Chapter 52 Case Study and Questions

Case Study

A 23-year old client admitted and just diagnosed with ulcerative colitis (UC) reports approximately 5 bloody stools daily. Vital signs show a pulse of 80 bpm, respiration rate of 18 breaths per minute, blood pressure of 124/88, and temperature of 97.6ºF. Mild abdominal tenderness on palpation is noted. The ESR is mildly elevated.

The nurse is teaching a client with Crohn disease about managing the disease with the adalimumab Which instruction does the nurse emphasize to the client?

A. A. "Avoid large crowds and anyone who is sick Rationale: The immunosuppressing action of HUMIRA.(adalimumab) Injection for Subcutaneous use places patients at increased risk for serious infection.

The nurse is caring for a client who has an exacerbation of Chron's disease. For what complications will the nurse monitor?

A. Anemia Rationale: Chron's is associated with diarrhea & sometimes bloody stools. Hypokalemia is associated with diarrhea and weight loss is a common finding.

The nurse is caring for a client diagnosed with peritonitis. The patient complains of abdominal pain of 7 on a scale of 10. What is the most appropriate initial action by the nurse?

A. Assess the patient's vital signs Rationale: feedback: Although pain control and fluid balance are important, the prioritization must be based on the patient's assessment.

An older adult client diagnosed with bacterial gastroenteritis reports abdominal cramping, diarrhea, nausea and vomiting, and fatigue for the past 24 hours. The nurse will monitor the client for what condition?

A. Dehydration Rationale: In older adults, dehydration occurs with viral and bacterial gastroenteritis and may require hospitalization. Electrolyte imbalances are also common, especially hypokalemia and hypernatremia. The aging skin is also at risk of compromise from frequent exposure to enzymes in the stool.

2. The nurse reviews medications the client has been taking recently. Which medication will the nurse question?

A.Ibuprofen (Motrin) Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID); NSAIDs increase the risk for bleeding.

3. Later in the afternoon, the client states that the abdominal pain is worsening. Which nursing intervention is appropriate to address the client's discomfort? (Select all that apply.)

A.Provide sitz baths as needed B.Administer analgesics as ordered C.Teach music therapy or guided imagery Rationale: Sitz baths will help prevent skin excoriation or irritation. Complementary therapies used in conjunction with analgesics can be very helpful in controlling pain. Antidiarrheal medications may provide symptomatic relief but does not directly address pain or discomfort. Evaluating tomorrow's foods would not address the client's immediate symptom of pain.

The nurse is teaching a client about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advise the client?

B. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." Rationale: Clients should consume a low-fiber diet while diverticulitis is active. to rest the gut and decrease inflammation. When inflammation resolves, a high-fiber diet is recommended.

The nurse is caring for a client with peritonitis from a perforated appendix. Which abdominal assessment finding will the nurse most likely expect?

B. Board-like abdomen Rationale: A board-like abdomen is one of the cardinal signs of peritonitis. Bowel sounds may or may not be present and severe distention is common .

The nurse is assessing an older client who has had frequent vomiting and diarrhea for the last 24 hours. Which vital sign change would be of most concern to the nurse?

B. Decreased blood pressure Rationale: Falling blood pressure indicates decreased tissue perfusion.

What priority laboratory analysis will the nurse review when caring for a client with Crohn's disease?

B. Hemoglobin Rationale: Crohn's disease presents as transmural inflammation that causes a thickened bowel wall, strictures, and deep ulcerations that result in severe diarrhea and malabsorption of vital nutrients. Anemia is common, usually from iron deficiency or malabsorption issues. C-reactive protein may be monitored as a marker of inflammation, albumin to assess nutritional status, and potassium related to losses from diarrhea.

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

B. Ingestion of parasites in the water Rationale: The most common cause of traveler's diarrhea is parasites ingested with drinking water.

1. How is the severity of the client's ulcerative colitis documented?

B. Moderate Rationale: In moderate UC, vital signs are often normal and there are less than 6 blood stools daily. C-reactive protein and/or EST may be elevated.

A client has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the client about diet and lifestyle choices?

C. "Lactose-containing foods should be reduced or eliminated from your diet." Rationale: Lactose can cause GI distress, as can carbonation. Vegetables should be cooked to reduce dietary roughage. Clients should be encouraged not to smoke.

5. The client is preparing for discharge. She asks what is the best way to take care of her skin. Which teaching will the nurse provide?

C."Wash with mild soap and warm water after each bowel movement." Rationale: Good skin care after each bowel movement is the best way to protect from excoriation or irritation due to frequent bowel movements. Pectin skin barriers are only used for ostomies; not UC. High-fiber or high-cellulose foods should be avoided, as should laxatives.

4. The client states, "I am afraid I'll never get to go out with my friends again because I can't be away from the toilet." Which nursing response is appropriate?

D. "It sounds like you are concerned about managing this disorder." Rationale: This response verbalizes the implied concern. Response A does not address the concern and requires the client to give an answer that defends her feelings. Responses B and C minimize the client's feelings and do not address concerns.

The nurse is teaching a group of senior citizens in a residential facility about how to prevent gastrointestinal (GI) infectious outbreaks, such as norovirus. What information will the nurse include as a priority intervention for the group?

D. Handwashing and hand sanitizing Rationale: Norovirus is transmitted via a fecal oral route. So, handwashing is the priority prevention.

A client has recently been placed on corticosteroids to treat ulcerative colitis. The nurse will monitor the client's laboratory results for evidence of which condition?

D. Hyperglycemia Rationale: Long-term adverse effects that commonly occur with steroid therapy include hyperglycemia, osteoporosis, peptic ulcer disease, and increased risk for infection.

A client is admitted to the hospital with right lower quadrant abdominal pain, nausea, and vomiting. What assessment would the nurse monitor to identify a potentially life-threatening complication based on the client's condition?

D. Vital signs Rationale: Life threatening fluid imbalance will be detected through vital signs assessment.