Chapter 57 Study Guide
A client 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?
Has another client with a stoma who performs self-care talk with the client
A client has developed gastroenteritis while traveling outside the country. What is the likely cause of the client's symptoms?
Ingestion of parasites in the water
A nurse cares for a client who is prescribed mesalamine (Asacol) for ulcerative colitis. The client states, "I am having trouble swallowing this pill." Which action should the nurse take?
Ask the health care provider to prescribe the medication as an enema instead
A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find?
- distended abdomen - inability to pass flatus - decreased urine output
A client is scheduled for discharge after surgery for inflammatory bowel disease. The client's spouse will be assisting home health services with the client's care. What is most important for the home health nurse to assess in the client and the spouse with regard to the client's home care.
Ability of the client and spouse to perform incision care and dressing changes
A nurse cares for an older adult client who has Salmonella food poisoning. The client's vital signs are heart rate: 102 beats/min, blood pressure: 98/55 mm Hg, respiratory rate: 22 breaths/min, and oxygen saturation: 92%. Which action should the nurse complete first?
Administer intravenous fluids (avoid dehydration from diarrhea)
The nurse is teaching a client who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the client to report to the health care provider?
Anorexia Headache Vomiting
A nurse reviews the chart of a client who has Crohn's disease and a draining fistula. Which documentation should alert the nurse to urgently contact the provider for additional prescriptions?
Serum potassium of 2.6 mEq/L
A nurse teaches a community group ways to prevent Escherichia coli infection. Which statements should the nurse include in this group's teaching?
wash your hands after any contact with animals use separate cutting boards for meat and vegetables
Which client does the charge nurse assign to an experienced LPN/LVN?
A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy
An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which client does the charge nurse assign to the float nurse?
A 36-year-old with peritonitis who just returned from surgery with multiple drains in place
A male client 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 change in position may be what is needed for you to have intercourse with you wife
The nurse is instructing a client with recently diagnosed diverticular disease about diet. What food does the nurse suggest the client include?
A slice of 5-grain bread
A client admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this client?
Using a sitz bath three times daily
A nurse is teaching a client with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client?
Avoid large crowds and anyone who is sick
A client has an anal fissure. Which intervention most effectively promotes perineal comfort for the client?
Using hydrocortisone cream to relieve pain
After teaching a client with diverticular disease, a nurse assesses the client's understanding. Which menu selection made by the client indicates the client correctly understood the teaching?
Baked fish with steamed carrots and a glass of apple juice
A client diagnosed with ulcerative colitis is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication?
Be aware of the symptoms of toxic megacolon that we discussed
A certified Wound, Ostomy, and Continence nurse is teaching a client about caring for a new ileostomy. What information is most important to include?
Call the health care provider if your stoma has a bluish or pale look
A home health client 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 client with self-care?
Checking and reporting the client's heart rate and blood pressure in lying, sitting, and standing positions
A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)?
Chronic diarrhea, abdominal pain, and fever
Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)?
Clients with UC may experience hemorrhage
A nurse is teaching a client about dietary methods to help manage exacerbations ("flare-ups") of diverticulitis. What does the nurse advise the client?
Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet
A client 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 client to do in the meantime?
Consume extra fluids to replace fluid losses
A client with ulcerative colitis is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the client's medication regimen?
Corticosteroid therapy will be tapered
After teaching a client with a parasitic gastrointestinal infection, a nurse assesses the client's understanding. Which statements made by the client indicate that the client correctly understands the teaching?
I must take a shower or bathe every day I should have my well water tested I will ask my sexual partner to have a stool test
After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching?
I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel
After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
I will take this medication with my breakfast each morning (Humira must be give via subcutaneous injection)
A nurse assesses a client with Crohn's disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider?
Distended abdomen
A client had a bowel resection yesterday for colorectal cancer. Which assessment finding does the nurse report immediately to the surgeon?
Distended, board-like abdomen
A client 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 client's care does the nurse make certain to discuss with the health care provider before the client's discharge?
Having a home health consultation for wound care
A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first?
Heart rate and rhythm
A nurse assesses a client who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestation should the nurse expect to find?
High-pitched, rushing bowel sounds due to the narrowing of the bowel lumen in Crohn's disease
The nurse is teaching a client about nutrition and diverticulitis. Which statement by the client indicates a need for further teaching?
I can have any fruits that I want
A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond?
It is usually ready to be closed in about 1 to 2 months
A client has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the client about diet and lifestyle choices?
Lactose-containing foods should be reduced or eliminated from your diet
A nurse cares for a client with ulcerative colitis. The client states, "I feel like I am tied to the toilet. This disease is controlling my life." How should the nurse respond?
