Nursing Questions and Answers
Nursing Questions and Answers
To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about
a. the presence of blood in the urine.
b. any erectile dysfunction (ED).
c. occurrence of a weak urinary stream.
d. lower back and hip pain.
Answer: C
Rationale: 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 with BPH.
Cognitive Level: Application Text Reference: pp. 1415-1416
Nursing Process: Assessment NCLEX: Physiological Integrity
A patient scheduled for a transurethral resection of the prostate (TURP) for BPH tells the nurse that he has delayed having surgery because he is afraid it will affect his sexual function. When responding to his concern, the nurse explains that
a. with this type of surgery, erectile problems are rare, but retrograde ejaculation may occur.
b. information about penile implants used for ED is available if he is interested.
c. there are many methods of sexual expression that can be alternatives to sexual intercourse.
d. sterility will not be a problem after surgery because sperm production will not be affected.
Answer: A
Rationale: Erectile problems are rare, but retrograde ejaculation may occur after TURP. 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.
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Cognitive Level: Application Text Reference: p. 1418
Nursing Process: Implementation NCLEX: Physiological Integrity
A 41-year-old man asks the nurse what he can do to decrease the risk of BPH. The nurse explains that
a. riding a bicycle raises prostate specific antigen levels and may increase BPH risk.
b. prevention is not possible because prostatic enlargement occurs with normal aging.
c. decreasing butter and margarine and increasing fruits in the diet may help.
d. taking a daily vitamin E supplement has reduced prostate size in some men.
Answer: C
Rationale: A diet high in saturated fats, found in foods like butter, is associated with an increased risk for BPH. Individuals who eat more fruits and vegetables may be at lower risk. Riding a bicycle does increase prostate-specific antigen (PSA) levels, but this is not associated with development of BPH. Dietary changes and increased exercise do appear to help prevent BPH. Vitamin E supplements do not decrease prostate size.
Cognitive Level: Comprehension Text Reference: p. 1415
Nursing Process: Implementation NCLEX: Physiological Integrity
The health care provider prescribes finasteride (Proscar) for a 56-year-old male patient who has a BPH symptom score of 12 on the AUA Symptom Index. When teaching the patient about the drug, the nurse informs him that
a. his interest in sexual activity may decrease while he is taking the medication.
b. he should change position from lying to standing slowly to avoid dizziness.
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.
Answer: A
Rationale: A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Orthostatic hypotension is a side effect of the α-blocking agents. Improvement in symptoms of obstruction takes 3 to 6 months. The medication does not cause hypertension.
Cognitive Level: Application Text Reference: p. 1417
Nursing Process: Implementation NCLEX: Physiological Integrity
A patient with irritative and obstructive bladder symptoms has an enlarged prostate on digital rectal examination (DRE) and an elevated PSA level. The nurse will anticipate that the patient will need teaching about
a. uroflometry studies.
b. cystourethroscopy.
c. transrectal ultrasonography (TRUS).
d. magnetic resonance imaging (MRI).
Answer: C
Rationale: In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to help differentiate BPH from prostatic cancer. Uroflowmetry studies will help determine the extent of urine blockage and treatment, but a differential diagnosis will be obtained first. Cystourethroscopy may be used after TRUS if the diagnosis is still uncertain. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process.
Cognitive Level: Application Text Reference: p. 1416
Nursing Process: Planning NCLEX: Physiological Integrity
A patient undergoing a TURP returns from surgery with a three-way urinary catheter with continuous bladder irrigation in place. The nurse observes that the urine output has decreased and the urine is clear red with multiple clots. The patient is complaining of painful bladder spasms. The most appropriate action by the nurse is to
a. administer the ordered IV morphine sulfate, 4 mg.
b. increase the flow rate of the continuous bladder irrigation.
c. give the ordered the belladonna and opium suppository.
d. manually instill 50 ml of saline and try to remove the clots.
Answer: D
Rationale: 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.
Cognitive Level: Application Text Reference: pp. 1420-1421
Nursing Process: Implementation NCLEX: Physiological Integrity
The wife of a patient who has undergone a TURP and has continuous bladder irrigation asks the nurse about the purpose of the continuous bladder irrigation. Which response by the nurse is appropriate?
a. “The bladder irrigation is needed to stop the postoperative bleeding in the bladder.”
b. “The irrigation is needed to keep the catheter from being occluded by blood clots.”
c. “Normal production of urine is maintained with the irrigations until healing occurs.”
d. “Antibiotics are being administered into the bladder with the irrigation solution.”
