a. blood in the urine.
b. lower back or hip pain.
c. erectile dysfunction (ED).
d. strength of the urinary stream.
The American Urological Association (AUA) Symptom Index 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.
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) occurring after TURP.
d. Teach that ED is not a common complication following a TURP.
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.
a. he should change position from lying to standing slowly to avoid dizziness.
b. his interest in sexual activity may decrease while he is taking the medication.
c. improvement in the obstructive symptoms should occur within about 2 weeks.
d. he will need to monitor his blood pressure frequently to assess for hypertension.
A decrease in libido is a side 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.
b. uroflowmetry studies.
c. magnetic resonance imaging (MRI).
d. transrectal ultrasonography (TRUS).
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.
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.
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.
a. how to care for an indwelling urinary catheter.
b. that the urine will appear bloody for several days.
c. about complications associated with urethral stenting.
d. that symptom improvement will occur in 2 to 3 weeks.
The patient will have an indwelling catheter for 24 to 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.
a. urinalysis collection.
b. uroflowmetry studies.
c. prostate specific antigen (PSA) testing.
d. transrectal ultrasound scanning (TRUS).
An annual digital rectal exam (DRE) and PSA are 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 are abnormal.
a. urinary stasis.
b. urinary incontinence.
c. possible fecal contamination of the surgical wound.
d. placement of a suprapubic catheter into the bladder.
The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery.
a. to restrict oral fluid intake.
b. pelvic floor muscle exercises.
c. the use of belladonna and opium suppositories.
d. how to perform intermittent self-catheterization.
Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L.
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 fiber and fluids in my diet to prevent constipation.”
d. “I should continue to schedule yearly appointments for prostate exams.”
Since 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.
b. hot flashes.
c. urinary incontinence.
d. increased infection risk.
Hot flashes may occur with decreased testosterone production. Dizziness may occur with the -blockers used for benign prostatic hyperplasia (BPH). Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy.
a. Ibuprofen (Motrin) should provide good pain control.
b. Prescribed antibiotics should be taken for 7 to 10 days.
c. Sexual intercourse and masturbation will help relieve symptoms.
d. Cold packs should be used every 4 hours to reduce inflammation.
Ejaculation helps drain the prostate and relieve pain. Warm baths are recommended to reduce pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed but usually do not offer adequate pain relief. Antibiotics for chronic prostatitis are taken for 4 to 12 weeks.
Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility
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.
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.
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 wife that concerns about sexual function are common with this diagnosis.
d. Teach the patient and the wife that impotence is rarely a problem after unilateral orchiectomy.
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.
a. he may have temporary erectile dysfunction (ED) because of postoperative swelling.
b. he should continue to use other methods of birth control for 6 weeks.
c. he should not have sexual intercourse until his 6-week follow-up visit.
d. he will notice a decrease in the appearance and volume of his ejaculate.
Because it takes about 6 weeks to evacuate sperm that are distal to the vasectomy site, the patient should use contraception for 6 weeks. ED that occurs after vasectomy is psychologic in origin and not related to postoperative swelling. The patient does not need to abstain from intercourse. The appearance and volume of the ejaculate are not changed because sperm are a minor component of the ejaculate.
a. ineffective role performance related to effects of ED.
b. anxiety related to inability to have sexual intercourse.
c. situational low self-esteem related to decrease in sexual activity.
d. ineffective sexuality patterns related to frequency of intercourse.
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.
a. “I will talk to the doctor 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.”
Because the patient’s increase in symptoms has occurred abruptly, the nurse should ask about OTC medications 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.
a. sexually transmitted disease (STD) infection.
b. testicular trauma.
c. testicular torsion.
d. undescended testicles.
Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STD infection, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer.
a. pain management.
b. emergency surgical repair.
c. aspiration of fluid from the scrotal sac.
d. application of warm packs to the scrotum.
Orchitis is very painful and effective pain management will be needed. The other therapies will not be used to treat orchitis.
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/hr.
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.
a. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH)
b. A 38-year-old who is being treated for acute prostatitis
c. A 48-year-old whose father died of metastatic prostate cancer
d. A 52-year-old who goes on long bicycle rides every weekend
The family history and elevation of PSA in the 48-year-old indicate that further evaluation of the patient for prostate cancer is needed. The elevations in PSA for the other patients are not unusual.
a. Increase the flow rate of the bladder irrigation.
b. Administer the prescribed IV morphine sulfate.
c. Give the patient the prescribed belladonna and opium suppository.
d. Manually instill and then withdraw 50 mL of saline into the catheter.
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.
a. “Are you using any recreational drugs or drinking a lot of alcohol?”
b. “Have you been experiencing an unusual amount of anxiety or stress?”
c. “Do you have any history of an erection that lasted for 6 hours or more?”
d. “Do you have any chronic cardiovascular or peripheral vascular disease?”
A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are not common etiologic factors in younger men.
a. Ask the patient about any prescription drugs he is taking.
b. Tell the patient that Viagra does not always work for ED.
c. Discuss the common adverse effects of erectogenic drugs.
d. Assure the patient that ED is commonly associated with aging.
Because some medications can cause ED and patients using nitrates should not take Viagra, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of Viagra 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.
a. A 44-year-old man who has perineal pain and a temperature of 100.4° F
b. A 66-year-old man who has a painful erection that has lasted over 7 hours
c. A 62-year-old man who has light pink urine after having a transurethral resection of the prostate (TURP) 3 days ago
d. A 23-year-old man who states he had difficulty maintaining an erection last night
Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications.
a. The patient’s symptoms have increased steadily over the last few years.
b. The patient has been using sildenafil (Viagra) several times every week.
c. The patient has had a gradual decrease in the force of his urinary stream.
d. The patient states that he has noticed a decrease in energy level for a few years.
The decrease in urinary stream may indicate benign prostatic hyperplasia (BPH) or prostate cancer, which are contraindications to the use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient.