MSN Exam for Colorectal Cancer

EXPLANATION

 

✔Correct answer:

Lung cancer. Lung cancer is the correct answer as it is the leading cause of cancer-related deaths among women. Despite the common perception that breast cancer is the most deadly cancer for women due to its high incidence, lung cancer actually claims more lives. This can be attributed to the aggressive nature of lung cancer and the fact that it is often diagnosed at a more advanced stage, making treatment more challenging and decreasing survival rates. The high mortality rate associated with lung cancer is also related to the harmful effects of smoking, which is a primary risk factor for developing the disease. However, it's important to note that non-smokers can also develop lung cancer, and there are various other contributing factors such as exposure to radon gas, secondhand smoke, and other environmental hazards.

Think of cancer types like different types of weeds in a garden. While some weeds (like breast cancer) might be more noticeable and widespread, it's another type of weed (lung cancer) that's harder to eradicate and more likely to overrun the garden if not detected and addressed early.

Lung cancer originates in the respiratory system, specifically in the lung tissue. It often starts in the cells lining the air passages. There are two main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), with NSCLC being more common. The disease can be particularly aggressive and has a high potential for metastasis, meaning it can spread rapidly to other parts of the body. The lungs' extensive blood supply and lymphatic system contribute to this potential for metastasis. Early detection is challenging because symptoms often appear only in advanced stages and can be mistaken for other less serious conditions, contributing to the high mortality rate.

 

✘Incorrect answer options:

Breast cancer. While breast cancer is the most common cancer among women and a significant cause of cancer-related death, it is not the leading cause of cancer-related deaths. Advances in detection and treatment have improved the survival rates for breast cancer significantly.

Colon and rectal cancer. Colon and rectal cancer (colorectal cancer) is a leading cause of cancer-related deaths, but it does not surpass lung cancer in mortality rates for women. Screening methods like colonoscopies have helped in early detection and treatment, improving survival rates.

Brain cancer. Brain cancer is not among the leading causes of cancer-related deaths in women. While it is a serious condition with significant mortality, the incidence and total number of deaths are lower compared to lung, breast, and colorectal cancers.

 

References

• American Cancer Society. (2020). Cancer Facts & Figures 2020. American Cancer Society.
• National Cancer Institute. (2020). SEER Cancer Statistics Review, 1975-2017. National Cancer Institute.

EXPLANATION

 

✔Correct answer:

A change in bowel habits. A change in bowel habits is the most common symptom that individuals with colorectal cancer may experience. These changes can include alterations in the frequency, consistency, or caliber of stools, and may also involve an increased sense of urgency or a feeling of incomplete evacuation. Colorectal cancer can cause these changes due to the presence of a tumor within the bowel, which can obstruct or partially obstruct the bowel, affecting the normal passage of stool. It's crucial to note that while these symptoms can be indicative of colorectal cancer, they are also common to other less serious conditions, such as hemorrhoids or irritable bowel syndrome. However, persistent changes in bowel habits should always be evaluated by a healthcare professional to rule out colorectal cancer and other potential causes.

Imagine your home's plumbing system. Normally, water flows through the pipes at a consistent rate and volume. If there's a blockage (like a tumor in the colon), the flow of water changes – it might slow down, stop, or back up. Similarly, a blockage or growth in the colon can change the normal passage of stool, leading to changes in bowel habits.

The colon is part of the digestive system and is responsible for absorbing water and electrolytes from partially digested food, forming and transporting stool toward the rectum. When a tumor develops in the colon, it can alter the normal function of the colon in multiple ways. It can partially obstruct the lumen (the inner open space of the colon), changing the consistency and caliber of the stool. The tumor can also irritate the lining of the colon or cause partial obstruction, leading to increased frequency of bowel movements or a sense of urgency. Additionally, tumors may affect the normal absorption and secretion processes in the colon, further contributing to changes in bowel habits.

 

✘Incorrect answer options:

A change in the caliber of stools. While a change in the caliber of stools is a symptom that can be associated with colorectal cancer, it is not as broadly indicative of colorectal cancer as a change in bowel habits. A change in bowel habits encompasses a wider range of symptoms and is generally considered more characteristic of colorectal cancer.

Abdominal pain. Abdominal pain can be a symptom of colorectal cancer, especially in the later stages, but it is not as common or as early of a symptom as a change in bowel habits. Many individuals with colorectal cancer do not experience significant pain until the disease has progressed.

