Prostate Cancer and BPH

The nurse taking a focused health history for a patient with possible testicular cancer will ask the patient about a history of 1. Testicular torsion. 2. Testicular trauma. 3. Undescended testicles. 4. Sexually transmitted infection (STI).

3. R: Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STI, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer.

The nurse teaches a 30-year-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? 1. Grilled steak, French fries, and vanilla shake 2. Hamburger with cheese, pudding, and coffee 3. Baked chicken, peas, apple slices, and skim milk 4. Grilled cheese sandwich, onion rings, and hot tea

1. R: A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

A client with benign prostatic hypertrophy (BPH) is being treated with terazosin (Hytrin) 2 mg at bedtime. The nurse should monitor the client's: 1. Urine nitrites. 2. White blood cell count. 3. Blood pressure. 4. Pulse.

3. Terazosin is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or orthostatic hypotension. The client should be instructed to change positions slowly. Urine nitrates, white blood cell count, and pulse rate are not affected by terazosin.

Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first? 1. 22-year-old who has noticed a firm, nontender lump on his scrotum 2. "feels like a bag of worms" 3. 40-year-old who has pelvic pain while being treated for chronic prostatitis 4. 70-year-old who is reporting frequent urinary dribbling after a prostatectomy

A. R: The patient's age and symptoms suggest possible testicular cancer. Some forms of testicular cancer can be very aggressive, so the patient should be evaluated by the health care provider as soon as possible. Varicoceles do require treatment, but not emergently. Ongoing pelvic pain is common with chronic prostatitis. Urinary dribbling is a common problem after prostatectomy.

A 33-year-old patient noticed a painless lump in his scrotum on self-examination of his testicles and a feeling of heaviness. The nurse should first teach him about what diagnostic test? 1. Ultrasound 2. Cremasteric reflex 3. Doppler ultrasound 4. Transillumination with a flashlight

A. When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.

The nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find which of the following as the "classic triad" of presenting symptoms occurring in patients with renal cancer? a. Fever, chills, flank pain b. Hematuria, flank pain, palpable mass c. Hematuria, proteinuria, palpable mass d. Flank pain, palpable abdominal mass, and proteinuria

B. Rationale: There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.

An elderly 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 which of the following factors that may dispose him to urinary tract infections (UTIs)? a. High-purine diet b. Sedentary lifestyle c. Benign prostatic hyperplasia (BPH) d. Recent use of broad-spectrum antibiotics

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 is teaching a male client to perform monthly testicular self-examinations. Which of the following points would be appropriate to make? 1. Testicular cancer is a highly curable type of cancer. 2. Testicular cancer is very difficult to diagnose. 3. Testicular cancer is the number one cause of cancer deaths in males. 4. Testicular cancer is more common in older men

1. R: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in younger men.

What should a male client over age 52 do to help ensure early identification of prostate cancer? 1. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. 2. Have a transrectal ultrasound every 5 years. 3. Perform monthly testicular self-examinations, especially after age 50. 4. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels checked yearly.

1. R: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and 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, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastases

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? 1. A 38-year-old who is being treated for acute prostatitis 2. A 48-year-old whose father died of metastatic prostate cancer 3. A 52-year-old who goes on long bicycle rides every weekend 4. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH)

2. R: 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.

The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer? 1. A 30-year-old white male with a history of cryptorchidism 2. A 48-year-old African American male with erectile dysfunction 3. A 19-year-old Asian male who had surgery for testicular torsion 4.A 28-year-old Hispanic male with infertility caused by a varicocele

1. R:The incidence of testicular cancer is four times higher in white males than in African American males. Testicular tumors are also more common in males who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to DES, and testicular cancer in the contralateral testis.

A community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following is a sign of testicular cancer? 1. Alopecia 2. Back pain 3. Painless testicular swelling 4. Heavy sensation in the scrotum

1. R: Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. Options B, C, and D are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.

A 65-year-old client has been told by the physician that his prostate cancer was graded at stage IIB. The client inquires if this means he is going to die soon. The best response by the nurse is which of the following? 1. "Prostate cancer at this stage is very slow growing." 2. "Prostate cancer at this stage is very fast growing." 3. "Prostate cancer at this stage has spread to the bone." 4. "Prostate cancer at this stage is difficult to predict."

1. R: Clients who have stage IA or IIB prostate cancer have an excellent survival rate. Prostate cancer is usually slow growing, and many men who have prostate cancer do not die from it. A stage I or II tumor is confined to the prostate gland and has not spread to the extrapelvic region or bone.

