Deck 15: Genitourinary Surgery

Question 1

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 ____________.

A) epinephrine; steroids and hormones
B) steroids; adrenaline and hormones
C) epinephrine; pituitary-stimulating hormone and adrenaline
D) pituitary hormones; cortisol and norepinephrine

Answer 1

A
Each adrenal gland has a medulla,which secretes epinephrine (adrenaline),and a cortex,which secretes steroids and hormones.

Question 2

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?

A) Prostate cancer stages of severity
B) Indications for selecting appropriate intervention
C) Prognosis and potential for recovery
D) Men who are at the greatest risk for prostate cancer

Answer 2

A
The AUA recommends that starting at age 40 the PSA test and digital rectal examination (DRE)be offered to men at average risk.Clinical evaluation and an elevated PSA usually indicate the need for a transrectal ultrasound needle biopsy to confirm the diagnosis.When the results of the biopsy are positive for cancer,the AUA score measures the severity of the cancer: stage A is clinically unsuspected disease; stage B means a tumor confined to the prostate gland; stage C refers to a tumor localized to the periprostatic area; and stage D means metastatic prostate cancer.

Question 3

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?

A) He should learn catheter care and measures to facilitate voiding after catheter removal.
B) The nurse should teach him about catheter care and how to void when it is removed.
C) He should be able to "teach-back" proper catheter care to the nurse.
D) The nurse should demonstrate proper catheter care techniques.

Answer 3

C
Information provided should be presented in language the patient can understand (lay terms)and clarified with the patient by having the patient repeat back and/or teach-back in his or her own words the information provided.Nursing interventions for the outcome statement,"The patient will demonstrate or regain a normal pattern of urinary elimination" include recommending that the nurse teach catheter care and measures to facilitate voiding after catheter removal as part of preoperative patient and family education and discharge planning.The nurse should then have the patient teach-back proper catheter care and provide time for questions and clarification about home care.

Question 4

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?

A) Slide an under-buttocks drape below his buttocks and pull out the fluid collection tray of the bed.
B) Place leaded shields over his thyroid and chest and document their placement on the perioperative nursing record.
C) Check, monitor, and document his position and body alignment.
D) Initiate the time-out briefing with the surgeon and anesthesia provider.

Question 5

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.

A) An identical twin or spouse, young, ABO and Rh factor compatibility
B) An identical twin or parent, good health, and large right kidney
C) An identical twin or sibling, no family history of diabetes, Rh factor compatibility
D) An identical twin, sibling, or parent, ABO and human leukocyte antigen (HLA) compatibility, good health

Question 6

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.

A) A Gleason score between 8 and 10 is associated with indications for curative surgery.
B) The first and second most common cell types are each given a score of 1 to 5, and the numbers are combined for a total score.
C) The number of cells in a given space determines the score; the lower the number, the more aggressive the cancer.
D) The Gleason score is determined by doubling the AUA score.

Question 7

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

A) One-fifth
B) 1 mL/kg body weight
C) One-third
D) 30 mL/hr

Question 8

An orthotopic neobladder is surgically created as a bladder substitute after a cystectomy,prostatectomy,or hysterectomy is performed for bladder cancer.Bladder substitution relies on meticulous dissection with preservation of the urinary sphincter and neurovascular bundles,as well as a watertight urethral anastomosis.Also termed the Le Bag continent diversion,which segments of the bowel and/or small intestine are used in this technique to create the neobladder?

A) Segment of sigmoid colon
B) Right colon and ileum
C) Proximal right colon segment with cecum
D) Transverse colon

Question 9

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.

A) 65+ years old, African descent, father had prostate cancer
B) 50+ years old, Pacific Islander descent, brother has prostate cancer
C) 36 years old, Jamaican descent, low-fat diet, no family history
D) 45 years old, African descent, low-fat diet

Question 10

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

A) Normal intra-abdominal positive pressure promotes renal drainage.
B) Slight distention of the renal pelvis initiates a wave of peristaltic contractions.
C) Distention of the proximal ureter facilitates gravity drainage through signaling channels.
D) Urine is propelled into the bladder when adrenal hormones bind with ureteral receptor sites.

Question 11

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) calyces.
B) pedicle.
C) hilum.
D) renal pelvis.

Question 12

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?

A) Place the patient back in supine position.
B) Extubate and reintubate.
C) Remove the instruments from the patient.
D) Create a surgical airway.

Question 13

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?

A) Irrigation catheter
B) Urethral catheter
C) Ureteral catheter
D) Pigtail catheter

Question 14

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:

A) say nothing; the epinephrine will minimize bleeding and prolong the anesthetic action.
B) tell the scrub person to write epinephrine 1:100,000 on the syringe and cup label.
C) alert the team that lidocaine with epinephrine was accidentally placed on the back table.
D) position the vial so that the original label is visible to the surgeon.

Question 15

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

A) The patient will be able to urinate before the bladder exceeds 350 mL of fullness.
B) The patient will regain his or her normal pattern of urinary elimination.
C) The patient will excrete 50 mL of urine per hour.
D) The patient will be able to ambulate to the bathroom following surgery.

Question 16

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) For palliative relief of obstruction for end-stage disease
B) For symptom relief of obstruction before initiating other treatments
C) For specimen retrieval for diagnostic cancer staging
D) For men who cannot tolerate, or who are not candidates for, high-intensity focused ultrasound

Question 17

Select the statement about the prostate that best reflects its location.

A) The prostate sits adjacent to the urethra.
B) The prostate sits below the urethra.
C) The prostate is anterior to the bladder.
D) The prostate is interposed between the bladder neck and the urethra.

Question 18

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?

A) TURP
B) Simple perineal prostatectomy
C) Radical open prostatectomy with lymph node dissection
D) No surgery, because he is probably not a candidate for surgery

Question 19

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) The patient will verbalize an acceptable anxiety level.
B) The patient will discuss fears and concerns regarding sexual function.
C) The patient will demonstrate or regain a normal pattern of urinary elimination.
D) The patient will use touch to convey caring and support.

Question 20

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

A) monitoring and recording the volume of intravenous (IV) and irrigating fluids instilled.
B) maintaining a closed urinary drainage system.
C) monitoring pH and specific gravity of urine.
D) monitoring serum electrolyte status.

Question 21

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?

A) Mild systemic disease
B) Diabetes
C) Posttreatment cancer in remission
D) Active cancer

Question 22

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.

A) It may be accomplished using a local anesthetic.
B) It can be used for patients unable to assume the lithotomy position.
C) It can be performed on the patient's bed on the nursing unit.
D) It provides a wide working channel for auxiliary instruments.

Question 23

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

A) Class I (clean)
B) Class II (clean-contaminated)
C) Class III (contaminated)
D) Class IV (infected)

Question 24

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

A) Determine electrolyte levels, measure irrigation fluid volume deficits, administer hypertonic IV saline
B) Administer hypertonic IV saline, administer IV diuretics, terminate surgery if reaction is severe
C) Evaluate electrolyte values, give IV diuretics, listen to breath sounds for signs of pulmonary edema
D) Determine the irrigation fluid volume deficit, reduce pressure on irrigation bag system, administer IV diuretics

Question 25

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.

A) Hypertension
B) Hyperthermia
C) Hypocalcemia
D) Hypokalemia