BPH, Prostate cancer, TURP/CBI, Erectile Dysfunction

A health care provider has explained to the client that he has an inflammation of the Cowper glands. Where are the Cowper glands located?

Below the prostate, within the posterior aspect of the urethra

Which client is most likely to develop prostate cancer according to a nurse working at a health screening at the local mall?

A 56-year-old African American man

A nurse is working in an oncology treatment center. Which clinical manifestation when reported by a client would the nurse know may be related to metastasis from prostate cancer?

Constant hip aching and discomfort

The client with benign prostatic hyperplasia (BPH) is considering use of medication in the management of symptoms. Which of the following drugs reduces the size of the prostate without lowering circulating levels of testosterone?

Finasteride (Proscar)

What should a male client older than age 50 do to help ensure early identification of prostate cancer?

Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.

Which component of client teaching helps the nurse assist a client following treatment for cancer of the prostate gland to manage and minimize the possibility of a recurrence of the primary cancer or metastasis?

Have regular prostate-specific antigen (PSA) levels tested and repeat lymph node biopsies.

A nurse is reviewing a journal article about benign prostatic hyperplasia and possible risk factors associated with this condition. Which factor would the nurse most likely find as playing a role in increasing a man's risk for this condition? Select all that apply. a. Hypertension b. Diabetes c. Atrial fibrillation d. Social alcohol use e. Smoking

a. Hypertension b. Diabetes e. Smoking Rationale: Recent studies have identified smoking (both current and former smoking), heavy alcohol consumption, hypertension, heart disease, and diabetes as risk factors associated with BPH. Atrial fibrillation has not been associated with BPH.

A patient informs the nurse that his father died of prostate cancer, so he wants to know ways in which to reduce his risk factors for developing it. What education can the nurse give to the patient to decrease modifiable risk factors? a. Limit red meat and dairy products high in fat. b. Quit smoking. c. Avoid wearing tight pants and underwear. d. Monitor blood pressure.

a. Limit red meat and dairy products high in fat. Rationale: The risk of prostate cancer is greater in men whose diet contains excessive amounts of red meat or dairy products that are high in fat.

Which is the most common type of prostate surgery? a. Transurethral resection of the prostate b. Retropubic prostatectomy c. Perineal prostatectomy d. Suprapubic prostatectomy

a. Transurethral resection of the prostate Rationale: Transurethral resection of the prostate, or TURP, is the most common procedure used and can be carried out through endoscopy. Suprapubic, perineal, and retropubic prostatectomies are surgical procedures for the prostate, but they are not the most common.

A clinical manifestation related to metastasis from prostate cancer is a. hip pain. b. weight gain. c. thrombocytopenia. d. polyuria.

a. hip pain. Rationale: Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, oliguria (decreased urine output), and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.

Which of the following is an immediate danger after a prostate surgery? a. Sexual dysfunction b. Hemorrhagic shock c. Catheter obstruction d. Deep vein thrombosis

b. Hemorrhagic shock Rationale: The immediate dangers after prostate surgery are bleeding and hemorrhagic shock. The patient is monitored for major complications such as hemorrhage, infection, deep vein thrombosis, catheter obstruction, and sexual dysfunction.

Which statement is accurate regarding sildenafil? a. Sexual stimulation is not needed to produce an erection. b. Its side effects include headache, flushing, and dizziness. c. It can be taken twice daily for increased effect. d. The medication should be taken right before intercourse.

b. Its side effects include headache, flushing, and dizziness. Rationale: Side effects of sildenafil include headache, flushing, and dizziness. Is should be taken 30 minutes to 4 hours before intercourse. Taking this medication more than once a day will not have an increased effect. The client will have no erection if stimulation does not occur.

