Hinkle 53 (1755-1769) Flashcards
The nurse is assessing urinary output 24 hours after a prostatectomy for a client with continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag?
A. Red wine colored
B. Tea colored
C. Amber
D. Light pink
ANS: D
Rationale: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light-pink color 24 hours after surgery.
A nurse is planning the postoperative care of a client who is scheduled for radical prostatectomy. What intraoperative position will place the client at particular risk for the development of deep vein thrombosis postoperatively?
A. Fowler position
B. Prone position
C. Supine position
D. Lithotomy position
ANS: D
Rationale: Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the client is placed in a lithotomy position during surgery. During a prostatectomy, the client is not placed in the supine, prone, or Fowler position.
A client has just been diagnosed with prostate cancer and is scheduled for brachytherapy the following week. The client and spouse are unsure of having the procedure because their child is 3 months’ pregnant. What is the most appropriate teaching the nurse should provide to this family?
A. The client should not be in contact with the baby after delivery.
B. The client’s treatment poses no risk to the child or the infant.
C. The client’s brachytherapy may be contraindicated for safety reasons.
D. The client should avoid close contact with the child for 2 months.
ANS: D
Rationale: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the client returns home after the procedure. Exposure of others to radiation is minimal, but the client should avoid close contact with pregnant women and infants for up to 2 months.
A nurse is teaching a 53-year-old man about prostate cancer, given the fact that the client has a family history of the disease. What information should the nurse provide to best facilitate the early identification of prostate cancer?
A. Have a digital rectal examination and prostate-specific antigen (PSA) test done as recommended.
B. Have a transrectal ultrasound every 5 years.
C. Perform monthly testicular self-examinations, especially after age 60.
D. Have a complete blood count (CBC), blood urea nitrogen (BUN), and creatinine assessment performed annually.
ANS: A
Rationale: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that are especially relevant when a client has a family history. Testicular self-examinations won’t identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.
A client has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens?
A. Continuous inflow and outflow of irrigation solution
B. Intermittent inflow and continuous outflow of irrigation solution
C. Continuous inflow and intermittent outflow of irrigation solution
D. Intermittent flow of irrigation solution and prevention of hemorrhage
ANS: A
Rationale: For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.
A nurse is providing an educational event to a local men’s group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group?
A. Native Americans/First Nations
B. White
C. Black
D. Asian
ANS: C
Rationale: Black men have the highest high risk of prostate cancer.
A man tells the nurse that their father died of prostate cancer and the client is concerned about their own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse’s response?
A. A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer.
B. HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant.
C. Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer.
D. Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.
ANS: A
Rationale: A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HNPCC is a form of colon cancer. The TP53 gene is associated with breast cancer.
A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on the right knee. While taking the client’s family history, the client states, “My father died of prostate cancer at age 48.” The nurse should instruct the client on which of the following health promotion activities?
A. The client will need PSA levels drawn starting at age 55.
B. The client should have testing for presence of the CDH1 and STK11 genes.
C. The client should have PSA levels drawn regularly.
D. The client should limit alcohol use due to the risk of malignancy.
ANS: C
Rationale: PSA screening is warranted by the client’s family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the client should be limited. However, this is not the most important health promotion intervention.
A nurse is caring for a 33-year-old male client who has come to the clinic for a physical examination. The client states not having a routine physical in 5 years. The health care provider’s digital rectal examination (DRE) reveals “stony” hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what?
A. A normal finding
B. A sign of early prostate cancer
C. Evidence of a more advanced lesion
D. Metastatic disease
ANS: C
Rationale: Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is “stony hard” and fixed. This finding is not suggestive of metastatic disease.
A client who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on sexual function. What aspect of prostate surgery should inform the nurse’s response?
A. Erectile dysfunction is common after prostatectomy as a result of hormonal changes.
B. All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction.
C. Erectile dysfunction after prostatectomy is expected, but normally resolves within several months.
D. Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.
ANS: B
Rationale: All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.
A client has returned to the medical–surgical floor from the post-anesthesia care unit (PACU). Upon inspection, the nurse notes leakage around the suprapubic tube. Which action by the nurse is most appropriate?
A. Cleanse the skin surrounding the suprapubic tube.
B. Inform the urologist of this finding as it is abnormal.
C. Remove the suprapubic tube and apply a wet to dry dressing.
D. Administer antispasmodic drugs as prescribed.
ANS: B
Rationale: After removal of the suprapubic catheter there may be urinary drainage from the stoma site. The urologist should be informed if there is significant leakage around a suprapubic catheter. Some leakage is expected, but larger amounts should be communicated to the care team. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.
A nurse is providing care for a client who has recently been admitted to the postsurgical unit from PACU following a transurethral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action?
A. Closely monitoring the input and output of the bladder irrigation system
B. Administering parenteral nutrition and fluids as prescribed
C. Monitoring the client’s level of consciousness and skin turgor
D. Scanning the client’s bladder for retention every 2 hours
ANS: A
Rationale: Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.
A client has experienced occasional urinary incontinence in the weeks since their prostatectomy. In order to promote continence, the nurse should encourage which of the following?
A. Pelvic floor exercises
B. Intermittent urinary catheterization
C. Reduced physical activity
D. Active range of motion exercises
ANS: A
Rationale: Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.
A client has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The client has a continuous bladder irrigation system in place. The client reports bladder spasms. What is the most appropriate nursing action to relieve the discomfort of the client?
A. Apply a cold compress to the pubic area.
B. Notify the urologist promptly.
C. Irrigate the catheter with 30 to 50 mL of normal saline as ordered.
D. Administer a smooth-muscle relaxant as ordered.
ANS: D
Rationale: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be relieved without the involvement of the urologist, who will normally order medications on a PRN basis.