Answer: B
Rationale: 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 maintain urine production. Antibiotics are given by the IV route, not through the bladder irrigation.
Cognitive Level: Comprehension Text Reference: pp. 1420-1421
Nursing Process: Implementation NCLEX: Physiological Integrity
A patient with symptomatic BPH is scheduled for visual laser ablation of the prostate (VLAP) at an outpatient surgical center. The nurse will plan to teach the patient
a. how to care for an indwelling urinary catheter.
b. that the urine will appear bloody for several days.
c. to expect an immediate improvement in urinary force.
d. that an intraprostatic urethral stent will be placed.
Answer: A
Rationale: The patient will have indwelling catheter for up to a week and will need to be instructed on catheter care to avoid problems such as infection. There is minimal bleeding with this procedure. It will take several weeks before the full benefits of the procedure take effect. Stent placement is not included in the procedure.
Cognitive Level: Application Text Reference: pp. 1420-1422
Nursing Process: Planning NCLEX: Physiological Integrity
The health care provider orders a blood test for prostate-specific antigen (PSA) when an enlarged prostate is palpated during a routine examination of a 56-year-old man. When the patient asks the nurse the purpose of the test, the nurse’s response is based on the knowledge that
a. elevated levels of PSA are indicative of metastatic cancer of the prostate.
b. PSA testing is the “gold standard” for making a diagnosis of prostate cancer.
c. baseline PSA levels are necessary to determine whether treatment is effective.
d. PSA levels are usually elevated in patients with cancer of the prostate.
Answer: D
Rationale: PSA levels are usually elevated above the normal in patients with prostate cancer. PSA testing does not determine whether metastasis has occurred. A biopsy of the prostate is needed for a definitive diagnosis of prostate cancer. Success of treatment is determined by a fall in PSA to an undetectable level; the patient’s baseline PSA is not needed to determine the success of treatment.
Cognitive Level: Application Text Reference: p. 1423
Nursing Process: Implementation NCLEX: Physiological Integrity
A 64-year-old man undergoes a perineal radical prostatectomy for stage C prostatic cancer. Postoperatively, the nurse establishes the nursing diagnosis of risk for infection related to
a. urinary stasis.
b. urinary incontinence.
c. possible fecal contamination of the surgical wound.
d. placement of a suprapubic catheter into the bladder.
Answer: C
Rationale: 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.
Cognitive Level: Application Text Reference: p. 1425
Nursing Process: Diagnosis NCLEX: Physiological Integrity
Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of urine. An appropriate nursing intervention for this patient is to teach the patient
a. pelvic floor muscle training.
b. the use of belladonna and opium suppositories.
c. how to perform intermittent self-catheterization.
d. to restrict oral fluid intake.
Answer: A
Rationale: 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.
Cognitive Level: Application Text Reference: p. 1428
Nursing Process: Planning NCLEX: Physiological Integrity
Following discharge teaching for a patient who has had a transurethral prostatectomy for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says,
a. “I will increase fiber and fluids in my diet to prevent constipation.”
b. “I should call the doctor if I have any incontinence at home.”
c. “I will avoid heavy lifting or driving until I get approval from my health care provider.”
d. “I should continue to schedule yearly appointments for prostate exams.”
Answer: B
Rationale: Incontinence is common for several weeks after a TURP. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.
Cognitive Level: Application Text Reference: p. 1422
Nursing Process: Evaluation NCLEX: Physiological Integrity
Leuprolide (Lupron) and bicalutamide (Casodex) are prescribed for a patient with cancer of the prostate. In teaching the patient about these drugs, the nurse informs the patient that side effects may include
a. low blood pressure.
b. decreased sexual drive.
c. urinary incontinence.
d. frequent infections.
Answer: B
Rationale: Hormonal therapy blocks the effects of testosterone and decreases libido. Hypotension is associated with the α-blockers used for 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.
Cognitive Level: Comprehension Text Reference: p. 1426
Nursing Process: Implementation NCLEX: Physiological Integrity
The nurse will teach the patient with chronic bacterial prostatitis that
a. PSA elevation indicates that he has concurrent prostate cancer.
b. Nonsteroidal antiinflammatory drugs (NSAIDs) usually provide adequate pain control.
c. sexual intercourse and masturbation will relieve symptoms.
d. antibiotics should be taken for 7 to 10 days.