Let's discuss potential factors that increase your symptoms
A nurse cares for a teenage girl with a new ileostomy. The client states, "I cannot go to prom with an ostomy." How should the nurse respond?
Let's talk to the enterostomal therapist about options for ostomy supplies and dress styles
A client admitted with severe gastroenteritis has been started on an IV, but the client continues having excessive diarrhea. Which medication does the nurse ask the health care provider about prescribing?
Loperamide (Imodium)
A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes?
Lower gastrointestinal bleeding - Erosion of the bowel wall Abscess formation - Localized pockets of infection develop in the ulcerated bowel lining Nonmechanical bowel obstruction - Paralysis of colon resulting from colorectal cancer
A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find?
Severe, steady right lower quadrant pain
A nurse plans care for a client with Crohn's disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this client's plan of care?
Skin protection
An 80-year-old client with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which health care provider request does the nurse implement first?
Start an IV solution of 5% dextrose in 0.45% normal saline at 125mL/hr
An obese client is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the client's home health nurse requires immediate action?
States, "I feel like the incision is splitting open"
The health care provider prescribes prednisone (Deltasone) for a client with ulcerative colitis. What health teaching is most important before the client begins the medication?
Teach the patient the importance of avoiding crowds
A client who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for the home health care follow-up. The client 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?
Written and oral instructions regarding symptoms to report to the health care provider
After teaching a client who has a new colostomy, the nurse provides feedback based on the client's ability to complete self-care activities. Which statement should the nurse include in this feedback
You cleaned the stoma well. Now you need to practice putting on the appliance
A client is admitted with severe viral gastroenteritis caused by norovirus. The client asks the nurse, "How did I get this disease?" Which answer by the nurse is correct?
You may have consumed contaminated food or water
A client newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the client about why this therapy has been prescribed?
Your intestinal inflammation will be reduced
A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this client's teaching?
drink plenty of fluids to prevent dehydration
After teaching a client who has diverticulitis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching
i will take a laxative nightly at bedtime to avoid becoming constipated. (laxatives are not recommended for clients with diverticulitis because they can increase pressure in the bowel, causing additional outpouching of the lumen)
A client with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The client asks the nurse how this is helpful for improving symptoms. How does the nurse reply?
it is absorbed quickly and allows the affected part of the GI tract to rest and heal
A nurse cares for a client who has a Giardia infection. Which medication should the nurse anticipate being prescribed for this client?
Metronidazole (Flagyl)
After teaching a client with an anal fissure, a nurse assesses the client's understanding. Which client actions indicate that the client correctly understands the teaching?
Taking a warm sitz bath several times each day using a bulk-producing agent to aid in elimination self-administering anti-inflammatory suppositories
A nurse cares for a client with a new ileostomy. The client states, "I don't think my friends will accept me with this ostomy." How should the nurse respond?
Tell me more about your concerns
After teaching a client who was hospitalized for Salmonella food poisoning, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
"I'll take the ciprofloxacin until the diarrhea has resolved." (should be taken for 10-14 days)
A nurse teaches a community group about food poisoning and gastroenteritis. Which statements should the nurse include in this group's teaching?
-Rotavirus is more common among infants and younger children -to prevent E. coli infection, don't drink water when swimming -parasitic diseases may not show up for 1 to 2 weeks after infection
A nurse teaches a client how to avoid becoming ill with Salmonella infection again. Which statements should the nurse include in this client's teaching?
-wash leafy vegetables carefully before eating or cooking them -wash hands before and after using bathroom -be sure meat is cooked to proper temp -avoid eating eggs that are sunny side up or undercooked
The RN receives a change-of-shift report about four clients. Which client does the nurse assess first?
A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102F
The nurse is caring for an older client who experiences an exacerbation of ulcerative colitis with severe diarrhea. What is the nurse's priority for care?
Monitor heart rate and rhythm
A nurse assesses a client who is recovering from an ileostomy placement. Which clinical manifestation should alert the nurse to urgently contact the health care provider?
Pale and bluish stoma
A client demonstrates the manifestations of diverticulitis with a suspected complication of peritonitis. What is the priority nursing intervention?
Preparing the client for emergency surgery
A nurse cares for a client who has food poisoning resulting from a Clostridium botulinum infection. Which assessment should the nurse complete first?
Respiratory rate. (Severe infection with C. botulinum can lead to respiratory failure)
A client returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this client after the client is situated in bed?
Semi-Fowlers
A nurse assesses a client who is hospitalized for botulism. The client's vital signs are temperature: 99.8° F (37.6° C), heart rate: 100 beats/min, respiratory rate: 10 breaths/min, and blood pressure: 100/62 mm Hg. Which action should the nurse take?
Stay with the client while another nurse calls the provider (botulism is at risk for respiratory failure)
