57 CHAPTER Care of Patients with Inflammatory Intestinal Disorders

16. What is the priority nursing concern for a patient with gastroenteritis? a. Nutrition therapy b. Fluid replacement c. Skin care d. Drug therapy

Fluid replacement

39. Which parasitic infection is manifested by diarrhea and occurs most commonly in immunosuppressed patients, especially those with human immunodeficiency virus (HIV)? a. Entamoeba histolytica b. Cryptosporidium c. Giardia lamblia d. Escherichia coli

Giardia lamblia

5. Which laboratory finding does the nurse expect may occur with a diagnosis of appendicitis? a. Decreased hematocrit and hemoglobin b. Increased coagulation time c. Decreased potassium d. Increased WBC count

Increased WBC count

38. The nurse is providing teaching for a patient with an anal fissure as a complication of Crohn's Disease. Which statement by the patient indicates the need for further teaching? a. "I will use warm sitz baths." b. "A diet that is low in bulk-producing agents is best for me." c. "Hydrocortisone cream may be helpful to decrease discomfort." d. "Topical antiinflammatory agents will help if I am uncomfortable."

"A diet that is low in bulk-producing agents is best for me."

12. The nurse is instructing a patient about home care after an exploratory laparotomy for peritonitis. Which statement by the patient indicates that teaching has been effective? a. "It is normal for the incision site to be warm." b. "I will stop taking the antibiotics if diarrhea develops." c. "I will call the health care provider for a temperature greater than 101° F." d. "I will resume activity with my bowling league this week for exercise."

"I will call the health care provider for a temperature greater than 101° F."

13. The patient with gastroenteritis due to infection with the norovirus asks the nurse how this illness occurred. Which statement by the patient indicates correct understanding of the nurse's teaching? a. "I got this infection from being around my grandchildren when they had respiratory illnesses." b. "It is likely that I got this illness from either contaminated water or food." c. "I may have gotten sick when I was travelling last month." d. "It's really important that everything I eat is cooked until it is well done."

"It is likely that I got this illness from either contaminated water or food."

22. A patient is prescribed sulfasalazine (Azulfidine) for the treatment of UC. Which patient statement indicates the patient is experiencing a side effect of this drug? a. "My skin is covered with a rash." b. "My knees hurt." c. "My appetite has increased." d. "I wake up at night sweating sometimes."

"My skin is covered with a rash."

40. Which statements does the nurse include while providing discharge instructions for a patient with giardiasis?(Select all that apply.) a. "Avoid contact with stool from dogs and beavers." b. "All household and sexual partners should have stool examinations for parasites." c. "Treatment will most likely consist of metronidazole (Flagyl)." d. "The infection can be transmitted to others until the amebicides kill the parasites." e. "Stools are examined 6 days after treatment to assess for eradication."

- "Avoid contact with stool from dogs and beavers." - "All household and sexual partners should have stool examinations for parasites." - "Treatment will most likely consist of metronidazole (Flagyl)." - "The infection can be transmitted to others until the amebicides kill the parasites."

21. A patient is suspected to have ulcerative colitis (UC). Which diagnostic tests does the nurse expect the patient to undergo to confirm the diagnosis? Select all that apply? a. Sigmoidoscopy b. C-reactive protein c. Albumin levels d. Erythrocyte sedimentation rate e. Magnetic resonance enterography (MRE) f. Clotting studies

- C-reactive protein - Albumin levels - Erythrocyte sedimentation rate - Magnetic resonance enterography (MRE)

17. Which are common manifestations in a 28-year-old patient with dehydration secondary to gastroenteritis?(Select all that apply.) a. Peripheral edema b. Elevated temperature c. Dry mucous membranes d. Hypertension e. Oliguria f. Poor skin turgor

- Elevated temperature - Dry mucous membranes - Oliguria - Poor skin turgor

6. Which statements about peritonitis are true?(Select all that apply.) a. Peritonitis is caused by contamination of the peritoneal cavity by bacteria or chemicals. b. Continuous ambulatory peritoneal dialysis (CAPD) can cause peritonitis. c. White blood cell counts are often decreased with peritonitis. d. Abdominal wall rigidity is a classic finding in patients with peritonitis. e. Chemical peritonitis is caused by leakage of pancreatic enzymes or gastric acids. f. Respiratory problems can be caused by increased abdominal pressure against the diaphragm.

