# A client with metastatic prostate cancer reports new mid-back pain, bilateral leg weakness, and difficulty starting urination. Which actions are immediate priorities? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374974&lang=en  
> language: en  
> subject: Management of Care  
> category: MOC

## Question

A client with metastatic prostate cancer reports new mid-back pain, bilateral leg weakness, and difficulty starting urination. Which actions are immediate priorities? Select all that apply.

1

Maintain strict bedrest with logroll precautions until cord stability is confirmed

2

Insert a urinary catheter and assess post-void residual

3

Wait for outpatient oncology follow-up to schedule imaging

4

Coordinate emergent MRI of the entire spine and consult radiation oncology

5

Administer high-dose IV dexamethasone as ordered before MRI

## Explanation

Malignant spinal cord compression is an oncologic emergency. Function preservation depends on hours: high-dose dexamethasone is given empirically when suspicion is high, BEFORE imaging if delay is anticipated. The whole spine is imaged because skip lesions are common. Radiation oncology or neurosurgery must be consulted urgently. Strict bedrest with logroll prevents further mechanical compression until stability is documented. Urinary retention is a sign of autonomic involvement and must be assessed. Outpatient follow-up is INAPPROPRIATE — irreversible paralysis can occur within hours.

## In-depth explanation

Cauda equina red flags: saddle anesthesia, urinary retention, fecal incontinence, bilateral leg weakness. ANY one warrants emergent imaging.

## Clinical scenario

Pain worse with recumbency, better when sitting. PSA elevated on last visit. MRI requested STAT for suspected cord compression.

## Key concepts

- **spinal cord compression** — Tumor or vertebral collapse compressing the cord; emergency requiring rapid decompression.
- **dexamethasone** — Corticosteroid that reduces tumor-associated cord edema.
- **cauda equina syndrome** — Compression of lumbosacral nerve roots causing saddle anesthesia and bladder/bowel dysfunction.

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