Gastric & Colon Cancer NCLEX - AHII Test 1

" A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. Which of the following is the appropriate nursing intervention?" "a) notify the physician b) measure abdominal girth c) irrigate the nasogastric tube d) continue to monitor the drainage (CORRECT)"

d) continue to monitor the drainage (CORRECT)"Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then to yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. The nurse does not need to notify the physician at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, a nasogastric tube should not be irrigated unless there are specific physician orders to do so.

"What is the best test to diagnose stomach cancer? "A. Upper endoscopic examination B. Barium enema C. Endoscopic retrograde cholangiopancreatogram (ERCP) D. Magnetic resonance imaging (MRI)

Upper endoscopic examination is the best diagnostic test for stomach cancer. It allows direct visualization and biopsy. Barium enema is for lower gastrointestinal problems and does not allow direct visualization. ERCP is an endoscopic procedure used to examine the liver, gallbladder, and pancreas. MRI is not used to diagnose stomach cancer.

"The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to colorectal cancer is necessary if the client identifies which of the following as an associated risk factor? "a) age younger than 50 years b) history of colorectal polyps c) family history of colorectal cancer d) chronic inflammatory bowel disease"

"a) age younger than 50 years- Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.

A nurse is teaching a client about the risk factors associated with colorectal cancer the nurse detemines that further teaching related to colorectal cancer is necessary if the client identifies which of the following as an associated risk factor? 1. Age younger than 50 2. history of colorectal polyps 3. family history of colorectal cancer 4. chronic IBD

1 is correct. Correctal cancer risk factors include age older than 50, a family history of the disease, polyps, and chronic IBD

The home healthcare nurse is caring for a client with cancer and the client is complaining of acute pain. The most appropriate nursing assessment of the client's pain would include which of the following? "1. the clients pain rating 2. nonverbal cues from the client 3. the nurses impression of the clients pain 4. pain relief after appropriate nursing intervention"

1) client pain ratingthe clients self report is a critical component of pain assessment. the nurse should ask the client about the description of the pain and listen carefully to the clients words used to describe the pain. the nurses impression of the clients pain is not appropriate in determining the clients level of pain. nonverbal cues from the client are important but are not the most appropriate pain assessment meausre. assessing pain relief is an important measure but this option is not realted to the subject of the question.

the client with a new colostomy is being discharged. which statement made by the client indicates the need for further teaching? 1. "if i notice any skin breakdown, i will call my HCP." 2 . "i should drink only liquids until the colostomy starts to work." 3. "i should not take a tub bath until the HCP says it is okay." 4. "i should not drive or lift more than five poinds."

2 . "i should drink only liquids until the colostomy starts to work."1. if the tissue around the stoma becomes excoriated, the client will be unable to pouch the stoma adequately, resulting in discomfort and leakage. the client understands the teaching. 2(CORRECT): the client should be on a regular diet, and the colostomy will have been working for several days prior to dischage. the client's statement inidcates the need for further teaching. 3. until the incision is completely healed, the client should not sit in bath water because of the potential contaminiation of the wound by the bath water. the client understands the teaching. 4. the client has had major surgery and should limit lifting to minimal weight. the client understands the teaching.

The community nurse is conducting a health promotion program and the topic of the discussion relates to the risk factors for gastric cancer. which risk factor, if identified by a client, indicates a need for further discussion? "1. Smoking 2. A high-fat diet 3. Foods containing nitrates 4. a diet of smoked, highly salted, and spiced food

2) high-fat dieta high fat diet plays a role in the development of cancer of the pancreas. options 1,3,4 are risk factors related to gastric cancer.

The client diagnosed with gastroesophageal reflux disease (GERD) is at greater risk for which disease? 1.Hiatal hernia.2.Gastroenteritis.3.Esophageal cancer.4.Gastric cancer.

3) esophageal" cancer 1. A hiatal hernia places the client at risk forGERD; GERD does not predispose the clientfor developing a hiatal hernia.2.Gastroenteritis is an inflammation of the stom-ach and intestine, usually caused by a virus. 3. Barrett's esophagitis results from long-term erosion of the esophagus as a result of reflux of stomach contents secondary toGERD. This is a precursor to esophagealcancer. 4.The problems associated with GERD resultfrom the reflux of acidic stomach contents intothe esophagus, which is not a precursor togastric cancer."

