8.13 Learning Activities
Learning Activities
Prostate Cancer Case Study[1]
Use the following information to answer case study questions 1-6.
Handoff Report:
1251: This is Mr. Robert Jackson, a 54-year-old (DOB 4/12/1969) male admitted for the management of newly diagnosed, locally advanced prostate cancer. He is a full code and has an allergy to penicillin. He weighs 82kg and has a BMI of 26.5. He has been experiencing increased urinary frequency and urgency for the past six months. He underwent a prostate biopsy, which revealed adenocarcinoma, and imaging studies confirmed the presence of lymph node involvement. Mr. Jackson is scheduled for a meeting with the oncology team later today to discuss treatment options. He is currently stable, but his family is quite emotional, and he’s struggling to process this new diagnosis. His most recent vitals are: Temperature 98.6°F (37°C), Pulse 80 bpm, Respirations 18 breaths/min, Blood Pressure 130/80 mmHg, and Oxygen Saturation 98% on room air. He did have some breakthrough pain earlier, rated at 6 out of 10, but it responded well to pain medication. His urine output has been scant, and we’re monitoring that closely. Please continue to assess his pain level, monitor his urine output, and provide emotional support to both the patient and his family.
History & Physical:Â
History
- No prior history of cancer
- Family history of hypertension and heart disease
- Patient reports he is a non-smoker and only drinks alcohol socially
Physical Findings
- Appears visibly anxious
- Abdomen is soft and non-tender
- Mild discomfort on palpation of the lower abdomen
Progress Notes:
14:30 – Nurse Note Client reports pain level 5/10 after receiving pain medication. Voiding small amounts of urine frequently. Encouraged to increase fluid intake. Family present and providing support.
16:00 – Oncology Note Discussed treatment options with client and family, including surgery, radiation therapy, and hormone therapy. Risks and benefits of each option explained, but client and family continue to express anxiety. Patient and family opted to proceed with radiation therapy followed by hormone therapy.
Lab/Diagnostic Results:
| Test | Result | Reference Range |
| PSA (Prostate Specific Antigen) | 12.5 ng/mL | 0 – 4.0 ng/mL |
| Biopsy – Prostate | Positive for Adenocarcinoma | N/A |
| CT Scan – Abdomen/Pelvis | Enlarged prostate with lymph node involvement | N/A |
Provider Orders:
| Consult oncology |
| Continuous EKG monitoring |
| Continuous oxygen saturation monitoring |
| Initiate IV fluids: 0.9% Normal Saline at 100 mL/hr |
| Morphine 2 mg IV push every 4 hours PRN for pain |
| Ondansetron 4 mg IV push every 8 hours PRN for nausea |
| Strict I&O |
| Bladder scan after every void |
| Soft diet as tolerated |
1. Based on Mr. Jackson’s presentation and history, what is the priority nursing assessment?
a) Assess pain level and provide pain relief measures.
b) Address the client’s anxiety and provide emotional support.
c) Monitor vital signs, particularly blood pressure and heart rate.
d) Evaluate the client’s understanding of his diagnosis and treatment options.
2. What is the most likely etiology for Mr. Jackson’s reported urinary changes?
a) Increased anxiety related to his new diagnosis.
b) Local tumor growth affecting the prostate gland.
c) Side effects from pain medication administration.
d) Underlying urinary tract infection.
3. Which of the following nursing diagnoses is most important for Mr. Jackson?
a) Risk for bleeding
b) Impaired urinary elimination
c) Disturbed body image
d) Ineffective coping
4. The nurse is developing an educational plan for Mr. Jackson. What information is essential to include regarding radiation therapy?
a) Radiation therapy will eliminate the need for future hormone therapy.
b) Patients undergoing radiation therapy will experience hair loss.
c) Side effects of radiation therapy may include fatigue, skin changes, and urinary issues.
d) Radiation therapy is typically administered on an inpatient basis for several weeks.
5. You are caring for Mr. Jackson, who is experiencing anxiety related to his new diagnosis and upcoming treatment. Which nursing intervention is MOST appropriate to address his anxiety?
a) Reassure him that his diagnosis is treatable and he has a good prognosis.
b) Provide him with educational materials about prostate cancer and treatment options.
c) Encourage him to express his feelings and concerns, providing a supportive and non-judgmental environment.
d) Distract him with therapeutic activities such as watching television or listening to music.
