Exam 2 Flashcards
A 73-year-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the “stream is less than it used to be.” The nurse should give the patient anticipatory guidance that what condition may be developing?
A. A tumor of the prostate
B. Benign prostatic hyperplasia
C. Bladder atony because of age
D. Age-related altered innervation of the bladder
B. Benign prostatic hyperplasia
Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men over age 50 and 80% of men over age 80. Only about 16% of men develop prostate cancer. Bladder atony and age-related altered innervations of the bladder do not lead to a weakened stream.
To accurately monitor progression of a symptom of decreased urinary stream, the nurse should encourage the patient to have which primary screening measure done on a regular basis?
A. Uroflowmetry
B. Transrectal ultrasound
C. Digital rectal examination (DRE)
D. Prostate-specific antigen (PSA) monitoring
C. Digital rectal examination (DRE)
Digital rectal examination is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia in men over 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.
The patient has had cardiovascular disease for some time and has now developed erectile dysfunction. He is frustrated because he cannot take erectogenic medications because he takes nitrates for his cardiac disease. What should the nurse do first to help this patient?
A. Give the patient choices for penile implant surgery.
B. Recommend counseling for the patient and his partner.
C. Obtain a thorough sexual, health, and psychosocial history.
D. Assess levels of testosterone, prolactin, LH, and thyroid hormones.
C. Obtain a thorough sexual, health, and psychosocial history.
The nurse’s first action to help this patient is to obtain a thorough sexual, health, and psychosocial history. Alternative treatments for the cardiac disease would then be explored if that had not already been done. Further examination or diagnostic testing would be based on the history and physical assessment, including hormone levels, counseling, or penile implant options.
After a vasectomy, what teaching should be included in the discharge teaching?
A. “You will want to use an alternative form of contraception for 6 weeks.”
B. “You may lose some secondary sexual characteristics after this surgery.”
C. “You may have erectile dysfunction for several months after this surgery.”
D. “You will be uncomfortable, but you may safely have sexual intercourse today.”
A. “You will want to use an alternative form of contraception for 6 weeks.”
As vasectomies are usually done for sterilization purposes, to safely have sexual intercourse, the patient will need to use an alternative form of contraception until semen examination reveals no sperm, usually at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site. Hormones are not affected, so there is no loss of secondary sexual characteristics or erectile function. Most men experience too much pain to have sexual intercourse on the day of their surgery, so this is not an appropriate comment by the nurse.
A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)?
A. E. coli bacteria in his urine
B. A very tender prostate gland
C. Complaints of chills and rectal pain
D. Complaints of urgency and frequency
B. A very tender prostate gland
A tender and swollen prostate is indicative of prostatis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatis.
A 33-year-old patient noticed a painless lump in his scrotum on self-examination of his testicles and a feeling of heaviness. The nurse should first teach him about what diagnostic test?
A. Ultrasound
B. Cremasteric reflex
C. Doppler ultrasound
D. Transillumination with a flashlight
A. Ultrasound
When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.
The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on “watchful waiting” status for 5 years. Six months ago his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations now indicate that the prostate cancer may be growing and he needs a change in his care (select all that apply)?
A. Casts in his urine B. Presence of α-fetoprotein C. Serum PSA level 10 ng/mL D. Onset of erectile dysfunction E. Nodularity of the prostate gland
C. Serum PSA level 10 ng/mL Correct
E. Nodularity of the prostate gland Correct
The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth.
Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy?
A. Assessing the patient’s incision
B. Irrigating the patient’s Foley catheter
C. Assessing the patient’s pain and selecting analgesia
D. Performing cleansing of the meatus and perineal region
D. Performing cleansing of the meatus and perineal region
Performing perineal care is an appropriate task for delegation. Selecting analgesia, irrigating the patient’s catheter, and assessing his incision are not appropriate skills or tasks for unlicensed personnel.
A 71-year-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a contact laser technique. What is the primary goal of this intervention?
