Chapter 66: Benign Prostatic Hyperplasia

Question 1

As an adult male ages, the prostate gland enlarges. When the enlargement of the gland begins to cause ______, it is called benign prostatic hyperplasia (BPH).

Answer 1

urinary dysfunction

Question 2

BPH is a very common condition of the ______ adult male.

Answer 2

older

Question 3

BPH can significantly impair the outflow of urine from the bladder, making a client susceptible to infection and _______.

Answer 3

retention

Question 4

Excessive amounts of urine retained can cause _____ of urine into the kidney, dilating the ureter and causing kidney infections.

Answer 4

reflux

Question 5

Risk Factors for BPH

Answer 5

Increased age
smoking, chronic alcohol use
sedentary lifestyle, obesity
western diet (high fat, protein, carb, low fiber)
diabetes mellitus, heart disease

Question 6

The _______ or I-PSS is an assessment tool used to determine the severity of manifestations and their effect on the client’s quality of life.

Answer 6

International Prostate Symptom Score

Question 7

With the I-PSS the client rates the severity of lower urinary tract manifestations using a _____ scale and also rates his quality of life as affected by urinary tract manifestations.

Answer 7

0 to 5

Question 8

Clients who have BPH typically report urinary frequency, urgency, hesitancy, or incontinence; ______ emptying of the bladder; dribbling post-voiding; nocturia; diminished force or urinary stream; straining with urination; and _____.

Answer 8

incomplete

hematuria

Question 9

Urinary _____ and persistent urinary retention leads to frequent UTIs.

Answer 9

stasis

Question 10

If PBH persists, back flow of urine into the ureters and kidney can lead to _______.

Answer 10

kidney damage

Question 11

With BPH you can use a urinalysis and culture to see if there is an elevated level of ______ and bacteria present with UTIs.

Answer 11

white blood cells

Question 12

With BPH a CBC will show a _____ infection present if the WBCs are elevated. ______ could be decreased due to hematuria.

Answer 12

systemic

RBC

Question 13

With BPH, BUN and creatinine will be _____, indicating kidney damage.

Answer 13

elevated

Question 14

With BPH you want to do a _____ to rule out prostate cancer.

Answer 14

PSA

Question 15

Culture and sensitivity of prostatic fluid can be performed if fluid is expressed during a _______.

Answer 15

DRE

Question 16

When doing a DRE for a patient with BPH the prostate will be enlarged, but _____.

Answer 16

smooth

Question 17

TRUS with needle aspiration biopsy is performed to rule out prostate cancer in the presence of a _______ prostate.

Answer 17

enlarged

Question 18

Frequent ejaculation releases retained prostatic fluids, thereby decreasing the size of the _____.

Answer 18

prostate

Question 19

Tell the client to avoid drinking large amounts of fluids at one time, and to urinate when the urge is ______ felt.

Answer 19

initially

Question 20

Tell the client to avoid bladder stimulants, such as ______ and caffeine.

Answer 20

alcohol

Question 21

Tell the client to avoid medications that cause decreased bladder tone, such as anticholinergics, decongestants, and _____

Answer 21

antihistamines

Question 22

Medication is used for _____ treatment of BPH.

Answer 22

conservative

Question 23

The goal of medication for BPH is to _______ uninhibited urine flow out of the bladder.

Answer 23

re-establish

Question 24

Dihydrotestosterone (DHT)-lowering medications such as 5-alpha reductase inhibitor (5-ARI), such as finasteride decrease the production of ______ in the prostate gland.

Answer 24

testosterone

Question 25

By decreasing the DHT often causes a decrease in the size of the ______.

Answer 25

prostate

Question 26

When taking a ______ you can reinforce that it can take 6 months to 1 year before effects of the medication are evident.

Answer 26

DHT med

Question 27

Inform the client that _____ and a decrease in libido are possible adverse effects of DHT meds.

Answer 27

impotence

Question 28

Advise the client taking DHT meds to report _____ to the provider.

Answer 28

breast enlargement

Question 29

_______ is a teratogenic to a male fetus. The medication is potentially absorbed through the skin. Women who are pregnant or who could become pregnant should avoid contact with tablets that are crushed or broken and with the semen of a client currently taking the medication.

Answer 29

Finasteride

Question 30

Aphal-adrenergic receptor antagonists cause relaxation of the _______ to the prostate gland.

Answer 30

bladder outlet

Question 31

Alpha blocking agents: tamsulosin decrease pressure on the urethra, thereby re-establishing a stronger ______.

Answer 31

urine flow.

Question 32

With _______ the client could experience postural hypotension can occur, and to slowly make changes in position.

Answer 32

alpha blocking agents: tamsulosin

Question 33

Warn the client that concurrent use of _______ with cimetidine can potentiate the hypotensive effect.

Answer 33

alpha blocking agents : tamsulosin

Question 34

One therapeutic procedure to treat BPH is _________ that uses low-levels of radiation to shrink the prostate.

Answer 34

transurtethral needle ablation

Question 35

One therapeutic procedure to treat BPH is _______ in which heat is applied to the prostate to decrease its size.

Answer 35

transurethral microwave therapy

Question 36

One therapeutic procedure to treat BPH is a _________ in which a stent is placed to keep the urethra patent, especially if the client is a poor candidate for surgery.

Answer 36

prostatic stent

Question 37

One therapeutic procedure to treat BPH is _______ also called contact laser prostatectomy. This is when laser energy is used to coagulate excess prostatic tissue.

Answer 37

interstitial laser coagulation

Question 38

One therapeutic procedure to treat BPH is ______ in which high-frequency electrical current is used to cut and vaporize excess tissue.

