Summer BPH Test 4

2 1 3 4 (Bladder spasms after a TURP are usually caused by the presence of clots that obstruct the catheter, so irrigation should be the first action taken. Administration of analgesics may help to reduce spasm. Administration of a bolus of IV fluids is commonly used in the immediate postoperative period to help maintain fluid intake and increase urinary flow. Oral fluid intake should be encouraged once you are sure that the client is not nauseated and has adequate bowel tone. Focus: Prioritization)

A 79-year-old who has just returned to the surgical unit following a TURP reports acute bladder spasms. In which order will you perform the following prescribed actions? 1. Administer acetaminophen/oxycodone 325 mg/5 mg (Percocet) 2 tablets. 2. Irrigate the retention catheter with 30 to 50 mL of sterile normal saline. 3. Infuse 500 mL of 5% dextrose in lactated Ringer's solution over 2 hours. 4. Offer the client oral fluids to at least 2500 to 3000 mL daily. _____, _____, _____, _____

b,d,e (Rationale Clinical manifestations of BPH include weak urinary​ stream, increased time to​ void, hesitancy, incomplete bladder​ emptying, postvoid​ dribbling, frequency,​ urgency, incontinence,​ nocturia, dysuria, and bladder pain. Fever and an elevated WBC count are not signs of BPH.)

A client is admitted to the hospital for elective knee surgery to be performed the following day. The client tells the nurse that he has benign prostatic hyperplasia​ (BPH). Which assessment findings support the diagnosis of​ BPH? (Select all that​ apply.) a Fever b Nocturia c Elevate white blood cell​ (WBC) count d Urinary frequency e Increased time to void

a,c,e (The nurse should instruct the client to drink about 3000 mL day. to keep the urine clear. The urine should be almost without color. About 2 weeks after turp when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the HCP or go the ER if at any time the urine turns bright red. The nurse should also instruct the client to report signs of infection. The client is NOT at risk for nutritional problems after TURP and can resume D.A.T. The client is not at specific risk for airway problems because the procedure is done under spinal anesthesia and the client does not need to take deep breaths and cough.)

A client is being discharged home 3 days post. TURP. What should the nurse instruct the client to do? Select all that apply a. drink at least 3000 mL of water per day b. increase calorie intake by eating 6 small meals a day c. report bright red bleeding to the HCP d. Take a deep breathe and cough every two hours e. report temp over 99 F (37.2 C)

4

A client is scheduled to undergo transurethral resection of the prostate. The procedure is to be done under spinal anesthesia. Post-operatvely, the nurse should assess the client for: 1 seizures 2 cardiac arrest 3 renal shutdown 4 respiratory paralysis

a,b,d,e (Rationale During the first 24dash-48 hours after a​ TURP, the client should be monitored closely for hemorrhage​ (frankly bloody urine​ output), the presence of large blood​ clots, decreased urinary​ output, increased bladder​ spasms, decreased hemoglobin and​ hematocrit, tachycardia, and hypotension. Hypertension would not be an expected complication.)

A client underwent a transurethral resection of the prostate​ (TURP) 24 hours ago. The nurse providing care for him would be especially vigilant in observing for which​ complications? (Select all that​ apply.) a Decreased urinary output b Hypotension c Hypertension d Hemorrhage e Large blood clots

c (The decision by the surgeon to insert a cath after TURP depnds on the amount of bleeding that is expected. During irrigation after a TURP the rate at which the solution enters the bladder should be increased when the drainage become brighter red. The color indicates the presence of blood. Increasing the solution helps flush the cath well so that clots do not plug it)

A client who has a TURP has a 3 way indwelling cath. with continuous bladder irrigation. In which of the following circumstances should the nurse increase the flow rate of the irrigation? a. when the drainage is continuous but slow b. when drainage appears cloudy and dark yellow c. when drainage becomes bright red d. when there is no drainage of urine and irrigating solution

b,c,d,e (Rationale TURP syndrome occurs when the client absorbs the irrigation fluids during and after surgery. Clinical manifestations are​ hyponatremia, decreased​ hematocrit, hypertension,​ bradycardia, nausea, and confusion. If not treated​ promptly, TURP syndrome may result in dysrhythmias​ and/or seizures. Hypotension is not a manifestation of this syndrome.)

