Chapter 66

A patient is concerned about becoming impotent because of the inability to sustain an erection and a history of a sexually transmitted infection as a young adult. What is the nurse's best response to this patient's concerns? 1) "An occasional incident like this is normal and common, and there is no reason to be concerned." 2) "Sexually transmitted infections may result in sexual problems in adults." 3) "Erectile dysfunction is the correct term for the inability to achieve or sustain an erection." 4) "The medical diagnosis of erectile dysfunction is not made until the man has erection difficulties in 25% or more of his interactions."

1) "An occasional incident like this is normal and common, and there is no reason to be concerned." 1 This patient is concerned about his masculinity and sexual abilities. The correct answer at this point is to tell him that it is common and normal for men to experience occasional erectile difficulties. 2 3 4This is true; however, this does not serve to alleviate the patient's concerns. If the patient continues to have difficulties achieving or sustaining an erection, further investigation should take place. Simply correcting the patient's use of medical terminology does not address his concerns

The nurse is caring for a patient who has a continuous bladder irrigation running following a prostatectomy. During the shift, a total of 1500 mL of irrigant is infused. The Foley bag is emptied twice for the shift with totals of 850 mL and 950 mL. What is the patient's actual urine output for the shift? 1) 300 mL 2) 250 mL 3) 100 mL 4) 950 mL

1) 300 mL 1 The total infused is 1500 mL. The total drained is 1800 mL. The total, or true output, is 300mL greater than the input. 2 This is not an accurate measurement of this patient's urine output. 3 This is not an accurate measurement of this patient's urine output. 4 This is not an accurate measurement of this patient's urine output.

The nurse is providing care to a patient who is diagnosed with benign prostatic hyperplasia (BPH). Which items in the patient's health history may have contributed to this diagnosis? Select all that apply. 1) 70 years of age 2) Diet high in milk 3) Excessive exercise 4) Diet high in meat and fats 5) African-American ethnicity

1) 70 years of age 4) Diet high in meat and fats 5) African-American ethnicity 1. This is correct. Although the exact cause is unknown, risk factors associated with BPH are increasing age, men of African-American descent, and a diet high in meat and fat. 2. This is incorrect. No link has been made to milk or exercise. 3. This is incorrect. No link has been made to milk or exercise. 4. This is correct. Although the exact cause is unknown, risk factors associated with BPH are increasing age, men of African-American descent, and a diet high in meat and fat. 5. This is correct. Although the exact cause is unknown, risk factors associated with BPH are increasing age, men of African-American descent, and a diet high in meat and fat.

The nurse is assessing a patient for symptoms of prostate cancer. Which symptoms would indicate the patient is experiencing an enlarged prostate? 1) Dysuria 2) Nerve pain 3) Bone pain 4) Bowel dysfunction

1) Dysuria 1 Symptoms of an enlarged prostate include hematuria, dysuria, reduction in urinary stream, nocturia, frequency of urination, and abnormal size of prostate on digital exam. 2 This choice indicates nerve impingement. 3 This choice indicates metastatic symptoms. 4 This choice indicates metastatic symptoms.

A nurse is screening a patient for prostate cancer. Which assessment findings would cause the nurse to suspect that the patient has prostate cancer? Select all that apply. 1) Fatigue 2) Back pain 3) Hematuria 4) Scrotal edema 5) Upper extremity weakness

1) Fatigue 2) Back pain 3) Hematuria 1. This is correct. Unfortunately, many patients with prostate cancer remain undiagnosed until the cancer is well established. Hematuria, back pain, bilateral lower extremity weakness, and fatigue are symptoms associated with prostate cancer. 2. This is correct. Unfortunately, many patients with prostate cancer remain undiagnosed until the cancer is well established. Hematuria, back pain, bilateral lower extremity weakness, and fatigue are symptoms associated with prostate cancer. 3. This is correct. Unfortunately, many patients with prostate cancer remain undiagnosed until the cancer is well established. Hematuria, back pain, bilateral lower extremity weakness, and fatigue are symptoms associated with prostate cancer. 4. This is incorrect. Scrotal edema is not a clinical manifestation associated with prostate cancer. 5. This is incorrect. Upper extremity weakness is not a clinical manifestation associated with prostate cancer.

