The relationship between colon polyps and colon cancer is those polyps:
eventually, all become malignant.
have a slow progression to colon cancer.
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have a rapid progression to colon cancer.
have no relationship to colon cancer.
B.
Colon polyps are usually slow-growing and take a long time to progress to cancer. This is the reason that a colonoscopy does not need to be repeated annually. While not all polyps grow slowly, this is the usual progression.
A 5-year-old has been diagnosed with pinworms. He lives with his mother. There are no other members of the household. How should his mother be managed?
Reassure the mother that if she develops symptoms, she will need to be treated.
Visually assess the mother’s rectum for redness or presence of worms.
Have the mother collect a stool specimen and send it to the laboratory.
Perform the “scotch tape” test and look at the collection under the microscope.
D.
The diagnosis of pinworms (Enterobiasis) is made by using a piece of scotch tape on a tongue depressor. It is touched against the patient’s rectum. The greatest yield of eggs will occur during the nighttime or early AM. Eggs will be found here if they are present. Worms and eggs are rarely found in stool specimens, so this is not a good plan. When the scotch tape is examined under a low power microscope, the eggs will be easily visualized since they are large and bean shaped. The finding of an adult worm would confirm the diagnosis. These are large enough to be seen with the naked eye. If the mother is symptomatic, she should be treated with or without a rectal exam. It is very likely she is infected.
A patient has been diagnosed with hepatitis B. The most commonly reported risk factor is:
drinking contaminated water.
eating contaminated food.
exposure to blood.
sexual exposure.
D.
Hepatitis B is transmitted by blood and body fluids. While exposure to infected blood or blood products would significantly increase the risk of infection in unvaccinated people, this is much less likely than becoming infected via sexual exposure or IV drug use. Hepatitis A is transmitted via fecal-oral routes. Drinking contaminated water and eating contaminated food implicate hepatitis A as the etiologic agent.
The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter, and:
E. coli.
Enterovirus.
Yersinia.
Shigella.
D.
Shigella will be shed continuously in the stool and should be easily identified on stool culture. When bacterial gastroenteritis is suspected, a stool specimen could be ordered for confirmation. Generally, these three pathogens are easily identified if they are present. Enterovirus produces a viral form of diarrhea. Yersinia produces the deadly disease called bubonic plague. E. coli is a typical colonic pathogen.
An 83-year-old patient is diagnosed with diverticulitis. The most common complaint is:
rectal bleeding.
bloating and cramping.
left lower quadrant pain.
frequent belching and flatulence.
C.
Diverticular disease is more common in older adults. About 70% of patients diagnosed with diverticulitis have left lower quadrant pain. Rectal bleeding may have varied etiologies, such as rectal carcinoma or hemorrhoids. Bloating and cramping are often found in patients with diverticular disease (diverticulosis) but not specifically diverticulitis. Belching and flatulence are not specifically associated with diverticulosis.
What is true regarding older adults who are overweight?
This is clearly associated with increased mortality in older adults.
Mortality in older adults related to overweight states declines over time.
BMI is a good way to assess nutritional status in older adults.
There are no potential metabolic or functional benefits to weight loss in older adults.
B.
Overweight and obese states are not as important in predicting mortality in older adults as they are in their younger counterparts. After age 65 years (some studies demonstrate after age 70), weight is less significant in decreasing risk for mortality than in younger adults. There are some benefits to weight loss in the obese older adults. One of them is better balance and decreased risk for falls. Others include less sleep apnea, decreased risk of diabetes, and decreased rates of shortness of breath with respiratory and cardiac diseases.
What medication used to treat patients who have GERD provides the fastest relief of heartburn symptoms?
Calcium carbonate
Ranitidine
Amantadine
Pantoprazole
A.
Calcium carbonate is an antacid. It provides rapid changes in gastric pH. This provides relief that can be noticed immediately. The increase in pH lasts for about 30 minutes and corresponds with resolution of symptoms. However, as pH decreases within 30 minutes, symptoms may return. Ranitidine is an H2 blocker. It provides relief in 1-2 hours. This usually lasts for about 6-12 hours. Amantadine is an antiviral not used to treat GERD. Pantoprazole is a proton pump inhibitor. This provides relief after several hours or days of daily consumption.
An 84-year-old presents with a stated involuntary weight loss. He states that he’s lost about 6 pounds in the last 6 or 8 weeks. What statement below is NOT part of the assessment?
The weight loss should be measured today and again in the next few weeks.
A laboratory evaluation should be performed.
Evaluate his dietary intake.
Evaluate his upper and lower extremity muscle mass.
D.
Involuntary weight loss in older adults is often due to malignancy or disease. The initial assessment of an older adult who reports involuntary weight loss is to document the weight loss. If prior measurements are part of the patient’s chart, this would be helpful. Laboratory assessment should also be performed. Consideration should be given to performing a CBC, TSH, and metabolic panel. Also consider chest and abdominal X-rays. If all are normal, he should be monitored and reweighed on the same scale for comparison. A dietary consult should be ordered. However, even with negative initial findings, a significant number of patients are later found to have disease or malignancy
A patient has a positive hepatitis B surface antibody. This means he:
has acute hepatitis B.
has chronic hepatitis B.
is immune to hepatitis B.
needs immunization to hepatitis B.
C.
The hepatitis B surface antibody indicates immunity to hepatitis B virus. Specifically, if this patient comes in contact with hepatitis B virus, he will not become infected with hepatitis B. The presence of hepatitis B surface antibody indicates immunity from immunization or actual infection. It also indicates recovery if the patient was infected.
