SG #36 Bowel Cancer

True or False The risk of colorectal cancer declines after the age of 65

False, the risk of colorectal cancer increases after the age of 65

A patient comes into the ER with manifestations of appendicitis. What is the highest priority when caring for this patient? A. withhold all food and fluids B. perform pre-op skin preparation C. insert saline lock for intravenous pain medication D. Teach post-op deep breathing, coughing, and leg exercises

A Rationale: oral food and fluids are withheld until a diagnosis is confirmed

a temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy: A. is the opening on the distal end of the client's left side B. is the opening on the client's left side C. is the opening on the client's right side D. is the opening on the distal right side

C. is the opening on the client's right side Rationale: the proximal end of the double-barrel colostomy is the end toward the small intestines.

true or false keeping your weight under control can help reduce your risk of developing colorectal cancer

True

True or False Colorectal cancer can develop anywhere in the large intestine, which includes the colon and rectum.

true

true or false a regular exercise routine can help reduce your risk of developing colorectal cancer

true

A patient has developed a paralytic ileus following recent abdominal surgery. What is the most important nursing action when caring for this patient/ A. monitor bowel sounds every hour B. maintain the patient on strict bedrest C. ensure nasogastric tube is functioning D. ensure that the patient is given a clear liquid diet

C Rationale: it is most important to maintain the patency of the nasogastric tube to remove gastric secretions and air that may apply pressure to the anastomosis site and cause failure of the suture line.

True or False Colorectal cancer is the 3rd most common cancer in U.S men and women

True

True or false Colorectal cancer can develop with few or no symptoms

True

True or False A colonoscopy is the only test available for colorectal cancer screening

False, fecal occult blood tests, flexible sigmoidoscopy, double-contrast barium enema, CT colonography, and colonoscopies are all diagnostic tests for colorectal cancer

A nurse assesses a client who is prescribed 5-fluorouracil (5-FU) chemotherapy intravenously for the treatment of colon cancer. Which assessment finding should alert the nurse to contact the health care provider? a. White blood cell (WBC) count of 1500/mm3 b. Fatigue c. Nausea and diarrhea d. Mucositis and oral ulcers

A Rationale: Common side effects of 5-FU include fatigue, leukopenia, diarrhea, mucositis, mouth ulcers & peripheral neuropathy. However, the client's WBC count is very low (normal range is 5000 to 10,000/mm3), so the provider should be notified.

an older patient is experiencing constipation. What should the nurse teach this patient to help with this health problem? SATA A. soup B. salad C. raspberries D. whole-wheat bread E. popcorn

A,B,D Rationale: a high fiber diet is recommended. There is no need to avoid soup. Salad and whole-wheat bread is encouraged. avoidance of foods with small seeds such as raspberries and popcorn is sometimes recommended.

A patient with a bowel obstruction has a nasogastric tube in place for gastric decompression. The nurse will perform which interventions associated with this treatment? SATA A. measure abdominal girth q4-8hrs B. provide the patient with generous amounts of oral fluids C. keep an accurate record of intake and output q2-4hrs D. document the amount and color of nasogastric tube drainage every shift E. monitor mental status at each patient encounter

A,C,D,E Rationale: accurate abdominal girth measurements allow for trending of decompression. Accurate intake and output monitors for fluid volume imbalances. Changes in amount or quality of NG tube drainage can indicate complications that should be addressed. monitoring mental status helps to identify complications such as shock and electrolyte imbalance.

The client has a good understanding of the means to reduce the chances of colon cancer when he states: A. "I will include more fresh fruits and veggies in my diet." B. "I will exercise day." C. "I will have an annual chest x-ray" D. "I will include more red meat in my diet."

A. "I will include more fresh fruits and veggies in my diet." Rationale: fruits and veggies are high in fiber which increases gut motility

When teaching a client about the signs of colorectal cancer, the nurse stresses that the most common complaint of persons with colorectal cancer is: A. change in bowel habits B. change in caliber of stools C. hemorrhoids D. abdominal pain

A. change in bowel habits Rationale: constipation, diarrhea, and/or constipation alternating with diarrhea are the most common symptoms of colorectal cancer

A client is diagnosed as having a bowel tumor. The nurse should monitor the client for which complications of this type of tumor? SATA A. flatulence B. peritonitis C. hemorrhage D. fistula formation E. bowel perforation F. lactose intolerance

B,C,D,E Rationale: complications of bowel tumors include bowel perforation, which can result in hemorrhage and peritonitis. other complications include bowel obstruction and fistula formation. flatulence can occur but is not a complication; lactose intolerance also is not a complication of intestinal tumor.

a nurse assigned to the ER evaluates a patient who underwent fiberoptic colonoscopy 18 hours previously. The patient reports increase abdominal pain, fever, and chills. Which of the following conditions poses the most immediate concern? A. viral gastroenteritis B. diverticulitis C. Bowel perforation D. colon cancer

C. bowel perforation Rationale: bowel perforation is the most serious complication of fiberoptic colonoscopy. Signs include; abdominal pain, fever, chills, and tachycardia.