Which symptom, if reported by a client, would lead the nurse to suspect colon cancer? 1) abdominal cramping 2) constant hunger 3) feeling of fullness, 4) weight gain

3)feeling of fullnessthe client with gastric cancer may report a feeling of fullness in the stomach, but not enough to cause him to seek medical care. Abdominal cramping isn't associated with gastric cancer and weight loss (not increased hunger or weight gain) are common with gastric cancer.

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary if the client identifies which of the following as an associated risk factor? 1. a history of inflammatory bowel disease 2. family history of colon cancer 3. a high fiber diet 4. a diet high in fats and carbohydrates

3. Colorectal cancer most often occurs in populations with diets low in fiber and high in refined carbohydrates, fats, and meats.

"The nurse is caring for clients in an outpatient clinic. Which information should the nurse teach regarding the American Cancer Society's recommendations for the early detection of colon cancer? "1. Beginning at age 60, a digital rectal examination should be done yearly. 2. After reaching middle age, a yearly fecal occult blood test should be done. 3. Have a colonoscopy at age 50 and then once every five to ten years. 4. A flexible sigmoidoscopy should be done yearly after age 40."

3. Have a colonoscopy at age 50 and then once every five to ten years. "1. A digital rectal examination is done to detect prostate cancer and should be started at age 40 years. 2. ""Middle age"" is a relative term; specific ages are used for recommendation. 3. The American Cancer Society recommends a colonoscopy at age 50 and every 5 to 10 years thereafter, and a flexible sigmoidoscopy and a barium enema every five years. 4. A flexible sigmoidoscopy should be done at five year intervals between the colonoscopy."

The Nurse is reviewing the preop orders of a client w/ a colon tumor who is scheduled for abdominal perineal resection and notes that the physician prescribed neomycin (Mycifradin) for the client. The nurse determines that this medication has been prescribed primarily: "1. To prevent an immune dysfunction 2. Because the client has an infection 3. To decrease the bacteria in the bowel 4. Because the client is allergic a penicillin"

3. To decrease the bacteria in the bowel To reduce the risk of contamination at the time of surgery, the bowel is emptied and cleansed. Laxatives and enemas are given to empty the bowel. intestinal anti-infectives such as neomycin or kanamycin (Kantrex) are administered to decrease the bacteria in the bowel.

"A gastrectomy is performed on a client with gastric cancer. Int he immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. Which of the following is the appropriate nursing intervention. "1. Notify the physician 2. Measure the abdominal girth 3. Irrigate the nasogastric tube 4. Continue to monitor the drainage

4. Continue to monitor the drainage Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then to yellow or clear. Because bloody drainage is expected in the immediate post-operative period, the nurse should continue to monitor the drainage. The nurse does not need to notify the physician at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, a nasogastric tube should not be irrigated unless there are specific physician perscriptions to do so.

The 85-year-old male client diagnosed with cancer of the colon asks the nurse, "Why did I get this cancer?" Which statement is the nurse's best response?1.Cancer of the colon is associated with a lack of fiber in the diet.2.Cancer of the colon has a greater incidence among those younger than age 50 years.3.Cancer of the colon has no known risk factors.4.Cancer of the colon is rare among male clients.

Answer 1: 1.A long history of low-fiber, high-fat, high-protein diets results in a prolonged transit time. This allows the carcinogenic agentsin the waste products to have a greater ex-posure to the lumen of the colon. 2.The older the client, the greater the risk of developing cancer of the colon. 3.Risk factors for cancer of the colon includeincreasing age; family history of colon canceror polyps; history of IBD; genital or breastcancer; and eating a high-fat, high-protein,low-fiber diet. 4.Males have a slightly higher incidence of coloncancers than do females.

"11. The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? "a. Duodenal ulcers b. Hemorrhoids c. Weight gain d. Polyps"

Answer D. Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

Teaching a client who has had recent bowel surgery how to facilitate the expulsion of feces may include the process of increasing intra-abdominal pressure. Which of the following best matches this process? "A.Crede's maneuver.B.Valsalva's maneuver.C.Heimlich's maneuver.D.Epley's maneuver

B)valsalva"The Valsalva's maneuver facilitates the expulsion of feces by closing the glottis and increasing the intra-abdominal pressure. Crede's maneuver is used to manually expel urine from the bladder, Heimlich's maneuver is used to dislodge food from the esophagus, and Epley's maneuver is used for vertigo.

