Exemplar 5.A - Benign Prostatic Hyperplasia
The client admitted with benign prostatic hyperplasia (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 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 is diagnosed with benign prostatic hyperplasia (BPH). Which topics are appropriate for the nurse to include in the teaching session related to the client's condition? Select all that apply. A) Self-care B) Nutrition C) Surgical approaches to treatment D) Pharmacologic approaches to treatment E) Permanent urinary catheterization
A) Self-care B) Nutrition C) Surgical approaches to treatment D) Pharmacologic approaches to treatment 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.
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 tissue must be reduced. B) Straining during urination must be avoided. C) Bladder pain must be managed. D) The weak urinary stream must be strengthened.
A) The enlarging mass of prostatic tissue must be reduced. 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 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 benign prostatic hyperplasia (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." BPH is a benign condition that 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.
Which statement most accurately describes why benign prostatic hyperplasia 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 urinary tract infections 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. 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 providing follow-up care for a client was recently diagnosed with benign prostatic hyperplasia (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 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 benign prostatic hyperplasia (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 of age D) Testicle removal due to cancer
B) Increased levels of estrogen 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 benign prostatic hyperplasia (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 liters daily. B) The client lists over-the-counter medications to be avoided. C) The client will voice an understanding of the importance of the use of antiembolic stockings and compression devices. D) The client will use a T-binder or scrotal support properly.
B) The client lists over-the-counter medications to be avoided. 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 caring for a client diagnosed with benign prostatic hyperplasia (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 over-the-counter cold medication for a cold." D) "I am drinking very little caffeine."
C) "I am using an over-the-counter cold medication for a cold." 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 client who is experiencing urinary retention. The client asks the nurse if it is possible that he is experiencing benign prostatic hyperplasia (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 are 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." 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 nurse is providing care to a client who is diagnosed with benign prostatic hyperplasia (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 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 medical-surgical unit. The client will be ready for discharge within the next few days. Which teaching point is appropriate for this client? A) The client should not 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 after surgery
C) The client should incorporate fruit juice in his diet. 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 benign prostatic hyperplasia (BPH). Which lifestyle change is appropriate for this client? A) Increasing caffeine intake B) Increasing alcohol intake C) Urinating at first urge D) Using over-the-counter antihistamines
C) Urinating at first urge 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 providing care to a client who is diagnosed with benign prostatic hyperplasia (BPH). Which items in the client's health history indicate a risk factor for this diagnosis? Select all that apply. A) Excessive exercise B) Decreased fluid intake C) Diet high in milk D) 70 years of age E) African American ethnicity
D) 70 years of age E) African American ethnicity 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 is recovering from minimally invasive surgery due to a diagnosis of benign prostatic hyperplasia (BPH). After assessing the client, the nurse expects which outcome for this client? A) Bowel continence B) Absence of pain C) No postoperative treatment D) Urinary continence
D) Urinary continence 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.