis, paraphimosis, hydrocele, spermatocele, and varicocele. Erectile dysfunction and priapism are erection disorders. Prostatitis is an infectious disorder.
After teaching a group of student about structural abnormalities of the male reproductive system, the instructor determines that the teaching was successful when the students identify which of the following as an example?
prostate Rationale: Prostatic cancer is second to skin cancer in frequency among American men. It ranks second as the cause of deaths from cancer. Cancer of the testes is a malignancy seen in men between 18 and 40 years of age. Although this cancer is relatively rare, accounting for approximately 1% of cancers in men, it is the most common type in men between 15 and 34 years of age and is the leading cause of cancer deaths in men between 25 and 34 years of age. Skin cancer ranks first in frequency among American men. Penile cancer is rare and occurs more often in men who are uncircumcised.
Which cancer ranks second as the cause of death in American men?
Voiding pattern Explanation: Alpha-adrenergic blockers, which include alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cardura), and tamsulosin, relax the smooth muscle of the bladder neck and prostate. This improves urine flow and relieves symptoms of BPH.
Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia?
scrotum Rationale: To maintain the temperature of the testes 3 degrees cooler than body temperature, smooth and skeletal muscles in the scrotum pull the tissue toward the body when external temperatures are cold. On the other hand, the smooth muscles relax, causing the scrotum to become loose and hang away from the body when environmental temperatures are hot. The scrotum is the divided sac of skin that contains the right and left testes, also called testicles. The location of the testes within the scrotal sac ensures optimum conditions for sperm production.
Which structure is involved in keeping the testes at the necessary temperature to ensure sperm production?
30 Explanation: When to take sildenafil: take the medication 30 minutes to 4 hours before intercourse. There must be sexual stimulation to produce an erection.
As treatment of erectile dysfunction, Viagra is taken how many minutes before intercourse to be effective?
Take prescribed antibiotics Explanation:
Which should be included as part of the home care instructions for a client with epididymitis and orchitis?
Gynecomastia Rationale: Adverse effects associated with leuprolide, a luteinizing hormone-releasing hormone agonist, are related to hypogonadism and include vasomotor flushing, loss of libido, decreased bone density, anemia, fatigue, increased fat mass, decreased muscle mass, gynecomastia, and mastodynia (breast/nipple tenderness).
A client is receiving leuprolide as part of his treatment for prostate cancer. The nurse would be alert for which of the following as a possible adverse effect?
-Urethral strictures are more frequent for TURP than for nontransurethral procedures.
A client is to undergo a TURP for BPH. Which statement is accurate with regard to a TURP?
use sterile technique when irrigating the catheter
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous better irrigation. Which nursing intervention is appropriate?
nocturnal penile tumescence tests Explanation: Nocturnal penile tumescence tests are conducted to monitor changes in penile circumference. This test can help to determine if erectile impotence has an organic or a psychological cause. In healthy men, nocturnal penile erections closely parallel rapid eye movement (REM) sleep in occurrence and duration. Organically impotent men show inadequate sleep-related erections that correspond to their waking performance. Arterial blood flow to the penis is measured using a Doppler probe. In addition, nerve conduction tests and extensive psychological evaluations may be carried out.
A client confides to the nurse that he cannot engage in sexual activity. The client is 27 years old and has no apparent history of chronic illness that would contribute to erectile dysfunction. What does a nurse know will be ordered for this client to assess his sexual functioning?
psychotherapy
A client has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The clients interdisciplinary plan of care should prioritize which of the following interventions?
"I understand I may develop urethral strictures as a result of having the TURP." Explanation: Urethral strictures are more frequent than with nontransurethral procedures, and repeated procedures may be necessary because the residual prostatic tissue grows back. TURP rarely causes erectile dysfunction but may trigger retrograde ejaculation, because removal of prostatic tissue at the bladder neck can cause the seminal fluid to flow backward into the bladder rather than forward through the urethra during ejaculation.
A client has been scheduled to undergo a Transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. The nurse knows that the client understands preoperative teaching when he makes which statement?
medication use Explanation: The diagnosis of erectile dysfunction requires a sexual and medical history; an analysis of presenting symptoms; a physical examination, including a neurologic examination; a detailed assessment of all medications, alcohol, and drugs used; and various laboratory studies.
Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction?
"I've had trouble getting started when I urinate, often straining to do so." Rationale: Symptoms that might alert the nurse to BPH include difficulty initiating urination and abdominal straining with urination. Although fever, urinary frequency, nocturia, pelvic pain, nausea, vomiting, and fatigue may be noted, they also may suggest other conditions such as urinary tract infection. Fever, nausea, vomiting, and fatigue are general symptoms that can accompany many conditions.
A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)?
continuous inflow and outflow of irrigation solution
A client has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens?
Administer a smooth-muscle relaxant as ordered.
A client has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The client has a continuous bladder irrigation system in place. The client reports bladder spasms. What is the most appropriate nursing action to relieve the discomfort of the client?
light pink Explanation: Bleeding may also result in the formation of clots, which then obstruct urine flow. The drainage normally begins as reddish-pink and then clears to a light pink within 24 hours after surgery. Bright red bleeding with increased viscosity and numerous clots usually indicates arterial bleeding. Venous blood appears darker and less viscous.
A client is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output she's a nurse expect to find in the drainage bag?
4.6 nanograms/milliliter Rationale: Normal prostate-specific antigen (PSA) levels are less than 4.0 nanograms/milliliter (ng/mL). A level of 4.6 ng/mL would be considered abnormal
A client is having prostate-specific antigen (PSA) testing done. Which result would the nurse identify as abnormal?
Evaluating patency of the drainage lumen Rationale: The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.
A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged IV pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow?
"The drug interferes with testosterone, which causes the prostate to shrink in size." explanation: The 5-alpha-reductase inhibitors finasteride (Proscar) and dutasteride (Avodart) are used to prevent the conversion of testosterone to DHT and decrease prostate size.
A client is prescribed dutasteride (avodart) as part of treatment for benign prostatic hyperplasia. When teaching the client about this drug, the nurse integrates knowledge of the drugs action. Which statement best reflects this?
Use sterile technique when irrigating the catheter. Rationale: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.
A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?
All prostatectomies carry a risk for nerve damage and consequent erectile dysfunction. explanation: All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves.
A client who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurses response?
Breast tenderness Rationale: Feminizing side effects occur with hormone therapy. The client's voice may become higher, hair and fat distribution may change, and breasts may become tender and enlarged. Libido and potency also are diminished.
A client with Stage IV prostate cancer is to receive hormone therapy. The nurse would inform the client about possible adverse effects including which of the following?
psychological etiology Explanation: Nocturnal penile tumescence tests are conducted to monitor changes in penile circumference. This test can help to determine if erectile impotence has an organic or a psychological cause. In healthy men, nocturnal penile erections closely parallel rapid eye movement (REM) sleep in occurrence and duration. Organically impotent men show inadequate sleep-related erections that correspond to their waking performance
A client with a history of hypertension is being seen by the urologist due to erectile dysfunction. Results from the clients nocturnal penile tumescence test measured several spontaneous erections while the client slept. What does this indicate?
Transurethral resection of the prostate (TURP) explantation: Transurethral resection of the prostate (TURP) remains the benchmark for surgical treatment for BPH. It involves the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra; no external skin incision is made. It can be performed with ultrasound guidance. The treated tissue either vaporizes or becomes necrotic and sloughs. The procedure is performed in the outpatient setting and usually results in less postoperative bleeding than a traditional surgical prostatectomy.
A client with benign prostatic hyperplasia doesn't respond to the medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client the nurse asked the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?
