Colon Cancer Test 5

b (During the health history portion of the nursing​ assessment, the nurse would ask the client if he has pain with defecation. Assessing​ weight, listening for bowel​ sounds, and palpating the abdomen for tenderness occur during the physical examination portion of the nursing assessment)

Mr. Baker is a​ 60-year-old man who is seen for an annual physical examination. The nurse is completing the nursing assessment for Mr. Baker. What would the nurse include in the health history to determine the​ client's risk for colon​ cancer? a Palpating the abdomen for tenderness b Asking the client if he has pain with defecation c Assessing current weight d Listening for bowel sounds

c (A client with a history of irritable bowel disease is at risk for colon cancer. Diabetes mellitus is not a known risk factor for colon cancer. Engaging in regular exercise and eating a diet high in fruits and vegetables are preventive factors for colon cancer.)

Mr. Cheney is a​ 49-year-old accountant who presented to the healthcare​ provider's office for an annual physical examination. During the health​ history, the nurse notes risk factors for colon cancer. What did the nurse note during the health history of this client to determine this risk for colon​ cancer? a Regular exercise b Diabetes mellitus c Irritable bowel disease d A diet high in fruits and vegetables

b (The nurse would anticipate that a fecal occult blood test will be ordered for this client. If that test is​ positive, a sigmoidoscopy or colonoscopy may be ordered. A colostomy is one of the treatments for colon​ cancer, not a diagnostic test.)

Mr. Freeman is a​ 54-year-old truck driver. He is seeking care because there is a family history of colon cancer. Which diagnostic test does the nurse anticipate will be ordered for this​ client? a Colostomy b Fecal occult blood test c Sigmoidoscopy d Colonoscopy

2, 3, 5, 6, 7 (Mouthwash should not include alcohol, because it has a drying action that leaves mucous membranes more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or vaginal cavity is not recommended. All other options are appropriate. Focus: Prioritization, knowledge)

Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients who must be placed on bleeding precautions? (Select all that apply.) 1. Provide mouthwash with alcohol for oral rinsing. 2. Use paper tape on fragile skin. 3. Provide a soft toothbrush or oral sponge. 4. Gently insert rectal suppositories. 5. Avoid aspirin or aspirin-containing products. 6. Avoid overinflation of blood pressure cuffs. 7. Pad sharp corners of furniture.

1, 3, 4, 5 (Women age 21 or over should have annual Pap smears, regardless of sexual activity. African-American men should begin prostate-specific antigen testing at age 45. Colonoscopy and annual fecal occult blood testing are recommended for those with average risk starting at age 50. Annual mammograms are recommended for women over the age of 40. )

People at risk are the target populations for cancer screening programs. Which of these asymptomatic patients need extra encouragement to participate in cancer screening? (Select all that apply.) 1. A 21-year-old white American woman who is sexually inactive, for a Pap test 2. A 30-year-old Asian-American woman, for an annual mammogram 3. A 45-year-old African-American man, for a prostate-specific antigen test 4. A 50-year-old African-American man, for a fecal occult blood test 5. A 50-year-old white American woman, for a colonoscopy 6. A 70-year-old Asian-American woman with normal results on three previous Pap tests, for a Pap test

6 2 3 5 4 1 (A pair of clean gloves should be put on before touching the skin or pouch. The stoma should be assessed for a healthy pink color. Washing, rinsing, and drying the skin and applying a skin barrier help to protect the skin. A good fit prevents gastric contents from spilling onto the skin. Focus: Prioritization)

Place the steps for performing colostomy care in the correct order. 1. Fit the pouch snugly around the stoma. 2. Assess the color and appearance of the stoma. 3. Wash the skin with mild soap and rinse with warm water. 4. Apply a skin barrier to protect the peristomal skin. 5. Dry the skin carefully. 6. Don a pair of clean gloves and remove the old pouch. _____, ____, _____, _____, _____, _____

2

TPN is prescribed for a client who has recently had a small and large bowel resection and who is currently NPO. The nurse should: 1. admin TPN thru a NG tube or gastrostomy tube 2. handle TPN using strict aseptic technique 3. auscultate for the presence of bowel sounds prior to adminstering TPN 4. designate a peripheral iv site for TPN administration