A client who has just undergone transurethral resection of the prostate​ (TURP) has developed TURP​ syndrome, according to the healthcare provider. Which findings during the nursing assessment support this​ diagnosis? (Select all that​ apply.) a Hypotension b Decreased hematocrit c Confusion d Hypertension e Hyponatremia

c (rectal and prostate exams can increase PSA levels. The prostatic palpitation should be done after the blood sample is drawn. The PSA level must be monitored more often than bi-annually if the level is elevated. A colonoscopy is not related to the findings. It is not necessary to void prior to having PSA blood levels drawn)

A client with BPH has an elevated PSA level. The nurse should: a. instruct the client to request having a colonoscopy before coming to conclusions about the PSA result b. instruct the client that the urologist will monitor the PSA level bi-annually when elevated c. determine if the prostatic palpatation was done before or after the clients blood sample was drawn. d. ask the client if he emptied his bladder before the blood sample was obtained.

3 (Terazosin is an antihypertensive drug that is also used to treat BPH. BP must be monitored to ensure the client does not develop hypotension, syncope, or orthostatic hypotension. Inform the client to change positions slowly)

A client with BPH is being treated with terazosin 2 mg at bedtime. The nurse should monitor the client for: 1 urine nitrites 2 WBC count 3 blood pressure 4 pulse

a,b,c,d (Rationale Lifestyle changes that may help clients with mild BPH include avoiding alcohol and​ caffeine, exercising​ regularly, including Kegel​ exercises, avoiding drinking fluids within 2 hours of​ bedtime, and reducing stress. Dietary intake of potassium is not related to BPH symptoms.)

A client with mild benign prostatic hyperplasia​ (BPH) tells the nurse that he prefers to do things open double quote"naturallyclose double quote" and doesn​'t want to take medication for his condition. He asks her if there are some things he can do to help his BPH without drugs. Which lifestyle changes used in the treatment for BPH would the nurse include in the response to the​ client? (Select all that​ apply.) a Reducing stress b Exercising​ regularly, including Kegel exercises c Avoiding alcohol and caffeine d Avoiding drinking fluids within 2 hours of bedtime e Increasing dietary intake of foods high in potassium

d (Rationale: 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 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 antihypertensive medications he was recently prescribed. b increased sexual activity since his wife has retired. c increased levels of exercise as he trains for a marathon. d over-the-counter medications he's been taking to treat cold symptoms.

b,d,e (a: backache occurs in prostate cancer that has spread, c: indication of prostate cancer, b: in presence of BPH pressure on urinary structures leads to urinary stasis, which promotes recurrence of UTI's. D: hematuria occurs with BPH E: overflow incontinence occurs with BPH due to increased volume of residual urine.)

A nurse in a providers office is obtaining a history from a client who is undergoing an evaluation for BPH. The nurse should identify that which of the following findings are indicative of this condition? select all that apply a. backache b. frequent uti c. weight loss d. hematuria e. urinary incontinence

d (Tamsulosin is an alpha-adrenergic receptor antagonist that relaxes the bladder outlet and the prostate gland which improves urinary flow. a: is an anticholinergic that treats overactive bladder. CONTRAINDICATED. Causes urinary retention. The others are not urinary meds)

A nurse is caring for a client who has a new diagnoses of BPH. The nurse should anticipate a prescription for which of the following medications? A oxybutynin b. diphenhydramine c. ipratropium d. tamsulosin

1 5 3 2 7 4 6 8 (Before checking postvoid residual, you should ask the patient to void, and then position him. Next you should open the catheterization kit and put on sterile gloves, position the patient's penis, clean the meatus, then lubricate and insert the catheter. All urine must be drained from the bladder to assess the amount of postvoid residual the patient has. Finally, the catheter is removed, the penis cleaned, and the urine measured. Focus: Prioritization)

In a male patient who must undergo intermittent catheterization, you are preparing to insert a catheter to assess the patient for postvoid residual. Place the steps for catheterization in the correct order. 1. Assist the patient to the bathroom and ask the patient to attempt to void. 2. Retract the foreskin and hold the penis at a 60- to 90-degree angle. 3. Open the catheterization kit and put on sterile gloves. 4. Lubricate the catheter and insert it through the meatus of the penis. 5. Position the patient supine in bed or with the head slightly elevated. 6. Drain all the urine present in the bladder into a container. 7. Cleanse the glans penis starting at the meatus and working outward. 8. Remove the catheter, clean the penis, and measure the amount of urine returned. ____, ____, _____, _____, ____, ____, _____, _____

b (Rationale: 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.)

