Medical-Surgical Nursing Week 7 Part 1

Which nursing interventions are appropriate for the patient with appendicitis?

Keeping the patient in a semi-Fowler's position

What surgical techniques are involved in the treatment of Crohn's disease?

Minimal invasive surgery (MIS) and stricturoplasty

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?

Semi-Fowler'

A patient is being discharged following a laparotomy for treatment of peritonitis. What complications should the patient report to the primary health care provider immediately? Select all that apply.

Signs of wound dehiscence Unusual or foul-smelling drainage A temperature higher than 101°F (38.3°C)

Which instructions should the nurse provide to the patient with appendicitis that is scheduled for surgery? Select all that apply.

Take antibiotics as prescribed. Take opioid analgesics as prescribed.

A patient with a new ileostomy is distressed because of the large amount of green liquid stool that must be emptied from the pouch several times each day. What does the nurse tell this patient?

"Eventually, the amount and consistency of the stool will change."

A patient has been newly diagnosed with ulcerative colitis. Which statement by the patient indicates a need for further teaching about the complications of the disease?

"I may have an increased risk of bladder infections caused by fistulas."

The nurse is teaching a patient about caring for an ileostomy at home. Which statement by the patient indicates a correct understanding of the teaching?

"I should use skin sealants and ostomy skin creams as needed to prevent irritation."

A patient with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The patient asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond?

"It is usually ready to be closed in about 1 to 2 months."

A patient newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine. Which explanation will the nurse give the patient about the reason for use of this drug?

"This medication causes intestinal inflammation to be reduced."

What are the common signs and symptoms of gastroenteritis?

Nausea and vomiting

What interventions should the nurse provide to a patient with inflammatory bowel disease who complains of abdominal pain?

Observe for signs and symptoms of peritonitis

What disorders does the nurse identify as acute inflammatory bowel disorders? Select all that apply.

Peritonitis Appendicitis Gastroenteritis

A patient demonstrates the manifestations of diverticulitis with a suspected complication of peritonitis. What is the priority nursing intervention?

Preparing the patient for emergency surgery

What postoperative measure must the patient take after undergoing abdominal surgery for peritonitis?

Report a temperature higher than 38°C.

What instruction should the nurse give to a patient with inflammatory bowel disease regarding skin care?

Tell the patient to apply a thin coat of A+D ointment or aloe cream.

Which complication is seen exclusively in patients with ulcerative colitis?

Colorectal cancer

Which sign of peritonitis appears first in an older adult?

Confusion

What term is used to describe a fistula that is present between the bowel and the bladder?

Enterovesical fistula

A patient has a low-grade fever and tenesmus. Which other clinical manifestations may indicate ulcerative colitis?

Inflammation of the joints

What would be the drug of choice for a patient with gastroenteritis who is prescribed antiperistaltic agents?

Loperamide

Which medication would be beneficial to the patient with gastroenteritis who has increased peristaltic movements?

Loperamide

What measures should be taken by a patient who has gastroenteritis to prevent transmission of the infection?

Maintain clean bathroom facilities.

A parent of a patient suffering from chronic inflammatory bowel disease informs the nurse, "My son leaks stools while he is sleeping." The nurse teaches the parent necessary steps to manage the child's nocturnal stool leakage. Which statement made by the parent indicates a need for further teaching?

"I should encourage my son to drink more milk."

The RN receives a change-of-shift report about four patients. Which patient does the nurse assess first?

25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F

The nurse is caring for a patient with peritonitis. What assessment findings will the nurse observe? Select all that apply.

Anorexia Distended abdomen

What laboratory findings are consistent with ulcerative colitis (UC)? Select all that apply.

Increased C-reactive protein Decreased potassium levels

A patient with ulcerative colitis complains of severe diarrhea with exacerbations. What is the drug of choice in this condition?

Glucocoticoids

A patient reports pain and a boardlike abdomen. What other findings would indicate peritonitis? Select all that apply.

High fever Dehydration Inability to pass feces

The patient requires a large amount of calories daily to promote the healing of a fistula. Which kind of diet should the nurse provide to the patient?

High-protein food

What physiological change is seen in a patient with ulcerative colitis?

