Transurethral resection syndrome—it does not have to be a mystery - Home Study Program - Brief Article

AORN Journal,  Jan, 2002  by Ann Chambers

• E-mail
• Print
• Link

Examination

TRANSURETHRAL RESECTION SYNDROME--IT
DOES NOT HAVE TO BE A MYSTERY

1. Transurethral resection (TUR) syndrome is

   a. sodium intoxification resulting in hyponatremia
      and other acid-base imbalances.
   b. water intoxification resulting in hypernatremia
      and other acid-base imbalances.
   c. sodium intoxication resulting in hypernatremia
      and other acid-base imbalances.
   d. water intoxication resulting in hyponatremia
      and other acid-base imbalances.

2. This complication occurs in approximately --
   of all patients undergoing transurethral resection
   of the prostate (TURP) procedures.

   a. 2%
   b. 4%
   c. 5%
   d. 6%

3. The prostate gland is the size of a chestnut (ie, 2
   cm x 4 cm) and

   a. contains the vas deferens, blood vessels, and
      lymphatics.
   b. is a pouch that lies behind the bladder.
   c. surrounds the urethra at the base of the bladder.
   d. is a convoluted duct suspended in the scrotum.

4. The vascular network of capillaries surrounding
   the musculofibrous tissue of the gland is called a

   a. carotid sinus.
   b. vascular cyst.
   c. vascular sinus.
   d. carotid cyst.

5. The opaque, alkaline fluid that preserves and
   mobilizes sperm is known as

   a. seminal fluid.
   b. prostatic secretion.
   c. lymph secretion.
   d. synovial fluid.

6. Landmarks used during TURP procedures to
   guide resection are the

   a. corpora cavernosa, epididymis, and bulbouretheral
      glands.
   b. verumontanum, corpora cavernosa, and bladder
      neck.
   c. bulbouretheral glands, right and left ureteral
      orifices, and epididymis.
   d. verumontanum, right and left ureteral orifices,
      and bladder neck.

 7. The release of -- increases with age and
    may cause the glandular tissue of the prostate to
    proliferate.

    a. testicular androgens
    b. prostatic secretion
    c. seminal fluid
    d. norepinephrine

8. The transitional zone is

   a. the triangular area whose points correspond
      with the junction of both ureters and the
      urethra.
   b. the part of the prostate near the urethra where
      growth of glandular tissue begins.
   c. a continuation of the epididymis that runs
      along the posterior edge of the testicle.
   d. divided into five main lobes--right and left
      inferior, anterior, posterior, and subcervical.

9. As urinary retention continues, the bladder wall
   becomes muscular, and --
   form in the bladder.

   a. tragomaschalia
   b. trabeculations
   c. tranzschelia
   d. trachelematomas

10. As urethral narrowing progresses, the patient
    may experience the following urinary symptoms:

    a. frequency, urinary retention, stress incontinence,
       burning, hesitancy, and polyuria.
    b. nocturia, dysuria, hematuria, polyuria, enuresis,
       and urinary incontinence.
    c. dysuria, frequency, nocturia, urinary retention,
       and urgency.
    d. urgency, hesitancy, hematuria, enuresis,
       urinary incontinence, and burning.

11. Urinary retention eventually can result in

    a. hematuria, kidney problems, dehydration, and
       anemia.
    b. recurrent urinary tract infections (UTIs), sepsis,
       polyuria, and electrolyte abnormalities.
    c. recurrent UTIs, hematuria, bladder stones, and
       kidney problems.
    d. bladder stones, polyuria, anemia, and
       pruritus.

12. The downside to the alternative treatments for
    symptomatic benign prostatic hypertrophy
    (BPH) is that none result in retrieval of tissue for
    pathology analysis.

    a. true
    b. false

13. -- medications act as alpha-adrenergic
    blockers, relaxing the urethral lumen
    and reestablishing urinary flow.

    a. Antihypertensive
    b. Antihistamine
    c. Antidysrhythmic
    d. Antiemetic

14. -- is an androgen
    hormone inhibitor that stops prostate
    enlargement and shrinks prostatic hypertrophic
    tissue.

    a. Alprazolam
    b. Bumetanide
    c. Chlorpropamide
    d. Finasteride

15. Transurethral needle prostate tissue ablation is
    the use of

    a. a microwave probe to overheat prostatic tissue,
       causing cellular destruction.
    b. an ultrasound-guided laser probe to cause prostatic
       tissue necrosis, opening the urethral
       lumen.
    c. a knife electrode and resectoscope to make
       cuts into the prostatic tissue, allowing it to
       spread open.
    d. high-frequency radio waves to heat and
       destroy prostate tissue.