A patient with prostate cancer is being discharged from the hospital. Which educational topic is inappropriate for this patient? 1) Provide information on doses of complementary herbs 2) Teach the patient and his family noninvasive methods of pain control 3) Stress the importance of keeping patient appointments with health-care providers 4) Provide the patient and the patient's family information on support groups

1) Provide information on doses of complementary herbs 1 The nurse does not have authorization to provide information on doses of complementary herbs. 2 When providing discharge instructions to the patient with prostate cancer, the nurse will teach the patient and his family noninvasive methods of pain control and stress the importance of keeping patient appointments with health-care providers. The nurse will also provide the patient and his family information on support groups. 3 When providing discharge instructions to the patient with prostate cancer, the nurse will teach the patient and his family noninvasive methods of pain control and stress the importance of keeping patient appointments with health-care providers. The nurse will also provide the patient and his family information on support groups. 4 When providing discharge instructions to the patient with prostate cancer, the nurse will teach the patient and his family noninvasive methods of pain control and stress the importance of keeping patient appointments with health-care providers. The nurse will also provide the patient and his family information on support groups.

The nurse is caring for a patient with erectile dysfunction (ED). Which medication should the nurse anticipate being prescribed for this patient? Select all that apply. 1) Tadalafil (Cialis) 2) Sildenafil (Viagra) 3) Buspirone (BuSpar) 4) Vardenafil (Levitra) 5) Methylphenidate (Ritalin)

1) Tadalafil (Cialis) 2) Sildenafil (Viagra) 4) Vardenafil (Levitra) 1. This is correct. Tadalafil (Cialis) works to relax the smooth muscles in the penis, allowing increased blood flow to the penis resulting in an erection. 2. This is correct. Sildenafil (Viagra) works to relax the smooth muscles in the penis, allowing increased blood flow to the penis resulting in an erection. 3. This is incorrect. Buspirone (Buspar) is an antianxiety agent and is not effective for erectile dysfunction (ED). 4. This is correct. Vardenafil (Levitra) works to relax the smooth muscles in the penis, allowing increased blood flow to the penis resulting in an erection. 5. This is incorrect. Methylphenidate (Ritalin) is a mild central nervous system stimulant and is not effective for ED.

The nurse is preparing an educational program on risk factors for the development of prostate cancer. Which information will the nurse include as being the greatest risk factor for developing prostate cancer? 1) The patient's age 2) A family history 3) A history of a vasectomy 4) A diet high in fat

1) The patient's age 1 The greatest risk for developing prostate cancer is age. Prostate cancer affects one out of every eight men over the age of 60. 2 Genetics, vasectomy, and a diet high in fat are also risk factors. 3 Genetics, vasectomy, and a diet high in fat are also risk factors. 4 Genetics, vasectomy, and a diet high in fat are also risk factors.

During a health history, the nurse learns that a patient has a recent onset of impotence. Which question will help identify a potential cause of this manifestation? 1) "Does this occur often?" 2) "For what diseases and disorders have you been treated?" 3) "Are you on any medications?" 4) "How does your partner feel about this problem?"

2) "For what diseases and disorders have you been treated?" 1 Asking the patient if the impotence occurs often will not help identify the cause of the problem. 2 A patient's health history can provide clues to the underlying cause of impotence. The question "for what diseases and disorders have you been treated" would provide the nurse with information as to possible causes for the recent onset of the disorder. 3 The question "are you on any medication?" would be beneficial to ask; however, it should be an open-ended question and not a closed-ended question as identified. The nurse should ask the patient to "list any medications" instead of asking "are you on any medication?" which could be answered with a yes or no. 4 Asking the patient how the partner feels about the problem also will not help identify a possible cause.

A patient reports 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 patient indicates the need for further education? 1) "Alpha blockers can be used to control my symptoms." 2) "I know I will get cancer of the prostate because of this." 3) "As my condition progresses, I may need to consider surgical management." 4) "There are nonsurgical treatment options available."

2) "I know I will get cancer of the prostate because of this." 1 Alpha blockers will help control the symptoms. 2 BPH is benign condition that does not necessarily progress to cancer. It is caused by an increase in size of the prostate gland and is seen in older males. 3 There are nonsurgical treatments available, such as medication to shrink the gland along with surgical management, such as resection. 4 There are nonsurgical treatments available, such as medication to shrink the gland along with surgical management, such as resection.

A nurse is caring for a patient who is prescribed a selective phosphodiesterase type 5 inhibitor for the treatment of erectile dysfunction. The nurse should include which statement when educating the patient regarding this medication? 1) "You should take this medication about 30 minutes before sexual activity." 2) "The action of this medication will last up to 36 hours." 3) "This medication will enhance erections with or without sexual stimulation." 4) "This medication should not be taken more than twice daily."

