Evolve Chapter 67
A client with erectile dysfunction has been prescribed a PDE-5 inhibitor. Which client statement demonstrates that nursing teaching about the medication has been effective? a) "I have to be sure to be careful when I sit up or stand up." b) "I can drink a little bit of alcohol before intercourse to help me out." c) "I will have my partner take this medication about 30 minutes before intercourse." d) "I need to increase fiber in my diet to avoid constipation."
a) "I have to be sure to be careful when I sit up or stand up." A side effect of PDF-5 inhibitors is vasodilation, which can cause profound hypotension. The client who states he needs to be careful when sitting or standing up has demonstrated understanding of this concern.Alcohol should be avoided when using a PDE-5 inhibitor. The medication is prescribed for the client; not the client's partner. PDE-5 drugs are not generally associated with constipation.
Which client will the nurse prioritize when teaching about prostate cancer screening? a) A 50-year-old African American b) A 22-year-old Indian American c) A 30-year-old Hispanic American d) A 45-year-old Native American
a) A 50-year-old African American In the United States, prostate cancer affects African-American men the most and at an earlier age. African-American men and men who have a first-degree relative with prostate cancer have a higher risk for prostate cancer.
A client with benign prostatic hyperplasia is being discharged with a prescription for prazosin. Which teaching will the nurse include? (Select all that apply.) a) Avoid drugs used to treat erection problems. b) Take the medication in the afternoon. c) Keep all appointments for follow-up laboratory testing. d) Hearing tests will need to be conducted periodically. e) Be careful when changing positions.
a) Avoid drugs used to treat erection problems. c) Keep all appointments for follow-up laboratory testing. e) Be careful when changing positions Drugs used to treat erectile dysfunction can worsen side effects, such as hypotension. Alpha-adrenergic blockers may cause orthostatic hypotension and can cause liver damage. The nurse needs to remind the client to be careful when changing positions and to keep all appointments for follow-up laboratory testing.These drugs do not affect hearing. Prazosin should be taken in the evening to decrease the risk of problems related to hypotension.
Which assessment finding is the priority for the nurse to report to the health care provider? a) Painless testicular lump b) Penile discharge c) Hematuria d) Decrease increase in libido
a) Painless testicular lump A painless lump or swelling in the testicles is the most common assessment finding of testicular cancer; this finding should be reported to the health care provider immediately.All other symptoms require nursing intervention, but these can be addresses after the painless testicular lump.
A client has undergone transurethral resection of the prostate (TURP). Which intervention does the nurse incorporate in the postoperative plan of care? (Select all that apply.) a) Perform intermittent urinary catheterization every 4 to 6 hours. b) Assist to mobilize as soon as permitted. c) Encourage urination around the catheter if pressure is felt. d) Administer antispasmodic medications. e) Place in a supine position with his knees flexed.
b) Assist to mobilize as soon as permitted. d) Administer antispasmodic medications. Antispasmodic drugs can be administered to decrease the bladder spasms that may occur due to catheter use. Assisting the client to a chair as soon as permitted postoperatively will help to decrease the risk of complications from immobility. An indwelling catheter and continuous bladder irrigation are in place for about 24 hours after TURP.The client would not try to void around the catheter. This would cause the bladder muscles to contract and may result in painful spasms. Intermittent urinary catheterization is not necessary and increases the risk for infection. Typically, the catheter is taped to the client's thigh, so he needs to keep his leg straight.
What will the nurse include in teaching to assist the client with BPH to address incontinence? a) Perform routine self-catheterization and bladder retraining. b) Practice Kegel exercises to improve muscle control. c) Request a prescription for sildenafil. d) Use analgesic medications as needed to maintain comfort.
b) Practice Kegel exercises to improve muscle control. Practicing Kegel exercises may help to regain urinary continence.Sildenafil is used to help restore erectile function, not for incontinence. Analgesic medications do not help with urinary continence. Self-catheterization and bladder retraining are used for neurogenic bladder.
The nurse is educating a group of young men about testicular self-examination (TSE). Which statement by a member of the group indicates teaching has been effective? a) "I will squeeze each testicle in my hand to feel any abnormalities." b) "I will examine my testicles right before taking a shower." c) "I will look and feel for any lumps or changes to my testes." d) "I only need to report large masses to my primary health care provider."
c) "I will look and feel for any lumps or changes to my testes." In TSE, the client would look and feel for any lumps or changes to the testes. Any lumps that are detected would be immediately reported. With early detection by monthly TSE and treatment, testicular cancer can usually be successfully cured.A TSE would be performed immediately following a shower. The client would gently roll each testicle between the thumb and forefinger rather than squeeze them. All masses must be reported to the primary health care provider, no matter the size.