A. Resumption of normal urinary drainage Correct
B. Maintenance of normal sexual functioning
C. Prevention of acute or chronic renal failure Incorrect
D. Prevention of fluid and electrolyte imbalances
A. Resumption of normal urinary drainage
The most significant signs and symptoms of BPH relate to the disruption of normal urinary drainage and consequent urine retention, incontinence, and pain. A laser technique vaporizes prostate tissue and cauterizes blood vessels and is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.
A patient is one day postoperative following a transurethral resection of the prostate (TURP). Which event is not an expected normal finding in the care of this patient?
A. The patient requires two tablets of Tylenol #3 during the night.
B. The patient complains of fatigue and claims to have minimal appetite.
C. The patient has continuous bladder irrigation (CBI) infusing, but output has decreased.
D. The patient has expressed anxiety about his planned discharge home the following day.
C. The patient has continuous bladder irrigation (CBI) infusing, but output has decreased.
A decrease or cessation of output in a patient with CBI requires immediate intervention. The nurse should temporarily stop the CBI and attempt to resume output by repositioning the patient or irrigating the catheter. Complaints of pain, fatigue, and low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient’s CBI.
A 72-year-old male is in the emergency
department because he has been unable to void for
the past 12 hours. The best method for the nurse to
use when assessing for bladder distention in a male
client is to check for:
■ 1. A rounded swelling above the pubis.
■ 2. Dullness in the lower left quadrant.
■ 3. Rebound tenderness below the symphysis.
■ 4. Urine discharge from the urethral meatus.
.
- The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. This swelling represents the distended bladder rising above the pubis into the abdominal cavity. Dullness does not indicate a distended bladder. The client might experience tenderness or pressure above the symphysis. No urine discharge is expected; the urine flow is blocked by the enlarged prostate.
During a client’s urinary bladder catheterization,
the nurse ensures that the bladder is emptied
gradually. The best rationale for the nurse’s action is
that completely emptying an overdistended bladder
at one time tends to cause:
■ 1. Renal failure.
■ 2. Abdominal cramping.
■ 3. Possible shock.
■ 4. Atrophy of bladder musculature.
- Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1000 mL at one time was the standard of practice, but this is no longer thought to be necessary as long as the overdistended bladder is emptied slowly.
The primary reason for lubricating the urinary
catheter generously before inserting it into a
male client is that this technique helps reduce:
■ 1. Spasms at the orifi ce of the bladder.
■ 2. Friction along the urethra when the catheter
is being inserted.
■ 3. The number of organisms gaining entrance to
the bladder.
■ 4. The formation of encrustations that may
occur at the end of the catheter.
- Liberal lubrication of the catheter before catheterization of a male reduces friction along the urethra and irritation and trauma to urethral tissues. Because the male urethra is tortuous, a liberal amount of lubication is advised to ease catheter passage. Lubrication of the catheter will not decrease spasms. The nurse should use sterile technique to prevent introducing organisms. Crusts will not form immediately. Irrigating the catheter as needed will prevent clot and crust formation.
The primary reason for taping an indwelling
catheter laterally to the thigh of a male client
is to:
■ 1. Eliminate pressure at the penoscrotal angle.
■ 2. Prevent the catheter from kinking in the urethra.
■ 3. Prevent accidental catheter removal.
■ 4. Allow the client to turn without kinking the
catheter.
- The primary reason for taping an indwelling catheter to a male client so that the penis is held in a lateral position is to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula.
Many older men with prostatic hypertrophy
do not seek medical attention until urinary obstruction
is almost complete. One reason for this delay in
seeking attention is that these men may:
■ 1. Feel too self-conscious to seek help when
reproductive organs are involved.
■ 2. Expect that it is normal to have to live
with some urinary problems as they grow
older.
■ 3. Fear that sexual indiscretions in earlier life
may be the cause of their problem.
■ 4. Have little discomfort in relation to the
amount of pathology because responses to
pain stimuli fade with age
- Research shows that older men tend to believe it is normal to live with some urinary problems. As a result these men often overlook symptoms and simply attribute them to aging. As part of preventative care for men older than 40, the yearly physical examination should include palpation of the prostate via rectal examination. Prostate specific antigen screening is also done annually to determine elevations or increasing trends in elevations. The nurse should teach male clients the value of early detection and adequate follow up for the prostate.