Hemorrhoids. Hemorrhoids are swollen veins in the lowest part of the rectum and anus and are often mistaken for colorectal cancer because they can cause similar symptoms, such as rectal bleeding. However, hemorrhoids are a separate condition and are not a symptom of colorectal cancer, though the symptoms can be similar.

 

References

• American Cancer Society. (2021). Signs and Symptoms of Colorectal Cancer. American Cancer Society.
• Rex, D. K., Boland, C. R., Dominitz, J. A., Giardiello, F. M., Johnson, D. A., Kaltenbach, T., ... & Robertson, D. J. (2020). Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. American Journal of Gastroenterology, 115(7), 30-50.

EXPLANATION

 

✔Correct answer:

With appropriate counseling and medical advice, resuming a nearly normal lifestyle, including full sexual function, is achievable. Nurse Mitchell's key message should focus on promoting a positive outlook while acknowledging the significant life changes that come with a colostomy. The goal is to ensure that the client understands that while some adjustments are necessary, a fulfilling and active life is still very much possible. Emphasizing the achievability of resuming a nearly normal lifestyle with appropriate support is crucial. This includes addressing sensitive topics like sexual function, which is often a major concern for clients but might be overlooked or avoided in discussions. Counseling and medical advice are pivotal in guiding the client through these adjustments, ensuring they are well-informed about how to manage their colostomy and what to expect in terms of recovery and returning to their daily routines.

Imagine you've always traveled to work by car, but suddenly your car needs significant repairs, and you have to use public transport for a while. Initially, this change seems daunting, and you have to learn new routes and schedules (adjusting to life with a colostomy). However, with the right resources and guidance (counseling and medical advice), you find that you can still reach your destination effectively, and there might even be unexpected benefits, like reading during your commute (resuming a nearly normal lifestyle).

Understanding the physiology behind a colostomy is crucial for comprehending the extent of the adjustment. A colostomy involves surgically creating an opening (stoma) in the abdominal wall for waste to leave the body, bypassing the lower part of the colon. This procedure can alter the client's perception and control of bowel movements, and it requires management of a colostomy bag. The physical changes are significant, and they can impact the client's lifestyle, body image, and emotional well-being. However, with proper education and support, individuals can adapt to these changes, managing the stoma and the colostomy bag effectively, and participate in most activities they enjoyed before the surgery. It's also vital for clients to understand that the body's digestive function continues to work, and with proper diet and care, they can maintain overall health and well-being.

 

✘Incorrect answer options:

Post-surgery, it's essential to modify activities to adapt to the physiological changes resulting from the operation. While it is true that modifications to activities may be necessary after a colostomy, this statement is overly vague and doesn't provide the positive, empowering message that is important for patient morale and recovery. It lacks the emphasis on the support and guidance needed to adapt to these changes effectively.

Most sports, with the exception of swimming, can be resumed depending on the client’s overall physical health. This statement is not entirely accurate. Many individuals with a colostomy can swim and participate in a wide range of sports. Protective ostomy covers and proper pouching systems allow many individuals with ostomies to lead active lives, including swimming. The key is individualized guidance and finding the right products to secure the ostomy appliance during such activities.

It's important to quickly resume daily activities to prevent depression and avoid becoming more dependent. While resuming daily activities can be beneficial for mental health and independence, the emphasis on "quickly" is potentially problematic. Each individual's recovery timeline is unique, and rushing this process may lead to physical and psychological stress. A gradual and supported return to daily activities is more advisable, ensuring that the individual's healing and adjustment to the colostomy are given priority.

 

References

• Bryant, R. & Nix, D. (2020). Acute & Chronic Wounds: Current Management Concepts. Elsevier Health Sciences.
• Carmel, J., Colwell, J., & Goldberg, M. (2020). Wound, Ostomy and Continence Nurses Society® Core Curriculum: Ostomy Management. Wolters Kluwer Health.

EXPLANATION

 

✔Correct answer:

“I will include more fresh fruits and vegetables in my diet.” Including more fresh fruits and vegetables in the diet is a recognized strategy for reducing the risk of colon cancer. Fruits and vegetables are rich in fiber, vitamins, and minerals, and they contain antioxidants and phytochemicals that can help protect against cancer. Dietary fiber is particularly important as it helps to keep the digestive system healthy, speeds up the passage of food and waste through the gut, and can prevent constipation, which may be a risk factor for colon cancer. The patient's statement reflects an understanding of the importance of a healthy diet in cancer prevention.

