Chapter 54: Lewis Med/Surg Study Guide

What accurately describes prostate cancer detection and/or treatment (select all that apply)? a. The symptoms of pelvic or perineal pain, fatigue, and malaise may be present. b. Palpation of the prostate reveals hard and asymmetric enlargement with areas of induration or nodules. c. Orchiectomy is a treatment option for all patients with prostatic cancer except those with stage IV tumors. d. The preferred hormonal therapy for treatment of prostate cancer includes estrogen and androgen receptor blockers. e. Early detection of cancer of the prostate is increased with annual rectal examinations and serum prostatic acid phosphatase (PAP) measurements. f. An annual prostate examination is recommended starting at age 45 for African American men with a first-degree relative with prostate cancer at an early age.

a, b, f. Pelvic or perineal pain, fatigue, malaise, and a hard, asymmetric, enlarged prostate may be present with prostate cancer. Annual prostate examination is recommended starting at a younger age for African American men because of increased diagnosis and mortality from prostate cancer in this ethnic group. An orchiectomy may be done with prostatectomy or for metastatic stages of prostate cancer. Hormonal treatment includes androgen deprivation therapy, luteinizing hormone-releasing hormone agonists, and androgen receptor blockers. Early detection of prostate cancer is best detected with annual rectal exams and serum PSA. Elevated prostatic acid phosphatase (PAP) will be seen with metastasis, not a new diagnosis.

A patient is seeking medical intervention for erectile dysfunction (ED). Why should he be thoroughly evaluated? a. It is important to determine if ED is reversible before treatment is started. b. Psychologic counseling can reverse the problem in 80% to 90% of the cases. c. Most treatments for ED are contraindicated in patients with systemic diseases. d. New invasive and experimental techniques currently used have unknown risks.

a. Before treatment for ED is initiated, reversibility must be determined so that appropriate treatment can be planned. The actual cause may be determined, but this is more expensive. Only a small percentage of ED is caused by psychologic factors. In the case of the 80% to 90% of ED that is of physiologic causes, interventions are directed at correcting or eliminating the cause or restoring function by medical means. Patients with systemic diseases can be treated medically if the cause cannot be eliminated. New invasive or experimental treatments are not widely used and should be limited to research centers.

What is the effect of finasteride (Proscar) in the treatment of BPH? a. A reduction in the size of the prostate gland b. Relaxation of the smooth muscle of the urethra c. Increased bladder tone that promotes bladder emptying d. Relaxation of the bladder detrusor muscle promoting urine flow

a. Finasteride results in suppression of dihydroxytestosterone (DHT) formation, which reduces the size of the prostate gland. Drugs affecting bladder tone are not indicated. α-Adrenergic receptor blockers are used to cause smooth muscle relaxation in the prostate, which improves urine flow.

A 47-yr-old patient who is experiencing hypogonadism has decided to try the testosterone gel Testim. What should the nurse teach the patient and his wife about this gel? a. Wash the hands with soap and water after applying it. b. His wife should apply it to help him feel better about using it. c. Do not wear clothing over the area until it has been absorbed. d. The gel may be taken buccally if it is not effective on the abdomen.

a. The gel may spread the testosterone to others if it is not washed off of his hands after application. If his wife applies the gel, she should wear gloves to prevent absorption of the testosterone and its effects on her body. Clothing over the area until it has dried is recommended. The gel is only topical; a buccal testosterone tablet is called Striant.

The extent of urinary obstruction caused by BPH can be determined by which diagnostic study? a. Uroflowmetry b. A cystometrogram c. Transrectal ultrasound d. Postvoiding catheterization

a. Uroflowmetry is used to measure the volume of urine expelled from the bladder to determine the extent of urethral blockage. Cystourethroscopy may also evaluate the degree of obstruction, but a cystometrogram measures bladder tone. A transrectal ultrasound may determine the size and configuration of the prostate gland. Postvoiding catheterization measures residual urine.

Which therapies for BPH are done on an outpatient basis (select all that apply)? a. Intraprostatic urethral stents b. Transurethral needle ablation (TUNA) c. Photovaporization of the prostate (PVP) d. Transurethral incision of prostate (TUIP) e. Transurethral microwave therapy (TUMT)

b, d, e. TUNA, TUIP, and TUMT are currently done on an outpatient basis or in a HCP's office

The nurse provides discharge teaching to a patient following a TURP and determines that the patient understands the instructions when he makes which statement? a. "I should use daily enemas to avoid straining until healing is complete." b. "I will avoid heavy lifting, climbing, and driving until my follow-up visit." c. "At least I don't have to worry about developing cancer of the prostate now." d. "Every day I should drink 10 to 12 glasses of liquids such as coffee, tea, or soft drinks."

b. Activities that increase intraabdominal pressure should be avoided until the surgeon approves these activities at a follow-up visit. Stool softeners and high-fiber diets may be used to promote bowel elimination, but enemas should not be used because they increase intraabdominal pressure and may initiate bleeding. Because TURP does not remove the entire prostate gland, the patient needs annual prostatic examinations to screen for cancer of the prostate. Fluid intake should be high, but caffeine and alcohol should not be used because they have a diuretic effect and increase bladder distention.

