HESI Case Study: Benign Prostatic Hyperplasia (BPH)

The client tells the nurse that he is uncomfortable with a constant feeling 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. Which nursing intervention best promotes effective communication? A. Instruct the client to try not to bear down around the catheter. B. Encourage increase in fluid intake to flush the bladder and relieve pressure. C. Explain how to do pelvic floor muscle exercises to strengthen bladder. D. Schedule regular administration of pain medication.

A. Instruct the client to try not to bear down around the catheter. Rationale: The client could damage the urinary sphincter if he tries to void around the catheter. Bearing down to try to urinate will create more pressure on the sphincter.

During administration of the aminocaproic acid infusion, the nurse monitors the client for adverse effects of the medication. What assessment data would indicate the onset of a thrombotic complication? A. Frothy pink sputum. B. Chest pain and dyspnea. C. Wheezing and stridor. D. Sudden high fever.

B. Chest pain and dyspnea. Rationale: Common manifestations of pulmonary embolism are chest pain and dyspnea.

Which instruction should the nurse provide to the client before starting the procedure? A. Explain importance of forcing all urine from bladder possible. B. While voiding into a special toilet, urine flow pressure will be monitored. C. Drink at least 16 ounces (448 grams) of water prior to procedure. D. Remain NPO following the procedure.

B. While voiding into a special toilet, urine flow pressure will be monitored. Rationale: The pressure of the urine flow is measured to determine the degree of obstruction.

Fill in the blank: The HCP prescribes an infusion of aminocaproic acid. The prescription is for a loading dose of aminocaproic acid IV 5 grams to be infused in 250 mL of 5% dextrose over 1 hour. The tubing drop factor is 15 gtt/mL. How many gtts/minute would the nurse set for the IV rate? (Enter numerical value only. If rounding is necessary, round to the whole number.)

63

Therapeutic Communication: Based on his continued lack of symptomatic improvement and high volumes noted during residual catheterization, the client elects to have surgery. A transurethral resection of the prostate (TURP) is performed. While the client is in surgery, his partner brings his belongings to the assigned room on the surgical nursing unit. The nurse assigned to the client care greets her. The nurse asks the client's partner if she has any questions or concerns. She responds calmly that she will be happy when he returns from surgery, and turns her head and looks away. Aware of the client's partner's body language, what action should the nurse implement? A. Let the client's partner know that you will be glad to answer any questions she may have. B. Ask the partner if she would like you to stay with her for a while. C. Acknowledge that you can see that she is uncomfortable. D. Take the partner's hand and offer silent support.

A. Let the client's partner know that you will be glad to answer any questions she may have. Rationale: This response gives the partner the opportunity to choose any further interaction, which include avoidance of physical touch between persons who are not close.

Postoperative Nursing: TURPAfter surgery, the client is admitted to the surgical nursing unit for overnight observation and postoperative care. Which postoperative intervention should the nurse perform first? A. Observe the urinary drainage. B. Palpate the bladder. C. Assess the level of pain. D. Encourage oral fluid intake.

A. Observe the urinary drainage. Rationale: A common postoperative complication that can be potentially life-threatening is bleeding, which will be seen in the urinary drainage.

The nurse recognizes that nonverbal behavior such as eye should not be ignored. What action is most important for the nurse to take regarding the partner's minimal eye contact? A. Understand this is reflecting unease in the healthcare environment. B. Tell the partner you noticed she appeared to look away when you were speaking. C. Accept that this is a nonverbal sign of lack of respect. D. Acknowledge this as a nonverbal cue that she is not being completely truthful.

B. Tell the partner you noticed she appeared to look away when you were speaking. Rationale: Avoiding eye contact or engaging in minimal eye contact should be addressed. This would be a common response when someone is uncomfortable and not handling a stressfull or unknown situation.