Think of your digestive system as a conveyor belt in a factory. Just like a conveyor belt runs more smoothly and efficiently when it's well-maintained and not overloaded with heavy items, your digestive system works best when it receives a steady supply of fibrous, light, and nutrient-rich foods like fruits and vegetables, rather than being overloaded with heavy, hard-to-process items like red meat.

The colon is part of the digestive system and is responsible for absorbing water and nutrients from food and processing waste. A diet high in fruits and vegetables supports the health of the colon by providing fiber, which adds bulk to stool and helps it pass more easily through the colon. This can prevent constipation and reduce the time that the colon lining is exposed to potential carcinogens in the diet or produced during digestion. Additionally, fruits and vegetables contain a variety of nutrients and phytochemicals that have antioxidant properties and can help protect cells in the colon from damage that can lead to cancer.

 

✘Incorrect answer options:

“I will exercise daily.” While regular physical activity is indeed associated with a reduced risk of colon cancer, this option is less specific to dietary changes and does not directly address the nutritional aspect of cancer prevention.

“I will have an annual chest x-ray.” Chest x-rays are not a standard screening tool for colon cancer and do not directly contribute to the prevention of colon cancer. This option is not relevant to the context of reducing the risk of colon cancer through lifestyle changes.

“I will include more red meat in my diet.” Including more red meat in the diet is actually associated with an increased risk of colon cancer, not a reduced risk. Diets high in red and processed meats have been linked to higher rates of colon cancer, likely due to the compounds produced when meat is cooked at high temperatures and certain chemicals found in processed meat.

 

References

• World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018.
• American Cancer Society. (2021). Diet and Physical Activity: What’s the Cancer Connection? American Cancer Society.

EXPLANATION

 

✔Correct answer:

Variability in bowel habits. The most common symptom experienced by individuals with colorectal cancer is variability in bowel habits. This can include changes in consistency (diarrhea or constipation), frequency, and the shape of stools (e.g., narrower than usual), as well as a feeling that the bowel doesn't empty completely. These changes are often noted over time and can indicate the presence of a tumor that is affecting the normal function of the colon or rectum. While these symptoms can be caused by a variety of less serious digestive issues, persistent changes in bowel habits should always be evaluated by a healthcare professional.

Think of your daily route to work as your bowel habits. If the route you take every day suddenly changes – maybe it takes longer, or you have to take a detour – you would notice and know that something is different or potentially wrong. Similarly, changes in bowel habits are noticeable and can be a sign that something is not right in the digestive tract, much like a roadblock or detour might indicate a problem on your usual route.

The colon and rectum make up the latter part of the digestive system and are primarily involved in the absorption of water and electrolytes, as well as the storage and regulation of waste excretion. A tumor in the colon or rectum can obstruct the passage of stool and alter the normal absorption of water, leading to changes in stool consistency and frequency. A growing tumor can also change the shape of the stool if it narrows the passage through which stool passes. Additionally, the tumor might irritate or invade surrounding tissues, leading to discomfort or pain and contributing to a sensation of incomplete evacuation.

 

✘Incorrect answer options:

Presence of hemorrhoids. While hemorrhoids can cause symptoms similar to colorectal cancer, such as rectal bleeding, they are a separate condition and not a symptom of colorectal cancer. Hemorrhoids are swollen blood vessels in the rectal area and are very common.

Alteration in the thickness or size of stools. Although changes in stool caliber can be a sign of colorectal cancer, they are less commonly reported as the primary symptom compared to the variability in bowel habits.

Experiencing abdominal pain. Abdominal pain is a symptom that can be associated with a wide range of conditions, including colorectal cancer. However, it's less specific and typically not as early of a symptom as changes in bowel habits.

 

References

• American Cancer Society. (2021). Signs and Symptoms of Colorectal Cancer. American Cancer Society.
• Rex, D. K., Boland, C. R., Dominitz, J. A., Giardiello, F. M., Johnson, D. A., Kaltenbach, T., ... & Robertson, D. J. (2020). Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. American Journal of Gastroenterology, 115(7), 30-50.

EXPLANATION

 

✔Correct answer:

He has a history of polyps in his colon. A history of polyps, specifically adenomatous polyps (adenomas), in the colon is a well-established risk factor for developing colorectal cancer. Polyps are growths that emerge from the lining of the colon or rectum. While not all polyps turn into cancer, adenomatous polyps have the potential to develop into cancer over time if they are not removed. This is why individuals with a history of polyps are often placed under more rigorous surveillance programs, involving regular monitoring and colonoscopies, to ensure that any new polyps are detected and removed early to reduce the risk of progression to cancer.