Before undergoing a TURP, what should the patient be taught? a. Some degree of urinary incontinence is likely to occur. b. This surgery results in some degree of retrograde ejaculation. c. Erectile dysfunction is a common complication of this prostate surgery. d. An indwelling catheter will be used to maintain urinary output until healing is complete.

b. Because of injury to the internal urinary sphincter, there is usually some degree of retrograde ejaculation following most transurethral surgeries, especially following TURP. Some semen travels back with ejaculation into the bladder and is eliminated with the next voiding. Urinary incontinence, erectile dysfunction, and continued catheterization are uncommon following TURP.

A patient with continuous bladder irrigation following a prostatectomy tells the nurse that he has bladder spasms and leaking of urine around the catheter. What should the nurse do first? a. Slow the rate of the irrigation. b. Assess the patency of the catheter. c. Encourage the patient to try to urinate around the catheter. d. Administer a belladonna and opium (B&O) suppository as prescribed.

b. The nurse should first check for the presence of clots obstructing the catheter or tubing and remove them by irrigation. Then a belladonna and opium (B&O) suppository is administered, if one is ordered. The flow rate of the irrigation fluid may be decreased if orders permit because fast-flowing, cold fluid may also contribute to spasms. The patient should not try to void around the catheter because this will increase the spasms.

Which treatment for BPH uses a low-wave radiofrequency to precisely destroy prostate tissue? a. Laser prostatectomy b. Transurethral needle ablation (TUNA) c. Transurethral microwave thermotherapy (TUMT) d. Transurethral electrovaporization of prostate (TUVP)

b. The transurethral needle ablation (TUNA) uses low-wave radiofrequency to heat the prostate, causing necrosis. Laser prostatectomy uses a laser beam. Transurethral microwave thermotherapy (TUMT) uses microwave radiating heat to produce coagulative necrosis of the prostate and is not used for men with rectal problems. Transurethral electrovaporization of prostate (TUVP) uses electrosurgical vaporization and desiccation to destroy prostate tissue.

Serum tumor markers that may be elevated on diagnosis of testicular cancer and used to monitor the response to therapy include: a. tumor necrosis factor (TNF) and C-reactive protein (CRP). b. α-fetoprotein (AFP) and human chorionic gonadotropin (hCG). c. prostate-specific antigen (PSA) and prostate acid phosphatase (PAP). d. carcinoembryonic antigen (CEA), antinuclear antibody (ANA) and HER-2.

b. α-Fetoprotein (AFP) and human chorionic gonadotropin (hCG) are glycoproteins that may be elevated in testicular cancer. If they are elevated before surgical treatment, the levels are noted, and if response to therapy is positive, the levels will decrease. Lactate dehydrogenase (LDH) may also be elevated. Tumor necrosis factor (TNF) is a normal cytokine responsible for tumor surveillance and destruction. C-reactive protein (CRP) is found in inflammatory conditions and widespread malignancies. PSA and PAP are used for screening of prostatic cancer. Carcinoembryonic antigen (CEA) is a tumor marker for cancers of the GI system. Antinuclear antibody (ANA) is found most frequently in autoimmune disorders. HER-2 is used as a marker in breast cancer.

When caring for a patient following a radical prostatectomy with a perineal approach, what is the priority nursing intervention the nurse should use to prevent complications? a. Use chemotherapy to prevent metastasis. b. Administer sildenafil (Viagra) as needed for erectile dysfunction. c. Provide wound care after each bowel movement to prevent infection. d. Insert a smaller indwelling urinary catheter to prevent urinary retention

c. A prostatectomy performed with a perineal approach has a high risk for infection because of the proximity of the wound to the anus, so wound care is the priority. Chemotherapy is usually not the first choice of drug therapy following surgery, nor is sildenafil. The catheter size would not be changed but the catheter would be removed. Urinary incontinence is a bigger problem than retention

On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need to know what? a. The effects of general anesthesia b. The possibility of short-term incontinence c. Home management of an indwelling catheter d. Monitoring for postoperative urinary retention

c. Because of edema, urinary retention, and delayed sloughing of tissue that occurs with a laser prostatectomy, the patient will have a postprocedure urinary catheter for up to 7 days. The procedure is done under local anesthetic, and incontinence or urinary retention is not usually a problem with laser prostatectomy.