Which of the following is considered first-line treatment for prostate cancer? a. Cryosurgery b. Radical prostatectomy c. Radiation d. Hormonal therapy

b. Radical prostatectomy Rationale: Radical prostatectomy is the complete surgical removal of the prostate, seminal vesicles, and often the surrounding fat, nerves, lymph nodes and blood vessels. It is considered the standard first-line treatment for prostate cancer. If prostate cancer is detected in its early stage, the treatment may be curative radiation therapy. Hormonal therapy for advanced prostate cancer suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of dihydrotestosterone.

. After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded? a. The normal saline irrigant is infusing at a rate of 50 drops/minute. b. The client reports bladder spasms and the urge to void. c. The urine in the drainage bag appears red to pink. d. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage

b. The client reports bladder spasms and the urge to void. Rationale: Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency.

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BPH)? a. Serum testosterone level b. Voiding pattern c. Size of the prostate d. Creatinine clearance

b. Voiding pattern Rationale: The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.

A patient comes to the clinic with complaints of inability to sustain an erection and is prescribed a PDE-5 inhibitor, sildenafil (Viagra). What medication should the nurse caution the patient about taking with this medication? a. Lisinopril (Prinivil) b. Levothyroxine (Synthroid) c. Isosorbide (Isordil) d. Diphenhydramine (Benadryl)

c. Isosorbide (Isordil) Rationale: These agents are contraindicated in men who take organic nitrates (e.g., isosorbide [Isordil], nitroglycerin), because taken together, these medications can cause side effects such as severe hypotension (Lee, 2011; Porth & Matfin, 2009; Wein et al., 2012).

After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first? a. Fluid restriction b. Artificial sphincter use c. Kegel exercises d. Self-catheterization

c. Kegel exercises Rationale: Kegel exercises are noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for the client with increased detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for post-prostatectomy incontinence. Self-catheterization may be used as a temporary measure but isn't a primary intervention.

The nurse is reviewing the history of a client with erectile dysfunction. Which of the following would the nurse least likely identify as contributing to the client's condition? a. Use of metoprolol for treating hypertension b. History of depression treated with fluoxetine c. New onset of anemia being treated with iron supplements d. History of type 2 diabetes mellitus for 10 years

c. New onset of anemia being treated with iron supplements Rationale: Anemia and iron supplements are not associated with erectile dysfunction. Diabetes, depression, and certain medications such as metoprolol and fluoxetine are associated with erectile dysfunction.

A client is prescribed dutasteride (Avodart) as part of treatment for benign prostatic hyperplasia (BPH). When teaching the client about this drug, the nurse integrates knowledge of the drug's action. Which statement best reflects this? a. "The drug causes nitrous oxide to be released, leading to increased blood flow and urination." b. "The drug restores the balance of the normal microorganisms found in the bladder to improve urine flow." c. "The drug causes the smooth muscles of the bladder

d. "The drug interferes with testosterone, which causes the prostate to shrink in size." Rationale: Dutasteride is a 5-alpha-reductase inhibitor that prevents the conversion of testosterone to DHT, thereby causing a decrease in prostate size. Alpha-adrenergic blockers such as alfuzosin, terazosin, doxazosin, and tamsulosin relax the smooth muscle of the bladder neck and prostate. Nitrous oxide is released in the vasculature of the penis during sexual stimulation, leading to smooth muscle relaxation in blood vessels and resulting in increased blood flow and an erection. Phosphodiesterase-5 inhibitors increase blood flow to the penis and are used to treat erectile dysfunction. Dutasteride does not restore the normal flora of the bladder. The contents of the bladder are sterile.

The nurse is reviewing the medical record of a client who has been diagnosed with prostate cancer. The nurse notes that the Gleason score was used to grade the cancer. Which total score would the nurse interpret as indicating a highly aggressive cancer? a. 3 b. 7 c. 5 d. 9

d. 9 Rationale: The Gleason score is the most commonly used tumor grading system which assigns two scores with a combined value ranging from 2 to 10. With each increase in Gleason score, there is an increase in tumor aggressiveness. High Gleason scores indicate more aggressive cancer. A total score of 8 to 10 indicate a high-grade cancer.