A patient with a suspected inguinal hernia should be examined:
in the prone position.
standing.
side-lying.
with patient squatting.
B.
The patient should be examined while he is standing. He should be asked to bear down, cough, or strain during the exam. Though hernias are far more common in males, they can be found in females too. In males, the patient should be asked to stand. The examiner should put his 2nd or 3rd finger through the scrotum and into the external ring. When the patient is asked to cough, a “silky” feel will butt up against the examiner’s finger, and the hernia can be easily felt.
A 15-year-old is about 10% below her ideal body weight. Laboratory studies were performed. Which complaint might be common in this patient (Labs in image)?
Headaches
Dizziness with standing
Muscle cramps
Hair loss
B.
This patient does not meet the strict criteria for an eating disorder, but it should be suspected. The other laboratory values are not the cause of her dizziness with standing. This is likely due to a low hemoglobin. She needs treatment for a probable iron deficiency anemia and elicitation of history to help identify the cause of her low hemoglobin.
A 45-year-old patient has the following laboratory values. How should they be interpreted (Labs in image)?
The patient has hepatitis.
The patient had hepatitis.
The patient should consider immunization.
The results are indeterminate
A.
This patient has a positive hepatitis B surface antigen (HBsAg). Therefore, he has hepatitis B. A positive anti-HBc is found in patients who either have hepatitis now or who have had it. The surface antibody (anti-HBs) would be expected to be negative in a patient with a positive surface antigen (HBsAg) because these two markers will not be positive at the same time.
A 37-year-old has routine blood work performed during an annual exam. On exam, he has a tender, enlarged liver. How should the nurse practitioner proceed (Labs in image)?
Repeat the liver enzymes today.
Order a hepatitis panel.
Have patient return in one week for recheck.
Order a CBC.
B.
The differential for a patient with elevated liver enzymes can reflect many different etiologies. Since the liver is tender and liver enzymes are elevated, a likely etiology is hepatitis. The size and consistency of the liver should be ascertained. The spleen should be assessed. If it is palpable, it is enlarged also. Hepatitis panel should be performed and strong consideration given to referral to gastroenterology. Repeating liver enzymes might be considered if the rest of the exam was normal and the lab values were the only abnormal values. The results of a CBC will not change the differential. The patient’s abnormal labs and exam make this urgent, and waiting a week will delay diagnosis and possible treatment.
Many older adults have cachexia. What characterizes this?
Anorexia and weight loss
Weakness and fatigue
Illness and loss of muscle mass
Starvation and weight loss
C.
Cachexia is common in older adults and is associated with increased mortality. It is described as a syndrome of underlying illness that is accompanied by loss of muscle mass. Illnesses associated with cachexia are malignancies, renal disease, COPD, and chronic heart failure. Other matters are associated with cachexia and may contribute to loss of muscle mass. These include loss of appetite, insulin resistance, and increased catabolism of bodily proteins.
A 70-year-old patient states that he had some bright red blood on the toilet tissue this morning after a bowel movement. He denies pain. What is the LEAST likely cause in this patient?
Hemorrhoids
Diverticulitis
Colon cancer
Anal fissure
D.
Nearly 1 in 3 patients in this age group with acute lower gastrointestinal bleeding have bleeding secondary to diverticulitis. Nearly 1 in 5 have colorectal cancer or polyps, though, polyps usually do not bleed. Patients who have anal fissures often complain of a tearing pain during bowel movements. Regardless of the etiology, this patient needs referral for a colonoscopy to identify the cause of bleeding. He is at high risk for colon cancer because of his age. The appropriate recommendation is referral to gastroenterology for colonoscopy.
A patient has received a prescription for metronidazole for treatment of C. difficile. What should be avoided in this patient?
Excess fluids
Vitamin B12
Grapefruit juice
Alcohol
D.
Patients should always be cautioned against alcohol ingestion (in any form) if they take metronidazole. Alcohol can (and usually does) produce a disulfiram reaction. This is characterized by abdominal cramps, nausea, vomiting, headache, and elevated body temperature. Precautions should remain until 72 hours after the last dose of metronidazole.
Older adults frequently complain of constipation. Which medication listed below does NOT increase the likelihood of constipation in an older adult?
Diltiazem
Hydrochlorothiazide
Calcium supplements
Metformin
D.
Diarrhea, not constipation, is a common side effect of metformin. Constipation is a common complaint in older adults because of medications they routinely consume and many diseases they often have. Some examples of medications that can cause constipation are opiate analgesics, NSAIDs, and antacids. Some diseases and conditions that can produce constipation are hypothyroidism, colon cancer, electrolyte abnormalities, immobility, and change in diet due to inability to chew food properly.
Which set of symptoms is most likely in a patient infected with C. difficile?
Headache, diarrhea, body aches
Body aches, fever, abdominal cramps
Fever, headache, diarrhea
Diarrhea, abdominal pain, nausea or vomiting
D.
The classic symptoms that patients with C. difficile experience are diarrhea, abdominal pain, and nausea or vomiting. This patient should be treated because symptoms are present. If no symptoms or mild symptoms are present, treatment can be delayed until symptoms develop or worsen. All patients who are infected do not exhibit symptoms. They do not need treatment.
A 56-year-old male patient has been diagnosed with an inguinal hernia. What symptom would make the nurse practitioner suspect an incarcerated hernia?
Dilated scrotal veins
Change in skin color
Constipation
Pain
D. [Show Less]