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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.
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The nurse is conducting a focused health history for a patient with possible testicular cancer. Which of the following topics should the nurse include in the assessment?
- A. Sexually transmitted infections (STIS)
- B. Testicular trauma
- C. Testicular torsion
- D. Undescended testicles
Correct Answer: D
Rationale: Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STIs, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer.
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.
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 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.
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.