Crohn’s, PUD, UC NCLEX – Flashcards
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In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease: (Source: Medical-Surgical Nursing, LHD pg. 1055) A. frequently results in toxic megacolon, B. causes fewer nutritional deficiencies than does ulcerative colitis, C. often recurs after surgery, whereas ulcerative colitis is curable with a colectomy, D. is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis.
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Answer C, often recurs after surgery, whereas ulcerative colitis is curable with a colectomyRationale: Because there is a high recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment.
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In planning the care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease: a) frequently results in toxic megacolon b) causes fewer nutritional deficiencies than does ulcerative colitis. c) often recurs after surgery, whereas ulcerative colitis is curable with a colectomy. d) is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis.
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CORRECT ANSWER: CBecause there is a high recurrence rate after surgical treatment of Crohn's disease, medications are the preferred treatment.
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"Which associated disorder might a client with ulcerative colitis exhibit "1. Gallstone 2. Hyronephrosis 3.Nephrolithiasis 3. Toxic megacolon
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Answer 3, Toxic megacolon is extreme dilation of a segemnt of the diseased colon caused by paralysis of the colon
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What is one of the major precipitating factors in the development of irritable bowel syndrome (IBS)? "A. Stress B. Peptic ulcers C. GERD D.Helicobacter pylori"
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Answer A: Stress, Rationale: Stress is one of the major factors for developing irritable bowel syndrome (IBS), along with dietary factors.
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The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record 1. Diarrhea 2. Chronic constipation 3. Constipation alternating with diarrhea 4. Stools constantly oozing form the rectum
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Answer 1: Diarrhea, Crohn's disease is characterized by nonbloody diarrhea and around 4-5 stools per day. Over time, episodes of diarrhea increase in frequency, duration, and severity.
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The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the client would support this diagnosis? 1. "My pain goes away when I have a bowel movement" 2. "I have bright red blood in my stool all the time" 3. "I have episodes of diarrhea and constipation" 4. "My abdomen is hard and rigid and I have a fever".
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1. (CORRECT) The terminal ileum is the most common site for regional enteritis and causes right lower quadrant pain that is relieved by defecation 2. Stools are liquid or semi-formed and usually do not contain blood 3. Episodes of diarrhea and constipation may be a sign/symptom of colon cancer, not Crohn'sdisease 4. A fever and hard rigid abdomen are signs/symptoms of peritonitis, a complication of Crohn's disease
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Which associated disorder might a client with Crohn's disease exhibit most often? 1. Ankylosing spondylitis 2. Colon cancer 3. Malabsorption 4. Lactase deficiency
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Answer 3; Malabsorption Because of the transmural nature of Crohn's disease lesions, malabsorption may occur with Crohn's disease. Although ankylosing spondylitis and colon cancer are more commonly associated with ulcerative colitis, they may be seen in clients with Crohn's disease, Lactase deficiency is caused by a congenital defect in which an enzyme isn't present.
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Nurse is caring for a patient with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the Dr? A. Hypotension B. Bloody diarrhea C. Rebound tenderness D. Hemoglobin of 12 mg/ dl
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C. Rebound tenderness because this could indicate peritonitis.
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A client with acute colcerative colitis requests a snack. Which of the following foods is the most appropriate to give the client? A. Carrots and ranch dip B. Whole grain cereal and milk C. A cup of popcorn and a cola D. Applesauce and a graham cracker
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D, appelsauce and graham cracker, The diet for a client with ulcerative coliits should be a low-fiber, low residue diet. The nurse should avoid foods such as whole grains, nuts and fresh fruit or vegetables. Typically lactose containing foods are also poorly tolerated. The client should also avoid caffeine, pepper, and alcohol.
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The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? 1. Provide a low-residue diet. 2. Monitor intravenous fluids. 3. Assess vital signs daily. 4. Administer antacids orally.
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1. The client's bowel should be placed on rest and no foods or fluids should be introduced into the bowel. 2. (CORRECT) The client requires fluids to help prevent dehydration from diarrheh and to replace fluid lost through normal body functioning. 3. The vital signs must be taken more often than daily in a client who is having an acute exacerbation of ulcerative colitis. 4. The client will receive anti-inflammatory and antidiarrheal medications, not antacids, which are used for gastroenteritis.
