Nursing Interventions for Prostate Cancer and Colorectal Cancer, Exams of Nursing

Download Nursing Interventions for Prostate Cancer and Colorectal Cancer and more Exams Nursing in PDF only on Docsity! 1 1 Module 4-5 Quiz-Questions and Verified Answers Latest Solved By Expert Top Ranked Solutions 1. A client is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? (Select all that apply.) a. Family history of prostate cancer b.Smoking c.Obesity d.Advanced age e. Eating too much red meat f. Race Rationale with page number: 1484 chi 72 Iggy. Prostate cancer is caused by a number of factors. Advanced age is the leading risk factor. The risk increases for men who have a first- degree relative (brother, father) with the disease. Other risk factors that may play a role are eating a diet high in animal fat (e.g., red meat) and refined carbohydrates or having a low fiber intake. Men who have had a vasectomy or those who were exposed to environmental toxins, such as arsenic, may also be at increased risk for the disease. African Americans are most at risk. 2. A client is diagnosed with metastatic prostate cancer. The client asks the nurse the purpose of his treatment with the luteinizing hormone–releasing hormone (LH-RH) agonist leuprolide (Lupron) and the bisphosphonate pamidronate (Acedia). Which statement by the nurse is most appropriate? a. “The treatment reduces testosterone and prevents bone fractures.” b.“The medications prevent erectile dysfunction and increase libido.” c. “There is less gynecomastia and osteoporosis with this drug regimen.” d.“These medications both inhibit tumor progression by blocking androgens.” Rationale with page number: pg. 1485 Iggy. Examples of LH-RH agonists are Leuprolide (Lupron), goserelin (Zoladex), and triptorelin (Trelstar). These drugs first stimulate the pituitary gland to release the luteinizing hormone (LH). After about 3 weeks, the pituitary gland “runs out” of LH, which reduces testosterone production by the testes 2 2 3. A 55-year-old African-American client is having a visit with his health care provider. What test should the nurse discuss with the client as an option to screen for prostate cancer, even though screening is not routinely recommended? a. Complete blood count b.Culture and sensitivity c. Prostate- specific antigen d. Cystoscopy Rationale with page number: Iggy 72. page 1482. PSA is a glycoprotein produced by the prostate. PSA analysis is used as a screening test for prostate cancer. If the test is performed, it should be drawn before the DRE because the examination can cause an increase in PSA caused by prostate irritation. 5 5 7. A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important? a. Assess the client’s gait and balance. b.Ask the client about the ease of urine flow. c. Document the report completely. d. Inquire about the client’s job risks. Rationale with page number: Back pain is a common first symptom and occurs before other problems or nerve deficits. Other symptoms include weakness, loss of sensation, urinary retention, and constipation. Loss of or reduced deep tendon reflexes along with reduced pinprick and vibratory sensations are other findings that may be present on physical assessment. Assess for back pain that worsens over time; neurologic changes; muscle weakness or a sensation of heaviness in the arms or legs; numbness or tingling in the hands or feet; inability to distinguish pinprick, touch, or hot and cold sensation; and an unsteady gait. Iggy Chapter 22 pg. 408 8. 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 Rationale with page number: The major risk factors for the development of colorectal cancer (CRC) include being older than 50 years, genetic predisposition, personal or family history of cancer, and/or diseases that predispose the patient to cancer such as familial adenomatous polyposis (FAP), Crohn's disease, and ulcerative colitis (McCance et al., 2014). Only a small percentage of colorectal cancers are familial and transmitted genetically. 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. Iggy Chapter 56 pg. 1127 9. A nurse prepares a client for a colonoscopy scheduled for tomorrow. The 6 6 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.” 7 7 Rationale with page number: Negative results do not completely rule out the possibility of CRC; for this reason additional testing may be suggested. Colonoscopy is the definitive test for the diagnosis of colorectal cancer. Iggy Ch. 56 pg. 1129 three tests 10. The process of digestion is important for every living organism for the purpose of nourishment. Where does most digestion take place in the body? The SMALL INTESTINE Rationale with page number: No rationale needed. Page 157 of Giddens Concept 17 11. A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? a. Administer intravenous opioid medications. b. Position the client with knees to chest. c. Insert a nasogastric tube for decompression. d. Assess the client’s bowel sounds. Rationale with page number: The nurse should immediately check for bowel sounds because a change in the nature or timing of abdominal pain in a client with an obstruction could indicate peritonitis or perforation. Iggy Ch. 56 page 1123 12. 