COLON RECTAL CANCER NCLEX

Where do most tumors develop in colorectal cancer? (Select all that apply.)

A.

Rectum

B.

Sigmoid colon

C.

Ascending colon

D.

Transverse colon

E.

Descending colon

A.

Rectum

B.

Sigmoid colon

Rationale: Although any portion of the colon may be affected, most tumors develop in the rectum and sigmoid colon

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 factor will the nurse include in the teaching session for this​ client? (Select all that​ apply.)

A.

Obesity

B.

Smoking

C.

Alcohol use

D.

Over 30 years of age

E.

Radiation exposure

A.

Obesity

B.

Smoking

C.

Alcohol use

E.

Radiation exposure

Rationale: The cause of colorectal cancer is unknown, but there are risk factors associated with the development of the disease. These risk factors include being older than 50 years of age; alcohol use; smoking; obesity; family history; inflammatory bowel disease; diet high in calories, meat proteins, and fats; previous radiation exposure; history of colorectal, ovarian, breast, or endometrial cancer; and polyps in the colon and rectum.

The nurse presenting to a group of older adults on gastrointestinal conditions should present which clinical manifestation of colorectal​ cancer? (Select all that​ apply.)

A.

Anemia

B.

Weight gain

C.

Abdominal pain

D.

Increased appetite

E.

Change in bowel pattern

A.

Anemia

C.

Abdominal pain

E.

Change in bowel pattern

​Rationale: 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.

Which plan of care does the nurse anticipate for a client with a family history of adenomatous​ polyposis?

A.

Genetic testing

B.

Removal of colon

C.

Annual colonoscopy

D.

Genetic counseling

B.

Removal of colon

Rationale: Genetic factors are strongly linked to the risk of colorectal cancer. A family history of the disease increases the risk for its​ development; therefore, genetic testing and counseling is important for the client. Individuals with familial adenomatous polyposis will inevitably develop colon cancer unless the colon is removed. An annual colonoscopy is not a plan of treatment for the individual with familial adenomatous​ polyposis; removal of the colon is recommended.

The nurse is caring for a client with Lynch syndrome. Which understanding of the nurse is accurate regarding the​ cancer?

A.

It primarily affects the descending colon.

B.

It is an autosomal recessive disorder.

C.

It tends to occur at a younger age.

D.

It is associated with diets high in​ meat, protein, and fat.

C.

It tends to occur at a younger age.

​Rationale: Lynch syndrome is a hereditary nonpolyposis colorectal cancer. Lynch syndrome is an autosomal dominant disorder that significantly increases the risk of colorectal cancers. Tumors affected by Lynch syndrome often affect the ascending colon and tend to occur at an early age. Although diets high in​ meat, protein, and fat can be a contributory factor in the development of colorectal​ cancer, it is not specifically an issue with Lynch syndrome due to its hereditary component.

The nurse is conducting a presentation on the early detection of colon cancer. Which should the nurse encourage members of the audience to report to their healthcare​ providers? (Select all that​ apply.)

A.

Fatigue

B.

Bowel changes

C.

Rectal bleeding

D.

Negative fecal occult blood testing

E.

Unexplained weight loss with adequate nutritional intake

A.

Fatigue

B.

Bowel changes

C.

Rectal bleeding

E.

Unexplained weight loss with adequate nutritional intake

​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 caring for a client who​ states, "I know I am supposed to have a sigmoidoscopy at my​ age, but I do not want to experience that. Is there anything else I can​ do?" What is the​ nurse's accurate​ response?

A.

​"The double contrast barium is an excellent alternative every 5​ years."

B.

​"We can perform a stool DNA test every​ year."

C.

​"You can use a take home fecal blood test kit every year for​ screening."

D.

​"It is​ painless, quick, and you will not remember the​ procedure."

C.

​"You can use a take home fecal blood test kit every year for​ screening."

