BPH
What question would be most important to ask a male client who is in for a digital rectal examination? a. "Have you noticed a change in the force of the urinary system?" b. "Have you noticed a change in tolerance of certain foods in your diet?" c. "Do you notice polyuria in the AM?" d. "Do you notice any burning with urination or any odor to the urine?"
A This change would be most indicative of a potential complication with (BPH) benign prostate hypertrophy.
26. The client with BPH undergoes a transurethral resection of the prostate. Postoperatively, the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome? a. Bradycardia and confusion b. Tachycardia and diarrhea c. Decreased urinary output and bladder spasms d. Increased urinary output and anemia
A Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.
The nurse is administering a psychotropic drug to an elderly client who has history of benign prostatic hypertrophy. It is most important for the nurse to teach this client to: a. Report incomplete bladder emptying b. Take the prescribed dose at bedtime. c. Add fiber to his diet. d. Exercise on a regular basis.
A Urinary retention is a common anticholinergic side effect of psychotic medications, and the client with benign prostatic hypertrophy would have increased risk for this problem. Adding fiber to one's diet and exercising regularly are measures to counteract another anticholinergic effect, constipation. Depending on the specific medication and how it is prescribed, taking the medication at night may or may not be important. However, it would have nothing to do with urinary retention in this client.
After undergoing a transurethral resection of the prostate to treat benign prostatic hypertrophy, a patient is retuned to the room with continuous bladder irrigation in place. One day later, the patient reports bladder pain. What should the nurse do first? a. Increase the I.V. flow rate b. Administer meperidine (Demerol) as prescribed c. Assess the irrigation catheter for patency and drainage d. Notify the doctor immediately
C Although postoperative pain is expected, the nurse should ensure that other factors, such as an obstructed irrigation catheter, aren't the cause of the pain. After assessing catheter patency, the nurse should administer an analgesic such as meperidine as prescribed. Increasing the I.V. flow rate may worse the pain. Notifying the doctor isn't necessary unless the pain is severe or unrelieved by the prescribed medication.
53. The nurse is reviewing a medication history of a client with BPH. Which medication should be recognized as likely to aggravate BPH? a. Metformin (Glucophage) b. Buspirone (BuSpar) c. Inhaled ipratropium (Atrovent) d. Ophthalmic timolol (Timoptic)
C Atrovent is a bronchodilator, and its anticholinergic effects can aggravate urinary retention. Glucophage and BuSpar do not affect the urinary system; timolol does not have a systemic effect.
What is the relationship between prostate cancer and the condition of an enlarged prostate, also known as BPH? a. BPH causes prostate cancer b. BPH is a symptom of prostate cancer c. BPH and prostate cancer are unrelated
C BPH and prostate cancer are unrelated
The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms? a. Urge incontinence b. Nocturia c. Decreased force in the stream of urine d. Urinary retention
C Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.
27. The client is admitted to the hospital with BPH, and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client's VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician? a. Red bloody urine b. Urinary output of 200 ml greater than intake c. Blood pressure of 100/50 and pulse 130. d. Pain related to bladder spasms.
C Frank bleeding (arterial or venous) may occur during the first few days after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 ml of greater than intake is adequate. Bladder spasms are expected to occur after surgery. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The physician should be notified.
Which of the following herbal preparations might a patient with a diagnosis of BPH disclose during the initial interview? a. Hawthorne (Crataegus) b. Licorice (Glycyrrhiza) c. Saw palmetto extract (Serenoa repens) d. Ma Huang (Ephedra sinica)
C Rationale: Saw palmetto is a popular over-the-counter medication that appears to be effective in improving BPH symptoms, and has relatively few side effects.
A 98-year-old patient with benign prostatic hyperplasia has a markedly distended bladder and is agitated and confused. All the following orders are received from the emergency department health care provider. Which order should the nurse act on first? a. Draw blood for blood urea nitrogen (BUN) and creatinine. b. Administer lorazepam (Ativan) 0.5 mg. c. Insert 16 French retention catheter. d. Schedule for IVP.
C Rationale: The patient's history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient's agitation may resolve once the bladder distention is corrected, and sedative drugs should be used cautiously in older patients. The IVP is an appropriate test, but does not need to be done urgently.
Which of the following responses would be accurate if given to the nurse during an initial interview from a patient with benign prostatic hypertrophy (BPH)? a. "I have pain and swelling of my both ankles." b. "I frequently drink wine with my evening meals." c. "I have difficulty starting a stream of urine, and it is a weak stream." d. "My bladder doesn't feel empty after I urinate, and I have to strain to pass the urine."
C Rationale: The symptoms of BPH are sometimes referred to as "nuisances," and include difficulty starting a stream of urine that is described as weak and the need to strain to urinate. Ultimately, in advanced cases, azotemia and renal failure can occur. Red wine is not a direct causative agent here.
A client asks the nurse what will eventually happen if he does not have his benign prostatic hypertrophy treated. The most accurate answer by the nurse will be which of the following? a. "Staghorn renal calculi or small calcium stones can occur as a result of untreated BPH." b. "Untreated BPH will lead to malignant hypertension." c. "Urine reflux and possibly hydronephrosis can result from untreated BPH." d. "If BPH is not treated, the client can develop pyelonephritis."
C Untreated BPH will lead to increased pressure in the bladder, which causes urine reflux into the ureters and can eventually lead to hydronephrosis, which can affect kidney function. These complications rarely occur, as BPH symptoms force most men to get treatment earlier.
