BPH Module 1- 114

The health care provider orders a blood test for prostate-specific antigen (PSA) when an enlarged prostate is palpated during a routine examination of a 56-year-old man. When the patient asks the nurse the purpose of the test, the nurse's response is based on the knowledge that a. elevated levels of PSA are indicative of metastatic cancer of the prostate. b. PSA testing is the "gold standard" for making a diagnosis of prostate cancer. c. baseline PSA levels are necessary to determine whether treatment is effective. d. PSA levels are usually elevated in patients with cancer of the prostate.

d PSA levels are usually elevated above the normal in pt with prostate cancer. PSA testing does not determine whether metasisis has occured. a biopsy of the prostate is needed for a definitive diagnosis of prostate cancer. success of tx is determined by a fall in PSA to an undetectable level; the pt baseline PSA is not needed to determine the success of tx

The client asks, "What does an elevated PSA test mean?" On which scientific rationale should the nurse base the response? 1.An elevated PSA can result from several different causes. 2.An elevated PSA can be only from prostate cancer. 3.An elevated PSA can be diagnostic for testicular cancer .4.An elevated PSA is the only test used to diagnose BPH

1.An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct.

A client has urge incontinence. When obtaining the health history, the nurse should ask if the client has:1. Inability to empty the bladder.2. Loss of urine when coughing.3. Involuntary urination with minimal warning.4. Frequent dribbling of urine.

3. A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urine retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of a vesicovaginal or urethrovaginal fistula.)

The nurse is explaining to a client with benign prostatic hyperplasia (BPH) the diagnostic tests that are used to differentiate BPH from prostate cancer. Which would the nurse include in the explanation? (Select all that apply.) A Digital rectal examination B Pelvic ultrasound C PSA level D Blood chemistry E Sperm count

A, C(In a digital rectal examination for BPH, the prostate is asymmetrical and enlarged; in prostate cancer, the exam shows nodules and a fixed position. PSA is specific to the prostate and is released by both benign and malignant cells; however, in BPH the amounts of the free form of PSA and complex PSA would be different. The other tests are not helpful in distinguishing cancer from BPH.)

During assessment of the client with urinary incontinence, which is the nurse most likely to find? (Select all that apply.) A) Perineal skin irritation B) Fluid intake of less than 1,500 mL/day C) A diet high in fiber D) History of antihistamine intake E) History of frequent urinary tract infections

A,B,E(Rationale:The perineum may become irritated by the frequent contact with urine. Normal fluid intake is at least 1,500 mL/day and clients often decrease their intake to try to minimize urine leakage. Urinary tract infections can contribute to incontinence. Antihistamines can cause urinary retention rather than incontinence. A diet high in fiber affects colon health, not urinary health.)

A patient with acute urinary retention associated with BPH is admitted to the emergency department. The patient has had no urine output for 16 hours, and the laboratory work shows a blood urea nitrogen (BUN) level of 50 mg/dl and a creatinine of 3.0 mg/dl. The nurse will anticipate a health care provider order to a. schedule the patient for inpatient hemodialysis. b. insert a retention catheter. c. start an IV line for fluid administration. d. administer furosemide (Lasix).

Answer: BRationale: The patient data indicate that the patient may have hydronephrosis and acute renal failure caused by the BPH; the initial therapy will be to insert a catheter. Hemodialysis may be needed if the elevation in BUN and creatinine persists, but it will not be ordered initially. Fluid administration and furosemide administration will increase the bladder distension.

The health care provider prescribes finasteride (Proscar) for a 56-year-old male patient who has a BPH symptom score of 12 on the AUA Symptom Index. When teaching the patient about the drug, the nurse informs him that a. his interest in sexual activity may decrease while he is taking the medication. b. he should change position from lying to standing slowly to avoid dizziness. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

Answer: ARationale: A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Orthostatic hypotension is a side effect of the α-blocking agents. Improvement in symptoms of obstruction takes 3 to 6 months. The medication does not cause hypertension.

A patient scheduled for a transurethral resection of the prostate (TURP) for BPH tells the nurse that he has delayed having surgery because he is afraid it will affect his sexual function. When responding to his concern, the nurse explains that a. with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur. b. information about penile implants used for ED is available if he is interested. c. there are many methods of sexual expression that can be alternatives to sexual intercourse. d. sterility will not be a problem after surgery because sperm production will not be affected.

Answer: ARationale: Erectile problems are rare, but retrograde ejaculation may occur after TURP. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns.

Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of urine. An appropriate nursing intervention for this patient is to teach the patient a. pelvic floor muscle training. b. the use of belladonna and opium suppositories. c. how to perform intermittent self-catheterization. d. to restrict oral fluid intake.

Answer: ARationale: Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L.

A patient with benign prostatic hyperplasia (BPH) with mild obstruction tells the nurse, "My symptoms have gotten a lot worse this week." Which response by the nurse is most appropriate? a. "The prostate gland normally changes slightly in size from day to day, and this may be making your symptoms worse." b. "Have you been taking any over-the-counter (OTC) medications recently?" c. "Have you talked to the doctor about surgical procedures such as transurethral resection of the prostate?" d. "I will talk to the doctor about ordering a prostate specific antigen test."

Answer: B Rationale: Because the patient's increase in symptoms has occurred abruptly, the nurse should ask about OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer and is not indicated in this patient, who has already been diagnosed with BPH.

following discharge teaching for a patient who has had a transurethral prostatectomy for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, a. "I will increase fiber and fluids in my diet to prevent constipation." b. "I should call the doctor if I have any incontinence at home." c. "I will avoid heavy lifting or driving until I get approval from my health care provider." d. "I should continue to schedule yearly appointments for prostate exams."

Answer: B Rationale: Incontinence is common for several weeks after a TURP. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.

The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate? a. "The bladder irrigation is needed to stop the postoperative bleeding in the bladder." b. "The irrigation is needed to keep the catheter from being occluded by blood clots." c. "Normal production of urine is maintained with the irrigations until healing occurs." d. "Antibiotics are being administered into the bladder with the irrigation solution."

Answer: B Rationale: The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or maintain urine production. Antibiotics are given by the IV route, not through the bladder irrigation.

A patient with irritative and obstructive bladder symptoms has an enlarged prostate on digital rectal examination (DRE) and an elevated PSA level. The nurse will anticipate that the patient will need teaching about a. uroflometry studies. b. cystourethroscopy. c. transrectal ultrasonography (TRUS). d. magnetic resonance imaging (MRI).

Answer: C Rationale: In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to help differentiate BPH from prostatic cancer. Uroflowmetry studies will help determine the extent of urine blockage and treatment, but a differential diagnosis will be obtained first. Cystourethroscopy may be used after TRUS if the diagnosis is still uncertain. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process.

A 41-year-old man asks the nurse what he can do to decrease the risk of BPH. The nurse explains that a. riding a bicycle raises prostate specific antigen levels and may increase BPH risk. b. prevention is not possible because prostatic enlargement occurs with normal aging. c. decreasing butter and margarine and increasing fruits in the diet may help. d. taking a daily vitamin E supplement has reduced prostate size in some men.

Answer: CRationale: A diet high in saturated fats, found in foods like butter, is associated with an increased risk for BPH. Individuals who eat more fruits and vegetables may be at lower risk. Riding a bicycle does increase prostate-specific antigen (PSA) levels, but this is not associated with development of BPH. Dietary changes and increased exercise do appear to help prevent BPH. Vitamin E supplements do not decrease prostate size.

The nurse recognizes that urinary elimination changes may occur even in healthy elders because: A) the bladder distends, and its capacity increases. B) elders ignore the need to void. C) the amount of urine retained after voiding increases. D) urine becomes more concentrated.

C(Rationale:The capacity of the bladder may decrease with age, but the muscle is weaker and can cause urine to be retained. Elders do not ignore the urge to void and may have difficulty in getting to the toilet in time. The kidneys become less able to concentrate urine with age)

An older male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)? A. High-purine diet B. Sedentary lifestyle C. Benign prostatic hyperplasia (BPH) D. Recent use of broad-spectrum antibiotics

C. Benign prostatic hyperplasia (BPH)BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi.

A man whose BPH has been successfully managed through medical treatment visits the provider's office and reports he has suddenly had a return of symptoms including frequency, urgency, and a sensation of incomplete emptying after voiding. The nurse collects a thorough history and suspects the possible cause of the sudden exacerbation of the client's symptoms may be: A) increased sexual activity since his wife has retired. B) antihypertensive medications he was recently prescribed. C) increased levels of exercise as he trains for a marathon. D) over-the-counter medications he's been taking to treat cold symptoms.

D(Over-the-counter medications, such as antihistamines and decongestants, can exacerbate the symptoms of BPH because they contain alpha adrenergic agents or have anticholinergic effects. Antihypertensives do not affect BPH. Increased sexual activity and exercise will not aggravate symptoms of BPH.)

A nurse is volunteering at a health screening event sponsored by a local church and community center. The nurse is educating men about benign prostatic hyperplasia (BPH). Which male would be at greatest risk for developing BPH? A) 38-year-old Japanese man who is a vegetarian B) 52-year-old Caucasian man who has a family history of BPH C) 27-year-old Hispanic man who has a family history of BPH D) 56-year-old African American man who eats meat daily

Rationale:Although the exact cause of BPH is unknown, risk factors include older age, family history, race (highest in African Americans and lowest in native Japanese), and a diet high in meat and fats.)

a 70 year old pt who had a TURP for BPH is being discharged from the hospital today. THe nurse determines that additional instruction is needed when the pt says which of the following. a. i should call the doctor if i have incontinence at home b. i will avoid drinking until i get approval from my doctor c. i will increase fiber and fluids in my diet to prevent consipation d. i should continue to schedule yearly appt for prostate exams

a because incontinence is common for several weeks after a TURP the pt does not need to call HCP if this occurs.

A nurse is instructing a client who is scheduled for a transurethral resection of the prostate (TURP) about his postoperative care. Which of the following information should the nurse include in the teaching?A. "You may have a continuous sensation of needing to void even though you have a catheter."B. "You will be on bed rest for the first 2 days after the procedure."C. "You will be instructed to limit your fluid intake after the procedure."D. "Your urine should be clear yellow the evening after the surgery."

a to reduce the risk of postoperative bleeding, the client will have a catheter with a large balloon that places pressure on the internal sphincter of the bladder. Pressure on the sphincter causes a continuous sensation of needing to void

the nurse is explaining to a client with benign prostatic hyperplasia (BPH) the diagnostic tests that are used to differentiate BPH from prostate cancer. The nurse includes which of the following in the explanation? (Select all that apply.) a. PSA level b. Blood chemistry c. Sperm count d. Digital rectal examinatione. Pelvic ultrasound

a. PSA leveld. DREIn a digital rectal examination for BPH, the prostate is asymmetrical and enlarged; in prostate cancer, the exam shows nodules and a fixed position. PSA is specific to the prostate and is released by both benign and malignant cells; however, in BPH the amounts of the free form of PSA and complex PSA would be different. The other tests are not helpful in distinguishing cancer from BPH.

A nurse is providing discharge instructions to a client who is postoperative from a TURP. Which of the following instructions should the nurse include? (Select all that apply.) A. Avoid sexual intercourse for 3 months after the surgery. B. If urine appears bloody, stop activity and rest. C. Avoid drinking caffeinated beverages .D. Take a stool softener once a day. E. Treat pain with ibuprofen (Motrin).

b c d excessive activity may cause recurrence of bleeding, caffeine is a bladder stimulant and should be avoided, the client should take a stool softener to keep the stool soft and prevent complication of bleeding at the time of a bowel movement

he nurse is assessing a client who is suspected of experiencing an enlarging prostate gland (BPH). The nurse expects the enlarging prostate in BPH to be manifested by assessment of problems with which of the following? a. Peripheral vascular function b. Urinary elimination c. Bowel elimination d. Skin integrity

b urinary elimination

A nurse in a provider's office is obtaining a history from a client who is being evaluated for benign prostatic hyperplasia (BPH). Which of the following findings are indicative of this condition? (Select all that apply.) A. Backache B. Frequent urinary tract infections C. Weight loss D. Hematuria E. Urinary incontinence

b, d, e in the presence of BPH, pressure on urinary structures leads to urinary stasis, which in turn promotes the occurence of urinary tract infections. Painless hematuria occurs in the presence of of BPH, overflow incontinence occurs in the presence of BPH

A nurse is volunteering at a health screening event sponsored by a local church and community center. The nurse is educating men about benign prostatic hyperplasia (BPH). Which of the following men is at greatest risk for developing BPH? a. A 27-year-old Hispanic man who has a family history of BPH b. A 56-year-old African American man who eats meat daily c. A 52-year-old Caucasian man who has a family history of BPH d. A 38-year-old Japanese man who is a vegetarian

b. A eats meat Although the exact cause of BPH is unknown, risk factors include older age, family history, race (highest in African Americans and lowest in native Japanese), and a diet high in meat and fats.