A client with testicular cancer is worried about sterility and the ability to conceive children later. To which resource does the nurse refer the client before surgery takes place? a) A psychologist b) American Cancer Society c) A sperm bank facility d) RESOLVE: The National Infertility Association
c) A sperm bank facility If the client is interested in having children, he would be encouraged to arrange for semen storage as soon as possible after diagnosis. A sperm bank facility provides comprehensive information on semen collection, storage of semen, the storage contract, costs, and the insemination process. Sperm collection needs to be completed before other treatment options commence.The client is referred to the American Cancer Society for more generalized information on testicular cancer. A psychologist may be helpful if the client has difficulty with sperm banking or has other concerns associated with testicular cancer. RESOLVE: The National Infertility Association is an appropriate referral if permanent sterility occurs and sperm storage has not been feasible.
A young adult with testicular cancer is admitted for unilateral orchiectomy and retroperitoneal lymph node dissection. Which task will the nurse delegate to assistive personnel (AP)? a) Discuss reproductive options with the client and significant other. b) Evaluate the client's understanding of chemotherapy and radiation treatment. c) Encourage the client to cough and deep-breathe after surgery. d) Teach about the availability of a gel-filled silicone testicular prosthesis.
c) Encourage the client to cough and deep-breathe after surgery. Reminding clients to perform coughing and deep-breathing activities can be delegated to APs.Client education and evaluation are more complex skills that must be done by licensed nurses.
After returning from transurethral resection of the prostate, the client's urine in the continuous bladder irrigation system is a burgundy color. Which client needs does the nurse anticipate will be prescribed after the surgeon sees the client? (Select all that apply.) a) Encouragement of oral fluids b) Emergency surgery c) Monitoring for anemia d) Antispasmodic drugs e) Increased intermittent irrigation
c) Monitoring for anemia d) Antispasmodic drugs Although not a common occurrence, bleeding may occur in the postoperative period. Venous bleeding, which is deep red or burgundy in color, is more common than arterial bleeding. The surgeon may apply traction on the catheter for a few hours to control the venous bleeding. Traction on the catheter is uncomfortable and increases the risk for bladder spasms, so analgesics or antispasmodics is usually prescribed. Hemoglobin and hematocrit would be monitored and trended for indications of anemia.Emergency surgery and increased intermittent irrigation would be indicated for an arterial bleed, which would be a bright red color. Encouragement of oral fluids are indicated after the catheter is removed.
A client reports taking a supplement that his partner recommended for benign prostatic hyperplasia (BPH). Which supplement does the nurse anticipate the client is taking? a) Magnesium b) Calcium c) Saw palmetto d) Feverfew
c) Saw palmetto Serenoa repens (saw palmetto), a plant extract, is often used by men with early to moderate BPH. Some studies show this supplement to be effective in treating BPH, while other studies show no benefit. The nurse will remind clients wanting to use complementary and integrative health therapies to check with their primary health care provider before taking anything.Magnesium, calcium, and feverfew are not therapies used for BPH.
The nurse is caring for four clients. With which client does the nurse discuss prostate cancer screening? a) A 23 year old with a history of urinary tract infections b) A 33 year old who sustained an injury to the external genitaliac. c) A 46 year old with uncontrolled hypertension d) A 57 year old who has fathered four children
d) A 57 year old who has fathered four children A man who is between 55 and 69 years old should make an informed decision about whether to have prostate cancer screening. The risk increases for men who have a first-degree relative (brother, father) with the disease.A history of urinary tract infections, injury to the external genitalia, and uncontrolled hypertension are not risk factors for prostate cancer.
The emergency nurse is assigned to care for four clients. Which client does the nurse see first? a) Young adult with a swollen, painful scrotum who has a recent history of mumps infection b) Older adult with a history of benign prostatic hyperplasia and palpable bladder distention c) Middle-age adult discharged 2 days ago after a TURP with hematuria d) Adolescent with an erection for "10 or 11 hours" who is reporting severe pain
d) Adolescent with an erection for "10 or 11 hours" who is reporting severe pain The nurse first attends to the client who has had an erection for "10 or 11 hours." This client has symptoms of priapism which is considered a urologic emergency because the circulation to the penis may be compromised. With an erect penis, the client may also be unable to void.The client with a swollen, painful scrotum, the client with hematuria, and the client with a history of benign prostatic hyperplasia can be seen after the client with the ongoing erection.