A nurse is reviewing the preoperative prescriptions for a client with colon tumor who is scheduled for abdominal perineal resection and notes that the physician has prescribed neomycin (Mycifradin) for the client. The nurse determines that this medication has been prescribed primarily for which of the following purposes? 1. To prevent an immune dysfunction 2. Because the client has an infection 3. To decrease the bacteria in the bowel 4. Because the client is allergic to penicillin

CORRECT ANSWER: 3. To decrease the bacteria in the bowel. Rationale: To reduce the risk of contamination at the time of surgery, the bowel is emptied and cleansed. Laxatives and enemas are given to empty the bowel. Intestinal anti-infectives such as neomycin or kanamycn (Kantrex) are administered to decrease the bacteria in the bowel.

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to colorectal cancer is necessary if the client identifies which of the following as an associated risk factor? "a) age younger than 50 years b) history of colorectal polyps c) family history of colorectal cancer d) chronic inflammatory bowel disease"

Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake? "A. Increase intake of liquids at mealtime to stimulate the appetite B. Serve three large meals per day plus snacks between each meal C. Avoid the use of liquid protein supplements to encourage eating at mealtime D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foodsThe nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods that the patient will eat.

"74. The community nurse is conducting a health promotion program and the topic of the discussion relates to the risk factors for gastric cancer. Which risk factor, if identified by a client, indicates a need for further discussion? "a) smoking b) a high-fat diet c) foods containing nitrates d) a diet of smoked, highly salted, and spiced food"

b) a high-fat diet - A high-fat diet plays a role in the development of cancer of the pancreas. Options A, C, and D are risk factorsrelated to gastric cancer.

"1. While being prepared for a biopsy, the patient asks the nurse what the difference is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a malignant tumor in that benign tumors "a. do not cause damage to adjacent tissue. b. do not spread to other tissues and organs. c. are simply an overgrowth of normal cells. d. frequently recur in the same site."

b. do not spread to other tissues and organs. The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize. Both types of tumors may cause damage to adjacent tissues. The cells differ from normal in both benign and malignant tumors. Benign tumors usually do not recur.

A client with cancer of the colon who is receiving chemotherapy tells a nurse that some foods on the metal tray taste bitter. The nurse would try ti limit which of the following foods that is most likely to cause this taste for the client? "a) cantaloupe b) potatoes c) beef d) custard"

beef: meat is perceived as bitter by clients with cancer

"During a routine health examination, a 30-year-old patient tells the nurse about a family history of colon cancer. The nurse will plan to: "a. teach the patient about the need for a colonoscopy at age 50. b. ask the patient to bring in a stool specimen to test for occult blood. c. schedule a sigmoidoscopy to provide baseline data about the patient. d. have the patient ask the doctor about specific tests for colon cancer.

d. have the patient ask the doctor about specific tests for colon cancer. "The patient is at increased risk and should talk with the health care provider about needed tests, which will depend on factors such as the exact type of family history and any current symptoms. Colonoscopy at age 50 is used to screen for individuals without symptoms or increased risk, but earlier testing may be needed for this patient because of family history. For fecal occult blood testing, patients use a take-home multiple sample method rather than bring one specimen to the clinic. The health care provider will take multiple factors into consideration before determining whether a sigmoidoscopy is needed at age 30."

"An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about "a. cancer support groups. b. avitaminosis, ostomy care, and community resources. c. prosthetic devices, skin conductance, and grief counseling. d. wound and skin care, nutrition, drugs, and community resources "

d. wound and skin care, nutrition, drugs, and community resources "Radiation therapy is used as an adjuvant to surgery or for palliation in stomach cancer treatment. The nurse's role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient's knowledge of radiation therapy. The nurse should teach the patient about the skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.

"The most effective treatment method for the nausea and vomiting that accompany chemotherapy is to: "A. Administer an oral antiemetic when the client complains of nausea and vomiting. B. Administer an antiemetic by intramuscular injection when the client complains of nausea and vomiting. C. Administer an antiemetic prior to the antineoplastic medication. D. Push fluids prior to administering the antineoplastic medication."

" C. Before starting therapy with agents with high emetic potential, clients may be pretreated with an antiemetic"

A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. Which of the following is the appropriate nursing intervention? a) notify the physician b) measure abdominal girth c) irrigate the nasogastric tube d) continue to monitor the drainage" e "

" D - Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then to yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. The nurse does not need to notify the physician at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, a nasogastric tube should not be irrigated unless there are specific physician orders to do so."

"The nurse is caring for a patient one day after an abdominal-perineal resection for cancer of the rectum. The nurse should question which of the following orders? "1. Discontinue the nasogastric tube. 2. Irrigate the colostomy. 3. Place petrolatum gauze over the stoma. 4. Administer Demerol 50 mg IM for pain."