2) "The action of this medication will last up to 36 hours." 1 The patient should take the medication an hour prior to sexual activity, not 30 minutes. 2 Sildenafil citrate (Viagra), vardenafil hydrochloride (Levitra), tadalafil (Cialis), and avanafil (Stendra) are all selective phosphodiesterase type 5 inhibitors used in the treatment of erectile dysfunction. The nurse should tell the patient that the action of this medication will last up to 36 hours. 3 This medication will enhance erections only with sexual stimulation and should not be taken more than once daily. 4 This medication will enhance erections only with sexual stimulation and should not be taken more than once daily.

The nurse is providing follow-up care for a patient was recently diagnosed with benign prostatic hyperplasia (BPH). Which nursing diagnosis is the priority for the nurse to include in the patient's plan of care? 1) Chronic Pain 2) Impaired Urinary Elimination 3) Constipation 4) Diarrhea

2) Impaired Urinary Elimination 1 Acute pain, not chronic pain, is also an appropriate diagnosis. 2 The priority diagnosis for a patient diagnosed with BPH is Impaired Urinary Elimination. 3 Patients with BPH have problems associated with urinary elimination, not bowel elimination. Constipation and Diarrhea are not appropriate nursing diagnoses for this patient. 4 Patients with BPH have problems associated with urinary elimination, not bowel elimination. Constipation and Diarrhea are not appropriate nursing diagnoses for this patient.

A male patient tells the nurse that he has no idea why his wife wants to stay married to him because he has not been able to "perform" sexually since his prostate surgery. Which diagnosis would be appropriate for this patient? 1) Ineffective Coping 2) Situational Low Self-Esteem 3) Hormonal Imbalance 4) Sexual Dysfunction

2) Situational Low Self-Esteem 1 The patient is viewing himself as less than a man and is concerned with his wife wanting to remain married to him. Situational Low Self-Esteem is the most appropriate nursing diagnosis for the patient at this time. 2 The patient may or may not be experiencing ineffective coping. 3 Hormonal imbalance is not a nursing diagnosis. 4 Sexual dysfunction is associated with anxiety concerning the cause of the dysfunction, which is not the case for the patient.

The nurse is planning care for a patient with erectile dysfunction. What should the nurse include in this patient's plan of care? 1) Names of psychologists with experience in treating the disorder 2) Types of devices and surgeries available to help with the disorder 3) Reason for disorder as being side effect of prescribed medication 4) Information on exact cause

2) Types of devices and surgeries available to help with the disorder 1 The nurse should not provide the names of psychologists who treat the disorder. 2 When planning the care of a patient with erectile dysfunction, the nurse should include information on medications for treatment and types of devices and surgeries available to help with the disorder. 3 Explaining the reason for the disorder as being a side effect of prescribed medication could cause the patient to discontinue medication necessary to treat other health disorders and should not be done. 4 Because an exact cause may be difficult to determine for the patient, this would not be appropriate for the nurse to include in the patient's plan of care.

A nursing instructor is teaching a group of student nurses about the cultural implications of prostate cancer. Which statement will the nursing instructor include in the teaching session? 1) "African-American men are at lowest risk for prostate cancer." 2) "Asian- and Native American men have the highest risk for developing prostate cancer." 3) "Approximately one in eight men ages 70 and older will be diagnosed with prostate cancer." 4) "A diet low in dairy increases a man's risk for developing prostate cancer."

3) "Approximately one in eight men ages 70 and older will be diagnosed with prostate cancer." 1 African-Americans have the highest incidence of prostate cancer in the United States and the world, with rates greater than 60% higher than those seen in Caucasians. 2 Asian- and Native American men have the lowest risk for prostate cancer. 3 Approximately one in eight men ages 70 and older will be diagnosed with prostate cancer. 4 A diet high in dairy increases a man's risk for developing prostate cancer

The nurse is caring for a patient diagnosed with benign prostatic hyperplasia (BPH) who is experiencing an increase in symptoms. Which statement by the patient would best explain the source of the increased symptoms? 1) "I have decreased oral intake at night." 2) "I recently had a vasectomy." 3) "I am using an over-the-counter cold medication for a cold." 4) "I am taking over-the-counter saw palmetto."

3) "I am using an over-the-counter cold medication for a cold." 1 Decreased oral intake does not cause BPH. 2 A vasectomy does not affect the symptoms of BPH. 3 Use of cold medications can increase symptoms because of their anticholinergic properties. 4 Use of saw palmetto and decreased oral intake at night may resolve symptoms.

