PROSTATE CANCER NCLEX
The nurse is providing education regarding screening for prostate cancer. Which age should the nurse instruct the men with low risk factors to initiate prostate cancer screening? A) 50 B) 40 C) 65 D) 35
A) 50 Rationale: For men at average risk of prostate cancer and whose life expectancy is at least 10 years, this discussion and informed decision should be initiated at 50 years of age.
The nurse is educating a client newly diagnosed with prostate cancer regarding the purpose of androgen deprivation therapy. Which teaching would the nurse include in this education? A) Androgen deprivation therapy decreases cancer cell growth B) Androgen deprivation therapy improves erectile dysfunction C) Androgen deprivation therapy increases tumor suppressor cells D) Androgen deprivation therapy is preferred over chemotherapy
A) Androgen deprivation therapy decreases cancer cell growth. Rationale: Most cancer cells are androgen dependent and depriving the cells of androgen hormones can cause the cells to either die or cease growing. Androgen deprivation therapy is used in conjunction with radiation and chemotherapy. Androgen deprivation will not improve erectile dysfunction.
The nurse is assessing a client with stage I prostate cancer. Which description is consistent with this stage? A) Confined to the prostate B) Poorly differentiated C) Lymph node involvement D) Extension into the seminal vesicle
A) Confined to the prostate Rationale: Stage I prostate cancer is confined to the prostate and is well differentiated. Stage II is poorly differentiated. Extension into the seminal vesicle occurs in stage III and lymph node involvement is in stage IV.
The nurse is discussing th most common symptom associated with diagnosis of advanced prostate cancer. Which symptom would the nurse include? A) Pain B) Diarrhea C) Nausea D) Edema
A) Pain Rationale: Pain is the most common symptom associated with prostate cancer due to bone metastasis. Prostate cancer in the early stages is often asymptomatic. Nausea, diarrhea, and edema are not generally associated with prostate cancer symptoms
A client with prostate cancer is being discharged from the hospital. Which educational topic is inappropriate for this client? A) Provide information on doses of complementary herbs B) Teach the client and his family methods of pain control C) Stress the importance of keeping client appointments with healthcare providers D) Provide the client and the client's family information on support groups
A) Provide information on doses of complementary herbs. Rationale: When providing discharge instructions to the client with prostate cancer, the nurse will teach the client and his family methods of pain control and stress the importance of keeping client appointments with healthcare providers. The nurse will also provide the client and his family information on support groups. The nurse does not have authorization to provide information on doses of complementary herbs.
The nurse is providing teaching to a client who will begin radiation therapy for prostate cancer. Which information should the nurse include regarding sexual function? A) Sexual function may be impaired B) It's not necessary to use condoms during intercourse C) Testosterone will be given to assist sexual function D) Sexual function will not be impaired
A) Sexual function may be impaired Rationale: Sexual function may be impaired. Testosterone would not be used, as tumors could be androgen dependent. Condoms would be recommended during intercourse to protect the client's partner from radiation.
The nurse is caring for a 42-year-old male client who was recently diagnosed with prostate cancer. What characteristic of the prostate cancer does the nurse need to be aware of for a client of this age compared to older men with prostate cancer? A) The cancer will likely be more aggressive for the younger client. B) The cancer will likely grow more slowly in the younger client. C) The cancer will likely be more responsive to treatment in the younger client. D) The cancer will likely not metastasize as quickly in the younger client.
A) The cancer will likely be more aggressive for the younger client. Rationale: Research has found that prostate cancers that are diagnosed at a younger age tend to be more aggressive, and metastasis may have already occurred, given the advanced disease state at the time of diagnosis. Evidence has not yet shown whether prostate cancer grows more slowly in younger clients or responds to treatment better in younger clients.
The nurse is preparing an educational program on risk factors for the development of prostate cancer. Which information will the nurse include as being the greatest risk factor for developing prostate cancer? A) The client's age B) A family history C) A history of vasectomy D) A diet high in fat
A) The client's age Rationale: The greatest risk for developing prostate cancer is age. Prostate cancer affects one out of every eight men over the age of 70. Genetics, vasectomy, and a diet high in fat are also risk factors.
The nurse is assessing a client for symptoms of prostate cancer. Which symptoms would indicate the client is experiencing an enlarged prostate? SATA A) Hematuria B) Dysuria C) Weight loss D) Bone pain E) Fatigue
A, B A) Hematuria B) Dysuria Rationale: Symptoms of an enlarged prostate include hematuria, dysuria, reduction in urinary stream, nocturia, frequency of urination, and abnormal size of prostate on digital exam. The other choices are related to metastasis and metabolic changes.
