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The nurse is caring for a patient who has benign prostatic hyperplasia (BPH) with mild obstruction and tells the nurse, 'My symptoms have gotten a lot worse this week.' Which of the following responses by the nurse is best?
- A. I will talk to the health care provider about ordering a prostate specific antigen (PSA) test.
- B. Have you been taking any over-the-counter (OTC) medications recently?
- C. Have you talked to the doctor about surgical procedures such as transurethral resection of the prostate (TURP)?
- D. The prostate gland changes slightly in size from day to day, and this may be making your symptoms worse
Correct Answer: B
Rationale: Because the patient's increase in symptoms has occurred abruptly, the nurse should ask about OTC medications (such as decongestants and anticholinergics) that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer.
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The nurse is admitting a patient scheduled for a unilateral orchiectomy for testicular cancer. The nurse notes that the patient does not talk to his partner and speaks to the nurse only to answer the admission questions. Which of the following actions is best for the nurse to take?
- A. Ask the patient if he has any questions or concerns about the diagnosis and treatment.
- B. Document the patient's lack of communication on the chart and continue preoperative care.
- C. Assure the patient's partner that concerns about sexual function are common with this diagnosis.
- D. Teach the patient and the partner that impotence is rarely a problem after unilateral orchiectomy.
Correct Answer: A
Rationale: The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer education about complications after orchiectomy. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.
The nurse is teaching a patient who is scheduled for a transurethral resection of the prostate (TURP) about continuous bladder irrigation. Which of the following information should the nurse include?
- A. Bladder irrigation decreases the risk of postoperative bleeding.
- B. Hydration and urine output are maintained by bladder irrigation.
- C. Bladder irrigation prevents obstruction of the catheter after surgery.
- D. Antibiotics are infused on a continuous basis with bladder irrigation.
Correct Answer: C
Rationale: The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or improve hydration. Antibiotics are given by the IV route, not through the bladder irrigation.
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.
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 is preparing a teaching plan for a patient with symptomatic benign prostatic hyperplasia (BPH) who is scheduled for photovaporization of the prostate (PVP) at an outpatient surgical centre. Which of the following information should the nurse include in the teaching plan?
- A. How to care for an in-dwelling urinary catheter?
- B. The urine will appear bloody for several days.
- C. Complications associated with urethral stenting.
- D. Symptom improvement will occur in 2-3 weeks.
Correct Answer: A
Rationale: The patient will have an in-dwelling catheter for 24-48 hours and will need teaching about catheter care. There is minimal bleeding with this procedure. Symptom improvement is almost immediate after PVP. Stent placement is not included in the procedure.