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prostate cancer

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1 prostate cancer on Fri Nov 04, 2011 4:39 pm

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1- A nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which of the following is a serious late sign of this oncological emergency?

a) headache
b) dysphagia
c) constipation
d) electrocardiographic changes


1- D
- Hypercalcemia is a late manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.





2- Hormone therapy is prescribed as the mode of treatment for a client with prostate cancer. The nurse understands that the goal of this form of treatment is to:

a) increase testosterone levels
b) increase prostaglandin levels
c) limit the amount of circulating androgens
d) increase the amount of circulating androgens

C
- Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the amount of circulating androgens because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms.



3- The nurse is caring for a client with cancer of the prostate following a prostatectomy. The nurse provides discharge instructions to the client and tells the client to:

a) avoid driving the car for 1 week
b) restrict fluid intake to prevent incontinence
c) avoid lifting objects heavier than 20 lb for at least 6 weeks
d) notify the physician if small blood clots are noticed during urination

C
- Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Option C is an accurate discharge instruction following prostatectomy.


4-A client with cancer receiving chemotherapy tells the nurse that some foods on the meal tray taste bitter. The nurse would try to limit which food that is most likely to cause this taste for the client?

a) beef
b) potatoes
c) custard
d) cantaloupe

A
- Chemotherapy may cause distortion of taste. Often, beef and pork are reported to taste bitter or metallic. The nurse can promote client nutrition by helping the client choose alternative sources of protein in the diet. Options B, C, and D are not likely to cause distortion of taste.


5- Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine?
a. Assisting with a naloxone challenge test before therapy begins
b. Discontinuing the drug immediately if signs of dependence appear
c. Changing the administration route to P.O. if the client can tolerate fluids
d. Obtaining baseline vital signs before administering the first dose

D. The nurse should obtain the client’s baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist. The nurse shouldn’t discontinue a narcotic agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.

6 -What should a male client over age 52 do to help ensure early identification of prostate cancer?
a. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
b. Have a transrectal ultrasound every 5 years.
c. Perform monthly testicular self-examinations, especially after age 50.
d. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels checked yearly.

A. The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won’t identify changes in the prostate gland due to its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastases

7- A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first?
a. Stand as far away from the implant as possible and call for help.
b. Pick up the implant with long-handled forceps and place it in a lead-lined container.
c. Leave the room and notify the radiation therapy department immediately.
d. Put the implant back in place, using forceps and a shield for self-protection, and call for help.


8-The client states, “I heard that all men get prostate cancer sometime in their lives.” In teaching the client about cancer incidence, the best response is based on the understanding that:
A. Lung cancer is the most frequently diagnosed cancer in men
B. Prostate cancer is the most frequently diagnosed cancer in men
C. Prostate cancer is the most prevalent in Caucasian men
D. There is no way to screen for prostate cancer, so it is the most common cause of cancer death in men

B: Prostate cancer is the most common cancer in men in the U.S., with lung cancer being second. The incidence of prostate cancer is significantly higher in African-American men worldwide. Screening is available for prostate cancer.


9-A 62-year-old man presents with urinary urgency
and frequency. Physical examination reveals a
1-cm, hard, right-sided prostate nodule. His serum
prostate-specific antigen (PSA) level is 14 ng/mL.
The best next step in managing this patient is to:
A) Repeat the PSA test in 3 months
B) Discuss potential treatment options with the
patient
C) Obtain a transrectal ultrasound and, whether
the results are abnormal or not, proceed with
prostate needle biopsy
D) Begin hormone therapy with leuprolide
E) Begin treatment with terazosin and schedule a
3-month follow-up appointment

C- Obtain a transrectal ultrasound and, whether
the results are abnormal or not, proceed with
prostate needle biopsy. This patient presents with
urinary obstructive symptoms, a suspicious prostate
nodule, and an elevated PSA level—all signs that
point to a diagnosis of cancer. However, before discussing
or implementing treatment, a histologic
diagnosis should be made and subsequent staging
performed. It is not appropriate to delay definitive
diagnosis with follow-up PSA testing or to attempt
treatment of benign prostatic hyperplasia.

10 -
Which of the following has NOT been associated
with prostate cancer risk?
A) Advanced age
B) African-American race
C) High-fat diet
D) An androgen-receptor germline polymorphism
E) Ionizing radiation

E- Ionizing radiation. No studies have linked ionizing
radiation with risk of developing prostate cancer.

