Deck 14: Genitourinary Surgery

Question 1

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 or sibling or parent,ABO and HLA compatibility,good health

Answer 1

D
The kidney donor must be in good health.ABO (blood typing)and histocompatibility (human leukocyte antigen [HLA] tissue typing)along with a negative white cell (lymphocyte)crossmatch determine donor-recipient compatibility.It is not necessary to match the Rh factor.If there is a family history of diabetes,a 5-hour glucose tolerance test is also performed (UNOS,2009).The ideal living donor is an identical twin,although any immediate family member (usually a sibling or parent)may be a donor.Usually the right kidney is chosen for removal because of its smaller size,leaving the donor patient with the left and larger kidney.

Question 2

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?

A) The patient will be free from injury related to the surgical position.
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) This plan addresses all three outcomes.

Answer 2

B
The outcome statement,"The patient will discuss fears and concerns regarding sexual function" is sensitive to the following nursing interventions:clarify the patient's understanding of risks and benefits of the surgical procedure;provide an open,accepting environment for the patient to discuss potentially embarrassing issues;maintain patient privacy and dignity;consider making a referral for the patient to discuss options available to achieve sexual function.

Question 3

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," what 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

Answer 3

B
The orthotopic ileocolic neobladder,or Le Bag continent diversion technique,uses the right colon and ileum as an orthotopic bladder replacement.Contraindications include previous radiation therapy,bowel disease (e.g.,diverticulosis,Crohn's disease,colitis),and other major medical problems.

Question 4

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 5

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

Question 6

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?

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

Question 7

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) All of the options are desired outcomes.

Question 8

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?

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 9

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) Prostate cancer stages of severity
B) Indications for selecting appropriate intervention
C) Prognosis and potential for recovery
D) All of the options define the AUA score system.

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

A) One fifth
B) 1 ml per kg body weight
C) One third
D) 30 ml per hour

Question 12

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?

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

Question 13

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 14

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?

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 15

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?

A) Transurethral resection of the prostate (TURP)
B) Simple perineal prostatectomy
C) Radical open prostatectomy with lymph node dissection
D) No surgery.Wilber is not a candidate for surgery.

Question 16

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

A) monitoring and recording the volume of IV and irrigating fluids instilled.
B) maintaining a closed urinary drainage system.
C) providing the patient with information on preventing recurrent urinary tract infections.
D) monitoring blood loss and volume replacement.

Question 17

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:

A) high-temperature nonionizing thermal energy.
B) cavitation of the prostate cell cytoplasm by the implosion of microscopic bubbles.
C) mechanical shearing force of ultrasonic waves.
D) radiofrequency coagulation of prostatic cell nuclei.

Question 18

Shawna Bolten,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.Shawna's immediate response should be:

A) no response;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) empty the cup and syringe and refill with 1% lidocaine without epinephrine.

Question 19

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

A) The prostate sits adjacent to the urethra,is 2 to 4 cm in depth,and weighs about 25 g.
B) The prostate sits below the urethra,is 2 to 3 cm in depth,and weighs 25 to 30 g.
C) The prostate sits below the bladder,is 2 cm in depth,and weighs about 25 to 40 g.
D) The prostate sits below the base of the bladder,is 4 cm at the base,and weighs 20 to 30 g.

Question 20

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.

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 and Jamaican descent,low-fat diet,no family history
D) 45 years old,African descent,low-fat diet

Question 21

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?

A) Systemic disease
B) Cardiovascular disease
C) Post-treatment cancer in remission
D) Active cancer

Question 22

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) Hypernatremia
D) Hypokalemia

Question 23

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 24

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) The cystoscope can be processed between patients without manual cleaning and disinfection.