Exam 14: Genitourinary Surgery

Wilber Johnson,an 84-year-old retired musician of Jamaican descent,was seen by his family practice physician for urinary problems.His physician performed a digital rectal exam (DRE),which was abnormal,ordered a PSA,and referred him to a urologist.Wilber'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 surgical treatment plan for Wilber?

High-intensity focused ultrasound (HIFU)is a noninvasive technique used in the treatment of prostate cancer.HIFU is a targeted therapy that is highly focused into a small area without causing collateral tissue damage.Aside from primary therapy,HIFU can be used as salvage therapy,primarily after radiation.HIFU can be performed as an outpatient procedure,often with an epidural anesthetic.The HIFU-directed energy modality is best described as:

James Romano,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 James' room to complete his discharge instructions,which she began 3 days ago on his admission to the preoperative unit.Although James 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 James that he will soon demonstrate or regain a normal pattern of urinary elimination,what statement would best ensure that James will be able to accomplish his outcome?

Justin Reynolds,a 26-year-old male with a ureteral stone,is transferred to the cystoscopy bed for a cystoscopy,ureteroscopy,and laser lithotripsy under fluoroscopy of a left ureteral stone.The circulating nurse assists Justin 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 Justin's assistance,she 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 Justin is asleep,intubated,and positioned into lithotomy?

Although each potential kidney transplant recipient is judged individually as a candidate,which condition from the list below would most likely eliminate a patient as a candidate for kidney transplant?

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.What desired outcome is addressed by this plan?

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

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.

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

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.

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

A wide variety of ureteral and urethral 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?

In transurethral resection of the prostate gland (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?

The Gleason score is similar to the AUA score because it also needs to be measured against microscopic samples of prostatic tissue.Select the statement that best defines the assignment of the Gleason score.

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

Select the statement about the prostate that best reflects its location,size,and weight.

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

Select the appropriate triad of corrective actions for the management of TURP syndrome in the intraoperative patient.

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 what important information about the tissue specimen?

A kidney transplant entails transplantation of a living-related or cadaveric donor kidney into the recipient's iliac fossa.It is performed in an effort to restore renal function and maintain life in a patient who has end-stage renal disease.Select the statement that best reflects the ideal living-related donor candidate.