"1. discontinued when peristalsis occurs 2. colostomy begins to function 3-6 days after surgery (correct) 3. done if no pouch in place, keeps stoma moist, cover with dry, sterile dressing 4. prevents post-op pain"

"The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which of the following abnormalities associated with this oncologic emergency? "a. hypokalemia b. hypocalcemia c. hypouricemia d. hypophosphatemia"

"Answer b: TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal failure. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia."

"The nurse planning care for the client who has had an abdominal-perineal resection for cancer of the colon. Which interventions should the nurse implement? Select all that apply. "1. Provide meticulous skin care to stoma 2. Asess the flank incision 3. Maintain the indwelling catheter 4. Irrigate the JP drains every shift 5. Position the client semirecumbent"

"Answer: 1,3,5. There are midline and perineal incisions not flank Jackson Pratt drains are emptied every shift but they are not irrigated."

For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client? "a) Client verbalizes feeling of anxiety b) Client does not guess at prognosis c) Client uses any effective method to reduce tension d) Client stops seeking information"

"Answer: A Verbalizing feelings is the client's first step in coping with the situational crisis. It also helps the health care team gain insight into the client's feelings, helping guide psychosocial care."

The day after abdominal surgery, the nurse auscultates the client's abdomen and notes faint bowel sounds in all four quadrants. The client also reports experiencing flatus. The nurse interprets these findings as: "a. imminent emesis. b. intestinal blockage. c. return of peristalsis d. paralytic ileus."

"Answer: C (return of peristalsis.) Rationale: Auscultation of the abdomen following abdominal surgery is important to determine the return of bowel function. Bowel sounds caused by peristalsis usually return within 24 hrs. after surgery. Flatus, or the passage of gas, is another positive sign that peristalsis is returning. Emesis, or vomiting, is not indicated in the stem, nor is blockage, or ileus, both of which are indicated by absence of bowel sounds and/or high-pitched bowel sounds."

"The nurse understands that cancerous lesions found in the stomach are the second most common cancer in the world. Which of the following is a risk factor for these malignant lesions? "A. Excessive alcohol consumption B. Being female under 40 years of age C. Exposure to leaded gasoline D. A Diet high in vegetables"

"Answer: C. Exposure to leaded gasoline Cancerous lesions found in the stomach are the second most common cancer in the world. Gastric cancer affects people over the age of 40 and is seen more often in men than in women. Risk factors for the development of gastric cancer include heredity, chronic gastritis, H. pylori infection, and pernicious anemia. Exposure to substances such as lead, grains, and leaded gasoline add to the risk for developing gastric cancer. A diet high in meat and fish is also a risk factor."

"The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which of the following factors in the patient's history increases the patient's risk for colorectal cancer? "A. Osteoarthritis B. History of rectal polyps C. History of lactose intolerance D. Use of herbs as dietary supplements"

"B. History of rectal polyps rationale: A history of rectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. The other factors identified do not pose additional risk to the patient."

A patient who has been told by the health care provider that the cells in a bowel tumor are poorly differentiated asks the nurse what is meant by "poorly differentiated." Which response should the nurse make? "a. ""The cells in your tumor do not look very different from normal bowel cells."" b. ""The tumor cells have DNA that is different from your normal bowel cells."" c. ""Your tumor cells look more like immature fetal cells than normal bowel cells."" d. ""The cells in your tumor have mutated from the normal bowel cells."""

"C Rationale: An undifferentiated cell has an appearance more like a stem cell or fetal cell and less like the normal cells of the organ or tissue. The DNA in cancer cells is always different from normal cells, whether the cancer cells are well differentiated or not. All tumor cells are mutations form the normal cells of the tissue."

"A patient with metastatic colorectal cancer is scheduled for both chemotherapy and radiation therapy. Patient teaching regarding these therapies for this patient would include an explanation that: "A. Chemotherapy can be used to cure colorectal cancer B. Radiation is routinely used as adjuvant therapy following surgery C. Both chemotherapy and radiation can be used as palliative treatments D. The patient should expect few if any side effects from chemo-therapeutic agents"

"C is Correct. Rationale: Chemotherapy can be used to shrink the tumor before surgery, as an adjuvant therapy after colon resection, and as palliative treatment for nonresectable colorectal cancer. Radiation therapy may be used postoperatively as an adjuvant to surgery and chemotherapy or as a palliative measure for patients with metastatic cancer."

