MedSurg Exam III
A client is diagnosed with metastatic prostate cancer. The client asks the nurse the purpose of his treatment with the lutenizing hormone releasing hormone agonist (Lupron) and the biphosphate pamidronate (Aredia). Which statement by the nurse is most appropriate? A. The treatment reduces testosterone and prevents bone fractures. B. The medications prevent erectile dysfunction and increase libido. C. There is less gynecomastia and osteoporosis with this drug regimen. D. These medications both inhibit tumor progression by blocking androgens.
A.
What are the medications that put a client at risk for osteoporosis?
-Anticonvulsants -Thyroid medication -Loop diuretics -Corticosteroids (prednisone)
What are the medication classes for osteoporosis?
-Biphosphates -Calcitonin -Calcium supplements -Estrogen replacement -Selective estrogen receptor modulator -Monoclonal antibody
Characteristic of PVD?
-Blood cannot get back up to the heart -Not an oxygen problem since the arteries are still working properly -Elevate legs with PVD -Warms legs, edema, irregularly shaped sores, no sharp pain, yellow and brown ankles
Manifestations of osteoporosis
-Fractures -Thoracic kyphosis -Acute back pain when lifting or bending -Restricted movement -Pain upon palpation of affected area -Loss of height
What are some medical conditions that put you at risk for osteoporosis?
-Hyperparathyroidism -Hyperthyroidism -DM -Cushing's syndrome -Malabsorption syndrome -Kidney impairment -Anorexia nervosa -COPD, asthma
What are the manifestations of peripheral atherosclerosis (PAD)?
-Intermittent claudication (pain when walking)
What are the risk factors of atherosclerosis?
-It usually affects people in their 60s and 70s -Men are more affected than women -High cholesterol (LDL) -Deaths: black/white men equally but black females greater than white females
Diagnostic tools for osteoporosis
-Laboratory tests, serum calcium, vitamin D, phosphorus, alkaline phosphatase (to rule out other metabolic bone disorders) -24 hr urine collection -FRAX (fracture risk assessment tool)
What is a osteopenia?
-Low bone mass -Precursor to osteoporosis
What are the main risk factors for osteoporosis?
-Low hormone levels (estrogen and testosterone) -Smoking and excessive alcohol -Excessive caffeine use -Prolonged immobility -Hx of gastric bypass -Low calcitonin levels -Thin lean body build -Age older than 60 years old
What is the main nursing role for peripheral artery disorders?
-Maintaining tissue perfusion by: Checking pulses, capillary refill, palpating warmth of the skin, assessing skin color -Educate the client and family about the disorder and management
Characteristics of PAD?
-Narrowed arteries -O2 cannot get down to the distal extremities -Low blood flow means low to no oxygen -Hang legs with PAD -Absent pulses, cool legs, absent hair, red round sores, toes and feet pale or black, and sharp pain calves with exercise or elevation
What is the nursing care for biphosphate meds?
-Take with a glass of water 30 minutes before eating -Remain standing/sitting for 30 minutes after oral dose -Risk for esophageal irritation so monitor for indigestion, chest pain, difficulty swallowing, bloody emesis -Monitor calcium levels (b/c hypocalcemia risks) -Client with IV preparations should have regular dental exams
A nurse is caring for a client who has prostate cancer. The nurse should expect the provider to prescribe which of the following medications for this client? A. Leuprolide B. Cyclophosphamide C. Finasteride D. Tamoxifen
A. Leuprolide treats cancer of the prostate hormonally. It antagonizes the androgens that androgen-dependent neoplasms require.
A nurse is caring for a client who is 2 hr postoperative following a transurethral resection of the prostate (TURP) gland. Which of the following assessments should the nurse view to be an indication of a postoperative complication? A. Output of burgundy colored urine. B. Pulse rate of 88/minute. C. Oral temperature of 38.2C (100.76F) D. An urge to void despite having an indwelling urinary catheter.
A. Output of burgundy colored urine may indicated venous bleeding, a potential complication following a TURP. Should this occur, the nurse should inform the provider and anticipate an order for increased CBI rate or manual irrigation of the catheter.
A nurse is caring for a client who has undergone a transurethral prostatectomy. Following catheter removal, the nurse should inform the client that he should expect which of the following variations in the color of his urine? A. Pale pink B. Bright yellow C. Bright red D. Dark amber
A. Pale pink. The client should expect to pass some small clots and tissue in his urine for a few days, which may give the urine a pale pink color. By 2 to 3 days after surgery, around the time of discharge, his urine should be clear yellow.
The nurse is teaching a client with benign prostatic hyperplasia. What statement indicates a lack of understanding by the client? A. There should be no problem with a glass of wine with dinner each night. B. I am so glad that I weaned myself off of coffee about a year ago. C. I need to inform my allergist that I cannot take my normal decongestant. D. My normal routine of drinking a quart of water during exercise needs to change.
A. The client did not associate wine with the avoidance of alcohol, and requires additional teaching. The nurse must teach a client with BPH to avoid alcohol, caffeine, and large quantities of fluid in a short amount of time to prevent over distention of the bladder.
A nurse is caring for a client who is postoperative following a transurethral resection of the prostate. Which of the following complications is the priority for the nurse to monitor for? A. Hemorrhage B. Infection C. Urinary retention D. Pain
A. The nurse should monitor the client's urinary output for blood clots and bright red tinged urine following surgery.
What are the biphosphates given for osteoporosis?