- Peritonitis is caused by contamination of the peritoneal cavity by bacteria or chemicals. - Continuous ambulatory peritoneal dialysis (CAPD) can cause peritonitis. - Abdominal wall rigidity is a classic finding in patients with peritonitis. - Respiratory problems can be caused by increased abdominal pressure against the diaphragm.

43. The patient who had an ileostomy asks the nurse about how to choose the best ostomy pouching system. Which guidelines best describe an effective system? Select all that apply? a. The adhesive barrier last 1-2 days. b. The system protects the patient's skin. c. The pouch system contains the drainage and reduces odor. d. The ostomy pouch system is relatively inexpensive. e. The pouch remains securely attached to the skin for a dependable period of time. f. A large pouch is best because it holds more stool.

- The system protects the patient's skin. - The pouch system contains the drainage and reduces odor. - The pouch remains securely attached to the skin for a dependable period of time.

4. The nurse on the surgical unit is expecting to admit the patient who has had an appendectomy with abscess. What does the nurse anticipate care for this patient will include?(Select all that apply.) a. Clear liquids b. Wound drains c. IV antibiotics d. Nonsteroidal antiinflammatory drugs (NSAIDs) for pain control e. Nasogastric (NG) tube care f. Prescribed opioid pain drugs

- Wound drains - IV antibiotics - Nasogastric (NG) tube care - Prescribed opioid pain drugs

10. What are the cardinal signs of peritonitis? (or) What key assessment data would the nurse expect to find in a patient with peritonitis? a. Fever and headache b. Dizziness with nausea and vomiting c. Abdominal pain, distention, and tenderness d. Nausea and loss of appetite

Abdominal pain, distention, and tenderness

18. As part of the routine treatment plan for a patient with bacterial gastroenteritis, which drugs does the nurse anticipate the patient will most likely be prescribed? a. Anticholinergics b. Antiemetics c. Antiperistaltic drugs d. Antibiotics

Antibiotics

45. Which action should the nurse delegate to the unlicensed assistive personnel (UAP) when providing care for a patient with Crohn's disease? a. Check the patient's daily weight. b. Instruct the patient about the importance of adequate nutrition. c. Assess the patient's skin for areas of breakdown. d. Provide the patient with information about the disease process.

Check the patient's daily weight.

21. A patient is suspected to have ulcerative colitis (UC). Which definitive diagnostic test does the nurse expect the patient to undergo in order to confirm the diagnosis? a. Colonoscopy b. C-reactive protein c. Albumin levels d. Erythrocyte sedimentation rate

Colonoscopy

35. Which type of stoma will a patient with diverticulitis most likely have postoperatively? a. Ileostomy b. Jejunostomy c. Colostomy d. Cecostomy

Colostomy

44. The patient comes to the Urgent Care Unit and describes symptoms of diarrhea, abdominal pain, and low-grade fever. She states she has constant abdominal pain in the right lower quadrant and has lost 25 pounds in the past month. What diagnosis does the nurse suspect? a. Ulcerative colitis b. Diverticulitis c. Peritonitis d. Crohn's disease

Crohn's disease

7. The fluid shift that occurs in peritonitis may result in which of the following? a. Intracellular fluid moving into the peritoneal cavity b. Significant increase in circulatory volume c. Decreased circulatory volume and hypovolemic shock d. Increased bowel motility caused by increased fluid volume

Decreased circulatory volume and hypovolemic shock

26. A patient with CD has a fistula. Which assessment finding indicates possible dehydration? a. Weight gain of 2 pounds in one day b. Abdominal pain c. Foul-smelling urine d. Decreased urinary output

Decreased urinary output

30. What is the nature of pain associated with diverticulitis? a. Intermittent becoming progressively steady b. Sharp and continuous c. Localized to the right upper quadrant d. Severe and incapacitating

Intermittent becoming progressively steady

29. Which type of diet has been implicated in the formation of diverticula? a. High-fat diet b. Low-protein diet c. High-cholesterol diet d. Low-fiber diet

Low-fiber diet

11. Which intervention does the nurse delegate to the unlicensed assistive personnel (UAP) when caring for a postoperative patient with peritonitis? a. Measure intake and output. b. Assess wound drainage. c. Administer IV antibiotics. d. Teach patient about wound care.

Measure intake and output.

25. Which statement is true about drug therapy for CD? a. Budesonide (Entocort EC) is a rapidrelease compound that delivers low local glucocorticoid concentrations to the terminal ileum for patients with CD. b. Methotrexate (Rheumatrex) is contraindicated in the treatment of CD. c. Metronidazole (Flagyl) has been helpful in patients with fistulas and CD. d. Adalimumab (Humira) is a glucocorticoid approved for the treatment of CD.

