Reproductive---Lippincott BPH

41. The primary reason for taping an indwelling catheter laterally to the thigh of a male client is to: 1. Eliminate pressure at the penoscrotal angle. 2. Prevent the catheter from kinking in the urethra. 3. Prevent accidental catheter removal. 4. Allow the client to turn without kinking the catheter.

41. 1. The primary reason for taping an indwelling catheter to a male client so that the penis is held in a lateral position is to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula.

42. Many older men with prostatic hypertrophy do not seek medical attention until urinary obstruction is almost complete. One reason for this delay in seeking attention is that these men may: 1. Feel too self-conscious to seek help when reproductive organs are involved. 2. Expect that it is normal to have to live with some urinary problems as they grow older. 3. Fear that sexual indiscretions in earlier life may be the cause of their problem. 4. Have little discomfort in relation to the amount of pathology because responses to pain stimuli fade with age.

42. 2. Some older men tend to believe it is normal to live with urinary problems. As a result, these men often overlook symptoms and simply attribute them to aging. As part of preventive care for men older than age 40, the yearly physical examination should include palpation of the prostate via rectal examination. Prostate-specific antigen screening also is done annually to determine elevations or increasing trends in elevations. The nurse should teach male clients the value of early detection and adequate follow-up for the prostate.

43. When caring for a client with a history of benign prostatic hypertrophy (BPH), the nurse should do which of the following? Select all that apply. 1. Provide privacy and time for the client to void. 2. Monitor intake and output. 3. Catheterize the client for postvoid residual urine. 4. Ask the client if he has urinary retention. 5. Test the urine for hematuria.

43. 1, 2, 4, 5. Because of the history of BPH, the nurse should provide privacy and time for the client to void. The nurse should also monitor intake and output, assess the client for urinary retention, and test the urine for hematuria. It is not necessary to catheterize the client.

44. The nurse should specifically assess a client with prostatic hypertrophy for which of the following? 1. Voiding at less frequent intervals. 2. Difficulty starting the flow of urine. 3. Painful urination. 4. Increased force of the urine stream.

44. 2. Signs and symptoms of prostatic hypertrophy include difficulty starting the flow of urine, urinary frequency and hesitancy, decreased force of the urine stream, interruptions in the urine stream when voiding, and nocturia. The prostate gland surrounds the urethra, and these symptoms are all attributed to obstruction of the urethra resulting from prostatic hypertrophy. Nocturia from incomplete emptying of the bladder is common. Straining and urine retention are usually the symptoms that prompt the client to seek care. Painful urination is generally not a symptom of prostatic hypertrophy.

46. A client is scheduled to undergo transurethral resection of the prostate. The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should assess the client for: 1. Seizures. 2. Cardiac arrest. 3. Renal shutdown. 4. Respiratory paralysis.

46. 4. If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Seizures, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.

47. A client with benign prostatic hypertrophy (BPH) is being treated with terazosin (Hytrin) 2 mg at bedtime. The nurse should monitor the client's: 1. Urine nitrites. 2. White blood cell count. 3. Blood pressure. 4. Pulse.

47. 3. Terazosin is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or orthostatic hypotension. The client should be instructed to change positions slowly. Urine nitrates, white blood cell count, and pulse rate are not affected by terazosin.

48. A client, who had a transurethral resection of the prostate (TURP), has a three-way indwelling urinary catheter with continuous bladder irrigation. In which of the following circumstances should the nurse increase the flow rate of the continuous bladder irrigation? 1. When drainage is continuous but slow. 2. When drainage appears cloudy and dark yellow. 3. When drainage becomes bright red. 4. When there is no drainage of urine and irrigating solution.

48. 3. The decision by the surgeon to insert a catheter after TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so that clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindicated when there is no return of urine and irrigating solution.

49. A client is to receive belladonna and opium suppositories, as needed, postoperatively after transurethral resection of the prostate (TURP). The nurse should give the client these drugs when he demonstrates signs of: 1. A urinary tract infection. 2. Urine retention. 3. Frequent urination. 4. Pain from bladder spasms.

49. 4. Belladonna and opium suppositories are prescribed and administered to reduce bladder spasms that cause pain after TURP. Bladder spasms frequently accompany urologic procedures. Antispasmodics offer relief by eliminating or reducing spasms. Antimicrobial drugs are used to treat an infection. Belladonna and opium do not relieve urine retention or urinary frequency.

50. A nursing assistant tells the nurse, "I think the client is confused. He keeps telling me he has to void, but that isn't possible because he has a catheter in place that is draining well." Which of the following responses would be most appropriate for the nurse to make? 1. "His catheter is probably plugged. I'll irrigate it." 2. "That's a common problem after prostate surgery. The client only imagines the urge to void." 3. "The urge to void is usually created by the large catheter, and he may be having some bladder spasms." 4. "I think he may be somewhat confused."

50. 3. The indwelling urinary catheter creates the urge to void and can also cause bladder spasms. The nurse should ensure adequate bladder emptying by monitoring urine output and characteristics. Urine output should be at least 50 mL/h. A plugged catheter, imagining the urge to void, and confusion are less likely reasons for the client's problem.

51. A physician has prescribed amoxicillin (Ampicillin) 100 PO b.i.d. The nurse should teach the client to do which of the following? Select all that apply. 1. Drink 300 to 500 mL of fluids daily. 2. Void frequently, at least every 2 to 3 hours. 3. Take time to empty the bladder completely. 4. Take the last dose of the antibiotic for the day at bedtime. 5. Take the antibiotic with or without food.

