MED/SURG2: Chapter 42

The primary health care provider includes a gluten-free diet for a patient with malabsorption syndrome. During the follow-up visit, it was found that the patient is unresponsive to the gluten-free diet alone and also needs pharmacologic therapy. Which category of drugs will the primary health care provider prescribe?

Corticosteroids

The nurse finds the presence of a pale stoma in a patient who has undergone ostomy surgery. What does the nurse suspect to have occurred?

Anemia

Which type of colon diversion is illustrated in the image?

Ascending colostomy

A nurse teaching a community group about ways to reduce the risk for colorectal cancer includes decreasing the dietary intake of:

Beef and pork

What is the cause of Zollinger-Ellison syndrome?

Biochemical and enzyme deficiency

Which other supplement may also be beneficial to the patient who is using a lactase enzyme?

Calcium supplements

Genotyping for which malabsorption condition involves testing for HLA-DQ2 and/or HLA-DQ8 antigens?

Celiac disease

Which manifestation should be suspected in a patient with riboflavin deficiency?

Cheilosis

What is a cause of primary peritonitis?

Cirrhosis with ascites

The nurse is caring for a patient who is scheduled to receive a course of long-term broad spectrum antibiotic therapy. The nurse knows the patient will need instruction on actions to take to prevent infection with which organism?

Clostridium difficile

The nurse is caring for a patient whose terminal ileum has been removed. What medication will the nurse administer to the patient?

Cobalamin supplement

A patient has been admitted to a medical unit with signs and symptoms of an intestinal blockage. The nurse should expect a prescription to prepare the patient for which diagnostic procedure?

Colonoscopy

A patient who has a family history of colon cancer asks the nurse about tests for colon cancer. Which of these is considered the best method for colorectal cancer (CRC) screening?

Colonoscopy

A patient has undergone sphincter-sparing surgery. For what common complication should the nurse closely assess?

Diarrhea

Which complication does the nurse monitor for in a patient who has a colonic J-pouch?

Difficulty evacuating stool

While reviewing the laboratory reports of a patient with chronic inflammation of the gastrointestinal tract, the nurse suspects toxic megacolon in the patient. Which laboratory finding supports the nurse's suspicion?

Elevated leukocytes

Which test is used to determine the extent of the tumor in a patient with gastrointestinal stromal tumors?

Endoscopic ultrasound

When planning nursing care for a patient with newly diagnosed diverticular disease, what is the most important goal for the nurse?

Identifying signs and symptoms of infection

Which statement is true regarding celiac disease?

It occurs due to an immune-mediated response

Which ostomy surgery is indicated in the figure?

Loop colostomy

A patient who has undergone sphincter-sparing surgery reports diarrhea to the nurse. Which medication does the nurse anticipate administering?

Loperamide

While assessing a patient with lactose intolerance, the nurse finds that the patient does not have calcium deficiency at follow-up visits. Which action of the patient is responsible for this improvement?

Mixing lactase enzyme with milk before drinking

The nurse is caring for a patient after an abdominoperineal resection. For what complications should the nurse monitor the patient?

Sexual dysfunction

The nurse is assigned to care for four patients who have had gastrointestinal surgery. Which patient would show a regular bowel pattern?

The patient who has undergone sigmoid colostomy

What is the cause of nonmechanical intestinal obstruction?

Thoracic spinal fracture

Which abnormal nutritional condition is treated with folic acid and tetracycline?

Tropical sprue

Which type of intestinal obstruction is depicted in the figure?

Volvulus

The nurse is caring for a patient who has undergone ostomy surgery. Which finding alerts the nurse to the possibility of an ischemic bowel?

Dusky blue stoma

The nurse is teaching a patient about ways to reduce the risk for short bowel syndrome. Which action of the patient can help to ensure a positive outcome?

Eating six small meals per day

The nurse teaches self-care of a stoma to a patient who has undergone ostomy surgery. Which statement of the patient indicates the need of further teaching?

"I should limit my fluid intake."

The nurse observes altered skin integrity in a patient who has undergone an ileostomy. What does the nurse attribute as the reason for the skin breakdown?

Flat stoma

What is the main manifestation of short bowel syndrome?

Steatorrhea

A patient with ulcerative colitis has been prescribed sulfasalazine. What instructions should the nurse give to the patient regarding the medication?

The medication may cause a yellowish orange discoloration of skin and urine.

The nurse is discussing postoperative care with a patient who had inguinal hernia repair the previous day. Which statement by the patient reflects a need for additional education?

"I can go back to my job at the moving company in four weeks."

