Benign Prostatic Hyperplasia (10 Questions)

1. M. Roger Tremblay, a 78-year-old male, presents to the Emergency Department accompanied by his son. He is visibly agitated, pacing near the bed, and diaphoretic. He states, "I have been trying to pee for 8 hours but nothing comes out except a few drops." His lower abdomen is visibly distended.

The physician orders:
*Bladder scan STAT.
*Insert indwelling urinary catheter (Foley) if volume > 400 mL.

The bladder scan reveals 950 mL of urine. The nurse attempts to insert a standard 16Fr Foley catheter but encounters firm resistance at the prostate and cannot advance the catheter.

Question:
What is the nurse’s best next action? *

Force the catheter firmly past the resistance to enter the bladder.

Apply ice to the lower abdomen to reduce swelling and try again in 1 hour.

Remove the catheter and attempt to re-insert using a Coudé-tip catheter.

Encourage the patient to stand up and try to void naturally.

2. M. André Gagnon, 66 years old, visits the urology clinic for follow-up of moderate BPH. He reports waking up 4-5 times a night to void. The physician adds a new medication to his regimen:
*Tamsulosin (Flomax) 0.4 mg PO daily.

Question:
When providing health teaching about this specific medication, what safety instruction is priority? *

"This medication may turn your urine an orange-red color."

"You should take this medication on an empty stomach for best absorption."

"Change positions slowly from lying to standing to prevent dizziness."

"You must have your blood pressure checked weekly for hypertension."

3. M. Jean-Paul Roy, 70 years old, is 4 hours post-operative following a Transurethral Resection of the Prostate (TURP). He has a 3-way catheter with Continuous Bladder Irrigation (CBI) running with Normal Saline.

The nurse observes the following:
*The drainage in the bag is bright red with numerous small clots.
*The irrigation fluid is dripping slowly.
*M. Roy reports a pain level of 2/10.

Question:
What is the nurse’s priority intervention? *

Clamp the catheter to allow a clot to form and stop the bleeding.

Administer the prescribed PRN opioid analgesic.

Increase the flow rate of the Continuous Bladder Irrigation (CBI).

Call the surgeon immediately to report hemorrhage.

4. M. Claude Lefebvre, 68 years old, is recovering on the unit 12 hours after a TURP. He has a CBI running. Suddenly, he complains of severe, cramping lower abdominal pain (rated 9/10) and a strong urge to void around the catheter. The nurse notices that urine output into the drainage bag has stopped.

Question:
What is the nurse’s initial action? *

Administer the prescribed Belladonna & Opium (B&O) suppository for spasms.

Increase the rate of the irrigation fluid.

Palpate the bladder and check the catheter tubing for kinks or clots.

Encourage the patient to perform relaxation breathing exercises.

5. M. Michel Bouchard, 55 years old, is being screened for prostate health. The physician orders the following tests:

*PSA (Prostate-Specific Antigen) blood level.
*DRE (Digital Rectal Examination).

The nurse enters the room to facilitate the tests.

Question:
Which sequence of procedures is correct to ensure accurate results? *

Assist with the DRE first, then draw the PSA blood sample immediately after.

Draw the PSA blood sample before the DRE is performed.

The order does not matter as the tests measure different things.

Instruct the patient to ejaculate 24 hours before the PSA test.

6. M. Robert Dubé, 72 years old, is taking Finasteride (Proscar) for BPH. He comes to the clinic for a 3-month follow-up. He expresses frustration, stating, "I've been taking this pill for 12 weeks, but my flow isn't much better. I think I should stop."

Question:
What is the nurse’s best response? *

"You are right; if it hasn't worked by now, it likely won't work for you."

"You should double the dose starting tomorrow to speed up the process."

"This medication works by shrinking the prostate, which can take 6 months to be effective."

"We need to switch you to antibiotics as you likely have an infection."

7. M. Pierre Fortin, 75 years old, is being discharged home following a TURP. The nurse is reviewing instructions to prevent post-operative bleeding complications. M. Fortin asks about his daily routine.

Question:
Which instruction is essential to include in the discharge teaching? *

"You may resume your daily jogging routine immediately to prevent clots."

"Avoid straining during bowel movements; use a stool softener if needed."

"Restrict fluid intake to 1L per day to reduce the need to void."

"It is safe to lift objects up to 50 lbs as long as you bend your knees."

8. M. Jacques Morin, 62 years old, presents with complaints of urinary hesitancy and a weak stream. He tells the nurse he has been taking an Over-the-Counter (OTC) medication for a head cold for the past 3 days.

The nurse reviews the medication bottle: "Contains Pseudoephedrine."

Question:
What is the nurse’s best explanation regarding this medication? *

"This medication is safe; it has no effect on your urinary system."

"You should drink less water while taking this to prevent pressure."

"Decongestants can tighten the muscles in the prostate and worsen your symptoms."

"This medication actually helps shrink the prostate temporarily."

9. M. Sylvain Côté, 69 years old, is 24 hours post-TURP.

The physician orders:
*Discontinue CBI.
*Remove Foley catheter tomorrow morning.
*Trial of Void (TOV).

The catheter is removed at 08:00. It is now 14:00 (6 hours later), and M. Côté has not voided. He reports feeling mild pressure but cannot urinate.

Question:
What is the nurse’s next action? *

Immediately re-insert the Foley catheter.

Administer a diuretic to stimulate urine production.

Perform a bladder scan to assess the volume of urine retained.

Tell the patient to wait another 2 hours.

10. M. Louis Pelletier, 71 years old, is admitted to the neurological unit for a suspected stroke. He has a history of BPH. The nurse notes he is confused and restless. While assessing the abdomen, the nurse notes a smooth, firm, oval mass extending from the symphysis pubis to the umbilicus.

Question:
What does this physical assessment finding indicate? *

A tumor of the colon.

A distended bladder.

An abdominal aortic aneurysm.

Normal prostate enlargement felt through the abdomen.