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.” Rationale with page number: A high fat diet, particularly high in animal fat from red meats, increases bile acid secretion and anaerobic bacteria, which 10 10 GI cancer, Crohn's disease, and other GI disturbances with familial links. Pg 1052 16. While caring for a female patient with advanced multiple sclerosis, the nurse is discussing the difference between hospice and palliative care. Which statement by the patient indicates understanding of the difference between hospice and palliative care? a. “I will need to get hospice care if I want my symptoms controlled.” b. “I can get palliative care right now— even though I am not going to die anytime soon.” c. “My doctor has to make the decision if I have hospice care.” 11 11 d. “I can't get any other treatments, even if they are experimental, if I choose palliative care.” Rationale with page number: B. Hospice care and palliative care are focused on the management of symptoms. Hospice care is provided to those who have a prognosis of less than six months to live. Palliative care is provided to any person who needs assistance with management of symptoms. Physicians delineate the prognosis, but the patient and family ultimately make the decision if they want care provided by hospice. 17. The nurse is orienting new staff to a clinical unit that provides palliative care. A new employee asks what “grief” is exactly. Which statement indicates that the nurse has correctly defined grief? a. The emotional response to a loss b. The outward, social expression of a loss c. The depression felt after a loss d. The loss of a possession or loved one Rationale with page number: A. Grief is the emotional response to a loss that is an individualized and deeply personal feeling related to a real or perceived loss. The outward, social expression of a loss is bereavement. Depression is not a normal response to loss, although there are many emotional feelings that occur related to a loss. The loss of a possession or a loved one is considered an actual loss. 18. The nurse has been caring for a 65-year-old male patient who has just died. In planning for follow-up bereavement care, the nurse knows that which person is at risk for disenfranchised grief? a. A daughter who lives in a different state b. The son who was with the client when he died c. An estranged ex-wife of the patient who lives nearby d. The 16-year-old grandchild of the patient Rationale with page number: C. pg. 858. Disenfranchised grief may occur with any loss that is not validated or recognized. This type of grief is encountered when a loss is experienced that cannot be openly acknowledged or publicly shared by the grieving person. An ex-wife who has been estranged from the deceased may not be able to openly express the grief that she may feel over the loss of someone who once played a significant part in her life. Other family members, such as a daughter who lives in another state, a son 12 12 who has been active in the patient's care, or a grandchild, are able to openly express their grief and are viewed by society as having an acceptable grief response. 19. The mother of two children, 8 and 10 years of age, has just experienced the death of her mother, the children's grandmother. The mother is concerned about the emotional impact attending the funeral may have on her children. She asks the nurse what she should do in relation to her children attending the funeral. What is the nurse's best response? 15 15 Rationale with page number: Boost 1113 -Each of these theories specifies stages and goals for achievement at each stage as people move successfully through the process of grieving. -These stages are to be regarded simply as a guide to understanding the process of grief, with no specific timeline detailing when people “should be” in a certain stage or “should” move from one stage to the next. 22. Which statement is true regarding advance directives? a. Advance directives apply only when the person has a chronic illness. b. Advance directives should be drawn up by family members of people who are incompetent. c. Discussion of advance directives is a nursing responsibility. Boost pg. 959 d. Advance directives should be kept in a safety deposit box until the person dies. Rationale with page number: Advance are legal documents that allow people to communicate their wishes about what type of medical care they would like to receive at the end of life. It is a nursing responsibility to be aware of types of advance directives available and to discuss the options with patients and families. A copy of the patient's advance directives should be part of the medical records. Advance directives are discussed in greater detail in Chapter 11. Boost p.1122 23. In which scenario is hospice care provided? a. Only in the homes of the terminally ill b.For any terminal illness that requires symptom control c. For cancer patients only in their last weeks of life d. In hospital settings based on the seriousness of the illness Rationale with page number: The care provided by hospice occurs in various settings with a focus on symptom control and with the understanding that dying is a part of the normal life cycle. Care is provided to patients and families in the home, residential or long-term care facilities, dedicated inpatient settings, designated hospital beds, and prisons, and even to homeless populations. Boost 1123 24. In caring for a dying patient, what is an appropriate nursing action to increase family involvement? a. Insisting that all bedside care be performed by the family b.Asking family members what they would like to do for their loved one and allowing them to participate c.Expecting the family to be able to perform the patient's daily needs and 16 16 to meet them consistently d.Refusing all assistance from the family, to decrease family stress Rationale with page number: Educate caregivers about how to provide physical care measures to allow the family to provide safe care in a manner that will allow comfort for the patient as well as the family. Boost p. 1125 25. The nurse caring for a dying patient understands that “nearing death awareness” is occurring when the patient asks which question. 