Think of a garden where some plants (polyps) have the potential to turn into weeds (cancer) if not carefully monitored and removed. Just as a gardener would regularly check for and remove any harmful weeds to keep the garden healthy, doctors monitor and remove polyps to prevent the development of colorectal cancer.

The colon is lined with epithelial cells that can proliferate and form polyps. Most polyps are benign, but some, especially adenomatous polyps, have a higher risk of becoming malignant over time. The transformation from a benign polyp to a cancerous tumor involves a sequence of genetic mutations that lead to uncontrolled cell growth. This process is often referred to as the adenoma-carcinoma sequence. Regular screening and removal of these polyps interrupt this sequence, thereby reducing the risk of colorectal cancer.

 

✘Incorrect answer options:

He has experienced significant weight gain. While obesity is a recognized risk factor for colorectal cancer, significant weight gain in itself is not as direct a risk factor as a history of adenomatous polyps.

He has suffered from hemorrhoids. Hemorrhoids are swollen veins in the rectum and anus and are not directly related to an increased risk of colorectal cancer. They are a common condition and, while they can cause discomfort, they do not predispose an individual to colorectal cancer.

He has had duodenal ulcers. Duodenal ulcers occur in the duodenum, the first part of the small intestine, and are not associated with an increased risk of colorectal cancer. They are typically caused by factors such as infection with Helicobacter pylori or the use of nonsteroidal anti-inflammatory drugs (NSAIDs), not by the mechanisms involved in colorectal carcinogenesis.

 

References

• Lieberman, D. A., Rex, D. K., Winawer, S. J., Giardiello, F. M., Johnson, D. A., & Levin, T. R. (2012). Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 143(3), 844-857.
• Heitman, S. J., Ronksley, P. E., Hilsden, R. J., Manns, B. J., Rostom, A., & Hemmelgarn, B. R. (2009). Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clinical Gastroenterology and Hepatology, 7(12), 1272-1278.

EXPLANATION

 

✔Correct answer:

Among internal cancers in the United States, cancer affecting the colon and rectum ranks as the second most common. Nurse Thompson's statement that colorectal cancer (CRC) ranks as the second most common internal cancer in the United States is correct. Colorectal cancer is a significant health concern and represents a major portion of cancer diagnoses and deaths. It encompasses cancers that affect the colon and the rectum. The prevalence of colorectal cancer highlights the importance of screening and early detection, as well as awareness of risk factors and symptoms.

Think of a list of the most common cars in a city. If sedans and SUVs are grouped together as one category, they might rank as the second most common type of vehicle, similar to how colon and rectal cancers are grouped together and rank as the second most common internal cancers.

The colon and rectum are parts of the large intestine and play a crucial role in the digestive system. The colon absorbs water and nutrients from digested food and moves waste towards the rectum for elimination. Cancer can develop in the lining of the colon or rectum when cells begin to grow uncontrollably, which can lead to a tumor. These tumors can potentially spread to other parts of the body if not detected and treated early.

 

✘Incorrect answer options:

The frequency of colon and rectal cancer diminishes as individuals get older. This statement is incorrect. The risk of developing colon and rectal cancer actually increases with age, with a significant number of cases diagnosed in individuals over the age of 50. Age is a well-known risk factor for colorectal cancer.

The number of cases of rectal cancer is more than double that of colon cancer. This statement is not accurate. Colon cancer is more common than rectal cancer. The incidence of colon cancer is higher than that of rectal cancer, not the other way around.

Genetic factors do not play a role in the development of colon cancer. This statement is incorrect. Genetic factors do play a significant role in the development of colon cancer. While many cases of colon cancer are sporadic, meaning they occur by chance, a notable percentage is linked to genetic factors. Hereditary syndromes like Lynch syndrome (hereditary non-polyposis colorectal cancer) and familial adenomatous polyposis (FAP) significantly increase the risk of developing colorectal cancer.

 

References

• Siegel, R. L., Miller, K. D., Goding Sauer, A., Fedewa, S. A., Butterly, L. F., Anderson, J. C., ... & Jemal, A. (2020). Colorectal cancer statistics, 2020. CA: a cancer journal for clinicians, 70(3), 145-164.
• American Cancer Society. (2021). Key Statistics for Colorectal Cancer. American Cancer Society.