Increase in white blood cell levels

What changes take place in a patient after a total proctocolectomy with a permanent ileostomy?

Stool volume decreases and becomes thick

A nurse is caring for a patient with a new diagnosis of moderate ulcerative colitis (UC). The nurse anticipates an order for which medication?

Sulfasalazine

What drug has a complication of hemolytic anemia in a patient with ulcerative colitis if taken in higher doses?

Sulfasalazine

Which medication is used as the first line treatment for mild ulcerative colitis?

Sulfasalazine

A patient with an exacerbation of ulcerative colitis (UC) has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving symptoms. How does the nurse reply?

"It is absorbed quickly and allows the affected part of the GI tract to rest and heal."

What is the typical incubation period of the Norwalk virus in a person with a normal immune system?

48 hours

A patient with ulcerative colitis is scheduled to undergo restorative proctocolectomy with ileo pouch-anal anastomosis (RPC-IPAA). What statements about the procedure are accurate? Select all that apply.

A temporary loop ileostomy is created. Parenteral antibiotics are given within 1 hour before the surgery. An internal pouch is created with the distal part of the small intestine.

A patient has vague symptoms that indicate an inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)?

Chronic diarrhea, abdominal pain, and fever

Which drug is often used to treat gastroenteritis caused by Shigella?

Ciprofloxacin

A patient with ulcerative colitis (UC) is prescribed sulfasalazine and corticosteroid therapy. As the disease improves, what change does the nurse expect in the patient's medication regimen?

Corticosteroid therapy will be tapered.

Which disorder is associated with inflammation of the small intestine?

Crohn's disease

Which statements about shigellosis are accurate? Select all that apply.

Humans are possible carriers for months. Cipro may be used for treatment of gastroenteritis Shigellosis is transmitted by direct fecal-oral routes

A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms?

Ingestion of parasites in the water

Which pathophysiological finding is least likely to occur in ulcerative colitis?

Intestinal mucosa becomes bluish.

A patient complains of severe diarrhea and abdominal pain. Which information collected from the patient would indicate an increased risk for inflammatory bowel disease? Select all that apply.

Intolerance to milk Exposure to antibiotics Travel to a tropical area

What postoperative measures are typically implemented for patients who have undergone abdominal surgery for peritonitis?

Irrigating the drain via sterile technique

Which statement about appendicitis is accurate?

It occurs mostly in young adults

Which medication is the drug of choice for the treatment of giardiasis?

Metronidazole

Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)?

Patients with UC may experience hemorrhage.

Gangrene of the bowel and sepsis are some of the most common indications for emergency surgery. With which inflammatory bowel disorder are these complications associated?

Peritonitis

A patient is experiencing an exacerbation of ulcerative colitis (UC). What is an important nursing action to help minimize the patient's discomfort?

Restricting lactose-containing foods

Which of the following are classic symptoms of celiac disease? Select all that apply.

Steatorrhea Abdominal pain Diarrhea and/or constipation

Which statement about the procedure for an appendectomy is correct?

Laparoscopy is an invasive procedure used to remove the inflamed appendix.

A patient admitted with severe gastroenteritis has been started on an IV, but the patient continues having excessive diarrhea. Which medication does the nurse ask the health care provider about prescribing?

Loperamide

A patient reports pain midway between the anterior iliac crest and the umbilicus in the right lower quadrant. The nurse documents that the patient is experiencing pain in which location?

McBurney's Point

A patient has been diagnosed with ulcerative colitis (UC) and reports having between four and five bloody stools per day. How does the nurse classify the intensity of the patient's UC?

Moderate

A patient had emergency surgery for peritonitis. Which nursing interventions are appropriate immediately after surgery? Select all that apply.

Monitoring the vital signs Monitoring the level of consciousness Encouraging the patient to consume food Maintaining the patient in a semi-Fowler's position

Which organism causes gastroenteritis and is possibly transmitted through the respiratory route?

Norovirus

What are the less-common causes for peritonitis? Select all that apply.

Perforating tumors Leakage during surgery Contamination during surgery

Which clinical findings in a patient indicate ulcerative colitis?

Presence of blood and mucus in the stool

After reviewing the case sheet of a patient experiencing severe abdominal pain and diarrhea, the nurse suspects ulcerative colitis. Which findings support the nurse's conclusion? Select all that apply.

Presence of blood in stools Intolerance to milk and milk products Use of non-steroidal anti-inflammatory drugs for pain

Which information is important to collect from a patient who is admitted to the hospital with diarrhea to determine the risk for gastroenteritis? Select all that apply.

Recent travel Recent restaurant meals Food items purchased recently

The nurse is caring for a patient admitted for gastroenteritis. What symptoms does the nurse expect to see in the patient? Select all that apply.

Fever Acute confusion Poor skin turgor

Which findings in a patient indicate dehydration? Select all that apply.

Fever Oliguria Poor skin turgor

Which findings does the nurse expect with a diagnosis of acute peritonitis? Select all that apply.

Fever Vomiting Tachycardia Rigid abdomen

What is a common complication of Crohn's disease?

Fistulas

What are potential complications of Crohn's disease? Select all that apply.

Fistulas Osteoporosis Malabsorption Abscess formation

What diagnostic test is preferred to differentiate between ulcerative colitis and Crohn's disease?

X-ray examination with barium enema

What is a clinical manifestation of Crohn's disease?

Abdominal pain

What is the common symptom associated with anorexia?

Vomiting

A patient with ulcerative colitis is scheduled for an ileostomy. Which preoperative information should the nurse provide to the patient and family members?

Empty the pouch when it is one-third to one-half full.

A nurse is teaching a patient with Crohn's disease about managing the disease with the drug adalimumab. Which instruction does the nurse emphasize to the patient?

"Avoid large crowds and anyone who is sick."

Which surgical procedure for removal of an inflamed appendix involves minimal intervention?

Transluminal endoscopic surgery

A certified Wound, Ostomy, and Continence Nurse is teaching a patient about caring for a new ileostomy. What information is most important to include?

"Call the healthcare provider if your stoma has a bluish or pale look."

The nurse is caring for a patient with ileo-anal pouch anastomosis who has undergone a restorative proctocolectomy. What pouch care advice given by the nurse will provide effective treatment?

"Change the entire pouch system every 3 to 7 days."

The primary health care provider prescribes natalizumab to a patient with Crohn's disease. Which health teaching is most important before beginning the medication?

"Cognitive, motor, and sensory changes have very lethal effects."

Which examination is used first to identify an enlarged appendix in a patient?

Abdominal ultrasound

Which findings are likely in a patient with peritonitis?

Abdominal wall rigidity

Which immediate order should the nurse expect from the primary health care provider who, while assessing a patient with gastroenteritis, observes increased peristaltic movements?

Administer oral dose of 4 mg loperamide.

A patient is admitted to the hospital with appendicitis. What signs/symptoms are consistent with this diagnosis? Select all that apply.

Anorexia Nausea and vomiting Rebound tenderness

A patient presents to the emergency department with complaints of severe abdominal pain near the right anterior iliac crest that later led to nausea and vomiting. Which acute inflammatory bowel disorder does the nurse suspect is the most likely cause?

Appendicitis

What is the most common cause of right lower quadrant pain?

Appendicitis

Which findings support the nurse's conclusion that a patient has gastroenteritis and may require hospitalization? Select all that apply.

Dehydration Hypovolemia Cardiac dysrhythmias

The registered nurse is supervising a student nurse providing preoperative care to a patient with ulcerative colitis who is scheduled for surgery. Which action of the student indicates effective learning?

The student nurse explains what an ileostomy is to the patient and family.

What should the nurse teach a patient with gastroenteritis? Select all that apply.

To use medicated cleansing wipes To apply a protective barrier cream to the skin To take sitz baths for 10 minutes two or three times daily

A patient admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this patient?

Using sitz baths three times daily

The nurse is teaching a patient who recently began taking sulfasalazine about the drug. What side effects does the nurse tell the patient to report to the health care provider? Select all that apply.

Vomiting Anorexia Headache

Which clinical investigations may be performed to diagnose septicemia?

White blood cell count

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 health care provider before the patient's discharge?

Having a home health consultation for wound care