Chapter 75: Care of Male Patients with Reproductive Problems Nursing School Test Banks

Chapter 75: Care of Male Patients with Reproductive Problems

Test Bank

MULTIPLE CHOICE

1. The nurse is assisting a client with limited mobility into position for examination of his prostate gland. How does the nurse best assist the client?

a.

Assist the client to bend over the examination table.

b.

Hold the client up as he bends over the bedside table.

c.

Help the client lie down in a side-lying fetal position.

d.

Assist the client to lie in a prone position.

ANS: C

A side-lying fetal position will be easiest for this client to assume so that the examination can proceed. It will be too difficult for him, as well as for the nurse, to attempt to stand up and lean over the examination table or bedside table. Placing the client in a prone position will not allow the prostate to be accessed as easily as placing him in a side-lying fetal position.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Nursing Process (Implementation)

2. A clients laboratory findings reveal an elevated serum acid phosphatase level and a high-normal prostate-specific antigen level. How does the nurse interpret this information?

a.

The client shows evidence of renal disease and should be evaluated further.

b.

These results may indicate prostate cancer. He should be further evaluated.

c.

These results are not abnormal. He does not need to be evaluated further.

d.

These results may indicate an infection. He should be evaluated further.

ANS: B

Both serum acid phosphatase and prostate-specific antigen levels will be elevated when the client has prostate cancer. The results are not indicative of renal disease or infection, but they are abnormal, may indicate prostate cancer, and should be further evaluated.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

3. Which client statement indicates understanding about a transrectal ultrasound?

a.

This will determine if the outlet of my bladder is obstructed.

b.

This will determine the amount of residual urine present.

c.

This is performed to view the interior of the bladder and urethra.

d.

This is performed to view the prostate and do a tissue biopsy.

ANS: D

A transrectal ultrasound is performed to view the prostate and surrounding structures and possibly also to do a tissue biopsy. A urodynamic pressure flow study will determine if the outlet of the clients bladder is obstructed. A bladder scan will determine the amount of residual urine that is present. A cytoscopy will allow the interior of the bladder and urethra to be visualized.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Teaching/Learning

4. Which statement indicates that a client understands the most appropriate time of day to take an alpha blocker drug for treatment of benign prostatic hyperplasia (BPH)?

a.

Ill take my medication at bedtime.

b.

As soon as I get up, I will take my medication.

c.

I will take my medication with food or milk.

d.

Ill take my medication on an empty stomach.

ANS: A

Bedtime dosing should decrease the risk of hypotension with an alpha blocker drug. Giving the medication during the day will increase the clients risk of experiencing weakness, lightheadedness, and dizziness.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Evaluation)

5. The nurse is assessing a client who has undergone a transurethral resection of the prostate (TURP). Which assessment finding requires immediate action by the nurse?

a.

Passing small blood clots after catheter removal

b.

Experiencing urinary frequency after catheter removal

c.

Having bright red drainage with multiple blood clots

d.

Having the urge to void continuously while the catheter is inserted

ANS: C

A client who undergoes a TURP is at risk for bleeding during the first 24 hours after surgery. Passage of small blood clots and tissue debris, urinary frequency and leakage, and the urge to void continuously while the client still has the catheter inserted are all considered to be expected complications of the procedure. They will resolve as the client continues to recover and the catheter is removed. However, the presence of bright red blood with clots indicates arterial bleeding and should be reported to the provider.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

6. A clients prostate-specific antigen (PSA) level is 2.0 ng/mL. Which action by the nurse is most appropriate?

a.

Inform the client that the results are normal and no cancer has been detected.

b.

Inform the client that results are normal and schedule a digital rectal examination.

c.

Let the client know that the results are elevated and he is at risk for prostate cancer.

d.

Tell the client that cancer is indicated and that the health care provider recommends watchful waiting.

ANS: B

A normal PSA in men younger than age 50 is less than 2.5 ng/mL. Although the finding is within normal limits for a PSA value, a client could have prostate cancer and not present with an elevated PSA. Also, laboratory findings should not be used as the sole screening tool. Without a digital rectal examination (DRE), the health care provider cannot know whether the client is in the early stages of prostate cancer. The client should be informed that although the level is within the normal range, he still needs a DRE.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

7. Which client diagnosed with prostate cancer is not a candidate for watchful waiting?

a.