The nurse is preparing a poster on prostate cancer for display at a health fair. Which information should the nurse include on the poster? SATA A) Prostate cancer occurs more often in African American men than in Caucasian American men. B) Prostate cancer is the most common type of cancer among men. C) Prostate cancer is the second leading cause of death in North America D) Prostate cancer confined to the prostate has a 100% survival rate at 5 years. E) Prostate cancer incidence is reduced in men who take large amounts of Vitamin A.
A, B, C, D Rationale: Prostate cancer is the most common type of cancer among men and is the second leading cause of death in North America. When confined to the prostate, the 5-year survival rate is 100%. If the cancer spreads regionally, the survival rate is 95% after 5 years. This disease occurs in African American men at a rate of more than 60% higher than seen in Caucasian American men. Asian Americans and Native Americans have the lowest incidence of prostate cancer. Taking large amounts of vitamin A does not reduce the incidence of prostate cancer.
The nurse is providing teaching to a client receiving brachytherapy. which point would the nurse prioritize? SATA A) Limit close contact with others B) Wear condoms during intercourse C) Assess skin for irritation D) Report urinary frequency E) Only wear cotton underwear
A, B, D Rationale: Limiting close contact and wearing condoms will decrease exposure to others. Brachytherapy can cause urinary frequency. Skin irritation is not common with brachytherapy. The client can wear underwear that is comfortable; it does not have to be cotton only
The nurse is evaluating the laboratory results of a client's elevated PSA test. Which statement regarding the PSA test should the nurse consider SATA A) Clients with a normal PSA may have prostate cancer B) An elevated PSA may indicate prostatitis C) Fluctuating PSA test results strongly indicate prostate cancer D) A UTI may elevate a client's PSA E) PSA levels should be interpreted in conjunction with a client's health history
A, B, D, E Rationale: Until recently, the National Cancer Institute guidelines included considering a PSA level of 4.0 ng/mL or lower to be normal. However, current research suggests that men with normal PSA levels may nevertheless have prostate cancer. Likewise, an elevated or fluctuating PSA level, which previously was considered to be a relative indication for prostate biopsy, has been known to occur also in conditions such as prostatitis and urinary tract infection. Therefore, PSA levels are now interpreted in conjunction with the client's health history.
A nurse is screening a client for prostate cancer. Which assessment findings would cause the nurse to suspect that the client has prostate cancer? SATA A) Fatigue B) Upper extremity weakness C) Back pain D) Hematuria E) Scrotal edema
A, C, D Fatigue, Back pain, Hematuria Rationale: Unfortunately, many clients with prostate cancer remain undiagnosed until the cancer is well established. Hematuria, back pain, bilateral lower extremity weakness, and fatigue are symptoms associated with prostate cancer.
The nurse is interviewing a client admitted with a diagnosis of prostate cancer and questions the client regarding his symptoms. Which symptom, if experienced by the client, supports the diagnosis? SATA A) Dysuria B) Polyuria C) Nocturia D) Frequent urination E) Reduction in urinary stream
A, C, D, E Rationale: Dysuria is painful or difficult urination that occurs because of prostatic cancer. As the tumor grows, it can compress the urethra, leading to urinary obstruction. The tumor may metastasize directly into the seminal vesicles or bladder or may spread via the lymphatic and venous systems. Other manifestations of prostate cancer include hematuria, nocturia, increased urinary frequency, reduction in urinary stream, and abnormal prostate on digital rectal exam. Polyuria is not a symptom of prostate cancer.
The nurse is teaching the client about the use of radiation for prostate cancer. Which fact would the nurse include in the teaching? SATA A) Precautions are necessary regarding pregnant women B) It is unacceptable to share bathrooms with other members of the household C) There is no restriction regarding close exposure with other members of the household. D) It is recommended that the client use condoms during intercourse. E) Sleep in a room alone for the first week to minimize prolonged exposure to others.
A, D, E Rationale: Precautions must be taken regarding the close contact with all persons in the household, especially children and pregnant women. Using a separate bathroom is not required. Condoms are needed to reduce radiation exposure during intercourse. It is also recommended that the client sleep alone for the first week to minimize exposure.
The nurse is providing teaching to a client to promote urinary elimination following a transurethral resection of the prostate. Which instruction should the nurse include? A) Void at intervals of 4-6 hours B) Perform pelvic floor exercises C) Increase fluid intake D) Take testosterone as prescribed
B) Perform pelvic floor exercises Rationale: Pelvic floor exercises will strengthen the pelvic floor and decrease stress incontinence. Increasing fluid intake can contribute to incontinence. Voiding should be every 2-4 hours. Testosterone would not be prescribed for urinary incontinence.
The nurse is discussing risks of external beam radiation for prostate cancer. The nurse would include which risk in this teaching? SATA A) Increased testosterone B) Erectile dysfunction C) Improved libido D) Urinary incontinence E) Rectal damage
B, D, E Rationale: Erectile dysfunction, urinary incontinence, and rectal damage can occur as a result of external beam radiation. Radiation would not increase testosterone levels or improve libido.
