Bowel Obstruciton & IBD- In class NCLEX

The patient is preparing for discharge. She asks what is the best way to keep her skin from breaking down. What is the nurse's best response? "Wash with mild soap and warm water after each bowel movement." "Apply a pectin-based skin barrier after each bowel movement." "Add high-fiber or high-cellulose foods to your diet." "Take a laxative daily at bedtime to facilitate morning bowel movements."

"Wash with mild soap and warm water after each bowel movement."

One month after abdominal surgery a client is readmitted to the hospital with recurrent abdominal pain and fever. The medical diagnosis is fistula formation with peritonitis. The nurse should maintain the client in the: 1. Supine position 2. Right Sims position 3. Semi-Fowler's position 4. Most comfortable position

3. Semi-Fowler's position This position promotes localization of purulent material and inflammation and prevents an ascending infection.

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? A. White bread, cheese, and green beans B. Fresh tomatoes, pears, and corn flakes C. Oranges, baked potatoes, and raw carrots D. Dried beans, All Bran (100%) cereal, and raspberries

D. Dried beans, All Bran (100%) cereal, and raspberries A high fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

What priority laboratory analysis should the nurse review when caring for a patient with Crohn's disease? Potassium Hemoglobin Serum albumin C-reactive protein

Hemoglobin Crohn's disease presents as transmural inflammation that causes a thickened bowel wall, strictures, and deep ulcerations that result in severe diarrhea and malabsorption of vital nutrients. Anemia is common, usually from iron deficiency or malabsorption issues

The client is admitted to the acute medical unit with complications of IBD. Which ordered medication would the nurse question? a. Mesalamine (asacol) b. Predisone (deltasone) c. Ibuprophen (motrin) d. loperamide (imodium)

Ibupropfen (motrin)

A client has emergency surgery for a ruptured appendix. After determining that the client is manifesting signs and symptoms of shock. The nurse should:

Notify surgeon immediately

A young male client with a history of ulcerative colitis is admitted to the hospital with severe abdominal pain and loose, bloody stools. Two months after leaving the hospital against medical advice, the client is readmitted for an exacerbation of the illness. At this time he is weak, thin, and irritable and is now willing to consider surgery to create an ileostomy. Which intervention will help meet the clients priority need at this time

Replace his lost fluids and electrolytes

he nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? a. Administering pain medication b. Obtaining a blood sample for laboratory studies c. Preparing to insert a nasogastric (NG) tube d. Administering I.V. fluids

a. Administering I.V. fluids I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance.

The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? a. Low-pitched and rumbling above the area of obstruction b. High-pitched and hypoactive below the area of obstruction c. Low-pitched and hyperactive below the area of obstruction d. High-pitched and hyperactive above the area of obstruction

d. High-pitched and hyperactive above the area of obstruction Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. The patient has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? 1. "The tube will help to drain the stomach contents and prevent further vomiting." 2. "The tube will push past the area that is blocked and thus help to stop the vomiting." 3. "The tube is just a standard procedure before many types of surgery to the abdomen." 4. "The tube will let us measure your stomach contents so that we can plan what type of intravenous (IV) fluid replacement would be best."

1. "The tube will help to drain the stomach contents and prevent further vomiting." The NG tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting

A client develops peritonitis and sepsis after the surgical repair of a ruptured diverticulum. What signs should the nurse expect when assessing the client? (Select all that apply.) 1. Fever 2 Tachypnea 3. Hypertension 4. Abdominal rigidity 5. Increased bowel sounds

1. Fever 2 Tachypnea 4. Abdominal rigidity 1 The metabolic rate will be increased and the temperature-regulating center in the hypothalamus resets to a higher than usual body temperature because of the influence of pyrogenic substances related to the peritonitis. 2 Tachypnea results as the metabolic rate increases and the body attempts to meet cellular oxygen needs. 4. With increased intra-abdominal pressure, the abdominal wall will become rigid and tender.

A client with an acute episode of ulcerative colitis is admitted to the hospital. When reviewing the client's laboratory results, the nurse identifies that the client's blood chloride level is decreased. What is the most efficient way this can be corrected? 1)Low-residue diet 2)Intravenous therapy 3)Oral electrolyte solution 4)Total parenteral nutrition (TPN)

2)Intravenous therapy Intravenous therapy ensures a rapid, well-controlled technique for electrolyte (chloride) replacement. There is no assurance that adequate chloride will be ingested and absorbed. Oral electrolyte solution is not a rapid or well-controlled method for correcting electrolyte deficiencies. TPN is not necessary at this time, although it may be used eventually.

On the third postoperative day after a subtotal gastrectomy, a client complains of severe abdominal pain. The nurse palpates the client's abdomen and identifies rigidity. The nurse should first: 1. Assist the client to ambulate 2. Obtain the client's vital signs 3. Administer the prescribed analgesic 4. Encourage the use of the spirometer

2. Obtain the client's vital signs Rigidity and pain are hallmarks of bleeding from the suture line and/or of peritonitis; vital signs provide supporting data.

A client with Crohn 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 what major deficiency? 1. Iron 2. Protein 3. Vitamin C 4. Linoleic acid

2. Protein- Linoleic acid 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 ferrous sulfate will result in anemia, it will not cause the other adaptations.

An older patient diagnosed with bacterial gastroenteritis reports abdominal cramping, diarrhea, nausea and vomiting, and fatigue for the past 24 hours. The nurse should monitor the patient for what priority assessment? A. Dehydration B. Hypokalemia C. Hypernatremia D. Perineal skin breakdown

A. Dehydration In older adults, dehydration occurs with viral and bacterial gastroenteritis and may require hospitalization- think hypovolemia

The client states, I am afraid I'll never get to go out with my friends again because I can't be away from the tolet. Which is the apropriate nursing response? a. what make you say that? b. your friends will understand c. I wouldn't worry about it if I were you d. it sound like you are concerned about managing this disorder when you are out.

It sound like you are concerned about managing this disorder when you are out.

When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching? a. I will be able to regulate when I have stools b. I will be able to wear the pouch until it leaks c. dried fruit and popcorn must be chewed very well d. the drainage from my stoma can damage my skin

a. I will be able to regulate when I have stools The ileostomy is in the ileum and drains liquid stool frequently. The ileostomy pouch is usually worn 4-7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin.

The nurse admitting a patient with acute diverticulitis explains that the initial plan of care is to a. administer IV fluids. b. give stool softeners and enemas. c. order a diet high in fiber and fluids. d. prepare the patient for colonoscopy.

a. administer IV fluids. A patient with acute diverticulitis will be NPO and given parenteral fluids.

A 25-year-old male patient calls the clinic complaining of diarrhea for 24 hours. Which action should the nurse take first? a. Inform the patient that laboratory testing of blood and stools will be necessary. b. Ask the patient to describe the character of the stools and any associated symptoms. c. Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte. d. Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility.

b. Ask the patient to describe the character of the stools and any associated symptoms. The initial response by the nurse should be further assessment of the patient.

A 71-year-old male patient tells the nurse that growing old causes constipation so he has been using a suppository for constipation every morning. Which action should the nurse take first? a. Encourage the patient to increase oral fluid intake. b. Assess the patient about risk factors for constipation. c. Suggest that the patient increase intake of high-fiber foods. d. Teach the patient that a daily bowel movement is unnecessary.

b. Assess the patient about risk factors for constipation. The nurse's initial action should be further assessment of the patient for risk factors for constipation and for his usual bowel pattern.

A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient? a. Bacteria in the perianal area can enter the urethra. b. Fistulas can form between the bowel and bladder. c. Drink adequate fluids to maintain normal hydration. d. Empty the bladder before and after sexual intercourse.

b. Fistulas can form between the bowel and bladder. Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse.

Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)? a. Restrict oral fluid intake. b. Monitor stools for blood. c. Ambulate four times daily. d. Increase dietary fiber intake.

b. Monitor stools for blood. Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to a. administer IV metoclopramide (Reglan). b. discontinue the patient's oral food intake. c. administer cobalamin (vitamin B12) injections. d. teach the patient about total colectomy surgery.

b. discontinue the patient's oral food intake. An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO.

A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be most useful in determining the cause of the patient's symptoms? a. "What type of foods do you eat?" b. "Is it possible that you are pregnant?" c. "Can you tell me more about the pain?" d. "What is your usual elimination pattern?"

c. "Can you tell me more about the pain?" A complete description of the pain provides clues about the cause of the problem.

Which clinical manifestation of inflammatory bowel disease are common to both patients with ulcerative colitis and crohn's disease ( select all that apply) a. restricted to rectum b. strictures are common c. bloody, diarrhea stools d. cramping abdominal; pain e. lesions penetrate intestine

c. bloody, diarrhea stools d. cramping abdominal; pain Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease

A client has recently been placed on corticosteroids as treatment for ulcerative colitis. The nurse should monitor the patient's laboratory results for evidence of which condition? a. Hypernatremia b. hypercalcemia c. hyperglycemia d. hyperkalemia

c. hyperglycemia

A client is being evaluated in the emergency department for a possible small bowel obstruction. Which signs and/or symptoms does the nurse expect to assess? a. Cramping intermittently, metabolic acidosis, and minimal vomiting b. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis c. Metabolic acidosis, upper abdominal distention, and intermittent cramping d. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

d. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

A 73-year-old patient with diverticulosis has a large bowel obstruction. The nurse will monitor for a. referred back pain. b. metabolic alkalosis. c. projectile vomiting. d. abdominal distention.

d. abdominal distention. Abdominal distention is seen in lower intestinal obstruction.

A patient is hospitalized with vomiting of "coffee-ground" emesis. The nurse suspects acute gastritis and will assess for: d. use of nonsteroidal anti-inflammatory drugs (NSAIDs).

d. use of nonsteroidal anti-inflammatory drugs (NSAIDs).

A patient who is nauseated and vomiting up blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about a. the amount of fat in the diet. b. history of recent weight gain or loss. c. any family history of gastric problems. d. use of nonsteroidal anti-inflammatory drugs (NSAIDs).

d. use of nonsteroidal anti-inflammatory drugs (NSAIDs). Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.