MS exam 1: Chapter 57
what is Crohn's disease?
-Cobblestone appearance of intestine -Chronic inflammation of the small intestine, colon, or both -Can have remission periods and exacerbation periods -Consider skin integrity -Severe diarrhea, malabsorption, anemia -May hear high-pitched rushing bowel sounds -Fistulas (abnormal opening between 2 organs or structures) form because of deep ulcerations -Fistulas can also go into other organs (bladder, vagina) -Steatorrhea is common -Surgery is needed if patient has a fistula (bowel resection)
what is UC (ulcerative colitis)?
-Inflammation of the rectum and colon -Can have periods of remission and periods of exacerbation -Main goal is to decrease diarrhea and monitor the skin -Could be losing weight -Surgery is only done if there is complications related to UC (minimize pain and monitor for lower GI bleeding) -Could have an ileostomy -Watch for S&S of dehydration
what are the diagnostic tests and interventions for appendicitis?
-Labs will not give you a diagnosis -Ultrasound can show an enlarged appendix, but CAT scan will give you diagnosis of appendicitis -Surgery is appendectomy
what is peritonitis?
-Life-threatening -Acute inflammation and infection of the abdominal cavity -Involves contamination by bacteria or chemicals
what are the interventions for peritonitis?
-Non-surgical approach: treat the shock -Surgical interventions: abdominal surgery to identify and repair the cause -Focus is on controlling the contamination, removing foreign material, and draining any fluid
what is appendicitis?
-The most common cause of RLQ pain -Happens because appendix is obstructed (usually by feces)- may see a stone of feces when they do a CAT scan -Initially the pain will be generalized to the abdomen and have vague symptoms -Symptoms may arise as it becomes more severe when it shifts to the RLQ (McBurney's point)
what are the S&S of peritonitis?
-abdominal pain, tenderness, and distension -third spacing: leads to hypovolemic shock -can have septic shock -WBC counts are often elevated to 20,000/mm^3
what are the causes of peritonitis?
-appendicitis -diverticulitis -PUD -gangrenous gallbladder -bowel obstruction
What are the S&S of appendicitis?
-elevated temp -elevated HR -abdominal pain -N/V -may start with cramping in the epigastric region -rebound tenderness
what are the S&S of severe UC (>6 bloody stools/day)
-fever -tachycardia -anemia -abdominal pain -elevated C-reactive protein and/or ESR
what can appendicitis lead to?
-infection -gangrene -sepsis -perforation -peritonitis
what are the key features of UC?
-location: begins in the rectum and proceeds in a continuous manner toward the cecum -etiology: unknown -peak incidence at age: 15-25 and 55-65 -number of stools: 10-20 liquid, bloody stools per day -complications: hemorrhage and nutritional deficiencies -need for surgery: infrequent
what are the key features of Crohn's disease?
-location: most often in the terminal ileum, with patchy involvement through all layers of the bowel -etiology: unknown -peak incidence at age: 15-40 -number of stools: 5-6 soft, loose stools per day (not bloody) -complications: fistulas (common) and nutritional deficiencies -need for surgery: frequent
Where is McBurney's point located?
-midway between the anterior iliac crest and the umbilicus in the right lower quadrant -this is the classic area for localized tenderness during the later stages of appendicitis.
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 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
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
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
A patient with a history of osteoarthritis has a 10-inch (25.5 cm) 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 health care provider before the patient's discharge? a. Having a home health consultation for wound care b. Requesting an antianxiety medication c. Requesting pain medication for the patient's osteoarthritis d. Placing the patient in a skilled nursing facility for rehabilitation
A
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
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 [170 grams]) c. Strawberries (1 cup [160 grams]) d. Tomato (1 medium)
A
the nurse is teaching a client about nutrition and diverticulosis. which food will the nurse teach the client to avoid? a. popcorn b. oatmeal c. bran d. lettuce
A
the nurse is caring for an older adult client who experiences an exacerbation of ulcerative colitis with severe diarrhea that have lasted a week. for which complications will the nurse assess? select all that apply. a. dehydration b. hypokalemia c. skin breakdown d. deep vein thrombosis e. hyperkalemia
A, B, C
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? Select all that apply. a. Anorexia b. Depression c. Drowsiness d. Frequent urination e. Headache f. Vomiting
A, E, F
which inststuction given by the nurse will be beneficial to an older patient with diverticulitis? select all that apply A. refrain from drinking alcohol b. use mild laxatives 3x a day c. refrain from physical activities like bending d. add tomatoes and strawberries in your diet e. eat a high-fiber diet during severe abdominal pain
A. refrain from drinking alcohol c. refrain from physical activities like bending
Which parameter would be monitored in a patient with chronic inflammatory bowel disease? A. weight loss B. skin in the perianal area C. heart and rate rhythm D. physical and emotional rest E. color, volume , and consistency of stools
A. weight loss B. skin in the perianal area D. physical and emotional rest E. color, volume , and consistency of stools
A Certified Wound, Ostomy, and Continence Nurse (CWOCN) 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
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
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
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
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
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 rest." 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
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°F (37.9°C) 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
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 (23 × 109/L) d. A 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr
B
the nurse is caring for a client who has just been prescribed a glucocorticoid to treat an exacerbation of ulcerative colitis. what teaching will the nurse provide? a. decrease the drug dose during the next exacerbation b. report fever to health care provider immediately c. determine if the client's insurance covers payment for this medication d. this drug will act as an antidiarrheal