The occupational health nurse if preparing a presentation to a group of factory workers about preventing colon cancer. Which information should be included in the presentation? "1. Wear a high-filtration mask when around chemicals. 2. Eat several servings of cruciferous vegetables daily. 3. Take a multiple vitamin every day. 4. Do not engage in high risk sexual behaviors."

"Correct Answer: 2 1. Some cancers have a higher risk of developing when the client is occupationaly exposed to chemicals, but cancer of the colon is not one of them. 2. Cruciferous vegetables, such as broccoli, cauliflower, and cabbage, are high in fiber. One of the risks for cancer of the colon is a high fat, low fiber, and high protein diet. The longer the transit time (the time for ingestion of the food to the elimination of the waste products), the greater the chance of developing cancer of the colon. 3. A multiple vitamin may improve immune system function, but it does not prevent colon cancer. 4. High risk sexual behavior places the client at risk for sexually transmitted diseases. A history of multpile sex partners and initial sexual experience at an early age does increase the risk for the development of cancer of the cervix in females."

The nurse is teaching a client about the modifiable risk factors than can reduce the risk for colorectal cancer. The nurse places the highest priority on discussing which risk factor with this client? "A. Age older than 30 years B. High fat and low fiber diet C. Distant relative with colorectal cancer D. Personal history of ulcerative colitis or GI polyps"

"Correct Answer: B Rationale: Common risk factors for colorectal cancer that cannot be changed include age older than 40, first-degree relative with colorectal caner, and history of bowel problems such as ulcerative colitis or familial polyposis. Clients should be aware of modifiable risk factors as part of general health maintenance and primary disease prevention. Modifiable risk factors are those that can be reduced and include a high fat and low fiber diet."

The client with polyps has watched a video on primary prevention of colon cancer. The nurse can evaluate teaching effectiveness when the client states "I should follow: "1. low sodium low fat high fiber diet." 2. a low fat, low refined sugar and decrease red meat while eating more fiber." 3. a gluten free, low fat diet." 4. a low carbohydrate, low fat, low tyramine diet.""

"Correct Answer: a low fat, low refined sugar and decrease red meat while eating more fiber." Rationale: The dietary recommendations for the prevention of colon rectal cancer include decreasing the amount of fat, refined sugar, red meats while increasing dietary fiber consumption. Nursing Process: Evaluation Client Needs: Physiological Integrity Cognitive Level: Application Objective: Explain the rationale for using selected diets including those for diarrhea and constipation, low residue, gluten free, and high fiber. Strategy: Use dietary knowledge, cancer knowledge to select the best answer."

A client undergoes a colonoscopy for colorectal cancer screening. During the procedure three small polyps were removed. Which nursing procedures are necessary when caring for the client immediately after the colonoscopy? "A. Monitor vital signs and inform her that there may be a small amount of blood in her stool. B. Observe for signs and symptoms of bowel perforation, monitor vital signs, and inform her that there may be a small amount of blood in her stool and to report excessive blood loss. C. Observe for signs and symptoms of bowel perforation, monitor vital signs, and inform her to follow a clear liquid diet. D. Monitor vital signs and inform her that there may be a small amount of blood in her stool, and tell her not to drive for two days."

1. B - Rationale: After a colonoscopy the nurse should observe the patient closely for signs of bowel perforation (rectal bleeding, abdominal pain and distention, malaise, fever, and mucopurulent drainage). Vital signs should be monitored until stable. Due to the polyp removal, there may be some blood, but excessive bleeding is not expected and must be reported. As well as monitoring vital signs and instructing the patient that a small amount of blood may be present, it is very important to educate and instruct to report excessive blood loss. The patient may resume a normal diet but is instructed to increase fluid intake due to fluids lost through laxatives and the NPO period. The patient should not drive for several hours after the procedure, until effects of any sedatives have worn off.

A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect: "a. hair loss. b. stomatitis. c. fatigue. d. vomiting.

Answer C. Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.

"The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? "a. Duodenal ulcers b. Hemorrhoids c. Weight gain d. Polyps"

Answer D. Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

Chemotherapy is one of the therapeutic modalities for cancer. This treatment is contraindicated to which of the following conditions? "a. Recent surgery b. Pregnancy c. Bone marrow depression d. All of the above

Answer: D. chemotherapy is contraindicated in cases of infection (chemotherapeutic agents are immunosuppressive), recent surgery (chemotherapeutic agent may retard the healing process), impaired renal and hepatic function (drugs are nephrotoxic and hepatotoxic), recent radiation therapy (immunosuppressive treatment), pregnancy (drugs can cause congenital defects) and bone marrow depression (chemo. Agents may aggravate the condition).