When taking a nursing history from a patient with BPH, the nurse would expect the patient to report: a. nocturia, dysuria, and bladder spasms. b. urinary frequency, hematuria, and perineal pain. c. urinary hesitancy, postvoid dribbling, and weak urinary stream. d. urinary urgency with a forceful urinary stream and cloudy urine.

c. Classic symptoms of uncomplicated BPH are those associated with irritative symptoms, including nocturia, frequency, urgency, dysuria, bladder pain, and incontinence associated with inflammation or infection. Obstructive symptoms caused by prostate enlargement include diminished caliber and force of the urinary stream, hesitancy or difficulty initiating voiding, intermittent urination, dribbling at the end of urination, and a feeling of incomplete bladder emptying because of urinary retention. Bladder spasms, hematuria, perineal pain, and cloudy urine do not occur with BPH.

What describes hypospadias? a. Scrotal lymphedema b. Undescended testicle c. Ventral urinary meatus d. Inflammation of the prepuce

c. Hypospadias is the urethral meatus located on the ventral surface of the penis. Scrotal lymphedema is called a hydrocele. An undescended testicle is cryptorchidism. Inflammation of the prepuce or foreskin is called phimosis.

A 55-yr-old man with a history of prostate cancer in his family asks the nurse what he can do to decrease his risk of prostate cancer. What should the nurse teach him about prostate cancer risks? a. Nothing can decrease the risk because prostate cancer is primarily a disease of aging. b. Treatment of any enlargement of the prostate gland will help to prevent prostate cancer. c. Substituting fresh fruits and vegetables for high-fat foods in the diet may lower the risk of prostate cancer. d. Using a natural herb, such as saw palmetto, has been found to be an effective protection against prostate cancer.

c. Most prostate cancers (about 75%) are considered sporadic. About the only modifiable risk factor for prostate cancer is its association with a diet high in red and processed meat and high-fat dairy products along with a low intake of vegetables and fruits. Age, ethnicity, and family history are risk factors for prostate cancer but are not modifiable. Environment may also play a role. Simple enlargement or hyperplasia of the prostate is not a risk factor for prostate cancer. There is no evidence that saw palmetto is more effective than a placebo.

The nurse should teach the patient having a vasectomy that what occurs after the procedure? a. The amount of ejaculate will be noticeably decreased. b. He may have difficulty maintaining an erection for several months. c. An alternative form of contraception must be used for 6 to 8 weeks. d. The testes will gradually decrease production of sperm and testosterone.

c. Until sperm distal to the anastomotic site is ejaculated or absorbed by the body, the semen will contain sperm and alternative contraceptive methods must be used. When a postoperative semen examination reveals no sperm, the patient is considered sterile. Following vasectomy, there is rarely noticeable difference in the amount of ejaculate because ejaculate is primarily seminal and prostatic fluid. Vasectomy does not cause erectile dysfunction (ED), nor does it affect testicular production of sperm or hormones.

Following a TURP, a patient has continuous bladder irrigation. Four hours after surgery, the catheter is draining thick, bright red clots and tissue. What should the nurse do? a. Release the traction on the catheter. b. Clamp the drainage tube and notify the patient's HCP. c. Manually irrigate the catheter until the drainage is clear. d. Increase the rate of the irrigation and take the patient's vital signs.

d. Bleeding and blood clots from the bladder are expected after a TURP, and continuous irrigation is used to keep clots from obstructing the urinary tract. The rate of the irrigation may be titrated to keep the clots from forming, if ordered, but the nurse should also check the vital signs because hemorrhage is the most common complication of prostatectomy. The traction on the catheter applies pressure to the operative site to control bleeding and should be relieved on schedule. The catheter will be manually irrigated only to release a blockage. Clamping the drainage tube is contraindicated because it would distend the bladder.

What differentiates chronic bacterial prostatitis from acute prostatitis? a. Postejaculatory pain b. Frequency, urgency, and dysuria c. Symptoms of a urinary tract infection (UTI) d. Most common reason for recurrent UTIs in adult men

d. Chronic bacterial prostatitis commonly causes UTIs in adult men and recurs frequently. The other options are true of both chronic and acute prostatitis, although not as severe with chronic.

