Transurethral Resection of the Prostate (11 Questions)

1. M. Jacques Tremblay, 68 years old, arrives on the unit following a TURP. He has a 3-way Foley catheter with Continuous Bladder Irrigation (CBI) running with Normal Saline. Upon assessment, the nurse notes the drainage in the collection bag is bright red with numerous small clots.

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

Clamp the irrigation tubing for 15 minutes to allow a clot to form at the surgical site.

Increase the rate of the bladder irrigation flow immediately.

Notify the urologist to request an order for Vitamin K.

Slow the irrigation rate to prevent bladder distension.

2. M. Robert Gagnon, 72 years old, is 4 hours post-TURP. During the admission assessment, he was alert and oriented. Now, he appears confused and disoriented. He complains of nausea. Vital signs: BP 160/90, HR 52 (bradycardia).

Question:
What condition should the nurse suspect? *

Hypovolemic Shock due to hemorrhage.

TURP Syndrome (Hyponatremia).

Post-operative infection (Sepsis).

Normal reaction to anesthesia.

3. M. Gilles Roy, 65 years old, is 1 day post-TURP. He calls the nurse reporting sharp, intermittent cramping pain in his lower abdomen and a strong urge to void.

Assessment:
*Vital Signs: BP 140/85, HR 88, RR 18, T 37.0°C.
*CBI: Urine is light pink and flowing freely; no clots noted in the tubing.
*Abdomen: Soft, non-distended.

Medical Orders:
*D5W 0.9% NaCl at 100 mL/hr.
*Acetaminophen 650 mg PO q4h PRN for mild pain.
*Morphine 2 mg SC q4h PRN for severe pain.
*Belladonna and Opium (B&O) suppository PRN q6h for bladder spasms.
*Manual irrigation 50 mL NS PRN for obstruction.

Question:
What is the most appropriate nursing intervention? *

Perform a manual irrigation with 50 mL NS to ensure patency.

Administer Morphine 2 mg SC immediately.

Administer the B&O suppository.

Encourage the patient to bear down as if voiding to release the pressure.

4. M. André Lemieux, 70 years old, is 6 hours post-TURP. He is agitated and pointing to his lower belly.

Assessment:
*Patient reports severe pain (9/10).
*CBI: The drip chamber is flowing rapidly, but no urine has appeared in the drainage bag for 45 minutes.
*Abdomen: Suprapubic area is distended and firm.

Medical Orders:
*Titrate CBI to keep urine pink.
*Irrigate catheter manually with 50-60 mL Normal Saline PRN if blocked.
*Meperidine (Demerol) 50 mg IM q4h PRN for pain.
*Dimenhydrinate (Gravol) 50 mg IM q4h PRN for nausea.

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

Administer Meperidine 50 mg IM for the severe pain.

Increase the rate of the CBI flow to flush the bladder.

Perform manual irrigation with Normal Saline.

Call the physician to request an order for a bladder scan.

5. M. Jean-Guy Cote, 74 years old, had his 3-way catheter removed at 08:00. It is now 14:00 (6 hours later), and he has not voided. He reports feeling fullness in his bladder.

Medical Orders:
*Discontinue CBI and catheter Day 2 post-op.
*Encourage PO fluids.
*Perform Bladder Scan if no void within 6-8 hours post-removal.
*If Bladder Scan volume > 400 mL, perform intermittent catheterization.

Question:
The nurse performs a bladder scan which shows 550 mL of urine. What is the next step? *

Encourage the patient to stand in a warm shower to stimulate voiding.

Document the finding and encourage him to wait another 2 hours.

Perform intermittent catheterization.

Reinsert a 3-way Foley catheter and restart CBI.

7. M. Pierre Fortin, 59 years old, is 2 days post-TURP. During morning care, he appears anxious and tells the nurse, "I read online that this surgery will ruin my sex life and I won't be able to have children or enjoy sex anymore." He is visibly distressed.

Medical Orders:
*Remove Foley catheter tomorrow morning at 06:00.
*Encourage PO fluids (2-3 L/day).
*Provide teaching regarding post-operative sexual function and retrograde ejaculation.