Client with very early cancer of the prostate

b.

Client who is asymptomatic

c.

Client who wants to avoid urinary incontinence as a result of treatment

d.

Client who refuses frequent digital rectal examinations (DREs)

ANS: D

To participate in watchful waiting, the client must be monitored on a regular basis with a DRE and prostate-specific antigen (PSA) testing. Clients who are asymptomatic, who have early cancer, and who wish to avoid urinary incontinence from treatment would all be excellent candidates for watchful waiting.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1638

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

8. A client is scheduled for a prostatectomy for benign prostatic hyperplasia (BPH). On the morning of surgery, the laboratory report on the clients urine indicates the presence of red blood cells, white blood cells, and bacteria. Which is the nurses highest priority action?

a.

Document the report in the clients chart.

b.

Insert a new Foley catheter before surgery.

c.

Strain the clients urine.

d.

Assess the clients vital signs and notify the health care provider.

ANS: D

The client may have a urinary tract infection. The nurse should obtain a set of vital signs and notify the provider of the laboratory results. Any surgery may need to be delayed if the client has infection. Documentation is needed after other actions have been taken. Inserting a catheter and straining the clients urine will not be beneficial.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

9. A client has been taking finasteride (Proscar) for 4 weeks and reports that he has not yet seen a reduction in symptoms. Which response by the nurse is most appropriate?

a.

Have you been taking the medication as ordered?

b.

It may take several months to see results.

c.

It may not be the right drug for you.

d.

We can try dutasteride (Avodart) next.

ANS: B

So that he does not become discouraged, the nurse should first reassure the client that this class of medications may take up to 6 months to be effective. The nurse then can assess for compliance, but asking that question first may put the client on the defensive. The client needs to try the medication for several more months before the health care team changes it. Avodart is in the same class of medications, and its use for up to 6 months of therapy may be required before results are seen.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)

MSC: Integrated Process: Nursing Process (Implementation)

10. A client had a transurethral prostatectomy and has incontinence. Which statement by the client indicates a need for clarification about managing this condition?

a.

I will practice stopping the urine stream to strengthen my sphincter control.

b.

I will limit my fluid intake every day to prevent incontinence.

c.

I will avoid vigorous activity for the first 3 weeks after surgery.

d.

I will avoid caffeinated beverages and spicy foods.

ANS: B

Unless fluid restriction is needed because of another medical problem, clients with incontinence should drink plenty of water and other fluids. Client statements regarding Kegel exercises, activity restrictions post-surgery, and avoiding bladder irritants are all indicative of understanding.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Evaluation)

11. A client with prostate cancer reports pain in his lower back and legs. Which action by the nurse is most appropriate?

a.

Discuss medications for arthritis.

b.

Perform a bladder scan.

c.

Facilitate imaging studies.

d.

Encourage weight-bearing exercises.

ANS: C

The primary site of metastasis for prostate cancer is the bone of the spine and the legs. The nurse should suspect metastasis and inform the health care provider. The client will need imaging studies to look for metastasis, and the nurse should facilitate them. The other interventions are not appropriate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

12. A client diagnosed with early prostate cancer is confused that surgery has not been planned. Which is the nurses best response?

a.

The disease is slow-growing. The risks of surgery at your age are not justified by the outcome.

b.

Your disease is so advanced that surgery at this point would not increase your chances of cure.

c.

Your disease is in a very early stage and is slow-growing. Your doctor will monitor you.

d.

This stage indicates that you do not really have cancer, so surgery is not necessary.

ANS: C

Early prostate cancer may have no clinical manifestations and may be found on a routine physical. It is slow-growing and may never become a problem for the client. Close follow-up (or watchful waiting) is the common prescription for this stage unless the client experiences symptoms. Telling the client that surgery is not justified, or that the cancer is too advanced at this point, and stating that he does not have cancer are inaccurate statements.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1638

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Teaching/Learning

13. A client with a catheter in place after a suprapubic prostatectomy has decreased urinary output. Which action by the nurse is most appropriate?

a.

Assess the client for bladder spasms.

b.

Encourage the client to drink more water.

c.

Administer pain medication.

d.

Have the client try to void around the catheter.

