BPH, Prostate Cancer
The nurse is assessing a client who had a transurethral resection of the prostate (TURP) six hours ago. He has a urinary catheter with continuous bladder irrigation running. What nursing observations would indicate a complication is developing? A) Catheter drainage and 50 ML in the past hour and increase in suprapubic pain B) Dark, grossly body catheter drainage with pieces of tissue C) Client states that he feels like he needs to void D) Moderate amount of bloody discharge from around the catheter
A) Catheter drainage and 50 ML in the past hour and increase in suprapubic pain The primary complication is the obstruction of the urinary catheter with clots or tissue. There should be a large amount of drainage from the catheter because the irrigating fluid is infusing into the bladder. The catheter drainage should be closer to 300 to 400 mL/hour. It is not unusual for the drainage to be grossly bloody on the operative day, but it should begin to clear over the next 24 hours. It is common to have a feeling of needing to void with a catheter in place.
A nurse is teaching a 53-year old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A) Have a digital rectal examination and prostate specific antigen (PSA) test done yearly. B) Have a transrectal ultrasound done every 5 years. C) Perform monthly testicular self-examinations, especially after age 60. D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.
A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.
An older adult client is having an annual physical exam at a provider's office. Which of the following client findings indicates additional follow up is needed in regard to the prostate gland? (Select all that apply.) A) PSA is 4.2 ng/mL. B) DRE reveals an enlarged and nodular prostate. C) The client reports a weak urine stream. D) The client reports urinating once during the night. E) Smegma is present below the glans of the penis.
A, B, C. Follow up is indicated for this client because his PSA is above 4.0 ng/mL and he reports a weak urine stream. An enlarged and nodular prostate is a possible indication of prostate cancer and requires further evaluation. Urinating once during the night is common in older adults due to redistribution of blood that may have been trapped in lower extremities during the day. Smegma is a normal secretion that can accumulate beneath the glans of the penis if not removed during hygiene.
The patient who underwent prostate cancer surgery is approaching the time of discharge from the hospital. What instruction should the nurse provide to this client as part of discharge teaching? Select all that apply. A) "Maintain a high fluid intake after you go home." B) "Call the healthcare provider immediately if you notice blood in your urine." C) "You may drive yourself home." D) "Avoid strenuous activity for 4-8 weeks." E) "Avoid heavy lifting for 2-4 weeks."
A, D Continued increased fluid intake will help the urine to remain dilute and reduce the risk of clot formation, The healing period after prostate surgery is 4-8 weeks, and the patient should avoid strenuous activity during this period. Blood in the urine is fairly common after surgery but only needs to be reported if it increases in amount instead of decreasing. The patient should not drive for 2 weeks, except for short rides. The client should avoid heavy lifting for 4-8 weeks after surgery while healing continues.
The nurse is teaching a client with benign prostatic hyperplasia (BPH). What statement indicates the client needs further information? a. "There should be no problem with drinking wine with dinner each night." b. "I am so glad that I weaned myself off of coffee about a year ago." c. "I need to inform my allergist that I cannot take my normal antihistamine." d. "My routine of drinking a quart (liter) of water first thing in the morning needs to change."
Answer: A Caffeine and alcohol have diuretic effects and so the nurse would teach about avoiding or limiting their intake. The statement about drinking wine indicates a need for further instruction. Antihistamines can cause urinary retention. Clients are taught to avoid drinking large quantities of fluid at one time.
The nurse is conducting a history on a male client to determine the severity of symptoms associated with prostate enlargement. Which finding is cause for prompt action by the nurse? a. Hematuria b. Urinary hesitancy c. Postvoid dribbling d. Weak urinary stream
Answer: A Hematuria, especially at the start or end of the urine stream, could indicate infection due to possible urine retention and would cause the nurse to act promptly. Common symptoms of benign prostatic hyperplasia are urinary hesitancy, postvoid dribbling, and a weak urinary stream due to the enlarged prostate causing bladder outlet obstruction.
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: A Rationale: 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: A Rationale: 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: A Rationale: 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 symptomatic BPH is scheduled for visual laser ablation of the prostate (VLAP) at an outpatient surgical center. The nurse will plan to teach the patient: a. how to care for an indwelling urinary catheter. b. that the urine will appear bloody for several days. c. to expect an immediate improvement in urinary force. d. that an intraprostatic urethral stent will be placed.