The nurse is teaching a patient about preventing constipation. Which interventions will the nurse teach the patient to implement? Select all that apply.

-Increased fluid intake -Daily exercise -Daily use of psyllium

Which statements are true regarding lactase deficiency and malabsorption? Select all that apply.

-Lactase deficiency can cause calcium deficiency -Lactase deficiency is associated with genetic factors. -Lactase deficiency is a condition in which the lactase enzyme is deficient or absent.

A patient with a rectal tumor has undergone an abdominal-perineal resection (APR). The nurse should monitor the patient for what postoperative complications? Select all that apply.

-Sexual dysfunction -Delayed wound healing -Persistent perineal sinus tracts

The nurse is caring for a patient with colorectal cancer who had a polypectomy during a colonoscopy. Which finding indicates a positive outcome?

Absence of malignancy at the resected margin of the polyp

Which diagnostic test does the nurse anticipate will be prescribed for a patient to diagnose appendicitis without ascites?

Peritoneoscopy

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?

"The tube will help to drain the stomach contents and prevent further vomiting."

A patient has a newly formed ileostomy and asks the nurse, "When can I start training my ostomy to only produce stool at certain times?" What is the nurse's appropriate response?

"We will not be able to train your ileostomy because of the frequent drainage from the site."

The nurse is teaching dietary measures to a patient with celiac disease. During follow-up visits, the nurse finds that the patient's condition is aggravated. Which statement made by the patient helps the nurse understand the reason that the patient's condition has worsened?

"I am eating rolled rye flakes as an evening snack.

The nurse is teaching dietary measures to a patient with celiac disease. During follow-up visits, the nurse finds that the patient's condition is aggravated. Which statement made by the patient helps the nurse understand the reason that the patient's condition has worsened?

"I am eating rolled rye flakes as an evening snack."

A patient has developed a complication after colostomy surgery. What statement made by the patient to the nurse indicates that further instruction is needed?

"I am including cooked split and black beans in my diet."

The nurse is teaching a caregiver about the measures to be taken while caring for a patient who has undergone ostomy surgery a week ago. Which statement indicates effective learning of the caregiver?

"I should observe the stoma color every 4 hours.

When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching?

"I will be able to regulate when I have stools."

The nurse is teaching measures about how to adapt with an ostomy. Which statements made by the patient indicate effective learning? Select all that apply.

-"I can wear clothes that will hide the stoma." -"I should avoid heavy lifting for 8 weeks after surgery." -"I should maintain contact with the local support services."

The nurse is caring for a patient who has undergone an abdominoperineal resection; the nurse suspects infection. Which findings support the nurse's conclusion? Select all that apply.

-Body temperature of 100.4° F -Edematous and erythematous stoma -White blood cell count of 15,000 cells/mL

A patient reports diarrhea and foul smelling, greasy stools to the nurse. An endoscopy reveals small intestinal mucosal disruption. Which diseases will the nurse suspect to be the cause of this condition? Select all that apply.

-Celiac disease -Crohn's disease -Whipple's disease

A 55-year-old patient with suspected bowel obstruction has had a nasogastric tube inserted at 8:00 AM. The tube should be checked routinely at which times?

12:00 PM and 4:00 PM

A patient is diagnosed with a rectovaginal fistula. For which surgery does the nurse prepare the patient?

2

After reviewing the diagnostic reports of a patient with colorectal cancer, the nurse concludes that the patient has a T2 type of primary tumor based on the growth of the tumor into what area?

Through the submucosa into the muscularis propria

Which figure indicates a single-barreled sigmoid colostomy?

3

The nurse is educating a patient about performing colostomy irrigation. What rationale does the nurse give the patient for the importance of doing the procedure?

To stimulate emptying of the colon

A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times?

8:00 AM, 12:00 PM, and 4:00 PM

The nurse is caring for a group of patients in the acute care facility. What patient will the nurse prepare for ileostomy surgery?

A patient who has familial polyposis

A colectomy is scheduled for an 81-year-old man with an abdominal mass, suspected bowel obstruction, and a history of rectal polyps. The nurse should plan to include which prescribed measure in the preoperative preparation of this patient?

Administration of a cleansing enema

The nurse inserts a urinary catheter into a patient with an intestinal obstruction. One hour after insertion, the nurse calculates that the urinary output is 0.4 mL/kg of the patient's body weight. What is the priority nursing intervention?

Report the finding to the primary health care provider

Which manifestation will be suspected in a patient who has folic acid deficiency?

Anemia

The nurse is caring for a patient with inflammatory bowel disease (IBD) and should monitor the patient for what systemic complication?

