#5: colorectal cancer

Question 1

The nurse is providing discharge teaching for a client with metastatic lung cancer who was admitted with a bowel impaction. Which of the following instructions is most helpful to prevent further episodes of constipation?
A. Maintain a high intake of fluid and fibre in the diet.
B. Reduce intake of medications causing constipation.
C. Eat several small meals per day to maintain bowel motility.
D. Sit upright during meals to increase bowel motility by gravity

Answer 1

A. Maintain a high intake of fluid and fibre in the diet.
(Increased fluid intake and a high-fibre diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fibre provide bulk that in turn increases peristalsis and bowel motility.)

Question 2

The nurse should administer a prn dose of magnesium hydroxide after noting which of the following findings while reviewing a client’s medical record?
A. Abdominal pain and bloating
B. No bowel movement for 3 days
C. A decrease in appetite by 50% over 24 hours
D. Muscle tremors and other signs of hypomagnesemia

Answer 2

B. No bowel movement for 3 days
(Magnesium hydroxide (milk of magnesia) is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the client who has not had a bowel movement for 3 days.)

Question 3

The nurse is preparing to administer a scheduled dose of docusate sodium when the client indicates an episode of loose stool and does not want to take the medication. Which of the following is the best action by the nurse?
A. Write an incident report about this untoward event.
B. Attempt to have the family convince the client to take the ordered dose.
C. Withhold the medication at this time and try to administer it later in the day.
D. Chart the dose as not given on the medical record and explain in the nursing progress notes

Answer 3

D. Chart the dose as not given on the medical record and explain in the nursing progress notes
(Whenever a client refuses medication, the dose should be charted as not given. An explanation of the reason should then be documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the client.)

Question 3

The nurse is preparing to administer a dose of bisacodyl. In explaining the medication to the client, the nurse would state that it acts in which of the following ways?
A. Increases bulk in the stool
B. Lubricates the intestinal tract to soften feces
C. Increases fluid retention in the intestinal tract
D. Increases peristalsis by stimulating nerves in the colon wall

Answer 3

D. Increases peristalsis by stimulating nerves in the colon wall
(Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms.)

Question 4

A client is prescribed “Colace 100 mg PO.” The client asks to take the medication in liquid form, and the nurse obtains an order for the interchange. Available is a syrup that contains 150 mg/15 mL. How many millilitres does the nurse administer?
A. 3 mL
B. 5 mL
C.10 mL
D.12 mL

Answer 4

C. 10 mL
(The concentration of the syrup is 150 mg/15 mL. 100 mg divided by 150 mg multiplied by 15 mL = 10 mL.)

Question 5

The nurse should instruct the client to do which of the following to best enhance the effectiveness of a daily dose of docusate sodium?
A. Take a dose of mineral oil at the same time.
B. Add extra salt to food on at least one meal tray.
C. Ensure dietary intake of 10 g of fibre each day.
D. Take each dose with a full glass of water or other liquid.

Answer 5

D. Take each dose with a full glass of water or other liquid.
(Docusate sodium (Colace) lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage, and must be taken with adequate fluids. The client should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fibre intake should be a minimum of 20 g daily to prevent constipation.)

Question 6

Which of the following cathartic agents in a client with renal insufficiency should the nurse question?
A. Bisacodyl
B. Senna
C. Cascara sagrada
D. Magnesium hydroxide

Answer 6

D. Magnesium hydroxide
Magnesium hydroxide (milk of magnesia) may cause hypermagnesemia in clients with renal insufficiency. The nurse should question this order with the health care provider before administration.

Question 7

A client who is administering a bisacodyl suppository asks the nurse how long it will take to work. The nurse replies that the client will probably need to use the bedpan or commode within which of the following time frames after administration?
A. 2–5 minutes
B. 15–60 minutes
C. 2–4 hours
D. 6–8 hours

Answer 7

B. 15–60 minutes
(Bisacodyl suppositories usually are effective within 15–60 minutes of administration, so the nurse should plan accordingly to assist the client to use the bedpan or commode.)

Question 8

The nurse is caring for a client in the emergency department with symptoms of acute abdominal pain, nausea, and vomiting. When the nurse palpates the client’s left lower abdominal quadrant, the client has pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis?
A. Rovsing’s sign
B. Referred pain
C. Chvostek’s sign
D. Rebound tenderness

Answer 8

A. Rovsing’s sign Correct
In clients with suspected appendicitis, Rovsing’s sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.

Question 9

The nurse is caring for an admitted client with abdominal pain, nausea, and vomiting. The client has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the client’s clinical picture?
A. Low pitched and rumbling above the area of obstruction
B. High pitched and hypoactive below the area of obstruction
C. Low pitched and hyperactive below the area of obstruction
D. High pitched and hyperactive above the area of obstruction

Answer 9

D. High pitched and hyperactive above the area of obstruction
(Early in intestinal obstruction, the client’s bowel sounds are hyperactive and high pitched, sometimes referred to as “tinkling” above the level of the obstruction. This occurs because peristaltic action increases to “push past” the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.)

Question 10

The nurse is planning care for a client with an abdominal mass and suspected bowel obstruction. Which of the following factors in the client’s history increases the client’s risk for colorectal cancer?
A. Osteoarthritis
B. History of rectal polyps
C. History of lactose intolerance
D.Use of herbs as dietary supplements

Answer 10

B. History of rectal polyps
(A history of rectal polyps places this client at risk for colorectal cancer. This tissue can degenerate over time and become malignant. The other factors identified do not pose additional risk to the client.)