Rationale: The recommendation for testing schedules for early detection of colorectal cancer begins at age 50. There are four options to choose from. The simplest option for a client who does not want to experience a sigmoidoscopy is an annual screening with a take home fecal blood test kit. The stool DNA test can be performed every 3 years. The double contrast barium may be uncomfortable for the​ client, resulting in noncompliance with screening.

The nurse is teaching a group of older adults about the risks of colorectal cancer. Which dietary recommendation should the nurse include in the​ session?

A.

​"Increase dietary cereal​ fiber, fruits, and​ vegetables."

B.

​"Increase intake of foods rich in calcium and folic​ acid, as well as fruits and​ vegetables."

C.

​"Increase dietary folic​ acid, meat​ proteins, and​ calories."

D.

​"Increase intake of meat​ proteins, some​ fats, fruits, and​ vegetables."

B.

​"Increase intake of foods rich in calcium and folic​ acid, as well as fruits and​ vegetables."

Rationale: Diets high in​ fruits, vegetables,​ calcium, and folic acid appear to reduce the risk of colorectal cancer. Cereal​ fiber, once thought to reduce colorectal cancer​ risk, now does not appear to play a role either way in its development. Diets high in​ calories, meat​ proteins, and fats are thought to increase the population of anaerobic bacteria in the gut. These anaerobes convert bile acids into carcinogens.

A pregnant woman at 10​ weeks' gestation is being screen for colorectal cancer. Which statement by the nurse accurately presents to the client the diagnostic​ challenge?

A.

​"Chemotherapeutic agents may cause harm to the​ fetus, so we cannot use​ them."

B.

​"Tumor marker level​ (CEA) may not be​ accurate, but it will not injure the​ fetus."

C.

​"Diagnostic imaging is limited due to risks of harming the​ fetus."

D.

​"Ultrasound imaging is impeded by uterine growth and may affect the​ fetus."

C.

​"Diagnostic imaging is limited due to risks of harming the​ fetus."

Rationale: Diagnostic imaging and other procedures are limited during pregnancy due to the use of radiation and contrast dye and their effects on the fetus. Pregnancy does not affect CEA levels. Ultrasound is used to assess tumor depth and involvement of other organs. Chemotherapeutic agents are not used in diagnosing colorectal cancer.

Which​ follow-up information will the clinic nurse provide for the client who has no family history of colorectal cancer and a negative​ colonoscopy?

A.

​"Sometimes a colonoscopy can show a false​ negative; you may want to complete a stool DNA test to confirm the​ results."

B.

​"You will not need another colonoscopy for 10​ years."

C.

​"You will not need another colonoscopy for 5​ years."

D.

​"There is no reason to repeat a​ colonoscopy."

B.

​"You will not need another colonoscopy for 10​ years."

​Rationale: The​ follow-up information the clinic nurse can provide the client who has no familial history of colorectal cancer and a negative colonoscopy​ is, "You will not need another colonoscopy for 10​ years." The client should continue to be screened throughout their lifetime.

The nurse is caring for a client who received chemotherapy for colon cancer and is at risk for bone marrow suppression. Which laboratory result should the nurse​ monitor?

A.

Folic acid

B.

Platelet count

C.

Carcinoembryonic antigen​ (CEA) level

D.

Vitamin B12

B.

Platelet count

​Rationale: The nurse would monitor the​ client's platelet count to check for signs of bone marrow suppression. The CEA level is a tumor marker detected in the blood of clients with colorectal cancer. If​ anemia, rather than colon​ cancer, were the​ problem, then monitoring folic acid and

B12

levels would be appropriate.

A client with colorectal cancer is exhibiting symptoms of anemia. Which diagnostic test does the nurse anticipate will be ordered for this​ client?

A.

Hemoccult

B.

Complete blood count

C.

Guaiac test

D.

Carcinoembryonic antigen​ (CEA) level

B.

Complete blood count

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

Which diagnostic test is used to determine cell​ differentiation?

A.

Sigmoidoscopy

B.

Fecal occult blood

C.

Carcinoembryonic antigen​ (CEA)

D.

Tissue biopsy

D.

Tissue biopsy

​Rationale: A tissue biopsy will confirm cancerous cells and cell differentiation. A sigmoidoscopy is used to visualize bowel​ tumors, 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.

A client diagnosed with colon cancer is preparing to undergo electrocoagulation of the tumor. The nurse understands that the client will undergo which​ procedure?

A.

Sigmoid colostomy

B.

Fulguration

C.

Local excision

D.

Laser photocoagulation

B.

Fulguration

​Rationale: 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.

The nurse could expect to prepare a client with a small rectal cancer for which​ procedure? (Select all that​ apply.)

A.

External radiation

B.

Systemic radiation

C.

Interstitial radiation

D.

Intracavity radiation

E.

Implantation radiation

A.

External radiation

D.

Intracavity radiation

E.

Implantation radiation

Rationale: Small rectal cancers may be treated with​ intracavity, external, or implantation radiation. Systemic radiation therapy entails a client swallowing or receiving radiation intravenously. Interstitial radiation requires the implants to be placed near or in the​ tumor, not in a body cavity.

A​ 49-year-old client presented to the healthcare​ provider's office for an annual physical examination. During his health​ history, the nurse noted risk factors for colon cancer. Which did the nurse note during this​ client's health history to determine a risk for colon​ cancer?

A.

Diabetes mellitus

B.

A diet high in fruits and vegetables

C.

Regular exercise

D.

Irritable bowel disease

D.

Irritable bowel disease

​Rationale: 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.

The nurse is assessing a client for risk factors associated with colorectal cancer. Which finding in the health history would indicate the client is at​ risk?

A.

History of polyps

B.

​Long-term use of laxatives

C.

History of heart disease

D.

Weight gain

A.

History of polyps

Rationale: A history of polyps is a risk factor 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 laxatives and a history of heart disease are not considered risk factors for colorectal cancer.

Which potential nursing diagnosis is most likely to be considered for the client with colorectal​ cancer?

A.

Skin​ Integrity, Impaired

B.

Cardiac​ Output, Decreased

C.

​Self-Care Deficit, Toileting

D.

​Nutrition, Imbalanced: Less than Body Requirements

D.

​Nutrition, Imbalanced: Less than Body Requirements

​Rationale: Nursing diagnoses for clients with colorectal cancer are individualized to each​ client's needs and may include Nutrition​ Imbalanced: Less than Body Requirements due to the side effects of the treatment and disease process. Pressure injury may occur if the client is immobile​ and/or nutritional needs are not met. ​Self-Care Deficit, Toileting is a possible​ diagnosis, but imbalanced nutrition is more universally consistent for a client with colorectal cancer. Cardiac output should not be affected in a client with colorectal cancer unless there is active bleeding.

​(NANDA-I ©2014)

Which nursing assessment should the nurse consider a priority for the client​ 2-weeks postcolostomy?

A.

Sexual dysfunction

B.

Nausea and vomiting

C.

Pain management

D.

Physical mobility

A.

Sexual dysfunction

​Rationale: The risk of sexual dysfunction should be a priority concern for a client with a colostomy.​ Psychologically, clients with an ostomy experience an altered body image and may experience low​ self-esteem. The client may be concerned about odors or pouch leakage during sexual​ activity; this emotional distress can contribute to sexual dysfunction. A colostomy should not affect the​ client's physical​ mobility, cause​ nausea, vomiting, or pain​ 2-weeks postsurgery.

Which is the minimally acceptable hourly urine output for a client weighing 141 lb and undergoing treatment for colorectal​ cancer?

A.

32​ mL/h

B.

42​ mL/h

C.

36​ mL/h

D.

40​ mL/h

A.

32​ mL/h

​Rationale: A client maintains adequate​ hydration, as evidenced by urinary output of at least 0.5​ mL/kg/h. This is calculated as​ follows: (Step​ 1) 141 lb​ ÷ 2.2 kg​ = 64.09 kg and​ (Step 2) 64 kg x 0.5​ mL/h = 32​ mL/h.