HESI Case Studies- Benign Prostatic Hyperplasia

Tests, along with urodynamic flow studies, indicate that Mr. Hamilton's prostate gland is enlarged significantly and treatment is recommended. Mr. Hamilton elects to try medical management of his symptoms. He receives prescriptions of oral finasteride (Proscar) and tamsulosin (Flomax). The nurse provides instructions about these medications. What information should be included when teaching Bob about Flomax?

"Change positions slowly, such as when standing up."

It is determined that Mr. Hamilton experienced a febrile transfusion reaction. This type of reaction is caused by the body's sensitivity to components in the donor blood such as WBCs, platelets, or plasma proteins. In addition to stopping the transfusion, the nurse sends the blood bag, tubing, and a urinalysis to the lab, and administers and antipyretic medication until Mr. Hamilton is once again afebrile. The nurse is upset that Mr. Hamilton experienced a transfusion reaction and the nurse talks with the change nurse about the situation. The nurse states "I never thought I would get sued for malpractice. Do you think i will be sued because of this?" What is the best initial response by the charge nurse?

"Describe everything you did that is related to the transfusion?"

Mr. Hamilton tells the nurse that he is uncomfortable, because he constantly feels like he has to urinate. The nurse explains that this is the result of the oversize balloon putting pressure on the sphincter of the bladder. What instructions should the nurse relate to Mr. Hamilton?

"Do not try to void around the catheter."

What instruction should the nurse provide Mr. Hamilton before starting the procedure?

"Empty your bladder completely."

Mr. Hamilton's PSA level is 6mg/ml, a slightly elevated level (normal is <4 ng/ml). Bob appears distressed and asks, "Do I have prostate cancer? Is that why I'm having these symptoms?" How should the nurse respond?

"I realize that this report is causing you concern. PSA levels can be elevated with gland enlargement, as well as cancer, so more tests are needed."

Based on his continued lack of symptomatic improvement and high volumes noted during residual catheterization, Mr. Hamilton elects to have surgery. A transurethral resection of the prostate is performed (TURP). While Mr. Hamilton is in surgery, his wife brings his belongings to his assigned room on the surgical nursing unit. The nurse assigned to Mr. Hamilton's care greets her. The nurse recognizes that Mrs. Hamilton is of Asia descent and asks Mrs. Hamilton about her cultural background. Mrs. hamilton states that she is Korean and that she met and married Mr. Hamilton during the Korean War. The nurse asks Mrs. Hamilton if she has any questions or concerns . Mrs. Hamilton responds calmly that she will be happy when Mr. Hamilton returns from surgery, and Mrs. Hamilton turns her head and looks away. What is the best response by the nurse?

"I will be glad to answer any questions you may have."

Mr. Hamilton asks if he will need to have any more yearly rectal exams. How should the nurse respond?

"You still need yearly rectal exams and PSA screenings."

Mr. Hamilton continues to take his medication for 9 months, but his symptoms do not improve significantly. He is scheduled for residual cathererization at the clinic. What catheter should the nurse select to perform the procedure?

- 12 French straight catheter

Early the next morning, the nurse notes that the catheter is draining a large volume of urine with bright red blood that seems thick. What actions should the nurse take? (select all that apply)

- Increase the flow rate of the CBI - Notify the HCP of the findings -Perform manual irrigation

Which additional manifestations would the nurse expect in client's with BPH?

- hesitancy when starting then urine stream -decrease in the size and force of urine stream -frequent urination, including nocturia

Mr. Hamilton tells the nurse that he has cut back on drinking fluids to reduce his symptoms. How should the nurse respond?

-"Decreasing fluid intake may increase your risk for developing a UTI."

Mr. Hamilton is scheduled for a digital rectal exam, serum prostate-specific antigen (PSA) level, urinalysis, serum creatinine, and blood urea nitrogen (BUN). He states he has had the rectal exam and PSA levels done before the prostate screening. He asks why the other lab test (creatinine and BUN levels) are necessary. What explanation should the nurse provide?

-"If your prostate gland is blocking the flow of urine, you may have some degree of kidney damage that can be detected with these tests."