The client's prostate specific antigen (PSA) level is 8 ug/mL (8 ng/mL), normal is 0-4 ug/mL (0.4 - 4 ng/mL). The client appears distressed and worried he has prostate cancer and wants to know if that is why he is having these symptoms. Which intervention should the nurse implement to address the client's concern? A. Inform the client that this information is often too complicated for a layperson to understand. B. Provide resource material to explain PSA testing and meaning of results. C. Explain that PSA levels can be elevated with gland enlargement, as well as cancer, so more tests are needed. D. Notify the healthcare provider to discuss the results with the client.

C. Explain that PSA levels can be elevated with gland enlargement, as well as cancer, so more tests are needed. Rationale: Elevated PSA levels are associated with prostate cancer. However, slight elevations may also occur in BPH. PSA levels may also be elevated as the result of infection, or if the prostate gland is manipulated during a digital rectal exam.

Which nursing interventions promotes effective communication when teaching the client about finasteride? (Select all that apply.) A. Liver function studies (LFTs) need to be monitored frequently. B. Most clients see significant change in BPH symptoms in 4 months. C. Clients should see increases in their libido as symptoms resolve. D. Protect the medication from light. E. Clients can experience breast enlargement.

A. Liver function studies (LFTs) need to be monitored frequently. B. Most clients see significant change in BPH symptoms in 4 months. D. Protect the medication from light. E. Clients can experience breast enlargement. Rationale: Finasteride has been known to have adverse effects of erection problems, decreased sexual desire, and a reduced semen amount.

Catheterization: The client continues to take his medications for 8 months, but his symptoms do not improve significantly and he is scheduled for a uroflowmetry study. The client arrives at the clinic early for the uroflowmetry test and is asking the nurse to explain the procedure. Which nursing intervention best promotes effective communication? A. Uroflowmetry is a non-invasive exam to measure the volume and flow of urine. B. The amount of urine left in the bladder after urinating is measured by inserting an indwelling catheter. C. An indwelling catheter will be inserted to measure the amount of urine in the bladder. D. Urine volume will be measured using an ultrasound machine.

A. Uroflowmetry is a non-invasive exam to measure the volume and flow of urine. Rationale: Uroflowmetry is a simple non-invasive procedure that measures the flow of urine which can indicate the extent of blockage the prostate is creating.

Diagnostic Tests: The client is scheduled for a digital rectal exam, serum prostate-specific antigen (PSA) level, urinalysis, serum creatinine, and blood urea nitrogen (BUN). The client states that he has had the rectal exam and PSA levels done before for prostate screening. He asks why the other lab tests (creatinine and BUN levels) are necessary. Which information is most important for the nurse to include when explaining the need for these tests? (Select all that apply.) A. Advise the client that normal kidney function will confirm prostate is not enlarged. B. Explain to the client how repeat tests are needed to evaluate evidence of dehydration that mimics BPH symptoms. C. Emphasize to the client that prostate enlargement may result in renal damage which these tests will evaluate. D. Inform the client that repeat testing is necessary as an enlarged prostate gland blocks urine flow and causes kidney damage. E. Advise the client that it is protocol for the healthcare provider (HCP) to conduct then recheck tests to compare previous results.

C. Emphasize to the client that prostate enlargement may result in renal damage which these tests will evaluate. D. Inform the client that repeat testing is necessary as an enlarged prostate gland blocks urine flow and causes kidney damage. E. Advise the client that it is protocol for the healthcare provider (HCP) to conduct then recheck tests to compare previous results. Rationale: Prostate enlargement may result in kidney damage, which can cause a change in urine production. As the flow of urine is blocked by the enlarged prostate gland, gradual dilation of the ureters (hydroureter) and kidneys (hydronephrosis) can occur, resulting in increased creatinine and BUN levels. It is important to monitor progression and degree of kidney damage.

Early the next morning, the nurse notes that the catheter is draining a large amount of thick, bright red urine. What actions should the nurse take? (Select all that apply.) A. Ask the client to apply pressure by bearing down. B. Release the tape traction on the catheter. C. Increase the flow rate of the CBI. D. Notify the HCP of the findings. E. Perform manual irrigation.