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The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the client would support this diagnosis? 1. "My pain goes away when I have a bowel movement." 2."I have bright red blood in my stool all the time." 3."I have episodes of diarrhea and constipation." 4."My abdomen is hard and rigid and I have a fever."
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Correct answer: #1 pain goes away w/ BM, The terminal ileum is the most common site for regional enteritis and causes right lower quadrant pain that is relieved by defecation.
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The nurse is reviewing the record of a client with Chron's disease. Which stool characteristic should the nurse expect to note documented in the client's record? 1. Diarrhea 2. Chronic constipation 3. Constipation alternating with diarrhea 4. Stool constantly oozing from teh rectum
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Diarrhea, Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options 2, 3, and 4 are not characteristics of Crohn's disease.
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"In planning care for the patient with crohns disease the nurse recognizes that a major difference between UC and Crohn's disease is that: 1. Frequently results in toxic megacolon 2. causes fewer nutritional deficiencies than does UC 3. Often recurs after surgery whereas UC is curable with a colectomy 4. is manifested by rectal bleeding and anemia more frequently than UC"
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Answer 3, "Medication is the primary treatment for Crohn's disease"
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A client is admitted with irritable bowel syndrome. The nurse would anticipate the client's history to reflect which of the following? 1. Pattern of alternating diarrhea and constipation. 2. Chronic diarrhea stools occurring 10-12 times per day. 3. Diarrhea and vomiting with severe abdominal distention. 4. Bloody stools with increased cramping after eating.
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Think about each answer choice. (1) correct-condition is often called spastic bowel disease; no inflammation is present (2) refers to inflammatory bowel disease such as ulcerative colitis or Crohn's disease (3) refers to inflammatory bowel disease such as ulcerative colitis or Crohn's disease (4) bloody stools do not occur 38.
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The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? "a. Hypotension b. Bloody diarrhea c. Rebound tenderness d. A hemoglobin level of 12 mg/dL"
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Answer C. Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.
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"The nurse is teaching the client about gastritis. Which of the following statements by the nurse would be more accurate in describing gastritis? 1. Erosion of the gastric mucosa 2. Inflammation of a diverticulum 3. Inflammation of the gastric mucosa 4. Reflux of stomach acid into the esophagus"
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"3. Gastritis is an inflammation of the gastric mucosa that may be accute (often resulting from exposure to local irritants) or chronic (associated w/ autoimmune infections or atrophic disorders of the somach). Erosion of the mucosa results in ulceration. Inflammation of the diverticulum is called diverticulitis; reflux of stomach acid is known as gastroesophageal reflux disease."
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"Which sign/symptom should the nurse expect to find in a client diagnosed with ulcerative colitis? 1. Twenty bloody stools a day. 2. Oral temperature of 102 ̊F. 3. Hard, rigid abdomen. 4. Urinary stress incontinence."
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Answer = 1. The colon is ulcerated and unable to absorb water, resulting in bloody diar- rhea. Ten (10) to 20 bloody diarrhea stools is the most common symptom of ulcerative colitis. 2. Inflammation usually causes an elevated temperature but is not expected in the client with ulcerative colitis. 3.A hard, rigid abdomen indicates peritonitis, which is a complication of ulcerative colitis but not an expected symptom. 4. Stress incontinence is not a symptom of colitis."
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The nurse is caring for a client diagnosed with ulcerative colitis. Which symptom(s) support this diagnosis? 1. Increased appetite and thirst 2. Elevated hemoglobin 3. Multiple bloody, liquid stools. 4. Exacerbations unrelated to stress
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Answer 3: Clients report as many as 10 to 20 liquid bloody stools in a day.
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The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to note documented in the client's record? 1. Diarrhea 2. Chronic constipation 3. Constipation alternating with diarrhea 4. Stool constantly oozing from the rectum
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Diarrhea, Rationale: Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration and severity. Options 2, 3 and 4 are not characteristics of Crohn's diease.