Which assessment finding would indicate that Mr. Hamilton is experiencing urinary retention?

-dullness heard on percussion below the umbilicus

Mr. Hamilton is scheduled to have emergency surgery as quickly as possible. His wife is with him, and she is very anxious and upset. While Mr. Hamilton is awaiting transport to the Operating Room (OR), which nursing staff should be assigned to his care?

A Rn who has worked on the unit for 3 years.

The nurses discuss the components needed to prove professional negligence or malpractice. They discuss "Breach of Duty." What statement best describes this term?

A nurse's actions do not meet established standards.

Which nursing diagnosis has the highest priority when implementing care?

Altered cardiac output

After surgery, Mr. Hamilton is admitted to the surgical nursing unit for overnight observation and postoperative care. Which postoperative intervention should the nurse perform first?

Observe the urinary drainage.

What analogy can the nurse use to describe how to contract the pelvic floor muscles?

Squeeze as if stopping the flow of urine.

The aminocaproic acid (Amicar) infusion successfully stops the bleeding without complications. Mr. Hamilton's hemoglobin and hematocrit drop as the result of the bleeding, and the HCP prescribes the administration of 1 unit of packed red blood cells. Which action should the nurse implement to reduce the risk for a hemolytic transfusion reaction?

Verify the blood type and Rh factor with another nurse.

The HCP prescribes an infusion of aminocaproic acid (Amicar). The prescription is for a loading dose of aminocaproic acid IV 5g to be infused in 250 ml of D5W over 1 hour. The tubing drop factor is 15drops/ml. How many drops per minute would the nurse set for the IV rate? (Round to whole number)

63 250ml/60 minutes x 15 drops/ml _________________ 63 drops per minute

The nurse recognizes nonverbal behavior such as eye contact varies in different cultures. How can the nurse best interpret Mrs. Hamilton's minimal eye contact, in light of Mrs. Hamilton's cultural background?

A cultural practice based on recognition of someone's social status.

What does Mr. Hamilton need to know about taking finasteride Proscar?

-Liver function studies (LFTs) need to be monitored frequently -most clients see significant change in BPH symptoms in 4 month -Medication should not be handled by women or children -Clients can experience breast tenderness and nipple discharge

When the transfusion is half infused, the unlicensed assistive personnel (UAP) tells the nurse that Mr. Hamilton is very nervous and has a headache. Which action should the nurse implement first?

Assess Mr. Hamilton for additional symptoms.

During administration of the aminocaproic acid (Amicar) infusion, the nurse monitors Mr. Hamilton for adverse effects of the medication. What assessment data would indicate the onset of thrombotic complication?

Chest pain and dyspnea

What action should the nurse take?

Document that the CBI is infusing incorrectly.

The nurse administers oxygen per face mask, ensures that the IV is patent, and notifies the HCP that Mr. Hamilton is experiencing overt bleeding and manifestations of hypovolemic shock. Specimens for stat blood work and arterial blood gases are drawn. Which lab value would the nurse question?

Hemoglobin 15.0g/dL

The nurse assesses that Mr. Hamilton's skin is warm and flushed. Mr. Hamilton reports having generalized body aches and he starts experiencing chills. His BP is 114/68, his pulse is 92, his respirations are 18, and his temperature is 102.2. The nurse suspects that Mr. Hamilton is experiencing a febrile transfusion reaction. What action should the nurse take next after stopping the transfusion?

Infuse normal saline solution through separate IV tubing.

While the nurse is monitoring Mr. Hamilton closely, which additional responsibility is best to assign to the LPN?

Prepare a client with renal failure for a scheduled dialysis treatment.

During the night, Mr. Hamilton reports increased bladder discomfort. The nurse's observation of the urinary drainage catheter indicates minimal output for the last 2 hours. What action should the nurse take?

Stop the CBI, and irrigate the catheter.

The nurse assesses Mr. Hamilton and determines that he is dyspneic, lethargic, pale and cool. He is experiencing a large amount of bright red bleeding in his catheter. In what position should the nurse place Mr. Hamilton?

Supine with feet elevated at a 45 degree angle.