Ch. 57
A male patient with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? a. "A change in position may be what is needed for you to have intercourse with your wife." b. "Have you considered going to see a marriage counselor with your wife?" c. "What has your wife said about your pouch system?" d. "You must get clearance from your primary health care provider before you attempt to have intercourse."
a. "A change in position may be what is needed for you to have intercourse with your wife."
A nurse is teaching a patient with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the patient? a. "Avoid large crowds and anyone who is sick." b. "Do not take the medication if you are allergic to foods with fatty acids." c. "Expect difficulty with wound healing while you are taking this drug." d. Monitor your blood pressure and report any significant decrease in it."
a. "Avoid large crowds and anyone who is sick."
A patient diagnosed with ulcerative colitis (UC) is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? a. "Be aware of the signs/symptoms of toxic megacolon that we discussed." b. "If diarrhea increases, you must let your primary health care provider know." c. "You must avoid pregnancy." d. "You will need to decrease your dose of sulfasalazine (Azulfidine)."
a. "Be aware of the signs/symptoms of toxic megacolon that we discussed."
A patient with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving signs/symptoms. How does the nurse reply? a. "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." b. "It provides key nutrients and extra calories to promote healing." c. "It is bland and reduces the secretion of gastric acids." d. "It does not contain caffeine or other GI tract stimulants."
a. "It is absorbed quickly and allows the affected part of the GI tract to rest and heal."
A patient with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis procedure performed. The patient asks the nurse, "How long do people with this procedure usually has a temporary ileostomy?" How does the nurse respond? a. "It is usually ready to be closed in about 1 to 2 months." b. "You need to talk to your primary health care provider about how long you will have this temporary ileostomy." c. "The period of time is indefinite-I am sorry that I cannot say." d. "You will probably have it for 6 months or longer, until things heal."
a. "It is usually ready to be closed in about 1 to 2 months."
A patient with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next? a. Asks the patient whether family members could be trained in stoma care. b. Has another patient with a stoma who performs self-care talk with the patient c. Requests that the primary health care provider request antidepressants and a psychiatric consult d. Suggests that the primary health care provider request a home health consultation so stoma care can be performed by a home health nurse
a. Asks the patient whether family members could be trained in stoma care.
The nurse is instructing a patient with recently diagnosed diverticular disease about diet. What food does the nurse suggest the patient include? a. a slice of 5-grain bread b. chuck steak patty (6 ounces) c. strawberries (1 cup) d. tomato (1 medium)
a. a slice of 5-grain bread
A patient is scheduled for discharge after surgery for inflammatory bowel disease. The patient's spouse will be assisting home health services with the patient's care. What is most important for the home health nurse to assess in the patient and the spouse with regard to the patient's home care? a. ability of the patient and spouse to perform incision care and dressing changes b. effective coping mechanisms for the patient and spouse after the surgical experience c. knowledge about the patient's requested pain medications d. understanding of the importance of keeping scheduled follow-up appointments
a. ability of the patient and spouse to perform incision care and dressing changes
The nurse is teaching a patient who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the patient to report to the primary health care provider? SATA a. anorexia b. depression c. drowsiness d. frequent urination e. headache f. vomiting
a. anorexia e. headache f. vomiting
A patient with a history of osteoarthritis has a 10-inch incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the patient's care does the nurse make certain to discuss with the primary care provider before the patient's discharge? a. having a home health consultation for wound care b. requesting an anti anxiety medication c. requesting pain medication for the patient's osteoarthritis d. placing the patient in a skilled nursing facility for rehabilitation
a. having a home health consultation for wound care
A certified wound, stony, and continence nurse is teaching a patient about caring for a new ileostomy. What information is most important to include? a. "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." b. "Call your primary health care provider if your stoma has a bluish or pale look." c. "Notify the primary health care provider if output from your stoma has a sweetish odor." d. "Remember that you must wear a pouch system at all times."
b. "Call your primary health care provider if your stoma has a bluish or pale look."
A nurse is teaching a patient about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advice the patient? a. "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." b. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." c. "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." d. "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."
b. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet."
A patient who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the patient to do in the meantime? a. "Avoid all solid foods to allow complete bowel reset." b. "Consume extra fluids to replace fluid losses." c. "Take an over-the-counter antidiarrheal medication." d. "Contact your primary health care provider for an antibiotic medication."
b. "Consume extra fluids to replace fluid losses."
A patient is admitted with severe viral gastroenteritis caused by norovirus. The patient asks the nurse, "How did I get this disease?" Which answer by the nurse is correct? a. "You may have contracted it from an infected infant." b. "You may have consumed contaminated food or water." c. "You may have come into contact with an infected animal." d. "You may have had contact with the blood of an infected person."
b. "You may have consumed contaminated food or water."
The RN receives a change-of-shift report about four patients. Which patient does the nurse assess first? a. A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift b. A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102 degrees Fahrenheit c. A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it d. A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea
b. A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102 degrees Fahrenheit
Which patient does the charge nurse assign to an experienced LPN/LVN? a. A 28-year-old who requires teaching about how to catheterize a Kock ileostomy b. A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy c. A 34-year-old with ulcerative colitis (UC) who has a white blood cell count of 23,000/mm3 d. A 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr
b. A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy
A patient has vague symptoms that indicate an acute inflammatory bowel disorder. Which signs/symptoms are most indicative of Crohn's disease (CD)? a.Abdominal pain relieved by bending the knees, constipation b. Chronic diarrhea, abdominal colicky pain, and fever c. Epigastric cramping & persistent rectal bleeding d. Hypotension with vomiting and headache
b. Chronic diarrhea, abdominal colicky pain, and fever
A patient admitted with severe gastroenteritis has been started on an IV, but the patient continues having excessive diarrhea. Which medication does the nurse expect the primary health care provider to prescribe? a. Balsalazide (Colazal) b. Loperamide (Imodium) c. Mesalamine (Asacol) d. Milk of Magnesia (MOM)
b. Loperamide (Imodium)
A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms? a. bacteria on the patient's hands b. ingestion of parasites in the water c. insufficient vaccinations d. overcooked food
b. ingestion of parasites in the water
Which is a correct statement differentiating Crohn's disease from ulcerative colitis? a. patients with CD experience about 20 loose, bloody stools daily b. patients with UC may experience hemorrhage c. the peak incidence of UC is between 15 and 40 years of age d. very few complications are associated with CD
b. patients with UC may experience hemorrhage
A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices? a. "Drinking carbonated beverages will help with your abdominal distress." b. "It's OK to smoke cigarettes, but you should limit them to 1/2 pack per day." c. "Lactose-containing foods should be reduced or eliminated from your diet." d. "Raw vegetables and high-fiber foods may help to diminish your symptoms."
c. "Lactose-containing foods should be reduced or eliminated from your diet."
A patient with ulcerative colitis (UC) is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the patient's medication regimen? a. Corticosteroid therapy will be stopped. b. Sulfasalazine (Azulfidine) will be stopped. c. Corticosteroid therapy will be tapered. d. Sulfasalazine (Azulfidine) will be tapered.
c. Corticosteroid therapy will be tapered.
A patient returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this patient after the patient is situated in bed? a. High fowler's b. Lateral sims' (side-lying) c. Semi-fowler's d. Supine
c. Semi-fowler's
A patient admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this patient? a. Applying hydrocortisone cream b. Cleaning the area with soap and hot water c. Using sitz baths three times daily d. Wearing absorbent cotton underwear
c. Using sitz baths three times daily
A home health patient has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (UAP) who assists the patient with self-care? a. instructing the patient about the use of electrolyte-containing oral rehydration products b. administering loperamide (Imodium) 4 mg from the patients medicine cabinet c. checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions d. teaching the patient how to clean the perineal area after each loose stool
c. checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions
An obese patient is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the patient's home health nurse requires immediate action? a. pain when coughing b. states, "I am too tired to walk very much" c. states, "I feel like the incision is splitting open" d. Temperature of 100.8 degrees Fahrenheit
c. states, "I feel like the incision is splitting open"
A patient newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the patient about why this therapy has been prescribed? a. "It is to stop the diarrhea and bloody stools." b. "This will minimize your GI discomfort." c. "With this medication, your cramping will be relieved." d. "Your intestinal inflammation will be reduced."
d. "Your intestinal inflammation will be reduced."
An ICU RN is "floated" to the medical-surgical unit. Which patient does the charge nurse assign to the float nurse? a. A 28-year-old with an exacerbation of Crohn's disease who has a drainage enterocutaneous fistula b. A 32-year-old with ulcerative colitis who needs discharge teaching about the use of hydrocortisone enemas c. A 34-year-old who has questions about how to care for a newly created oleo-anal reservoir d. A 36-year-old with peritonitis who just returned from surgery with multiple drains in place
d. A 36-year-old with peritonitis who just returned from surgery with multiple drains in place
A patient has an anal fissure. Which intervention most effectively promotes perineal comfort for the patient? a. Administering a Fleet's enema when needed b. Applying heat to acute inflammation for pain relief c. Avoiding the use of bulk-forming agents d. Using hydrocortisone cream to relieve pain
d. Using hydrocortisone cream to relieve pain
An 80-year-old patient with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first? a. administer acetaminophen (Tylenol) 650 mg rectally b. draw blood for a CBC and serum electrolytes c. obtain a stool specimen for culture and sensitivity d. start an IV solution of 5% dextrose in 0.45 NS at 125 mL/hr
d. start an IV solution of 5% dextrose in 0.45 NS at 125 mL/hr
A patient who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The patient tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members? a. a list of medical supply facilities where wound care supplies may be purchased b. proper hand washing techniques to avoid cross-contamination of the patient's wound c. the amount of pain medication that the patient is allowed to take in each dose d. written and oral instructions regarding signs/symptoms to report to the primary health care provider
d. written and oral instructions regarding signs/symptoms to report to the primary health care provider