17 17 a. “Where are my shoes? I need to get ready for the trip.” b.“Is my daughter from California going to come and visit before I die?” c. “When do you think that I am going to die?” d.“How much longer can I live without food or water?” Rationale with page number: “Nearing Death Awareness” Boost Chapter 42 pg. 1126 26. For a patient who is receiving chemotherapy, which laboratory result is of particular importance? A. White blood cell count (WBC) B. Prothrombin time and partial thromboplastin time C. Electrolyte levels D. Blood urea nitrogen level Rationale with page number: Iggy Chapter 22 pg. 396 “Side effects of Chemotherapy” “Interprofessional Collaborative Care” 27. Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients who must be placed on bleeding precautions? (Select all that apply). A. Provide mouthwash with alcohol for oral rinsing. B. Use paper tape on fragile skin. C. Provide a soft toothbrush or oral sponge. D. Gently insert rectal suppositories. E. Avoid aspirin or aspirin-containing products. F. Avoid over-inflation of blood pressure cuffs. G. Pad sharp corners of furniture. Rationale with page number: Iggy Chapter 22 pg. 398 Chart 22-5 “Prevention of Injury for the Patient with Thrombocytopenia” Chart 22-6 “Preventing Injury or Bleeding” 28. In the care of a patient with neutropenia, what tasks can be delegated to a UAP? (Select all that apply). C. Assessing for sore throat, cough, or burning with urination. D. Gathering the supplies to prepare the room for protective isolation. E. Reporting superinfections, such as candidiasis. A. Taking VS every 4 hours B. Reporting temperature of more than 100.4F. 20 20 D. Place a padded tongue blade on the wall above the patient’s bed. Rationale with page number: UAPS can't assess and you wouldn't put anything in a pts mouth when they are having a seizure 33. Which type of seizure is most likely to cause death for the patient? A. Status epilepticus B. Myoclonic seizures C. Subclinical seizures D. Psychogenic seizures 21 21 Rationale with page number: Status epilepticus is a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes. It is a potential complication of all types of seizures. Seizures lasting longer than 10 minutes can cause death! Page 879 Iggy chi 42 34. A patient admitted to the hospital following a generalized tonic-clinic seizure asks the nurse what caused the seizure. What is the best response by the nurse? B. “Epilepsy is an inherited disorder. Does anyone else in your family have a seizure disorder?” C. “In seizures, some type of trigger causes sudden, abnormal bursts of electrical discharges.” D. “Scar tissue in the brain alters the chemical balance, creating uncontrolled electrical discharges.” Rationale with page number: Although a seizure is an abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain, scar tissue is not the cause of this occurrence. A single seizure may occur for no known reason. Triggers can be linked to seizures such as in head trauma while some seizures are caused by: pathologic conditions of the brain, such as a tumor; prolonged infection or chronic illness; metabolic imbalances; drug/alcohol withdrawal. Iggy pg. 878 35. When teaching a patient with a seizure disorder about the medication regimen, what is to most important for the nurse to emphasize? A. The patient should increase the dosage of the medication if stress is increased. B. Most over-the-counter and prescription drugs are safe to take with antiseizure drugs. C. Stopping the medication abruptly may increase the intensity and frequency of seizures. D. If gingival hypertrophy occurs, the HCP should be notified and the drug may be changed. Rationale with page number: Certain herbs can interact with antiseizure drugs (see Complementary and Alternative Therapy Box 19.1), and dose adjustment may be required. Teach patients not to self-medicate with over- the-counter (OTC) drugs without first consulting a health care provider. Teach pts not to abruptly stop drug therapy but rather to withdraw the prescribed drug gradually under medical supervision to prevent seizure rebound (recurrence of A. “So many factors can cause epilepsy that it is impossible to say what caused your seizure.” 22 22 seizures) and status epilepticus. Pharmacology pg. 253 36. A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. The best response by the nurse includes what information about BPH. A. BPH is a benign tumor that does not spread beyond the prostate gland. B. BPH is a precursor to prostate cancer buy does not yet show any malignant changes. C. BPH is an enlargement of the gland caused by an increase in the size of existing cells. Rationale with page number: D. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells. 25 25 irrigate the catheter with normal saline solution per surgeon or hospital protocol.” This rationale does not apply to the possibly answers noted above. 41. A patient with continuous bladder irrigation following a prostatectomy tells the nurse that he has bladder spasms and leaking of urine around the catheter. What should the nurse do first? A. Slow the rate of the irrigation. B. Assess the patency of the catheter. C. Encourage the patient to try to urinate around the catheter. D. Administer a belladonna and opium (B&O) suppository as prescribed. Rationale with page number: Iggy Ch 72 page 1480 - Care of the Patient after Transurethral Resection of the Prostate • Assess the patient for reports of severe bladder spasms with decreased urinary output, which may indicate obstruction. • If the urinary catheter is obstructed, irrigate it per agency or surgeon protocol. • Notify the surgeon immediately if the obstruction does not resolve by hand irrigation 42. The nurse provided discharge teaching to a patient following a TURP and determines that the patient understands the instructions when he makes which statement? A. “I should use daily enemas to avoid straining until healing is complete.” B. “I will avoid heavy lifting, climbing, and driving until my follow-up visit.” C. “At least I don’t have to worry about developing cancer of the prostate now.” D. “Every day I should drink 10 to 12 glasses of liquids such as coffee, tea, or soft drinks.” Rationale with page number: Iggy Ch 72 page 1486 - “Encourage the patient to walk short distances. Lifting may be restricted to no more than 15 lb. (6.8 kg) for up to 6 weeks if an open procedure was done. Remind him to maintain an upright position and not to walk bent or flexed. Vigorous exercise such as running or jumping should be avoided for at least 6 weeks and then gradually introduced.” 43. What accurately describes prostate cancer detection and /or treatment (select all that apply)? C. Orchiectomy is a treatment option for all patients with prostatic cancer except those with stage IV tumors. D. The preferred hormonal therapy for treatment of prostate cancer includes estrogen and androgen receptor blockers. A. The symptoms of pelvic or perineal pain, fatigue, and malaise may be present. B. Palpation of the prostate reveals hard and symmetric enlargement with areas of induration or nodules. (1483) 26 26 E. Early detection of cancer of the prostate is increased with annual rectal examinations and serum prostatic acid phosphatase (PAP) measurements. Rationale with page number: Iggy Ch. 72, pg. 1481-1486 B: On rectal examination, a prostate that is found to be stony hard and with palpable irregularities or indurations is suspected to be malignant. F: Men at a higher risk for prostate cancer, including African Americans or men who F. An annual prostate examination is recommended starting at age 45 for African American men with a first-degree relative with prostate cancer at an early age. (pg 1482) 27 27 have a first-degree relative with prostate cancer before the age of 65 years, should have this discussion at age 45 years. 44. A terminally ill patient is unresponsive and has cold, clammy skin with mottling on the extremities. The patient’s husband and two grown children are arguing at the bedside about where the patient’s funeral should be held. What should the nurse do first? A. Ask the family members to leave the room if they are going to argue. B. Take the family members aside and explain that the patient may be able to hear them. C. Tell the family members that this decision is premature because the patient has not yet died. D. Remind the family that this should be the patient’s decision and to ask her if she regains consciousness. Rationale with page number: Boost, Chapter 42, pg. 1121 Universal manifestations of imminent death include a decrease in urine output, cold and mottled extremities, and changes in vital signs...Physical symptoms at the end of life include weakness and fatigue, increased drowsiness, and sleeping more and responding less. 45. A patient is receiving care to manage symptoms of a terminal illness when the disease no longer responds to treatment. What is this type of care known as? A. Terminal care (Hospice) B. Palliative care C. Supportive care D. Maintenance care Rationale with page number: Boost, Chapter 42, pg. 1123 Terminal care (hospice) is a program that provides comfort and supportive care for terminally ill patients and their families, either directly or on a consulting basis with the patient's physician or another community agency. When the patient or a surrogate decision maker accepts or chooses the hospice benefit, curative treatments are no longer a focus of care. The goal becomes symptom control and quality-of-life measures. 46. A patient in the last stages of life is experiencing shortness of breath and air hunger. Based on practice guidelines, what is the most appropriate action by the nurse? A. Administer oxygen. B. Administer bronchodilators. C. Administer antianxiety agents. D. Use any methods that make the patient more comfortable. Rationale with page number: Iggy Chapter 7, page 110. Opioids such as