1

The client with colon cancer is having a barium enema. The nurse should instruct the client to take which type of med after the procedure is completed? 1. laxative 2. anticholinergic 3. antacid 4. demulcent

2 ( a dark red to purple stoma indicates abnormal inadequate blood supply)

The nurse assesses the clients stoma during the initial postop period. What observation should the nurse report to the HCP immediatley? 1. The stoma is slightly edematous 2. The stoma is dark red to purple 3. The stoma oozes a small amount of blood 4. The stoma does not expel stool

a (Rationale: The client who will not participate in the care of the colostomy is likely in denial and is likely to have disturbed body image. The client who inspects the colostomy is showing signs of acceptance. The client who attempts to use the bathroom has a knowledge deficit. Requesting pain medication does not indicate that the client denies the existence of the colostomy.)

The nurse caring for an older client with a colostomy selects disturbed body image as a nursing diagnosis based on which of the following client behaviors? a Client requests nurse to teach the family to change appliance. b Client requests frequent pain medication. c Client inspects colostomy. d Client attempts to use the bathroom for bowel movement.

a (Rationale Abdominal tenderness supports the diagnosis of colorectal cancer. The client would experience​ anorexia, not an increase of appetite. Weight​ loss, not weight​ gain, is expected. Smoking is a risk factor for developing colorectal cancer. The fact that there is no history of smoking does not support the diagnosis. )

The nurse conducts a nursing assessment of a client with colorectal cancer. Which finding supports the current diagnosis of colorectal​ cancer? a Abdominal tenderness b No history of smoking c Weight gain from last assessment d An increased appetite

b (Rationale A history of polyps is a risk factor that is determined in the health history portion of the nursing assessment that supports the risk for colorectal cancer. Weight​ loss, not weight​ gain, would also support colorectal cancer.​ Long-term use of laxative and a history of heart disease are not considered risk factors for colorectal cancer.)

The nurse is assessing a client for risk factors associated with colorectal cancer. Which findings in the health history would indicate the client is at risk for colorectal​ cancer? a Weight gain b History of polyps c History of heart disease d ​Long-term use of laxatives

b (Rationale: Colorectal cancer is usually very slow growing and manifestations do not appear until the cancer is advanced. The nurse must be aware that changes in bowel elimination habits and bleeding may be the only early symptoms. Eating disorders and fluid status will not give the nurse information about possible colon cancer. Altered mental status in a client with colorectal cancer would not be evident until the cancer has metastasized.)

The nurse is assessing a client in the clinic who has vague complaints of changes in bowel habits. Which of the following will be the nurse's next action? a Ask the client about eating disorders. b Ask the client about rectal bleeding. c Assess the client's fluid status. d Assess the client's mental status.

2 5 3 1 6 4 (When evisceration of an abdominal wound occurs, the nurse would remain with the client and summon help to bring the necessary supplies to the clients room. The client would be placed in low fowlers position to lessen tension on the abd. The nurse would not attempt to reinsert the protruding organs. Instead, the nurse would moisten a sterile nonadherent dressing with warm, sterile NS and cover the wound. It is important to conduct an ongoing assessment until the surgeon arrives because the client is at risk for shock. Documentation of the incident and the clients condition would be completed immed after the incident.: Lippencott)

The nurse is assisting the client to ambulate following a bowel resection. Suddenly the client reports a sharp abd. pain. The nurse assesses the client and determines the wound has eviscerated. Prioritize the following nursing actions in chronological order to show how the nurse would respond. All options must be used. 1. assess the clients response 2. call for assistance from other nursing personnel 3. document the incident, including the clients condition 4 cover the wound with sterile, nonadherent dressing moistened with sterile NS 5. place the client in low fowlers position 6 notify the surgeon

c (Rationale The nurse anticipates that​ fulguration, also referred to as​ electrocoagulation, will be performed because of the size of the tumor and the​ client's classification of a poor surgical risk. Tumor resection is the treatment of choice for colon​ cancer, but is not considered because the client is a poor surgical risk. Laser photocoagulation and local excision would be appropriate for a small tumor.)

The nurse is caring for a client diagnosed with colon cancer. The client is considered a poor surgical​ risk, but has a large tumor. Which intervention does the nurse anticipate will be performed to treat this client​'s ​cancer? a Local excision b Laser photocoagulation c Electrocoagulation d Tumor resection

c (Rationale The nurse would anticipate that folinic acid​ (leucovorin) to be given with fluorouracil​ (5-FU). This medication is not given with the other chemotherapeutic agents administered in the treatment of colorectal cancer.)

