Examination: Laparoscopic Radical Prostatectomy

Examination: Laparoscopic Radical Prostatectomy

APRIL 2002, VOL 75,NO 4 Examination IAPAROSCOPIC RADICAL PROSTATE-llllY d. motor control. leading cause of cancer death among men in the United Sta...

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APRIL 2002, VOL 75,NO 4


d. motor control.

leading cause of cancer death among men in the United States. a. first b. second c. third d. fourth

1.Prostate cancer is the

7.Clinical symptoms of prostate enlargement include all of the following except a. hesitancy. b. nocturia. c. dysuria. d. polyuria.

2. What are the two most common side effects of the traditional major open abdominal approach for surgical treatment of prostate cancer? a. urinary incontinence and sterility b. impotence and chronic diarrhea c. impotence and urinary incontinence d. chronic diarrhea and sterility

8.The incidence of prostate cancer is higher in males. a. African American b. Asian c. Caucasian d. Hispanic

3.The prostate gland is made up of fibromuscular tissue and a. contains alveoli and tubular ducts. b. is a convoluted duct suspended in the scrotum. c. contains the vas deferens, blood vessels, and lymphatics. d. is a pouch that lies behind the bladder.


%The highest risk factor for prostate cancer occurs if a a. relative had an onset of clinically recognized disease after age 65. b. man has two second-degree relatives who are affected. c. first-degree relative had an onset of clinically recognized disease at age 53 or younger. d. man has a first-degree relative who is affected.

fascia comprises two layers of endopelvic fascia, which separates the prostate from the rectum. a. Dartos b. Hypodermis c. Epimysium d. Denonvilliers’

1O.American Cancer Society statistics estimate 10 year survival rates from prostate cancer to be a. 94%. b. 83%. c. 72%. d. 61%.

zone of the prostate is the 5. The smallest and is where benign prostate hypertrophy occurs. a. transition b. medial c. central d. peripheral 6.Neurovascular fibers located on each side of the prostate contain blood and nerve supply critical to a. urinary continence. b. erectile function. c. tactile sensation.

11.Elevated prostate specific antigen (PSA) levels reflect abnormalities of the prostate, including all of the following except a. fertility. b. infection. c. benign prostatic hypertrophy. d. recent prostatic biopsy. 12Grading cancer is one of the most important factors in predicting all of the following except a. long-term results.


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19-Alternative treatment options to LRP include a. an open surgical approach, radiation, cryosurgery, and observation. b. radiation, observation, biologic therapy, and observation. c. an open surgical approach, cryosurgery, radiation, chemotherapy. d. observation, biologic therapy, chemotherapy, and cryosurgery.

b. treatment options. c. response to treatment. d. potential for survival.

1 8 0 n the Gleason scale, a moderately-differentiated aggressive tumor is given a score of a. one to three. b. three to five. c. five to seven. d. seven to nine.

#).A two-day preoperative bowel prep is ordered to a. provide postoperative bowel rest. b. reduce the risk of rectal injury. c. lessen postoperative pain by postponing bowel emptying. d. decrease the risk of cross contamination.

1 A T h e significant difference between Gleason grading and the TNM and Whitmore-Jewett staging methods is that grading is based on cell pathology, whereas staging is determined by clinical examination or testing. a. true b. false

21.The patient is required to complete a bowel prep several days before surgery that includes all of the following except a. remaining on a clear liquid diet for two days before surgery. b. taking antibiotics at 10 AM and noon the day before surgery. c. taking magnesium citrate at noon the day before surgery. d. self-administering a Fleets enema the night before surgery.

15.Localized or regional tumors are treated most commonly with a. hormonal therapy or radiation. b. radical prostatectomy or chemotherapy. c. hormonal therapy or chemotherapy. d. radiation or radical prostatectomy. IBLaparoscopic radical prostatectomy (LRP) reduces trauma, resulting in all of the following except a. less postoperative pain. b. reduced risk of structural deformity. c. reduced length of hospital stay. d. more rapid return to normal activity.

=By signing the informed consent form, the patient agrees to laparoscopic and, possibly open, radical prostatectomy. a. true b. false

17.Men with localized prostate cancer are considered candidates for LRP, providing they a. have not had previous pelvic surgery or radiation and are not morbidly obese. b. do not have diabetes and are not morbidly obese or older than 76 years of age. c. have not had previous radiation, are not obese, and do not have coronary artery disease. d. do not have diabetes or coronary artery disease and have not had previous pelvic surgery. 18.To help rule out metastases, a bone scan is performed on patients with a PSA level greater than a. six. b. eight. c. 10. d. 12.

