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The nurse is assessing a patient with benign prostatic hyperplasia (BPH). Which of the following symptoms should the nurse assess to determine the severity of the BPH?
- A. Blood in the urine
- B. Lower back or hip pain
- C. Erectile dysfunction (ED)
- D. Strength of the urinary stream
Correct Answer: D
Rationale: The American Urological Association (AUA) Symptom Index (used in Canada) for a patient with BPH asks questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and back or hip pain are not typical symptoms of BPH.
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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.
The nurse is caring for a patient recently diagnosed with benign prostatic hyperplasia (BPH) who tells the nurse that he does not want to have a transurethtral resection of the prostate (TURP) because he is afraid it might affect his ability to have intercourse. Which of the following actions should the nurse take?
- A. Offer reassurance that sperm production is not affected by TURP.
- B. Discuss alternative methods of sexual expression besides intercourse.
- C. Provide education about the use of medications for erectile dysfunction (ED).
- D. Teach that erectile dysfunction (ED) is unlikely following a TURP.
Correct Answer: D
Rationale: ED is not a concern with TURP, although retrograde ejaculation is likely and the nurse should discuss this with the patient. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns.
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 is caring for a patient with erectile dyfunction (ED) following treatment for benign prostatic hyperplasia (BPH). He shares with the nurse that he is seeking treatment as his wife 'is losing patience with the situation.' Which of the following nursing diagnoses is best for the patient?
- A. Ineffective role performance related to alteration in body image
- B. Anxiety related to threat to current status (inability to have sexual intercourse)
- C. Situational low self-esteem related to alteration in body image
- D. Ineffective sexuality pattern related to skill deficit about alternatives related to sexuality
Correct Answer: A
Rationale: The patient's statement indicates that the relationship with his wife is his primary concern. Although anxiety, low self-esteem, and ineffective sexuality patterns also may be concerns, the patient information suggests that addressing the role performance problem will lead to the best outcome for this patient.
The nurse working in a health clinic receives calls from all these patients. Which of the following patients should be seen by the health care provider first?
- A. A 64-year-old man who has perineal pain and a temperature of 38°C (100.4°F)
- B. A 60-year-old man who has a painful erection that has lasted over 5 hours
- C. A 62-year-old man who has light pink urine after having a transurethral resection of the prostate (TURP) 3 days ago
- D. A 23-year-old man who states had had difficulty maintaining an erection last night
Correct Answer: B
Rationale: Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications.