EAQ Chronic Inflammatory Bowel Disorders

Which clinical manifestation is seen in Crohn's disease? Weight gain Vomiting Abdominal pain Six or more bloody stools per day

Abdominal pain Rationale: Most patients with Crohn's disease have weight loss caused by malabsorption. Vomiting is not commonly seen in patients with Crohn's disease. Six or more bloody stools per day would be seen in ulcerative colitis.

Which symptom is most indicative of Crohn's disease? Epigastric cramping Hypotension with vomiting Chronic diarrhea, abdominal pain, and fever Abdominal pain is relieved by bending the knees

Chronic diarrhea, abdominal pain, and fever Rationale: Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis. Epigastric cramping is a symptom more indicative of appendicitis. Hypotension with vomiting is not characteristic of CD.

Which complication is seen exclusively in patients with Ulcerative Colitis? Cholelithiasis Malabsorption Colorectal cancer Abscess formation

Colorectal Cancer Rationale: Colorectal cancer is a major complication of ulcerative colitis that is seen in patients who have a history of that disease for more than 10 years. Cholelithiasis is an extraintestinal complication observed in patients with both ulcerative colitis and Crohn's disease. Malabsorption is a common complication seen both in ulcerative colitis and Crohn's disease; however this condition is more common in Crohn's disease. Abscess formation is also seen in patients with both ulcerative colitis and Crohn's disease.

Which term is used to describe a fistula that is present between the bowel and the bladder? Enteroenteric fistula Enterovesical fistula Enterovaginal fistula Enterocutaneous fistula

Enterovesical Fistula

Which complication is associated with Crohn's disease? Fistula Hemorrhage Hypovolemia Colorectal cancer

Fistula Rationale: Crohn's disease is an inflammatory bowel disease that causes abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. Strictures and deep ulcerations occur in Crohn's disease, which increases the risk for developing bowel fistulas. Hemorrhage is a complication associated with ulcerative colitis (UC). Hypovolemia is a complication associated with gastroenteritis. Colorectal cancer is a complication associated with UC.

Which potential complication is associated with Crohn's disease? Fistulas Osteoporosis Malabsorption Stomach cancer Abscess formation

Fistulas Osteoporosis Malabsorption Abscess formation

Which complication is commonly seen in Crohn's disease? Fistulas Tenesmus Liquid stool Bloody stool

Fistulas Rationale: Crohn's disease is an inflammatory disease that usually affects the small intestine and the colon. The patient with Crohn's disease is at risk for fistulas caused by the presence of strictures and deep ulcerations in the bowel wall. Patients with ulcerative colitis have bloody and liquid stools and report tenesmus, an unpleasant and urgent sensation to defecate. The lower abdominal colicky pain reduces with defecation.

Which medication would a patient with ulcerative colitis who complains of severe diarrhea with exacerbations be taught to take for flare-ups? Glucocorticoids Aminosalicylates Immunomodulators Antidiarrheal drugs

Glucocorticoids Rationale: Aminosalicylates are used to treat mild to moderate ulcerative colitis. Antidiarrheal drugs provide symptomatic management of diarrhea. However, these drugs are given very cautiously because they can cause colon dilation and toxic megacolon (massive dilation of the colon and subsequent colonic ileus that can lead to gangrene and peritonitis).

Which kind of diet would be provided to a patient to promote the healing of a fistula? High-fiber food Low-vitamin food High-protein meals Low-calorie meals

High-protein meals

A patient has a low-grade fever and tenesmus. Which other clinical manifestation may indicate ulcerative colitis? Increase in appetite Difficulty passing stools Inflammation of the joints Formation of lesions outside the mouth

Inflammation of the joints Rationale: Appetite would be decreased because mealtimes may be unpleasant because eating is associated with pain. Patients with ulcerative colitis have an increased frequency of stools rather than difficulty passing stools. Patients with ulcerative colitis may have lesions or ulcers inside the mouth involving the tongue, palate, and pharynx rather than outside the mouth.

Which physiological change is seen in a patient with ulcerative colitis? Increase in hemoglobin levels Hyperalbuminemia Leukocytosis Hyperkalemia

Leukocytosis Rationale: Because of chronic blood loss, hemoglobin levels decrease in patients with ulcerative colitis. Serum albumin levels decrease because of loss of protein (albumin) in the stool, so hyperalbuminemia would not be seen. Blood levels of potassium decrease as a result of frequent diarrhea stools and malabsorption, so a patient would have hypokalemia.

Which medication would be helpful in a patient who has a fistula associated with Crohn's disease? Mesalamine Sulfasalazine Azithromycin Metronidazole

Metronidazole Rationale: Fistulas occur as a result of acute exacerbations of Crohn's disease. Mesalamine and sulfasalazine are effective in the treatment of inflammatory bowel disease. Azithromycin is used in the treatment of gastroenteritis.

Which surgical techniques are involved in the treatment of Crohn's disease? Minimal invasive surgery (MIS) and ileostomy Minimal invasive surgery and stricturoplasty Ileostomy and natural orifice transluminal endoscopic surgery (NOTES) Stricturoplasty and natural orifice transluminal endoscopic surgery

Minimal Invasive Surgery and Stricturoplasty Rationale: MIS is performed for treating Crohn's disease, which involves one or more small incisions, less pain, and quicker surgical recovery. Stricturoplasty is performed for bowel strictures related to Crohn's disease. Ileostomy and NOTES are the surgical techniques for treating ulcerative colitis.

A patient has been diagnosed with ulcerative (UC) and reports having between four and five bloody stools per day. How would the nurse classify the intensity of this patient's UC? Mild Severe Moderate Fulminant

Moderate Rationale: In moderate UC, the patient will experience more than four bloody stools per day. In mild UC, there are fewer than four bloody stools, and more than six with severe UC. With fulminant UC, there are more than 10 bloody stools per day.

Which clinical findings in a patient indicate ulcerative colitis? Bowel fistulas Thickened bowel wall Inflammation of the ileum and colon Presence of blood and mucus in the stool

Presence of blood and mucus in the stool Rationale: Strictures and deep ulcerations occur in Crohn's disease, which put the patient at risk for developing bowel fistulas. Thickened bowel walls and inflammation of ileum and colon are seen in Crohn's disease.

A patient reports having seven to nine bloody stools per day. The nurse finds that the patient has fever, tachycardia, anemia, and abdominal pain. The patient's laboratory reports indicate elevated C-reactive protein. Which classification of ulcerative colitis (UC) do these findings support? Mild Severe Moderate Fulminant

Severe Rationale: Absence of abnormal laboratory findings and less than four stools per day without blood indicate mild UC. Mild abdominal pain, nausea, and more than four stools per day without blood indicate moderate UC. Colonic distention, anemia, and more than 10 stools per day indicate fulminant UC.

Which classic symptom is seen in celiac disease? Weight gain Steatorrhea Osteoporosis Abdominal pain Diarrhea and/or constipation

Steatorrhea Abdominal pain Diarrhea and/or Constipation Rationale: Classic symptoms include weight loss, anorexia, diarrhea and/or constipation, steatorrhea, abdominal pain and distention, and vomiting.

Which physiological changes take place in a patient after about a week after having a total proctocolectomy with a permanent ileostomy? The effluent has a foul odor. The stool becomes reddish in color. Stool volume increases and becomes thin. Stool volume decreases and becomes thick.

Stool volume decreases and becomes thick. Rationale: Volume decreases and becomes thick or pastelike because of increased absorption of sodium and water.

Which medication would be used as the first-line treatment for mild ulcerative colitis? Infliximab Prednisone Loperamide Sulfasalazine

Sulfasalazine Rationale: Infliximab alone is not effective in treating ulcerative colitis. Glucocorticoids such as prednisone are prescribed during exacerbations of the disease. Antidiarrheal drugs such as loperamide provide symptomatic management of the disease.

About which medication would the nurse teach a patient who is newly diagnosed with moderate ulcerative colitis (UC)? Azathioprine Sulfasalazine Mercaptopurine Sulfamethoxazole

Sulfasalazine Rationale: Sulfamethoxazole is an antibiotic that can be used to treat gastroenteritis caused by shigellosis. Both azathioprine and mercaptopurine are prescribed to manage the symptoms of Crohn's disease.

The nurse is teaching a patient with ulcerative colitis about different medication regimens. Which drug would the nurse explain has a complication of hemolytic anemia if taken in higher doses? Olsalazine Balsalazide Mesalamine Sulfasalazine

Sulfasalazine Rationale: Sulfasalazine is an aminosalicylate drug.

Which patient required infliximab treatment? The patient with heart disease The patient with Crohn's disease The patient with multiple sclerosis The patient with diverticular disease

The patient with Crohn's disease Rationale: Metronidazole plus trimethoprim/sulfamethoxazole is recommended for patients with diverticular disease.

Which patient is at risk for celiac disease? The patient with multiple sclerosis The patient who is receiving prednisone The patient with diabetes mellitus type I The patient who is receiving paromomycin

The patient with Diabetes Mellitus Type 1 Rationale: Diabetes mellitus type 1 is a metabolic disorder, which affects the metabolic function and can cause problems in gluten digestion. Patients who have autoimmune disorders such as diabetes type 1 are at the highest risk for celiac disease. Multiple sclerosis in an inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged and is not a risk factor for developing celiac disease. Prednisone is a glucocorticoid and can cause osteoporosis as a side effect, not celiac disease. Paromomycin can cause dizziness as a side effect and does not place a patient at risk for celiac disease.

Which medication prevents the migration of white blood cells (WBCs) to inflamed bowel tissue? Prednisone Vedolizumab Azathioprine Metronidazole

Vedolizumab Rationale: Vedolizumab is an intestinal-specific leukocyte traffic inhibitor. It prevents the migration of WBCs to inflamed bowel tissue. Prednisone is used to treat ulcerative colitis. Azathioprine is used to treat Crohn's disease. Metronidazole is the drug of choice to treat giardiasis.

Which diagnostic test is preferred to differentiate between ulcerative colitis and Crohn's disease? CT scan Colonoscopy Magnetic resonance enterography X-ray examination with barium enema

X-Ray Examination with Barium Enema Rationale: Preferred over other test because of its accuracy. A CT scan is done to confirm the disease or its complications. A colonoscopy may be done to aid in diagnosis. A magnetic resonance enterography helps assess the status of a patient's inflammatory bowel disease.