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Exemplar 5.1: Benign Prostatic Hyperplasia

Description

I'm gonna have a couple questions about Bill. Bill is a 65 year old male who has BPH. His prostate is moderately enlarged, and he's having ever increasing troubles with urinary retention. He's first going to ask you about pharmacologic and nonpharmacologic therapies for his BPH. When that doesn't work, he asks you about the surgical interventions. You will provide education, pre-op, and post-op care for Bill in his series of problems.
Olivia McRitchie
Quiz by Olivia McRitchie, updated more than 1 year ago
Olivia McRitchie
Created by Olivia McRitchie over 6 years ago
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Resource summary

Question 1

Question
You are teaching a class about benign prostatic hyperplasia to a group of middle aged men. Which of the following statements made by a member of the audience indicates that more teaching is needed?
Answer
  • "The prostate gland borders the the urethra, near the lower part of the bladder."
  • "Benign prostatic hyperplasia begin when small nodules are formed in the inner layers of the prostate."
  • "This condition occurs over a long period of time, so it's more common in older men."
  • "An androgen is a hormone that causes the development of male sex characteristics. The main hormone that causes growth of prostate is dihydrotestosterone."
  • "Androgen levels decrease in older men, but estrogen causes the prostate gland to become sensitive to dihydrotestosterone."
  • "BPH rarely causes symptoms before the age of 50."

Question 2

Question
Almost all men develop BPH if they live long enough.
Answer
  • True
  • False

Question 3

Question
Which symptom is used to classify BPH?
Answer
  • Problems with voiding and storage
  • The presence of diverticula
  • Hydroureter
  • Hydronephrosis

Question 4

Question
Select all of the potential complications of BPH.
Answer
  • Diverticula
  • Ureter obstruction
  • Infection
  • Hydroureter
  • Hydronephrosis
  • Renal insufficiency
  • Incomplete bladder emptying
  • Urinary incontinence

Question 5

Question
There are surgical procedures that can reverse BPH
Answer
  • True
  • False

Question 6

Question
You are speaking with a middle aged man showing signs of BPH. He is about to undergo a digital rectal examination. The doctor has left the room to get the lubricant, and you are left to answer questions about the procedure. The man, annoyed at having to have a finger stuck in his rectum, asks you what exactly the point to this procedure is. Which of the following answers is the proper response?
Answer
  • "This is the most common diagnostic test for BPH; the doctor will feel your prostate to determine if it is enlarged, and determine a course of action from there."
  • "The doctor will be checking his finger to see if it comes back with residue."
  • "The doctor is doing this to rule out prostate cancer."
  • "The doctor is determining that it is a prostate problem rather than a bladder problem."

Question 7

Question
Which of the following patients would NOT be a candidate for surgery?
Answer
  • A man with urinary retention
  • A man with hematuria
  • A man with bladder stones
  • A man with renal insufficiency.
  • Any man with BPH is a candidate for surgery

Question 8

Question
You have a 65 year old male named Bill come into your office for a regular checkup. He was told by his doctor about a year prior that he has mild BPH, but that it's perfectly natural and 1/3 patients with mild BPH will have their symptoms cleared up with no intervention. He has just been informed by his doctor that he was part of the 2/3 of patients whose symptoms did not clear up without intervention, and that his prostate is now moderately enlarged. He asked the doctor about pharmacologic and nonpharmacologic therapies, but did not receive a sufficient response, and instead was just given finasteride "to help". Frustrated, he asks you, the nurse, what the potential pharmacological and nonpharmacological therapies are. Select the appropriate educational responses you can give Bill.
Answer
  • "Avoid over the counter decongestants like Sudafed, Suphedrin, and Silfedrine."
  • "Avoid taking antihistamines."
  • "Finasteride is called an alpha-blocker; these drugs relax the smooth muscle of the prostate and bladder neck to increase urine flow."
  • "Finasteride can cause impotence, decreased libido, and decreased volume of ejaculate. No serious adverse effects have been reported with the drug."
  • "Your doctor may combine finasteride with prazostin to prevent the progression of BPH."