When caring for a client with a history of
benign prostatic hypertrophy (BPH), the nurse
should do which of the following? Select all that
apply.
■ 1. Provide privacy and time for the client to void.
■ 2. Monitor intake and output.
■ 3. Catheterize the client for post void residual
urine.
■ 4. Ask the client if he has urinary retention.
■ 5. Test the urine for hematuria.
1.2.4.5. Because of the history of benign prostatic hypertrophy, the nurse should provide privacy and time for the client to void. The nurse should also monitor intake and output, assess the client for urinary retention, and test the urine for hematuria. It is not necessary to catheterize the client.
The nurse should specifically assess a client
with prostatic hypertrophy for which of the following ?
■ 1. Voiding at less frequent intervals.
■ 2. Diffi culty starting the fl ow of urine.
■ 3. Painful urination.
■ 4. Increased force of the urine stream.
- Signs and symptoms of prostatic hypertrophy
include diffi culty starting the fl ow of urine, urinary
frequency and hesitancy, decreased force of the
urine stream, interruptions in the urine stream when
voiding, and nocturia. The prostate gland surrounds
the urethra, and these symptoms are all attributed
to obstruction of the urethra resulting from prostatic
hypertrophy. Nocturia from incomplete emptying
of the bladder is common. Straining and urine
retention are usually the symptoms that prompt the
client to seek care. Painful urination is generally not
a symptom of prostatic hypertrophy.
- The nurse is reviewing the medication history
of a client with benign prostatic hypertrophy
(BPH). Which medication will likely aggravate BPH?
■ 1. Metformin (Glucophage).
■ 2. Buspirone (BuSpar).
■ 3. Inhaled ipratropium (Atrovent).
■ 4. Ophthalmic timolol (Timoptic).
- Ipratropium is a bronchodilator, and its
anticholinergic effects can aggravate urine retention.
Metformin and buspirone do not affect the urinary
system; timolol does not have a systemic effect.
A client is scheduled to undergo transurethral
resection of the prostate. The procedure is to
be done under spinal anesthesia. Postoperatively,
the nurse should assess the client for:
■ 1. Seizures.
■ 2. Cardiac arrest.
■ 3. Renal shutdown.
■ 4. Respiratory paralysis.
- If paralysis of vasomotor nerves in the
upper spinal cord occurs when spinal anesthesia
is used, the client is likely to develop respiratory
paralysis. Artifi cial ventilation is required until the
effects of the anesthesia subside. Seizures, cardiac
arrest, and renal shutdown are not likely results of
spinal anesthesia.
A client with benign prostatic hypertrophy
(BPH) is being treated with terazosin (Hytrin) 2 mg
at bedtime. The nurse should monitor the client’s:
■ 1. Urine nitrites.
■ 2. White blood cell count.
■ 3. Blood pressure.
■ 4. Pulse.
- Terazosin is an antihypertensive drug that
is also used in the treatment of BPH. Blood pressure
must be monitored to ensure that the client does
not develop hypotension, syncope, or orthostatic
hypotension. The client should be instructed to
change positions slowly. Urine nitrates, white blood
cell count, and pulse rate are not affected by terazosin
A client underwent transurethral resection of
the prostate (TURP), and a large three-way indwelling
urinary catheter was inserted in the bladder
with continuous bladder irrigation. In which of the
following circumstances should the nurse increase
the flow rate of the continuous bladder irrigation?
■ 1. When drainage is continuous but slow.
■ 2. When drainage appears cloudy and dark yellow.
■ 3. When drainage becomes bright red.
■ 4. When there is no drainage of urine and irrigating
solution.