A gastrectomy is performed on a client with gastric cancer. In the immediate post-op period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action? A. measure abdominal girth B. irrigate the nasogastric tube C. continue to monitor the drainage D. notify the HCP

C. continue to monitor drainage Rationale: Following gastrectomy, drainage from the tube is normally bloody for 24 hours post-op, changes to brown-tinged, and is then yellow or clear. because bloody drainage is expected in the immediate post-op period, the nurse should continue to monitor the drainage.

A client has late-stage colon cancer with metastasis to the spine and bones. Which nursing intervention does the nurse add to the care plan to address a priority problem? a. Provide six small meals and snacks daily. b. Offer the client prune juice twice a day. c. Ensure that the client gets adequate rest. d. Give the client pain medications around the clock.

D Rationale: although all interventions might be appropriate, a client with late-stage cancer and bone metastases is at risk for severe pain.

The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment finding indicates that the colostomy is beginning to function? A. The passage of flatus B. absent bowel sounds C. the client's ability to tolerate food D. bloody drainage from the colostomy

A. the passage of flatus Rationale: the nurse should expect the colostomy to begin to function within 72 hours after surgery. The nurse should assess for a return of peristalsis, listen for bowel sounds, and check for the passage of flatus. The client would remain NPO until bowel sounds return and the colostomy is functioning. Bloody drainage is not expected from the colostomy.

A patient is experiencing frequent large, fatty, foul-smelling stools. What additional information should the nurse obtain from the patient? A. known family history of colorectal cancer B. the relationship of episodes to particular foods C. history of alternating diarrhea and constipation D. possible exposure to enterotoxins in food or water

B Rationale: steatorrhea is impairment in fat absorption leading to excess fat in feces. Steatorrhea and diarrhea typically occur with diseases of malabsorption because fat, water, and other nutrients are poorly absorbed.

Before discharge, the nurse scheduled the client who had a colostomy for colorectal cancer for discharge instruction about resuming activities. The nurse should plan to help the client understands that: A. Most sports activities, except for swimming, can be resumed based on the client's overall physical condition. B. With counseling and medical guidance, a near normal lifestyle, including complete sexual function is possible. C. After surgery, changes in activities must be made to accommodate for the physiologic changes caused by the operation. D. Activities of daily living should be resumed as quickly as possible to avoid depression and further dependency.

B Rationale: there are few physical restraints on activity post-op, but the client may have emotional problems resulting from image changes.

You must rearrange the room assignment for several clients. Which two clients would best suited to put in the same room? (Choose the 2 letters that applies). A. a 35 yo female with copious, intractable diarrhea and vomiting B. a 40 yo female second day post-op cholecystectomy C. A 62 yo female with colon cancer receiving chemotherapy and radiation D. a 53 yo female with pain relate to alcohol associated pancreatitis

B & D Rationale: Both clients will need frequent pain assessments and medications. Clients with copious diarrhea or vomiting will frequently need enteric isolation. Cancer clients receiving chemotherapy are at risk for immunosuppression and are likely to need reverse isolation

A patient with inflammatory bowel disease is prescribed sulfasalazine (Azulfidine). What should the nurse teach the patient about taking this medication? SATA A. take vitamin C while on the drug B. take the drug after a meal C. use a sunscreen while taking this drug D. limit fluid intake to 1500mL per day or less E. Use aspirin rather than NSAIDs for minor pain

B,C Rationale: taking medication after a meal reduces GI distress. This drug increases sensitivity to the sun. Vitamin C and aspirin should be avoided while taking this drug. Fluid should be increased, not decreased.

After teaching a client who is recovering from a colon resection, the nurse assesses the client's understanding. Which statements by the client indicate a correct understanding of the teaching? (SATA) a. I must change the ostomy appliance daily and as needed. b. I will use warm water and a soft washcloth to clean around the stoma. c. I might start bicycling and swimming again once my incision has healed. d. Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown. e. I will check the stoma regularly to make sure that it stays a deep red color. f. I must avoid dairy products to reduce gas and odor in the pouch.

B,C,D Rationale: The ostomy appliance should be changed as needed when the adhesive begins to decrease, placing the appliance at risk of leaking. Changing the appliance daily can cause skin breakdown as the adhesive will still be secured to the clients skin. The client should avoid using soap to clean around the stoma because it might prevent effective adhesion of the ostomy appliance. The client should use warm water and a soft washcloth instead. The tissue of the stoma is very fragile, and scant bleeding may occur when the stoma is cleaned. The flange should be cut to fit snugly around the stoma to reduce contact between excretions and the client's skin. Exercise (other than some contact sports) is important for clients with an ostomy. The stoma should remain a soft pink color. A deep red or purple hue indicates ischemia and should be reported to the surgeon right away. Yogurt and buttermilk can help reduce gas in the pouch, so the client need not avoid dairy products.