16. The more invasive open prostatectomy procedures
    for BPH are reserved for patients who have
    all of the following problems except

    a. an extremely large prostate.
    b. infertility problems.
    c. a prostate shape that makes TURP too risky.
    d. a urological abnormality that necessitates an
       abdominal incision for access to the prostate.

17. Many patients undergoing TURP are older than
    50 years of age; therefore, special care must be
    taken when

    a. positioning the patient's legs if limited range of
       motion is a problem or if a hip prosthesis is
       present.
    b. taking vital signs preoperatively, intraoperatively,
       and postoperatively because hypertension
       frequently is a problem.
    c. establishing a baseline level of consciousness
       and awareness because Alzheimer's disease
       often is a problem.
    d. identifying preoperative electrolyte imbalances
       because dehydration frequently is a
       problem.

18. The scrub person flushes all air out of the irrigation
    tubing because

    a. air can be absorbed into the peripheral vascular
       system and cause an air embolism.
    b. air flowing through the field can cause an
       electrical hazard during the use of electrosurgery.
    c. the presence of air bubbles increases the likelihood
       of bleeding.
    d. air bubbles inhibit visualization of the surgical
       field.

19. During a TURP procedure, the surgeon resects
    the glandular substance

    a. distal to the verumontanum and proximal to
       the bulbouretheral glands.
    b. proximal to the verumontanum and distal to
       the bladder neck.
    c. proximal to the bulbouretheral glands and distal
       to the bladder neck.
    d. proximal to the epididymis and distal to the
       verumontanum.

20. The surgeon removes as much tissue as necessary
    without penetrating the -- to
    allow the patient to void.

    a. prostatic capsule
    b. vascular sinus
    c. urethra
    d. excretory ducts

21. Bleeding must be controlled before the patient
    leaves the cystology room because

    a. the patient may not be conscious and able postoperatively
       to notify caregivers that he is
       bleeding excessively.
    b. hemorrhaging can occur within minutes of
       transfer to the postoperative anesthesia care
       unit (PACU).
    c. clots can form in the bladder and obstruct the
       catheter, trapping urine and irrigant in the
       bladder.
    d. bleeding postoperatively can cause permanent
       impotence.

22. The surgeon and circulating nurse may apply
    traction to the catheter to

    a. confirm proper catheter placement and
       reassess bleeding.
    b. pull the catheter balloon against the prostate to
       compress the gland, applying pressure on
       bleeding vessels.
    c. pull the catheter balloon against the prostate to
       compress the gland and further dilate the urethral
       lumen.
    d. confirm proper catheter placement and further
       dilate the urethral lumen.

23. The proper use of stirrups for placing the patient
    in the lithotomy position and the use of thromboemboletic
    stockings and a sequential compression
    device helps

    a. improve return of arterial blood flow to the
       heart.
    b. minimize the potential for musculoskeletal
       injury.
    c. minimize the potential for deep vein thrombosis.
    d. avoid nerve damage with proper body alignment.

24. All of the following complications of the TURP
    procedure are beyond the perioperative nurse's
    control except for the risk of

    a. hemorrhage.
    b. extravasation of irrigant into the abdomen.
    c. catheter or urethral blockage.
    d. burn injury from the use of electrosurgery.

25. If the sphincter is injured during the resection, the
    patient will experience

    a. retrograde ejaculation.
    b. stress urinary incontinence.
    c. impotence.
    d. urinary clots for up to two weeks.

26. The fluid is absorbed into the patient's blood
    stream when

    a. the irrigant is warmed.
    b. the pressure of the irrigant is greater than the
       patient's diastolic blood pressure.
    c. the pressure of the irrigant is lower than the
       patient's diastolic blood pressure.
    d. water is used as the irrigant.

27. Increased intravascular volume and cerebral
    edema are caused by

    a. hypotonic fluid drawing electrolytes into the
       intracellular spaces.
    b. electrolytes shifting out of cells as fluid shifts
       into cells, resulting in cellular edema.
    c. fluid shifting out of the cells as electrolytes
       shift into the cells to matching the tonicity to
       that of the extracellular space.
    d. hypertonic fluid drawing electrolytes out of
       intracellular spaces.

28. Warming of the irrigant is important because
    hypothermia causes all of the following problems
    except

    a. slowing the body's metabolism.
    b. prolonging the effects of anesthetic agents.
    c. vasoconstriction and increased bleeding.
    d. slowing the blood's ability to clot.