- The decision by the surgeon to insert a
catheter after TURP or prostatectomy depends on
the amount of bleeding that is expected after the
procedure. During continuous bladder irrigation
after a TURP or prostatectomy, the rate at which
the solution enters the bladder should be increased
when the drainage becomes brighter red. The color
indicates the presence of blood. Increasing the flow
of irrigating solution helps flush the catheter well so
that clots do not plug it. There would be no reason
to increase the fl ow rate when the return is continuous
or when the return appears cloudy and dark
yellow. Increasing the fl ow would be contraindicated
when there is no return of urine and irrigating
solution.
A client is to receive belladonna and opium
suppositories, as needed, postoperatively after
transurethral resection of the prostate (TURP). The
nurse should give the client these drugs when he
demonstrates signs of:
■ 1. A urinary tract infection.
■ 2. Urine retention.
■ 3. Frequent urination.
■ 4. Pain from bladder spasms.
- Belladonna and opium suppositories are
prescribed and administered to reduce bladder
spasms that cause pain after TURP. Bladder spasms
frequently accompany urologic procedures. Antispasmodics offer relief by eliminating or reducing
spasms. Antimicrobial drugs are used to treat an
infection. Belladonna and opium do not relieve
urine retention or urinary frequency.
A nursing assistant tells the nurse, “I think
the client is confused. He keeps telling me he has to
void, but that isn’t possible because he has a catheter
in place that is draining well.” Which of the
following responses would be most appropriate for
the nurse to make?
■ 1. “His catheter is probably plugged. I’ll irrigate
it in a few minutes.”
■ 2. “That’s a common complaint after prostate
surgery. The client only imagines the urge to
void.”
■ 3. “The urge to void is usually created by the
large catheter, and he may be having some
bladder spasms.”
■ 4. “I think he may be somewhat confused.”
- The indwelling urinary catheter creates the
urge to void and can also cause bladder spasms. The
nurse should ensure adequate bladder emptying by
monitoring urine output and characteristics. Urine
output should be at least 50 mL/hour. A plugged
catheter, imagining the urge to void, and confusion
are less likely reasons for the client’s complaint.
A physician has ordered amoxicillin 100
P.O. BID (Ampicillin). The nurse should teach the
client to: Select all that apply.
■ 1. Drink 2,500 mL of fl uids daily.
■ 2. Void frequently, at least every 2 to 3 hours.
■ 3. Take time to empty the bladder completely.
■ 4. Take the last dose of the antibiotic for the day
at bedtime.
■ 5. Take the antibiotic with food.
1, 2, 3, 4. Ampicillin may be given with or
without food, but the nurse should instruct the client
to obtain an adequate fl uid intake (2,500 mL)
to promote urinary output and to fl ush out bacteria
from the urinary tract. The nurse should also
encourage the client to void frequently (every 2 to
3 hours) and empty the bladder completely. Taking
the antibiotic at bedtime, after emptying the bladder,
helps to ensure an adequate concentration of the
drug during the overnight period.
In discussing home care with a client after
transurethral resection of the prostate (TURP), the
nurse should teach the male client that dribbling of
urine:
■ 1. Can be a chronic problem.
■ 2. Can persist for several months.
■ 3. Is an abnormal sign that requires intervention.
■ 4. Is a sign of healing within the prostate.
- Dribbling of urine can occur for several
months after TURP. The client should be informed
that this is expected and is not an abnormal sign.
The nurse should teach the client perineal exercises
to strengthen sphincter tone. The client may need
to use pads for temporary incontinence. The client should be reassured that continence will return in a
few months and will not be a chronic problem. Dribbling
is not a sign of healing, but is related to the
trauma of surgery.
A priority nursing diagnosis for the client
who is being discharged to home 3 days after transurethral
resection of the prostate (TURP) is:
■ 1. Defi cient fl uid volume.
■ 2. Imbalanced nutrition: Less than body requirements.
■ 3. Impaired tissue integrity.
■ 4. Ineffective airway clearance.
- Defi cient fl uid volume is a priority diagnosis
because the client needs to drink a large amount
of fl uids to keep the urine clear. The urine should
be almost without color. About 2 weeks after TURP,
when desiccated tissue is sloughed out, a secondary
hemorrhage could occur. The client should be
instructed to call the surgeon or go to the emergency
department if at any time the urine turns bright red.