The nurse is instructing a patient about the medication sildenafil (Viagra). Which patient statement indicates teaching has been effective? 1) "Viagra should be taken with food." 2) "I can take Viagra anywhere from one to six hours before sex." 3) "I can take only one pill in a 24-hour period." 4) "Grapefruit juice will decrease the effects of Viagra."

3) "I can take only one pill in a 24-hour period." 1 Sildenafil should be taken on an empty stomach, not with food. 2 The optimum time for administration is one hour before sex, but it can be taken up to four hours before sex. 3 Taking only one pill in a 24-hour period is the recommended dosing for sildenafil (Viagra). 4 Grapefruit juice can lead to increased, not decreased, levels of sildenafil

The nurse is preparing to discharge a patient recovering from prostate surgery for cancer. What should the nurse emphasize when providing discharge instructions for this patient? 1) "You may drive yourself home." 2) "Avoid strenuous activity and heavy lifting for two weeks." 3) "It is quite common to notice blood in your urine following this type of surgery." 4) "Reduce your fluid intake so you won't need to void as often."

3) "It is quite common to notice blood in your urine following this type of surgery." 1 The patient should not drive after surgery for at least two weeks. 2 The healing period after prostate surgery is four to eight weeks, and the patient should avoid strenuous activity during this time. 3 Blood in the urine is fairly common after surgery. 4 Continued increase in fluid intake will help the urine to remain dilute and reduce the risk of clot formation

A patient is scheduled to undergo a prostate biopsy. The patient asks the nurse what is expected immediately following the procedure. Which response by the nurse is the most appropriate? 1) "You will need to avoid strenuous activity for 24 hours." 2) "Your sexual partners will need to be notified." 3) "You will likely experience discomfort for 24-48 hours after the procedure." 4) "You will not have any restrictions following the biopsy."

3) "You will likely experience discomfort for 24-48 hours after the procedure." 1 Strenuous activity is avoided only for about four hours. 2 There is no need to notify sexual partners following the procedure. 3 The patient may experience discomfort for one to two days after the procedure. 4 The patient must restrict activity for only a short period after the procedure.

The nurse is caring for a male patient of Japanese descent who is experiencing urinary retention. The patient asks the nurse if it is possible that he is experiencing benign prostatic hyperplasia (BPH). Which response by the nurse is the most appropriate? 1) "No, you are not old enough to have BPH." 2) "Your symptoms are not consistent with BPH." 3) "Your provider will run some tests; however, you are considered low-risk for BPH." 4) "Where did you get an idea that you might have BPH?"

3) "Your provider will run some tests; however, you are considered low-risk for BPH." 1 While age does increase the risk of BPH, it is not the only factor to consider. 2 The patient is experiencing urinary retention, which is consistent with BPH. 3 The nurse must always provide honest responses to patient questions. Telling the patient that the provider will run tests but due to his ethnicity, he is considered low-risk for developing BPH is the most appropriate response. 4 Asking a patient where he got that idea is demeaning.

The nurse is conducting a health history with a patient diagnosed with erectile dysfunction. Which finding could provide a possible cause for the patient's problem? 1) Blood pressure of 118/68 mmHg 2) Body mass index (BMI) of 24.5 3) Alcohol intake of four to six beers each day 4) Plays golf twice a week

3) Alcohol intake of four to six beers each day 1 Recreational sports, a body mass index within normal limits, and a normal blood pressure would not provide a possible cause for the patient's recent experience with the disorder. 2 Recreational sports, a body mass index within normal limits, and a normal blood pressure would not provide a possible cause for the patient's recent experience with the disorder. 3 The risk factors for erectile dysfunction are numerous. They include advancing age, diseases such as heart disease and diabetes, trauma, and the use of prescription or illicit drugs. Excessive use of alcohol can also result in erectile dysfunction. 4 Recreational sports, a body mass index within normal limits, and a normal blood pressure would not provide a possible cause for the patient's recent experience with the disorder

A patient is recovering from prostate surgery on a medical-surgical unit. The patient will be ready for discharge within the next few days. Which teaching point is appropriate for this patient? 1) The patient should not drive for six weeks after surgery. 2) The patient should call the health-care provider immediately for any pain. 3) The patient should increase the fiber in his diet. 4) The patient should avoid heavy lifting for two weeks after surgery.

3) The patient should increase the fiber in his diet. 1 The patient may not drive for two weeks after surgery. 2 The patient is taught to avoid heavy lifting for four to eight weeks after discharge and to call the doctor for severe abdominal or chest pain. 3 The patient should be encouraged to increase the fiber in his diet, as straining for bowel movements after surgery can cause increased pressure in the prostate area. The patient and family are taught good dietary habits to keep bowel movements regular and soft. 4 The patient is taught to avoid heavy lifting for four to eight weeks after discharge and to call the doctor for severe abdominal or chest pain.

