HESI CASE STUDY 2022 EXAM UPDATE- BENIGN PROSTATIC
HYPERPLASIA - BOB HAMILTON
Bob Hamilton, a 66-year-old white male visits the men's health clinic accompanied by his Asian
American wife, Lyn. He reports increasing urinary frequency, dribbling, and nocturia. He is
scheduled for diagnostic tests to detect benign prostatic hyperplasia (BPH). - ANS IS
Which additional manifestations would the nurse expect in clients with BPH? - ANS IS Hesitancy
when starting the urine stream.
This is a common manifestation in men with BPH, along with nocturia, frequency, post-void
dribbling, and hematuria.
Decrease in the size and force of urine stream.
It is common for men with BPH to experience a decrease in the size and force of the urine stream,
rather than an increase, due to the obstruction of the urethra caused by the enlarged prostate gland.
Frequent urination, including nocturia.
Besides hesitancy and decrease in size and force of urine stream, frequency and nocturia are also
common manifestations of BPH.
The nurse initiates a physical examination to further investigate Mr. PerryHamilton's symptoms.
Which assessment finding would indicate that Mr. Hamilton is experiencing urinary retention? -
ANS IS Observance of bladder distention.
Bladder distention is an assessment finding in urinary retention.
Dullness heard on percussion below the umbilicus.
A distended bladder will sound dull upon percussion.
Observance of dribbling after voiding.
This is a symptom of urinary retention.
, Mr. Hamilton tells the nurse that he has cut back on drinking fluids to reduce his symptoms. Which
instruction is most important for the nurse to provide to Mr. Hamilton? - ANS IS Increase fluid
intake to increase the risk of developing a urinary tract infection.
Men with BPH often restrict fluid intake to reduce symptoms, but this should be discouraged
because it increases the risk for urinary tract infection.
Mr. Hamilton is scheduled for a digital rectal exam, serum prostate-specific antigen (PSA) level,
urinalysis, serum creatinine, and blood urea nitrogen (BUN). He states that he has had the rectal
exam and PSA levels done before for prostate screening. He asks why the other lab tests (creatinine
and BUN levels) are necessary.
Which information should be included in the nurse's explanation? - ANS IS Prostate enlargement
may result in renal damage, causing a decreased of urine production in the kidneys, which these
tests will evaluate.
***Prostate enlargement may result in kidney damage, which can cause a change in urine
production.
When the prostate gland is blocking the flow of urine, some degree of kidney damage that can be
detected with these tests.
***As the flow of urine is blocked by the enlarged prostate gland, gradual dilation of the ureters
(hydroureter) and kidneys (hydronephrosis) can occur, resulting in increased creatinine and BUN
levels.
Mr. Hamilton's PSA level is 8 ng/mL, a slightly elevated level (normal is > 2.5 ng/mL). Mr. Hamilton
appears distressed and he asks, "Do I have prostate cancer? Is that why I'm having these
symptoms?"
Which action by the nurse is most helpful? - ANS IS Explain that PSA levels can be elevated with
gland enlargement, as well as cancer, so more tests are needed.
***Elevated PSA levels are associated with prostate cancer. However, slight elevations may also
occur in BPH. PSA levels may also be elevated as the result of infection, or if the prostate gland is
manipulated during a digital rectal exam.
HYPERPLASIA - BOB HAMILTON
Bob Hamilton, a 66-year-old white male visits the men's health clinic accompanied by his Asian
American wife, Lyn. He reports increasing urinary frequency, dribbling, and nocturia. He is
scheduled for diagnostic tests to detect benign prostatic hyperplasia (BPH). - ANS IS
Which additional manifestations would the nurse expect in clients with BPH? - ANS IS Hesitancy
when starting the urine stream.
This is a common manifestation in men with BPH, along with nocturia, frequency, post-void
dribbling, and hematuria.
Decrease in the size and force of urine stream.
It is common for men with BPH to experience a decrease in the size and force of the urine stream,
rather than an increase, due to the obstruction of the urethra caused by the enlarged prostate gland.
Frequent urination, including nocturia.
Besides hesitancy and decrease in size and force of urine stream, frequency and nocturia are also
common manifestations of BPH.
The nurse initiates a physical examination to further investigate Mr. PerryHamilton's symptoms.
Which assessment finding would indicate that Mr. Hamilton is experiencing urinary retention? -
ANS IS Observance of bladder distention.
Bladder distention is an assessment finding in urinary retention.
Dullness heard on percussion below the umbilicus.
A distended bladder will sound dull upon percussion.
Observance of dribbling after voiding.
This is a symptom of urinary retention.
, Mr. Hamilton tells the nurse that he has cut back on drinking fluids to reduce his symptoms. Which
instruction is most important for the nurse to provide to Mr. Hamilton? - ANS IS Increase fluid
intake to increase the risk of developing a urinary tract infection.
Men with BPH often restrict fluid intake to reduce symptoms, but this should be discouraged
because it increases the risk for urinary tract infection.
Mr. Hamilton is scheduled for a digital rectal exam, serum prostate-specific antigen (PSA) level,
urinalysis, serum creatinine, and blood urea nitrogen (BUN). He states that he has had the rectal
exam and PSA levels done before for prostate screening. He asks why the other lab tests (creatinine
and BUN levels) are necessary.
Which information should be included in the nurse's explanation? - ANS IS Prostate enlargement
may result in renal damage, causing a decreased of urine production in the kidneys, which these
tests will evaluate.
***Prostate enlargement may result in kidney damage, which can cause a change in urine
production.
When the prostate gland is blocking the flow of urine, some degree of kidney damage that can be
detected with these tests.
***As the flow of urine is blocked by the enlarged prostate gland, gradual dilation of the ureters
(hydroureter) and kidneys (hydronephrosis) can occur, resulting in increased creatinine and BUN
levels.
Mr. Hamilton's PSA level is 8 ng/mL, a slightly elevated level (normal is > 2.5 ng/mL). Mr. Hamilton
appears distressed and he asks, "Do I have prostate cancer? Is that why I'm having these
symptoms?"
Which action by the nurse is most helpful? - ANS IS Explain that PSA levels can be elevated with
gland enlargement, as well as cancer, so more tests are needed.
***Elevated PSA levels are associated with prostate cancer. However, slight elevations may also
occur in BPH. PSA levels may also be elevated as the result of infection, or if the prostate gland is
manipulated during a digital rectal exam.
