Reproductive- Lippincott Prostate Cancer

105. The nurse is caring for a client who will have a bilateral orchiectomy. The client asks what is involved with this procedure. The nurse's most appropriate response would be? "The surgery: 1. Removes the entire prostate gland, prostatic capsule, and seminal vesicles." 2. Tends to cause urinary incontinence and impotence." 3. Freezes prostate tissue, killing cells." 4. Results in reduction of the major circulating androgen, testosterone."

105. 4. Bilateral orchiectomy (removal of testes) results in reduction of the major circulating androgen, testosterone, as a palliative measure to reduce symptoms and progression of prostate cancer. A radical prostatectomy (removal of entire prostate gland, prostatic capsule, and seminal vesicles) may include pelvic lymphadenectomy. Complications include urinary incontinence, impotence, and rectal injury with the radical prostatectomy. Cryosurgery freezes prostate tissue, killing tumor cells without prostatectomy.

The Client with Cancer of the Prostate 104. An African-American aged 45 asks the nurse if he should have prostate cancer screening tests. The nurse should tell the client 1. The Prostate-Specific Antigen (PSA) test is reliable for detecting the presence of prostate cancer only after age 50. 2. He is at risk for prostate cancer and should discuss screening with his health care provider. 3. To have prostate cancer screening exams only if he has difficulty voiding. 4. Regular sexual activity promotes health of the prostate gland to prevent cancer.

104. 2. The client has two risk factors for cancer of the prostate, being an African- American and having a family history of prostate cancer, and should discuss having prostate screening exams with his health care provider. Current (2012) recommendations from the American Cancer Society (ACS) indicate that at age 50 men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have digital rectal exam and a PSA test as screening for prostate cancer. ACS recommends that men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening because risk outweighs the benefits. Men at high risk—African- American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65—should discuss the options for having prostate screening exams at age 45; and those with multiple family members affected by the disease before age 65 should discuss the options with their physician at age 40. PSA tests have varying reliability and should be used as recommended by the health care provider. The client is at risk for prostate cancer and should not wait until symptoms appear. Having sex does not prevent prostate cancer. the opportunity to make an informed decision with their health care provider about having a

106. The nurse is teaching a group of men about prostate cancer. Which of the following points should be included in the instruction? Select all that apply. 1. Prostate cancer is usually multifocal and slow growing. 2. Most prostate cancers are adenocarcinoma. 3. The incidence of prostate cancer is higher in African-American men, and the onset is earlier. 4. All men over age 40 should have a digital rectal exam and a prostate-specific antigen (PSA) lab test. 5. Cancer cells are detectable in the urine and prostate cancer can be detected with a simple urinalysis.

106. 1, 2, 3, Cancer of the prostate gland is the second-leading cause of cancer death among American men and is the most common carcinoma in men older than age 65. Incidence of prostate cancer is higher in African-American men, and onset is earlier. Most prostate cancers are adenocarcinoma. Prostate cancer is usually multifocal, slow growing, and can spread by local extension, by lymphatics, or through the bloodstream. Men should discuss the need for screening exams with their health care provider, as routine screening exams are no longer recommended by the American Cancer Society. The urine does not have prostate cancer cells.

107. When a client is receiving hormone replacement for prostate cancer, the nurse should do which of the following? Select all that apply. 1. Inform the client that increased libido is expected with hormone therapy. 2. Reassure the client that erectile dysfunction will not occur as a consequence of hormone therapy. 3. Provide the client the opportunity to communicate concerns and needs. 4. Utilize communication strategies that enable the client to gain some feeling of control. 5. Suggest that an appointment be made to see a psychiatrist.

107. 3, 4. Hormone manipulation deprives tumor cells of androgens or their byproducts and, thereby, alleviates symptoms and retards disease progression. Complications of hormonal manipulation include hot flashes, nausea and vomiting, gynecomastia, and sexual dysfunction. As part of supportive care, provide explanations of diagnostic tests and treatment options and help the client gain some feeling of control over his disease and decisions related to it. To help achieve optimal sexual function, give the client the opportunity to communicate his concerns and sexual needs. Inform the client that decreased libido is expected after hormonal manipulation therapy, and that impotence may result from some surgical procedures and radiation. A psychiatrist is not needed.

108. A client asks the nurse why the prostate- specific antigen (PSA) level is determined before the digital rectal examination. The nurse's best response is which of the following? 1. "It is easier for the client." 2. "A prostate examination can possibly decrease the PSA." 3. "A prostate examination can possibly increase the PSA." 4. "If the PSA is normal, the client will not have to undergo the rectal examination."

108. 3. Manipulation of the prostate during the digital rectal examination may falsely increase the PSA levels. The PSA determination and the digital rectal examination are no longer recommended as screening tools for prostate cancer. Prostate cancer is the most common cancer in men and the second leading killer from cancer among men in the United States. Incidence increases sharply with age, and the disease is predominant in the 60- to 70- year-old age group.

109. The nurse is performing a digital rectal examination. Which of the following findings is a key sign for prostate cancer? 1. A hard prostate, localized or diffuse. 2. Abdominal pain. 3. A boggy, tender prostate. 4. A nonindurated prostate.

109. 1. On digital rectal examination, key signs of prostate cancer are a hard prostate, induration of the prostate, and an irregular, hard nodule. Accompanying symptoms of prostate cancer can include constipation, weight loss, and lymph- adenopathy. Abdominal pain usually does not accompany prostate cancer. A boggy, tender prostate is found with infection (eg, acute or chronic prostatitis).

110. A client is undergoing a total prostatectomy for prostate cancer. The client asks questions about his sexual function. The best response by the nurse is which of the following? "Loss of the prostate gland means that: 1. You will be impotent." 2. You will be infertile and there will be no ejaculation. You can still experience the sensations of orgasm." 3. You will have no loss of sexual function and drive." 4. Your erectile capability will return immediately after surgery."

110. 2. Loss of the prostate gland interrupts the flow of semen, so there will be no ejaculation fluid. The sensations of orgasm remain intact. The client needs to be advised that return of erectile capability is often disrupted after surgery, but within 1 year 95% of men have returned to normal erectile function with sexual intercourse.

111. A 65-year-old client has been told by the physician that his prostate cancer was graded at stage IIB. The client inquires if this means he is going to die soon. The best response by the nurse is which of the following? 1. "Prostate cancer at this stage is very slow growing." 2. "Prostate cancer at this stage is very fast growing." 3. "Prostate cancer at this stage has spread to the bone." 4. "Prostate cancer at this stage is difficult to predict."

111. 1. Clients who have stage IA or IIB prostate cancer have an excellent survival rate. Prostate cancer is usually slow growing, and many men who have prostate cancer do not die from it. A stage I or II tumor is confined to the prostate gland and has not spread to the extrapelvic region or bone.

112. A client with prostate cancer is treated with hormone therapy consisting of diethylstilbestrol (DES; Stilphostrol), 2 mg daily. The nurse should instruct the client to expect to have: 1. Tenderness of the scrotum. 2. Tenderness of the breasts. 3. Loss of pubic hair. 4. Decreased blood pressure.

112. 2. Diethylstilbestrol causes engorgement and tenderness of the breasts (gynecomastia). Stilbestrol is prescribed as palliative therapy for men with androgendependent prostatic carcinoma. An increase in blood pressure can occur. Tenderness of the scrotum and dramatic changes in secondary sexual characteristics should not occur.