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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.
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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 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.
The health care provider prescribes finasteride for a patient who has benign prostatic hyperplasia (BPH). Which of the following information should the nurse include when teaching the patient about the drug?
- A. Change position from lying to standing slowly.
- B. Sexual activity interest may decrease while he is taking the medication.
- C. Improvement in the obstructive symptoms should occur within about 2 weeks.
- D. Required to monitor blood pressure frequently to assess for hypertension.
Correct Answer: B
Rationale: A decrease in libido is an adverse effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient also is taking a medication for erectile dysfunction (ED), it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension.
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 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.