Question 9

Question
Select appropriate teachings that you would give to a patient on an alpha-adrenergic blocker.
Answer
  • "This drug will inhibit the conversion of testosterone to DHT and cause the enlarged prostate to shrink in size."
  • "Make position changes slowly to prevent dizziness and accidental falls."
  • "Take and record your heart rate daily."
  • "Call your doctor before taking any medications for coughs, colds, or allergies."

Question 10

Question
Which of the following would NOT be an appropriate teaching for a patient with MILD BPH?
Answer
  • "Make sure you urinate at first urge."
  • "Avoid alcohol and caffeine."
  • "Drink small amounts of fluid spread throughout the day, right up until you go to bed."
  • "Avoid over the counter cold and sinus medications that contain decongestants or antihistamines."
  • "Do Kegel exercises regularly."
  • "Try to decrease your stress level."

Question 11

Question
Bill * comes back to you after trying finasteride. His prostate is still moderately enlarged, and he's very annoyed with the lack of improvement. He now asks you about surgical interventions that he can undergo. Select the correct patient teaching information you can give to Bill. *See description for info. If you can't, he''s a 65-year-old man who was prescribed finasteride for mild BPH. It didn't work though, and his BPH got worse.
Answer
  • "Transurethral microwave thermotherapy and transurethral needle ablation are minimally invasive options."
  • "All procedures, minimally invasive or not, carries the risk of impotence or incontinence."
  • "Transurethral resection of the prostate is a common procedure in which a resectoscope is inserted into the urethra and used to remove obstructing tissue."
  • "Transurethral incision of the prostate is a procedure in which the prostate is split to reduce pressure on the bladder. "
  • "Transurethral incision of the prostate and prostatectomy surgeries are commonly used for very large prostates."
  • "Laser surgery involves using a cytoscope to pass a YAG laser fiber through the urethra into the prostate to vaporize obstructing tissue. It may not be effective if your prostate is too enlarged though."

Question 12

Question
Bill* has been approved for a tranurethral resection of the prostate surgery. You are planning preoperative care, and want to make sure that he understands the nature of the procedure. Which of the following statements made by the patient indicates that MORE teaching is needed? *See description for info. If you can't, he''s a 65-year-old man prescribed finasteride for mild BPH. It didn't work though, and his BPH got worse. Now he needs surgery.
Answer
  • "This is a surgical procedure in which obstructing tissue is removed with the wire loop of a resectoscope and electrocautery is inserted through the urethra. Tissue is removed 1 piece at a time and flushed into the bladder, then out at the end of the surgery."
  • "The prostate gland borders the urethra, near the lower part of the bladder, and secretes solutions that increase sperm motility during sexual intercourse."
  • "I will not experience impotence or incontinence following this procedure.
  • "I should not be embarrassed to ask my nurse questions, even though she is female."
  • "I will have a urinary catheter following the procedure, but it is not permanent."
  • "I may be required to wear sequential pneumatic compression stockings after the procedure."

Question 13

Question
Bill * is out of his transurethra resection of the prostate (TURP) surgery. You are now caring for him post-op. He has an 18-22 Fr 3 way catheter with a 30-45 mL balloon. It's on continuous bladder irrigation. Select the appropriate post-op interventions for Bill. *See description for info. If you can't, he''s a 65-year-old man prescribed finasteride for mild BPH. It didn't work though, and his BPH got worse. He has to undergo transurethral resection of the prostate surgery,
Answer
  • Monitor vital signs very closely for the first 24 hours.
  • Administer the appropriate pain medications.
  • Keep Bill in antiembolic stockings
  • Restrict fluid intake
  • Monitor Bill closer if you notice bloody urine,
  • Instruct Bill to not strain when trying to void with the catheter in.
  • Assess the catheter for color, consistency of amount, and presence of blood clots every 3-4 hours
  • Assess for hyponatremia, hypertension, bradycardia, nausea, and confusion.
  • Notify Bill that he may may experience a burning sensation, dribbling, and/or urinating small blood clots after the catheter is removed.
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