Chapter 67 Questions

Which potential causes of organic erectile dys-function does the nurse assess for in a client? Select all that apply A. Kidney disease B. Diverticulitis C. Thyroid disorders D. Obesity E. Diabetes mellitus F. Penile traum

A, C, E, F -Potential causes of organic erectile dysfunction include: vascular endocrine, or neurologic diseases; chronic diseases (e.g., diabetes melli-tus, renal failure); penile disease or trauma; and surgery or pharmaceutical therapies

Which common serum tumor markers does the nurse expect will be ordered to confirm a client's suspected diagnosis of testicular cancer? Select all that apply A. Early prostate cancer antigen (EPCA-2) B. Lactate dehydrogenase (LDH) C. Alpha-fetoprotein (AFP) D. Beta human chorionic gonadotropin (hCG) E. BRCA1 mutation F. Glutathione S-transferase (GST P

B, C, D -Common serum tumor markers that are used when formulating a diagnosis of testicular can-cer are: alpha-fetoprotein (AFP), beta human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). Early prostate cancer antigen (EPCA-2) may be a serum marker for prostate cancer. Glutathione S-transferase (GST P1) mutation increases the risk for prostate cancer. BRCA1 mutation increases a woman's risk for breast cancer

Which client does the nurse recognize has the highest risk for development of prostate cancer? A. 45-year-old Asian American with a history of benign prostatic hyperplasia B. 55-year-old Hispanic American who practices poor dietary intake C. 65-year-old Caucasian American with two cousins who developed prostate cancer D. 75-year-old African American whose father and brother developed prostate cancer

D -The risk of prostate cancer increases for men who have a first-degree relative (father, brother, son) with the disease, and for African-American men.

What is the nurse's best response when a client who had a vasectomy asks when sexual inter-course can be safely resumed? A. "Your surgeon will discuss the timing and will tell you when it is safe to have sex again." B. "It depends on how much swelling, pain, and bruising you experience after the surgery." C. "Just to be safe, you should probably wait at least 6 months or more before having sex." D. "Sexual intercourse should be avoided for at least 1 week after your surgery."

D -Heavy lifting, sports, and sexual intercourse should be avoided for at least 1 week. Teach the client and partner to use an alternate form of contraception until a 3-month follow-up. At that time, a semen analysis will be performed to determine if the procedure was effective.

Which question will the nurse ask a client to determine whether the drug tamsulosin is achieving the desired therapeutic effect? A. "Do you have a green or yellow discharge from your penis?" B. "Are you having any problems achieving an erection?" C. "Does your urine have a strong odor or appear cloudy?" D. "Are you continuing to have difficulty passing urine?"

D -Tamsulosin is an alpha1 adrenergic antagonist drug. These drugs act to relax smooth muscle in the bladder neck, which will help make uri-nation less difficult.

What does the nurse teach an older client with prostate cancer who is scheduled to have a digital rectal examination (DRE) and a prostate-specific antigen (PSA) test? A. The PSA laboratory test is drawn before the DRE. B. The DRE is completed 2 weeks before the PSA. C. The PSA is reviewed first because DRE may not be necessary. D. Both tests can be completed at the client's convenience

A -The PSA laboratory test should be drawn before the DRE because this examination can cause an increase in PSA due to prostate irritation.

Which priority information will the nurse gather from a client who is seeking a prescrip-tion for sildenafil for erectile dysfunction? A. Medication prescription for nitrate drugs B. Presence of nocturnal or morning erections C. Use of any illicit drugs or substances D. Dietary consumption of proteins each day

A -The nurse asks the client whether he takes nitrates. Men who are prescribed nitrates must avoid PDE5 inhibitors (e.g., sildenafil) because the vasodilation effects can cause a profound hypotension and reduce blood flow to vital organs.

Which technique is best when the nurse assesses an obese client who reports symptoms associated with benign prostatic hyperplasia? A. Instructing the client to urinate, then using the bedside ultrasound bladder scanner B. Applying gentle pressure to the bladder to elicit urgency, then instructing the client to void C. Having the client drink several large glasses of water, then percussing the bladder D. Instructing the client to undress from the waist down, then inspecting and palpating the bladder

A -Clients with obesity are best assessed with per-cussion by the health care provider, or bedside ultrasound bladder scanner by the nurse, rather than by inspection or palpation. Instruct the client to urinate before the examination

Which nursing actions are included in the care of a client who had a transurethral resection of the prostate (TURP)? Select all that apply A. Helping the client out of the bed to the chair as soon as permitted to prevent complications of immobility B. Using normal saline solution for the intermittent bladder irrigant unless otherwise prescribed C. Monitoring and documenting the color, consistency, and amount of urine output D. Providing a safe environment for the client because of temporary changes in mental status E. Assessing the client for reports of severe bladder spasms with decreased urinary output F. Checking the drainage tubing frequently for external obstructions such as kinks, and internal obstructions such as blood clots