ANS: A

Bladder spasms and decreased urinary output can indicate obstruction. The nurse should assess whether the client is experiencing these spasms and should treat the client with an antispasmodic if needed. Encouraging increased intake will not be helpful if the problem is obstruction. Pain medication will not be helpful, although an antispasmodic can be beneficial. Trying to void around the catheter is not recommended.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

14. A client had a seminoma removed via an open procedure. The following day, the clients abdomen is soft and nontender, but no bowel sounds are present. Which action by the nurse is most appropriate?

a.

Encourage the client to ambulate several times a day.

b.

Reassess the clients abdomen in 4 hours.

c.

Document the finding and call the surgeon immediately.

d.

Give the client a laxative and encourage high-fiber food.

ANS: A

Paralytic ileus is a complication of open seminoma removal. However, on the day after a major, lengthy operation, it is common for bowel sounds to still be absent. Narcotic analgesics can diminish bowel activity. The client can improve peristalsis with increased activity. It is not necessary to re-examine the client in 4 hours, nor is it necessary to call the surgeon right away. A laxative probably is not needed yet. The client should eat high-fiber foods when they can be tolerated.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

15. Which client is most likely to have organic erectile dysfunction?

a.

Middle-aged man who first had sexual intercourse at age 15

b.

Middle-aged man who has had diabetes mellitus for 25 years

c.

Young man who had a myocardial infarction 2 years ago

d.

Young man who has a job that causes him high stress levels

ANS: B

Organic erectile dysfunction occurs as a gradual reduction in sexual functioning. Diabetes mellitus causes microvascular and macrovascular complications that decrease the sensation and autonomic nerve activity required for achievement of an erection. The other factors will not increase the clients risk for development of organic erectile dysfunction.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1642

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

16. A client is going home after outpatient surgery for a hydrocele. Which information does the nurse emphasize in teaching this client?

a.

Report to the doctor immediately any drainage from your drain.

b.

Use a condom during intercourse to prevent incisional infection.

c.

Sit when you urinate until all swelling is gone and drainage has stopped.

d.

Wear the scrotal support device for at least 3 weeks after surgery.

ANS: D

Edema from residual inflammation can remain for several weeks. This problem is increased if the scrotum is not supported and can cause the client considerable discomfort. The client needs to wear a supportive garment such as a jockstrap during this time. If the client goes home with a drain in place, serosanguineous drainage can be expected for up to 2 days.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1646

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Teaching/Learning

17. A client had a spermatocele removed in an outpatient surgical center. Which statement by the client indicates good understanding of discharge instructions?

a.

The heavy drainage will go away within a few days.

b.

I need to buy dressing supplies at the drugstore.

c.

I should report any redness or drainage from the incision.

d.

Because of all the narcotics Ill be taking, I will need laxatives.

ANS: C

A spermatocele is removed via a small scrotal incision. Heavy drainage should not occur, nor should extensive dressing supplies be needed. The small incision should not require the use of large doses of narcotics.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

18. A client who was treated 1 year ago for testicular cancer now has an elevated serum alpha-fetoprotein level. Which topic is most important for the nurse to teach this client about?

a.

Sperm banking options

b.

Effects of chemotherapy

c.

Hospice philosophy

d.

Importance of yearly monitoring

ANS: B

Alpha-fetoprotein is a tumor marker that is not produced in significant amounts by normal adult tissues. An increase in the level of alpha-fetoprotein after treatment most commonly indicates recurrence or metastasis. Chemotherapy is used to treat recurrent or metastatic disease. The client should already have been taught about sperm banking. Hospice is not indicated at this time. Because a rise in these levels indicates recurrence or metastasis, yearly monitoring is not appropriate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Planning)

19. A client is scheduled for a penectomy for penile cancer. Which action by the nurse is most important?

a.

Teaching the client to sit when he urinates

b.

Demonstrating dressing changes and wound cleaning

c.

Assessing the clients psychosocial status and support

d.

Explaining the purpose of the in-dwelling catheter

ANS: C

Clients may have strong emotional responses to penectomy, even when they seem to be accepting of the surgery, and the risk for suicide is present. It is critical to assess the clients emotional status and support systems before the operation is performed (and afterward). The other actions are appropriate too but do not take priority over ensuring the clients safety.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Coping Mechanisms)

MSC: Integrated Process: Nursing Process (Assessment)

20. Which client statement indicates understanding about post-orchiectomy care for testicular cancer?

a.

