productive of bloody sputum (sputum=secretions from deep in the lungs). After a few days of testing and treatment, the patients nurse reads a physicians note on the chart: I have told the patient that the etiologies of his hemoptysis are: 1) exacerbation of his chronic emphysema and 2) the new diagnosis of lung cancer. The onsets of both were contributed to by his longstanding smoking. 1. The patient asks the nurse for more information. Which of the following explanations to the patient best indicates a full understanding of the patients situation? a. You have a disease process that was iatrogenically caused by cigarette smoking. Incorrect: iatrogenically means caused by a medical person. b. You have a sudden onset of a chronic lung disease that was brought on by lung cancer. Incorrect: the chronic lung disease was part of the medical history of the patient; the term chronic means a long-standing disease, not a sudden onset. c. The coughing up of blood is caused by a worsening of a disease youve had for a long time plus a new problem– lung cancer. d. These diseases have been creeping up on you for probably 20 years; it just goes to show that you should never have taken up smoking. Incorrect: no evidence in the scenario to support this sentence. (Besides, it sounds very judgmental.) 2. Based on all the information you have on the patient, which statement is most likely correct? a. The patient has a poor prognosis because of the comorbidities of lung cancer and cigarette smoking. Incorrect: Smoking is a risk factor not a disease that would fit the term comorbidity. b. Lung cancer was a sequela of the bloody sputum. Incorrect: the bloody sputum was part of the S&S of cancer; this answer implies the bloody sputum caused the cancer. c. A precipitating factor for the acute hospitalization was overexertion when the patient started an exercise class. Incorrect: no evidence in the scenario to support this sentence. d. Heavy cigarette smoking was a risk factor in the patients developing emphysema and lung cancer.

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