Answer: C
Rationale: Ejaculation helps drain the prostate and relieve pain. PSA elevation may be due to the prostatitis. NSAIDs are prescribed, but are often inadequate to control pain. Antibiotics should be continued for 4 to 16 weeks.
Cognitive Level: Application Text Reference: p. 1429
Nursing Process: Implementation NCLEX: Physiological Integrity
A couple is seen at the infertility clinic because they have not been able to conceive. When performing a focused examination to determine any possible causes for infertility, the nurse will check the man for the presence of
a. hydrocele.
b. varicocele.
c. epididymitis.
d. paraphimosis.
Answer: B
Rationale: Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility.
Cognitive Level: Comprehension Text Reference: p. 1431
Nursing Process: Assessment NCLEX: Physiological Integrity
In teaching a male patient to perform testicular self-examination, the nurse includes the information that
a. the only structure normally felt in the scrotal sac is the testis.
b. the examination should be done when the scrotum is warm.
c. an appointment with the health care provider is needed if one testis is larger than the other.
d. an examination should be performed whenever the patient showers or bathes.
Answer: B
Rationale: The testes will hang lower in the scrotum when the temperature is warm, 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 (TSE) monthly.
Cognitive Level: Comprehension Text Reference: p. 1433
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance
A 32-year-old man scheduled for a unilateral orchiectomy for testicular cancer is admitted to the hospital the morning of surgery. He is accompanied by his wife but does not talk to her and does not initiate interaction with the nurse. The most appropriate action by the nurse is to
a. ask the patient if he has any questions or concerns about the diagnosis and treatment.
b. tell the patient’s wife that concerns about sexual function are common with this diagnosis.
c. teach the patient that impotence is rarely a problem after unilateral orchiectomy.
d. document the patient’s lack of communication on the chart and continue preoperative care.
Answer: A
Rationale: 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, it is inappropriate for the nurse to initiate teaching. It would be inappropriate for the nurse to provide patient teaching without further assessment of the patient’s teaching needs and concerns. Documentation of the patient’s lack of interaction is not an adequate nursing action in this situation.
Cognitive Level: Application Text Reference: p. 1428
Nursing Process: Implementation NCLEX: Psychosocial Integrity
When performing discharge teaching for a patient who has undergone a vasectomy in the health care provider’s office, the nurse instructs the patient that
a. he may have temporary erectile dysfunction (ED) because of postoperative swelling.
b. he should not have sexual intercourse until his 6-week follow-up visit.
c. he should continue the use of other methods of birth control for 6 weeks.
d. he will notice a decrease in the appearance and volume of his ejaculate.
Answer: C
Rationale: 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.
Nursing Questions and Answers.
Cognitive Level: Comprehension Text Reference: pp. 1433-1434
Nursing Process: Implementation NCLEX: Physiological Integrity
A 22-year-old man tells the nurse at the health clinic that he has recently become unable to achieve an erection. When assessing for possible etiologic factors, which question should the nurse ask first?
a. “Have you been experiencing an unusual amount of stress?”
b. “Do you have any history of an erection that lasted for 6 hours or more?”
c. “Are you using any recreational drugs or drinking a lot of alcohol?”
d. “Do you have any chronic diseases, such as diabetes mellitus?”
Answer: C
Rationale: A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and chronic illness also contribute to ED, but they are not common etiologic factors in younger men.
Cognitive Level: Application Text Reference: p. 1434
Nursing Process: Assessment NCLEX: Physiological Integrity
A 53-year-old man tells the nurse he has not been able to function sexually for several years but is now interested in using Viagra (sildenafil). In responding to the patient’s interest, the nurse
a. questions the patient about any prescription drugs he is taking.
b. tells the patient that Viagra is an appropriate treatment for only a few types of ED.
c. asks the patient about any previous treatment for hydrocele.
d. reassures the patient that a gradual decline in erectile function is common with aging.
Answer: A
Rationale: Because some medications can cause ED and patients using nitrates should not take Viagra, the nurse should ask about prescription drug use. Viagra is a helpful therapy for most types of ED. Hydrocele is not a risk factor for ED or a contraindication to erectogenic drugs. Severe ED is not a normal consequence of aging in a 53-year-old patient.
Cognitive Level: Application Text Reference: p. 1435
Nursing Process: Implementation NCLEX: Physiological Integrity
A 46-year-old man has had erectile dysfunction (ED) for about 3 years when he finally seeks help for the problem. He tells the nurse that he decided to seek help because his wife “is losing patience with the situation.” The most appropriate nursing diagnosis for the patient is
a. risk for anxiety related to inability to perform sexually.
b. situational low self-esteem related to loss of satisfying sexual activity.
c. ineffective sexuality patterns related to ED.
d. ineffective role performance related to effects of ED.