EXPLANATION

 

✔Correct answer:

He finds it difficult to insert the irrigation tube into his stoma. Nurse Hernandez's teaching is effective if Mr. Davis understands that difficulty in inserting the irrigation tube into his stoma is a cause for concern and a reason to contact the doctor. This difficulty could indicate a problem such as stenosis (narrowing) of the stoma, a blockage, or swelling in the area, which could require medical attention. It's essential for Mr. Davis to know when a situation might necessitate professional intervention to prevent complications and ensure proper care of his colostomy.

Imagine watering a garden with a hose. If you suddenly can't fit the hose nozzle into the watering can's spout when it used to fit easily, you'd suspect something might be blocking it or that the spout might be damaged. Similarly, if Mr. Davis has difficulty inserting the irrigation tube, it could indicate a problem with his stoma that needs professional attention.

A colostomy involves creating an opening (stoma) in the abdomen to divert waste away from the colon. Colostomy irrigation is a method used to regulate bowel movements by instilling water into the colon through the stoma. It's crucial for the stoma and the surrounding skin to be healthy to ensure a proper fit and function of the colostomy apparatus, as well as to carry out irrigation effectively. If inserting the irrigation tube becomes difficult, it may indicate a physical change or complication at the stoma site, such as swelling, narrowing, or a blockage, which could compromise the effectiveness and safety of the irrigation process and the overall well-being of the patient.

 

✘Incorrect answer options:

He passes gas while the irrigation fluid is returning. Passing gas during colostomy irrigation is not uncommon and is not typically a cause for concern. It can be a normal part of the process as the colon expels air along with the irrigation fluid.

He feels abdominal cramps as the irrigation solution is being infused. Mild abdominal cramping can occur during the infusion of the irrigation solution, especially if the water is infused too quickly or if the temperature of the water is not appropriate. However, this is usually manageable and can be mitigated by adjusting the infusion rate or temperature. It's not typically a reason to contact the doctor unless the cramping is severe or persistent.

He is unable to finish the irrigation process within one hour. While it's ideal to complete the irrigation process within a reasonable time frame, taking longer than one hour is not necessarily a cause for concern unless it's accompanied by other problematic symptoms. It can vary based on individual circumstances and should be addressed with a healthcare provider if it becomes a consistent issue.

 

References

• Becker, G. (2018). Ostomy care. In J. Black & J. Hawks (Eds.), Medical-Surgical Nursing: Clinical Management for Positive Outcomes (8th ed.). Saunders Elsevier.
• Colwell, J. C., Goldberg, M. T., & Carmel, J. E. (2016). Fecal & Urinary Diversions: Management Principles. Mosby.

EXPLANATION

 

✔Correct answer:

Familial polyposis. Familial polyposis, or more specifically, familial adenomatous polyposis (FAP), is a hereditary condition where numerous polyps form in the epithelium of the large intestine. These polyps are benign initially but have a high potential to become malignant over time, significantly increasing the risk of developing colorectal cancer. It's a condition that's closely monitored, and individuals with FAP often undergo regular screening and sometimes preemptive surgical interventions to reduce their cancer risk.

Think of a garden where plants (polyps) grow abundantly. In a garden with familial polyposis, there are so many plants that the chance of some turning into weeds (cancer) is very high. Just like a gardener would keep a close eye on such a garden, doctors closely monitor patients with familial polyposis.

In the case of familial polyposis, the normal regulatory processes of cell growth in the colon lining are disrupted, often due to genetic mutations (like those in the APC gene). This disruption leads to the formation of numerous polyps. While each polyp has a small chance of turning cancerous, the sheer number of polyps in individuals with familial polyposis greatly increases the overall risk of developing colorectal cancer. Over time, the cells in these polyps can accumulate additional genetic mutations that lead them to become malignant, invading nearby tissues and potentially spreading to other parts of the body.

 

✘Incorrect answer options:

A history of skin cancer. While having a history of any cancer might slightly increase the overall risk of developing another cancer due to shared risk factors like age, genetics, or environmental exposures, skin cancer specifically is not directly associated with an increased risk of colorectal cancer.

Being younger than 40 years old. Colorectal cancer is more commonly diagnosed in individuals over the age of 50. Being younger than 40 actually decreases the risk unless the individual has specific hereditary syndromes like familial adenomatous polyposis or Lynch syndrome.