Aphthous ulcers

A patient reports periumbilical pain that increases after coughing and sneezing. The patient prefers to lie still with the right leg flexed. What condition does the nurse suspect?

Appendicitis

The nurse is assessing a patient following a bowel resection with a permanent colostomy. The patient says, "How am I supposed to care for a colostomy? I can't look at my scars." What is the nurse's priority action?

Ask the patient to discuss fears or concerns about the colostomy

Which condition should the nurse suspect in a patient with nutritional abnormalities and progressive disruption of jejunal and ileal tissue?

Tropical sprue

The nurse is caring for a patient in the initial postoperative period after having an ileostomy. What is a priority nursing action for this patient?

Using transparent pouches for the patient

Which condition is suspected in a malnourished patient with pruritic, vesicular skin lesions on the face and altered thyroxin levels?

Celiac disease

Which malabsorption disease includes the presence of dermatitis herpetiformis?

Celiac disease

The nurse recalls that which medication blocks epidermal growth factor in patients with colorectal cancer?

Cetuximab

Which medication will the nurse expect the primary health care provider to prescribe to a patient with malabsorption who has diarrhea and steatorrhea as well as limited ileal resection of 90 cm?

Cholestyramine

While caring for a patient with inflammatory bowel disease (IBD), the nurse notes that the patient has malabsorption. What deficiency does the nurse expect to find in the patient?

Vitamin D deficiency

A patient has an inguinal hernia. The patient asks the nurse to explain the diagnosis. How should the nurse respond?

Explain that a hernia is a loop of bowel protruding through a weak spot in the muscles of the abdomen

Which gastrointestinal manifestation is seen due to bacterial fermentation of unabsorbed carbohydrates?

Flatulence

The nurse is caring for a patient after a sigmoid colostomy. What type of stool does the nurse anticipate when assessing the patient?

Formed

Which disease has symptoms of gastrointestinal bleeding, bloating, nausea, and vomiting and is treated with imatinib mesylate?

Gastrointestinal stromal tumors

What does the arrow indicate in the following figure?

Hartmann's pouch

A patient is scheduled for ostomy surgery and an ostomy site is selected within the rectus muscle on a flat surface of the abdomen. For what complication should the nurse monitor the patient?

Hernia

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer?

History of colorectal polyps

The nurse is caring for a patient experiencing diarrhea caused by clostridium difficile. Which nursing diagnosis is the patient at the least risk of experiencing?

Impaired physical mobility

Which medication can decrease intestinal motility?

Opioid antidiarrheals

The nurse is caring for a patient who has undergone an ileostomy. What is the appropriate nursing action for this patient?

Instructing the patient to wear a drainable collecting pouch constantly for 4 to 7 days before changing

The nurse is assessing a patient who shows signs of severe malnutrition and anticipates that intestinal transplantation will be performed. Which condition supports the nurse's conclusion?

The patient has intestinal failure and life-threatening complications.

What cause of malabsorption will the nurse suspect in a patient with diarrhea and steatorrhea and whose medical history indicates Crohn's disease?

The patient has short bowel syndrome

What cause of malabsorption will the nurse suspect in a patient with diarrhea and steatorrhea and whose medical history indicates Crohn's disease?

The patient has short bowel syndrome.

The nurse finds that a patient who has undergone an ileostomy has a urinary output of 1800 mL/day. What should the nurse infer from this assessment finding?

This is a normal finding

What statement is incorrect regarding Clostridium difficile infection?

With each occurrence the probability of reoccurrence decreases

For which clinical manifestation that occurs in both ulcerative colitis and Crohn's disease should the nurse monitor the patient?

Diarrhea

What is the cause of malabsorption in the patient who has lymphangiectasia?

Disturbed lymphatic circulation

The nurse provides postoperative care one day after a patient undergoes colostomy surgery. The patient's stoma is moist and dark pink, with no obvious drainage. Which action should the nurse take?

Document the normal findings

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend?

Dried beans, All Bran (100%) cereal, and raspberries

Which condition involves inflammation of all layers of the bowel wall?

Crohn's disease

Which part of the gastrointestinal tract has the highest percentage of gastrointestinal stromal tumors?

Stomach

A nurse is caring for a patient with acute abdominal pain. The nurse should implement which of these interventions? Select all that apply.

-Provide oxygen per nasal cannula. -Establish an IV line for infusion of fluids -Insert a urinary catheter and obtain urinalysis

The nurse performs a detailed health history for a patient with a possible bowel obstruction. Which of these are manifestations of an obstruction in the small intestine? Select all that apply.