B
the nurse is caring for a client who has celiac disease. which food will the nurse remove from the client's dietary tray? select all that apply. a. rice b. graham crackers c. croissant d. fresh peaches e. chicken breast
B, C
a client who recently had laparoscopic surgery to treat a ruptured appendix has developed subsequent peritonitis. the client currently has two Jackson-Pratt drains placed in the abdomen. which finding(s) would the nurse report immediately to the surgeon? select all that apply. a. serosanguinous drainage b. fever c. cloudy drainage d. painful abdominal distention e. pain level of 3 on a scale of 1 to 10
B, C, D
A pathology report indicates that a patient is infected with Trypanosoma Cruz and is diagnosed with chronic chugs disease. Which finding would the nurse assess in this patient? A. Anorexia B. Cardiac dysrhythmias C. Steatorrhea D. Impaired urinary elimination
B. Cardiac dysrhythmias
Which surgical techniques are involved in the treatment of Crohn disease? A. Minimal invasive (MIS) and ileostomy B. Minimal invasive surgery and stricturoplasty C. Ileostomy and natural orfice transluminal endoscopic surgery (NOTES) D. Stricturoplasty and natural orifice transluminal endoscopic surgery
B. Minimal invasive surgery and stricturoplasty
About which medication would the nurse teach a patient who is newly diagnosed with moderate ulcerative colitis (UC)? A. Azathioprine B. Sulfasalazine C. Mercaptopurine D. Sulfamethoxazole
B. Sulfasalazine
Which instruction Would the nurse include in the teaching plan for a patient with ulcerative colitis about ileostomy care? A. consume a high-fiber diet regularly B. avoid taking energetic coated medications C. empty your pouch when it is completely full D. Change the entire pouch system every 2 to 3 weeks
B. avoid taking energetic coated medications
Which laboratory finding is consistent with ulcerative colitis (UC)? select all that apply A. decreased ESR B. increased C-reactive protein C. decrease WBC D. increased sodium levels E. decreased potassium levels
B. increased C-reactive protein E. decreased potassium levels
Which finding supports the diagnosis of the ulcerative colitis in a patient who is experiencing severe abdominal pain and diarrhea? select all that apply A. presence of bowel fistulas B. presence of melon in the stool C. presence of multiple fractures D. intolerance to milk and milk products E. Use of NSAIDs for pain
B. presence of melon in the stool D. intolerance to milk and milk products E. Use of NSAIDs for pain
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 (unlicensed assistive personnel [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 patient's 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
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
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 ½ 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
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
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
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°F (38.2°C).
C
after the nurse teaches a patient about caring for an ileostomy at hone, which statement by the patient indicates the correct understanding? A. I will change the pouch within hour after meals and as necessary B. I may use bulk forming laxatives if I had not had a stool in 6-12 hours C. I should use skin sealants and stony skin creams as needed to prevent irritation D. I should empty the ileostomy pouch when it is 2/3 full
C. I should use skin sealants and stony skin creams as needed to prevent irritation
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
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
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 handwashing 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
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 complete blood count and serum electrolytes. c. Obtain a stool specimen for culture and sensitivity. d. Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.
D
An intensive care unit (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 (CD) who has a draining enterocutaneous fistula b. A 32-year-old with ulcerative colitis (UC) 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 ileo-anal reservoir d. A 36-year-old with peritonitis who just returned from surgery with multiple drains in place
D
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? 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."
which complication is associated with Crohn's disease? a. fistula b. hemorrhage c. hypovolemia d. colorectal cancer
a. fistula
which medication would a patient with ulcerative colitis who complains of severe diarrhea with exacerbations be tough to take for flare-ups? a. glucocorticoids b. aminosalicylates c.immunomodulator d.antidiarrheal drugs
a. glucocorticoids
a patient reports severe diarrhea and abdominal pain. Which information collected form patient indicate the increased risk for inflammatory bowel disease? select all that apply a. intolerance to milk b. exposure to antibiotics c. travel to a tropical area d. change ins stool color from yellow to brown e. use of NSAIDs
a. intolerance to milk b. exposure to antibiotics c. travel to a tropical area e. use of NSAIDs
with sulfasalazine, which side effect should be reported to health care provider? select all that apply a. vominting b. anorexia c. headache d. depression e. depression f. drowsiness
a. vominting b. anorexia c. headache
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 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. Have 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
b. Have another patient with a stoma who performs self-care talk with the patient
Which is a statement correctly differentiates Crohn's disease (CD) from ulcerative colitis (UC)? 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.
Which question would the nurse ask while assessing a patient with ulcerative colitis (UC)? a. Did you eat Street foods recently? b. have you had any surgeries in the past year? c. does anyone from your family have the same complaints? d. were you on antibiotic treatments within the past 3 months?
d. were you on antibiotic treatments within the past 3 months?
which medication is helpful in a patient with fistula associated with Crohn's disease? A. mealamine b. sulfasalazine c.azithromycin d.metronidazole
d.metronidazole