Metronidazole (Flagyl) has been helpful in patients with fistulas and CD.

32. Which drug is often used in older patients for pain management of moderate to severe diverticulitis? a. Ibuprofen (Motrin) (An NSAID drug) b. Acetaminophen (Tylenol) (An acetaminophen-based drug) c. Aspirin (Anacin) (An aspirin-based drug) d. Morphine sulfate (Duramorph) (An opioid analgesic drug)

Morphine sulfate (Duramorph) (An opioid analgesic drug)

33. Which statement about diverticular disease is true? a. Most diverticula occur in the sigmoid colon. b. Diverticula are uncomfortable even when not inflamed. c. High-fiber diets contribute to diverticula occurrence. d. Diverticula form where intestinal wall muscles are weak.

Most diverticula occur in the sigmoid colon.

42. The patient recovering from surgery peritonitis tell the nurse that he is experiencing abdominal pain and has developed foul-smelling drainage from his wound, and his incision is red and swollen. What is the nurse's best first action? a. Clean and dress the incision. b. Measure the patient's abdominal girth. c. Notify the health care provider. d. Please the patient on bedrest in semi-fowler's position.

Notify the health care provider.

37. Which description best defines an anal fissure? a. Perianal tear that can be very painful b. Duct obstruction and infection c. Communicating tract d. Localized area of induration with pus

Perianal tear that can be very painful

31. The nurse is assessing an older adult patient with abdominal pain. Assessment findings include generalized abdominal pain with rigidity, nausea and vomiting, elevated temperature (101.2°F), increased heart rate (122/minute) and chills. The patient is also somewhat confused and does not know where he is. What does the nurse suspect with this patient? a. Crohn's disease b. Ulcerative colitis c. Diverticulitis d. Peritonitis

Peritonitis

3. The patient has been diagnosed with acute appendicitis. Based on this diagnosis, which intervention does the nurse perform? a. Start a bowel cleansing program. b. Prepare the patient for surgery. c. Apply a heating pad to the lower abdomen. d. Assess the patient's knowledge about dietary modifications.

Prepare the patient for surgery.

15. The nurse is assessing a patient with viral gastroenteritis. Which symptom is the nurse most concerned about? a. Orthostatic blood pressure changes b. Poor skin turgor c. Dry mucous membranes d. Rebound tenderness

Rebound tenderness

25. Which statement is true about drug therapy for Crohn's disease (CD) or ulcerative colitis(UC)? a. Infliximab is used to manage episodes of diarrhea with CD. b. Sulfasalazine is the first aminosalicylate approved for UC c. Metronidazole has been helpful in patients with fistulas and UC d. Adalimumab is a glucocorticoid approved for treatment of CD.

Sulfasalazine is the first aminosalicylate approved for UC

34. Which is a preventive measure for diverticular disease? (or) The nurse would teach the patient about what preventive measure for diverticular disease? a. Excluding whole-grain breads from the diet b. Avoiding fresh apples, broccoli, and lettuce c. Taking bulk agents such as psyllium hydrophilic mucilloid (Metamucil) d. Taking routine anticholinergics to reduce bowel spasms

Taking bulk agents such as psyllium hydrophilic mucilloid (Metamucil)

19. The nurse is caring for a patient with gastroenteritis who has frequent stools. Which task is best to delegate to the UAP? a. Teach the patient to avoid toilet paper and harsh soaps. b. Instruct the patient on how to take a sitz bath. c. Use a warm washcloth to remove stool from the skin. d. Dry the skin with absorbent cotton.

Use a warm washcloth to remove stool from the skin.

1. The patient comes to the emergency department (ED) with right lower quadrant pain. What does the ED nurse suspect? a. Gastroenteritis b. Ulcerative colitis c. Appendicitis d. Crohn's disease

Appendicitis

8. The respiratory problems that may accompany peritonitis are a result of which factor? a. Associated pain interfering with ventilation b. Decreased pressure against the diaphragm c. Fluid shifts to the thoracic cavity d. Decreased oxygen demands related to the infectious process

Associated pain interfering with ventilation

9. Which nursing intervention is part of nonsurgical management for a patient with peritonitis? a. Monitor weekly weight and intake and output. b. Insert a nasogastric tube to decompress the stomach. c. Order a breakfast tray when the patient is hungry. d. Administer NSAIDs for pain.