-Rapid onset -Frequent, copious vomiting -Colicky, cramping, intermittent pain

The nurse is reviewing various food choices for a patient who has been newly diagnosed with celiac disease. Which food choices are appropriate selections for this patient? Select all that apply.

-Salsa and corn chips -Yogurt with fresh fruit -Scrambled eggs and sausage

The nurse has provided teaching to a patient who has diverticular disease but is not experiencing an acute episode at this time. Which statement by the patient reflects an adequate understanding of the teaching?

"I will decrease my intake of fat and red meat."

The nurse is teaching dietary instructions to a patient with inflammatory bowel disease (IBD) who is lactose intolerant. Which instruction is most beneficial to the patient?

"Include yogurt in your diet."

In a patient who has undergone a loop colostomy, the primary health care provider holds the loop in place by inserting a plastic rod for 7 to 10 days after the surgery. What reason would the nurse explain to the patient about this procedure?

"Plastic rods prevent the loop from slipping back into the abdominal cavity."

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease? Select all that apply

-Diarrhea stools -Cramping abdominal pain

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease? Select all that apply.

-Diarrhea stools -Cramping abdominal pain

The nurse is caring for a patient with colorectal cancer who has a partially closed wound. Which parameters associated with the condition should the nurse monitor? Select all that apply.

-Edema -Erythema -Elevated leukocyte count

The nurse is preparing a nutritional plan for a patient with celiac disease. Which foods will the nurse include in the nutritional plan? Select all that apply.

-Eggs -Yogurt -Potatoes

Which laboratory parameters does the nurse need to assess in a patient who has recently undergone ileostomy? Select all that apply.

-Fluid deficits -Sodium levels -Potassium levels

A patient with inflammatory bowel disease (IBD) is prescribed prednisone. For what complications that are associated with the medication should the nurse monitor? Select all that apply.

-Hypokalemia -Potential toxic megacolon

The nurse recognizes that which treatment strategy is beneficial for patients with stage I colorectal tumors?

Laparoscopic surgery

While reviewing the complete blood count (CBC) report of a patient with intestinal obstruction, the nurse notes a decreased hematocrit level. What reason does the nurse suspect for this finding?

Strangulation with necrosis

In which programs should the nurse instruct a patient with Crohn's disease to participate during an exacerbation of the disease?

Stress management

The nurse reviews the medication profile of a patient with inflammatory bowel disease (IBD) who presents with yellow-orange discoloration of the skin. Which medication does the nurse suspect is responsible for the patient's symptoms?

Sulfasalazine

The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site?

The patient must be able to see the site.

What pathophysiology will the nurse suspect in a patient who reports night blindness?

Vitamin A deficiency

A colectomy is scheduled for a 38-year-old woman with ulcerative colitis. The nurse should plan to include what prescribed measure in the preoperative preparation of this patient?

Administration of a cleansing enema

Which is a manifestation of electrolyte depletion?

Muscle cramps

The nurse is caring for a patient who had a laparotomy one day ago and has a nasogastric tube in place. During suctioning of the nasogastric tube, the nurse finds that the nasogastric aspirate has become bright red in color. What action should the nurse take first?

Notify the surgeon

What is the reason that a patient who has undergone a Billroth II gastrectomy has malabsorption?

Loss of surface area

When assessing a patient with a gastrointestinal disorder, the nurse finds an absence of bowel sounds and peristalsis. The assessment findings are indicative of what condition?

Paralytic ileus

The nurse is reviewing the reports of different patients. Which patient is susceptible for an obstruction of the colon?

Patient A

The nurse is assessing four patients. Which patient's fluid requirement would remain the same after surgery?

Patient D

Which gastrointestinal disorder does the nurse recall occurs because of trauma from a knife wound?

Peritonitis

The nurse reviews the medical record of a patient with inflammatory bowel disease (IBD) and notes hypoalbuminemia. The nurse recognizes that the finding is indicative of what condition?

Poor nutrition

What is the highest priority information to include in preoperative teaching for a patient scheduled for a colectomy?

Postoperative activities and pain management

The nurse is caring for a patient with inflammatory bowel disease (IBD). To maintain remission, the nurse expects that the patient will receive a prescription for what medication?

Prednisone

Which type of intestinal obstruction does the nurse recall is observed in a patient with collagen vascular disease?

Pseudo-obstruction

While assessing a patient with gastrointestinal stromal tumors, the nurse suspects that the patient is in the early stage of disease. Which symptoms support the nurse's suspicion? Select all that apply.

