Exam 15: Genitourinary Surgery

The PSA test is a serum lab test for prostate-specific antigen.If the test value is elevated,the patient is at risk for carcinoma of the prostate; a PSA value greater than 10 ng/mL is highly suggestive of prostatic carcinoma.Tissue from a transrectal prostate biopsy provides the cellular information to confirm the diagnosis.The American Urological Association (AUA)prostate cancer staging tool essentially provides which important information about the tissue specimen?

In TURP,the surgeon passes a resectoscope into the bladder through the urethra and resects successive pieces of tissue from around the bladder neck and the lobes of the prostate gland,leaving the capsule intact.TURP is traditionally indicated for patients with benign obstructive disease of the prostate.A TURP would be indicated for a patient with malignant prostatic disease under which of the following conditions?

A 68-year-old retired school teacher is recovering on postoperative day 2 from a robotic-assisted laparoscopic prostatectomy.The perioperative lead nurse for the urology surgery division has arrived in the patient's room to complete his discharge instructions,which she began 3 days ago on his admission to the preoperative unit.Although the patient has been taught that it is normal to go home with a catheter after this type of procedure,he expresses concerns about his ability to care for his urinary catheter at home.After the nurse assures him that he will soon demonstrate or regain a normal pattern of urinary elimination,which statement would best ensure that the patient will be able to accomplish his outcome?

During urologic surgery,large quantities of irrigating fluids are infused intraoperatively.An appropriate nursing intervention would include:

During a robotic-assisted laparoscopic prostatectomy,the patient,positioned in steep Trendelenburg,exhibited signs of deteriorating oxygenation and loss of secured airway requiring immediate intervention.What is the next priority to respond to the emergency?

The adrenal glands lie retroperitoneally beneath the diaphragm,capping the medial aspects of the superior pole of each kidney.The adrenal medulla secretes ______________,while the adrenal cortex secretes ____________ and ____________.

An 84-year-old retired musician was seen by his family practice physician for urinary problems.His physician performed a DRE,which was abnormal,ordered a PSA,and referred him to a urologist.The patient's PSA was 12 ng/mL.His transrectal prostatic biopsy was positive.The biopsy specimen determined a Gleason score of 10,and his AUA score was D2.Based on this clinical diagnostic information,what is the best treatment plan for the patient?

The kidneys are highly vascular organs.Approximately how much of the entire circulating blood volume is processed by the kidneys at any one time?

Each potential kidney transplant recipient is judged individually as a candidate.Which condition would most likely eliminate a patient as a candidate for kidney transplant?

Prostate cancer is the most frequently diagnosed cancer in men and is the second leading cause of cancer death in men.Select the triad that best reflects the individual with the highest risk for prostate cancer.

Which action best reflects the movement of urine from the renal pelvis to the bladder?

The lead perioperative nurse in the robotic prostatectomy division of the urology service has developed a standardized plan of care that the nurses will use to deliver individualized patient care and education according to recognized standards of care.Interventions include the following: clarifying the patient's understanding of the risks and benefits of the surgical procedure; providing an open,accepting environment for the patient to discuss potentially embarrassing issues; and maintaining patient privacy and dignity.Which desired outcome is addressed by this plan?

A perioperative nurse relieved the circulating nurse in OR 5,where they were about to begin a circumcision on a 17-year-old patient under general anesthesia.After she received the hand-off report from the circulating nurse,she noticed an empty vial of lidocaine 1% with epinephrine 1:100,000 by the computer,where she had signed herself in as the relief nurse.During the hand-off report,the scrub person showed her the medication cup on the sterile field.It was labeled "lidocaine 1%." The scrub person had drawn up 10 mL in a syringe to hand to the surgeon for a penile block.Her immediate response should be to:

The flexible cystoscope is a delicate and valuable endoscopic instrument indicated for diagnostic bladder evaluation for patients with obstructive symptoms from prostatic hyperplasia and a rigid prostatic urethra.It has valuable benefits because of its small diameter and flexibility.Select benefits that support the use of flexible endoscopy in the outpatient setting.

The renal artery and vein enter and exit the kidney on the medial side of the organ through a concave area known as the:

A wide variety of drains,stents,and other catheters are designed and used for specific urologic procedures.A commonly used catheter is described by its tip.What catheter type is described as open-ended tip,whistle tip,cone tip,and olive tip?

Endoscopic examination of the urinary tract,with a sterile cystoscope,is typically designated as which wound classification category?

A 26-year-old man with a ureteral stone is transferred to the urology bed for a cystoscopy,ureteroscopy,and laser lithotripsy under fluoroscopy.The circulating nurse assists the patient into a position of comfort and positions his arms,tucking them at his sides,with the lift sheet over his arm and under his body.With the patient's assistance,the nurse ensures that his sacrum is positioned just above the break in the OR bed and that his legs and feet are safely and securely supported for anesthesia induction and intubation.From the interventions below,what important nursing action should the nurse perform as soon as the patient is asleep,intubated,and positioned into lithotomy?

TURP syndrome is a state of severe hyponatremia,caused by systemic absorption of irrigating fluid during the procedure.Select the sign/symptom that the anesthesia provider would report in a patient experiencing TURP syndrome.

Patients having genitourinary surgery are at risk for impaired urinary elimination.Select the statement that best reflects a desired outcome for an adult patient.