I will avoid contact sports to prevent injury and development of cancer in my remaining testis.

b.

I will always use a condom because I am at increased risk for acquiring a sexually transmitted disease.

c.

I will wear an athletic supporter and cup to prevent testicular cancer in my remaining testicle.

d.

I will continue to perform testicular self-examination (TSE) monthly on my remaining testicle.

ANS: D

Treatment (e.g., surgery, radiation, chemotherapy) for testicular cancer does not protect the person from development of testicular cancer in the remaining testicle. A monthly TSE should be performed to monitor for changes in size, shape, or consistency of the testis. The other statements are inaccurate. Testicular cancer is not caused by trauma, cannot be prevented by an athletic cup, and does not cause increased risk for sexually transmitted diseases.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Evaluation)

21. The client with sickle cell anemia has had an erection for longer than 4 hours. How does the nurse intervene?

a.

Administer a diuretic to increase urine output.

b.

Attempt to relieve pressure by catheterizing the client.

c.

Document the finding and reassess in 4 hours.

d.

Notify the health care provider and prepare to give meperidine (Demerol).

ANS: D

Prolonged penile erectionpriapismis common during sickle cell crisis. It is considered a urologic emergency because circulation to the penis may be compromised, and the client may not be able to void. Therefore, the provider must be notified promptly. Demerol is often given to induce hypotension. A diuretic will not help the client. Catheterization should be reserved for the man who cannot void. Waiting another 4 hours to intervene may lead to ischemia.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Implementation)

22. Which intervention helps the client with chronic prostatitis prevent spread of infection to other areas of the urinary tract?

a.

Wear a condom during intercourse.

b.

Avoid alcohol and caffeinated beverages.

c.

Be sure to empty your bladder completely at each voiding.

d.

Sexual intercourse or masturbation can help drain the prostate.

ANS: D

The prostate is not easily penetrated by antibiotics and can serve as a reservoir for microorganisms, which can infect other areas of the genitourinary tract. Draining the prostate regularly through intercourse or masturbation decreases the number of microorganisms present and reduces the risk for further infection. The other interventions listed will be ineffective with prostatitis.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1649

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Teaching/Learning

23. A client with BPH asks why his enlarged prostate is causing difficulty with urination. Which is the nurses most accurate response?

a.

It compresses the urethra, blocking the flow of urine.

b.

It presses on the kidneys, decreasing urine formation.

c.

It secretes acids that weaken the bladder, causing dribbling.

d.

It destroys nerves, decreasing awareness of a full bladder.

ANS: A

The prostate gland encircles the urethra and bladder neck like a doughnut. Enlargement of the gland constricts the urethra and obstructs the outflow of urine by encroaching on the bladder opening. The other responses are inaccurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Teaching/Learning

24. A client has decided to treat his enlarged prostate with saw palmetto. Which is the nurses best response?

a.

Youll need to get permission from your health care provider to make that decision.

b.

Saw palmetto is a well-respected alternative therapy for benign prostatic hyperplasia.

c.

Have you discussed this decision with your family?

d.

What has your health care provider told you about this choice of therapy?

ANS: D

Saw palmetto is an alternative therapy for benign prostatic hyperplasia (BPH) that has not yet been proven to be therapeutic. A clients decision to use this as the primary form of treatment should be discussed with his provider. Some herbs and natural products interfere with the actions of medications taken for other conditions. The other statements do not give the client accurate information to help him make this decision.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Teaching/Learning

25. A client is receiving brachytherapy for prostate cancer. Which intervention is most important for the nurse to include in the clients care plan?

a.

Reassure the client that erectile dysfunction does not occur with brachytherapy.

b.

Help the client plan activities interspersed with rest periods during the day.

c.

Remind the client that while hospitalized, he cannot have any visitors.

d.

Discuss hospice philosophy and availability with the client and family.

ANS: B

Fatigue is common throughout treatment and may continue for several months after treatment has concluded. The client will need to learn to manage the fatigue; this can include spacing activities and planning for rest periods throughout the day. Erectile dysfunction can occur as a side effect of brachytherapy. This procedure is usually done on an outpatient basis, and the client does not pose a danger to others. Brachytherapy is often a first-line treatment choice, so discussion of hospice is not appropriate at this time.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Basic Care and ComfortRest and Sleep)

MSC: Integrated Process: Teaching/Learning

26. A client is taking goserelin (Zoladex). What periodic assessment does the nurse plan for this client?

a.