11 - A 52-year-old man with diffuse bone pain from
metastatic androgen-independent prostate cancer
has not responded to secondary hormone treatments.
All of the following are reasonable treatment
options EXCEPT:
A) Estramustine and mitoxantrone
B) Mitoxantrone and corticosteroids
C) Strontium-89
D) Narcotic analgesics
E) Estramustine and vinblastine

A- Estramustine and mitoxantrone. Although used
individually for treatment of metastatic prostate cancer,
the combination of estramustine and mitoxantrone
has not been tested for safety and efficacy
in treating metastatic prostate cancer

12 -
A 62-year-old man with metastatic prostate cancer
has a rising PSA level despite treatment with
leuprolide and flutamide. What should be the first
step in managing this asymptomatic man with hormone-
refractory disease?
A) Treat with aminoglutethimide
B) Discontinue flutamide to attempt to obtain an
antiandrogen withdrawal response
C) Discontinue leuprolide
D) Treat with diethylstilbestrol
E) Perform an orchiectomy

B- Discontinue flutamide to attempt to obtain
an antiandrogen withdrawal response. Androgenindependent
prostate cancer frequently responds to
secondary hormone manipulations. The first maneuver
to try in this setting should be antiandrogen
withdrawal, which may induce a clinical and/or PSA
response in 15% to 29% of cases.1 Leuprolide
should not be discontinued. Diethylstilbestrol and
orchiectomy would not be expected to induce further
response. Aminoglutethimide could be used
after antiandrogen withdrawal has been tried.

13 -A 72-year-old man with a history of localized prostate
cancer presents to his physician with pain in his ribs.
He underwent a radical prostatectomy 4 years earlier
but was subsequently lost to follow-up. A bone
scan demonstrates diffuse skeletal metastases; the
patient’s serum PSA level is 97 ng/mL. The best
next step in managing this patient is to:
A) Treat with strontium-89 to relieve the patient’s
pain
B) Perform a rib biopsy to rule out other malignancies
C) Perform an orchiectomy
D) Treat with flutamide alone
E) Perform a needle biopsy of the prostatectomy
site to confirm recurrent disease

C - Perform an orchiectomy. Recurrent metastatic
disease after local therapy (surgery or radiation) is a
continuing problem. Most men are asymptomatic
and have a rising PSA level before clinical or radiographic
findings. This patient presents with
unequivocal metastatic disease: pain, widespread
osteoblastic metastases, and a highly elevated PSA
level. Further biopsies are unnecessary.

14 - Routine PSA testing in a 66-year-old otherwise
healthy man reveals an increase from 3 to
7.7 ng/mL within 1 year. Biopsies demonstrate
Gleason grade 3 + 3 adenocarcinoma in one of six
needle cores. Treatment options for this patient
include all of the following EXCEPT:
A) Radical retropubic prostatectomy
B) Radical perineal prostatectomy
C) Three-dimensional conformal radiotherapy
D) Brachytherapy
E) Laparoscopic pelvic lymphadenectomy

E - Laparoscopic pelvic lymphadenectomy. This
patient’s PSA level doubled in less than 1 year. This
rate of increase, or PSA velocity, is significantly associated
with the presence of cancer. Laparoscopic
pelvic lymphadenectomy is a staging procedure
employed before initiating definitive therapy (eg,
prostatectomy or radiotherapy). With accurate staging
via PSA testing and computed tomography scanning,
the role of routine staging lymphadenectomy
is diminishing

15 - A 62-year-old man presents with urinary urgency
and frequency. Physical examination reveals a
1-cm, hard, right-sided prostate nodule. His serum
prostate-specific antigen (PSA) level is 14 ng/mL.
The best next step in managing this patient is to:
A) Repeat the PSA test in 3 months
B) Discuss potential treatment options with the
patient
C) Obtain a transrectal ultrasound and, whether
the results are abnormal or not, proceed with
prostate needle biopsy
D) Begin hormone therapy with leuprolide



C- Obtain a transrectal ultrasound and, whether
the results are abnormal or not, proceed with
prostate needle biopsy. This patient presents with
urinary obstructive symptoms, a suspicious prostate
nodule, and an elevated PSA level—all signs that
point to a diagnosis of cancer. However, before discussing
or implementing treatment, a histologic
diagnosis should be made and subsequent staging
performed. It is not appropriate to delay definitive
diagnosis with follow-up PSA testing or to attempt
treatment of benign prostatic hyperplasia.


S/S ICP
A - Decreased LOC -confusion, lethargy, disorientation.
B - Pupillary dysfunction, slow reaction to light leading to fixed pupils.
C - Hemiparesis or hemiplegia = later decorticate or decerebrate positioning.
D - Projectile vomiting without nausea.
E - Increased BP, bradycardia, altered respiratory pattern.
Source: Pearson p 962


3 positions that are contraindicated for pt with ICP:

Three Positions Contraindicated with Increased ICP
1.Extreme neck or hip flexion/extension
2.Maintaining the head of the bed at a angle less than 30 degrees (Flat or Prone)
3.Body not midline or in neutral position (Coughing, Sneezing, Straining)

Source: ATI: Adult Surgical Nursing.

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