A, B, C, D, E, F -All of these options are appropriate nursing actions when caring for a client after a TURP. See Best Practice for Patient Safety & Quality Care Care of the Patient After Transurethral Resection of the Prostate in your text for additional appropriate nursing care actions to take after a client has a TURP

After a transrectal ultrasound with biopsy for prostate cancer, what instructions will the nurse provide the client? Select all that apply A. Report fever, chills, bloody urine, and any difficulty voiding. B. The biopsy will diagnose if you have prostate cancer. C. Drink plenty of fluids during the first 24 hours. D. Expect to see bright red bleeding at first. E. Report any pink color in the urine to the health care provider. F. Avoid strenuous physical activity.

A, B, C, F -After a transrectal ultrasound with biopsy, the nurse teaches a client to report fever, chills, bloody urine, and any difficulty voiding. He is advised to avoid strenuous physical activity and to drink plenty of fluids, especially in the first 24 hours after the procedure. The nurse teaches that a small amount of bleeding turning the urine pink is expected during this time. Bright red bleeding should be reported to the health care provider immediately. The biopsy provides an accurate diagnosis for prostate cancer.

Which questions will the nurse ask a client to determine the presence of signs and symptoms of benign prostatic hyperplasia (BPH)? Select all that apply A. "Have you noticed a sensation of incomplete bladder emptying?" B. "Have you recently experienced a testicular or bladder infection?" C. "Have you noticed dribbling or leaking after you finish urination?" D. "How many times do you have to get up during the night to urinate?" E. "Have you noticed blood at the start or at the end of urination?" F. "Have you noticed increased force or size of your urine stream?"

A, C, D, E -The nurse asks the client about the number of times he awakens during the night to void (nocturia). Other important topics to question a client about include: difficulty in starting (hesitancy) and continuing urination; reduced force and size of the urinary stream ("weak" stream); sensation of incomplete bladder emp-tying; straining to begin urination; postvoid (after voiding) dribbling or leaking; and hema-turia (blood in the urine) when starting the urine stream or at the end of urination

Which instructions will the nurse teach a client after an open retroperitoneal lymph node dis-section (RPLND) for testicular cancer? Select all that apply A. Do not lift anything that weighs over 15 lbs. B. Limit intake of fluids to 1000 to 1200 mL per day. C. Do not drive a car until the health care provider allows it. D. Perform monthly testicular self-examination on the remaining testicle. E. Report fever, drainage, or increasing tenderness around the incision. F. Avoid climbing stairs during the first week after surgery.

A, C, D, E -The nurse teaches the client the following in-structions after RPLND: do not lift anything over 15 lb (6.8 kg), avoid stair climbing, and do not drive a car for several weeks. Notify the surgeon immediately if chills, fever, vomiting, increasing incisional pain, drainage, or dehis-cence of the incision occurs. Perform monthly testicular self-examination (TSE) on the re-maining testis. The client should not limit fluid intake to 1000 to 1200 mL per day

To which common sites does the nurse expect metastasis when a client has prostate cancer? Select all that apply. A. Liver B. Pancreas C. Lungs D. Lumbar spine E. Kidneys F. Bones of the pelvis

A, C, D, F -Common sites of metastasis from prostate cancer are the nearby lymph nodes and bones, although it can also metastasize to the lungs or liver. The bones of the pelvis, sacrum, and lumbar spine are most often affected.

Which criteria will the nurse assess in a client with benign prostatic hyperplasia that indicate the need for a surgical treatment? Select all that apply A. Hydronephrosis B. Acute urinary tract infection unresponsive to first-line antibiotics C. Hematuria D. Chronic urinary tract infection secondary to residual urine in bladder E. Recurrent kidney stones F. Acute urinary retention due to obstruction

A, C, D, F -For a client with BPH, some or all of these cri-teria indicate the need for surgery: acute urinary retention due to obstruction; chronic urinary tract infections secondary to residual urine in the bladder; hematuria; hydronephresis; and persistent pain with decrease in urine flow.

Which diagnostic procedure does the nurse expect the health care provider to order to test a client with an enlarged bladder, for bladder outlet obstruction? A. Bladder ultrasound scan B. Urodynamic pressure-flow study C. Computed tomography scan D. Transrectal ultrasoun

B -The health care provider orders a urodynamic pressure-flow study to help in determining if there is urine blockage or weakness of the de-trusor muscle.