Weight and abdominal girth

b.

Pulmonary function tests

c.

Bone density testing

d.

Abdominal ultrasound

ANS: C

Zoladex is a luteinizing hormonereleasing hormone (LH-RH) agonist. Side effects include hot flashes, erectile dysfunction, decreased libido, gynecomastia, and osteoporosis. A periodic bone density screening test should be done to assess for osteoporosis. The other assessments would not be needed to assess for side effects of this drug.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Teaching/Learning

27. The nurse is performing a psychosocial assessment of a young man diagnosed with testicular cancer. Which does the nurse include as a priority in the assessment?

a.

Encouraging the client to verbalize his thoughts and feelings to his health care provider

b.

Assisting the client in locating a support group for men with testicular cancer

c.

Asking the client to rate his fears of sexual deficiency on a scale of 1 to 10

d.

Identifying all components of his support system, including his partner

ANS: D

Part of conducting a psychosocial assessment is determining who makes up the clients support system. It would be ineffective merely to refer the client to a support group, ask him to rate his fears of sexual inadequacy, or encourage him to discuss thoughts and feelings not with the nurse, but with his provider.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Support Systems)

MSC: Integrated Process: Nursing Process (Assessment)

28. The nurse is caring for a young adult who just got married and has been diagnosed with testicular cancer. To which community resource does the nurse refer him?

a.

American Cancer Society

b.

Red Cross

c.

Sperm bank

d.

Public Health Department

ANS: C

The young man with testicular cancer should be referred to a sperm bank, so that he will have the option to have children in the future if he so desires. The other resources listed will not provide assistance in this area. The American Cancer Society does offer several resources for clients with cancer and their families, but referral to a sperm bank would be the priority owing to the mans age and his newly married status.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareReferrals) MSC: Integrated Process: Nursing Process (Implementation)

29. An older client with benign prostatic hyperplasia (BPH) and hypertension is being treated with doxazosin (Cardura) while staying in the hospital. Which activity does the nurse delegate to the unlicensed assistive personnel (UAP) as a priority?

a.

Helping the client choose low-sodium meal items

b.

Assisting the client whenever he gets out of bed

c.

Encouraging the client to use the spirometer hourly

d.

Frequently re-orienting the client to his surroundings

ANS: B

When treating a client in an inpatient setting with alpha blockers such as doxazosin (Cardura) or terazosin (Hytrin), the nurse must provide for the clients safety because this medication can cause orthostatic hypotension or syncope. The nurse should instruct the UAP to help the client whenever he gets out of bed, to prevent injury. Because this medication is being used for BPH and not for hypertension, a low-sodium diet is not necessary. Using the spirometer is always a good intervention, but it use is not related to safety and to this medication. The client, although older, may not be confused and may not need frequent reorientation.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlAccident/Injury Prevention)

MSC: Integrated Process: Nursing Process (Implementation)

MULTIPLE RESPONSE

1. Which symptoms are expected in orchitis? (Select all that apply.)

a.

Scrotal pain

b.

Dysuria

c.

Scrotal edema

d.

Priapism

e.

Penile discharge

f.

Inability to ejaculate

ANS: A, B, C, E

Manifestations of orchitis include scrotal pain, edema, reports of heavy feelings in the involved testicle(s), dysuria, pain on ejaculation, blood in the semen, and discharge from the penis. Ejaculation may be painful. Priapism is not a manifestation.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1650

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. A client has returned to the nursing unit after a prostatectomy. Which activities does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

a.

Demonstrating how to use the incentive spirometer

b.

Measuring and recording output from the in-dwelling catheter

c.

Encouraging the client to get out of bed and into the chair

d.

Irrigating the catheter with normal saline for blood clots

e.

Re-taping the catheter tape if the client reports pain

ANS: B, C

The UAP can assess and document intake and output and can encourage the client to get out of bed. Use of the incentive spirometer is taught by the nurse or respiratory therapist. The catheter is irrigated by the nurse. The catheter should be taped so that slight traction is left on it to help with bleeding; this may cause discomfort and would need to be explained to the client. The catheter should not be repositioned and then re-taped.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe Effective Care Environment (Management of CareDelegation)

MSC: Integrated Process: Nursing Process (Implementation)

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