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 Administer pain medication in the form of a suppository. b Report the assessments to his urologist. c Assess his intake and output since surgery. d Nothing, because these manifestations are expected following a TURP.

b (Rationale: The goal of medical treatment is to promote urine flow to prevent complications such as urinary tract infections, hydronephrosis, or other results of obstructed urine flow, so lack of urinary tract infections would be a positive outcome indicating the treatment is working. While sexual function is of concern to the medical team, sexual performance is not the goal of treatment. Physiological needs always are the priority. Clear dark amber color is abnormal; the color should be clear and light yellow. BPH does not affect activity or golf.)

The nurse is evaluating the effectiveness of the medical treatment of a client with BPH and determines it has been effective based on which finding? a The client has been able to maintain sexual function since beginning treatment. b The client has had no urinary tract infections since beginning treatment. c The client reports his urine is clear dark amber in color. d The client reports he has remained active and plays golf once a week.

b,e (Rationale: 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)

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 Blood chemistry b Digital rectal examination c Pelvic ultrasound d Sperm count e PSA level

3 (ipratropium is a bronchodilator, and its anticholinergic effects can aggravate urine retention.)

The nurse is reviewing the med history of a client with BPH. Which medication will likely aggravate BPH? 1. metformin 2. buspirone 3. inhaled ipratropium 4. ophthalmic timolol

1,2,4,5 (because of the HX of BPH, the nurse should provide privacy and time for the client to void. The nurse should also monitor intake and output, assess the client for urinary retention, and test the urine for hematuria. It is not necessary to cath the client)

When caring for a client with a history of BPH what should the nurse do? select all that apply 1. provide privacy and time for the client to void 2. monitor intake and output 3. catheterize the client for postvoid residual urine 4. ask the client if he has urinary retention 5 test the urine for hematuria

d ( Feedback Rationale: This is stated in an appropriate way to allow the client to feel free to ask any questions about his sexual concerns. The other answers presume problems or contain judgmental attitudes.)

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

3

When emptying the clients bladder during a urinary catheterization, the nurse should allow the urine to drain from the bladder slowly to prevent: 1. renal failure 2. abdominal cramping 3. possible shock 4 atrophy of bladder musculature

2 ( Ans: 2 Prostate disease increases the risk of UTIs in men because of urinary retention. The wife's UTI should not affect the patient. The times of the catheter usage and kidney stone removal are too distant to cause this UTI. Focus: Prioritization)

You are admitting a 66-year-old male patient suspected of having a urinary tract infection (UTI). Which piece of the patient's medical history supports this diagnosis? 1. Patient's wife had a UTI 1 month ago 2. Followed for prostate disease for 2 years 3. Intermittent catheterization 6 months ago 4. Kidney stone removal 1 year ago

3 (A palpable bladder and restlessness are indicators of urinary retention, which would require action (such as insertion of a catheter) to empty the bladder. The other data would be consistent with the client's diagnosis of BPH. More detailed assessment may be indicated, but no immediate action is required. Focus: Prioritization)

You are assessing a long-term-care client with a history of benign prostatic hyperplasia (BPH). Which information will require the most immediate action? 1. The client states that he always has trouble starting his urinary stream. 2. The chart shows an elevated level of prostate-specific antigen. 3. The bladder is palpable above the symphysis pubis and the client is restless. 4. The client says he has not voided since having a glass of juice 4 hours ago.

2 (Hemorrhage is a major complication after TURP and should be reported to the surgeon immediately. The other assessment data also indicate a need for nursing action, but not as urgently. Focus: Prioritization)

You are caring for a client who has just returned to the surgical unit after a TURP. Which assessment finding will require the most immediate action? 1. Blood pressure reading of 153/88 mm Hg 2. Catheter that is draining deep red blood 3. Client not wearing antiembolism hose 4. Client reports of abdominal cramping

4 (Because tamsulosin blocks alpha receptors in the peripheral arterial system, the most significant side effects are orthostatic hypotension and dizziness. To avoid falls, it is important that the client change positions slowly. The other information is also accurate and may be included in client teaching but is not as important as decreasing the risk for falls. Focus: Prioritization)

A 67-year-old client with BPH has a new prescription for tamsulosin (Flomax). Which statement about tamsulosin is most important to include when teaching this client? 1. "This medication will improve your symptoms by shrinking the prostate." 2. "The force of your urinary stream will probably increase." 3. "Your blood pressure will decrease as a result of taking this medication." 4. "You should avoid sitting up or standing up too quickly

b,c,d,e (Amox may be given with or without food, but the nurse should instruct the client to obtain adequate fluid intake, 2500-3000 mL to promote urinary output and to flush out bacteria from the urinary tract. The nurse should also encourage the client to void freq. every 2-3 hrs. and empty the bladder completely. Taking the antibiotic at bed time after emptying the bladder helps to ensure adequate concentration of the drug during the overnight period)

A HCP has prescribed amoxicillin 100 PO two times a day. What should the nurse instruct the client to do? Select all that apply a. drink 300-500 mL daily b. Void frequently, at least every 2-3 hours c. take time to empty the bladder completely. d. take the last dose of antibiotic for the day at bed time. e. take the antibiotic with or without food

a ( finasteride is an androgen inhibitor, therefore women who are pregnant or may become pregnant should be told to avoid touching the tablets.. Answer b is incorrect because there are no benefits to giving the med with food. Answer c is incorrect because it can take 6 months to a year to be effective. Answer d is not an accurate statement.)

A client with BPH has been started on Proscar (finasteride). The nurses discharge teaching should include: a. telling the clients wife not to touch the tablets b. explaining the medication should be taken with food c. telling the client symptoms will improve in 1-2 weeks d. instructing the client to take the medication at bedtime to prevent nocturia.

a,b,d (The client should increase fluid intake over 1000 mL/day; therefore c is incorrect. The client is not restricted to bed and should be encouraged to ambulate; therefore e is incorrect.)

A client with BPH has undergone TURP. Which nursing interventions are parts of the clients post-operative care? Select all that apply a. monitoring vital signs b. maintaining constant bladder irrigation c. limiting fluid intake to 1000 mL per day d. checking for postoperative bleeding e. maintaining bed rest for 48 hrs.

a (to reduce the risk of post op 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)

A nurse is instructing a client who is scheduled for TURP about his post operative 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

b,c,d (provider instructs avoid sex typically 2-6 weeks, avoid non steroidal anti-inflammatory drugs because they cause bleeding. )

A nurse is providing discharge instructions to a client who is post op following 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 caffeine d. take a stool softner daily e. treat pain with ibuprofen

d (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 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 A 27-year-old Hispanic man who has a family history of BPH b A 38-year-old Japanese man who is a vegetarian c A 52-year-old Caucasian man who has a family history of BPH d A 56-year-old African American man who eats meat daily

c (Although postoperative pain is expected, the nurse should make sure that other factors, such as an obstructed irrigation catheter, aren't the cause of the pain. After assessing catheter patency, the nurse should administer an analgesic, such as meperidine, as prescribed. Increasing the I.V. flow rate may worsen the pain. Notifying the physician isn't necessary unless the pain is severe or unrelieved by the prescribed medication.)

After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, a male client returns to the room with continuous bladder irrigation. On the first day after surgery, the client reports bladder pain. What should Nurse Anthony do first? A Increase the I.V. flow rate B Notify the physician immediately C Assess the irrigation catheter for patency and drainage D Administer meperidine (Demerol), 50 mg I.M., as prescribed

1

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 distension in a male client is to check for: 1 a rounded swelling above the pubis 2 dullness in the LLQ 3 rebound tenderness below the symphysis 4 urine discharge from urethral meatus

d (Rationale Age is the most common risk factor for BPH. Almost all men will develop BPH if they live long enough. There may be a racial component as​ well, because Black and Hispanic men develop BPH earlier than White​ men, but Asian men develop it later.​ Smoking, sexual​ history, and a sedentary lifestyle are not risk factors for developing BPH.)

An older adult client is admitted for a transurethral resection of the prostate​ (TURP) to treat benign prostatic hyperplasia​ (BPH). Which item in the client​'s health history placed him at risk for developing​ BPH? a More than one sexual partner b Smoking history c Sedentary lifestyle d Age

a (Continuous bladder irrigation are ordered following TURP to prevent blood clots from forming and blocking the catheter. )

Continuous bladder irrigations are ordered for a pt following TURP. The purpose of continuous bladder irrigations is to: a. prevent formation of blood clots b. administer intravesical medication c. prevent post operative pain d maintain bladder tone

b (Dribbling can occur for several months after TURP. the client should be informed this is expected and NOT abnormal. The nurse should teach the client perineal exercises to strengthen sphincter tone. The client may need to use pads for temp 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.)

In discussing home care with a client after TURP the nurse should teach the male client that dribbling of urine : a. can be a chronic problem b. can persist for several months c. is an abnormal sign that requires intervention d. is a sign of healing within the prostate

a,b,d (Rationale Side effects of​ 5-alpha reductase​ inhibitors, such as dutasteride​ (Avodart) and finasteride​ (Proscar), may include​ impotence, decreased​ libido, and decreased volume of ejaculate. Gynecomastia and renal insufficiency are not side effects for these medications.)

The client has been prescribed dutasteride​ (Avodart) for benign prostatic hyperplasia​ (BPH). Which potential adverse effects would the nurse include in the medication teaching for this​ medication? (Select all that​ apply.) a Impotence b Decreased volume of ejaculate c Gynecomastia d Decreased libido e Renal insufficiency

d (In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.)

The client who has a cold is seen in the emergency room with inability to void. Because the client has a history of BPH, the nurse determines that the client should be questioned about the use of which of the following medications? A Diuretics B Antibiotics C Antitussives D Decongestants

2 (S/S of BPH include difficulty starting flow of urine, urinary frequency and hesitancy, decreased force of urine stream, interruptions in the urine stream when voiding and nocturia. The prostate gland surrounds the urethra, and these symptoms are attributed to obstruction of the urethra resulting from BPH. Nocturia is common. Straining and urine retention are usually the symptoms that prompt the client to seek care.)

The nurse should specifically assess the client with BPH for: 1. voiding at less frequent intervals 2. difficulty starting the flow of urine 3. painful urination 4. increased force in the urine stream

1 (prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula)

The primary reason for taping an indwelling catheter laterally to the thigh of a male client is to : 1 eliminate pressure to the penoscrotal angle 2 prevent the catheter from kinking in the urethra 3 prevent accidental catheter removal 4 allow the client to turn without kinking the catheter

1 (The risk for contrast-induced kidney failure is greatest in patients who are older or dehydrated. If possible, arrange for the patient to have this procedure early in the day to prevent dehydration. The purpose of this procedure is to assess kidney function and identify anomalies. The administration of drugs that affect the gag reflex is not done during this procedure. Focus: Supervision, prioritization)

You are supervising a senior nursing student who is caring for a 78-year-old scheduled for an intravenous pyelography. What information would you be sure to stress about this procedure to the nursing student? 1. "After the procedure, monitor urine output because the contrast dye increases the risk for kidney failure in older adults." 2. "The purpose of this procedure is to measure kidney size." 3. "Because this procedure assesses kidney function, there is no need for a bowel prep." 4. "Keep the patient NPO after the procedure because during the procedure the patient will receive drugs that affect the gag reflex."

c ( The indwelling cath creates the urge to void and can also cause bladder spasms. The nurse should ensure adequate bladder emptying by monitoring urine output and characteristics. Urine output should be at least 50 mL/hr A plugged cath, imagining the urge to void, and confusion are less likely reasons for the clients problem)

The UAP tells the nurse I think the client is confused. He keeps telling me he has to void, but that is not possible, he has a cath in place that is draining well. The nurse should tell the UAP: a. his cath is probably plugged. I will irrigate it b. That is a common problem after prostate surgery. The client only imagines the urge to void. c. The urge to void is usually created by the large catheter, and he may be having some bladder spasms. d. I think he may be somewhat confused.

d (Rationale: The 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.)

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

c

The 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 which of the following symptoms? a Skin integrity b Peripheral vascular function c Urinary elimination d Bowel elimination