Question:
What is the most accurate explanation the nurse should provide? *

"Unfortunately, most men become permanently impotent after this procedure, but there are medications that can help."

"You will be sterile, but you will still have erections. You may experience 'dry' orgasms where semen goes into the bladder."

"Your sexual function will not change at all; the prostate does not affect ejaculation."

"You will experience pain during intercourse for the first year, but it will subside."

8. M. Jean-Guy Cote, 74 years old, had his 3-way catheter removed 4 hours ago. He calls the nurse to the bathroom. He is upset and says, "Look, I wet myself again. I can't seem to hold it when I stand up. Is my bladder ruined?" The nurse observes clear urine on his gown.

Medical Orders:
*Discontinue CBI and catheter.
*Teach Pelvic Floor Muscle (Kegel) exercises.
*Monitor voiding pattern.

Question:
What is the most appropriate nursing response? *

"I will call the doctor to reinsert the catheter since you are incontinent."

"You should stop drinking water for the rest of the day to prevent accidents."

"This is a permanent side effect of the surgery, and you will need to wear incontinence pads from now on."

"This is a temporary condition caused by the stretching of the sphincter; doing the prescribed Kegel exercises will help you regain control."

9. M. Sylvain Lapointe, 63 years old, is 2 hours post-TURP. The nurse enters the room to check the CBI. The patient appears pale and diaphoresis is noted. The drainage in the catheter bag has changed from light pink to a thick, dark red consistency resembling ketchup, with numerous clots.
Vital signs: BP 92/54, HR 110, RR 24.

Medical Orders:
*Continuous Bladder Irrigation with Normal Saline.
*Notify Surgeon immediately if: Systolic BP < 100, HR > 100, or drainage becomes bright red/thick.
*Hematocrit and Hemoglobin STAT.

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

Increase the CBI rate and recheck vitals in 15 minutes.

Apply traction to the catheter by taping it firmly to the patient's leg.

Notify the surgeon immediately

Administer a bolus of 500 mL Normal Saline IV.

10. M. Denis Turcotte, 71 years old, is 24 hours post-TURP. During the start-of-shift assessment, the nurse checks the urinary drainage bag. The urine is completely clear and colorless. The patient reports feeling a sensation of fullness in his bladder. The irrigation fluid is currently running at a wide-open rate (rapid flow).

Medical Orders:
*Titrate CBI rate to maintain urine light pink to clear.
*Furosemide 20 mg IV daily.
*Bed rest with bathroom privileges.

Question:
What is the most appropriate nursing intervention? *

Stop the irrigation completely and remove the catheter.

Maintain the current rapid rate to prevent clot formation.

Call the physician to request a diuretic.

Slow down the rate of the continuous bladder irrigation.

11. M. Claude Gagnon, 72 years old, is 12 hours post-TURP. He presses the call bell frantically. Upon entering the room, the nurse finds M. Gagnon grimacing, sweating, and clutching his lower abdomen.

Assessment:
*Patient reports: "My bladder feels like it is going to explode! It hurts so much!" (Pain 10/10).
*CBI Status: The irrigation fluid is running at a rapid rate (wide open).
*Output: The drainage bag has been empty for the past 45 minutes.
*Physical Exam: The suprapubic area is visibly distended, firm to palpation, and clear fluid is bypassing the catheter and leaking around the urinary meatus onto the sheets.

Medical Orders:
*Continuous Bladder Irrigation (CBI) with Normal Saline.
*Perform manual irrigation with 50 mL Normal Saline PRN if catheter is blocked.
*Morphine 2 mg IV q4h PRN for severe pain.
*Belladonna & Opium (B&O) suppository q6h PRN for spasms.

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

Administer the B&O suppository to relax the bladder muscles.

Stop the Continuous Bladder Irrigation (CBI) inflow immediately.

Disconnect the catheter from the drainage bag and perform manual irrigation immediately.

Administer Morphine 2 mg IV to control the severe pain.