6. Two hours after receiving a dose of morphine, Mr. Jackson reports his pain level is an 8 out of 10. After verifying his medication orders, what is the nurse’s best action?
a) Administer Morphine 2 mg IV push as ordered.
b) Administer Ondansetron 4 mg IV push for potential nausea.
c) Contact the physician to request a higher dose of pain medication.
d) Reposition the patient and encourage relaxation techniques.
Vaginal Discharge Case Study[2]
Use the following information to answer case study questions 1-6.
Handoff Report:
1507: This is a 25-year-old female, Maria Hernandez, presenting to the clinic with complaints of vulvar itching, burning, and discharge. She is a full code and has an allergy to penicillin. She weighs 60 kg and has a BMI of 23.1. The client states that she recently completed a course of antibiotics for an ear infection and has never had these symptoms before. She describes a thick, white, curd-like vaginal discharge. Upon assessment, her vulva appears erythematous and irritated, with no lesions noted. The client reports experiencing significant discomfort, rating her pain as 5/10 on a numerical pain scale, and expresses anxiety about the cause of her symptoms. Vital signs are as follows: BP 118/76, HR 88, RR 18, Temp 98.2 degrees F, O2 saturation 100% on room air.
 History & Physical:
History
- Client is in a monogamous relationship and sexually active
- Client expresses concern and embarrassment about her symptoms
- Reports living in a humid climate
- Frequently wears tight clothing and underwear
Physical Findings
- Visible erythema and white patches in the vulvar area
- No pelvic examination performed in the clinic
Provider Orders:
| Basic Metabolic Panel (BMP), once, now |
| Complete Blood Count (CBC), once, now |
| Wet Prep, now |
- Based on Maria Hernandez’s presenting symptoms and history, which of the following is the most likely diagnosis?
a) Bacterial vaginosis
b) Vulvovaginal candidiasis
c) Trichomoniasis
d) Chlamydia
2. Which of the following nursing diagnoses is most appropriate for Maria Hernandez?
a) Impaired Urinary Elimination
b) Impaired Skin Integrity
c) Acute Pain
d) Ineffective coping
3. What is the most likely cause of Maria Hernandez’s vulvovaginal candidiasis?
a) Recent unprotected sexual intercourse.
b) Wearing tight fitting clothing.
c) Living in a humid climate.
d) Recent antibiotic therapy for an ear infection.
4. Maria is prescribed fluconazole to treat her condition. Other than taking this medication, what other intervention should the nurse teach Maria about?
a) Apply over-the-counter hydrocortisone cream to reduce itching.
b) Provide cool compresses or sitz baths for symptomatic relief of itching and burning.
c) Encourage the use of feminine hygiene products to manage discharge.
d) Recommend daily douching with a water and vinegar solution.
- After receiving education, Maria Hernandez states, “I think I got this from my boyfriend.” How should the nurse respond?
a) “Yes, it is possible to transmit yeast infections sexually.”
b) “While some infections can be sexually transmitted, vulvovaginal candidiasis is not considered one of them. It is caused by an overgrowth of yeast that is already present in the body.”
c) “You should talk to your boyfriend about getting tested for sexually transmitted infections.”
d) “Let’s focus on your treatment plan and how to prevent future infections.”
6. The nurse is teaching Maria Hernandez about preventing future yeast infections. Which statement by the client indicates a need for further education?
a) “I will make sure to wear cotton underwear and avoid tight-fitting pants.”
b) “I should avoid douching or using scented feminine hygiene products.”
c)Â “It’s okay to use a vaginal deodorant to mask any unpleasant odors.”
d) “I will change out of wet swimsuits or workout clothes as soon as possible.”
Test your knowledge using this NCLEX Next Generation-style case study. You may reset and resubmit your answers to this question an unlimited number of times.[6]
- Prostate Cancer Case Study developed by Angela Landry for OpenRNÂ is licensed under CC BY-NC 4.0 ↵
- Vaginal Discharge Case Study developed by Angela Landry for OpenRNÂ is licensed under CC BY-NC 4.0 ↵
- Reproductive Glossary Cards Set 1 by OpenRNÂ is licensed under CC BY-NC 4.0 ↵
- Reproductive Glossary Cards Set 2 by OpenRNÂ is licensed under CC BY-NC 4.0 ↵
- Reproductive Glossary Cards Set 3 by OpenRNÂ is licensed under CC BY-NC 4.0 ↵
- “HP Chapter 8 Case Study A" by Kellea Ewen for OpenRN is licensed under CC BY-NC 4.0 ↵