- Insert a nasogastric tube to decompress the stomach

24. A patient with ulcerative colitis (UC) who has had an ileostomy is being discharged home. The nurse has provided discharge teaching. Which statements by the patient indicate the teaching has been effective?(Select all that apply.) a. "I will avoid foods that cause gas." b. "I will call the health care provider if I have a fever over 101° F." c. "I will change the adhesive for the appliance daily." d. "I know the pouch needs emptying when I feel pain in that area." e. "I will call the health care provider if I feel like my heart is beating fast." f. "I will include adequate amounts of salt and water in my diet because an ileostomy causes their loss".

- "I will avoid foods that cause gas." - "I will call the health care provider if I have a fever over 101° F." - "I will call the health care provider if I feel like my heart is beating fast." - "I will include adequate amounts of salt and water in my diet because an ileostomy causes their loss".

14. Which interventions are useful in preventing spread of gastroenteritis?(Select all that apply.) a. Careful handwashing b. Sanitize all surfaces that may be contaminated c. Prophylactic use of antibiotics d. Easily accessible hand sanitizers e. Test all food preparation employees f. Proper food and beverage preparation

- Careful handwashing - Sanitize all surfaces that may be contaminated - Easily accessible hand sanitizers - Proper food and beverage preparation

20. Which characteristics pertain to Crohn's disease (CD)(Select all that apply.) a. Begins in the rectum and proceeds in a continuous manner toward the cecum b. Fistulas commonly develop c. Five to six soft, loose stools per day that are nonbloody d. Increased risk of colon cancer e. Some patients experience extraintestinal manifestations such as migratory polyarthritis, ankylosing spondylitis, and erythema nodosum f. Cobblestone appearance of the internal intestine

- Fistulas commonly develop - There are Five to six soft, loose stools per day that are nonbloody - There is a Cobblestone appearance of the internal intestine

36. Which interventions does the nurse expect to implement when caring for a patient with diverticulitis?(Select all that apply.) a. Laxative and enemas as ordered b. IV fluids to prevent dehydration c. Broad-spectrum antibiotics d. Teach the patient to refrain from lifting or straining e. Keep the patient NPO if symptoms are severe

- IV fluids to prevent dehydration - Broad-spectrum antibiotics - Teach the patient to refrain from lifting or straining - Keep the patient NPO if symptoms are severe

2. The nurse is caring for the patient with acute appendicitis. Which interventions will the nurse perform?(Select all that apply.) a. Maintain the patient on NPO status. b. Administer IV fluids as prescribed. c. Apply warm compresses to the right lower abdominal quadrant. d. If tolerated, maintain the patient in the semi-fowler's position. e. Administer laxatives.

- Maintain the patient on NPO status. - Administer IV fluids as prescribed. - If tolerated, maintain the patient in the semi-fowler's position.

27. In caring for a patient with Crohn's Disease, the nurse observes for which complications?(Select all that apply.) a. Peritonitis b. Small bowel obstruction c. Nutritional and fluid imbalances d. Presence of fistulas e. Appendicitis f. Severe nausea and vomiting

- Peritonitis - Small bowel obstruction - Nutritional and fluid imbalances - Presence of fistulas

23. Which statement is true about the medical treatment of UC? a. Infliximab (Remicade) is approved as a first-line therapy. b. Immunomodulators are not thought to be effective; however, in combination with steroids, they may offer a synergistic effect. c. When a therapeutic level of glucocorticoids is reached, the dosage of the drug stays the same to maintain the therapeutic effect. d. The method of action for the aminosalicylates is interruption of the pain pathway.

Immunomodulators are not thought to be effective; however, in combination with steroids, they may offer a synergistic effect.

41. The ED nurse is assessing a patient admitted with frequent, liquid, foul-smelling stools containing mucus and blood. Assessment findings include temperature 103.8° F, tenesmus, abdominal tenderness, and vomiting. Which additional laboratory tests does the nurse expect to collect? a. Serial stool samples b. Urine culture c. Throat culture d. Sputum culture

Serial stool samples

28. Which surgical procedure involves removal of the colon, rectum, and anus with surgical closure of the anus? a. Restorative proctolectomy with ileo pouch-anal anastomosis (RPC-IPAA) b. Natural orifice transluminal endoscopic surgery (NOTES) c. Sigmoid colostomy d. Total proctocolectomy with a permanent ileostomy

Total proctocolectomy with a permanent ileostomy