BPH, prostate cancer
The effect of Proscar in the tx of BPH is a. reduction in size of 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 musculature promoting urine flow
a. reduction in size of prostate gland (rationale- Proscar resultsi n suppresion of androgen formation by inhibiting the formation of testosterone metabolite dihydroxytesterone, the principle prostatic androgen, and results in decrease int he size of the prostate gland. Alpha adrenergic blockers are used to cause smooth muscle relaxation in the tx of BPH, but drugs affecting bladder tone are not indicated.)
13. 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 should 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.
12. Priority Decision: 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 then may administer a belladonna and opium (B&O) suppository if one is ordered. The patient should not try to void around the catheter because this will increase the spasms. The flow rate of the irrigation fluid may be decreased if orders permit because fast-flowing, cold fluid may also contribute to spasms.
15. Priority Decision: 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 chemotherapeutic agents 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.
5. 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 postprocedure catheterization 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.
14. A 55-year-old man with a history of prostate cancer in his family asks the nurse what he can do to decrease the 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, 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. Simple enlargement or hyperplasia of the prostate is not a risk factor for prostate cancer.
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. urinary hesitancy, postvoid dribbling, and weak urinary stream (rationale- Classic symptoms of uncomplicated BPH are those associated with urinary obstruction and include diminished caliber and force of the urinary stream, hesitancy, dribbling at the end of urination, and feeling of incomplete bladder emptying because of urinary retention. Irritative symptoms including nocturne, dysuria, urgency, or hematuria occur if infection results from urinary retention.)
The extent of urinary obstruction caused by BPH can be determined by a. a cystometrogram b. transrectal ultrasound c. urodynamic flow studies d. postvoiding catherization
c. urodynamic flow studies (rationale- Urinary flow meters are used to measure the urinary flow rate, which is decreased in vesicle neck obstruction. Cystourethroscopy may also evaluate the degree of obstruction, but a cystometrogram measures bladder tone, post voiding catheterization measures residual urine, and a rectal ultrasound may determine the size and configuration of the prostate gland.)
A patient asks the nurse what the difference between BPH and cancer of the prostate is. The best response by the nurse includes the information that BPH is a. a benign tumor that not does spread beyond the prostate gland b. a precursor to prostate cancer but does not yet show any malignant changes c. an enlargement of the gland caused by an increase in the size of existing cells d. a benign enlargement of the gland due to an increase in the number of normal cells
d. a benign enlargement of the gland due to an increase in the number of normal cells (rationale- hyperplasia is an increase in the number of cells, and in BPH it is thought that the enlargement caused by the increase in new cells results from endocrine changes associated with aging. Hypertrophy refers to an increase in the size of existing cells. The hyperplasia is not considered a tumor, not does BPH predispose to cancer of the prostate.)
Following a TURP, a patient has a continuous bladder irrigation. Four hours after surgery, the catheter drainage contains thick, bright red clots and tissue. The nurse should a. release the traction on the catheter b. manually irrigate the catheter until the drainage is clear c. clamp the drainage tube and notify the patient's physician d. increase the rate of the irrigation and take the patient's vital signs
d. increase the rate of the irrigation and take the patient's vital signs (rationale- Bleeding and blood clots from the bladder are expected after prostatectomy and continuous irrigation is used to keep clots from obstructing the urinary tract. The rate of the irrigation may b e increased to keep the clots from forming if order, 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 only be relieved with specific orders. The catheter does not need to be manually irrigated unless there are signs that the catheter is obstructed, and clamping the draining tube is contraindicated because it would cause bladder distention.)