A client had a transurethral prostatectomy for benign prostatic hypertrophy. He's currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of the interventions should be done first? a. Administer an oral analgesic b. Stop the irrigation and call the physician c. Administer a belladonna and opium suppository as ordered by the physician. d. Check for the presence of clots, and make sure the catheter is draining properly.
D Blood clots and blocked outflow if the urine can increase spasms. The irrigation shouldn't be stopped as long as the catheter is draining because clots will form. A belladonna and opium suppository should be given to relieve spasms but only after assessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.
20. The client who has a cold is seen in the emergency room with inability to void. Because the client has a history of BPH, the nurse determines that the client should be questioned about the use of which of the following medications? a. Diuretics b. Antibiotics c. Antitussives d. Decongestants
D In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.
Romeo Diaz, age 78, is admitted to the hospital with the diagnosis of benign prostatic hyperplasia (BPH). He is scheduled for a transurethral resection of the prostate (TURP). It would be inappropriate to include which of the following points in the preoperative teaching? a. Expect bloody urine, which will clear as healing takes place. b. TURP is the most common operation for BPH. c. Explain the purpose and function of a two-way irrigation system. d. He will be pain free.
D Surgical interventions involve an experience of pain for the client which can come in varying degrees. Telling the pain that he will be pain free is giving him false reassurance.
Which of the following signs and symptoms would indicate that a client has benign prostatic hypertrophy (BPH)? a. Hematuria b. Flank pain c. Impotence d. Difficulty starting the urinary stream
D The symptoms of BPH are related to obstruction as a result of an enlarged prostate. Difficulty in starting the urinary stream is a common symptom, along with dribbling, hesitancy and urinary retention.
A client is admitted to the hospital with benign prostatic hyperplasia, the nurse most relevant assessment would be: a. Perineal edema b. Flank pain radiating in the groin c. Urethral discharge d. Distention of the lower abdomen
D This indicates that the bladder is distended with urine, therefore palpable.
Of the options below, which can be symptoms of BPH? Check all that you think fit: a. Sexual dysfunction b. Intestinal pain c. Difficulty urinating d. Urinary incontinence
A, C, D Recent studies suggest that there is a correlation between lower urinary tract symptoms and sexual dysfunction in aging patients. In fact, the severity of urinary symptoms and the degree of sexual dysfunction are strongly correlated, indepently of age. In particular, community-based studies have found that a significant number of patients with symptomatic BPH have sexual dysfunction.
55. A client with BPH is being treated with terazosin (Hytrin) 2mg at bedtime. The nurse should monitor the client's: a. Urinary nitrites b. White blood cell count c. Blood pressure d. Pulse
C Terazosin (Hytrin) 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 postural hypotension. The client should be instructed to change positions slowly. Urinary nitrites, white blood cell count, and pulse rate are not affected by terazosin.
Alpha blockers in the treatment of BPH are associated with all of the following except: A. Improvment in symptoms in 2-3 weeks B. Minimal changes in blood pressure C. Once daily dosing D. Side effects of dizziness and fatigue E. 25% decrease in prostate size
E 25% decrease in prostate size
How common is BPH? a. 50% of men in their 60s b. 10% of men in their 60s c. 90% of men in their 60s d. 30% of men in their 60s
A Although the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before the age of 40, but more than half of men in their 60s, and as many as 90% in their 70s and 80s, have some symptoms of BPH
An older male comes to the emergency room with a history of urinary frequency, urgency, and low back pain. The nurse recognizes that these are symptoms of which of the following? a. Benign Prostatic Hypertrophy b. Herniated intervertebral disk c. Kidney stones d. Renal failure
A BPH is enlargement of the prostate gland; symptoms include hesitancy, frequency, dysuria, nocturia, retention, and flank pain due to hydronephrosis. b. causes spinal nerve root compression; symptoms are knife-life back pain, poor posture, altered gait. c. symptoms include pain, diaphoresis, N/V, fever, chills, and hematuria. d. symptoms include oliguria, proteinuria, hematuria, urine is dilute.
While working with a 72-year-old male undergoing treatment for benign prostatic hyperplasia (BPH), the nurse is questioned by the family about the incidence of BHP in males over 70. Which of the following percentages of males over 70 will the nurse say has BHP? a. More than 90% b. Slightly under 75% c. 50% d. 60%
A More than 90% of males over 70 have BHP.
The obstructive and irritative symptom complex caused by benign prostatic hypertrophy is termed a. prostatism. b. prostatectomy. c. prostatitis. d. prostaglandin.
A Symptoms of prostatism include increased frequency of urination, nocturia, urgency, dribbling, and a sensation that the bladder has not completely emptied. 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.
Which of the following alpha-blocking agents are currently prescribed for persons with BPH? (Select all that apply.) a. Tamsulosin (Flomax) b. Doxazosin mesylate (Cardura) c. Verapamil (Calan) d. Tamoxifen (Nolvadex)
A, B Rationale: Alpha-adrenergic blocking medications such as tamsulosin and doxazosin may be prescribed for patients with BPH. These medications function by constricting the prostate gland, which results in reduction of urethral pressure and the improvement of urine flow.
Transurethral resection of the prostate (TURP) is associated with all of the following except: a. Transfusion rate of 2-4% b. Retrograde ejaculation in 50% of men c. Erectile dysfunction in 2% d. Outpatient procedure in most cases e. Most effective long term treatment
D Outpatient procedure in most cases
