Inflammation practice questions

The nurse correlates which clinical manifestation to the pathophysiology of a gastric ulcer? A. Pernicious anemia B. Constipation C. Acute epigastric pain after eating D. Hypertension

C With a gastric ulcer, pain is triggered or worsened by eating, when there is increased acid content of the stomach, which erodes the lesion and stimulates the exposed nerve endings. Pernicious anemia occurs with chronic gastritis. Constipation and hypertension are not manifestations of gastric ulcers.

The nurse is caring for a client who has IBD. Reports 14 loose bloody stools per day x 2 days. VS- Temp 99.6, HR 120, RR 20, BP 88/55. Pain scale 6/10. Hgb 8.5mg/dl. Weight loss of 5 lbs over last 3 weeks. What is the nursing priority? A. Start IV NS at 150ml/hr B. Morphine 4mg IVP C. Anti diarrhea medication D. Start TPN at 40ml/hr E. NPO to prepare for surgery

A

The client is eight (8) hours postoperative small bowel resection. Which data indicate the client has had a complication from the surgery? A. A hard, rigid, boardlike abdomen. B. High-pitched tinkling bowel sounds. C. Absent bowel sounds. D. Complaints of pain at "6" on the pain scale.

A A hard, rigid, boardlike abdomen is the hallmark sign of peritonitis, which is a life-threatening complication of abdominal surgery. This occurs when the client has a nasogastric tube connected to suction and has minimal peristalsis and is not a complication of the surgery. The client has had general anesthesia for this surgery, and absent bowel sounds at eight (8) hours postoperative does not indicate a complication. The client with this type of surgery is expected to have pain at a "6" or higher on a 1-to-10 scale; this is not considered a complication.

Which information should the nurse discuss with the client to prevent an acute exacerbation of diverticulosis? A. Increase the fiber in the diet. B. Drink at least 1,000 mL of water a day. C. Encourage sedentary activities. D. Take cathartic laxatives daily.

A Increasing fiber will help prevent constipation, the number-one reason for an acute exacerbation of diverticulosis, which results in diverticulitis. The client should increase fluid intake to prevent constipation to at least 2,500 mL/day. The client should exercise daily to prevent constipation. The client should take bulk-forming laxatives, which helps prevent constipation by adding bulk to the stool. Cathartic laxatives are harsh colonic stimulants and should not be taken on a daily basis.

The client diagnosed with IBD is prescribed total parenteral nutrition (TPN). Which intervention should the nurse implement? A. Check the client's glucose level. B. Administer an oral hypoglycemic. C. Assess the peripheral intravenous site. D. Monitor the client's oral food intake

A TPN is high in dextrose, which is glucose; therefore, the client's blood glucose level must be monitored closely. The client may be on sliding-scale regular insulin coverage for the high glucose level. The TPN must be administered via a subclavian line because of the high glucose level. The client is NPO to put the bowel at rest, which is the rationale for administering the TPN.

The nurse is caring for a client diagnosed with rule-out peptic ulcer disease. Which test confirms this diagnosis? A. Esophagogastroduodenoscopy. B. Magnetic resonance imaging (MRI). C. Occult blood test. D. Gastric acid stimulation.

A The esophagogastroduodenoscopy (EGD) is an invasive diagnostic test that visualizes the esophagus, stomach, and duodenum to accurately diagnose an ulcer and evaluate the effectiveness of the client's treatment. Magnetic resonance imaging (MRI) shows cross-sectional images of tissue or blood flow. An occult blood test shows the presence of blood but not the source. A gastric acid stimulation test is used to understand the pathophysiology of ulcer disease, but it has limited usefulness.

The client diagnosed with acute diverticulitis is complaining of severe abdominal pain.On assessment, the nurse finds a hard, rigid abdomen and T 102°F. Which intervention should the nurse implement? A. Notify the health-care provider. B. Prepare to administer a Fleet's enema. C. Administer an antipyretic suppository. D. Continue to monitor the client closely

A These are signs of peritonitis, which is life threatening. The health-care provider should be notified immediately.A Fleet's enema will not help a life- threatening complication of diverticulitis.A medication administered to help decrease the client's temperature will not help a life-threatening complication.These are signs/symptoms indicating a possible life-threatening situation and require immediate intervention.

The nurse anticipates the client with possible ulcerative colitis will describe her diarrhea as: A. Bloody B. Green and frothy C. Gray with observable fat D. Clay-colored

A. Bloody diarrhea common for UC

The 70-year-old client is admitted to the medical unit diagnosed with acute diverticulitis. Which interventions should the nurse implement? Select all that apply. A. Tell the client not to eat or drink. B. Start an intravenous line. C. Assess the client for abdominal tenderness. D. Have the dietitian consult for a low-residue diet. E. Place the client on bedrest with bathroom privileges.

ABCE The client should remain NPO until the inflammation in the colon resolves. The client should have an IV to maintain hydration while being NPO. The nurse should assess the client for complications of a ruptured diverticulum. The client will be NPO to rest the bowel. The client is kept on bedrest with bathroom privileges to decrease colon activity. Ambulation increases peristalsis.

The nurse is teaching a class on diverticulosis. Which interventions should the nurse discuss when teaching ways to prevent an acute exacerbation of diverticulosis? Select all that apply. A. Eat a high-fiber diet. B. Increase fluid intake. C. Elevate the HOB after eating. D. Walk 30 minutes a day. E. Take an antacid every two (2) hours

ABD A high-fiber diet will help to prevent constipation, which is the primary reason for diverticulitis.Increased fluids will help keep the stool soft and prevent constipation. This will not do anything to help prevent diverticulitis.Exercise will help prevent constipation. No medications are prescribed to prevent an acute exacerbation of diverticulitis. Antacids are used to neutralize hydrochloric acid in the stomach.

The nurse recognizes that the treatment of H. pylori includes which medications? (Select all that apply.) A. PPIs B. Antiemetics C. Antibiotics D. NSAIDs E. Antacids

AC There are various treatment regimens for H. pylori eradication and most include the combination of a proton pump inhibitor (PPI) with two antibiotics for 7 to 14 days. H. pylori release a toxin that promotes mucosal inflammation and ulceration, stimulating the release of cytokines and other mediators of inflammation that contribute to mucosal damage. Damage to gastroduodenal mucosa allows for decreased resistance to bacteria, and thus infection from H. pylori bacteria may occur.

The healthcare provider prescribes a combination of antibiotics for a patient with a peptic ulcer. The patient asks you why these types of medications are being given. What is the nurse's best response? A. "It will increase mucus production in your stomach." B. "The combination of antibiotics will help to rid the stomach of the H. pylori bacteria." C. "This medication will help buffer the gastric acid in your stomach." D. "It is used only as a prophylactic to prevent colonization of bacteria in the stomach."

B : H. pylori infections can remain active for life, if not treated appropriately. Elimination of this organism allows ulcers to heal more rapidly and remain in remission longer. Two or more antibiotics are given concurrently to increase the effectiveness of therapy and to lower the potential for bacterial resistance. The antibiotics are also combined with a proton pump inhibitor or an H2-receptor antagonist

Which specific data should the nurse obtain from the client who is suspected of having peptic ulcer disease? A. History of side effects experienced from all medications. B. Use of nonsteroidal anti-inflammatory drugs (NSAIDs). C. Any known allergies to drugs and environmental factors. D. Medical histories of at least three (3) generations.

B A history of problems the client has experienced with medications is taken during the admission interview. This information does not specifically address peptic ulcer disease. Use of NSAIDs places the client at risk for peptic ulcer disease and hemorrhage. NSAIDs suppress the production of prostaglandin in the stomach, which is a protective mechanism to prevent damage from hydrochloric acid. Allergies are included for safety, but this is not specific for peptic ulcer disease. Information needs to be obtained about past generations so the nurse can analyze any potential health problems, but this is not specific for peptic ulcer disease.

The nurse is caring for a patient in the emergency department with abdominal pain, fever, nausea, and vomiting. The patient is suspected of having appendicitis. What intervention may the provider order to confirm diagnosis? A. Flat-plate x-ray of the abdomen, chemistry panel B. CT scan, complete blood count (CBC), abdominal assessment for rebound tenderness C. Administer a laxative to see if symptoms improve D. Colonoscopy, esophagogastroduodenoscopy (EGD), and endoscopic retrograde cholangiopancreatogram (ERCP)

B In patients with appendicitis, as the inflammatory process proceeds, pain is shifted to the right lower quadrant of the abdomen and becomes more severe and steady in the area of McBurney's point. When applying and releasing pressure to this area, if the patient notes increased pain when pressure is released, this is called rebound tenderness and is another indication of appendicitis. An abdominal CT may indicate inflammation or enlargement of the appendix. While a flat plate x-ray of the abdomen and serum chemistries may be ordered, they are diagnostically definitive. Laxatives are contraindicated due to the risk of perforation. There is no indication for colonoscopy, EGD, or ERCP in the patient with appendicitis.

A patient is admitted to the hospital for treatment for diverticulitis. The nurse recognizes which interventions appropriate for this patient? A. High-fiber diet, ambulate frequently, IV fluids, pain medications B. Antibiotics, IV fluids, NPO, NG tube, pain medications C. Laxatives, enemas, diet, pain medications D. Surgery with follow-up physical therapy

B Patients with diverticulitis who are hospitalized are treated with broad-spectrum antibiotics, IV fluids, and placed NPO to allow the bowel to rest. The patient may have a nasogastric (NG) tube for bowel decompression. Laxatives and enemas should be avoided because they increase intestinal motility. Pain medications may be given as needed, and opiates are frequently needed. If patients develop complications such as perforation, hemorrhage, obstruction, or abscess, they may require surgery to remove the diseased portion of the colon.

Which assessment data indicate to the nurse the client's gastric ulcer has perforated? A. Complaints of sudden, sharp, substernal pain. B. Rigid, boardlike abdomen with rebound tenderness. C. Frequent, clay-colored, liquid stool. D. Complaints of vague abdominal pain in the right upper quadrant.

B Sudden sharp pain felt in the substernal area indicates angina or myocardial infarction.A rigid, boardlike abdomen with rebound tenderness is the classic sign/symptom of peritonitis, which is a complication of a perforated gastric ulcer. Clay-colored stools indicate liver disorders, such as hepatitis.Clients with gallbladder disease report vague to sharp abdominal pain in the right upper quadrant.

The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? A. Provide a low-residue diet. B. Rest the client's bowel. C. Assess vital signs daily. D. Administer antacids orally

B The client's bowel should be placed on rest and no foods or fluids should be introduced into the bowel.Whenever a client has an acute exacerbation of a gastrointestinal disorder, the first intervention is to place the bowel on rest. The client should be NPO with intravenous fluids to prevent dehydration. The vital signs must be taken more often than daily in a client who is having an acute exacerbation of ulcerative colitis.The client will receive anti-inflammatory and antidiarrheal medications, not antacids, which are used for gastroenteritis.

A 67-year-old male is suspected of having a peptic ulcer. The nurse monitors for a decrease in which diagnostic value with GI hemorrhage in this patient? A. Reticulocyte count B. Hematocrit C. Prothrombin time D. IgG antibodies to H. pylori

B The hematocrit reflects acute magnitude of blood loss after a period of 2 to 24 hours depending on bleeding rate; serial hematocrit assessments can follow a patient's course. Other hemodynamic assessments, such as a complete blood count, coagulation tests, and electrolytes (i.e., BUN and creatinine) should also be included to assess fluid volume deficit.

Which interventions should the nurse discuss regarding prevention of an acute exacerbation of diverticulosis? Select all that apply. A. Eat a low-fiber diet. B. Drink 2,500 mL of water daily. C. Avoid eating foods with seeds. D. Walk 30 minutes a day. E. Take an antacid every two (2) hours.

BCD A high-fiber diet will prevent constipation, the primary reason for diverticulosis/diverticulitis. A low-fiber (residue) diet is prescribed for acute diverticulitis.Increased fluids help to keep the stool soft and prevent constipation.It is controversial if seeds cause an exacerbation of diverticulosis, but this is an appropriate intervention to teach until proven otherwise.Exercise helps to prevent constipation, which can cause an exacerbation of diverticulitis.There are no medications used to help pre- vent an acute exacerbation of diverticulosis/ diverticulitis. Antacids are used to neutralize hydrochloric acid in the stomach.

The nurse is caring for a clients on a medical floor. After the shift report, which client should be assessed first?A. The client who is 2/3 of the way through a blood transfusion and has no complaints of dyspnea or hivesB. The client diagnosed with leukemia who has a hematocrit of 18% and petechiae covering the bodyC. The client with peptic ulcer disease who called over the intercom to say that he is vomiting bloodD. The client diagnosed with Crohns disease who is complaining of perineal discomfort

C A. The patient is tolerating the blood transfusion and still has blood left to goB. this is an expected finding with a client with leukemiaC. this client has a potential for hemorrhaging this client should be assessed firstD. this is an expected finding with Crohn's disease not life-threatening

The nurse is caring for a client diagnosed with ulcerative colitis. Which symptom(s) support this diagnosis? A. Increased appetite and thirst. B. Elevated hemoglobin. C. Multiple bloody, liquid stools. D. Exacerbations unrelated to stress.

C Clients suffering from ulcerative colitis experience anorexia, not an increased appetite. The hemoglobin and hematocrit are decreased, not elevated, as a result of blood loss. Clients report as many as 10 to 20 liquid, bloody stools in a day. Stressful events have been linked to an increase in symptoms. The nurse needs to assess for perceived stress in the client's life producing symptoms.

The nurse is discussing the therapeutic diet for the client diagnosed with diverticulosis. Which meal indicates the client understands the discharge teaching? A. Fried fish, mashed potatoes, and iced tea. B. Ham sandwich, applesauce, and whole milk. C. Chicken salad on whole-wheat bread and water. D. Lettuce, tomato, and cucumber salad and coffee.

C Fried foods increase cholesterol. Mashed potatoes do not have the peel, which is needed for increased fiber. Applesauce does not have the peel, which is needed for increased fiber, and the option does not identify which type of bread; whole milk is high in fat. Chicken salad, which has vegetables such as celery, grapes, and apples, and whole-wheat bread are high in fiber, which is the therapeutic diet prescribed for clients with diverticulosis. An adequate intake of water helps prevent constipation. Tomatoes and cucumbers have seeds, and many health-care providers recommend clients with diverticulosis avoid seeds because of the possibility of the seeds entering the diverticulum and becoming trapped, leading to peritonitis.

The client diagnosed with ulcerative colitisis prescribed a low-residue diet. Which meal selection indicates the client understands the diet teaching? A. Grilled hamburger on a wheat bun and fried potatoes. B. A chicken salad sandwich and lettuce and tomato salad. C. Roast pork, white rice, and plain custard. D. Fried fish, whole grain pasta, and fruit salad.

C Fried potatoes, along with pastries and pies, should be avoided. Raw vegetables should be avoided because this is roughage. A low-residue diet is a low-fiber diet. Products made of refined flour or finely milled grains, along with roasted, baked, or broiled meats, are recommended. Fried foods should be avoided, and whole grain is high in fiber. Nuts and fruits with peels should be avoided.

The home health nurse must see all of the following clients. Which client should the nurse assess first? A. The client who is postoperative from an open cholecystectomy who has green drainage coming from the T-tube. B. The client diagnosed with congestive heart failure who complains of shortness of breath while fixing meals. C. The client diagnosed with AIDS dementia whose family called and reported that the client is vomiting "coffee grounds stuff." D. The client diagnosed with end-stage liver failure who has gained three (3) pounds and is not able to wear house shoes.

C The T-tube is inserted into the common bile duct to drain bile until healing occurs, and bile is green, so this is expected. The client with CHF would be expected to experience dyspnea on exertion. Coffee-ground emesis indicates gastrointestinal bleeding, and this client should be seen first. The client in end-stage liver failure is unable to assimilate protein from the diet, which leads to fluid volume retention and resulting weight gain. This is expected for this client.

The client is admitted to the medical unit with a diagnosis of acute diverticulitis. Which health- care provider's order should the nurse question? A. Insert a nasogastric tube. B. Start an IV with D5W at 125 mL/hr. C. Put the client on a clear liquid diet. D. Place the client on bedrest with bathroom privileges.

C The client will have a nasogastric tube because the client will be NPO, which will decompress the bowel and remove hydrochloric acid. Preventing dehydration is a priority with the client who is NPO. The nurse should question a clear liquid diet because the bowel must be put on total rest, which means NPO. The client is in severe pain and should be on bedrest, which will help rest the bowel.

The client is diagnosed with ulcerative colitis. Which sign/symptom warrants immediate intervention by the nurse? A. The client has 20 bloody stools a day. B. The client's oral temperature is 99.8°F. C. The client's abdomen is hard and rigid. D. The client complains of urinating when coughing.

C The colon is ulcerated and unable to absorb water; 10 to 20 bloody diarrhea stools is the most common symptom of ulcerative colitis and does not warrant immediate intervention. This is not an elevated temperature and does not warrant immediate intervention by the nurse. A hard, rigid abdomen indicates peritonitis, a complication of ulcerative colitis, and warrants immediate intervention

An 80-year-old patient is admitted to the hospital for diverticulitis. The family states that the family member isn't acting normally. The patient does not have specific complaints. The nurse correlates this data to which characteristics of older adults? A. They typically complain of a lot of pain with diverticulitis. B. They often have referred pain to another site. C. They may exhibit a change in mental status before any other symptoms occur. D. They will be having other symptoms such as nausea and vomiting.

C The first sign that may appear in the elderly is a change in mental status. Baseline temperature is often decreased from normal in the older adult. Therefore, one of the most common signs of infection may not be apparent in the older adult and the patient may present with increased confusion, falling, and anorexia.

The nurse has been assigned to care for a client diagnosed with peptic ulcer disease. Which assessment data require further intervention? A. Bowel sounds auscultated 15 times in one (1) minute. B. Belching after eating a heavy and fatty meal late at night. C. A decrease in systolic blood pressure (BP) of 20 mm Hg from lying to sitting. D. A decreased frequency of distress located in the epigastric region.

C The range for normoactive bowel sounds is from five (5) to 35 times per minute. This would require no intervention. Belching after a heavy, fatty meal is a symptom of gallbladder disease. Eating late at night may cause symptoms of esophageal disorders. A decrease of 20 mm Hg in blood pressure after changing position from lying, to sitting, to standing is orthostatic hypotension. This could indicate the client is bleeding. A decrease in the quality and quantity of discomfort shows an improvement in the client's condition. This would not require further intervention.

The client is diagnosed with an acute exacerbation of Crohn's disease. Which assessment data warrant immediate attention? A. The client's WBC count is 10 (× 10^3)/mm3. B. The client's serum amylase is 100 units/dL. C. The client's potassium level is 3.3 mEq/L. D. The client's blood glucose is 148 mg/dL.

C This white blood cell (WBC) level is WNL and would not warrant immediate intervention. This amylase level is within normal limits This potassium level is low as a result of excessive diarrhea and puts the client at risk for cardiac dysrhythmias. Therefore, these assessment data warrant immediate intervention. The client's blood glucose level is elevated, but it would not warrant immediate intervention for a client with Crohn's disease who has hypokalemia.

The client is complaining of painful swallowing secondary to mouth ulcers. Which statement indicates the nurse's teaching is effective? A. "I will brush my teeth with a soft-bristle toothbrush." B. "I will rinse my mouth with Listerine mouthwash." C. "I will swish with antifungal solution and then swallow." D. "I will avoid spicy foods, tobacco, and alcohol."

D A soft-bristle toothbrush will not affect painful swallowing.An alcohol-based mouthwash (Listerine) is irritating to the oral cavity and can increase pain. An antifungal medication should be used with candidiasis and is not effective treatment for plain mouth ulcers.Irritating substances should be avoided during the outbreaks of ulcers in the mouth. Spicy foods, alcohol, and tobacco are common irritants the client should avoid.

The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto-Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse the medications are effective? A. A decrease in alcohol intake. B. Maintaining a bland diet. C. A return to previous activities. D. A decrease in gastric distress.

D Decreasing the alcohol intake indicates the client is making some lifestyle changes. The client with peptic ulcer disease (PUD) is prescribed a regular diet, but the type of diet does not determine if the medication is effective. The return to previous activities indicates the client has not adapted to the lifestyle changes and has returned to the previous behaviors which precipitated the peptic ulcer disease Antibiotics, proton pump inhibitors, and Pepto-Bismol are administered to decrease the irritation of the ulcerative area and cure the ulcer. A decrease in gastric distress indicates the medication is effective.

The nurse is teaching the client diagnosed with diverticulosis. Which instruction should the nurse include in the teaching session? A. Discuss the importance of drinking 1,000 mL of water daily. B. Instruct the client to exercise at least three (3) times a week. C. Teach the client about eating a low-residue diet. D. Explain the need to have daily bowel movements.

D The client should drink at least 3,000 mL of water daily to help prevent constipation. The client should exercise daily to help prevent constipation. The client should eat a high-fiber diet to help prevent constipation. The client should have regular bowel movements, preferably daily. Constipation may cause diverticulitis, which is a potentially life-threatening complication of diverticulosis.

The client is two (2) hours post colonoscopy. Which assessment data warrant intermediate intervention by the nurse? A. The client has a soft, nontender abdomen. B. The client has a loose, watery stool. C. The client has hyperactive bowel sounds. D. The client's pulse is 104 and BP is 98/60.

D The client's abdomen should be soft and nontender; therefore, this finding would not require immediate intervention. The client had to clean the bowel prior to the colonoscopy; therefore, watery stool is expected. The client was NPO and received bowel preparation prior to the colonoscopy; there- fore, hyperactive bowel sounds might occur and do not warrant immediate intervention. Bowel perforation is a potential complication of a colonoscopy. Therefore, signs of hypotension—decreased BP and increased pulse—warrant immediate intervention from the nurse.

Which assessment data supports the client's diagnosis of gastric ulcer to the nurse? A. Presence of blood in the client's stool for the past month. B. Reports of a burning sensation moving like a wave. C. Sharp pain in the upper abdomen after eating a heavy meal. D. Complaints of epigastric pain 30 to 60 minutes after ingesting food.

D The presence of blood does not specifically indicate diagnosis of an ulcer. The client could have hemorrhoids or cancer resulting in the presence of blood. A wavelike burning sensation is a symptom of gastroesophageal reflux. Sharp pain in the upper abdomen after eating a heavy meal is a symptom of gallbladder disease. In a client diagnosed with a gastric ulcer, pain usually occurs 30 to 60 minutes after eating but not at night. In contrast, a client with a duodenal ulcer has pain during the night often relieved by eating food. Pain occurs one (1) to three (3) hours after meals.

The client diagnosed with diverticulitis is complaining of severe pain in the left lower quadrant and has an oral temperature of 100.6°F. Which intervention should the nurse implement first? A. Notify the health-care provider. B. Document the findings in the chart. C. Administer an oral antipyretic. D. Assess the client's abdomen.

D These are classic signs/symptoms of diverticulitis; therefore, the HCP does not need to be notified.These are normal findings for a client diagnosed with diverticulitis, but on admission the nurse should assess the client and document the findings in the client's chart. The nurse should not administer any food or medications.The nurse should assess the client to determine if the abdomen is soft and nontender. A rigid tender abdomen may indicate peritonitis

The client is diagnosed with an acute exacerbation of inflammatory bowel disease (IBD). Which food selection would be the best choice for a meal? A. Roast beef on wheat bread and a milk shake. B. Hamburger, french fries, and a cola. C. Pepper steak, brown rice, and iced tea. D. Roasted turkey, instant mashed potatoes, and water.

D Wheat bread and whole grains should be avoided, and most clients cannot tolerate milk products. Fried foods such as hamburger and french fries should be avoided. Raw fruits and vegetables such as lettuce and tomatoes are usually not tolerated. Whole grains such as brown rice should be avoided. White rice can be eaten. Spicy meats and foods should be avoided. Meats can be eaten if prepared by roasting, baking, or broiling. Vegetables should be cooked, not raw, and skins should be removed. Instant mashed potatoes do not have the skin. A low-residue diet should be eaten.

Medication used to treat diverticulitis

antibiotics

Medication used to treat peptic ulcers

omeprazole

Serious complication of diverticulitis

perforation