The client is not specifi cally at risk for nutritional
problems after TURP. The client is not specifi cally at
risk for impaired tissue integrity because there is no
external incision, and the client is not specifi cally
at risk for airway problems because the procedure is
done under spinal anesthesia.
.
A client with benign prostatic hypertrophy
(BPH) has an elevated prostate-specifi c antigen
(PSA) level. The nurse should?
■ 1. Instruct the client to have a colonoscopy
before coming to conclusions about the PSA
results.
■ 2. Instruct the client that a urologist will monitor
the PSA level biannually when elevated.
■ 3. Determine if the prostatic palpation was done
before or after the blood sample was drawn.
■ 4. Ask the client if he emptied his bladder
before the blood sample was obtained.
- Rectal and prostate examinations can
increase serum PSA levels; therefore, instruct the
client that a manual rectal examination is usually
part of the test regimen to determine prostate
changes. The prostatic palpation should be done
after the blood sample is drawn. The PSA level must
be monitored more often than biannually when it is
elevated. Having a colonoscopy is not related to the
fi ndings of the PSA test. It is not necessary to void
prior to having PSA blood levels tested
A 28-year-old male is diagnosed with acute
epididymitis. The nurse should assess the client for:
■ 1. Burning and pain on urination.
■ 2. Severe tenderness and swelling in the scrotum.
■ 3. Foul-smelling ejaculate.
■ 4. Foul-smelling urine.
- Epididymitis causes acute tenderness and
pronounced swelling of the scrotum. Gradual onset
of unilateral scrotal pain, urethral discharge, and
fever are other key signs. Epididymitis is occasionally,
but not routinely, associated with urinary tract
infection. Burning and pain on urination and foulsmelling
ejaculate or urine are not classic symptoms
of epididymitis.
A 20-year-old client is being treated for
epididymitis. Teaching for this client should include
the fact that epididymitis is commonly a result of a:
■ 1. Virus.
■ 2. Parasite.
■ 3. Sexually transmitted infection.
■ 4. Protozoon.
- Among men younger than age 35,
epididymitis is most frequently caused by a sexually
transmitted infection. Causative organisms are usually
chlamydia or Neisseria gonorrhoeae. The other
major form of epididymitis is bacterial, caused by
the Escherichia coli or Pseudomonas organisms. The
nurse should always include safe sex teaching for a
client with epididymitis. The client should also be advised against anogenital intercourse because this
is a mode of transmission of gram-negative rods to
the epididymis.
- When teaching a client to perform testicular
self-examination, the nurse explains that the examination
should be performed:
■ 1. After intercourse.
■ 2. At the end of the day.
■ 3. After a warm bath or shower.
■ 4. After exercise.
- After a warm bath or shower, the testes
hang lower and are both relaxed and in the ideal
position for manual evaluation and palpation.
The nurse is assessing a client’s testes. Which
of the following fi ndings indicate the testes are
normal?
■ 1. Soft.
■ 2. Egg-shaped.
■ 3. Spongy.
■ 4. Lumpy.
- Normal testes feel smooth, egg-shaped,
and firm to the touch, without lumps. The surface
should feel smooth and rubbery. The testes should
not be soft or spongy to the touch. Testicular malignancies
are usually nontender, nonpainful hard
lumps. Lumps, swelling, nodules, or signs of infl ammation
should be reported to the physician.
- A client has a testicular nodule that is highly
suspicious for testicular cancer. A laboratory test
that supports this diagnosis is:
■ 1. Decreased alpha fetoprotein (AFP).
■ 2. Decreased beta–human chorionic gonadotropin
(hCG).
■ 3. Increased testosterone.
■ 4. Increased AFP.
- AFP and hCG are considered markers that
indicate the presence of testicular disease. Elevated
AFP and hCG and decreased testosterone are markers
for testicular disease. Measurements of AFP,
hCG, and testosterone are also obtained throughout
the course of therapy to help measure the effectiveness
of treatment.