=.Having laparoscopic equipment and flat-screen monitors mounted on booms a. provides better visibility for,the surgeon. b. reduces staff member back strain injury. c. allows greater versatility for monitor and equipment placement. d. eases work for environmental cleaning staff members.

24. Which of the following outcome statements would be appropriate for the nursing diagnoses “Fluid volume deficit related to preoperative bowel prep, NPO status, and surgery?” a. The patient is free from signs and symptoms of physical injury. b. The patient’s fluid, electrolyte, and acid-base


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balance is consistent with or improved from baseline levels. C. The patient participates in decisions affecting his plan of care. d. The patient participates in the rehabilitation process.

=.The surgeon performs the majority of dissection using the a. laparoscopic electrosurgical monopolar unit. b. bipolar electrosurgical unit. c. laparoscopic scissors. d. ultrasonic scalpel.

=.The circulating nurse attaches a padded shoulder rest (ie, kidney rest) to the top of the bed on the patient’s left side to a. raise the left flank intraoperatively to improve visibility of the surgical site. b. provide an arm rest for the anesthesia care provider during intubation of the patient. c. lessen postoperative shoulder pain from abdominal insufflation with carbon dioxide. d. prevent the patient from sliding when the OR bed is placed in a steep Trendelenburg’s position.

31.The anesthesia care provider injects indigo carmine intravenously because the dye helps the surgeon a. ensure that the urethra’s continuity has not been disturbed through the area of prostate dissection. b. identify inadvertent bladder puncture that may have occurred during urethral bladder reanastomosis. c. ensure that rectal laceration has not occurred when exposing the prostatic pedicles and vas deferens. d. identify the ureteral orifices during bladder dissection and urethral bladder reanastomosis.

26.Which o f the following nursing diagnoses would be appropriate for a patient undergoing LRF’? a. risk for activity intolerance b. risk for ineffective breathing patterns related to hypothermia c. risk for impaired home maintenance management (eg, indwelling Foley catheter care) d. risk for sleep pattern disturbance


lacerations. a. true b. false

27.The scrub person ensures that the catheter balloon has been tested to prevent inadvertent balloon rupture inside the patient before handing the catheter to the surgeon. a. true b. false =The surgeon inserts __ 10-mm and ports and sutures them all into place. a. one I three b. two I three c. one I two d. two I two


surgeon injects air into the urethra using a

60-mL catheter-tipped syringe to check for rectal


=.According to the preference card, the patient’s legs are placed in a. Allen stirrups with the knees in slight adduction and parallel to the table. b. cane stirrups with the knees adducted. c. Allen stirrups with the legs in slight abduction and parallel to the ground. d. cane stirrups with the legs in slight abduction.

33.According to the clinical pathway, the patient should be ambulating by the a. afternoon of surgery. b. evening of surgery. c. morning after surgery. d. afternoon the day after surgery. =Manipulation and irrigation of the balloon or catheter is strictly forbidden because it could a. increase the patient’s pain. b. slow bladder contractions, which help decrease bleeding. c. threaten the anastomosis of the urethra and bladder neck. d. increase postoperative bleeding.


may be administered orally every eight hours if the patient experiences bladder spasms. a. Oxybutynin b. Oxycodone c. Oxycontin d. Oxymorphone


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=The Foley catheter is removed by the surgeon an average of days postoperatively. a. five b. seven c. 10 d. 12

b. it is more challenging to complete the procedure laparoscopically on obese patients. c. a BMI less than 30 may increase the risk of postoperative impotence. d. it is more challenging to perform the procedure on underdeveloped adolescents.

37.A clinical pathway is used for all of the following reasons except to a. track errors and omissions in treatment made by individual care providers for the quality improvement program. b. quickly assess and monitor a patient's progression along the continuum. c. identify and track variances easily and allow for more rapid changes to the care path. d. provide a summation of specific nursing interventions and their effect on the variance.

