A nurse is instructing coworkers about how to minimize lower back pain and avoid repeated episodes of back pain.

Which of the following strategies should the nurse include? (Select all that apply.)

Choice A rationale

Dysuria, or painful urination, is a common symptom in benign prostatic hyperplasia (BPH) due to the mechanical compression of the urethra by the enlarged prostate, which increases resistance to urine flow. This obstruction leads to bladder overdistention and subsequent irritation, often causing a burning sensation upon voiding as the bladder muscles strain against the increased outflow resistance.

Choice B rationale

Polyuria, characterized by abnormally frequent urination, especially at night (nocturia), is a hallmark of BPH resulting from bladder irritation and incomplete emptying. The residual urine reduces the functional bladder capacity, leading to more frequent urges to void, as the detrusor muscle senses distension at lower volumes, especially during periods of decreased fluid reabsorption at night.

Choice C rationale

While benign prostatic hyperplasia causes an increase in the total amount of prostate-specific antigen (PSA) produced, the levels are usually only mildly to moderately elevated (often <4 ng/mL, though up to 10 ng/mL is possible). Critically elevated PSA levels (e.g., >10 ng/mL or a very high rate of rise) are more suggestive of prostate cancer, not typically benign BPH, which involves non-malignant tissue proliferation.

Choice D rationale

Difficulty starting the flow of urine (hesitancy) is a classic lower urinary tract symptom (LUTS) in BPH caused by the mechanical narrowing of the prostatic urethra. The bladder detrusor muscle must generate significantly increased pressure to overcome this outflow obstruction, resulting in a delay between the sensation of needing to void and the actual initiation of the urine stream.

Choice A rationale

While vitamin K, found in green leafy vegetables, is essential for the synthesis of clotting factors (II, VII, IX, X), it is relevant to individuals on warfarin therapy. For general deep vein thrombosis (DVT) prevention, the focus is on promoting venous return and preventing stasis, not dietary modification regarding vitamin K, unless a client is on specific anticoagulants.

Choice B rationale

Massaging lower extremities in a client at risk for DVT is contraindicated because it could theoretically dislodge a pre-existing, non-symptomatic clot. Dislodgement can convert the deep vein thrombus into a pulmonary embolus (PE), a life-threatening complication where the clot travels to the pulmonary vasculature, impeding gas exchange.

Choice C rationale

Sequential compression devices (SCDs) use intermittent, pneumatic pressure to cyclically compress the leg, simulating the action of the skeletal muscle pump. This external compression promotes venous blood flow from the superficial to the deep veins, which effectively reduces venous stasis and the associated risk of thrombus formation, a primary mechanism in DVT pathogenesis.

Choice D rationale

Limiting movement of the lower extremities increases venous stasis, which is a key component of Virchow's triad (venous stasis, endothelial injury, hypercoagulability) and a major risk factor for DVT formation. Promoting activity, such as frequent position changes, ambulation, or ankle pumps, is the core physical intervention for preventing DVT.