29. Water may be used for short TURP procedures,
    but is not used commonly because it

    a. conducts the electrical current but not the thermal
       properties of the electrosurgical unit.
    b. elevates serum glucose and leaves the surgical
       site and instruments very sticky.
    c. is metabolized into carbon dioxide, glucose,
       and water, posing a problem for patients with
       diabetes.
    d. is not isotonic and eventually will result in
       hemolysis.

30. Mannitol is an osmotic diuretic that has been
    used for irrigation; however, it

    a. causes hyperkalemia, resulting in cardiac
       arrhythmias and muscular weakness.
    b. is metabolized into carbon dioxide, glucose,
       and water, posing a problem for patients with
       diabetes.
    c. is permeable to the intracellular and
       extracellular spaces, resulting in elevated
       mannitol levels.
    d. may cause dehydration, hyperosmolality,
       neurological disturbances, and systemic
       acidosis.

31. When using glycine as the irrigant for TURP
    procedures, hyperammonemia and water intoxification
    can lead to

    a. prolonged bleeding and hypotension.
    b. nausea and diarrhea.
    c. cerebral edema and seizures.
    d. hyperventilation and pulmonary edema.

32. Patients with the following conditions have a
    greater risk of developing TUR syndrome:

    a. liver disease, UTIs, significant muscular atrophy,
       bladder stones, or obstructive uropathy.
    b. significant muscular atrophy, hypertension,
       anemia, UTIs, or kidney stones.
    c. liver disease, hypotension, cirrhosis, diabetes,
       or obstructive uropathy.
    d. congestive heart failure, chronic obstructive
       pulmonary disease, or bladder stones.

33. Patients who present with a large prostate may
    undergo
    a. a transurethral incision of the prostate or a
       TURP procedure performed in two steps.
    b. a transurethral microwave thermotherapy or an
       open prostatectomy.
    c. an open prostatectomy or a transurethral needle
       prostate tissue ablation done in two steps.
    d. an open prostatectomy or a TURP procedure
       performed in two steps.

34. Chest pain and failed spontaneous diuresis are
    caused by

    a. hemorrhage decreasing the arterial pressure.
    b. ischemia in the heart and kidneys.
    c. hypertension as a result of of hyponatremia.
    d. bradycardia and hypertension.

35. Spinal anesthesia is preferred over general anesthesia
    for TURP procedures because

    a. the patient remains awake, allowing assessment
       of the patient's mental status and subjective
       symptoms.
    b. it can be administered to the patient more rapidly
       than general anesthesia.
    c. bleeding is easier to control, and anesthetic
       agents used for spinal anesthesia are not affected
       by water intoxication.
    d. the patient will remain pain free for a longer
       time postoperatively.

36. Early symptoms of TUR syndrome include

    a. nausea and/or vomiting, hypotension, cyanosis,
       and dyspnea.
    b. apprehension, hypertension, neuromuscular
       disturbances, and decreased urinary output.
    c. nausea and/or vomiting, visual disturbances,
       dizziness, and headache.
    d. apprehension, nausea and/or vomiting, disorientation,
       bradycardia, and lethargy.

37. As the procedure begins, the circulating nurse
    raises the pole on which the irrigant hangs to no
    more than -- above the patient's
    bladder.

    a. 40 cm
    b. 60 cm
    c. 40 inches
    d. 60 inches

38. The risk of fluid volume overload related to
    excess fluid intake is an appropriate nursing
    diagnosis for a patient undergoing a TURP procedure.
    All of the following nursing interventions
    are appropriate for this diagnosis except

    a. recognizes and reports deviation in diagnostic
       study results.
    b. collaborates in fluid management and hangs
       irrigant at lowest possible level to maintain
       surgeon's visibility.
    c. increases rate of continuous bladder irrigation
       if output begins to darken.
    d. monitors patient for signs and symptoms of
       imbalance.

39. When TUR syndrome is suspected, the
    circulating nurse

    a. keeps the height of the irrigant at the lowest
       possible level and switches to saline as soon
       as electrosurgery is complete.
    b. stops the procedure as soon as possible
       and uses electrosurgery, if needed, to stop
       bleeding.
    c. administers furosemide as soon as laboratory
       results are received confirming water
       intoxication.
    d. administers 3% to 5% hypertonic saline
       solution in incremental doses followed by
       frequent serum sodium checks.

40. The circulating nurse reports all of the following
    information to the postanesthesia care unit
    (PACU) nurse except

    a. that the patient is or may be experiencing fluid
       volume excess.
    b. the laboratory values and treatments provided.
    c. weight of prostatic tissue excised.
    d. whether pressure lines need to be inserted in
       the PACU or that the patient already has them
       inserted.