A patient with excruciating back pain that has been getting worse ...

[WhattoUnderstand]

A patient with excruciating back pain that has been getting worse over the past few months comes to the Emergency Department.
 
  His chief complaint is excruciating back pain that has been getting worse over the past few months. He has also noticed decreased sensation in his lower extremities, some urinary incontinence, and feels like he never really empties his bladder all the way after voiding. Following diagnostic testing, the patient is diagnosed with advanced prostate cancer with spinal cord compression. The nurse should anticipate administering which medications to this patient? Select all that apply.
  A)
  Ketoconazole, a fungicide, to lower serum testosterone levels.
  B)
  Bisphosphonates, such as pamidronate, to inhibit bone loss
  C)
  Phosphate-binding agents such as aluminum hydroxide
  D)
  Sulfonamides with trimethoprim (Bactrim) to treat the urinary tract infection (UTI)
  E)
  Calcium carbonate to prevent osteoporosis

Question 2

A pregnant teenager has arrived at a free clinic seeking care. She has had no prenatal care and is currently 27 weeks' gestation.
 
  Upon testing for a sexually transmitted disease (STD), it is found that she has active T. pallidum (syphilis). Given the fact that she has active syphilis at this stage in her pregnancy, it is very likely her fetus is at risk for: Select all that apply.
  A)
  being born prematurely.
  B)
  congenital defects.
  C)
  unstable blood glucose levels.
  D)
  cyanosis in limbs after delivery.
  E)
  blindness.

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Answer to Question 1

Ans:
A, B

Feedback:

Inhibitors of adrenal androgen synthesis (ketoconazole) are used for treatment of patients with advanced prostate cancer who present with spinal cord compression. This is because these men need rapid decreases in their testosterone levels. The bisphosphonates (pamidronate) act by inhibiting osteoclastic activity. They prevent osteopenia, prevent and delay skeletal complications in patients with metastatic bone involvement, and provide palliation of bone pain. There is no indication that this patient has a UTI. Patients with this malignancy usually have hypercalcemia, and therefore administration of calcium supplements would be contraindicated.

Answer to Question 2

Ans:
A, B

Feedback:

There is rapid transplacental transmission of the organism from the mother to the fetus after 16 weeks' gestation, so that active infection in the mother during pregnancy can produce congenital syphilis in the fetus. Untreated syphilis can cause prematurity, stillbirth, and congenital defects and active infection in the infant. Unstable blood glucose levels can occur with diabetic mothers, and many infants have some acrocyanosis immediately following birth. Blindness from syphilis can occur decades after initial infection, so it would not be present at birth.

[WhattoUnderstand]

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[diesoon]

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