A client with Stage IV prostate cancer is to receive hormone therapy. The nurse would inform the client about possible adverse effects including which of the following? a. Deepening of voice b. Enhanced potency c. Increased libido d. Breast tenderness

d. Breast tenderness Rationale: Feminizing side effects occur with hormone therapy. The client's voice may become higher, hair and fat distribution may change, and breasts may become tender and enlarged. Libido and potency also are diminished.

A patient experiences hypotension, lethargy, and muscle spasms while receiving bladder irrigations after a transurethral resection of the prostate (TURP). What is the first action the nurse should take? a. Increase the rate of the IV fluids. b. Prepare the patient for an ECG. c. Administer a unit of packed red blood cells. d. Discontinue the irrigations.

d. Discontinue the irrigations. Rationale: Transurethral resection syndrome is a rare but potentially serious complication of TURP. Symptoms include lethargy, hypotension, and muscle spasms. The first action the nurse should take is to discontinue irrigation. The other interventions listed are not appropriate.

A client is receiving leuprolide as part of his treatment for prostate cancer. The nurse would be alert for which of the following as a possible adverse effect? a. Nipple retraction b. Muscle overgrowth c. Reports of increased libido d. Gynecomastia

d. Gynecomastia Rationale: Adverse effects associated with leuprolide, a luteinizing hormone-releasing hormone agonist, are related to hypogonadism and include vasomotor flushing, loss of libido, decreased bone density, anemia, fatigue, increased fat mass, decreased muscle mass, gynecomastia, and mastodynia (breast/nipple tenderness).

The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following? a. Light pink with few red streaks b. Reddish-pink with numerous clots c. Dark amber with copious mucous d. Light yellow and clear

d. Light yellow and clear Rationale: Typically a three-way catheter drainage system is removed when the urine appears clear and amber (light yellow). Reddish-pink urine with clots usually occurs in the immediate postoperative period. Eventually the urine becomes light pink within 24 hours after surgery. Dark amber urine suggests concentrated urine commonly associated with dehydration.

A client with erectile dysfunction who had a penile implant inserted has been taught how to identify malfunction of the device. Which of the following if stated by the client as indicative of malfunction would indicate to the nurse that the client has understood the teaching? a. Migration of the cylinders, pump, or reservoir from their intended location b. Erosion of penile or urethral tissue c. Underinflation or bulging of the cylinders during inflation d. Erosion of scrotal, bowel, or blad

a. Migration of the cylinders, pump, or reservoir from their intended location Rationale: Malfunction of the device is characterized by the underinflation, bulging of the cylinders during inflation, and a loss of fluid from the implant. Erosion of penile or urethral tissue occurs due to a mis-sized implant, pressure, or friction of the implanted cylinders. Erosion of scrotal, bowel, or bladder tissue occurs if an implant with a fluid reservoir is used. Migration of the cylinders, pump, or reservoir from their intended location is accompanied by pain, tenderness, and dysfunction of components that are part of the device.

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include: a. continuous inflow and outflow of irrigation solution. b. continuous inflow and intermittent outflow of irrigation solution. c. intermittent flow of irrigation solution and prevention of hemorrhage. d. intermittent inflow and continuous outflow of irrigation solution.

a. continuous inflow and outflow of irrigation solution. Rationale: When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

A 48-year-old man recently diagnosed with benign prostatic hyperplasia (BPH) reports consuming <i>Serenoa repens</i> (saw palmetto berry). The nurse needs to intervene if the physician orders which treatment? a. Terazosin b. Finasteride c. Ketoconazole d. Sipuleucel-T

b. Finasteride Rationale: Serenoa repens (saw palmetto berry) should not be used with finasteride. Terazosin is an alpha-adrenergic blocker and can be taken with Serenoa repens. Sipuleucel-T is a therapeutic cancer vaccine. Ketoconazole is an adrenal-ablating drug used to inhibit cytochrome P450 enzymes.