The nurse is providing care to a patient who is diagnosed with mild benign prostatic hyperplasia (BPH). Which lifestyle change is appropriate for this patient? 1) Increasing caffeine intake 2) Decreasing alcohol intake 3) Urinating at first urge 4) Using over-the-counter antihistamines

3) Urinating at first urge 1 The patient should also eliminate caffeine and alcohol from the diet. 2 The patient should also eliminate caffeine and alcohol from the diet. 3 A patient who is diagnosed with mild BPH is often treated with lifestyle changes and a "wait and see" approach. Urinating at first urge is a lifestyle change that is appropriate for this patient. 4 It is also important for this patient to avoid using over-the-counter antihistamines.

A patient asks for a prescription for tadalafil (Cialis). What would be important for the nurse know prior to planning interventions for this patient? 1) "Do you have diabetes mellitus?" 2) "Do you take blood pressure medication?" 3) "Do you have any sexually transmitted infections?" 4) "Do you use nitroglycerine?"

4) "Do you use nitroglycerine?" 1 Having diabetes mellitus is not a contraindication to the use of tadalafil (Cialis). 2 Taking blood pressure medication is not a contraindication to the use of tadalafil (Cialis). 3 Having a sexually transmitted infection is not a contraindication to the use of tadalafil (Cialis). 4 Combining tadalafil (Cialis) with nitroglycerine can lead to serious hypotension.

The nurse is caring for a patient who returns to the unit following transurethral resection of the prostate due to prostate cancer with a three-way Foley catheter in place. The patient states that he has the urge to urinate and wants the catheter removed. Which response by the nurse is the most appropriate? 1) "This must be a complication, because the Foley catheter is supposed to evacuate clots that cause the sensation you are describing." 2) "The spasm is an unexpected finding because the procedure does not invade the urethra." 3) "The sensation is caused by the silicone used in the catheter. I will speak to the doctor about switching to a different catheter." 4) "This is an expected sensation, but the Foley catheter must remain in place."

4) "This is an expected sensation, but the Foley catheter must remain in place." 1 Antispasmodics may be prescribed for the patient with a three-way irrigation catheter. Spasms are not a complication of the catheter but rather an expected finding. 2 The procedure does invade the urethra. 3 The substance that the catheter is made of does not affect spasms. 4 Patients with a three-way Foley catheter usually complain of sensations of having to void despite the presence of the catheter. This urge to void is caused by the pressure exerted by the balloon in the internal sphincter of the bladder and the wide diameter of the catheter that is used for the purpose of irrigation

A nurse is treating a patient with diabetes mellitus who reports erectile dysfunction (ED). Which hormonal cause contributes to ED? 1) Increased prolactin levels 2) Decreased aldosterone levels 3) Decreased circulating catecholamines 4) Decreased thyroid-stimulating hormone

4) Decreased thyroid-stimulating hormone 1 2 3 This does not contribute to ED. 4 Hormonal causes of ED include decreased testosterone, decreased prolactin, and alterations in thyroid function. A decrease in thyroid-stimulating hormone (TSH) would be a cause of this disorder

While receiving discharge teaching, an adult patient recovering from a prostatectomy is distressed to learn that episodes of incontinence may occur. Which should the nurse teach the patient to help minimize incontinence? 1) Proper administration of incontinence medication 2) Steps to change the Foley catheter bag every day 3) Fluid restriction 4) Kegel exercises

4) Kegel exercises 1 Medication and Foley catheters are not appropriate long-term treatments for this complication. 2 Medication and Foley catheters are not appropriate long-term treatments for this complication. 3 Restricting fluids may cause further urinary problems and is not advised. 4 Urinary incontinence after surgery is not unexpected. Teaching the patient Kegel exercises is the best way to help him eliminate or reduce occasions of stress incontinence.

A patient is recovering from minimally invasive surgery due to a diagnosis of benign prostatic hyperplasia (BPH). After assessing the patient, the nurse expects which outcome for this patient? 1) Bowel continence 2) Absence of pain 3) No postoperative treatment 4) Urinary continence

4) Urinary continence 1 Most patients, due to pain and swelling in the area, may have problems with constipation immediately following the surgical intervention. 2 The patient will need postoperative teaching and will experience some amount of discomfort. 3 The patient will need postoperative teaching and will experience some amount of discomfort. 4 After surgery and removal of the catheter, the patient should return to urinary continence as expected.