Although the cause of testicular cancer is
unknown, it is associated with a history of:
■ 1. Undescended testes.
■ 2. Sexual relations at an early age.
■ 3. Seminal vesiculitis.
■ 4. Epididymitis.
- Cryptorchidism (undescended testes) carries
a greatly increased risk for testicular cancer.
Undescended testes occurs in about 3% of male
infants, with an increased incidence in premature
infants. Other possible causes of malignancy include
chemical carcinogens, trauma, orchitis, and environmental
factors. Testicular cancer is not associated
with early sexual relations in men, even though cervical
cancer is associated with early sexual relations
in women. Testicular cancer is not associated with
seminal vesiculitis or epididymitis.
Risk factors associated with testicular malignancies include: ■ 1. African-American race. ■ 2. Residing in a rural area. ■ 3. Lower socioeconomic status. ■ 4. Age older than 40 years.
- The incidence of testicular cancer is higher
in men who live in rural rather than suburban
areas. Testicular cancer is more common in white
than black men. Men with higher socioeconomic
status seem to have a greater incidence of testicular
cancer. The exact cause of testicular cancer is
unknown. Cancer of the testes is the leading cause
of death from cancer in the 15- to 35-year-old agegroup.
A client with a testicular malignancy undergoes a radical orchiectomy. In the immediate postoperative period the nurse should particularly assess the client for: ■ 1. Bladder spasms. ■ 2. Urine output. ■ 3. Pain. ■ 4. Nausea.
- Because of the location of the incision
in the high inguinal area, pain is a major problem
during the immediate postoperative period. The
incisional area and discomfort caused by movement
contribute to increased pain. Bladder spasms and
elimination problems are more commonly associated
with prostate surgery. Nausea is not a priority
problem.
sicles) may
A right orchiectomy is performed on a client
with a testicular malignancy. The client expresses
concerns regarding his sexuality. The nurse should
base the response on the knowledge that the client:
■ 1. Is not a candidate for sperm banking.
■ 2. Should retain normal sexual drive and function.
■ 3. Will be impotent.
■ 4. Will have a change in secondary sexual characteristics.
- Unilateral orchiectomy alone does not
result in impotence if the other testis is normal. The
other testis should produce enough testosterone
to maintain normal sexual drive, functioning, and
characteristics. Sperm banking before treatment is
commonly recommended because radiation or chemotherapy
can affect fertility.
A client diagnosed with seminomatous testicular
cancer expresses fear and questions the nurse
about his prognosis. The nurse should base the
response on the knowledge that:
■ 1. Testicular cancer is almost always fatal.
■ 2. Testicular cancer has a cure rate of 90% when
diagnosed early.
■ 3. Surgery is the treatment of choice for testicular
cancer.
■ 4. Testicular cancer has a 50% cure rate when
diagnosed early.
- When diagnosed early and treated aggressively,
testicular cancer has a cure rate of about
90%. Treatment of testicular cancer is based on
tumor type, and seminoma cancer has the best prognosis.
Modes of treatment include combinations of
orchiectomy, radiation therapy, and chemotherapy.
The chemotherapeutic regimen used currently is
responsible for the successful treatment of testicular
cancer.
The nurse is developing a program about
prostate cancer for a health fair. The nurse should
provide information about which of the following
topics?
■ 1. The Prostate-Specifi c Antigen (PSA) test is reliable
for detecting the presence of prostate cancer.
■ 2. For all men, age 50 and older, the American
Cancer Society recommends an annual rectal
examination.
■ 3. Avoid lifting more than 20 lb aids in prevention
of prostate cancer.
■ 4. Regular sexual activity promotes health of the
prostate gland to prevent cancer.
- Most prostate cancer is adenocarcinoma
and is palpable on rectal examination because
it arises from the posterior portion of the gland.