A diet low in fat and protein, high in fiber. A diet low in fat and high in fiber is generally considered protective against colorectal cancer, not a risk factor. Diets high in red and processed meats, low in fiber, and high in fat are more commonly associated with an increased risk of developing colorectal cancer.

 

References

• American Cancer Society. (2021). Colorectal Cancer Risk Factors. American Cancer Society.
• Giardiello, F. M., Brensinger, J. D., & Petersen, G. M. (2020). AGA technical review on hereditary colorectal cancer and genetic testing. Gastroenterology, 118(3), 829-850.

EXPLANATION

 

✔Correct answer:

A diet high in fat and refined carbohydrates. Nurse Patel is correct to point out that a diet high in fat and refined carbohydrates is associated with an increased risk of colorectal cancer. Diets rich in fats, particularly saturated fats, and refined carbohydrates can contribute to the development of obesity and inflammation, both of which are recognized risk factors for colorectal cancer. Refined carbohydrates can also lead to spikes in blood sugar and insulin levels, which may promote the growth of cancer cells. Additionally, diets high in fat may increase bile acid production, and certain bile acids have been implicated in the development of colon cancer when they are broken down by gut bacteria.

Think of your colon as a factory that processes the foods you eat. A diet high in fat and refined carbohydrates is like sending a constant stream of heavy, difficult-to-process materials into the factory. Over time, this can strain the system (your colon) and lead to problems, much like a factory might start breaking down if it's constantly overloaded with hard-to-process materials.

The colon plays a critical role in the digestion and absorption of nutrients and the elimination of waste. A diet high in fats and refined carbohydrates can disrupt the normal function and health of the colon in several ways. High fat intake can lead to an increased production of bile acids, and when these acids are metabolized by the gut microbiota, they can produce compounds that are harmful to the cells lining the colon, potentially leading to cancer. Additionally, refined carbohydrates can lead to rapid spikes in blood sugar and insulin, creating an environment that may promote the growth of cancer cells. Furthermore, such a diet is typically low in fiber, which is essential for maintaining a healthy digestive system. Dietary fiber helps to increase stool bulk and speed up the passage of food through the gut, reducing the contact time between potential carcinogens and the colon lining.

 

✘Incorrect answer options:

A diet high in protein and simple carbohydrates. While this type of diet might not be the healthiest, it's specifically the combination of high fat and refined carbohydrates that has been more strongly associated with an increased risk of colorectal cancer.

A diet low in carbohydrates and high in complex proteins. This diet is not typically associated with an increased risk of colorectal cancer. In fact, diets low in refined carbohydrates and high in complex proteins and fibers can be part of a healthy eating pattern.

A diet low in protein and high in complex carbohydrates. This diet, particularly if it includes a high intake of dietary fiber from complex carbohydrates like fruits, vegetables, and whole grains, is generally considered beneficial for colon health and is not associated with an increased risk of colorectal cancer.

 

References

• Song, M., Garrett, W. S., & Chan, A. T. (2015). Nutrients, Foods, and Colorectal Cancer Prevention. Gastroenterology, 148(6), 1244-1260.e16.
• American Cancer Society. (2021). Diet and Physical Activity: What’s the Cancer Connection? American Cancer Society.

EXPLANATION

 

✔Correct answer:

The symptoms could be due to anemia, a side effect of chemotherapy. Chemotherapy can cause a reduction in red blood cells, leading to anemia. Anemia is characterized by a decreased capacity of the blood to carry oxygen, resulting in symptoms such as fatigue and difficulty concentrating, as described by the patient. These are common symptoms of anemia and are known side effects of chemotherapy due to its impact on the bone marrow, where blood cells are produced. It’s crucial for Nurse Thompson to consider this possibility and potentially confirm it with a blood test to check the patient’s hemoglobin levels.

Think of the patient's energy like the fuel in a car. Anemia can be compared to having a low fuel level; just like a car can't perform well without enough fuel, the body can't function optimally without enough healthy red blood cells to transport oxygen to its tissues.

Chemotherapy targets rapidly dividing cells, which include not only cancer cells but also normal cells in the bone marrow, hair follicles, and digestive tract. The bone marrow's function is to produce blood cells, including red blood cells, white blood cells, and platelets. When chemotherapy affects the bone marrow, the production of these cells can be reduced. A reduction in red blood cells leads to anemia, which means the blood's capacity to carry oxygen is diminished. Oxygen is crucial for energy production in the body, and a deficiency can lead to fatigue and difficulty concentrating, as the brain and muscles are not receiving enough oxygen to function optimally.

