Nokea
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.
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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.
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 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 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 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.