The nurse is performing a digital rectal examination. Which of the following findings is a key sign for prostate cancer? 1. A hard prostate, localized or diffuse. 2. Abdominal pain. 3. A boggy, tender prostate. 4. A nonindurated prostate.

1. R: On digital rectal examination, key signs of prostate cancer are a hard prostate, induration of the prostate, and an irregular, hard nodule. Accompanying symptoms of prostate cancer can include constipation, weight loss, and lymph- adenopathy. Abdominal pain usually does not accompany prostate cancer. A boggy, tender prostate is found with infection (eg, acute or chronic prostatitis)

An adult male client has been unable to void for the past 12 hours. The best method for the nurse to use when assessing for bladder distention in a male client is to check for: 1. A rounded swelling above the pubis. 2. Dullness in the lower left quadrant. 3. Rebound tenderness below the symphysis. 4. Urine discharge from the urethral meatus.

1. R: The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. This swelling represents the distended bladder rising above the pubis into the abdominal cavity. Dullness does not indicate a distended bladder. The client might experience tenderness or pressure above the symphysis. No urine discharge is expected; the urine flow is blocked by the enlarged prostate.

A 27-year-old man who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is best for the nurse to take? 1. Teach the patient and the wife that impotence is unlikely after unilateral orchiectomy. 2. Ask the patient if he has any questions or concerns about the diagnosis and treatment. 3. Document the patient's lack of communication on the chart and continue preoperative care. 4. Inform the patient's wife that concerns about sexual function are common with this diagnosis.

2. R: The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer teaching about complications after orchiectomy. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.

In discussing home care with a client after transurethral resection of the prostate (TURP), the nurse should teach the male client that dribbling of urine: 1. Can be a chronic problem. 2. Can persist for several months. 3. Is an abnormal sign that requires intervention. 4. Is a sign of healing within the prostate.

2. Dribbling of urine can occur for several months after TURP. The client should be informed that this is expected and is not an abnormal sign. The nurse should teach the client perineal exercises to strengthen sphincter tone. The client may need to use pads for temporary incontinence. The client should be reassured that continence will return in a few months and will not be a chronic problem. Dribbling is not a sign of healing, but is related to the trauma of surgery.

Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the patient understands the purpose of a biopsy? 1. "The biopsy will tell the doctor whether the cancer has spread to my other organs." 2. "The biopsy will help the doctor decide what treatment to use for my enlarged prostate." 3. "The biopsy will determine how much longer I have to live." 4. "The biopsy will indicate the effect of the cancer on my life."

2. R: A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. Biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life; the three remaining statements indicate a need for patient teaching.

A client with prostate cancer is treated with hormone therapy consisting of diethylstilbestrol 2 mg daily. The nurse should instruct the client to expect to have: 1. Tenderness of the scrotum. 2. Tenderness of the breasts. 3. Loss of pubic hair. 4. Decreased blood pressure.

2. R: Diethylstilbestrol causes engorgement and tenderness of the breasts (gynecomastia). Stilbestrol is prescribed as palliative therapy for men with androgendependent prostatic carcinoma. An increase in blood pressure can occur. Tenderness of the scrotum and dramatic changes in secondary sexual characteristics should not occur.

The nurse should specifically assess a client with prostatic hypertrophy for which of the following? 1. Voiding at less frequent intervals. 2. Difficulty starting the flow of urine. 3. Painful urination. 4. Increased force of the urine stream.

2. Signs and symptoms of prostatic hypertrophy include difficulty starting the flow ofurine, urinary frequency and hesitancy, decreased force of the urine stream, interruptions inthe urine stream when voiding, and nocturia. The prostate gland surrounds the urethra, andthese symptoms are all attributed to obstruction of the urethra resulting from prostatic hypertrophy. Nocturia from incomplete emptying of the bladder is common. Straining and urine retention are usually the symptoms that prompt the client to seek care. Painful urination is generally not a symptom of prostatic hypertrophy.

Many older men with prostatic hypertrophy do not seek medical attention until urinary obstruction is almost complete. One reason for this delay in seeking attention is that these men may: 1. Feel too self-conscious to seek help when reproductive organs are involved. 2. Expect that it is normal to have to live with some urinary problems as they grow older. 3. Fear that sexual indiscretions in earlier life may be the cause of their problem. 4. Have little discomfort in relation to the amount of pathology because responses to pain stimuli fade with age.

2. Some older men tend to believe it is normal to live with urinary problems. As a result, these men often overlook symptoms and simply attribute them to aging. As part of preventive care for men older than age 40, the yearly physical examination should include palpation of the prostate via rectal examination. Prostate-specific antigen screening also is done annually to determine elevations or increasing trends in elevations. The nurse should teach male clients the value of early detection and adequate follow-up for the prostate.

