A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer?
A 60-year-old lawyer who works 65 hours per week.
A 72-year-old who eats fast food frequently.
A 37-year-old who drinks eight cups of coffee daily.
A 44-year-old with irritable bowel syndrome (IBS).
The Correct Answer is B
Choice A reason: While a high-stress job and long working hours can impact overall health and lead to sedentary behavior, they are not direct, established primary risk factors for colorectal cancer. Age is a factor for this client, but the dietary and age combination of another client presents a significantly higher risk profile.
Choice B reason: This client has two major risk factors: advanced age and a poor diet. The risk of colorectal cancer increases significantly after age 50. Furthermore, fast food is typically high in red and processed meats and animal fats while being low in fiber, which are well-documented dietary contributors to colorectal carcinogenesis.
Choice C reason: There is currently no strong scientific evidence linking high coffee consumption to an increased risk of colorectal cancer. In fact, some studies suggest that coffee may have a protective effect due to its antioxidant properties. This client’s age (37) also places them in a lower-risk category for the disease.
Choice D reason: Irritable bowel syndrome (IBS) is a functional disorder and does not increase the risk of colorectal cancer. It should not be confused with inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn’s disease, which involves chronic inflammation of the intestinal mucosa and does significantly elevate cancer risk.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Cobalamin supplementation is primarily indicated for patients with Crohn's disease involving the terminal ileum or those who have undergone significant ileal resection. Ulcerative colitis affects the colon and rectum, not the ileum where B12 absorption occurs, making this intervention inappropriate for an acute UC exacerbation.
Choice B reason: Metoclopramide is a prokinetic agent used to treat gastroparesis and nausea by increasing upper gastrointestinal motility. In acute ulcerative colitis, increasing motility is contraindicated as it can worsen abdominal cramping, diarrhea, and potentially precipitate toxic megacolon, which is a life-threatening complication of severe colonic inflammation.
Choice C reason: Management of acute ulcerative colitis exacerbations requires bowel rest to reduce mucosal irritation and gastrointestinal secretions. Transitioning the patient to NPO (nothing by mouth) status helps decrease peristalsis, minimize abdominal pain, and reduce the frequency of bloody stools, allowing the inflamed colonic mucosa time to heal.
Choice D reason: While a total proctocolectomy is a curative surgical option for ulcerative colitis, it is not the immediate priority during an acute admission for an exacerbation. Medical stabilization using corticosteroids and bowel rest is the first-line approach; surgical education is reserved for when the acute phase resolves.
Correct Answer is A
Explanation
Choice A reason: Diabetes mellitus and hypertension are the leading two causes of end-stage kidney disease in the United States. Poorly controlled hypertension causes high pressure in the renal arterioles, leading to nephrosclerosis, while diabetes causes basement membrane thickening and glomerular damage. The combination of these two chronic conditions significantly accelerates the progression of renal failure more than other isolated factors.
Choice B reason: Polycystic kidney disease (PKD) is a significant genetic cause of renal failure, but it is much rarer in the general population compared to diabetes and hypertension. While many patients with PKD will eventually require dialysis or a transplant, the sheer prevalence and systemic impact of diabetic nephropathy and hypertensive nephrosclerosis make Choice A the higher statistical risk group.
Choice C reason: Morbid obesity and vascular disorders are risk factors for renal impairment, as they contribute to metabolic syndrome and reduced renal perfusion. However, they are generally considered secondary risk factors. They often lead to the development of diabetes or hypertension, which then serve as the direct mechanisms for the development of chronic kidney disease and eventual ESKD.
Choice D reason: Severe chronic obstructive pulmonary disease (COPD) affects respiratory function and can lead to right-sided heart failure (cor pulmonale), which may reduce renal perfusion. However, it is not a primary driver of end-stage kidney disease. The pathological changes in COPD are primarily pulmonary and do not directly damage the renal parenchyma in the same way that glucose and high pressure do.
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