-Nausea -Bloating -Vomiting

The student nurse is preparing a patient for an ostomy surgery under the supervision of the registered nurse. Which interventions by the student nurse indicate effective learning? Select all that apply.

-Selects the rectus muscle site for placing the stomas -Prepares the patient psychologically for the ostomy -Selects a stoma site that will be clearly visible to the patient

The nurse is preparing a nutritional plan for a patient with short bowel syndrome. What will the nurse include in the nutritional plan? Select all that apply.

-Soluble-fiber diet -Calcium supplements -Glutamine

When teaching a patient with celiac disease about dietary changes, which food items should the nurse instruct this patient to restrict? Select all that apply.

-Wheat -Rye -Barley -Oatmeal

For what reason does the nurse suspect a patient may have inflammation of the mouth and lips as well as oral ulcers?

Iron deficiency

Which statement is true regarding a double-barreled stoma?

It involves bringing both the proximal and distal ends through the abdominal wall as two separate stomas.

The nurse is presenting information about gastroenteritis to a group of nursing students. What is appropriate for the nurse to include in the education?

It is caused by a norovirus

Which malabsorption disease is associated with cramping abdominal pain?

Lactase deficiency

Which is the most common malabsorption disorder?

Lactose intolerance

What nursing diagnostic statement would be assigned the highest priority in the plan of care for a patient who has ulcerative colitis?

Deficient fluid volume

Which integumentary manifestation is associated with zinc deficiency?

Dermatitis

The nurse is educating a patient about dietary fiber and the ways to incorporate it into the daily diet. What information should the nurse include while teaching this patient about fiber intake?

Drink at least 2 liters of water daily.

The nurse is teaching a patient with diverticulosis about nutritional changes to avoid exacerbations. Which meal selection indicates the patient understands the nurse's instructions?

Fish, green beans, baked potato

The nurse is caring for a patient experiencing diarrhea caused by clostridium difficile. What action should the nurse take?

Handwashing

A patient presents with frequent copious vomiting and cramping intermittent pain. While assessing the abdomen, the nurse auscultates high-pitched bowel sounds. The assessment findings are consistent with what condition?

Intestinal obstruction

For what complication should the nurse assess a patient after total proctocolectomy with an ileal pouch/anal anastomosis surgery?

Pouchitis

Which test indicates whether or not a patient has adequate absorption of vitamin K?

Prothrombin time

After reviewing a patient's medical record the nurse finds that the patient has a stage I tumor in the left colon. For which treatment does the nurse prepare the patient?

Laparoscopic surgery

Which statement is true regarding the enzyme lactase?

Over-the-counter lactase breaks down the lactose in milk

The nurse is reviewing the medical records of four patients. Which patient will the nurse prepare for an ileostomy surgery?

Patient A

The nurse is assessing a colostomy in a patient who had a colectomy 24 hours ago. Which of these assessment findings is considered normal for a new stoma?

Dark pink to red color

The nurse is assessing a patient who has undergone a total proctocolectomy with ileal pouch/anal anastomosis 6 months ago. Which finding indicates a positive outcome of surgery?

Decreased number of bowel movements

Which laboratory finding is associated with brittle fingernails?

Decreased red blood cell count

A patient is scheduled for surgery to have a permanent ostomy created. What does the nurse remember is the preferred site for the ostomy?

Descending colon

The student nurse is providing postoperative care to a patient who underwent ostomy surgery. Which action of the student nurse indicates the need for correction?

Emptying collecting bags when filled completely

A patient reports foul smelling diarrhea and flatulence to the nurse. The nurse also finds abdominal distention, steatorrhea, and rheumatoid arthritis. Which food should the nurse include in the patient's diet plan?

Gluten-free food

Which condition is a common manifestation associated with protein deficiency?

Hair thinning

The nurse collaborates with an enterostomal therapist to create a teaching plan for a patient with Crohn's disease who has a new ileostomy. Which lifestyle change would be appropriate for inclusion in the plan?

Increased fluid intake to 2 to 3 L/day

The nurse finds transient incontinence of mucus in a patient who has recently undergone ileostomy. What reason does the nurse suspect for this finding?

Intraoperative manipulation of the anal canal

The nurse is assessing a malnourished patient who has dental enamel hypoplasia along with iron and folate deficiencies. The nurse instructs the patient to consume a gluten-free diet. What additional symptoms will the nurse observe?

Rash on the scalp

The nurse irrigates the stoma of a patient who has undergone ostomy surgery every 24 to 48 hours. Which ostomy surgery has the patient undergone?

Sigmoid colostomy