A client is undergoing a total prostatectomy for prostate cancer. The client asks questions about his sexual function. The best response by the nurse is which of the following? "Loss of the prostate gland means that: 1. You will be impotent." 2. You will be infertile and there will be no ejaculation. You can still experience the sensations of orgasm." 3. You will have no loss of sexual function and drive." 4. Your erectile capability will return immediately after surgery."

2. Loss of the prostate gland interrupts the flow of semen, so there will be no ejaculation fluid. The sensations of orgasm remain intact. The client needs to be advised that return of erectile capability is often disrupted after surgery, but within 1 year 95% of men have returned to normal erectile function with sexual intercourse.

A client asks the nurse why the prostate- specific antigen (PSA) level is determined before the digital rectal examination. The nurse's best response is which of the following? 1. "It is easier for the client." 2. "A prostate examination can possibly decrease the PSA." 3. "A prostate examination can possibly increase the PSA." 4. "If the PSA is normal, the client will not have to undergo the rectal examination."

3. R: Manipulation of the prostate during the digital rectal examination may falsely increase the PSA levels. The PSA determination and the digital rectal examination are no longer recommended as screening tools for prostate cancer. Prostate cancer is the most common cancer in men and the second leading killer from cancer among men in the United States. Incidence increases sharply with age, and the disease is predominant in the 60- to 70- year-old age group.

A client with benign prostatic hypertrophy (BPH) has an elevated prostate-specific antigen (PSA) level. The nurse should: 1. Instruct the client to request having a colonoscopy before coming to conclusions about the PSA results. 2. Instruct the client that a urologist will monitor the PSA level biannually when elevated. 3. Determine if the prostatic palpation was done before or after the blood sample was drawn. 4. Ask the client if he emptied his bladder before the blood sample was obtained.

3. Rectal and prostate examinations can increase serum PSA levels; therefore, instruct the client that a manual rectal examination is usually part of the test regimen to determine prostate changes. The prostatic palpation should be done after the blood sample is drawn. The PSA level must be monitored more often than biannually when it is elevated. Having a colonoscopy is not related to the findings of the PSA test. It is not necessary to void prior to having PSA blood levels tested.

A client, who had a transurethral resection of the prostate (TURP), has a three-way indwelling urinary catheter with continuous bladder irrigation. In which of the following circumstances should the nurse increase the flow rate of the continuous bladder irrigation? 1. When drainage is continuous but slow. 2. When drainage appears cloudy and dark yellow. 3. When drainage becomes bright red. 4. When there is no drainage of urine and irrigating solution.

3. The decision by the surgeon to insert a catheter after TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so that clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindicated when there is no return of urine and irrigating solution.

A client visits the clinic to be screened for prostatic cancer. Which laboratory measure is used to screen for prostatic cancer? 1. Creatinine phosphokinase (CPK) 2. Aspartate aminotransferase (AST) 3. Blood urea nitrogen (BUN) 4. Prostate specific antigen (PSA)

4 Rationale:The screening test for prostatic cancer is a prostate specific antigen (PSA) test. Creatinine phosphokinase (CPK) measurement is performed to measure damage to muscles (i.e., myocardial damage). The aspartate aminotransferase (AST) lab test provides information about liver damage, and the BUN level is a measure of the ability of the kidneys to clear protein.

A client is scheduled to undergo transurethral resection of the prostate. The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should assess the client for: 1. Seizures. 2. Cardiac arrest. 3. Renal shutdown. 4. Respiratory paralysis.

4. If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Seizures, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.

The nurse is caring for a client who will have a bilateral orchiectomy. The client asks what is involved with this procedure. The nurse's most appropriate response would be? "The surgery: 1. Removes the entire prostate gland, prostatic capsule, and seminal vesicles." 2. Tends to cause urinary incontinence and impotence." 3. Freezes prostate tissue, killing cells." 4. Results in reduction of the major circulating androgen, testosterone.

4. R: Bilateral orchiectomy (removal of testes) results in reduction of the major circulating androgen, testosterone, as a palliative measure to reduce symptoms and progression of prostate cancer. A radical prostatectomy (removal of entire prostate gland, prostatic capsule, and seminal vesicles) may include pelvic lymphadenectomy. Complications include urinary incontinence, impotence, and rectal injury with the radical prostatectomy. Cryosurgery freezes prostate tissue, killing tumor cells without prostatectomy.

The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? 1. Duodenal ulcers 2. Hemorrhoids 3. Weight gain 4. Polyps

4. R: Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain is an indication of colorectal cancer.