=.The average hospital stay for an open radical prostatectomy is a. 1.5 days. b. 2.6 days. c. 3.8 days. d. 4.9 days. 40.Follow-up indicates that patients who undergo the laparoscopic procedure are able to return to normal daily activities within two to three weeks, whereas patients undergoing the open procedure take weeks. a. three to five b. four to six c. five to seven d. six to eight

38.A maximum body mass index (BMI) of 30 is used as a guideline for candidate selection because a. a BMI greater than 30 indicates a propensity for postoperative bleeding. AORN, Association of perioperotive Registered Nurses, is accredited as a provider of continuing education in nursing by the American Nurses Credentioling Centers (ANCC's) Commission on Accreditotion. AORN recognizes this activity as continuing education for registered nurses. This recognition does not imply that AORN or the ANCC's Commission on Accreditation approves or endorses any product included in the activity. AORN maintains the following state board of nursing provider numbers: Alabama ABNPOO75, California CEP730 19, and Florida FBN 2296. Check

with your state boord of nursing for occeptobility of education activiiy for relicensure.

Professionol nurses ore invited fa submit manuscripts for the Home Study Program. Manuscripts or queries should be sent to Editor, AORN Journal, 21 70 S Parker Rd, Suite 300, Denver, CO 8023 1571 1 . As with all manuscripts sent to the Journal, papers submitted for Home Study Pragrams should not have been previouslypublished or submitted simultaneously to any other publicotion.

Menstrual Pain Severely Affects Almost Half of US Women Millions of women suffer mild to moderate pain during menstruation each month, according to a Jan 29, 2002, news release from Whitehall-Robins Healthcare. This pain usually is tolerable, but for 43% of US women the pain is so severe that it disrupts their daily lives. These findings come from a national StrategyOne omnibus survey conducted from Aug 16 to 20, 200 1. An estimated 600 million hours of work and $2 billion in productivity are lost each year due to menstrual pain. Approximately 18% of women surveyed said they have missed one or more days of work, school, or other activities during the past year because of menstrual cramps. Seventy-five percent of

those surveyed said they experience one to five days of pain or discomfort during their menstrual period. There are many methods, however, to alleviate menstrual cramp pain, including exercise, heat therapy, leg elevation, and over-the-counter pain relievers. This survey questioned 546 menstruating women ages 18 to 49 about menstrual pain and its effect on daily living. The sample was chosen by random digit dialing. To Many, Menstrual Pain Puts Brakes on Career, Family Life, New Survey Finds (news release, Madison, NJ: Wbifeba//-RobinsHeolfbcare, Jan 29, 2002) h t t p : / w , newsdesk.corn (accessed 29 Jan 2002). 788


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Answer Sheet LAPAROSCOPIC RADICAL PROSTATECTOMY lease fill out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2 170 S Parker Rd, Suite 300 Denver, CO 8023 1-5711 or fax with credit card information to (303) 750-3212.

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A score of 70% correct is required for credit.

Session Number

Event # 02081 Session # 6474 Contact hours: 2.5 Fee: Members $12.50; Nonmembers $25

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Program offered April 2002. The deadline for this program is April 30,2005. 1 . Record your six-digit member identification number in the appropriate section below (see your member card). 2. Completely darken the space that indicates your answer to the examination starting with question one. Use blue or black ink. 3. Record the time required to complete the program

Mark only one answer per question. - .

4. Enclose fee if information is mailed.

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Fee enclosed or bill the credit card indicated 0 MC fl Visa 0Am Express 0 Discover Card # Expiration date Signature (lor crcdrl card aullionml~on)


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The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5. OBJECTIVES

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(Low) (High) (Low) (High) 100000 200000 300000 400000 500000 600000 700000 800000 900000 [email protected]@@@ [email protected]@@@ [email protected]@0 1300000 14 00000 1500000

To what extent were the following objectives of this Home Study Program achieved? (1) Identify the anatomy of the male reproductive system. (2) Discuss the preoperative assessment and care of the patient undergoing laparoscopic radical prostatectomy (LRP). (3) Explain the perioperative nursing care of the patient undergoing LRP. (4) Describe the surgical steps of the LRP procedure. (5) Discuss the postoperative course of the patient recovering from LRP. PURPOSWGOAL

To educate the perioperative nurse about laparoscopic radical prostatectomy for the treatment of prostate cancer. CONTENT

(6)Did this article increase your knowledge of the subject matter? (7)Was the content clear and organized? (8)Did this article facilitate learning? (9)Were your individual objectives met? (1 0)How well did the objectives relate to the overall purposelgoal? TEST OUESTlONSlANSWERS

(1 1) Were they reflective of the content? (1 2 ) Were they easy to understand? (1 3) Did they address important points? What other topics would you like to see addressed in a hture Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):

Author names and addresses: