Nokea
Probably the most widely used in-office or at-home occult blood test is the Hemoccult II. The patient has come to the clinic because he thinks there is blood in his stool. When you reviewed his medications, you noted he is on antihypertensive drugs and NSAIDs for early arthritic pain. You are sending the patient home with the supplies necessary to perform 2 hemoccult tests on his stool and mail the samples back to the clinic. What instruction would you give this patient?
- A. Take all your medications as usual.
- B. Take all your medications except the antihypertensive medications.
- C. Don't eat highly acidic foods 72 hours before you start the test.
- D. Avoid vitamin C for 72 hours before you start the test.
Correct Answer: D
Rationale: Red meats, aspirin, nonsteroidal anti-inflammatory drugs, turnips, and horseradish should be avoided for 72 hours prior to the study, because they may cause a false-positive result. Also, ingestion of vitamin C from supplements or foods can cause a false-negative result. Acidic foods do not need to be avoided.
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A nurse is caring for a newly admitted patient with a suspected GI bleed. The nurse assesses the patient's stool after a bowel movement and notes it to be a tarry-black color. This finding is suggestive of bleeding from what location?
- A. Sigmoid colon
- B. Upper GI tract
- C. Large intestine
- D. Anus or rectum
Correct Answer: B
Rationale: Blood shed in sufficient quantities in the upper GI tract will produce a tarry-black color (melena). Blood entering the lower portion of the GI tract or passing rapidly through it will appear bright or dark red. Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool or if blood is noted on toilet tissue.
Results of a patient's preliminary assessment prompted an examination of the patient's carcinoembryonic antigen (CEA) levels, which have come back positive. What is the nurse's most appropriate response to this finding?
- A. Perform a focused abdominal assessment.
- B. Prepare to meet the patient's psychosocial needs.
- C. Liaise with the nurse practitioner to perform an anorectal examination.
- D. Encourage the patient to adhere to recommended screening protocols.
Correct Answer: B
Rationale: CEA is a protein that is normally not detected in the blood of a healthy person; therefore, when detected it indicates that cancer is present, but not what type of cancer is present. The patient would likely be learning that he or she has cancer, so the nurse must prioritize the patient's immediate psychosocial needs, not abdominal assessment. Future screening is not a high priority in the short term.
A nurse is promoting increased protein intake to enhance a patient's wound healing. The nurse knows that enzymes are essential in the digestion of nutrients such as protein. What is the enzyme that initiates the digestion of protein?
- A. Pepsin
- B. Intrinsic factor
- C. Lipase
- D. Amylase
Correct Answer: A
Rationale: The enzyme that initiates the digestion of protein is pepsin. Intrinsic factor combines with vitamin B12 for absorption by the ileum. Lipase aids in the digestion of fats and amylase aids in the digestion of starch.
A medical patient's CA 19-9 levels have become available and they are significantly elevated. How should the nurse best interpret this diagnostic finding?
- A. The patient may have cancer, but other GI disease must be ruled out.
- B. The patient most likely has early-stage colorectal cancer.
- C. The patient has a genetic predisposition to gastric cancer.
- D. The patient has cancer, but the site is unknown.
Correct Answer: A
Rationale: CA 19-9 levels are elevated in most patients with advanced pancreatic cancer, but they may also be elevated in other conditions such as colorectal, lung, and gallbladder cancers; gallstones; pancreatitis; cystic fibrosis; and liver disease. A cancer diagnosis cannot be made solely on CA 19-9 results.
A nurse is caring for a patient who is scheduled for a colonoscopy and whose bowel preparation will include polyethylene glycol electrolyte lavage prior to the procedure. The presence of what health problem would contraindicate the use of this form of bowel preparation?
- A. Inflammatory bowel disease
- B. Intestinal polyps
- C. Diverticulitis
- D. Colon cancer
Correct Answer: A
Rationale: The use of a lavage solution is contraindicated in patients with intestinal obstruction or inflammatory bowel disease. It can safely be used with patients who have polyps, colon cancer, or diverticulitis.