Answer: A Rationale: The patient will have indwelling catheter for up to a week and will need to be instructed on catheter care to avoid problems such as infection. There is minimal bleeding with this procedure. It will take several weeks before the full benefits of the procedure take effect. Stent placement is not included in the procedure.
A new nurse care for several client after radical prostatectomies for prostate cancer. What action by the nurse indicates a need to review care measures for this type of client? a. Delegates emptying and recording contents of the drainage devices. b. Administers a suppository to the client who reports constipation. c. Removes the sequential compression stockings on ambulatory clients. d. Discusses long-term complications such as erectile dysfunction.
Answer: B After a radical prostatectomy, the nurse would not provide a rectal suppository for constipation. All rectal treatments are contraindicated. The nurse would delegate emptying and recording drainage, remove the sequential pressure devices when clients begin ambulating, and discuss long-term complications of the operation.
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.
Leuprolide (Lupron) and bicalutamide (Casodex) are prescribed for a patient with cancer of the prostate. In teaching the patient about these drugs, the nurse informs the patient that side effects may include: a. low blood pressure. b. decreased sexual drive. c. urinary incontinence. d. frequent infections.
Answer: B Rationale: Hormonal therapy blocks the effects of testosterone and decreases libido. Hypotension is associated with the α-blockers used for BPH. Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy.
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.
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: B Rationale: 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 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 client has returned from a transurethral resection of the prostate with a continuous bladder irrigation. Five hours after the operation, the nurse notes the drainage is bright red with clots. What action should the nurse take first? a. Review the most recent hemoglobin and hematocrit. b. Take vital signs and begin immediate irrigation with sterile water. c. Notify the primary health care provider immediately. d. Remind the client not to pull on the catheter.
Answer: C Bright red urinary drainage with clots may indicate arterial bleeding. The nurse would notify the primary health care provider immediately and begin irritating the catheter with sterile normal saline (not sterile water). The nurse can delegate the vital signs. The nurse would review hemoglobin and hematocrit and would remind the client not to pull on the catheter for all clients with bladder irrigation. But for this client who may be bleeding the nurse would take further action to address the problem.
A nurse is providing education to a new 55-year-old African-American client about screening for prostate cancer. What action by the nurse is most appropriate? a. Inform the client that recommendations vary, so screening is a personal choice. b. Let the client know that as an African American, he should be screened annually. c. Teach the client that he is in a high risk group and should discuss screening. d. Give the client written information that discourages screening until age 70.
Answer: C Clients in certain high risk groups should discuss screening for prostate cancer with their primary health care providers at age 45. High risk groups include African Americans and men with a first-degree relative who was diagnosed with prostate cancer before the age of 65. This new client will be encouraged to discuss screening even though he is past the age of initial discussion. Recommendations do vary somewhat, but he is in a recognized high risk group. The nurse would not say that he should be screened annually. Screening is not recommended for men over the age of 70.
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: C Rationale: 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.
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
Answer: C Rationale: 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.
The nurse will teach the patient with chronic bacterial prostatitis that: a. PSA elevation indicates that he has concurrent prostate cancer. b. Nonsteroidal antiinflammatory drugs (NSAIDs) usually provide adequate pain control. c. sexual intercourse and masturbation will relieve symptoms. d. antibiotics should be taken for 7 to 10 days.
Answer: C Rationale: Ejaculation helps drain the prostate and relieve pain. PSA elevation may be due to the prostatitis. NSAIDs are prescribed, but are often inadequate to control pain. Antibiotics should be continued for 4 to 16 weeks.
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. Cognitive Level: Application Text Reference: p. 1416 Nursing Process: Planning NCLEX: Physiological Integrity
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.
Answer: C Rationale: 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.
A 64-year-old man undergoes a perineal radical prostatectomy for stage C prostatic cancer. Postoperatively, the nurse establishes the nursing diagnosis of risk for infection related to: a. urinary stasis. b. urinary incontinence. c. possible fecal contamination of the surgical wound. d. placement of a suprapubic catheter into the bladder.
Answer: C Rationale: The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery.
A client is diagnosed with benign prostatic hyperplasia and seems sad and irritable. After assessing the client's behavior, which statement by the nurse would be the most appropriate? a. The urine incontinence should not prevent you from socializing.• b. You seem depressed and should seek more pleasant things to do.• c. It is common for men at your age to have changes in mood.• d. Nocturia could cause interruption of your sleep and cause changes in mood.
Answer: D Frequent visits to the bathroom during the night could cause sleep interruptions and affect the client's mood and mental status. Telling the client his symptoms should not lead to less socialization is patronizing. Instructing the client to seek more pleasant things to do also is patronizing. Neither statement has any information the client could find useful. The statement about age has no validity and again does not offer useful information.
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.
Answer: D Rationale: PSA levels are usually elevated above the normal in patients with prostate cancer. PSA testing does not determine whether metastasis has occurred. A biopsy of the prostate is needed for a definitive diagnosis of prostate cancer. Success of treatment is determined by a fall in PSA to an undetectable level; the patient's baseline PSA is not needed to determine the success of treatment.
The nurse working in a health clinic receives calls from all these patients. Which patient should be seen by the doctor first? a. A 23-year-old man who states he had difficulty maintaining an erection last night b. A 44-year-old man who has perineal pain and a temperature of 100.4° F c. A 62-year-old man who has light pink urine after having a TURP 3 days ago d. A 66-year-old man who has a painful erection that has lasted over 9 hours
Answer: D Rationale: Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications.
A patient undergoing a TURP returns from surgery with a three-way urinary catheter with continuous bladder irrigation in place. The nurse observes that the urine output has decreased and the urine is clear red with multiple clots. The patient is complaining of painful bladder spasms. The most appropriate action by the nurse is to: a. administer the ordered IV morphine sulfate, 4 mg. b. increase the flow rate of the continuous bladder irrigation. c. give the ordered the belladonna and opium suppository. d. manually instill 50 ml of saline and try to remove the clots.
Answer: D Rationale: The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.
Select all that apply: A client is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? a. First-degree relative with prostate cancer b. Smoking c. Obesity d. Advanced age e. Eating too much red meat f. Race
Answers: A, D, E, F Risk factors for prostate cancer include having a first-degree relative with the disease, advanced age, and African-American race. Smoking, obesity, and eating too much red meat are not considered risk factors. Research is exploring the relationship with diet.
The nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the laboratory results of these patients. Which patient's PSA result is most important to report to the health care provider? a. A 38-year-old who is being treated for acute prostatitis b. A 48-year-old whose father died of metastatic prostate cancer c. A 52-year-old who goes on long bicycle rides every weekend d. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH)
B A 48-year-old whose father died of metastatic prostate cancer The family history of prostate cancer and elevation of PSA indicate that further evaluation of the patient for prostate cancer is needed. Elevations in PSA for the other patients are not unusual.
A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurses response? A) Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B) All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C) Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D) Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.
B. All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.
A 51-year-old man is scheduled for an annual physical exam at the outpatient clinic. The nurse will plan to teach the patient about the purpose of a. urinalysis collection. b. uroflowmetry studies. c. prostate specific antigen (PSA) testing. d. transrectal ultrasound scanning (TRUS).
C. prostate specific antigen (PSA) testing. An annual digital rectal exam (DRE) and PSA are recommended starting at age 50 for men who have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA are abnormal.
A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family? A.The patient should not be in contact with the baby after delivery. B. The patients treatment poses no risk to his daughter or her infant. C. The patients brachytherapy may be contraindicated for safety reasons. D. The patient should avoid close contact with his daughter for 2 months.
D. The patient should avoid close contact with his daughter for 2 months. Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient returns home after the procedure. Exposure of others to radiation is minimal, but the patient should avoid close contact with pregnant women and infants for up to 2 months.
A nurse is providing a program for older men in a senior community about measures that can be taken to reduce the risk for prostate cancer. Which of the following would the nurse include in the program? a. Decrease red meat and fat intake. b. Decrease lycopene intake. c. Increase fiber intake. d. Avoid foods high in sodium.
a. red meat and fat Some studies have shown an increase of prostate cancer in societies with diets high in red meats and fats. The other options have not been shown to impact the incidence of prostate cancer.