Alendronate, ibandronate, risedronate, zeldronic acid
What carries oxygenated blood to peripheral tissues, have high psi, and does not have valve
Arteries
What is the most common chronic arterial disorder characterized by thickening, loss of elasticity, and calcification of the arterial walls?
Arteriosclerosis
What is a form of arteriosclerosis that is characterized by deposits of fat and fibrin that obstruct and harden the arteries?
Atherosclerosis
A client has returned from a transurethral resection of the prostate with a continuous bladder irrigation. Which action by the nurse is a priority if bright red urinary drainage and clots are noted 5 hours after the surgery? A. Review the hemoglobin and hematocrit as ordered. B. Take vital signs and notify the surgeon immediately. C. Release the traction on the three way catheter. D. Remind the client not to pull on the catheter.
B. Bright red urinary drainage with clots may indicate arterial bleeding. Vital signs should be taken and the surgeon notified.
A nurse is caring for a client who is 5 hr postoperative following a transurethral resection of the prostate (TURP). The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first? A. Notify the provider. B. Check the tubing for kinks. C. Adjust the rate of the bladder irrigant. D. Irrigate the catheter.
B. Check the tubing for kinks. When providing client care, the nurse should first use the least restrictive intervention; therefore, the nurse should check the catheter tubing for kinks. The nurse must ensure constant flow of the bladder irrigant into the catheter and outward drainage from the catheter to prevent clotting.
A nurse is caring for a client who has benign prostatic hyperplasia (BPH). Which of the following medications should the nurse plan to administer? A. Danazol B. Finasteride C. Fluoxymesterone D. Methlytestosterone
B. Finasteride is an a 5 alpha reductase inhibitor, used for treatment of BPH to prevent the conversion of testosterone and to decrease prostate size.
A nurse is providing an education program about dietary interventions to reduce the risk for prostate cancer. Which of the following information should the nurse include? A. Increase animal fat in the diet. B. Increase fatty fish in the diet. C. Reduce dietary fiber intake. D. Increase complex carbohydrates in the diet.
B. Increase fatty fish in the diet. The client should increase intake of fish and increase omega 3 fatty acids to reduce the risk for prostate cancer.
A nurse is planning care for a client who is 2 hours postoperative following a transurethral resection of the prostate. The client is receiving continuous bladder irrigation. Which of the following interventions should the nurse include? A. Restrict the client's fluid intake. B. Remind the client he might feel a constant urge to void. C. Monitor the client's urine output every 6 hours. D. Weight the client daily.
B. The client who is receiving continuous bladder irrigation will experience a continuous urge to void because of pressure on the internal sphincter from the catheter balloon.
A nurse is caring for a client who is 1 day postoperative following a TURP and has a continuous bladder irrigation in place. Which of the following actions should the nurse take? (SATA). A. Add the amount of bladder irrigation to the total output. B. Use sterile technique when preparing the irrigation solution. C. Ensure the drainage tubing is patent and without obstruction. D. Contact the surgeon if the client reports a continual need to void. E. Notify the surgeon if the urine is bright red in appearance or has large clots.
B. Using sterile technique decreases the risk of contamination with microorganisms and reduces the possibility of infection. Many clients who undergo TURP are older adults who may have other chronic disease that increase their susceptibility to infection. C. For continuous drainage, the nurse should be sure that the clamp on the drainage tubing is open and check the volume of the fluid in the drainage bag. It prevents accumulation of solution in the bladder, which can cause bladder distention and possible injury. E. It is normal to see a few small blood clots and pink tinged drainage, but urine that is bright red, ketchup-like, or has large clots is an indication of bleeding and should be reported to the surgeon.
A nurse is caring for a client who is postoperative following a transurethral resection of the prostate (TURP). The nurse should plan to administer the client's PRN bethanechol when the client reports which of the following manifestations? A. Bladder spasms. B. Severe pain. C. An inability to void. D. Frequent episodes of painful urination.
C. An inability to void. Bethanechol is a cholinergic medication that stimulates the parasympathetic nervous system, this improving the tone and motility of the smooth muscles of the urinary tract enough to initiate urination.
A nurse is caring for a client who has benign prostatic hyperplasia (BPH). The nurse should expect which of the following findings? A. Urge incontinence B. Critically elevated prostate-specific antigen (PSA) level C. Difficulty starting the flow of urine D. Painful urination
C. Hesitancy or difficulty starting the flow of urine is an expected finding of BPH.
A nurse is evaluating a client's laboratory results. The nurse should recognize that an increase in the client's prostate specific antigen (PSA) laboratory value is indicative of which of the following diagnoses? A. Breast cancer B. Colon cancer C. Liver cancer D. Prostate cancer
D. An increased PSA level is indicative of a prostate cancer diagnosis, as well as other prostate problems.
A nurse and an unlicensed assistive personnel are caring for a client with an open radical prostatectomy. Which comfort measure could the nurse delegate to the UAP? A. Administering an antispasmodic for bladder spasms. B. Managing pain through PCA pump C. Apply ice to a swollen scrotum and penis D. Helping the client transfer from the bed to the chair
D. The UAP could aid the client in transferring from the bed to the chair and with ambulation. The nurse would be responsible for medication administration, assessment of swelling, and the application of ice if needed.
What are the common fracture sites for osteoporosis?
Hip, wrist, spine
What does disorders of the peripheral arteries do?
Limit the availability of oxygen and nutrients to the tissues.
What are the calcitonin meds for osteoporosis?
Miacalcin or fortical
When is zoledronic acid (reclast) administer IV?
Once per year for osteoporosis, every 2 years for prevention
What carries blood back to the heart, has low pressure, and has valves?
Veins