Urolithiasis, BPH and Prostate Cancer

The nurse is conducting an interview of an older client and is concerned about the possibility of benign prostatic hyperplasia (BPH). Which are characteristics of this disorder? Select all that apply.

• Nocturia

• Incontinence

• Enlarged prostate.

• Nocturnal emissions

• Decreased desire for sexual intercourse

Answer explanation

Nocturia, incontinence, and an enlarged prostate are characteristics of BPH and need to be assessed for in clients over 50 years of age. Nocturnal emissions are commonly associated with prepubescent individuals. Low testosterone levels (not BPH) may be associated with a decreased desire for sexual intercourse.

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia?

• Nocturia

• Scrotal edema

• Occasional constipation

• Decreased force in the stream of urine.

Answer explanation

Decreased force in the stream of urine is an early symptom of benign prostatic hyperplasia. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur. Constipation or scrotal edema is not associated with benign prostatic hyperplasia.

A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis. The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply.

• Peritoneal dialysis

• Analysis of the urinary stone

• Intravenous opioid analgesics

• Insertion of a nephrostomy tube

• Placement of a ureteral stent with ureteroscopy

Answer explanation

Urolithiasis is the condition that occurs when a stone forms in the urinary system. Hydronephrosis develops when the stone has blocked the ureter and urine backs up and dilates and damages the kidney. Priority treatment is to relieve the obstruction in the ureter and allow the urine to drain. This is accomplished by placement of a percutaneous nephrostomy tube to drain urine from the kidney and placement of a ureteral stent to keep the ureter open. Peritoneal dialysis is not needed since the kidney is functioning. Stone analysis will be done later when the stone has been retrieved and analyzed. Opioid analgesics are necessary for pain relief but do not treat the obstruction.

The nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP) to treat prostate cancer. The client has a three-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and would expect which urine color during the immediate postoperative period?

• Pale pink urine

• Dark pink urine

• Tea-colored urine

• Bright red blood with small clots in the urine

Answer explanation

If the bladder irrigation is infusing at a sufficient rate, the urinary drainage through the Foley tubing would be pale pink. Additionally, no clots would be present. Dark pink urine indicates that the rate of the irrigation solution needs to be increased. Tea-colored urine is not seen after TURP but may be noted in a client with other renal disorders such as renal failure. Bright red bleeding and clots could indicate a complication, and if this is noted, it needs to be reported to the primary health care provider.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, would the nurse identify as a risk factor for this disorder?

• Hypoglycemia

• Diabetes mellitus

• Coronary artery disease

• Orthostatic hypotension

Answer explanation

Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, the presence of urinary stones, and the presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in the remaining options are not associated risk factors.

The nursing student is caring for a client with benign prostatic hyperplasia (BPH). The nursing instructor asks the student to identify the clinical manifestations associated with this condition. The student needs further teaching if the student states that which finding is an early symptom of BPH?

• Nocturia

• Hematuria

• Decreased force of urine stream

• Difficulty initiating urine stream

Answer explanation

Hematuria is not an early sign of BPH. Nocturia, decreased force of urine stream, and difficulty initiating urine stream are all early signs of BPH.

The nurse provides discharge instructions to a client after prostatectomy. What is the priority discharge instruction for this client?

• Avoid driving a car for at least 1 week.

• Increase fluid intake to at least 2.5 L/day.

• Avoid lifting any objects greater than 30 lb (13.6 kg).

• Contact the primary health care provider (PHCP) if small clots are noticed in the urine.

Answer explanation

A daily intake of 2.5 L of fluid needs to be maintained to limit clot formation and prevent infection. Driving a car and sitting for long periods are restricted for at least 3 weeks. The client needs to be instructed to avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. Passing small pieces of tissue or blood clots in the urine for up to 2 weeks after surgery is expected and does not necessitate contacting the PHCP.

The nurse is caring for a client just after ureterolithotomy for treatment of calculi and is monitoring the drainage from the ureteral catheter hourly. Suddenly, the catheter stops draining. The nurse assesses the client and determines that which could be the cause of the problem? Select all that apply.

• Blood clots

• Mucous shreds

• Ureteral edema

• Chemical sediment

• Catheter displacement

Answer explanation

After ureterolithotomy, a ureteral catheter is put in place. Urine flows freely through it for the first 2 to 3 days. As ureteral edema diminishes, urine leaks around the ureteral catheter and drains directly into the bladder. At this point, drainage through the ureteral catheter diminishes. Immediately after surgery, absence of drainage usually is caused by blockage from blood clots, mucous shreds, chemical sediment, or catheter displacement.

The nurse is assessing a client who has returned from the postanesthesia care unit after transurethral resection of the prostate (TURP) to treat prostate cancer. The nurse would assess for which color in the urinary drainage tubing that indicates proper irrigation and adequate functioning of the device?

• Pale pink

• Dark pink

• Bright red

• Red with clots

Answer explanation

If the bladder irrigation solution is infusing at a sufficient rate, the urinary drainage will be pale pink. A dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation would be increased. Bright red bleeding and red urine with clots would be reported to the surgeon because either finding could indicate complications.

The nurse caring for a client immediately after transurethral resection of the prostate (TURP) notices that the client has suddenly become confused and disoriented. Which is the priority nursing action for this client?

• Reorient the client.

• Notify the surgeon.

• Ensure that a clock and calendar are in the room.

• Increase the flow rate of the intravenous infusion.

Answer explanation

The client who suddenly becomes disoriented and confused after TURP could be experiencing early signs of hyponatremia. This may occur because the flushing solution used during the operative procedure is hypotonic. If the solution is absorbed through the prostate veins during surgery, the client experiences increased circulating volume and dilutional hyponatremia. The nurse needs to notify the surgeon of these symptoms. Reorienting the client and ensuring that a clock and calendar are visible may be helpful but do not correct the problem. The nurse does not increase the flow rate of an intravenous infusion without a prescription from the surgeon. In addition, speeding up the flow rate could potentially worsen the problem, depending on the solution that is infusing.