The nurse is caring for a client receiving chemotherapeutic agents in the treatment of colorectal cancer. Which chemotherapeutic agent would the nurse expect to be administered with folinic acid​ (leucovorin)? a Oxaliplatin b Irinotecan​ (CPT-11) c Fluorouracil​ (5-FU) d Capecitabine

a (Rationale: The client needs to be able to discuss sexual needs and changes openly with the partner and healthcare professional. The client has an ileostomy, not a colostomy. The client should reach a tolerable level of pain, but will likely still feel some discomfort. The client with an ileostomy will likely have a new diet prescribed by the physician.)

The nurse is caring for a client who has an ileostomy due to colorectal cancer. When planning care, which of the following outcomes would the nurse consider for this client? a Demonstrates a willingness to discuss changes in sexual function b Resumes previous diet habits c Performs care on colostomy d Will be pain-free

a (Feedback Rationale: Radiation therapy can cause decreases in the white blood cell count and the platelet count, putting the client at risk for infection and bleeding. The electrolyte panel and cardiac enzymes are not priority tests)

The nurse is caring for a client who is being treated with radiation to shrink a tumor before undergoing surgery. The nurse anticipates monitoring which of the following priority results during radiation therapy? a Platelet count and WBC b Platelet count and electrolyte panel c Cardiac enzymes and electrolyte panel d White blood cell count (WBC) and electrolyte panel

d (Rationale: The older client's skin is more fragile, which can increase the risk for infection with breaks in the skin, making this a high-priority intervention. Foods such as cabbage often produce gas, which can cause embarrassment for the client with a colostomy. Colonoscopy is not done on a yearly basis. Exercising is important, but a lower priority than skin care.)

The nurse is caring for an 83-year-old client who had a colostomy for colorectal cancer. Which of the following interventions is the priority when teaching this client colostomy care at home? a Importance of exercise twice a day b Inclusion of high-fiber foods such as cabbage in the diet c Yearly screening colonoscopy d Skin care

4 (norm albumin is 3.5-5.0. this low level (2.8) indicates malnutrition/catabolism)

The nurse is checking the lab results of a client with colon cancer admitted for further chemo. The client has lost 30 lbs since initiation of treatment. Which lab result should be reported to the healthcare provider? 1. blood glucose 95 2. total cholesterol 182 3. hgb 12.3 4. alb 2.8

a,b,d,e (Rationale Risk factors in the health history that the nurse would encourage the audience to report to their healthcare providers include unexplained weight​ loss, bowel​ changes, rectal​ bleeding, and fatigue. A negative fecal occult blood testing would not be reported to the healthcare provider.)

The nurse is conducting a presentation on the early detection of colon cancer. What should the nurse encourage members of the audience to report to their healthcare​ providers? ​(Select all that​ apply.) a Bowel changes b Fatigue c Negative fecal occult blood testing d Rectal bleeding e Unexplained weight loss with adequate nutritional intake

b (Feedback b>Rationale: Yogurt has a tendency to thicken stools. The other foods listed tend to cause the stool to be looser)

The nurse is initiating teaching for a client with a colostomy and the family regarding foods that affect the consistency of stools in the client's colostomy. Which of the following foods will the nurse tell the family will help the stool solidify? a Dried beans b Yogurt c Fried foods d Spicy foods

a,d (Rationale: Inflammatory bowel disease (Crohn's) and a family history of polyps indicate a higher risk for developing colorectal cancer. Females are not more prone to experience colorectal cancer than males, and the risk age is 50. Celiac disease and diverticulosis do not present a higher risk for colorectal cancer.)

The nurse is presenting a program at a community center about colorectal cancer to promote the new cancer screening center at the hospital. For which of the following participants will the nurse advise a screening colonoscopy? (Select all that apply.) a The client with Crohn's disease b The client with celiac disease c The female client who is 48 years old d The client with a family history of polyps e The client with diverticulosis

a (Rationale Biopsy results that show the tumor has invaded the submucosa indicate Stage 1 cancer. The other responses do not indicate the correct staging for this finding.)

The nurse is providing care to a client who recently had a biopsy for colon cancer. The biopsy indicates that the tumor has invaded the submucosa and the client asks the nurse what this means. Which response by the nurse is most​ appropriate? ​a "This means you are Stage​ 1." ​b "This means you are Stage​ 2." c ​"This means you are Stage​ 0." ​d "This means you are Stage​ 3."

b,c,d,e (Rationale Screening for colorectal cancer is recommended starting at age 50 years. The client should have a yearly fecal occult blood​ test; and a flexible​ sigmoidoscopy, double-contrast barium​ enema, or CT colonoscopy every 5​ years; or a colonoscopy every 10 years.)

The nurse is providing education to a client at the primary care clinic. Which screenings are recommended for colorectal​ cancer? ​(Select all that​ apply.) a Screening beginning at age 40 years b Colonoscopy every 10 years c CT colonoscopy every 5 years d Flexible sigmoidoscopy every 5 years e Yearly fecal occult blood test

4 (Other risk factors include age, familial polyps, colorectal polyps, high fat or low fiber diet)

The nurse should teach clients about which potential risk factor for the development of colon cancer? 1. chronic constipation 2. long term use of laxatives 3. history of smoking 4. history of IBD

b (Rationale: Calcium and folic acid supplements are one measure that can help prevent colon cancer. Intake of increased fluids is not considered a preventive measure for colorectal cancer. The client should cease smoking totally and should continue to take measures for weight loss to help prevent colon cancer. )

The nurse works in a gastrointestinal clinic with clients who have various bowel disorders and cancer. The nurse considers prevention of colorectal cancer a significant nursing care issue. Which of the following statements by a client indicate to the nurse that teaching has been effective? a "I'm down to 25 pounds over my ideal weight." b "I have increased my intake of calcium and folic acid." c "I have reduced my smoking to one pack a day." d "I have increased my intake of fluids significantly."

3 (Further assess what the patient means by having "control over my own life and death." This could be an indirect statement of suicidal intent. A patient who believes he will be cured should also be assessed for misunderstanding what the physician said; however, the patient may need to use denial as a temporary defense mechanism. The patient's acknowledgment that the treatments are for control of symptoms or plans for the immediate future suggest an understanding of what the physician said. Focus: Prioritization)

The physician tells the patient with cancer that there will be an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. Which patient statement would concern you the most? 1. "My symptoms will eventually be cured; I'm so happy that I don't have to worry any longer." 2. "My doctor is trying to help me control the symptoms; I am grateful for the extension of time with my family." 3. "My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death." 4. "Initially, I may have to take some time off of work for my treatments; I can probably work full time in the future."

a,b,c (The clinical manifestations of colon cancer include changes in bowel​ patterns, abdominal​ pain, and anemia. The client would experience decreased appetite and weight​ loss, not increased appetite and weight​ gain, with colon cancer.)

What are the clinical manifestations of colon​ cancer? ​(Select all that​ apply.) a Anemia b Abdominal pain c Change in bowel pattern d Weight gain e Increased appetite

3 (high fiber may produce loose stools, severe restriction NOT, encourage client to drink 2000-3000 mL/day)

When planning diet teaching to a client with colostomy, the nurse should develop a plan that emphasizes which dietary instruction? 1. foods containing roughage should not be eaten 2. liquids are best limited to prevent diarrhea 3. clients should experiment to find the diet best for them 4. a high fiber diet will produce a regular passage of stool

a,b,c,e (Known risk factors for the development of colorectal cancer include an age of 50​ years, history of​ smoking, family history of colorectal​ cancer, and history of inflammatory bowel disease. A diet high in carbohydrates has not been identified as a risk​ factor, but a diet high in calories and animal fat is associated with colorectal cancer.)

Which are known risk factors associated with the development of colorectal​ cancer? ​(Select all that​ apply.) a Smoking b Age of 50 years c Inflammatory bowel disease d Diet high in carbohydrates e Family history

3 (clients over 50 with history of IBD are at highest risk.. other risk factors for colon cancer are a diet high in animal fat, large amounts of red meat and fatty foods with low fiber and the presence of colon cancer in a first gen relative)

Which client is at the highest risk for colorectal cancer? 1. the client who smokes 2. the client who eats vegetarian diet 3. the client who has been treated for crohns for 20 years 4. the client who has a family history of lung cancer

b (A tissue biopsy will confirm cancerous cells and cell differentiation. A sigmoidoscopy is used to visualize bowel tumors but not their differentiation. Fecal occult blood only detects blood in the​ feces, not tumor differentiation. CEA estimates prognosis and detects cancer recurrence but does not provide evidence of cellular differentiation.)

Which diagnostic test is used to determine cell​ differentiation? a Carcinoembryonic antigen​ (CEA) b Tissue biopsy c Sigmoidoscopy d Fecal occult blood

d (The appropriate assessment for a client with urinary calculi is to monitor input and output. Urinary calculi can cause urinary​ retention; therefore, the nurse must closely monitor intake and output. Determining level of consciousness and assessing bowel sounds are not assessment items that focus on urinary calculi. Recommending bed rest is not a nursing assessment.)

Which nursing assessment is appropriate for a client with urinary​ calculi? a Recommending complete bed rest b Assessing bowel sounds c Determining level of consciousness d Monitoring input and output

a (Peritonitis can advance to shock and circulatory failure, so fluid and electrolyte balance is the priority focus of nursing management. Gastric irrigation may be needed periodically to ensure patency of the nasogastric tube. Although pain management is important for comfort and psychosocial care will address concerns such as anxiety, focusing on fluid and electrolyte imbalance will maintain hemodynamic stability.)

Which of the following aspects is the priority focus of nursing management for a client with peritonitis? A Fluid and electrolyte balance B Gastric irrigation C Pain management D Psychosocial issues

a

Which of the following diets is most commonly associated with colon cancer? A Low-fiber, high fat B Low-fat, high-fiber C Low-protein, high-carbohydrate D Low carbohydrate, high protein

b (Abdominal pain causing rigidity of the abdominal muscles is characteristic of peritonitis. Abdominal distention may occur as a late sign but not early on. Bowel sounds may be normal or decreased but not increased. Right upper quadrant pain is characteristic of cholecystitis or hepatitis.)

Which of the following symptoms would a client in the early stages of peritonitis exhibit? A Abdominal distention B Abdominal pain and rigidity C Hyperactive bowel sounds D Right upper quadrant pain

1

Which skin prep would be best to apply around the clients colostomy? 1. adhesive skin barrier 2. petroleum jelly 3. cornstarch 4. antiseptic cream

b (A client with renal calculi is at risk of developing a urinary tract infection. Cloudy urine would be an indicator of infection. Nausea and vomiting often occur with renal calculi but do not indicate infection. An oral temperature of​ 99.1°F does not indicate​ infection, but dehydration. Right flank pain is a common clinical manifestation of renal calculi and does not indicate infection.)

Which symptom indicates to the nurse that the client may still have an infection related to renal​ calculi? a Nausea and vomiting b Cloudy urine c Oral temperature of 99.1degrees°F d Right flank pain

a (Fulguration is the use of electrocoagulation to shrink tumors and is used for clients who are poor surgical risks. Local excision is used for small​ tumors, performed during​ endoscopy, and does not use electrocoagulation. Laser​ photocoagulation, not​ electrocoagulation, is used during endoscopic procedures. A sigmoid colostomy is an excision of the tumor with a permanent colostomy and does not use electrocoagulation.)

Which treatment involves the use of electrocoagulation to shrink​ tumors? a Fulguration b Local excision c Sigmoid colostomy d Laser photocoagulation

2 5 3 4 1 6 (Stay calm and stay with the client. Any increase in intra-abdominal pressure will worsen the evisceration; placement of the client in a semi-Fowler position with knees flexed will decrease the strain on the wound site. (Note: If shock develops, the client's head should be lowered.) Continuously monitor vital signs, particularly for a decrease in blood pressure or increase in pulse rate, while your colleague gathers supplies and notifies the physician. Covering the site protects tissue. Ultimately, the client will need emergency surgery. Focus: Prioritization)

You are caring for an obese postoperative client who underwent surgery for bowel resection. As the client is moving in bed, he comments, "Something popped open." Upon examination you note wound evisceration. Place in order the steps for handling this complication. 1. Cover the intestine with sterile moistened gauze. 2. Stay calm and stay with the client. 3. Check the vital signs, especially blood pressure and pulse. 4. Have a colleague gather sterile supplies and contact the physician. 5. Put the client into semi-Fowler position with knees slightly flexed. 6. Prepare the client for surgery as ordered. _____, _____, _____, _____, _____, _____

1 3 2 4 (Tumor lysis syndrome is an emergency involving electrolyte imbalances and potential renal failure. A patient scheduled for surgery should be assessed and prepared for surgery. A patient with breakthrough pain needs assessment, and the physician may need to be contacted for a change of dosage or medication. Anticipatory nausea and vomiting has a psychogenic component that requires assessment, teaching, reassurance, and administration of antiemetics. Focus: Prioritization)

You have just received the morning report from the night shift nurse. List the order of priority for assessing and caring for the following patients. 1. A patient who developed tumor lysis syndrome around 5:00 am 2. A patient who reports breakthrough pain since last dose of pain medication 3. A patient scheduled for exploratory laparotomy this morning 4. A patient with anticipatory nausea and vomiting for the past 24 hours _______, _______, _______, _______

2

A 42 year old is interested in making dietary changes to reduce the risk of colon cancer. What dietary selections should the nurse suggest? 1. croissant, granola and peanut butter squares, whole milk 2. bran muffin, skim milk, stir fried broccli 3. granola, bagel with cream cheese, cauliflower salad 4. oatmeal raisen cookies, baked potato with sour cream, turkey sandwich

4 (The patient's physical condition is currently stable, but emotional needs are affecting his or her ability to receive the information required to make an informed decision. The other diagnoses are relevant, but if the patient leaves the clinic the interventions may be delayed or ignored. Focus: Prioritization)

A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While you are trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority diagnosis? 1. Diarrhea/Constipation related to altered bowel patterns 2. Deficient Knowledge related to the disease process and diagnostic procedure 3. Risk for Deficient Fluid Volume related to rectal bleeding and diarrhea 4. Anxiety related to unknown outcomes and perceived threats to body integrity

3 (OXYGEN : decrease Hgb after surgery.. not approp. to increase infusion.. would need to get prescription to do so)

A client had a colon resection yesterday. The client Hgb was 14.1 yesterday and today it is 7.2 The clients O2 is 87%. After reviewing the chart and notifying the HCP the nurse should first: (chart: 1000 mL NS q8h VS q4h Morphine Sulfate 10 mg IV q4h PRN pain NPO O2 2-4 L/min per mask 1. Take VS q h 2. Increase saline infusion to 150 gtt/h 3. admin O2 at 2 L/min 4. Determine when last pain med was administered

1 3 2 4 (ambulate: least invasive to restart peristalsis, IV fluid to restore F/E balance. NG to reduce gastric secretions. Last hyperalimentation to correct protein deficiency )

A client is admitted with a bowel obstruction. The client has N/V and crampy abd pain. The HCP has written the following prescriptions: for the client to be up ad lib, have narcotics for pain, have NG tube inserted if needed, and for IV Ringers lactate and hyperalimentation of fluids. What should the nurse do in order of priority from first to last? 1. assist with ambulation to promote peristalsis 2. insert nasogastric tube 3. administer Ringer lactate 4. start an infusion of hyperalimentation fluids

a,b,d,e (Rationale The cause of colorectal cancer is unknown but there are risk factors associated with the development of the disease. These risk factors include age older than 50​ years; alcohol​ use; smoking;​ obesity; family​ history; inflammatory bowel​ disease; high-calorie​ diet; radiation​ exposure; history of​ colorectal, ovarian,​ breast, or endometrial​ cancer; and polyps in the colon and rectum.)

A client is being seen in a gastrointestinal clinic for complaints of painless rectal​ bleeding, diarrhea, and abdominal cramping. The client asks the nurse about the risk factors for colorectal cancer. Which risk factors will the nurse include in the teaching session for this​ client? ​(Select all that​ apply.) a Radiation exposure b Obesity c Age over 30 years d Smoking e Alcohol use

a,b,d,e (Rationale The client with colorectal cancer may have no symptoms for many years. Other manifestations of colorectal cancer include abdominal​ pain, constipation or​ diarrhea, anorexia, abdominal or rectal​ mass, and weight loss. The client would not have a weight gain.)

A client presents to the emergency department with complaints of rectal bleeding for the past few days. The provider admits the client for a colonoscopy and further​ work-up for rectal bleeding and suspects that the client may have colorectal cancer. What are the possible manifestations of colorectal​ cancer? ​(Select all that​ apply.) a Abdominal or rectal mass b Anorexia c Weight gain d Abdominal pain e Diarrhea

3 (dehydrated)

A client recieving chemo for mets colon cancer is admitted to the hosp because of prolonged vomitting. Assessment findings include irregular pulse of 120 bpm, BP 88/48, RR 14, K 2.9, ABG PH 7.46, PCO 45, PO2 95, and HCO3 29. The nurse should implement which prescription first? 1. O2 at 4 L NC 2. repeat labs in q4 3. 5% dextrose in 1/2 NS with KCL 40 mEq at 125 mL/hr 4. 12 lead ECG

2,4,5

A client recieving monthly doses of chemo for treatment of stage III colon cancer. Which lab results should the nurse report to the oncologist before the next dose of chemo is administered? select all that apply 1. hgb 14.5 2. plt 40,000 3. BUN 12 4. WBC 2300 5. Temp 101.2 F 6. Urine specific gravity 1.020

d (Rationale The nurse should recognize that individuals go through a grieving process when adjusting to a colostomy. The nurse should be accepting and provide the client opportunities to share her concerns and feelings when ready.)

A client refuses to look at or care for her colostomy. What statement by the nurse would be most​ appropriate? a ​"It has been 4 days since your​ surgery, and you will soon be discharged. You have to learn to care for your colostomy before you leave the​ hospital." b ​"I understand how you are feeling. It is important for you to feel attractive and you think having a colostomy changes your​ attractiveness." ​c "I think we will need to teach your husband to care for your colostomy if you are not going to be able to do​ it." d ​"I can see that you are upset. Would you like to share your concerns with​ me?"

1,3,4,6 (RAtionale: preop the client will require instruction regarding the need for turning, coughing, deep breathing, splinting, and leg ROM. The client will also need to learn about colostomy care and the reason for early postoperative ambulation. Addressing feelings of disturbed body image is also appropriate at this time. Learning dietary guidelines and instruction the client about S/S of bowel obstruction are part of the post operative care)

A client who is experiencing colon cancer is scheduled to undergo a colostomy. Which interventions would be appropriate to include in a preoperative teaching plan? Select all that apply 1. Demonstrate turning, coughing, deep breathing, splinting and leg ROM excercises, and provide rationales for each procedure. 2. instruct on dietary guidlines for healing 3. arrange for an ET to speak with the client about colostomy care 4. explain the need for early post operative ambulation 5, instruct the client on S/S of intestinal obstruction. 6. Enourage the client to express feelings about changes in body image.

1,2,4

A client with colon cancer undergoes surgical removal of a segment of colon and creation of a sigmoid colostomy. What assessments by the nurse indicate the client is developing complications with in the first 24 hours? select all that apply 1. coarse breathe sounds auscultated bilaterally 2. dusky appearance of the stoma 3. no drainage in the ostomy appliance 4. temp greater than 101.2 5 decreased bowel sounds

d (Rationale The nurse would anticipate the healthcare provider to order a complete blood count to assess for anemia. The guaiac test and the Hemoccult are fecal occult blood tests used to detect blood in the feces. The CEA is ordered to estimate​ prognosis, monitor​ treatment, and detect cancer recurrence.)

A client with colorectal cancer is exhibiting symptoms of anemia. Which diagnostic test does the nurse anticipate will be ordered for this​ client? a Guaiac test b Hemoccult c Carcinoembryonic antigen​ (CEA) level d Complete blood count

d (Rationale Colorectal cancer has a high rate of​ recurrence; therefore, chemotherapy and radiation are often used for treatment after surgical intervention. Radiation therapy is used after surgery to reduce the risk of pelvic tumors.)

A client with colorectal cancer is scheduled to receive radiation therapy. The client asks the nurse why this is necessary since surgical intervention has already occurred. The nurse bases the response to the client on which​ rationale? a Colorectal cancer is treated exclusively with chemotherapy. b A primary treatment for colorectal cancer is radiation therapy. c Colorectal cancer has a low rate of recurrence. d It is used to reduce the risk of pelvic tumors.

1 (rationale: A high fiber, low fat food such as vege chili increases gastric motility and decreases the chance of constipation, helping to reduce the risk of colon cancer. The other choices are not representative of a high fiber, low fat diet.)

A nurse is providing nutritional teaching to a client with a family history of colon cancer. Which food choice by the client demonstrates an understanding of the correct diet to follow? 1. vegetarian chili 2. hot dogs and sauerkraut 3. egg salad on rye bread 4. spaghetti and meat sauce

c (Fecal occult test should be done annually by clients age 50-75. Colonoscopy is recommended every 10 years at age 50 for a person with no family history of cancer. A biopsy DURING and endoscopy can confirm diagnosis. A sigmoidoscopy is recommended every 5 years beginning at age 50.)

ATI: A nurse is providing teaching about colon cancer to a group of women 45-65 years of age. Which of the following statements should the nurse include in the teaching? a. colonoscopies for individuals with no history of cancer should begin at age 40. b. A sigmoidoscopy is recommended every 5 years beginning at age 60. c. Fecal occult blood tests should be done annually starting at age 50. d. An endoscopy provides a definitive diagnoses of colon cancer.

3 (Cleaning the skin around the stoma with mild soap and water and drying thoroughly helps keep the area clean. The appliance would be changed early in the morning, the stoma should be covered with a gauze pad to prevent seepage of urine. The faceplate or wafer would not be more than 3 mm larger than the stoma to reduce the skin area in contact with the urine)

An enterostomal nurse is caring for a client with a newly placed ileal conduit. Which instruction about skin care at the stoma site would be given? 1. change the appliance at bedtime 2. Leave the stoma open to air while changing the appliance 3. Clean the skin around the stoma with mild soap and water and dry it thouroughly. 4. Cut the faceplate or wafer of the appliance no more than 4 mm larger than the stoma.

2,3,4 (The client would avoid red meat, poultry and fish as well as beets, broccoli, cauliflower, horseradish, mushrooms and turnips. Such fruits as cantaloupe, melons and grapefruits are also prohibited. Tomatoes and peas are acceptable. The client would be taught to maintain a high fiber diet in order to promote colonic emptying time and fecal bulk, which aid in obtaining specimens)

As part of a routine screen for colorectal cancer, a client must undergo fecal occult blood testing. Which foods would the nurse instruct the client to avoid for 48=72 hours before the test and throughout the collection period? Select all that apply. 1. High fiber foods 2. Red meat 3. Turnips 4. Cantaloupe 5. Tomatoes 6. Peas

3

lifestyle influences that are considered risk factors for colorectal cancer include: 1. a diet low in vitamin C 2. a high dietary intake of artificial sweetners 3. a high fat low fiber diet 4 multiple sex partners

2 (The UAP can reinforce dietary and fluid restrictions after the RN has explained the information to the client. It is also possible that the UAP can administer the enema; however, special training is required, and policies may vary among institutions. Medication administration should be performed by licensed personnel. Focus: Delegation)

1. When a client is being prepared for a colonoscopy procedure, which task is most suitable to delegate to the UAP? 1. Explaining the need for a clear liquid diet 1 to 3 days before the procedure 2. Reinforcing "nothing by mouth" status 8 hours before the procedure 3. Administering laxatives 1 to 3 days before the procedure 4. Administering an enema the night before the procedure

1,3 ( may have decreased alb levels, weight gain is not a direct consequence)

A client with colon cancer has developed ascites, the nurse should conduct a focused assessment for which signs and symptoms? select all that apply 1. respiratory distress 2. bleeding 3. F/E imbalances 4. weight gain 5. infection

2 (Tumor lysis syndrome can result in severe electrolyte imbalances and potential kidney failure. The other laboratory values are important to monitor to identify general chemotherapy side effects but are less pertinent to tumor lysis syndrome. Focus: Prioritization)

Following chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory value requires particular attention? 1. Platelet count 2. Electrolyte levels 3. Hemoglobin level 4. Hematocrit

3

A client has a NG tube inserted at the time of abdominal perineal resection with perm colostomy for colon cancer. This tube will most likely be removed when the client demonstrates: 1. absence of N/V 2. passage of mucus from the rectum 3. passage of flatus and feces from colostomy 4. absence of stomach drainage for 24 hrs

3 (nephrotoxicity a possible complication)

a client recieving chemo has an elevated serum creatinine. The nurse should next: 1. cancel the next chemo 2. administer the next chemo 3. notify the HCP 4. obtain a urine specimen