Depending on the drug, most are taken on demand 15 minutes, 1/2 hrs, to 1 hr before sexual activity Explanation: When PDE-5 inhibitors are taken about 1 hour before sexual activity, they are effective in producing an erection with sexual stimulation; the erection can last about 1 to 2 hours. table 59-3 pg 1759
A client with erectile dysfunction has been prescribed PDE 5 inhibitor. What would the nurse include in the client education?
"You may experience headache and some flushing with this drug." Explanation:
A client with erectile dysfunction is prescribed sildenafil. Which of the following with the nurse include in a teaching plan for this client?
under-inflation or bulging of the cylinders during inflation
A client with erectile dysfunction who had a penile implant inserted has been taught how to identify the function of the device. Which of the following is stated by the client as indicative of malfunction would indicate to the nurse that the client has understood the teaching?
-the client drinks 5- 6 alcoholic drinks per day -the client has a history of hypertension explanation:
A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the clients history, what might the nurse know that contributes to erectile dysfunction? Select all that apply
age of first ejaculate Rationale: Age of first ejaculate would most likely not be asked. Premature ejaculation or other concerns of a sexual nature, pain during sexual intercourse, and contraceptive practices would most likely be included in the health history.
A nurse is obtaining a male client's health history before performing a physical examination. Which information would most likely not be obtained?
-Thickening of the seminiferous tubules -Decrease in sexual energy level -Loss of testicular firmness Rationale: Age-related changes in the male reproductive system are associated with decreased sex hormone secretion, especially testosterone. Subsequently, the older man experiences decreased sexual energy, loss of testicular firmness, shrinkage of the testes, enlargement of the prostate gland, and thickening of the seminiferous tubules.
A nurse is preparing a presentation for a local senior citizen group about age-related changes in the body systems. Which of the following would the nurse include as associated with the male reproductive system? Select all that apply.
Closely monitoring the input and output of the bladder irrigation system.
A nurse is providing care for a client who has recently been admitted to the post surgical unit from PACU following a transurethral resection of the prostate. The nurse is aware of the nursing diagnosis of risk for imbalanced fluid volume. In order to assess for this risk, the nurse should prioritize what action?
light yellow and clear Explanation: The drainage bag is monitored for bloody urine, and the dressings and surgical incision are examined for bleeding. The color of the urine is carefully noted and documented; a change in color from pink to amber indicates reduced bleeding. pg 1776
A nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following?
-smoking -hypertension -diabetes
A nurse is reviewing a journal article about the name prostatic hyperplasia and possible risk factors associated with this condition. Which factor with the nurse most likely find as playing a role of increasing a man's risk for this condition? Select all that apply.
hypertension
A nurse is reviewing the history of a client who is experiencing difficulty sustaining an erection. Which of the following might the nurse suspect as a possible contributing factor?
Prepuce Rationale: In an uncircumcised male, the prepuce, sometimes referred to as the foreskin, that covers the glans is removed by circumcision. The glans is the rounded head of the penis. The corpora cavernosa is erectile tissue. The mons pubis is fatty tissue near the pubic bones.
A nurse is teaching a client about a circumcision. Which external reproductive structure is removed by circumcision?
take the clients BP Explantation: These agents are contraindicated in men who take organic nitrates (e.g., isosorbide [Isordil], nitroglycerin), because taken together, these medications can cause side effects such as severe hypotension
A patient comes to the emergency department and tells the nurse, I took a pill to help me perform and then passed out. The nurse is assessing the client and finds a nitroglycerin patch on his back. What is the first intervention the nurse must perform?
Discontinue the irrigation Explanation: Symptoms of Transurethral Resection Syndrome include the following: Collapse, Headache, Hypotension, Lethargy and confusion, Muscle spasms, Nausea and vomiting, Seizures, Tachycardia. If symptoms arise irrigation should be discontinued before other interventions. Chart 59-4 pg 1773
A patient experiences hypertension, lethargy, and muscle spasms while receiving bladder irrigations after a transurethral resection of the prostate. What is the first action the nurse should take?
