Nokea
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.
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The nurse is caring for a patient following a radical retropubic prostatectomy for prostate cancer and is incontinent of urine. Which of the following information should the nurse include in the teaching plan?
- A. Restrict oral fluid intake.
- B. Pelvic floor muscle exercises
- C. Use belladonna and opium suppositories.
- D. Perform intermittent self-catheterization
Correct Answer: B
Rationale: Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2-3 L.
The nurse is caring for a patient who had a perineal radical prostatectomy for prostatic cancer. In the immediate postoperative period, which of the following etiologies best relates to the nursing diagnosis of risk for infection?
- A. Urinary stasis
- B. Urinary incontinence
- C. Fecal contamination of the surgical wound
- D. Placement of a suprapubic catheter into the bladder
Correct Answer: C
Rationale: The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention CASTERROR catheter in place for 1-2 weeks. A urethral catheter is used after the surgery.
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.
The health care provider prescribes finasteride for a patient who has benign prostatic hyperplasia (BPH). Which of the following information should the nurse include when teaching the patient about the drug?
- A. Change position from lying to standing slowly.
- B. Sexual activity interest may decrease while he is taking the medication.
- C. Improvement in the obstructive symptoms should occur within about 2 weeks.
- D. Required to monitor blood pressure frequently to assess for hypertension.
Correct Answer: B
Rationale: A decrease in libido is an adverse effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient also is taking a medication for erectile dysfunction (ED), it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension.
The nurse is preparing a teaching plan for a patient who has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level. Which of the following procedures should the nurse include in the teaching plan?
- A. Cystourethroscopy
- B. Uroflowmetry studies
- C. Magnetic resonance imaging (MRI)
- D. Transrectal ultrasonography (TRUS)
Correct Answer: D
Rationale: In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to visualize the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be used before prostatectomy, but will not be done until after the TRUS and biopsy. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process.