cellular regulation Exemplar 2.D Colorectal Cancer

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The nurse is speaking with a client who wants information regarding colorectal cancer. Which statement indicates the client understood the information presented by the nurse?

A) The risk of colorectal cancer decreases with age.
B) Colorectal cancer can be detected in early stages by measuring the level of the carcinogenic embryonic antigen (CEA).
C) Colorectal cancer occurs more frequently in clients who have a history of inflammatory bowel disease.
D) Colorectal cancer has no symptoms in the early stage and there are no definitive diagnostic tests.
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Terms in this set (16)
The nurse is speaking with a client who wants information regarding colorectal cancer. Which statement indicates the client understood the information presented by the nurse?

A) The risk of colorectal cancer decreases with age.
B) Colorectal cancer can be detected in early stages by measuring the level of the carcinogenic embryonic antigen (CEA).
C) Colorectal cancer occurs more frequently in clients who have a history of inflammatory bowel disease.
D) Colorectal cancer has no symptoms in the early stage and there are no definitive diagnostic tests.
C

Explanation: Colorectal cancer is asymptomatic in the early stages. Screening tools such as annual fecal occult blood testing and colonoscopy performed every 5-10 years can detect the cancer when it is still in the curable stage. The risk of colorectal cancer rises with age and it is the most common cancer after the age of 65. Carcinogenic embryonic antigen (CEA) is not considered a diagnostic test but is used as a tumor marker to follow and manage the disease in clients diagnosed with the disease. The incidence of colorectal cancer is increased in clients with a history of ulcerative colitis, and these clients need diligent screening.
The nurse provides an educational session for community members about the risk factors for colorectal cancer. Which participant statement indicates that teaching has been effective? Select all that apply.

A) "There is a genetic link in the development of colorectal cancer."
B) "People with other bowel diseases are at increased risk for developing this cancer."
C) "Eating a diet high in red meat reduces the risk for developing this type of cancer."
D) "Eating cereal fiber reduces the risk of developing colorectal cancer."
E) "Taking aspirin and a multivitamin each day reduces the risk of colorectal cancer."
ABE

Explanation: Genetic factors are strongly linked to the risk for colorectal cancer. Family history of the disease increases an individual's risk for its development. Inflammatory bowel diseases increase the risk of colorectal cancer. The disease is prevalent in people who consume diets high in meat proteins. Cereal fiber does not play a role in the development of colorectal cancer. The use of aspirin and multivitamins may reduce the risk of developing colorectal cancer.
A client recovering from surgery to place a permanent colostomy as treatment for colon cancer is concerned that her spouse will no longer find her sexually attractive. Which response by the nurse is the most appropriate?

A) "Tell me more about the concerns you are having."
B) "Would you like me to speak with your husband for you?"
C) "Do not worry about sex right now. It is more important to focus on recovery."
D) "I will refer you to a counselor to talk about your concerns."
A

Explanation: Since the client has expressed concern to the nurse regarding sexual functioning, the nurse should ask the client to expand upon why there are concerns. Although a referral may be needed for the client at some point, this is not the most appropriate response by the nurse. Telling the client not to worry about the concern and offering to speak to her spouse are not the most appropriate responses at this time.
A client has just been told that a colectomy and ileostomy are needed to treat a new diagnosis of colon cancer. Which diagnosis should the nurse use to plan this client's preoperative nursing care?

A) Knowledge Deficit
B) Risk for Disuse Syndrome
C) Risk for Perioperative-Positioning Injury
D) Anticipatory Grieving
D

Explanation: The client and family will require support to deal with their emotional response to learning the client has cancer and will undergo body image-changing surgery. Disuse syndrome and injury from positioning may be factors after surgery. Now is not the time to begin instructions, because the client will most likely be unable to learn or concentrate on what the nurse is teaching.
The nurse is evaluating care provided to a client recovering from surgery for colorectal cancer. Which outcomes indicate that care has been successful? Select all that apply.

A) Client reports pain level as an 8 on a rating scale of 0 to 10.
B) Client has an hourly urine output of 45 mL.
C) Client performs morning care with assistance.
D) Client states family members will care for the ostomy at home.
E) Client tolerates full liquid diet and is requesting solid food.
BCE

Explanation: Evidence that care has been effective includes an adequate hourly urine output of at least 0.5 mL/kg/hr, ability to perform activities of daily living, and tolerating oral intake. Not participating in the care of an ostomy and stating that family will provide the care needed are evidence of ineffective coping, an undesirable outcome. Pain rating should be at a level or 3 or less as evidence of successful care.
The nurse is preparing care for a client recovering from surgery for colorectal cancer. Which interventions should the nurse use when creating a pain management plan for this client?
Select all that apply.

A) Provide pain medication upon request.
B) Assess surgical site for inflammation.
C) Assess bowel sounds.
D) Administer pain medication after painful procedures.
E) Instruct to use a pillow to splint when deep breathing and coughing.
Answer: B, C, E

Explanation: Pain level should be routinely assessed and pain medication should be provided based upon the assessment and not only when the client requests medication for pain. The surgical site should be routinely assessed for inflammation as a potential source of pain. Bowel sounds should be assessed, as a paralytic ileus could cause an increase in pain. Pain medication should be provided before painful procedures. The client should be instructed to use a pillow to splint the incision when deep breathing and coughing.
The nurse is teaching a client scheduled for a colonoscopy on pre- and post-procedure care. Which statement by the client indicates the need for further teaching?

A) "I will likely have medications that will make me drowsy during the test."
B) "It might be quite painful."
C) "The physician might take tissue samples for further analysis."
D) "The procedure will only take about 1 hour."
Answer: B

Explanation: The colonoscopy is not a painful examination. It usually takes about an hour. The client will be given conscious sedation, which causes drowsiness. Tissue samples are often taken during colonoscopies.
A client receiving radiation therapy as treatment for colorectal cancer is experiencing nausea and vomiting. What should the nurse encourage the client to do?

A) Avoid all food and liquid until nausea and vomiting stop.
B) Delay the intake of a meal until 3-4 hours after treatment.
C) Eat spicy or well-seasoned foods instead of bland foods.
D) Use a commercial mouthwash before eating a meal.
Answer: B

Explanation: Nausea and vomiting are not uncommon in client receiving radiation, and the client may benefit from delaying meals for a few hours after treatment, allowing the primary effects to subside somewhat. Avoiding all food and liquid could put the client at risk for dehydration. Using a mouthwash and eating spicy foods are not recommended interventions for nausea and vomiting.
A client with terminal colon cancer is refusing all food and fluids. The client has a living will that states no artificial nutrition is to be provided; however, the family is asking for a gastrostomy tube. What should the nurse do?

A) Take the case to the hospital's ethics committee.
B) Talk to the physician so he or she can move forward with the family's wishes.
C) Honor the client's refusal and help the family come to terms with the situation.
D) Honor the family's wishes and have them sign a consent form.
Answer: C

Explanation: A nurse is morally obligated to withhold food and fluids if it is determined to be more harmful to administer them than to withhold them. The nurse must also honor competent clients' refusal of food and fluids. This position is supported by the ANA's Code of Ethics for Nurses, through the nurse's role as a client advocate and through the moral principle of autonomy. Clients, not their families, should make decisions about their own health care and treatment. The physician may or may not be involved, but would not disregard the client's refusal. An ethics committee is usually considered when there is an ethical dilemma and more input is needed to make a decision. In this case, the client has made a decision and it should be honored.
A nurse is caring for a client who has had a double-barrel colostomy. Which is true regarding the proximal stoma? Select all that apply.
A) It is also called the mucous fistula.
B) It diverts feces to the abdominal wall.
C) It expels mucus from the distal colon.
D) It is a functional stoma.
E) It expels mucus from the proximal colon.
Answer: B, D

Explanation: When a double-barrel colostomy is performed, two separate stomas are created. The distal colon is not removed, but bypassed. The proximal stoma, which is functional, diverts feces to the abdominal wall. The distal stoma, also called the mucous fistula, expels mucus from the distal colon.
The nurse is caring for a client with colorectal cancer who is post-operative from a transverse colostomy placement. What area of the bowel is involved? A) A B) B C) C D) D E) EAnswer: A Explanation: Colostomies take the name of the portion of the colon from which they are formed. The transverse colon is the area of the bowel involved.A client has colorectal cancer at stage I, T2. What has the tumor invaded? A) The submucosa of the bowel B) The muscularis propria of the bowel C) The perirectal tissues D) The lymph nodesBA client with colorectal cancer has no metastasis in regional lymph nodes. What can the nurse conclude from this about metastasis of this cancer? A) The distal lymph nodes and other major organs will also not have metastasis. B) The tumor has instead metastasized to distal lymph nodes. C) The nurse cannot conclude anything about metastasis to other areas of the body. D) The tumor has instead metastasized through the circulatory system to other major organs.CWhich complaint by the client should the nurse report to the physician as a potential indication of colorectal cancer? A) Abdominal pain B) Constipation C) Diarrhea D) Rectal bleedingDThe nurse is assessing several children with polyps in the colon and rectum. Which child is at highest risk of developing colorectal cancer in adulthood? A) A 4-year-old with isolated juvenile polyps B) A 6-month-old with diffuse juvenile polyposis of infancy C) A 12-year-old with juvenile polyposis coli D) A 7-year-old with adenomatous polypsCThe nurse is assessing an older adult client recently diagnosed with colorectal cancer. What information is important for the nurse to ask for when completing the geriatric assessment? A) The names, addresses, and birthdates of all of the client's children B) The client's food diary for the past month C) A complete list of all medications and supplements the client is currently taking D) Whether the client has ever had a gastrointestinal disorder that caused diarrheaC