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The nurse prepares for the admission of a client with a perforated duodenal ulcer. Which of the following should the nurse expect to observe as the primary initial symptom? 1. Fever 2. Pain 3. Dizziness 4. Vomiting
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2, Pain: 1. Fever - later with peritonitis (S/S: pain, nausea, vomiting, rigid abdomen, low-grade fever, absent bowel sounds, shallow respirations). 2. Pain - CORRECT: sudden, sharp, begins mid-epigastric; boardlike abdomen. 3. Dizziness - later with shock (S/S: hypotension, tachycardia, tachypnea, decreases urinary output, decrased LOC). 4. Vomiting - seen with peritonitis
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The client diagnosed with Crohn's disease is crying and tells the nurse, "I can't take itanymore. I never know when I will get sick and end up here in the hospital." Whichstatement would be the nurse's best response? 1."I understand how frustrating this must be for you."2."You must keep thinking about the good things in your life." 3. "I can see you are very upset. I'll sit down and we can talk."4."Are you thinking about doing anything like committing suicide?"
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Answer 3, I can see you are very upset, I'll sit down and we can talk, "1.The nurse should never tell a client that they understand what they are going through.2.This is not addressing the client's feelings. 3. (Correct answer) The client is crying and is expressing feel-ings of powerlessness; therefore the nurseshould allow the client to talk. 4.The client is crying and states "I can't take itanymore," but this is not a suicidal commentor situation."
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The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the client supports this diagnosis? 1. "My pain goes away when I have a bowel movement." 2. "I have bright red blood in my stool all the time." 3. "I have episodes of diarrhea and constipation." 4. "My abdomen is hard and rigid and I have a fever."
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1. "My pain goes away when I have a bowel movement, 1. (correct) The terminal ileum is the most common site for regional enteritis, which causes right lower quandrant pain that is relieved by defecation. 2. Stools are liquid or semiformed and do not contain blood. 3. Episodes of diarrhea and constipation may be a sign/symptom of colon cancer, not Crohn's disease. 4. A fever and hard rigid abdomen are signs/symptoms of peritonitis, a complication of Crohn's disease.
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Following bowel resection, a patient has a nasogastric tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube prn as ordered, but the irrigating fluid does not return. Which of the following should be the priority action by the nurse? A. Notify the physician B. Auscultate for bowel sounds. C. Reposition the tube and check for placement. D. Remove the tube and replace it with a new one.
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C, reposition the tube and check for placementThe tube may be resting against the stomach wall. The first action by the nurse, since this was intestinal surgery (not gastric surgery), is to reposition the tube and check it again for placement.
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"Older patients with longstanding or severe Crohn's disease can exhibit which of the following? a Hyperalbuminemia b)Hypoalbuminemia c) Decreased sedimentation rate d)Nausea and vomiting
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Hypoalbuminemia, Rationale wasn't given for this question but Crohns affects the GI tract which will affect the ability to absorb protein so it is lost through the urine.
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The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care? -1) a. sexual dysfunction b. body image, disturbed c. fear related to poor prognosis d. Nutrition: more than body requirements, imbalanced
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Answer B. Body image, disturbed relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch). No data in the question support options A and C. Nutrition: less than body requirements, imbalanced is the more likely nursing diagnosis.
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18. The client is diagnosed with an acute exacerbation of IBD. Which priority intervention should the nurse implement first? "1. Weigh the client daily and document it in the client's chart. 2. Teach coping strategies such as dietary modifications. 3. Record the frequency, amount, and color of stools. 4. Monitor the client's oral fluid intake every shift."
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Answer 3, Record the frequency, amount, and color of stools"Rationale by answer option: 1. Weighing the client daily will help identify if the client is experiencing malnutrition, but it is not the priority intervention during an acute exacerbation. 2. Coping strategies help develop healthy ways to deal with this chronic disease that has remissions and exacerbations, but it is not the priority intervention. 3. The severity of the diarrhea helps determine the need for fluid replacement. The liquid stool should be measured as part of the total output. (CORRECT) 4. The client will be NPO when there is an acute exacerbation of IBD to allow the bowel to rest."
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During the assessment of a patient with acute abdominal pain, the nurse should: a. perform deep palpation before ausculation b. obtain BP and pulse rateto determine hypervolemic changes c. auscultate bowel sounds because hyperactive bowel sounds suggest paralytic ileus d. measure body temperature because and elevated temperature may indicate an inflammatory or infectious process.
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Answer D, If the temperature is elevated pain may be due to infection.
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A patient returns to his room following a lower GI series. When he is assessed by the nurse, he complains of weakness. Which of the following nursing diagnoses should receive priority in planning his care? 1. Alteration in sensation - gustatory 2. Constipation, colonic 3. High risk for fluid volume deficit 4. Nutrition, less than body requirements
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Answer 3, high risk for fluid vol. deficitprep for test: low-residue or clear liquid diet 2 days, NPO midnight, enemas, laxatives, post-test: laxatives to remove barium
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The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? 1.Provide a low-residue diet.2.Monitor intravenous fluids.3.Assess vital signs daily.4.Administer antacids orally.
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2. The client requires fluid to prevent dehydration from diarrhea and to replace fluid lost through normal body functioning.
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A client with inflammatory bowel disease is receiving TPN (total parenteral nutrition) via an infusion pump. When administering TPN it is essential that the nurse: A. monitor the clients blood glucose level Q2H at the bedside with a glucometer B. change the TPN solution bag every 24 hours even if there is solution left in the bag C. instruct the client to breathe shallowly when changing the TPN tubing using sterile technique D. speed up the rate of the TPN infusion if the amount delivered has fallen behind the prescribed hourly rate
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B. TPN solutions are high in glucose and are administered at room temperature, factors that increase the risk of microbial growth in the solution. They should be changed daily or sooner if they appear cloudy.
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A client with Crohn's disease is admitted to the hospital with a history of chronic, bloody diarrhea, weight loss, and signs of general malnutrition. The client has anemia, a low serum albumin level, and signs of negative nitrogen balance. The nurse concludes that the client's health status is related to a major deficiency of: 1. Iron 2. Protein 3. Vitamin C 4. Linoleic acid
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CORRECT ANSWER 2: Protein deficiency causes a low serum albumin level, which permits fluid shifts from the intravascular to the interstitial compartment, resulting in edema. Decreased protein also causes anemia; protein intake must be increased. Although a deficiency of iron will result in anemia, it will not cause the other adaptations. Vitamin C and linoleic acid are unrelated to these adaptations.
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The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure would the nurse tell the client to do? "a. Increase fluid intake b. Place heat on the abdomen c. Perform the irrigation in the evening d. Reduce the amount of irrigation solution"
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Answer A. To enhance effectiveness of the irrigation and fecal returns, the client is instructed to increase fluid intake and to take other measures to prevent constipation. Options B, C and D will not enhance the effectiveness of this procedure.
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Which diagnostic test is used first to evaluate a client with upper GI bleeding? "a) Hemoglobin levels and hematocrit (HCT) b) Endoscopy c) Arteriography d) Upper GI series
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Correct Answer: (A) Hgb and Hct levels" Hemoglobin and HCT are typically performed first in clients with upper GI bleeding to evaluate the extent of blood loss. Endoscopy is then performed to directly visualize the upper GI tract and locate the source of bleeding. An upper GI series, or barium study, usually isn't the diagnostic method of choice, especially in a client with acute active bleeding who's vomiting and unstable. An upper GI series is also less accurate than endoscopy. Although an upper GI series might confirm the presence of a lesion, it wouldn't necessarily reveal whether the lesion is bleeding. Arteriography is an invasive study associated with life-threatening complications and wouldn't be used for an initial evaluation.
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The nurse is assigning clients for the evening shift. Which of the following clients are appropriate for the nurse to assign to a licensed practical nurse to provide client care? Select all that apply. "1. A client with Crohn's disease who is receiving total parenteral nutrition (TPN). 2. A client who underwent inguinal hernia repair surgery 3 hours ago. 3. A client with an intestinal obstruction who needs a Cantor tube inserted. 4. A client with diverticulitis who needs teaching about his take-home medications. 5. A client who is experiencing an exacerbation of his ulcerative colitis."
