Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur?

Correct Answer: D

Rationale: The correct answer is D because early metastasis to the brain can impair the patient's ability to recognize the seriousness of symptoms. This can delay diagnosis and treatment, leading to a higher percentage of patients having metastasis at the time of diagnosis. A is incorrect because there are treatment modalities for kidney cancer beyond palliative care. B is incorrect as diagnostic tests like imaging studies can detect tumors before they metastasize. C is incorrect because while classic symptoms may not always be present, other symptoms and diagnostic tests can still lead to an earlier diagnosis.

Correct Answer: D

Rationale: The correct answer is D: constipation. Slowed metabolism can lead to decreased gastrointestinal motility, resulting in constipation. This occurs because the digestive system processes food more slowly, leading to less frequent bowel movements. Nausea (choice A) is more commonly associated with gastrointestinal issues or medication side effects. Oily hair (choice B) is typically related to hormonal imbalances or poor hygiene. Tachycardia (choice C) is an increased heart rate that is not directly linked to slowed metabolism.

Correct Answer: D

Rationale: The correct answer is D because after a ureterolithotomy, there may be drainage from the tissue drain, which is a normal occurrence. This drainage helps to prevent complications such as infection and promotes healing. The drainage should decrease over time as the body heals. Choices A, B, and C are incorrect as they do not align with the typical expectations following a ureterolithotomy procedure. Postoperative pain should be managed with medication, postoperative depression may occur but is not a universal expectation, and enforced bed rest for a week is not typically necessary.

Correct Answer: C

Rationale: The correct answer is C: Recommend eating the amount of protein prescribed. This is the most appropriate intervention because it aligns with the prescribed dietary requirements for Susan's health. By following the prescribed protein intake, Susan can ensure she is meeting her nutritional needs and promoting optimal health. Explanation: 1. A (Praise her for cutting back even further than instructed on protein): This choice is incorrect as it encourages behavior that goes against the prescribed dietary recommendation, which could negatively impact Susan's health. 2. B (Suggest that if she eats less protein she should increase carbohydrates): This choice is incorrect as it does not address the issue of inadequate protein intake and may lead to an imbalance in her macronutrient intake. 3. D (Refer her to the dietician): While referring her to a dietician may be beneficial for further guidance, it does not directly address the immediate issue of Susan not consuming the prescribed amount of protein.