A nurse is assessing a patient who will begin chemotherapy treatments the next day.
Which statement by the patient would indicate that they are in the denial stage of the grief process?

Choice A rationale

Hyperkalemia, an elevated serum potassium level (normal range 3.5-5.0 mEq/L), is characterized by symptoms such as muscle weakness, fatigue, and cardiac arrhythmias, not typically tingling sensations in the extremities. This symptom constellation is distinct from neurological manifestations.

Choice B rationale

Hypocalcemia, a decreased serum calcium level (normal range 8.5-10.5 mg/dL), can cause neuromuscular irritability leading to symptoms like muscle spasms, tetany, and perioral numbness. While it can cause sensory disturbances, the generalized tingling in hands and feet is more indicative of peripheral nerve damage.

Choice C rationale

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of various chemotherapeutic agents. It results from damage to peripheral nerves, leading to sensory symptoms like tingling (paresthesias), numbness, pain, and motor weakness, predominantly in a stocking-glove distribution.

Choice D rationale

While diabetes can cause peripheral neuropathy due to chronic hyperglycemia damaging nerves, it is not a direct consequence of chemotherapy. The question specifically attributes the symptom to chemotherapy, making CIPN the most direct and likely cause in this context.

Choice A rationale

Enlarged gonads are not a typical side effect of estrogen therapy for prostate cancer. Estrogens, by acting as negative feedback on the hypothalamic-pituitary-gonadal (HPG) axis, suppress luteinizing hormone (LH) and follicle-stimulating hormone (FSH) release from the pituitary. This suppression leads to decreased testicular production of testosterone, resulting in gonadal atrophy (shrinkage), rather than enlargement, and reduced sperm production.

Choice B rationale

Acne is not a common side effect of estrogen therapy in males; in fact, it often improves. Acne is primarily androgen-dependent, stimulated by high levels of testosterone and other androgens, which promote sebum production and follicular keratinization. Estrogen therapy, by suppressing testosterone, effectively reduces androgenic stimulation, leading to a decrease in sebaceous gland activity and subsequent improvement in acne symptoms.

Choice C rationale

Increased hirsutism, or excessive hair growth, is not a typical side effect of estrogen therapy in males. Hirsutism is primarily driven by androgenic hormones, which stimulate terminal hair growth in androgen-sensitive areas. Estrogen therapy, by reducing endogenous testosterone levels, often leads to a decrease in body hair and may result in a more feminized hair pattern, rather than increased hirsutism.

Choice D rationale

Gynecomastia, the enlargement of male breast tissue, is a very common and expected side effect of estrogen therapy for prostate cancer. Estrogens stimulate the proliferation of mammary ductal epithelial cells and increase fat deposition in breast tissue. This effect is dose-dependent and results from the direct agonistic action of estrogens on estrogen receptors in breast tissue, leading to breast tenderness and palpable breast enlargement.