A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met? a. "I'll have to stay in the hospital for about 3 to 4 days after the surgery." b. "I'll have a small incision on my lower abdomen after the procedure." c. "The surgeon is going to remove the entire prostate gland." d. "The surgeon is going to insert a scope through my ur

d. "The surgeon is going to insert a scope through my urethra to remove a portion of the gland." Rationale: TURP involves the surgical removal of the inner portion of the gland through an endoscope inserted through the urethra. There is no external skin incision. Typically, the procedure is performed in an outpatient setting but may require an overnight hospital stay.

A 65-year-old man complains to his health care provider that, when he urinates, he has to start and stop several times over a period of minutes in order to fully empty his bladder. The nurse is aware that this is not uncommon in men over the age of 60. This "double voiding" is directly related to which of the following

Hyperplasia of the prostate gland

Medical management of BPH includes pharmacologic therapy. Which of the following medications would the nurse expect the health care provider to prescribe for this diagnosis? a. Analgesic b. Diuretic c. Antispasmodic d. Alpha-adrenergic blocker

d. Alpha-adrenergic blocker Rationale: Alpha-adrenergic blockers relax the smooth muscle of the bladder neck and prostate, improving urine flow and relieving BPH symptoms. Reference:

Bright red bleeding following prostate surgery indicates which of the following? a. Disseminated intravascular coagulation b. Venous bleed c. Thrombocytopenia d. Arterial bleed

d. Arterial bleed Rationale: Bright red bleeding with increased viscosity and numerous clots usually indicates arterial bleeding, and requires surgical intervention. Venous bleeding, which is dark red in color, may be controlled by the provider via "overinflating" the urinary catheter balloon and applying traction to the catheter so that the balloon holding the urinary catheter in place applies pressure to the prostatic fossa. It does not represent disseminated intravascular coagulation or thrombocytopenia.

A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged IV pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow? a. Attaching the infusion set to an infusion pump b. Counter-balancing the I.V. pole c. Collecting a urine specimen before beginning irrigation d. Evaluating

d. Evaluating patency of the drainage lumen Rationale: The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.

Which of the following would a nurse include in a teaching plan for a client with benign prostatic hyperplasia who is not yet a candidate for surgery? a. Performing deep breathing exercises periodically b. Using appropriate coping to allay anxiety c. Doing leg exercises at least daily d. Maintaining optimal bladder emptying

d. Maintaining optimal bladder emptying Rationale: For the client with benign prostatic hyperplasia who is not yet a candidate for surgery, the nurse would teach a client how to maintain optimal bladder emptying. The surgical client requires support and information to allay anxiety. The nurse teaches deep breathing and leg exercises for the client who is to have surgery.

The nurse is preparing a discharge teaching plan for a client who has had a prostatectomy. Which of the following would be appropriate to include? a. Engaging in strenuous exercise to strengthen abdominal muscles b. Waiting to urinate for 5 to 10 minutes after feeling the initial urge c. Using a bearing down motion to promote complete bladder emptying when voiding d. Performing perineal exercises frequently throughout the day

d. Performing perineal exercises frequently throughout the day Rationale: After a prostatectomy, the client should be instructed in how to perform perineal exercises and to perform them hourly throughout the day, each day. In addition, the client should avoid bearing down (straining) to urinate because of the increased risk for hematuria. He should also avoid strenuous exercise, which increases the tendency to rebleed. The client should be instructed to urinate as soon as he feels the first urge to do so.

Which is an age-related change affecting the male reproductive system? a. Patency increases. b. Testes become soft. c. Prostate secretion increases. d. Plasma testosterone levels decrease.

d. Plasma testosterone levels decrease. Rationale: Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate? a. Restrict fluids to prevent the client's bladder from becoming distended. b. Tell the client to try to urinate around the catheter to remove blood clots. c. Prepare to remove the catheter. d. Use sterile technique when irrigating the catheter.

d. Use sterile technique when irrigating the catheter. Rationale: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.