Chap 57 Chronic Inflammatory Bowel Disorders
A patient with ulcerative colitis is scheduled for an ileostomy. Which preoperative information should the nurse provide to the patient and family members? 1 Empty the pouch before eating. 2 Change the pouch during active times. 3 Change the entire pouch system every 4 to 9 days. 4 Empty the pouch when it is one-third to one-half full
Empty the pouch when it is one-third to one-half full
What surgical techniques are involved in the treatment of Crohn's disease? 1 Minimal invasive surgery (MIS) and ileostomy 2 Minimal invasive surgery (MIS) and stricturoplasty 3 Ileostomy and natural orifice transluminal endoscopic surgery (NOTES) 4 Stricturoplasty and natural orifice transluminal endoscopic surgery (NOTES)
Minimal invasive surgery (MIS) and stricturoplasty
A patient has vague symptoms that indicate an inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? 1 Epigastric cramping 2 Hypotension with vomiting 3 Chronic diarrhea, abdominal pain, and fever 4 Abdominal pain relieved by bending the knees
Chronic diarrhea, abdominal pain, and fever
What interventions should the nurse provide to a patient with inflammatory bowel disease who complains of abdominal pain? 1 Avoid analgesics 2 Advise to drink milk 3 Encourage exercise and walking 4 Observe for signs and symptoms of peritonitis
Observe for signs and symptoms of peritonitis
What is a clinical manifestation of Crohn's disease? 1 Nausea 2 Vomiting 3 Abdominal pain 4 Dryness of mucous membranes
Abdominal pain
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? 1 Sulfasalazine will be stopped. 2 Sulfasalazine will be tapered. 3 Corticosteroid therapy will be stopped. 4 Corticosteroid therapy will be tapered
Corticosteroid therapy will be tapered
What is a common complication of Crohn's disease? 1 Fistulas 2 Tenesmus 3 Liquid stools 4 Bloody stools
Fistulas
What are potential complications of Crohn's disease? Select all that apply. 1 Fistulas 2 Osteoporosis 3 Malabsorption 4 Stomach cancer 5 Abscess formation
Fistulas Osteoporosis Malabsorption Abscess formation
A patient with ulcerative colitis complains of severe diarrhea with exacerbations. What is the drug of choice in this condition? 1 Glucocorticoids 2 Aminosalicylates 3 Immunomodulators 4 Antidiarrheal drugs
Glucocorticoids
What physiological change is seen in a patient with ulcerative colitis? 1 Increase in hemoglobin levels 2 Increase in serum albumin levels 3 Increase in white blood cell levels 4 Increase in blood levels of sodium, potassium, and chlorine
Increase in white blood cell levels
Which pathophysiological finding is least likely to occur in ulcerative colitis? 1 The colon becomes narrowed. 2 Ulcers are seen in the intestine. 3 Intestinal mucosa becomes bluish. 4 Intestinal mucosa becomes reddened.
Intestinal mucosa becomes bluish.
What diagnostic test is preferred to differentiate between ulcerative colitis and Crohn's disease? 1 Computed tomography (CT) scan 2 Colonoscopy 3 Magnetic resonance enterography 4 X-ray examination with barium enema
X-ray examination with barium enema
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? 1 "I may have up to 20 liquid, bloody stools a day." 2 "I should monitor closely for gastrointestinal hemorrhage." 3 "I may have an increased risk of bladder infections caused by fistulas." 4 "I will have an increased risk of colorectal cancer, especially after 10 years."
"I may have an increased risk of bladder infections caused by fistulas."
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? 1 "Eventually, the amount and consistency of the stool will change." 2 "The color and amount of your stool indicates a possible infection." 3 "Once your small intestine heals, you will only wear a pouch intermittently." 4 "You may need to wear a larger pouch so you won't have to empty it so often.
"Eventually, the amount and consistency of the stool will change."
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? 1 Requesting an antianxiety medication 2 Having a home health consultation for wound care 3 Requesting pain medication for the patient's osteoarthritis 4 Placing the patient in a skilled nursing facility for rehabilitation
Having a home health consultation for wound care
What laboratory findings are consistent with ulcerative colitis (UC)? Select all that apply. 1 Decreased erythrocyte sedimentation rate (ESR) 2 Increased C-reactive protein 3 Decreased white blood cell (WBC) count 4 Increased sodium levels 5 Decreased potassium levels
Increased C-reactive protein Decreased potassium levels
A patient has a low-grade fever and tenesmus. Which other clinical manifestations may indicate ulcerative colitis? 1 Increase in appetite 2 Difficulty passing stools 3 Inflammation of the joints 4 Formation of lesions outside the mouth
Inflammation of the joints
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. 1 Intolerance to milk 2 Exposure to antibiotics 3 Travel to a tropical area 4 Change in stool color from yellow to brown 5 Elimination of the bowels two or three times in a day
Intolerance to milk Exposure to antibiotics Travel to a tropical area
Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? 1 Patients with UC may experience hemorrhage. 2 Very few complications are associated with CD. 3 The peak incidence of UC is between 15 and 40 years of age. 4 Patients with CD experience about 20 loose, bloody stools daily
Patients with UC may experience hemorrhage.