Although the PSA is not a perfect screening test, the
American Cancer Society recommends an annual
rectal examination and blood PSA level for all men
age 50 and older, or starting at age 40 if African
American or if there is family history of prostate
cancer. To help achieve optimal sexual function,
give the client the opportunity to communicate his
concerns and sexual needs. Regular sexual activity
does not prevent cancer.
The nurse is caring for a client who will
have a bilateral orchiectomy. The client asks what
is involved with this procedure. The nurse’s most
appropriate response would be? “The surgery:
■ 1. Removes the entire prostate gland, prostatic
capsule, and seminal vesicles.”
■ 2. Tends to cause urinary incontinence and
impotence.”
■ 3. Freezes prostate tissue, killing cells.”
■ 4. Results in reduction of the major circulating
androgen, testosterone.”
- Bilateral orchiectomy (removal of testes)
results in reduction of the major circulating androgen,
testosterone, as a palliative measure to reduce
symptoms and progression of prostate cancer.
A radical prostatectomy (removal of entire prostate
gland, prostatic capsule, and seminal vesicles) may include pelvic lymphadenectomy. Complications
include urinary incontinence, impotence, and rectal
injury with the radical prostatectomy. Cryosurgery
freezes prostate tissue, killing tumor cells without
prostatectomy.
The nurse is teaching a client newly diagnosed
with prostate cancer. Which of the following points
should be included in the instruction? Select all that
apply.
■ 1. Prostate cancer is usually multifocal and
slow-growing.
■ 2. Most prostate cancers are adenocarcinoma.
■ 3. The incidence of prostate cancer is higher
in African American men, and the onset is
earlier.
■ 4. A prostate specifi c antigen (PSA) lab
test greater than 4 ng/mg will need to be
monitored.
■ 5. Cancer cells are detectable in the urine.
1, 2, 3, 4. Cancer of the prostate gland is the
second-leading cause of cancer death among American
men and is the most common carcinoma in
men older than age 65. Incidence of prostate cancer
is higher in African American men, and onset is
earlier. Most prostate cancers are adenocarcinoma.
Prostate cancer is usually multifocal, slow-growing,
and can spread by local extension, by lymphatics, or
through the bloodstream. Prostate-specifi c antigen
(PSA) greater than 4 ng/mg is diagnostic; a free PSA
level can help stratify the risk of elevated PSA levels.
Metastatic workup may include skeletal x-ray,
bone scan, and CT or MRI to detect local extension,
bone, and lymph node involvement. The urine does
not have prostate cancer cells.
When a client is receiving hormone replacement
for prostate cancer, the nurse should do which
of the following? Select all that apply.
■ 1. Inform the client that increased libido is
expected with hormone therapy.
■ 2. Reassure the client and his signifi cant other
that erectile dysfunction will not occur as a
consequence of hormone therapy.
■ 3. Provide the client the opportunity to communicate
concerns and needs.
■ 4. Utilize communication strategies that
enable the client to gain some feeling of
control.
■ 5. Suggest that an appointment be made to see a
psychiatrist.
3, 4. Hormone manipulation deprives tumor
cells of androgens or their by-products and, thereby,
alleviates symptoms and retards disease progression.
Complications of hormonal manipulation
include: hot fl ashes, nausea and vomiting, gynecomastia,
and sexual dysfunction. As part of supportive
care, provide explanations of diagnostic tests
and treatment options and help the client gain some
feeling of control over his disease and decisions
related to it. To help achieve optimal sexual function,
give the client the opportunity to communicate
his concerns and sexual needs. Inform the client
that decreased libido is expected after hormonal
manipulation therapy, and that impotence may
result from some surgical procedures and radiation.
A psychiatrist is not needed.
A client asks the nurse why the prostate
specifi c antigen (PSA) level is determined before the
digital rectal examination. The nurse’s best response
is which of the following?
■ 1. “It is easier for the client.”
■ 2. “A prostate examination can possibly
decrease the PSA.”
■ 3. “A prostate examination can possibly
increase the PSA.”
■ 4. “If the PSA is normal, the client will not have
to undergo the rectal examination.”