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"2,5 The nurse should consider client needs and scope of practice when assigning staff to provide care. The client who is recovering from inguinal hernia repair surgery and the client who is experiencing an exacerbation of his ulcerative colitis are appropriate clients to assign to a licensed practical nurse as the care they require fall within the scope of practice for a licensed practical nurse. It is not within the scope of practice for the licensed practical nurse to administer TPN, insert nasoenteric tubes, or provide client teaching related to medications."
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THe nurse is caring for a client with a diagnosis of Crohn's disease. When evaluating a clients response to healthcare intervention, which expected outcome is the most important for the client: A. does skincare B. takes oral fluids C. gains .5 lb per week D. experiences less abdominal cramping
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Answer C = gains .5lbs/wk, weight loss usually is severe with Crohn's disease, therefore, weight gain is a priority. this goal is specific, realistic, measureable and has a timeframe.
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A client with inflammatory bowel disease (IBD) requires an ileostomy. The nurse would instruct the client to do which of the following measures as an essential part of caring for the stoma? 1.Perform massage of the stoma three times a day. 2.Include high-fiber foods in the diet, especially nuts. 3.Limit fluid intake to prevent loose stools. 4.Cleanse the peristomal skin meticulously.
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4; cleanse peristomal skin meticulously1.It is not an intervention used for ileostomies. 2.Clients should avoid the high-fiber and gas-producing foods. 3.These clients are not on fluid restriction. 4.Careful cleansing is necessary to prevent skin breakdown and skin irritation.
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Older patients with longstanding or severe Crohn's disease can exhibit which of the following? A. Hyperalbumineria B. Hypoalbumenria C. Decreased Sedimentation Rate (ESR) D. Nausea and Vomiting
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B, hypoalbumenriaThey may be seen with conditions in which the body does not properly absorb and digest protein, such as Crohn's disease or celiac disease, or in which large volumes of protein are lost from the intestines.
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A client who has a history of Crohn's disease is admitted to the hospital with fever, diarrhea, cramping, abdominal pain, and weight loss. The nurse should monitor the client for: ) 1. Hyperalbuminemia. 2. Thrombocytopenia. (3.) Hypokalemia. 4. Hypercalcemia.
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Hypokalemia is the most expected laboratory finding owing to the diarrhea. Hypoalbuminemia can also occur in Crohn's disease; however, the client's potassium level is of greater importance at this time because a low potassium level can cause cardiac arrest. Anemia is an expected development, but thrombocytopenia is not. Calcium levels are not affected.
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"The client is diagnosed with Crohn's disease, also known as regional enteritis. Whichstatement by the client would support this diagnosis? (1)."My pain goes away when I have a bowel movement."2."I have bright red blood in my stool all the time."3."I have episodes of diarrhea and constipation."4."My abdomen is hard and rigid and I have a fever."
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"(1).The terminal ileum is the most common site for regional enteritis and causes right lower quadrant pain that is relieved by defecation. 2.Stools are liquid or semi-formed and usually do not contain blood.3.Episodes of diarrhea and constipation may be asign/symptom of colon cancer, not Crohn'sdisease.4.A fever and hard rigid abdomen are signs/symptoms of peritonitis, a complication of Crohn's disease."
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"Which of the following would be the highest priority information to include in preoperative teaching for a 68-year old patient scheduled for a colectomy? "A. how to care for the wound (B). how to deep breath and cough C. the location and care of drains after surgery D. what medications will be used during surgery"
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Because anasthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the pt. to cough and deep breathe. Otherwise, the pt. could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge.
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"The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis? "A. "You'll need to drink at least two to three glasses of milk daily." B. "It would likely be beneficial for you to eliminate drinking alcohol." C. "Many people find that a minced or pureed diet eases their symptoms of PUD." D. "Your medications should allow you to maintain your present diet while minimizing symptoms.""
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"Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD and alcohol is best avoided because it can delay healing."
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In planning care for a patient with ulcerative colitis, the nurse should anticipate which of the following diagnostic procedures? a. sigmoidodscopy b. colonoscopy, c. rectal mucosa biopsy, d. all of the above
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Diagnosis of ulcerative colitis is confirmed with the use of sigmoidoscopy, colonoscopy, and rectal mucosa biopsy.
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The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that a manifestion of an obstruction in the large intestine is (select all that apply) a ) a largely distended abdomen b) diarrhea that is loose or liquid c) persistent, colickcy abdominal pain d) profuse vomiting that relieves abdominal pain.
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A & C: distended abd + colicky abd painPersistent, colicky abdominal pain is seen with lower intestinal obstruction. Abdominal distention is markedly incerased in lower interestinal obstructions. Onset of a large intestine obstruction is gradual, vomiting is rare, and there is usually absolute constipation.
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The client with inflammatory bowel disease had surgery to create a continent kock's ileostomy yesterday. The client refuses to look at the stoma when the nurse is teaching stoma care. The best nursing intervention for the nurse to take is to: "A. notify the physician that the patient is depressed. B. continue patient teaching to meet care goals. C. encourage the client to verbalize feelings related to the stoma. D. offer the client a mirror so they can examine the stoma later when they wish to do so."
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C, encourage to talk about feelingsRationale: Clients who have a stoma often experience alterations in body image. The nurse should encourage the client to verbalize feelings related to disease process and stoma
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A client who has a history of chronic ulcertaive colitis is diagnosed with anemia. The nurse intreprets that which factor is most likely responxible for the anemia? a. Blood Loss b. Intestinal hookworm c. intestinal malaborption d. Decreased intake of dietary iron
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Blood loss, The client with chronic ulcerative colitis is most likely enemic as a result of chronic blood loss in small amounts tha occurs with exacerbations of the disease. These clients often have bloody stools and are at increasd risk for anemia. There is no information in the question to supprot options b. or d. In ulcerative colitis, the large intestine is involves, not the small intestine, where vitamin B12 and folic acid are absorbed (option c.)
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"Which goal for the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis? source: "A:promoting self care and independence B:managing diarrhea C:maintaining adequate nutrition D:promoting rest and comfort"
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"B. managing diarrhea Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best achieved by haulting the exacerbation. The client may recieve antidiarrheal agents, antispasmodic agents, bulk hydrophilic agents, or anti-inflammatory drugs."
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The nurse is preparing for discharge of a client who recieved a colectomy 4 days earlier. Which of the following nursing care goals has the highest priority prior to discharge?"A: Lung are clear per auscultation B: incision is healed without redness or drainage C: bowel sounds present, client expels flatus D: vital signs within normal limits"
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The correct answer is C because a collectomy involved the GI tract, the return of normal GI function is most important; the nurse assures the client is expelling gas prior to discharge.
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A client who has had ulcerative colitis for the past 5 years is admitted to the hospital with an exacerbation of the disease. Which of the following factors was most likely of greatest significance in causing an exacerbation of ulcerative colitis? 1. A demanding and stressful job. 2. Changing to a modified vegetarian diet 3. Beginning a weight-training program 4. Walking 2 miles every day
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C, Stressful and emotional events have been clearly linked to exacerbations of ulcerative colitis, although their role in the etiology of the disease has been disproved. A modified vegetarian diet or an exercise program is an unlikely cause of the exacerbation
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When planning care for a client with ulcerative colitis who is experiencing an exacerbation of symptoms, which client care activities can the nurse appropriately delegate to an unlicensed assistant? Select all that apply. / 1. Assessing the client's bowel sounds. 2. Providing skin care following bowel movements.3. Evaluating the client's response to antidiarrheal medications. 4. Maintaining intake and output records. 5. Obtaining the client's weight.
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(2,4, & 5 are CORRECT)The nurse can delegate the following basic care activities to the unlicensed assistant: providing skin care following bowel movements, maintaining intake and output records, and obtaining the client's weight. Assessing the client's bowel sounds and evaluating the client's response to medication are registered nurse activities that cannot be delegated.
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Which of the following would be the highest priority information to include in preoperative teaching for a 68-year-old patient scheduled for a colectomy? "A: How to care for the wound B: How to deep breathe and cough C: The location and care of drains after surgery D: What medications will be used during surgery"
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B: How to deep breathe and coughBecause anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge.
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"Treatment of Crohn's disease? "1. Diet 2. Vitamins 3. Medications 4. Surgery 5. All of thee above
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"A low residue diet is recommend low fiber diet vitamins and iron suplements are recommended Surgery is an option and helps to relieve symptoms (lecture)"
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The client diagnosed with IBD is prescribed TPN. Which nursing intervention should the nurse implement? (Med-Surg Success, 2nd Edition, Davies Q&A Success Series) 1, Check the patients glucose level 2. Administer and oral hypoglycemic 3. Access the peripheral IV site. 4. Monitor the client's oral food intake
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1, Check patient's glucose level
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The nurse cares for a client receiving a balanced completed food by tube. The nurse knows the MOST common complication of a tube feeding is which of the following? "1: Edema 2: Diarrhea 3: Hypokalemia 4: Vomiting"
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2, diarrhea
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A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? a. Providing IV fluids and inserting a nasogastric tube; b. Administering oral bicarbonate and testing the patient's gastric pH level; c. Performing a fecal occult blood test and administering IV calcium gluconate; d. Starting parenteral nutrition and placing the patient in a high-Fowler's position;
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A, IV fluids + NG tubeA perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term
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"A client is admitted with inflammatory bowel syndrome (Crohn's disease). Which treatment measures should the nurse expect to be part of the care plan? SELECT ALL THAT APPLY! "1) Laculose therapy 2) High fiber diet 3) High protein milkshakes 4) Corticosteroid therapy 5) Antidiarrheal medications
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4) Corticosteroid therapy 5) Antidiarrheal medications
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"Which of the following diets would be most appropriate for the client with ulcerative colitis? 1. High-calorie, low-protein. 2. High-protein, low-residue. 3. Low-fat, high-fiber. 4. Low-sodium, high-carbohydrate."
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"2. High protein, low residue Clients with ulcerative colitis should follow a well-balanced high-protein, high-calorie, low-residue diet, avoiding such high-residue foods as whole-wheat grains, nuts, and raw fruits and vegetables. Clients with ulcerative colitis need more protein for tissue healing and should avoid excess roughage. There is no need for clients with ulcerative colitis to follow low-sodium diets."
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"The nurse is teaching about irritable bowel syndrome. Which of the following would be most important? "A. Reinforcing the need for a balanced diet B. Encouraging the client to drink 16 ounces of fluid with each meal C. Telling the client to eat a diet low in fiber D. Instructing the client to limit his intake of fruits and vegetables"
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A, reinforce the need for balanced dietThe nurse should reinforce the need for a diet balanced in all nutrients and fiber. Foods that often cause diarrhea and bloating associated with irritable bowel syndrome include fried foods, caffeinated beverages, alcohol, and spicy foods. Therefore, answers B, C, and D are incorrect.
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"The most common surgical procedures for patients with ulcerative colitis are: 1.Subtotal colectomy and ileostomy. 2.Colostomy and ileo-conduit. 3.Laparoscopic gastrectomy. 4.Segmental resection or
answer
Rationale: Surgery might be necessary for functional older patients with acute disease when drug therapy fails and when multiple precancerous lesions are detected. The most common surgical procedures are subtotal colectomy and ileostomy.
question
"The nurse explains to the patient with gastoesophageal reflux disease that this disorder "a. result in acid erosion and ulceration of the esophagus caused by frequent vomiting. b. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms. c. is the protrusion of a portion of the stomach into the esophagus through an opening in the diaphragm. D. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus
answer
"4. Correct answer: d Rationale: Gastroesophageal reflux disease (GERD) results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower esophageal sphincter (LES) is a common cause of gastric reflux."
question
What is the first line Tx of IBD exacerbation?
answer
IV steriods corticosteriods/methylprednisolone Antibiotics
question
True or False You can take Toradol IV for as long as you need to manage pain for IBD?
answer
FALSE Can only give for 72hrs b/c it causes renal failure then give Tylenol