Answer: D
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 may also be concerns, the data in the stem suggest that addressing the role performance problem will lead to the best outcome for this patient.
Cognitive Level: Application Text Reference: p. 1436
Nursing Process: Diagnosis NCLEX: Psychosocial Integrity
The nurse working in a health clinic receives calls from all these patients. Which patient should be seen by the doctor first?
a. A 23-year-old man who states he had difficulty maintaining an erection last night
b. A 44-year-old man who has perineal pain and a temperature of 100.4° F
c. A 62-year-old man who has light pink urine after having a TURP 3 days ago
d. A 66-year-old man who has a painful erection that has lasted over 9 hours
Answer: D
Rationale: 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.
Cognitive Level: Analysis Text Reference: p. 1430
Nursing Process: Assessment NCLEX: Physiological Integrity
The doctor is considering whether to prescribe testosterone replacement therapy for a 62-year-old man who is concerned about a gradual decrease in sexual performance. Which information obtained by the nurse is most important to communicate to the doctor?
a. The patient states that he has noticed a decrease in energy level for a few years.
b. The patient has had a gradual decrease in the force of his urinary stream.
c. The patient has been using sildenafil (Viagra) several times every week.
d. The patient’s symptoms have increased steadily over the last few years.
Answer: B
Rationale: The decrease in urinary stream may indicate BPH or prostate cancer, which are contraindications to use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient.
Cognitive Level: Application Text Reference: p. 1437
Nursing Process: Assessment NCLEX: Physiological Integrity
A patient with benign prostatic hyperplasia (BPH) with mild obstruction tells the nurse, “My symptoms have gotten a lot worse this week.” Which response by the nurse is most appropriate?
a. “The prostate gland normally changes slightly in size from day to day, and this may be making your symptoms worse.”
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?”
d. “I will talk to the doctor about ordering a prostate specific antigen test.”
Answer: B
Rationale: 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 and is not indicated in this patient, who has already been diagnosed with BPH.
Cognitive Level: Application Text Reference: p. 1421
Nursing Process: Assessment NCLEX: Physiological Integrity
When obtaining a focused health history for a patient with possible testicular cancer, the nurse will ask the patient about any history of
a. testicular torsion.
b. STD infection.
c. undescended testicles.
d. testicular trauma.
Answer: C
Rationale: 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.
Cognitive Level: Comprehension Text Reference: pp. 1430-1431
Nursing Process: Assessment NCLEX: Physiological Integrity
When planning teaching for a patient who has had a unilateral orchiectomy and chemotherapy for testicular cancer, the nurse will include information about the need for
a. regular follow-up appointments to detect other types of malignancies.
b. aspiration of sperm from the remaining testis if infertility occurs.
c. testosterone supplements to help maintain erectile function.
d. application of ice to the scrotum to minimize pain and swelling.
Answer: A
Rationale: The patient will need regular follow-up to detect secondary malignancies that may occur as the result of the chemotherapy. Since infertility occurs as a result of damage to the remaining testis by chemotherapeutic drugs, aspiration of sperm is not used to treat infertility. The remaining testis will produce adequate testosterone. Application of ice will be used to reduce postoperative swelling immediately after surgery, but will not be needed at the time chemotherapy is complete.
Cognitive Level: Application Text Reference: p. 1432
Nursing Process: Planning NCLEX: Physiological Integrity
A patient with acute urinary retention associated with BPH is admitted to the emergency department. The patient has had no urine output for 16 hours, and the laboratory work shows a blood urea nitrogen (BUN) level of 50 mg/dl and a creatinine of 3.0 mg/dl. The nurse will anticipate a health care provider order to
a. schedule the patient for inpatient hemodialysis.
b. insert a retention catheter.
c. start an IV line for fluid administration.
d. administer furosemide (Lasix).
Answer: B
Rationale: The patient data indicate that the patient may have hydronephrosis and acute renal failure caused by the BPH; the initial therapy will be to insert a catheter. Hemodialysis may be needed if the elevation in BUN and creatinine persists, but it will not be ordered initially. Fluid administration and furosemide administration will increase the bladder distension.
Cognitive Level: Application Text Reference: p. 1415
Nursing Process: Planning NCLEX: Physiological Integrity
Nursing Questions and Answers