- Manipulation of the prostate during the
digital rectal examination may falsely increase the
PSA levels. The PSA determination and the digital
rectal examination are both necessary as screening
tools for prostate cancer, and both are recommended
for all men older than age 50. Prostate cancer is the
most common cancer in men and the second leading
killer from cancer among men in the United
States. Incidence increases sharply with age, and
the disease is predominant in the 60- to 70-year-old
age-group.
The nurse is performing a digital rectal
examination. Which of the following fi nding is a
key sign for prostate cancer?
■ 1. A hard prostate, localized or diffuse.
■ 2. Abdominal pain.
■ 3. A boggy, tender prostate.
■ 4. A nonindurated prostate.
- On digital rectal examination, key signs
of prostate cancer are a hard prostate, induration of
the prostate, and an irregular, hard nodule. Accompanying
symptoms of prostate cancer can include
constipation, weight loss, and lymphadenopathy.
Abdominal pain usually does not accompany prostate
cancer. A boggy, tender prostate is found with
infection (e.g., acute or chronic prostatitis).
A client is undergoing a total prostatectomy
for prostate cancer. The client asks questions about
his sexual function. The best response by the nurse
is which of the following?
■ 1. “Loss of the prostate gland means that you
will be impotent.”
■ 2. “Loss of the prostate gland means that you
will be infertile and there will be no ejaculation.
You can still experience the sensations
of orgasm.”
■ 3. “Loss of the prostate gland means that you
will have no loss of sexual function and
drive.”
■ 4. “Loss of the prostate gland means that your
erectile capability will return immediately
after surgery.”
- Loss of the prostate gland interrupts the
flow of semen, so there will be no ejaculation fl uid.
The sensations of orgasm remain intact. The client
needs to be advised that return of erectile capability
is often disrupted after surgery, but within 1 year
95% of men have returned to normal erectile function
with sexual intercourse.
A 65-year-old client has been told by the physician
that his prostate cancer was graded at stage
IIB. The client inquires if this means he is going to
die soon. The best response by the nurse is which of
the following?
■ 1. “Prostate cancer at this stage is very slow
growing.”
■ 2. “Prostate cancer at this stage is very fast
growing.”
■ 3. “Prostate cancer at this stage has spread to the
bone.”
■ 4. “Prostate cancer at this stage is diffi cult to
predict.”
- Clients who have stage IA or IIB prostate
cancer have an excellent survival rate. Prostate
cancer is usually slow growing, and many men who
have prostate cancer do not die from it. A stage I or
II tumor is confi ned to the prostate gland and has
not spread to the extrapelvic region or bone.
A client with prostate cancer is treated with
hormone therapy consisting of diethylstilbestrol
(DES; Stilphostrol), 2 mg daily. The nurse should
instruct the client to expect to have:
■ 1. Tenderness of the scrotum.
■ 2. Tenderness of the breasts.
■ 3. Loss of pubic hair.
■ 4. Decreased blood pressure.
- Diethylstilbestrol causes engorgement and
tenderness of the breasts (gynecomastia). Stilbestrol
is prescribed as palliative therapy for men
with androgen-dependent prostatic carcinoma. An
increase in blood pressure can occur. Tenderness
of the scrotum and dramatic changes in secondary
sexual characteristics should not occur.
The client is taking sildenafi l (Viagra) P.O. for
erectile dysfunction. The nurse should instruct the
client about which of the following?
■ 1. Sildenafi l (Viagra) may be taken more than
one time per day.
■ 2. The health care provider should be notifi ed
promptly if the client experiences sudden or
diminished vision.
■ 3. Sildenafi l (Viagra) offers protection against
some sexually transmitted diseases (STDs).
■ 4. Sildenafi l (Viagra) does not require sexual
stimulation to work.
- Sildenafi l (Viagra) should not be taken
more than once per day. Viagra offers no protection
against sexually transmitted diseases. Viagra has no
effect in the absence of sexual stimulation. The client
should notify his health care provider promptly if he experiences sudden or decreased vision loss in
one or both eyes.