Prostate biopsy Rationale: If prostate cancer is detected early, the likelihood of cure is high (Eggert, 2010). It can be diagnosed through an abnormal finding with the digital rectal examination (DRE), serum prostate-specific antigen (PSA), and ultrasound-guided transrectal ultrasound (TRUS) with biopsy. Detection is more likely with the use of combined diagnostic procedures. The diagnosis of prostate cancer is confirmed by a histologic examination of tissue removed surgically by transurethral resection of the prostate (TURP), open prostatectomy, or ultrasound-guided transrectal needle biopsy.
A patient is suspected to have prostate cancer related to observed clinical symptoms. What definitive test can the nurse assist with to confirm a diagnosis of prostate cancer?
continuous inflow and outflow of irrigation solution.
A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:
Kegel exercises Rationale: Kegel exercises are noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for the client with increased detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for post-prostatectomy incontinence. Self-catheterization may be used as a temporary measure but isn't a primary intervention.
After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?
Erectile dysfunction may be due to testosterone insufficiency Explanation: Organic causes include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic kidney injury, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin lymphoma, leukemia), neurologic disorders (neuropathies, Parkinsonism, spinal cord injury [SCI], multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse.
After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following is true?
"I should avoid fluids like coffee and tea." Rationale: With prostatitis, the client should avoid foods and liquids with diuretic action such as coffee and tea. He also needs to complete the full course of prescribed antibiotic therapy, not just until the symptoms are gone. Hot sitz baths may be used to promote relief. Fluids are encouraged to satisfy thirst but are not forced because an effective medication level must be maintained in the urine.
After teaching about self-care measures to a client who has been diagnosed with prostatitis, the nurse determines that the teaching was successful when the client states which of the following?
can reveal a hydrocele Rationale: DRE is recommended as part of the regular health checkup for every man older than 50 years of age. It is a screening for cancer of the prostate gland. It enables the examiner to assess the size, shape, and consistency of the prostate gland
Which is inconsistent with a digital rectal examination (DRE)?
Transurethral resection of the prostate TURP Rationale: Transurethral resection of the prostate, or TURP, is the most common procedure used and can be carried out through endoscopy. Suprapubic, perineal, and retropubic prostatectomies are surgical procedures for the prostate, but they are not the most common.
Which is the most common type of prostate surgery?
How to perform a testicular self-examination Rationale: The nurses should teach all men, especially those who have had cryptorchidism, to perform testicular self-examination to detect any abnormal mass in the scrotum. The nurse instructs the clients to examine the testicles monthly, preferably when warm, such as in the shower. Having regular PSA levels, lymph node biopsies, and blood tests for measuring serum acid phosphatase are for the clients who are treated for prostate cancer.
Which of the following should nurses teach all men, especially those who have had cryptorchidism?
Maintaining optimal bladder emptying Explanation: For the client with BPH who is not yet a candidate for surgery, the nurse would teach a client how to maintain optimal bladder emptying. The surgical client requires support and information to allay anxiety. The nurse teaches deep breathing and leg exercises for the client who is to have surgery.
Which of the following would nurse include in the teaching plan for a client with benign prostatic hyperplasia who is not yet a candidate for surgery?
Take prescribed antibiotics Rationale: Home care for a client with epididymitis and orchitis includes instructions to continue administering prescribed antibiotics and to take Sitz baths, apply local heat after scrotal swelling subsides, avoid lifting, and refrain from sexual intercourse until symptoms are relieved.
Which should be included as part of the home care instructions for a client with epididymitis and orchitis?
Brachytherapy Rationale: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. Hormone therapy for advanced prostate cancer suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of DHT. Teletherapy involves 6 to 7 weeks of daily radiation treatments. High-dose ketoconazole (HDK) lowers testosterone through its abilities to decrease both testicular and endocrine production of androgen.
Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer?