Colorectal Cancer

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? a.Cancer of the colon is associated with a lack of fiber in the diet. b.Cancer of the colon has a greater incidence among those younger than age 50 years. c.Cancer of the colon has no known risk factors. d.Cancer of the colon is rare among male clients.

A 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 exposure to the lumen of the colon. B.The older the client, the greater the risk of developing cancer of the colon. C.Risk factors for cancer of the colon include increasing age; family history of colon cancer or polyps; history of IBD; genital or breast cancer; and eating a high-fat, high-protein,low-fiber diet. D.Males have a slightly higher incidence of colon cancers than do females.

Which information obtained by the nurse about a patient with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for patient teaching? a. The patient swims a mile 5 days a week. b. The patient eats frequently during the day. c. The patient showers with Dove soap daily. d. The patient has a history of dental caries.

A Rationale: The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change the habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.

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 ~ 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. She may want to delay chemotherapy by a day or two. Certainly the client is at high risk for infection. The other assessment findings are consistent with common side effects of 5-FU that would not need to be reported immediately.

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.

The pt presents with a complete blockage of the large intestine from a large tumor. Which HCP's order would the nurse question? a. Obtain consent for a colonoscopy and biopsy. b. Start an IV of 0.9% saline at 125 mL/hr. c. Administer 3 liters of Go Lytely. d. Give tap water enemas until it is clear.

C GoLytely would cause severe cramping and could cause an emergency. Tap water enema is the way to clean out the pt before diagnostic testing.

The nurse is admitting a male client with a diagnosis of adenocarcinoma of the rectosigmoid colon. Which assessment data support this diagnosis? a. Reports up to 20 bloody stools per day. b. States he has a feeling of fullness after a heavy meal. c. Has diarrhea alternating with constipation. d. Complains of RLQ pain with rebound tenderness.

C The most common symptom of CRC is change in bowel habits.

The client who has had an abdominal perineal resection is being discharged. Which info should nurse teach? a. The stoma should be a white, blue, or purple color. b. Limit ambulation to prevent the pouch from coming off. c. Take pain meds when pain level is at 8. d. Empty pouch when 1/3 to 1/2 full.

D A. Wrong. These colors represent lack of circulation, emergency. Should be pink. B. Wrong. Encourage ambulation. Pouch shouldn't fall off. C. Wrong. Pain meds should be taken before pain reaches 5. D. Correct. Prevent leakage and heaviness.

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 ~ Although all interventions might be appropriate, a client with late-stage cancer and bone metastases is at risk for severe pain. Giving the client pain medication around the clock is the best way to manage this type of pain.

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 ~ 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 85 y.o. male client diagnosed with colon cancer asks the nurse, "Why did I get colon cancer?" Which is best response about colon cancer? 1. Lack of fiber in the diet. 2. Greatest incidence among those younger than 50. 3. Has no known risk factors. 4. Rare among male clients.

1. Prolonged transit time due to low fiber diet allows for carcinogens to build up in the lumen of colon.

The occupational health nurse is preparing a presentation to a group of factory workers about preventing colon cancer. Which information should be included? 1. Wear a high filtration mask around chemicals. 2. Eat several servings of cruciferous vegetables daily. 3. Take a multivitamin daily. 4. Do not engage in high-risk sexual behavior.

2.

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

1. Correct. Thorough skin care is needed. 2. Wrong. Midline and perineal incisions, not flank. 3. Correct. Perineal wound means a catheter to keep urine out of incision. 4. Wrong. JP drains are emptied every shift, not irrigated. 5. Don't sit upright because it puts pressure on perineum.

The nurse writes a psychosocial problem of "risk for altered sexual functioning related to new colostomy. Which intervention should the nurse implement? 1. Tell pt. that there should be no intimacy for at least 3 months. 2. Ensure that the pt and partner are able to change the ostomy pouch. 3. Demonstrate with charts possible sexual positions for the pt. to assume. 4. Teach the pt. to protect the pouch from being dislodged during sex.

1. Wrong. Eliminate because of the use of the word "no". 2. Wrong. Not addressing the issue. 3. Wrong. Out of nurse's area of expertise. Doesn't have access to sexual position charts. 4.Correct. Dislodged pouch may further cause body image issues.

The client who has had an abdominal perineal resection is being discharged. Which info should nurse teach? 1. The stoma should be a white, blue, or purple color. 2. Limit ambulation to prevent the pouch from coming off. 3. Take pain meds when pain level is at 8. 4. Empty pouch when 1/3 to 1/2 full.

1. Wrong. These colors represent lack of circulation, emergency. Should be pink. 2. Wrong. Encourage ambulation. Pouch shouldn't fall off. 3. Wrong. Pain meds should be taken before pain reaches 5. 4. Correct. Prevent leakage and heaviness.

the nurse caring for the pt 1day post op sigmoid resection notes a moderate amount of dark reddish brown drainage on the midline abdominal incision. Which intervention is first? 1. Mark the drainage on the dressing with the time and date. 2. Change the dressing immediately using sterile technique. 3. Notify the health care provider immediately. 4. Reinforce the dressing with a sterile gauze pad.

1.Correct. Mark drainage to determine if active bleeding is occurring because dark reddish brown drainage indicates old blood. 2. Wrong. Surgical dressing is only changed by surgeon until ordered. 3. Wrong. Assess before calling HCP. 4. Wrong. May need to reinforce dressing, but after assessment.

The pt complains to the nurse of unhappiness with the HCP. Which intervention should the nurse do next? 1. Call HCP and suggest he or she talk to pt 2. Determine what about he HCP is bothering pt. 3. Notify nursing supervisor to arrange a new HCP to take over. 4. Explain that pt. has to keep HCP till after discharge.

2.

The pt with a new colostomy is being discharged. Which statement indicates a need for further teaching? 1. If I notice any skin breakdown I will call 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's ok. 4. I should not drive or lift more than 5 pounds.

2. Pt should be on a regular diet with working colostomy for several days before discharge.

The nurse is admitting a male client with a diagnosis of adenocarcinoma of the rectosigmoid colon. Which assessment data support this diagnosis? 1. Reports up to 20 bloody stools per day. 2. States he has a feeling of fullness after a heavy meal. 3. Has diarrhea alternating with constipation. 4. Complains of RLQ pain with rebound tenderness.

3. The most common symptom of CRC is change in bowel habits.

The 85 y.o. male client diagnosed with colon cancer asks the nurse, "Why did I get colon cancer?" Which is best response about colon cancer? a. Lack of fiber in the diet. b. Greatest incidence among those younger than 50. c. Has no known risk factors. d. Rare among male clients.

A Prolonged transit time due to low fiber diet allows for carcinogens to build up in the lumen of colon.

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. a. Provide meticulous skin care to stoma b. Assess the flank incision c. Maintain the indwelling catheter d. Irrigate the JP drains every shift e. Position the client semirecumbent

Answer: A,C,E. A. Correct. Thorough skin care is needed. B. Wrong. Midline and perineal incisions, not flank. C. Correct. Perineal wound means a catheter to keep urine out of incision. D. Wrong. JP drains are emptied every shift, not irrigated. E. Don't sit upright because it puts pressure on perineum.

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? a. a history of inflammatory bowel disease b. family history of colon cancer c. a high fiber diet d. a diet high in fats and carbohydrates

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

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? a. To prevent an immune dysfunction b. Because the client has an infection c. To decrease the bacteria in the bowel d. Because the client is allergic to penicillin

C 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.

A nurse cares for a client with colon cancer who has a new colostomy. The client states, "I think it would be helpful to talk with someone who has had a similar experience." How should the nurse respond? a. I have a good friend with a colostomy who would be willing to talk with you. b. The enterostomal therapist will be able to answer all of your questions. c. I will make a referral to the United Ostomy Associations of America. d. You'll find that most people with colostomies don't want to talk about them.

C ~ Nurses need to become familiar with community-based resources to better assist clients. The local chapter of the United Ostomy Associations of America has resources for clients and their families, including Ostomates (specially trained visitors who also have ostomies). The nurse should not suggest that the client speak with a personal contact of the nurse. Although the enterostomal therapist is an expert in ostomy care, talking with him or her is not the same as talking with someone who actually has had a colostomy. The nurse should not brush aside the client's request by saying that most people with colostomies do not want to talk about them. Many people are willing to share their ostomy experience in the hope of helping others.

A nurse teaches a client who is at risk for colon cancer. Which dietary recommendation should the nurse teach this client? a. Eat low-fiber and low-residual foods. b. White rice and bread are easier to digest. c. Add vegetables such as broccoli and cauliflower to your new diet. d. Foods high in animal fat help to protect the intestinal mucosa.

C ~ The client should be taught to modify his or her diet to decrease animal fat and refined carbohydrates. The client should also increase high-fiber foods and Brassica vegetables, including broccoli and cauliflower, which help to protect the intestinal mucosa from colon cancer.

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should the nurse take? a. Ask if the client is experiencing pain in the right shoulder. b. Perform a rectal examination and assess for polyps. c. Contact the provider and recommend computed tomography. d. Administer a laxative to increase bowel movement activity.

C ~ The presence of visible peristaltic waves, accompanied by high-pitched or tingling bowel sounds, is indicative of partial obstruction caused by the tumor. The nurse should contact the provider with these results and recommend a computed tomography scan for further diagnostic testing. This assessment finding is not associated with right shoulder pain; peritonitis and cholecystitis are associated with referred pain to the right shoulder. The registered nurse is not qualified to complete a rectal examination for polyps, and laxatives would not help this client.

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

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.

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 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

The nurse is caring for pts in an outpatient clinic. Which info should the nurse teach regarding the American Cancer Society's recommendations for early detection of colon cancer? 1. Beginning at age 60, a digital rectal exam should be done annually. 2. After pt reaches middle age, yearly fecal occult test. 3. At age 50, a colonoscopy, then once every 5-10 years. 4. A flexible sigmoidoscopy should be done yearly after age 40.

3.

The pt presents with a complete blockage of the large intestine from a large tumor. Which HCP's order would the nurse question? 1. Obtain consent for a colonoscopy and biopsy. 2. Start an IV of 0.9% saline at 125 mL/hr. 3. Administer 3 liters of Go Lytely. 4. Give tap water enemas until it is clear.

3. GoLytely would cause severe cramping and could cause an emergency. Tap water enema is the way to clean out the pt before diagnostic testing.

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? a. Age younger than 50 b. history of colorectal polyps c. family history of colorectal cancer d. chronic IBD

A Colorectal cancer risk factors include age older than 50, a family history of the disease, polyps, and chronic IBD

When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? a. "Can you tell me what has been helpful to you in the past when coping with stressful events?" b. "How long ago were you diagnosed with this cancer?" c. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?" d. "How do you feel about having a possibly terminal illness?"

A Rationale: Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is not considered to have a terminal illness at this time, and this question is likely to worry the patient unnecessarily.

The occupational health nurse is preparing a presentation to a group of factory workers about preventing colon cancer. Which information should be included? a. Wear a high filtration mask around chemicals. b. Eat several servings of cruciferous vegetables daily. c. Take a multivitamin daily. d. Do not engage in high-risk sexual behavior.

B Eat several servings of cruciferous vegetables daily.

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

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: a. low sodium low fat high fiber diet." b. a low fat, low refined sugar and decrease red meat while eating more fiber." c. a gluten free, low fat diet." d. a low carbohydrate, low fat, low tyramine diet."

B 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.

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 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 nurse caring for the pt 1day post op sigmoid resection notes a moderate amount of dark reddish brown drainage on the midline abdominal incision. Which intervention is first? a. Mark the drainage on the dressing with the time and date. b. Change the dressing immediately using sterile technique. c. Notify the health care provider immediately. d. Reinforce the dressing with a sterile gauze pad.

A A.Correct. Mark drainage to determine if active bleeding is occurring because dark reddish brown drainage indicates old blood. B. Wrong. Surgical dressing is only changed by surgeon until ordered. C. Wrong. Assess before calling HCP. D. Wrong. May need to reinforce dressing, but after assessment.

A client with cancer of the colon who is receiving chemotherapy tells a nurse that some foods on the meal tray taste bitter. The nurse would try to 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

C beef: meat is perceived as bitter by clients with cancer

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

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.

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".

C 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 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.

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 ~ 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.

A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. An important nursing intervention for the patient is to a. teach about the importance of nutrition during treatment. b. have the patient eat large meals when nausea is not present. c. administer prescribed antiemetics 1 hour before the treatments. d. offer dry crackers and carbonated fluids during chemotherapy.

C Rationale: Treatment with antiemetics before chemotherapy may help to prevent anticipatory nausea. Although nausea may lead to poor nutrition, there is no indication that the patient needs instruction about nutrition. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea.

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 ~ 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.

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 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 cares for a client newly diagnosed with colon cancer who has become withdrawn from family members. Which action should the nurse take? a. Contact the provider and recommend a psychiatric consult for the client. b. Encourage the client to verbalize feelings about the diagnosis. c. Provide education about new treatment options with successful outcomes. d. Ask family and friends to visit the client and provide emotional support.

B ~ The nurse recognizes that the client may be expressing feelings of grief. The nurse should encourage the client to verbalize feelings and identify fears to move the client through the phases of the grief process. A psychiatric consult is not appropriate for the client. The nurse should not brush aside the client's feelings with discussions related to cancer prognosis and treatment. The nurse should not assume that the client desires family or friends to visit or provide emotional support.

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? a. Beginning at age 60, a digital rectal examination should be done yearly. b. After reaching middle age, a yearly fecal occult blood test should be done. c. Have a colonoscopy at age 50 and then once every five to ten years. d. A flexible sigmoidoscopy should be done yearly after age 40.

C a. A digital rectal examination is done to detect prostate cancer and should be started at age 40 years. b. "Middle age" is a relative term; specific ages are used for recommendation. c. 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. d. A flexible sigmoidoscopy should be done at five year intervals between the colonoscopy.

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 ~ 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.

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

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.

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 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.

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 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.

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 ~ The nurse should encourage the client to have frequent colonoscopies to identify abnormal polyps and cancerous cells early. The abnormal gene associated with colon cancer is an autosomal dominant gene mutation that does not skip a generation and places the client at high risk for cancer. Changing the client's diet, preemptive chemotherapy, and removal of polyps will decrease the client's risk but will not prevent cancer. However, a client at risk for colon cancer should eat a low-fat and high-fiber diet.