A nursing instructor is teaching a group of student nurses about the risk factors for prostate cancer. Which statement will the nursing instructor include? A) "African American men are at lowest risk for prostate cancer." B) "Asian American and Native American men have the highest risk for developing prostate cancer." C) "Approximately 1 in 8 men ages 70 and older will be diagnosed with prostate cancer." D) "A diet low in dairy increases a man's risk for developing prostate cancer."
C) "Approximately 1 in 8 men ages 70 and older will be diagnosed with prostate cancer." Rationale: African Americans are at a particularly high risk for developing prostate cancer. Approximately one in eight men ages 70 and older will be diagnosed with prostate cancer. A diet high in dairy increases a man's risk for developing prostate cancer.
The nurse is providing a seminar to men regarding screening for prostate cancer. Which percentage should the nurse present as the 5-year survival rate for prostate cancer confined to the prostate? A) 80% B) 95% C) 100% D) 85%
C) 100% Rationale: The 5-year survival rate for prostate cancer confined to the prostate is 100%. It is a commonly occurring cancer. If the cancer spreads, the survival rate is 95% after 5 years.
The nurse is providing education regarding dietary risk for prostate cancer. Which food would the nurse prioritize as carrying the highest risk? A) Vegetables B) Fish C) Dairy D) Fruits
C) Dairy Rationale: Diets high in animal fat, such as dairy products, increase the risk for prostate cancer. Vegetables, fruits, and fish would be acceptable dietary choices.
Which screening test is used to detect prostate cancer? A) Mammography B) CA 125 C) PSA D) Sigmoidoscopy
C) PSA Rationale: PSA is the screening test for prostate cancer. CA 125 is a tumor marker for ovarian cancer. Sigmoidoscopy is a screening test for colon cancer. Mammography is a screening test for ovarian cancer.
The nurse is caring for a client with transurethral resection of the prostate for prostate cancer. Which nursing diagnosis would the nurse prioritize? A) Comfort, Impaired B) Urinary Elimination, Impaired C) Urinary retention D) Sexual Dysfunction
C) Urinary retention Rationale: Urinary retention is the priority for this client. Urinary incontinence and sexual dysfunction are important but are not priorities over retention of urine. Impaired comfort could be related to the retention of urine; however, it would be secondary to the retention of urine
The nurse is planning care for a client scheduled for prostatectomy. The client's spouse wants to know if the client will have any limitations after the surgery. Which complications is the client likely to have that should be incorporated into his plan of care? SATA A) Constipation B) Gynecomastia C) Impaired urinary elimination D) Risk for falls E) Sexual dysfunction
C, E Impaired urinary elimination Sexual dysfunction Rationale: Following a prostatectomy, the client is most at risk for sexual dysfunction and urinary stress incontinence. There is no reason to suspect that this client is at risk for constipation or falls. Gynecomastia is a side effect of treatment with estrogen compounds, not surgery.
The nurse is teaching a client about the estrogen compound (diethylstilbestrol) that has been prescribed for prostate cancer. Which statement indicates that the teaching has been successful? A) "This drug does not put me at risk for any cardiovascular problems." B) " The effects of the drug are irreversible." C) "It is a very expensive drug and may require insurance approval." D) "It may cause my breasts to enlarge."
D) "It may cause my breasts to enlarge." Rationale: Estrogen compounds are more likely than other hormone therapy for prostate cancer to cause gynecomastia (hypertrophy of breast tissue). Estrogen compounds can cause an increased risk of cardiovascular problems. The effects of the drug are reversible and it is not expensive, so there should be no insurance issue.
A 73-year-old man was just diagnosed with stage II prostate cancer. The client's wife hears the word "cancer" and immediately begins crying. She says, "How long does he have to live?" Which response by the nurse is appropriate? A) "Don't worry about how long he will live. Just live every day to the fullest and enjoy the time you have left together?" B) "If we treat the cancer aggressively with surgery and radiation, he should live several more years." C) "Prostate cancer is usually aggressive in older men, so he may only have a short time to live." D) "Older men who are diagnosed with prostate cancer usually die from causes other than the cancer."
D) "Older men who are diagnosed with prostate cancer usually die from causes other than the cancer." Rationale: In an older man with a lower stage of cancer at diagnosis, the cancer is likely slow-growing, and he is more likely to die from other preexisting comorbidities than from the cancer itself. Therefore, the nurse cannot predict how long the client may live after diagnosis. Prostate cancer is usually aggressive in younger men, not older men. Early-stage prostate cancer in older men may not be treated aggressively. Instead, the healthcare team may take a more conservative "watchful waiting" approach, depending on other health conditions. It is not within the nurse's scope of practice to suggest aggressive treatment strategies. The nurse should not dismiss the client's or client's family's concerns by telling them to not worry.
