A 76-year-old with benign prostatic hyperplasia (BPH) is agitated and
confused, with a markedly distended bladder. Which intervention
prescribed by the health care provider should the nurse implement first?
a. Insert a urinary retention catheter.
b. Schedule an intravenous pyelogram (IVP).
c. Draw blood for a serum creatinine level.
d. Administer lorazepam (Ativan) 0.5 mg PO. - ANS ✓A
The patients history and clinical manifestations are consistent with acute
urinary retention, and the priority action is to relieve the retention by
catheterization.
The BUN and creatinine measurements can be obtained after the catheter is
inserted. The patients agitation may resolve once the bladder distention is
corrected, and sedative drugs should be used cautiously in older patients.
The IVP is an appropriate test but does not need to be done urgently.
The nurse is caring for a patient who has had an ileal conduit for several
years. Which nursing action could be delegated to unlicensed assistive
personnel (UAP)?
a. Change the ostomy appliance.
b. Choose the appropriate ostomy bag.
c. Monitor the appearance of the stoma.
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d. Assess for possible urinary tract infection (UTI) - ANS ✓A
Changing the ostomy appliance for a stable patient could be done by UAP.
Assessments of the site, choosing the appropriate ostomy bag, and
assessing for (UTI) symptoms require more education and scope of practice
and should be done by the registered nurse (RN).
A 44-year-old patient is unable to void after having an open loop resection
and fulguration of the bladder. Which nursing action should be
implemented first?
a. Assist the patient to soak in a 15-minute sitz bath.
b. Insert a straight urethral catheter and drain the bladder.
c. Encourage the patient to drink several glasses of water.
d. Teach the patient how to do isometric perineal exercises. - ANS ✓A
Sitz baths will relax the perineal muscles and promote voiding.
Although the patient should be encouraged to drink fluids and Kegel
exercises are helpful in the prevention of incontinence, these activities
would not be helpful for a patient experiencing retention. Catheter
insertion increases the risk for urinary tract infection (UTI) and should be
avoided when possible
A 63-year-old male patient had a cystectomy with an ileal conduit
yesterday. Which new assessment data is most important for the nurse to
communicate to the physician?
a. Cloudy appearing urine
b. Hypotonic bowel sounds
c. Heart rate 102 beats/minute
d. Continuous stoma drainage - ANS ✓C
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Tachycardia may indicate infection, hemorrhage, or hypovolemia, which
are all serious complications of this surgery.
The urine from an ileal conduit normally contains mucus and is cloudy.
Hypotonic bowel sounds are expected after bowel surgery. Continuous
drainage of urine from the stoma is normal.
Which action will the nurse anticipate taking for an otherwise healthy 50-
year-old who has just been diagnosed with Stage 1 renal cell carcinoma?
a. Prepare patient for a renal biopsy.
b. Provide preoperative teaching about nephrectomy.
c. Teach the patient about chemotherapy medications.
d. Schedule for a follow-up appointment in 3 months. - ANS ✓B
The treatment of choice in patients with localized renal tumors who have
no co-morbid conditions is partial or total nephrectomy.
A renal biopsy will not be needed in a patient who has already been
diagnosed with renal cancer. Chemotherapy is used for metastatic renal
cancer. Because renal cell cancer frequently metastasizes, treatment will be
started as soon as possible after the diagnosis.
To determine the severity of the symptoms for a 68-year-old patient with
benign prostatic hyperplasia (BPH) the nurse will ask the patient about
a. blood in the urine.
b. lower back or hip pain.
c. erectile dysfunction (ED).
d. force of the urinary stream. - ANS ✓D
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.
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A 58-year-old patient who has been recently diagnosed with benign
prostatic hyperplasia (BPH) tells the nurse that he does not want to have a
transurethral resection of the prostate (TURP) because it might affect his
ability to maintain an erection during intercourse. Which action should the
nurse take?
a. Provide teaching about medications for erectile dysfunction (ED).
b. Discuss that TURP does not commonly affect erectile function.
c. Offer reassurance that sperm production is not affected by TURP.
d. Discuss alternative methods of sexual expression besides intercourse. -
ANS ✓B
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.
The health care provider prescribes finasteride (Proscar) for a 67-year-old
patient who has benign prostatic hyperplasia (BPH). When teaching the
patient about the drug, the nurse informs him that
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. - ANS ✓B
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 is also taking a medication for erectile dysfunction
(ED), it should not occur with finasteride alone. Improvement in symptoms
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