Nokea
The nurse is caring for a patient who had a transurethral resection of the prostate (TURP) and has a continuous bladder irrigation with symptoms of painful bladder spasms. The nurse observes a decrease in urine output and clots in the urine. Which of the following actions should the nurse take first?
- A. Increase the flow rate of the bladder irrigation.
- B. Administer the prescribed IV morphine sulphate.
- C. Give the patient the prescribed belladonna and opium suppository.
- D. Manually instill and then withdraw 50 mL of saline into the catheter.
Correct Answer: D
Rationale: The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.
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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.
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 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 is providing teaching for a patient with cancer of the prostate who has been prescribed leuprolide. Which of the following adverse effects should the nurse include in the teaching plan about this drug?
- A. Dizziness
- B. Hot flashes
- C. Urinary incontinence
- D. Increased infection risk.
Correct Answer: B
Rationale: Hot flashes may occur with decreased testosterone production. Dizziness may occur with the alpha-blockers used for benign prostatic hyperplasia (BPH). Urinary incontinence may occur after prostate surgery, but it is not an expected medication adverse effect. Risk for infection is increased in patients receiving chemotherapy.
A 51-year-old male patient is scheduled for an annual physical exam at the outpatient clinic. Which of the following diagnostic tests should the nurse plan to teach to the patient?
- A. Urinalysis collection
- B. Uroflowmetry studies
- C. Digital rectal exam (DRE)
- D. Transrectal Ultrasound scanning (TRUS)
Correct Answer: C
Rationale: An annual digital rectal exam (DRE) is recommended starting at age 50 for men who have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA is abnormal.