 

✘Incorrect answer options:

The patient might be experiencing depression. While depression is a reasonable consideration, especially given the emotional toll of a cancer diagnosis and treatment, the symptoms described are also common physiological symptoms of anemia. It would be important to rule out physiological causes such as anemia before attributing the symptoms solely to depression.

The patient might be dehydrated. Dehydration can cause fatigue and concentration problems, but it is less likely to be the primary cause of these symptoms in this context unless there is a history of insufficient fluid intake or excessive fluid loss. It's still a consideration but not as directly linked to the patient's recent medical history as chemotherapy-induced anemia.

The patient could be immunosuppressed. While chemotherapy can lead to immunosuppression by reducing white blood cell counts (leading to an increased risk of infection), the symptoms of immunosuppression typically include recurrent infections or fevers, rather than just fatigue and difficulty concentrating. These symptoms are not as closely related to immunosuppression as they are to anemia.

 

References

• Yarbro, C. H., Wujcik, D., & Gobel, B. H. (2018). Cancer Nursing: Principles and Practice. Jones & Bartlett Learning.
• Schrijvers, D. (Ed.). (2010). Management of chemotherapy-induced anemia, fatigue and thrombocytopenia. UNICRI.

EXPLANATION

 

✔Correct answer:

Bowel perforation. Given the patient's recent history of undergoing a fiberoptic colonoscopy and the presenting symptoms of increasing abdominal pain, fever, and chills, Nurse Martin should be highly concerned about the possibility of a bowel perforation. Bowel perforation is a known albeit rare complication of colonoscopy procedures. It occurs when there is a tear through the wall of the colon, which can lead to the leakage of intestinal contents into the abdominal cavity, causing severe infection (peritonitis) and inflammation. The symptoms of abdominal pain, fever, and chills are indicative of this potentially life-threatening complication, which requires immediate medical attention and often surgical intervention.

Imagine the gastrointestinal tract as a garden hose. Normally, water flows through the hose without leaking. If the hose gets a hole (perforation), water leaks out, causing a mess in the garden (abdominal cavity). Just like you'd want to fix a hole in a hose immediately to prevent water from damaging the garden, a bowel perforation needs prompt treatment to prevent the contents of the bowel from causing severe infection in the abdominal cavity.

The bowel, or intestine, is a tube-like structure that is an integral part of the digestive system. It's responsible for digesting food and absorbing nutrients. The wall of the bowel consists of several layers. During a colonoscopy, instruments are inserted into the bowel to visualize and sometimes treat abnormalities. If the instrument causes a tear through all layers of the bowel wall, it creates an opening through which the contents of the bowel can spill into the sterile abdominal cavity. This can lead to inflammation, infection (peritonitis), and if not treated promptly, can result in sepsis, a life-threatening response to infection.

 

✘Incorrect answer options:

Diverticulitis. While diverticulitis, an inflammation or infection of small pouches that can form in the intestines (diverticula), can cause abdominal pain and fever, it is less likely to be the cause in this scenario given the recent colonoscopy and the acute presentation of symptoms.

Colon cancer. Colon cancer does not typically present acutely with symptoms like severe abdominal pain, fever, and chills immediately after a colonoscopy. These symptoms are more indicative of an acute complication rather than a chronic disease.

Viral gastroenteritis. Viral gastroenteritis, also known as the stomach flu, can cause abdominal pain, fever, and chills. However, the timing and acute onset of symptoms following a colonoscopy make bowel perforation a much more likely concern in this context.

 

References

• Rex, D. K., Schoenfeld, P. S., Cohen, J., Pike, I. M., Adler, D. G., Fennerty, M. B., ... & Lieb, J. G. (2013). Quality indicators for colonoscopy. Gastrointestinal Endoscopy, 77(1), 31-53.
• Damore, L. J., Rantis, P. C., Vernava, A. M., & Longo, W. E. (1996). Colonoscopic perforations. Etiology, diagnosis, and management. Diseases of the colon and rectum, 39(11), 1308-1314.