Which clinical findings in a patient indicate ulcerative colitis? 1 Bowel fistulas 2 Thickened bowel wall 3 Inflammation of the ileum and colon 4 Presence of blood and mucus in the stool
Presence of blood and mucus in the stool
Which of the following are classic symptoms of celiac disease? Select all that apply. 1 Weight gain 2 Steatorrhea 3 Osteoporosis 4 Abdominal pain 5 Diarrhea and/or constipation
Steatorrhea Abdominal pain Diarrhea and/or constipation
What changes take place in a patient after a total proctocolectomy with a permanent ileostomy? 1 The effluent has a foul odor. 2 The stool becomes reddish in color. 3 Stool volume increases and becomes thin. 4 Stool volume decreases and becomes thick.
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? 1 Azathioprine 2 Sulfasalazine 3 Mercaptopurine 4 Sulfamethoxazole
Sulfasalazine
What drug has a complication of hemolytic anemia in a patient with ulcerative colitis if taken in higher doses? 1 Oslalazine 2 Balsalazide 3 Mesalamine 4 Sulfasalazine
Sulfasalazine
What instruction should the nurse give to a patient with inflammatory bowel disease regarding skin care? 1 Encourage skin care with soap and water. 2 Instruct the patient to use tissues for wiping. 3 Advise the patient to gently rub the area dry. 4 Tell the patient to apply a thin coat of A+D ointment or aloe cream
Tell the patient to apply a thin coat of A+D ointment or aloe cream
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? 1 "I should encourage my son to drink more milk." 2 "I should not give my son carbonated beverages." 3 "I should give my son fruits such as oranges and lemons." 4 "I should not give my son foods such as cabbage and broccoli."
"I should encourage my son to drink more milk."
What term is used to describe a fistula that is present between the bowel and the bladder? 1 Enteroenteric fistula 2 Enterovesical fistula 3 Enterovaginal fistula 4 Enterocutaneous fistula
Enterovesical fistula
What measures should be taken by a patient who has gastroenteritis to prevent transmission of the infection? 1 Maintain clean bathroom facilities. 2 Share glasses, dishes, and eating utensils with others. 3 Prepare or handle food that will be consumed by others. 4 Inform the primary health care provider if symptoms persist beyond 5 days
Maintain clean bathroom facilities
Which disorder is associated with inflammation of the small intestine? 1 Peritonitis 2 Gastroenteritis 3 Crohn's disease 4 Ulcerative colitis
Crohn's disease
The primary health care provider prescribes natalizumab to a patient with Crohn's disease. Which health teaching is most important before beginning the medication? 1 "This drug masks the symptoms of infection." 2 "A cold and a sore throat are common infections." 3 "A headache and abdominal pain are common side effects." 4 "Cognitive, motor, and sensory changes have very lethal effects."
"Cognitive, motor, and sensory changes have very lethal effects."
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? 1 "It is bland and reduces the secretion of gastric acids." 2 "It does not contain caffeine or other gastrointestinal (GI) tract stimulants." 3 "It provides key nutrients and extra calories to promote healing." 4 "It is absorbed quickly and allows the affected part of the GI tract to rest and heal.
"It is absorbed quickly and allows the affected part of the GI tract to rest and heal.
A certified Wound, Ostomy, and Continence Nurse is teaching a patient about caring for a new ileostomy. What information is most important to include? 1 "Remember that you must wear a pouch system at all times." 2 "Call the health care provider if your stoma has a bluish or pale look." 3 "Notify the health care provider if output from your stoma has a sweetish odor." 4 "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present."
"Call the health care 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? 1 "Do not empty your pouch until it is full." 2 "Do not change the pouch during inactive times." 3 "Change the entire pouch system every 10 days." 4 "Change the entire pouch system every 3 to 7 days."
"Change the entire pouch system every 3 to 7 days."
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. 1 A temporary loop ileostomy is created. 2 Metronidazole is avoided after the surgery. 3 The colon, rectum, and anus are removed by RPC-IPAA. 4 Parenteral antibiotics are given within 1 hour before the surgery. 5 An internal pouch is created with the distal part of the small intestine.
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.