The client diagnosed with stomach cancer has developed dissemenated intravascular coagulopathy (DIC). Which collaborative intervention would the nurse implement? A) Prepare to administer IV heparin. B) Assess for frank hemorrhage from venipuncture sites. C) Monitor for decreased LOC. D) Prepare to administer TPN;

Correct A. Heparin interferes w/ the clotting cascade and may prevent further clotting factor consumption resulting in uncontrolled thromboses formation. B. Assessment is an independent intervention; not collaborative and doesn't require a HCP order. C. ssessment is an independent intervention; not collaborative and doesn't require a HCP order. D. TPN is not a tx for a pt w/ DIC.

"The night before surgery for colon cancer, the client refuses the bowel preparation and angrily threatens to leave the hospital. Which of the following is the best response? A. "A tranquilizer will help soothe your nerves and make the preparation less painful". B. "I'll call your minister to sit with you until you calm down and take your medications". C. "Tell me what is upsetting you and what I can do to help." D. "I will call the physician to come and talk to you again about the surgery"."

Correct answer: Answer C is the only answer that supports the client and allows the client identify and discuss the issues causing the uncooperative behavior. The nurse understands that cancer surgery in the bowels can cause fears: loss of body function, self-image, and death, etc. and the client needs to verbalize these fears. The other answers assume the client's needs without asking.

"A client has been diagnosed with colon cancer of the rectum. While completing the preoperative checklist the client asks the nurse "Where will my stoma be?" The nurse's best response is A. right upper quadrant. B. left upper quadrant C. right lower quadrant D. left lower quadrant

D) LLQ"Rationale: A client with cancer of the rectum will have an abdominoperineal resection. The anal canal will be closed and a stoma will be formed from the proximal sigmoid colon in the left lower quadrant of the abdomen. The other 3 answers are in correlation with earlier sections of the colon which is further from the rectum"

"75. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. Which of the following is the appropriate nursing intervention? "a) notify the physician b) measure abdominal girth c) irrigate the nasogastric tube d) continue to monitor the drainage

D)Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then to yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. The nurse does not need to notify the physician at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, a nasogastric tube should not be irrigated unless there are specific physician orders to do so.

"A female client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in nursing plan of care? "a) Monitoring temperature b) Ambulation three times daily c) Monitoring the platelet count d) Monitoring for pathological fractures"

Monitoring the PLT count"Answer: C Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for the preventing bleeding. Option A elates to monitoring for infection, particularly if leukopenia is present. Option B & D, although important in the plan of care, are not related directly to thrombocytopenia."

"Which one of the following expected outcomes about nutrition would be appropriate for a client who has had a total gastrectomy for gastric cancer? The client will: "a.) Regain any weight lost within 4 weeks of the surgical procedure. b.) Eat three full meals a day without experiencing gastric complications. c.) Learn to self-administer enteral feedings every 4 hours. d.) Maintain adequate nutrition through oral or parenteral feedings."

RATIONALE: An appropriate expected outcome is for the client to maintain nutrition either through oral or total parenteral feedings. Oral and total parenteral nutrition may also be used concurrently. It is not realistic to expect the client to regain weight loss within 4 weeks of surgery. After surgery, it is recommended that the client eat six small meals a day rather than three full meals to decrease symptoms of dumping syndrome. Enteral feedings are not part of the expected outcome for gastric surgery. NURSING PROCESS STEP: Evaluation CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Basic care and comfort

"The nurse is performing an admission assessment on a client diagnosed with a right colon tumor. The nurse asks the client about which characteristic symptom of this type of tumor? "a) rectal bleeding b) flat, ribbon-like stool c) crampy, colicky abdominal pain) d) alternating constipation and diarrhea"

c) crampy, colicky abdominal pain)Vague abdominal discomfort or crampy, colicky abdominal pain is a characteristic symptom of a right colon tumor. Options A, B, and D are symptoms associated with left colon tumors.

"The teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about: "a. cancer support groups, alopecia, and stomatitis b. avitaminosis, ostomy care, and community resources c. prosthetic devices, skin conductance, and grief counseling d. wound and skin care, nutrition, drugs, and community resources

d. wound and skin care, nutrition, drugs, and community resourcesRationale: Radiation therapy is used as an adjuvant to surgery or for palliation in stomach cancer treatment. The nurse's role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient's knowledge of radiation therapy. The nurse should teach the patient about the skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.