A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. The best response by the nurse includes what information about BPH? a. BPH is a benign tumor that does not spread beyond the prostate gland. b. BPH is a precursor to prostate cancer but does not yet show any malignant changes. c. BPH is an enlargement of the gland caused by an increase in the size of existing cells. d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells.

d. Hyperplasia is an increase in the number of cells and in benign prostatic hyperplasia (BPH), it is thought that the enlargement caused by the increase in new cells results from hormonal changes associated with aging. The hyperplasia is not considered a tumor, nor has BPH been proven to predispose to cancer of the prostate. Hypertrophy refers to an increase in the size of existing cells

A 66-yr-old male patient is experiencing ED. He and his wife have used tadalafil (Cialis), but because he experienced priapism they have decided to change their treatment option to an intraurethral device. How should the nurse explain how this device works? a. The device relaxes smooth muscle in the penis. b. Blood is drawn into corporeal bodies and held with a ring. c. The device is implanted into corporeal bodies to firm the penis. d. The device directly applies drugs that increase blood flow in the penis.

d. Intraurethral devices include the use of vasoactive drugs administered as a topical gel or medication pellet (alprostadil) inserted into the urethra (intraurethral) using a medicated urethral system for erection (MUSE) device, or an injection into the penis (intracavernosal self-injection). The vasoactive drugs enhance blood flow into the penile arteries for erection. Erectogenic drugs (e.g., tadalafil [Cialis]) cause smooth muscle relaxation and increase blood flow to promote an erection. Blood drawn into corporeal bodies and held with a ring is achieved with a vacuum constriction device (VCD). Devices implanted into corporeal bodies to firm the penis are penile implants. Androgen or testosterone replacement therapy may also be used for erectile dysfunction.

What is an explanation that the nurse should give to the wife of the patient who asks what her husband's diagnosis of paraphimosis means? a. Painful, prolonged erection b. Inflammation of the epididymis c. Painful downward curvature of an erect penis d. Retracted tight foreskin preventing return over the glan

d. Paraphimosis is tightness of the foreskin and the inability to pull it forward from a retracted position to return it over the glans. It is usually associated with leaving the foreskin pulled back during a bath, use of a urinary catheter, or intercourse. Painful, prolonged erection is priapism. Epididymitis is inflammation of the epididymis. A painful downward curvature of an erect penis is chordee.

The cremasteric reflex is absent in which problem of the scrotum and testes? a. Hydrocele b. Varicocele c. Spermatocele d. Testicular torsion

d. The cremasteric reflex is elicited by light stroking of the inner aspect of the thigh in a downward direction with a tongue blade. In testicular torsion, or a twisted spermatic cord that supplies blood to the testes and epididymis, this reflex is absent on the swollen side. Hydrocele is scrotal lymphedema from interference with lymphatic drainage of the scrotum. Varicocele is dilation of the veins that drain the testes. Spermatocele is a sperm-containing cyst of the epididymis

What is the most common screening intervention for detecting BPH in men over age 50? a. PSA level b. Urinalysis c. Cystoscopy d. Digital rectal examination

d. The prostate gland can be easily palpated by rectal examination, and enlargement of the gland is detected early if yearly examinations are performed. If symptoms of prostatic hyperplasia are present, further diagnostic testing, including prostate-specific antigen (PSA), a urinalysis, and cystoscopy may be indicated.

A couple has not been able to become pregnant. The wife has not been diagnosed with any infertility problems. Which treatment will the nurse expect to teach the couple about if the problem is the most common testicular problem causing male infertility? a. Antibiotics b. Semen analysis c. Avoidance of scrotal heat d. Surgery to correct the problem

d. Varicocele is the most common testicular cause of infertility. Surgical ligation of the spermatic vein is done to correct the problem. Antibiotics are used if there is an infection, but this is not as common as a varicocele. Semen analysis is the first study done when investigating male infertility, but it is not a treatment. Avoidance of scrotal heat is a lifestyle change that may be used with idiopathic infertility.

Which characteristics describe transurethral resection of the prostate (TURP) (select all that apply)? a. Best used for a very large prostate gland b. Inappropriate for men with rectal problems c. Involves an external incision prostatectomy d. Uses transurethral incision into the prostate e. Most common surgical procedure to treat BPH f. Resectoscopic excision and cauterization of prostate tissue

e, f. The transurethral resection of the prostate (TURP) is the most common surgical procedure to treat BPH and uses a resectoscopic excision and cauterization of prostate tissue. Photovaporization of the prostate (PVP) or a simple open prostatectomy may be used for a very large prostate and has an external incision. TUMT is not approved for men with rectal problems. Transurethral incision into the prostate to expand the urethra for a small to moderate-sized prostate is done with a transurethral incision of the prostate (TUIP).