Answer 38

electrovaporization of the prostate

Question 39

One therapeutic procedure to treat BPH is _____ which is an option for clients who do not receive adequate relief from conservative measures.

Answer 39

surgical resection

Question 40

One therapeutic procedure to treat BPH is _______ which involves incisions into the prostate to relieve constriction of the urethra.

Answer 40

transurethral incision of the prostate

Question 41

The transurethral incision of the prostate is minimally invasive and typically performed in an _____ setting. Tissue is not removed with this procedure.

Answer 41

outpatient

Question 42

One therapeutic procedure to treat BPH is _______ which uses a laser to remove excess prostatic tissue that is obstructing the client's urethra. The extra tissue is then moved to the bladder where the client eliminates it in the _____.

Answer 42

Holmium laser enucleation of the prostate | urine

Question 43

After having a Holmium laser enucleation of the prostate procedure the client often has an ____ urinary catheter that is left in place overnight.

Answer 43

indwelling

Question 44

The most common surgical procedure for BPH is ______, which is performed using a resectoscope that is inserted through the urethra and trims away excess prostatic tissue, enlarging the passageway of the urethra through the prostate

Answer 44

TURP - Transurethral resection of the prostate

Question 45

When transuretheral resection of the prostate (TURP) is done, typically, ______ and spinal anesthesia are used.

Answer 45

epidural

Question 46

When transuretheral resection of the prostate (TURP) carefully assess cardio, respiratory, and _____ systems preoperative. Make sure the client fully understands the procedure and what to expect postoperative.

Answer 46

renal

Question 47

Postoperative treatment for a TURP usually includes placement of an ______ catheter. This drains urine and allows fro instillation of a continuous bladder irrigation (CBI) or _________ (isotonic) or another prescribed irrigating solution to keep the catheter free from obstruction.

Answer 47

indwelling three way | normal saline

Question 48

The rate of the CBI is adjusted to keep the irrigation return pink or _______. If bright-red or ketchup appearing (arterial) bleeding with clots is observed, the nurse should ____ the CBI rate.

Answer 48

lighter | increase

Question 49

If the 3 way catheter becomes obstructed (bladder spasms, reduced irrigation outflow), turn off the CBI and irrigate with ____ irrigation solution using a large piston syringe or per facility or surgeon portocol. Contact the surgeon if unable to dislodge the clot.

Answer 49

50 mL

Question 50

When using CBI, record the amount of irrigating solution instilled (generally very large volumes) and the amount of return. The difference equals _____.

Answer 50

urine output

Question 51

Postoperatively with a TURP monitor vs and ______. You will need to administer/provide ____ fluids.

Answer 51

urinary output | increased

Question 52

After a TURP monitor for ____ (persistent bright red bleeding unresponsive to increase in CBI and traction on the catheter or reduced Hgb levels) and report to the provider.

Answer 52

bleeding

Question 53

Assist the client to ambulate as soon as possible to reduce the risk of ______ and other complications that occur due to immobility.

Answer 53

deep vein thrombosis

Question 54

Administer the following meds after a TURP

Answer 54

Analgesics (surgical manipulation or incisional discomfort) Antispasmodics (bladder spasms) Antibiotics (prophylaxis) Stool softeners (avoid straining)

Question 55

Postoperatively with a TURP, the catheter is removed, monitor urinary output. The initial voiding following removal can be uncomfortable, red in color, and contain _____. The color of the urine should progress toward _____ in 2 to 3 days.

Answer 55

clots | amber

Question 56

Instruct the client that expected output is ____ to ____ mL every 3 to 4 hours after a TURP procedure. The client should contact the provider if unable to void.

Answer 56

150 ml to 200 ml

Question 57

After a TURP the client should avoid heavy lifting, strenuous exercise, straining and sexual intercourse for the prescribed length of time (usually ___ to ____ weeks)

Answer 57

2 to 6 weeks

Question 58

After a TURP tell the client to drink ______ 8 oz glasses of water each day unless contraindicated.

Answer 58

12 or more

Question 59

After a TURP tell the client to avoid _______ due to increased risk for bleeding.

Answer 59

NSAIDs

Question 60

After a TURP tell the client to avoid bladder stimulants such as ______ and ______.

Answer 60

alcohol and caffeine

Question 61

After a TURP tell the client to tell the client that if urine becomes bloody, to stop activity, rest and _____.

Answer 61

increase fluid intake

Question 62

After a TURP tell the client to contact the surgeon for persistent bleeding or _____ (less than expected output or distention).

Answer 62

obstruction

Question 63

Complications of procedures to treat BPH include regrowth of prostate tissue and _____ of bladder neck obstruction.

Answer 63

reoccurrence

Question 64

TURP complications include * ** Monitor the client and intervene for bleeding * ** Provide antibiotic prophylaxis to the client

Answer 64

urethral trauma urinary retention bleeding infection

Question 65

_____ occurs in the presence of prostate cancer that has spread to other areas of the body.

Answer 65

Backache

Question 66

In the presence of BPH, pressure on _______ leads to urinary stasis, which in turn promotes the occurrence of urinary tract infections.

Answer 66

urinary structures

Question 67

Weight loss occurs in the presence of _______.

Answer 67

prostate cancer

Question 68

Hematuria occurs in the presence of _____.

Answer 68

PBH

Question 69

Overflow incontinence occurs in the presence of BPH due to an increased volume of ______.

Answer 69

residual urine

Question 70

Oxybutynin is an anticholinergic med that is used to treat ________.

Answer 70

overactive bladder

Question 71

Anticholinergic meds are contraindicated for a client who has _____.

Answer 71

BPH

Question 72

Oxybutynin causes urinary ______.

Answer 72

retention