The nurse assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate? A. clamp the surgical drain B. change the dressing as prescribed C. notify the HCP D. remove and replace the perineal packing

B. change the dressing as prescribed Rationale: immediately after surgery, serosanguineous drainage from the perineal would is expected. Therefore, the nurse should change the dressing as prescribed

Discharge instructions for a patient who has been operated on for colorectal cancer include irrigating the colostomy. The nurse knows her teaching is effective when the patient states he'll contact the doctor if: A. He expels flatus while the return is running out B. he has difficulty inserting the irrigation tube into the stoma C. he experiences abdominal cramping while the irrigant is infusing D. he's unable to complete the procedure in 1 hour

B. he has difficulty inserting the irrigation tube into the stoma Rationale: difficulty with insertion may indicate stenosis of the bowel.

A nurse prepares a client for a colonoscopy scheduled for tomorrow. The client states, "My doctor told me that the fecal occult blood test was negative for colon cancer. I don't think I need the colonoscopy and would like to cancel it." How should the nurse respond? a. Your doctor should not have given you that information prior to the colonoscopy. b. The colonoscopy is required due to the high percentage of false negatives with the blood test. c. A negative fecal occult blood test does not rule out the possibility of colon cancer. d. I will contact your doctor so that you can discuss your concerns about the procedure.

C Rationale: A negative result from a fecal occult blood test does not completely rule out the possibility of colon cancer. To determine whether the client has colon cancer, a colonoscopy should be performed so the entire colon can be visualized and a tissue sample taken for biopsy. The client may want to speak with the provider, but the nurse should address the clients concerns prior to contacting the provider.

A nurse teaches a client who is recovering from a colon resection. Which statement should the nurse include in this clients plan of care? a. You may experience nausea and vomiting for the first few weeks. b. Carbonated beverages can help decrease acid reflux from anastomosis sites. c. Take a stool softener to promote softer stools for ease of defecation. d. You may return to your normal workout schedule, including weight lifting.

C Rationale: Clients recovering from a colon resection should take a stool softener as prescribed to keep stools a soft consistency for ease of passage. Nausea and vomiting are symptoms of intestinal obstruction and perforation and should be reported to the provider immediately. The client should be advised to avoid gas-producing foods and carbonated beverages, and avoid lifting heavy objects or straining on defecation.

Which of the following characteristics are risk factors for colorectal cancer? A. low fat, low protein, high fiber diet B. history of skin cancer C. family history of colon cancer D. age younger than 40

C. Rationale: family history of colon cancer is a risk factor for colorectal cancer

A nurse cares for a client who has a family history of colon cancer. The client states, "My father & brother had colon cancer. What is the chance that I will get cancer?" How should the nurse respond? a. If you eat a low-fat and low-fiber diet, your chances decrease significantly. b. You are safe. This is an autosomal dominant disorder that skips generations. c. Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer. d. You should have a colonoscopy more frequently to identify abnormal polyps early.

D Rationale: the nurse should encourage the client to have frequent colonoscopies to identify abnormal polyps and cancerous cells early.

A nurse assesses clients at a community health center. Which client is at highest risk for the development of colorectal cancer? a. A 37-year-old who drinks eight cups of coffee daily b. A 44-year-old with irritable bowel syndrome (IBS) c. A 60-year-old lawyer who works 65 hours per week d. A 72-year-old who eats fast food frequently

D Rationale: Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a heavy workload do not increase the risk for colon cancer.

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. hemorrhoids B. duodenal ulcers C. weight gain D. polyps

D. Polyps Rationale: colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. weight loss- not weight gain- is an indication of colorectal cancer.

Which of the following statements about colon and rectal cancer is correct? A. there is no hereditary component to. colon cancer B. the incidence of colon and rectal cancer decreases with age C. rectal cancer affects more than twice as many people as colon cancer D. cancer of the colon and rectum is the second most common type of internal cancer in the US

D. cancer of the colon and rectum is the second most common type of internal cancer in the US

A client is being evaluated for cancer of the colon. In preparing the client for barium enema, the nurse should: A. place the client on CBR a day before the study B. render an oil retention enema and give laxative the night before C. Instruct the client to swallow 6 radiopaque tablets the evening before the study D. give laxative the night before and a cleansing enema in the morning before the test

D. give laxative the night before and a cleansing enema in the morning before the test Rationale: to obtain accurate results in the procedure, the bowels must be emptied of fecal material thus the need for laxative and enema.