The nurse is caring for a man who has returned to the unit from the recovery room following a transurethral resection of the prostate (TURP). His urinary drainage bag is filled with dark red fluid with obvious clots. He is having painful bladder spasms. What would the nurse do first? a. Assess his intake and output since surgery. b. Report the assessments to his urologist. c. Nothing, because these manifestations are expected following a TURP. d. Administer pain medication in the form of a B&O (belladonna and opiates) suppository.

b. report to the urologist The nurse should notify the surgeon. Dark red fluid with obvious clots and painful bladder spasms could indicate that the client may be hemorrhaging postoperatively; the doctor will need to know this to direct the next actions needed to keep the client safe. The other answers do not address the need for appropriate action.

When conducting a health assessment, which of the following would most likely elicit information about sexual concerns? a. "Following your prostate surgery, when did you first notice you had problems with sexual intercourse?" b. "Tell me about your experience with sexual function since you developed prostate enlargement." c. "Do you miss having sex?" d. "Why do you think you should be sexually active at your age?"

b. tell me about your experience with sexual functionThis is stated in an appropriate way to allow the client to feel free to ask any question about his sexual concerns. The other answers presume problems or contain judgmental attitudes.

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. the presence of blood in the urine. b. any erectile dysfunction (ED). c. occurrence of a weak urinary stream. d. lower back and hip pain.

c the american urological association (AUA) symptom index for a patient with BPH asks questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and back or hip pain are not typical symptoms with BPH

The nurse hangs a new 3000 mL bag of irrigating fluid for a postoperative client who has had a transurethral resection of the prostate and sets the irrigation rate based on: a. Client comfort. b. Size of the urinary drainage bag .c. Color of the client's urine. d. Milliliters to be administered per hour.

c. color of urineThe irrigation fluid is set to infuse as rapidly as needed to dilute urine to a pale pink color in order to prevent the formation of clots that could occlude urine flow. Client comfort will improve with the proper rate because clots are flushed and spasms are reduced; however, this is not the criterion used to set the drip. Milliliters per hour and size of the drainage bag are not considerations used to determine the rate of the drip.

A nurse is caring for a client who has a new diagnosis of benign prostatic hyperplasia (BPH). The nurse should anticipate a prescription for which of the following medications? A. Oxybutynin (Ditropan) B. Diphenhydramine (Benadryl) C. Ipratropium (Atrovent) D. Tamsulosin (Flomax)

d tamulosin is an alpha adrenergic receptor antagonist that relaxes the bladder outlet and the prostate gland which improves urinary flow

A man whose BPH has been successfully managed through medical treatment visits the provider's office and reports he has suddenly had a return of symptoms including frequency, urgency, and a sensation of incomplete emptying after voiding. The nurse collects a thorough history and suspects the possible cause of the sudden exacerbation of the client's symptoms may be:a. Increased sexual activity since his wife has retired.b. Increased levels of exercise as he trains for a marathon .c. Antihypertensive medications he was recently prescribed. d. Over-the-counter medications he's been taking to treat cold symptoms.

d. OTC cold medsOver-the-counter medications such as antihistamines and decongestants can exacerbate the symptoms of BPH because they contain alpha adrenergic agents or have anticholinergic effects. Antihypertensives do not affect BPH. Increased sexual activity and exercise will not aggravate symptoms of BPH.

a 76 y o with benign prostatic hyperplasia is agitated and confused, with a markedly distended bladder. which intervention prescribed by the HCP should the nurse implement first? a. insert a urinary retention catheter b. schedule an Intravenous pyelogram (IVP) c. draw blood for a serum creatinine level d. administer lorazepam 0.5 mg po

the patients hx and mainfestations are consistent with acute urinary retention and priority action is to relieve the retention by catherization. the BUN and creatinine measurements can be obtained after the catheter is inserted. pt agitation may resolve once the bladder distention is corrected