51. 2, 3, 4, 5. Ampicillin may be given with or without food, but the nurse should instruct the client to obtain an adequate fluid intake (2,500 to 3,000 mL) to promote urinary output and to flush out bacteria from the urinary tract. The nurse should also encourage the client to void frequently (every 2 to 3 hours) and empty the bladder completely. Taking the antibiotic at bedtime, after emptying the bladder, helps to ensure an adequate concentration of the drug during the overnight period.

52. In discussing home care with a client after transurethral resection of the prostate (TURP), the nurse should teach the male client that dribbling of urine: 1. Can be a chronic problem. 2. Can persist for several months. 3. Is an abnormal sign that requires intervention. 4. Is a sign of healing within the prostate.

52. 2. Dribbling of urine can occur for several months after TURP. The client should be informed that this is expected and is not an abnormal sign. The nurse should teach the client perineal exercises to strengthen sphincter tone. The client may need to use pads for temporary incontinence. The client should be reassured that continence will return in a few months and will not be a chronic problem. Dribbling is not a sign of healing, but is related to the trauma of surgery.

53. The nurse should instruct the client who is being discharged to home 3 days after transurethral resection of the prostate (TURP) to do which of the following? Select all that apply. 1. Drink at least 3,000 mL water per day. 2. Increase calorie intake by eating six small meals a day. 3. Report bright red bleeding to the health care provider. 4. Take deep breaths and cough every 2 hours. 5. Report a temperature over 99°F.

53. 1, 3, 5. The nurse should instruct the client to drink a large amount of fluids (about 3,000 mL/day) to keep the urine clear. The urine should be almost without color. About 2 weeks after TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the emergency department if at any time the urine turns bright red. The nurse should also instruct the client to report signs of infection such as a temperature over 99°F. The client is not specifically at risk for nutritional problems after TURP and can resume a diet as tolerated. The client is not specifically at risk for airway problems because the procedure is done under spinal anesthesia and the client does not need to take deep breaths and cough.

54. A client with benign prostatic hypertrophy (BPH) has an elevated prostate-specific antigen (PSA) level. The nurse should: 1. Instruct the client to request having a colonoscopy before coming to conclusions about the PSA results. 2. Instruct the client that a urologist will monitor the PSA level biannually when elevated. 3. Determine if the prostatic palpation was done before or after the blood sample was drawn. 4. Ask the client if he emptied his bladder before the blood sample was obtained.

54. 3. Rectal and prostate examinations can increase serum PSA levels; therefore, instruct the client that a manual rectal examination is usually part of the test regimen to determine prostate changes. The prostatic palpation should be done after the blood sample is drawn. The PSA level must be monitored more often than biannually when it is elevated. Having a colonoscopy is not related to the findings of the PSA test. It is not necessary to void prior to having PSA blood levels tested.

39. When emptying the client's bladder during a urinary catheterization, the nurse should allow the urine to drain from the bladder slowly to prevent: 1. Renal failure. 2. Abdominal cramping. 3. Possible shock. 4. Atrophy of bladder musculature.

39. 3. Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. The nurse should empty the bladder slowly. Removal of urine from the bladder does not cause renal failure. The client may experience cramping, but the primary concern is the potential for shock. Bladder muscles will not atrophy because of a catherization.

Benign Prostatic Hypertrophy 38. An adult male client has been unable to void for the past 12 hours. The best method for the nurse to use when assessing for bladder distention in a male client is to check for: 1. A rounded swelling above the pubis. 2. Dullness in the lower left quadrant. 3. Rebound tenderness below the symphysis. 4. Urine discharge from the urethral meatus.

38. 1. The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. This swelling represents the distended bladder rising above the pubis into the abdominal cavity. Dullness does not indicate a distended bladder. The client might experience tenderness or pressure above the symphysis. No urine discharge is expected; the urine flow is blocked by the enlarged prostate.

40. The primary reason for lubricating the urinary catheter generously before inserting the catheter into a male client is that this technique helps reduce: 1. Spasms at the orifice of the bladder. 2. Friction along the urethra when the catheter is being inserted. 3. The number of organisms gaining entrance to the bladder. 4. The formation of encrustations that may occur at the end of the catheter.

40. 2. Liberal lubrication of the catheter before catheterization of a male reduces friction along the urethra and irritation and trauma to urethral tissues. Because the male urethra is tortuous, a liberal amount of lubrication is advised to ease catheter passage. The female urethra is not tortuous, and, although the catheter should be lubricated before insertion, less lubricant is necessary. Lubrication of the catheter will not decrease spasms. The nurse should use sterile technique to prevent introducing organisms. Crusts will not form immediately. Irrigating the catheter as needed will prevent clot and crust formation.

45. The nurse is reviewing the medication history of a client with benign prostatic hypertrophy (BPH). Which medication will likely aggravate BPH? 1. Metformin (Glucophage). 2. Buspirone (BuSpar). 3. Inhaled ipratropium (Atrovent). 4. Ophthalmic timolol (Timoptic).

45. 3. Ipratropium is a bronchodilator, and its anticholinergic effects can aggravate urine retention. Metformin and buspirone do not affect the urinary system; timolol does not have a systemic effect.