C. Increase the flow rate of the CBI. D. Notify the HCP of the findings. E. Perform manual irrigation. Rationale: The flow rate of the CBI should be increased, to decrease the risk for blood clot obstruction to the catheter.

The nurse initiates a physical examination to further investigate the client's symptoms. Which assessment finding would indicate that the client is experiencing urinary retention related to BPH? (Select all that apply.) A. Presence of a bruit auscultated over the renal artery. B. Complaints of flank pain on gentle palpation. C. Observance of bladder distention. D. Dullness heard on percussion below the umbilicus. E. Observance of dribbling after voiding.

C. Observance of bladder distention. D. Dullness heard on percussion below the umbilicus. E. Observance of dribbling after voiding. Rationale: Bladder distention is an assessment finding in urinary retention. A distended bladder will sound dull upon percussion. This is a symptom of urinary retention.

During the night, the client 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? A. Apply gentle pressure over the bladder. B. Continue the CBI, and notify the HCP. C. Stop the CBI, and irrigate the catheter. D. Gradually increase the flow rate of the CBI.

C. Stop the CBI, and irrigate the catheter. Rationale: The catheter is most likely obstructed by blood clots and should be manually irrigated with 50 ml of sterile, 0.9% sodium chloride. The nurse should first check to make sure there are no kinks in the drainage tubing or other obvious signs of catheter obstruction!

Clinical Manifestations: The nurse questions the client about other symptoms they may be experiencing. Which assessment findings warrants immediate intervention by the nurse? (Select all that apply.) A. Hesitancy when starting the urine stream. B. Decrease in the size and force of urine stream. C. Sudden painful inability to urinate. D. Painful, frequent urination. E. Frequent urination, including nocturia.

C. Sudden painful inability to urinate. D. Painful, frequent urination. Rationale: C is a sign of acute obstruction and requires an indwelling urinary catheter to allow urine to drain. D is a sign of urinary tract infection that requires antibiotic therapy as soon as possible.

Client Teaching: Medication Therapy - Test results, along with urodynamic flow studies, indicate that the client prostate gland is significantly enlarged, and treatment is recommended. The client elects to try medical management of his symptoms. He receives prescriptions for oral finasteride and terazosin. The nurse provides instructions about these medications. What information should be included when teaching the client about terazosin? A. Avoid caffeine within 2 hours of taking the medication. B. Take this medication on an empty stomach. C. This medication can cause dizziness so it should be taken at night. D. Symptoms subside within two weeks.

C. This medication can cause dizziness so it should be taken at night. Rationale: Terazosin is an alpha-adrenergic blocking agent and is likely to cause orthostatic hypotension and dizziness, especially when the client first starts the medication. It is recommended to take the medication at night.

The client tells the nurse that he will have cut back on drinking fluids to reduce their symptoms. Which instruction is most important for the nurse to provide to the client? A. Restrict fluid intake until test results are back. B. Increase the intake of diuretic-type fluids, such as coffee or tea, to increase urine flow. C. Consider taking an over the counter (OTC) herbal supplement. D. Decrease fluid intake to increase the risk of developing a urinary tract infection.

D. Decrease fluid intake to increase the risk of developing a urinary tract infection. Rationale: Clients with BPH often restrict fluid intake to reduce symptoms, but this should be discouraged because it increases the risk for urinary tract infection.

The client has continuous bladder irrigation (CBI) infusing with 0.9% sodium chloride. Eight hours after surgery, the urinary drainage is reddish pink. What action should the nurse take? A. Notify the HCP of the drainage. B. Stop the CBI and irrigate the catheter. C. Increase the rate of flow of the CBI. D. Document that the CBI is infusing correctly.

D. Document that the CBI is infusing correctly. Rationale: Normal drainage is reddish pink, clearing to light pink within 24 hours postoperatively. The drainage should be clear yellow by the 4th postoperative day. 0.9% sodium chloride is the desired solution for irrigation because it is isotonic. Hypotonic or hypertonic solutions may result in fluid shifts.