Nokea
The clinic nurse is reviewing patient laboratory results on the following four patients. Which of the following patients is priority to report to the health care provider?
- A. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH) and has an elevated PSA test
- B. A 38-year-old who is being treated for acute prostatitis with an elevated PSA.
- C. A 48-year-old whose father died of metastatic prostate cancer and has a positive PCA3 test
- D. A 52-year-old who goes on long bicycle rides every weekend and has a positive PCA3 test
Correct Answer: C
Rationale: The family history (first degree relative) and elevation of PCA3 in the 48-year-old indicate that further evaluation of the patient for prostate cancer is most needed for this patient. The 52-year-old who goes on long bicycle rides every weekend and has a positive PCA3 test would be next priority. The elevations for the other patients are not unusual.
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The nurse is admitting a patient with benign prostatic hyperplasia (BPH) who has urinary retention and new onset elevations in blood urea nitrogen (BUN) and creatinine. Which of the following prescribed therapies should the nurse implement first?
- A. Schedule an abdominal computed tomography (CT) scan
- B. Insert a urinary retention catheter.
- C. Draw blood for a complete blood count.
- D. Infuse normal saline at 50 mL/hour.
Correct Answer: B
Rationale: The patient data indicate that the patient may have acute renal failure caused by the BPH. The initial therapy will be to insert a catheter. The other actions also are appropriate, but they can be implemented after the acute urinary retention is resolved.
The nurse is conducting discharge teaching with a patient who has undergone a vasectomy in the health care provider's office. Which of the following information should the nurse include in the discharge instructions?
- A. May have temporary erectile dyfunction (ED) because of postoperative swelling.
- B. Should continue to use other methods of birth control for 6 weeks.
- C. Should not have sexual intercourse until his 6-week follow-up visit.
- D. Will notice a decrease in the appearance and volume of his ejaculate.
Correct Answer: B
Rationale: Because it takes about 6 weeks to evacuate sperm that are distal to the vasectomy site, the patient should use contraception for 6 weeks. ED that occurs after vasectomy is psychological in origin and not related to postoperative swelling. The patient does not need to abstain from intercourse. The appearance and volume of the ejaculate are not changed because sperm are a minor component of the ejaculate.
Which of the following information should the nurse include when teaching a patient to perform testicular self-examination?
- A. Testicular self-examination should be done in a warm area.
- B. The only structure normally felt in the scrotal sac is the testis.
- C. Testicular self-examination should be done at least every week.
- D. Call the health care provider if one testis is larger than the other.
Correct Answer: A
Rationale: The testes will hang lower in the scrotum when the temperature is warm (e.g., during a shower), and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One testis is normally larger. The patient should perform testicular self-examination monthly.
The nurse is assessing a 53-year-old man who has been having increasing problems with erectile dysfunction (ED) for several years and is interested in using sildenafil. Which of the following actions should the nurse take first?
- A. Ask the patient about any prescription drugs he is taking.
- B. Tell the patient that sildenafil does not always work for ED.
- C. Discuss the common adverse effects of erecogenic drugs.
- D. Assure the patient that ED is commonly associated with aging.
Correct Answer: A
Rationale: Because some medications can cause ED and patients using nitrates should not take sildenafil, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of sildenafil therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease in a 53-year-old.
The nurse has completed discharge teaching for a patient who had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Which of the following patient statements indicate that additional instruction is required?
- A. I will avoid driving until I get approval from my doctor.
- B. I should call the doctor if I have any incontinence at home.
- C. I will increase fibre and fluids in my diet to prevent constipation.
- D. I should continue to schedule yearly appointments for prostate exams.
Correct Answer: B
Rationale: Since urinary incontinence is common for several weeks after a TURP the patient does not need to call the health care provider if this occurs. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.