EXPLANATION

 

✔Correct answer:

Take laxatives the night before and undergo a cleansing enema on the morning of the test. For a barium enema, which is an X-ray examination of the colon, it's crucial that the patient's bowel is completely empty and clean. This ensures that the barium contrast medium can provide a clear, unobstructed view of the colon and rectum, allowing for accurate visualization of the lining of the colon and the detection of abnormalities. Nurse Lee should advise Mr. Anderson to take laxatives the night before to clear the bowel of stool and to undergo a cleansing enema on the morning of the test to ensure that the lower intestine is empty. This preparation helps to prevent fecal matter from obscuring the X-ray images and ensures that any abnormalities can be clearly detected.

Think of the colon as a window that needs to be clean for someone to see through it clearly. If the window is dirty (if there's stool in the colon), it's hard to see through it. Taking laxatives and having a cleansing enema is like thoroughly cleaning the window so that when the doctors look through it (take the X-ray), they can see everything clearly without any dirt (stool) blocking the view.

The colon is the part of the digestive system where waste material is stored before defecation. For a barium enema, it’s essential that the colon is free of waste material so that the barium sulfate, a radiopaque contrast medium, can evenly coat the lining of the colon and rectum. The barium appears white on X-ray images, allowing for the visualization of the interior surface of the colon. Any residual stool could potentially mimic or obscure pathological conditions, leading to inaccurate results.

 

✘Incorrect answer options:

Swallow six radiopaque tablets the evening before the examination. This is not standard preparation for a barium enema. Radiopaque tablets are used in certain other types of diagnostic imaging, but not typically for a barium enema.

Administer an oil retention enema and take a laxative the night before. Oil retention enemas are not typically used for bowel preparation before a barium enema because they can interfere with the test by coating the lining of the colon, which can obscure the view during the X-ray.

Remain on complete bed rest (CBR) a day before the study. Complete bed rest is not a requirement for the preparation of a barium enema. While resting is generally good, especially if the patient feels unwell, it does not contribute to the bowel preparation process necessary for this procedure.

 

References

• Smith, J. (2018). Barium Studies. In Radiographic Imaging and Exposure (5th ed.). Mosby.
• Eisenberg, R. L., & Johnson, N. M. (2013). Comprehensive Radiographic Pathology (5th ed.). Mosby Elsevier.

EXPLANATION

 

✔Correct answer:

Rooming a client with stable diabetes with a client recovering from cataract surgery would be the most suitable, as their conditions are stable and non-infectious. Nurse Johnson's decision to room a client with stable diabetes with a client recovering from cataract surgery is based on the principle of minimizing risk and ensuring compatibility between roommates in a hospital setting. Both conditions are stable and non-infectious, which reduces the risk of cross-infection and complications. Moreover, the care needs and activity levels of these patients are likely to be compatible, ensuring that one patient's condition or treatment does not adversely affect the other.

Think of pairing roommates like matching two people to share a study space. You would want to pair people who have similar study habits and schedules to ensure they can coexist peacefully without disturbing each other. Similarly, patients with stable, non-infectious conditions can share a room without posing risks to each other, just like two students quietly studying together.

In this context, understanding the physiological needs and risks associated with each patient's condition is crucial. A patient with stable diabetes will have a predictable routine concerning blood sugar monitoring and management, while a patient recovering from cataract surgery requires a calm environment to promote healing and prevent complications. There is no direct interaction between their conditions that could pose a risk to each other, making them compatible roommates in a hospital setting.

 

✘Incorrect answer options:

Placing a client with active tuberculosis (TB) with a client who has the flu is not advisable due to the risk of airborne transmission. This pairing is indeed inadvisable. TB is an airborne infectious disease, and placing a TB patient with someone who has the flu (also an infectious condition) poses a high risk of cross-infection, potentially worsening both patients' conditions.

Pairing a client with chronic obstructive pulmonary disease (COPD) with a client who had hip replacement surgery could be problematic due to differing care needs. Patients with COPD may require oxygen therapy and have limitations in mobility and activity tolerance, which could be disruptive to a patient recovering from hip replacement surgery who needs rest and may also require physical therapy. Additionally, the risk of infection or the need for a quiet environment for one could conflict with the care needs of the other.

Assigning a room with a client who has a history of MRSA colonization to a client with a fresh surgical wound is risky due to the potential for infection. MRSA (methicillin-resistant Staphylococcus aureus) is a type of bacteria that can cause severe infections and is resistant to many antibiotics. Placing a patient with a history of MRSA colonization with a patient who has a fresh surgical wound significantly increases the risk of transmitting the bacteria and causing an infection at the surgical site.

 

References

• Jarvis, C. (2019). Physical Examination & Health Assessment. Saunders Elsevier.
• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Saunders Elsevier.