Question 11

The nurse is preparing to insert a nasogastric tube into a client with an abdominal mass and suspected bowel obstruction. The client asks the nurse why this procedure is necessary. Which of the following responses is best?
A. “The tube will help to drain the stomach contents and prevent further vomiting.”
B. “The tube will push past the area that is blocked, and thus help to stop the vomiting.”
C. “The tube is just a standard procedure before many types of surgery to the abdomen.”
D. “The tube will let us measure your stomach contents so that we can plan what type of IV fluid replacement would be best.”

Answer 11

A. “The tube will help to drain the stomach contents and prevent further vomiting.”
(The nasogastric tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting.)

Question 12

The nurse is caring for a client with a suspected bowel obstruction who has had a nasogastric tube inserted at 0400 hours. The nurse shares in the morning report that the day shift (0700–1500 hours) staff should check the tube for patency at which of the following times?
A. 0700, 1000, and 1300 hours
B. 0800 and 1200 hours
C. 0900 and 1500 hours
D. 0900, 1200, and 1500 hours

Answer 12

B. 0800 and 1200 hours
(A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 0400 hours, it would be due to be checked at 0800 hours and 1200 hours.)

Question 13

The nurse who inserted a nasogastric tube for a client with suspected bowel obstruction should write which of the following priority nursing diagnoses on the client’s problem list?
A. Anxiety related to nasogastric tube placement
B. Abdominal pain related to nasogastric tube placement
C. Risk for deficient knowledge related to nasogastric tube placement
D. Altered oral mucous membrane related to nasogastric tube placement

Answer 13

D. Altered oral mucous membrane related to nasogastric tube placement Correct
With nasogastric tube placement, the client is likely to breathe through the mouth and may experience irritation in the affected nares. For this reason, the nurse should plan preventive measures based on this nursing diagnosis.

Question 14

A colectomy is scheduled for a client with an abdominal mass, possible bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this client?
A. Instruction on irrigating a colostomy
B. Administration of an oral osmotic lavage
C. A high-fibre diet the day before surgery
D. Administration of IV antibiotics for bowel preparation

Answer 14

B. Administration of an oral osmotic lavage
(Bowel preparation before surgery includes orally administered osmotic lavages (e.g., GoLYTELY). This has shortened the classic 72-hour preparation with clear liquids, cathartics, and enemas.)

Question 15

Which of the following information should be the highest priority information to include in preoperative teaching for a client scheduled for a colectomy?
A. How to care for the wound?
B. How to deep-breathe and cough?
C. The location and care of drains after surgery
D. What medications will be used during surgery?

Answer 15

B. How to deep-breathe and cough?
(Because anaesthesia, an abdominal incision, and pain can impair the client’s respiratory status in the postoperative period, it is of high priority to teach the client to cough and deep-breathe. Otherwise, the client could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge.)

Question 16

The nurse asks a client scheduled for colectomy to sign the operative consent as directed in the health care provider’s preoperative orders. The client states that the health care provider has not really explained well what is involved in the surgical procedure. Which of the following is the best action by the nurse?
A. Ask family members whether they have discussed the surgical procedure with the health care provider.
B. Have the client sign the form and state that the health care provider will visit to explain the procedure before surgery.
C. Explain the planned surgical procedure as well as possible, and have the client sign the consent form.
D. Delay the client’s signature on the consent and notify the health care provider about the conversation with the client.

Answer 16

D. Delay the client’s signature on the consent and notify the health care provider about the conversation with the client.
(The client should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the client. The nurse should notify the health care provider, who has the responsibility for obtaining consent.)

Question 17

Two days following a colectomy for an abdominal mass, a client reports gas pains and abdominal distension. The nurse plans care for the client based on the knowledge that the symptoms occur as a result of which of the following?
A. Impaired peristalsis
B. Irritation of the bowel
C. Nasogastric suctioning
D. Anastomosis site inflammation

Answer 17

A. Impaired peristalsis
(Until peristalsis returns to normal following anaesthesia, the client may experience slowed gastrointestinal motility leading to gas pains and abdominal distension.)

Question 18

The nurse is caring for a client following bowel resection and has a nasogastric tube to suction, but symptoms of nausea and abdominal distension. The nurse irrigates the tube prn as prescribed, but the irrigating fluid does not return. Which of the following actions is priority?
A. Notify the health care provider.
B. Auscultate for bowel sounds.
C. Reposition the tube and check for placement.
D. Remove the tube and replace it with a new one.

Answer 18

C. Reposition the tube and check for placement.
(The tube may be resting against the stomach wall. The first action by the nurse, since this is intestinal surgery (not gastric surgery), is to reposition the tube and check it again for placement.)

Question 19

The nurse is caring for a postoperative client with a colostomy. The nurse is preparing to administer a dose of famotidine when the client asks why the medication was prescribed since the client does not have a history of heartburn or gastro-esophageal reflux disease (GERD). Which of the following statements is the best response by the nurse?
A. “This will prevent air from accumulating in the stomach, causing gas pains.”
B. “This will prevent the heartburn that occurs as a adverse effect of general anaesthesia.”
C. “The stress of surgery is likely to cause stomach bleeding if you do not receive it.”
D. “This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again.”

Answer 19

D. “This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again.”

Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the client is not eating a regular diet after surgery.