What is the nurse's best action when assessing a client after open radical prostatectomy and finding scrotal and penile swelling? A. Notify the health care provider and monitor for inability to urinate. B. Elevate the scrotum and penis, then apply ice to the area intermittently. C. Assist the client to increase mobility by using early ambulation. D. Observe the urethral meatus for redness, discharge, and abnormal output.

B -After open radical prostatectomy, when the nurse assesses and finds swelling of the scrotum and penis, the best action is to elevate the scro-tum and penis and apply ice to the area inter-mittently for the first 24 to 48 hours. The cause of this swelling is from the disrupted pelvic lymph flow

What action will the advanced practice nurse take after performing a digital rectal examina-tion on a client with benign prostatic hyperplasia (BPH)? A. Instruct the client to remain in a supine position with knees bent. B. Massage the prostate to obtain a fluid sample for possible prostatitis. C. Use a sterile cotton-tipped applicator for a sample from the penis for possible infection. D. Administer pain medication to relieve the discomfort from the examination.

B -After palpating the prostate gland through a digital rectal examination (DRE), the nurse practitioner may massage the prostate to obtain a fluid sample for examination to rule out pros-tatitis (inflammation and possible infection of the prostate), a common problem that can occur with BPH

Which behavioral modification instructions will the nurse teach a client with benign prostatic hyperplasia (BPH)? Select all that apply. A. Take diuretics to increase urine output. B. Limit alcohol intake. C. Avoid caffeine containing beverages. D. Do not consume large amounts of fluid in a short time. E. Avoid sexual intercourse. F. Avoid taking antihistamine drugs

B, C, D, F -Behavioral modifications that the nurse teaches a client with BPH include avoidance of drink-ing large amounts of fluid in a short period of time, especially before going out or at bedtime; limiting caffeine and alcohol consumption, as these have a diuretic effect; and avoiding drugs that can cause urinary retention, especially an-ticholinergics, antihistamines, antipsychotics, and muscle relaxants

Which laboratory test suggests to the nurse that a client with prostate cancer has metastasis to the bone? A. Decreased alpha-fetoprotein B. Increased blood urea nitrogen (BUN) C. Elevated serum alkaline phosphatase D. Decreased serum creatinine

C -The laboratory test result that suggests metasta-sis of prostate cancer to the bones is elevated serum alkaline phosphatase levels. These clients also have severe pain.

What does the nurse practitioner suspect when performing an examination on a young male client and finding a testicular lump that is hard and painless? A. Prostate cancer B. Epididymitis C. Testicular cancer D. Erectile dysfunction

C -The most common finding in a client with testicular cancer is a painless, hard swelling or enlargement of the testicle. A health care pro-vider palpates the testes for lumps and swelling that are often not visib

Which instruction will the nurse provide to a client who is taking a phosphodiesterase-5 (PDE5) inhibitor drug for erectile dysfunction? A. If one pill does not work, wait an hour and take a second pill. B. Use relaxation techniques before and after taking this drug. C. Abstain from alcohol use before sexual intercourse. D. Do not perform heavy lifting while using this medication

C -The nurse teaches a client taking PDE5 inhibitors to abstain from alcohol before sexual intercourse because it may impair the ability to have an erection.

Which action does the nurse teach a client with BPH to perform that can help relieve obstructive symptoms? A. Urinate before going to bed and immediately upon waking. B. Consume fluids regularly throughout the day. C. Increase the frequency of sexual intercourse. D. Urinate forcefully after drinking a large glass of water

C -The nurse teaches the client that frequent sex-ual intercourse can reduce obstructive symp-toms because it causes the release of prostatic fluid. This approach is helpful for a client whose obstructive symptoms result from an enlarged prostate with a large amount of retained pros-tatic fluid.

Which symptom does the nurse most likely expect when admitting a client diagnosed with benign prostatic hyperplasia (BPH)? A. Erectile dysfunction B. Pain in the scrotum C. Difficulty passing urine D. Constipation

C -As the client's prostate gland enlarges, it ex-tends upward into the bladder and inward, causing bladder outlet obstruction. Because of this, the nurse expects the symptom of diffi-culty in starting and continuing urinatio

Which laboratory tests does the nurse expect to be ordered to screen for prostate cancer in a client with benign prostatic hyperplasia (BPH)? Select all that apply A. Urinalysis and urine culture B. Complete blood count (CBC) C. Prostate-specific antigen (PSA) D. Blood urea nitrogen (BUN) E. Serum acid phosphatase F. Serum creatinine

C, E -Laboratory tests for cancer screening include PSA (most commonly used to test for early prostate cancer), and serum acid phosphatase (to screen for metastatic prostate cancer). Cre-atinine and BUN evaluate renal function. CBC looks for evidence of systemic infection or ane-mia. A urinalysis and urine culture evaluate for systemic infection and if there is blood in the urine, for anemia.