What approach is appropriate for interpreting the prostate-specific antigen (PSA) level as a diagnostic factor for prostate cancer? A) A PSA level higher than 4.0 ng/mL indicates prostate cancer B) A PSA level lower than 4.0 ng/mL indicates prostate cancer C) A fluctuating PSA leve indicates prostate cancer D) An abnormal PSA level alone is not enough to diagnose prostate cancer.
D) An abnormal PSA level alone is not enough to diagnose prostate cancer. Rationale: The National Cancer Institute used to consider a PSA level of 4.0 ng/mL or lower to be normal, but men with normal PSA levels may still have prostate cancer. PSA levels above 4.0 ng/mL or PSA levels that fluctuate could be an indication of prostate cancer, but it could also indicate prostatitis or urinary tract infection. Therefore, PSA levels must be interpreted in conjunction with the patient's health history and other diagnostic tests to confirm a diagnosis of prostate cancer.
Which hormones are believed to have a role in the development of prostate cancer? A) Prolactin B) Endorphin C) Estrogens D) Androgens
D) Androgens Rationale: Androgens are hormones synthesized in the testes and adrenal cortex in males that promote expression of male sex characteristics. They are believed to have a role in the development of prostate cancer. Estrogens, endorphins, and prolactin have not been linked to the development of prostate cancer.
While receiving discharge teaching, an adult client recovering from a prostatectomy is distressed to learn that episodes of incontinence may occur. Which should the nurse teach the client to help minimize incontinence? A) Proper administration of incontinence medication B) Steps to change the Foley catheter bag every day C) Fluid retention D) Kegel exercises
D) Kegel exercises Urinary incontinence after surgery is not unexpected. Teaching the client Kegel exercises is the best way to help him eliminate or reduce occasions of stress incontinence. Restricting fluids may cause further urinary problems and is not advised. Medication and Foley catheters are not appropriate long-term treatments for this complication.
Which lab test is performed to screen for prostate cancer? A) BNP B) CMP C) CBC D) PSA
D) PSA Rationale: PSA is the screening test for prostate cancer. CBC and CMP may be performed to provide a baseline prior to treatment; however, they are not diagnostic for prostate cancer. BNP is a test to assess clients with heart failure.
The nurse is providing education to a client who has undergone a radical prostatectomy. Teaching on which topic is mostly likely to help decrease symptoms of urinary incontinence? A) Estrogen cream application B) Placement of a urostomy C) The use of a condom catheter D) Pelvic floor exercises
D) Pelvic floor exercises Rationale: Urinary incontinence may occur due to prostate surgery for benign prostate hyperplasia, or prostate cancer. Pelvic floor muscle exercises such as Kegel exercises help to strengthen the pelvic muscles. Reductase inhibitors decrease the outlet resistance in overflow incontinence. Condom catheters would be used if the client was unable to control the flow of urine. Estrogen creams are used to treat females with urge incontinence. A urostomy is performed to bypass the urethra and cure bladder incontinence after trauma or surgery
What is the primary reason that prostate cancer rarely metastasizes to the bowel? A) The capsular artery supplies blood to the bowel before the prostate. B) The inferior vesicle artery supplies blood to the bowel before the prostate C) The rectourethral fistula acts as a physical barrier to metastasis D) The denonvilliers fascia acts as a physical barrier to metastasis
D) The Denonvilliers fascia acts as a barrier to metastasis. Rationale: Despite its proximity to the rectum, metastasis to the bowel is uncommon in prostate cancer, because a tough sheet of tissue, the Denonvilliers fascia, acts as an effective physical barrier between the bowel and prostate. A rectourethral fistula may develop as a result of treatment for prostate cancer. The inferior vesicle artery and capsular artery provide blood to the prostate but not the bowel.
The nurse understands that which surgery involves removal of parts of the prostate gland through the penis and urethra? A) Perineal prostatectomy B) Radical prostatectomy C) Retropubic prostatectomy D) Transurethral prostatectomy
D) Transurethral prostatectomy Rationale: Transurethral resection of the prostate (TURP) involves removal of parts of the prostate gland by a surgical instrument that is inserted into the end of the penis and through the urethra. Radical prostatectomy involves removal of the prostate, prostate capsule, seminal vesicles, and a portion of the bladder neck. A fairly new treatment is laparoscopic radical prostatectomy, in which small incisions are made in the abdomen and a laparoscope is inserted and used to remove the prostate. Retropubic prostatectomy may be performed because it allows adequate control of bleeding, visualization of the prostate bed and bladder neck, and access to pelvic lymph nodes. Perineal prostatectomy is often preferred for older men or those who are poor surgical risks.
