The nurse is caring for a client who asks why blood levels of Carcinoembryonic Antigen (CEA) is drawn at periodic intervals. Which of the following responses describes the correct rationale?

Decrease levels of CEA indicate the treatment of your colon cancer was effective

Increased levels of CEA indicate that surgery to correct your diverticulitis was effective

Increased levels of CEA indicate a return of your pancreatitis

Decreased levels of CEA indicate that you have Ulcerative Colitis

Answer and Explanation

The Correct Answer is A

A. Decrease levels of CEA indicate the treatment of your colon cancer was effective: CEA is a tumor marker primarily used to monitor treatment response in certain cancers, especially colorectal cancer. A decrease in CEA levels after treatment suggests a positive response and reduced tumor burden.

B. Increased levels of CEA indicate that surgery to correct your diverticulitis was effective: CEA is not used to monitor diverticulitis. It is mainly associated with cancers, particularly colorectal cancer. An increase in CEA levels suggests possible cancer recurrence or progression, not resolution of diverticulitis.

C. Increased levels of CEA indicate a return of your pancreatitis: CEA is not a marker for pancreatitis. Pancreatitis is typically monitored using amylase, lipase, and imaging studies.

D. Decreased levels of CEA indicate that you have Ulcerative Colitis: Ulcerative colitis is an inflammatory bowel disease (IBD) that is not diagnosed or monitored using CEA. While chronic inflammation may increase cancer risk over time, CEA is not a direct indicator of UC.

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Correct Answer is B

Explanation

A. "Your colostomy will not produce formed stool.” A sigmoid colostomy produces formed stool because it is at the end of the large intestine, where water is absorbed.

B. "You will have a stoma in your left lower abdomen." A sigmoid colostomy is placed in the left lower quadrant (LLQ) of the abdomen.

C. "You should expect your stoma to be a purple color." A healthy stoma should be pink to red and moist. A purple, dusky, or dark-colored stoma may indicate ischemia and requires immediate evaluation.

D. "The end of the stoma will be painful after this procedure." The stoma itself does not have nerve endings, so it should not be painful. However, the surrounding abdominal incision may be sore.

A. Void prior to the paracentesis B. Ask about family history of malignant hyperthermia. C. Place the patient in the prone position for the procedure D. Administer metronidazole prophylactically for infection

Correct Answer is A

Explanation

A. Void prior to the paracentesis: Before a paracentesis, the patient is typically instructed to void to reduce the risk of puncturing the bladder during the procedure. It is an essential preparatory step.

B. Ask about family history of malignant hyperthermia: Malignant hyperthermia is related to anesthetic agents, not paracentesis.

C. Place the patient in the prone position for the procedure: The correct position for paracentesis is high Fowler’s (sitting upright at 45–90°) to allow fluid to collect in the lower abdomen for easier drainage.

D. Administer metronidazole prophylactically for infection: This is not a routine intervention before a paracentesis, as the risk of infection is managed with sterile technique during the procedure.

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The nurse is caring for a client who asks why blood levels of Carcinoembryonic Antigen (CEA) is drawn at periodic intervals. Which of the following responses describes the correct rationale?

Nursing Test Bank

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