Med Surg - Chapter 57 - Care of Patients with Inflammatory Intestinal Disorders

Which laboratory parameters should the nurse assess in the patient who presents with symptoms of diverticulitis? Select all that apply. 1 Hematocrit 2 Hemoglobin 3 Serum albumin 4 Serum potassium 5 White blood cell (WBC) count

1 Hematocrit 2 Hemoglobin 5 White blood cell (WBC) count The hematocrit and hemoglobin values should be monitored in the patient with diverticulitis because the hematocrit value may decrease due to severe bleeding. The WBC count may be elevated in the patient due to infection. Serum albumin levels should be monitored in the patient with malabsorption syndrome. Serum potassium levels should be assessed in the patient with diarrhea.

Which patient is at risk for celiac disease (CE)? 1 The patient with multiple sclerosis 2 The patient who is receiving prednisone 3 The patient with diabetes mellitus type I 4 The patient who is receiving paromomycin

3 The patient with diabetes mellitus type I Diabetes mellitus type I is a metabolic disorder. It affects normal metabolism, which affects the metabolic function and can cause problems in gluten digestion. Diabetes mellitus type I can also result in CE. Multiple sclerosis is an inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. It does not cause CE. Multiple sclerosis affects sensory function and does not cause gluten digestion problems. Prednisone is a glucocorticoid. Prolonged consumption of prednisone causes osteoporosis as a side effect, not celiac disease. Paromomycin causes dizziness as a side effect and does not place a patient at risk for celiac disease.

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

4 Presence of blood and mucus in the stool Presence of blood and mucus in the stool is caused by bleeding in the intestinal mucosa. This symptom is indicative of ulcerative colitis. Strictures and deep ulcerations occur in Crohn's disease, which put the patient at risk for developing bowel fistulas. Thickened bowel walls and inflammation of ileum and colon are seen in Crohn's disease.

Which bacteria may cause gastroenteritis? 1 Shigella species 2 Gonococcal species 3 Pneumococcal species 4 Staphylococcal species

1 Shigella species Gastroenteritis is a very common health problem that affects the small bowel and is caused either by bacterial or viral infection. Shigella species bacteria are transmitted by direct and indirect fecal-oral routes leading to gastroenteritis . Peritonitis may occur due to Gonococcus, Staphylococcus, and Pneumococcus infections .

What is the common symptom associated with anorexia? 1 Vomiting 2 Diarrhea 3 Abdominal cramping 4 Temperature greater than 101°F

1 Vomiting Common symptoms of anorexia are nausea and vomiting. Gastroenteritis may manifest as diarrhea and abdominal cramping. Perforation of the appendix may result in peritonitis with a temperature greater than 101°F.

The nurse is assessing an older patient with diverticulitis. Which instructions given by the nurse will be beneficial to this patient? Select all that apply. 1 "Refrain from drinking alcohol." 2 "Use mild laxatives three times a day." 3 "Refrain from physical activities like bending." 4 "Add tomatoes and strawberries in your diet." 5 "Eat a high-fiber diet during severe abdominal pain."

1 "Refrain from drinking alcohol." 3 "Refrain from physical activities like bending." Inflammation of diverticula indicates diverticulitis. A patient with diverticulitis should avoid alcohol because it irritates the bowel. An older patient with diverticulitis should refrain from physical activities such as bending and coughing to prevent an increase in intra-abdominal pressure, which can result in perforation of the diverticulum. An older patient should refrain from taking laxatives because laxatives increase intestinal motility. Tomatoes and strawberries should not be consumed as they contain seeds that may block the diverticula. In the acute phase of diverticulitis, the patient should refrain from eating a high-fiber diet.

What is the typical incubation period of the Norwalk virus in a person with a normal immune system? 1 48 hours 2 72-96 hours 3 7 days 4 2-7 weeks

1 48 hours The Norwalk virus has an incubation period of 48 hours. The incubation period for shigellosis is 1-7 days. The period that campylobacter enteritis is communicable is 2-7 weeks. None of the disorders discussed in the chapter has a specific incubation period of 72-96 hours.

A patient is admitted to the hospital with appendicitis. What signs/symptoms are consistent with this diagnosis? Select all that apply. 1 Anorexia 2 Nausea and vomiting 3 Rebound tenderness 4 Decreased white blood cell count 5 Abdominal pain relieved by coughing

1 Anorexia 2 Nausea and vomiting 3 Rebound tenderness Symptoms consistent with appendicitis include abdominal pain that is aggravated by coughing, nausea and vomiting, anorexia, rebound tenderness, and an increased white blood cell count.

What is a risk factor for liver cancer? 1 Cirrhosis 2 Fatty liver 3 Hepatomegaly 4 Portal vein thrombosis

1 Cirrhosis Cirrhosis is a severe scarring of the liver, and this chronic condition may lead to liver cancer. Fatty liver is caused by the accumulation of fats and etiological factors, which include diabetes mellitus and obesity; this condition may not lead to liver cancer. Hepatomegaly is a sign of underlying problems, which may or may not include liver cancer. Portal vein thrombosis is blockage or narrowing of the portal vein by a blood clot; this condition may not be a risk factor for liver cancer.

Which condition is the most common cause of peritonitis? 1 Diverticulitis 2 Peritoneal dialysis 3 Perforating tumors 4 Leakage during surgery

1 Diverticulitis Peritonitis mostly occurs due to contamination of the peritoneal cavity by bacteria or chemicals. Diverticulitis may lead to peritonitis due to the bacterial invasion into the peritoneum. Conditions such as peritoneal dialysis, perforating tumors, and leakage during surgery are less likely to cause peritonitis.

When performing an abdominal assessment on a patient diagnosed with pancreatitis, the nurse notes gray-blue discoloration around the periumbilical area, a dull sound on percussion, and normal bowel sounds. What action by the nurse is priority? 1 Document the findings 2 Prepare the patient for the operating room 3 Contact the health care provider immediately 4 Obtain a stat hemoglobin and hematocrit level

1 Document the findings A blue discoloration around the periumbilical area is a normal finding in a patient with acute pancreatitis. A dull sound on percussion may be caused from pancreatic ascites. The findings should be documented. The patient does not need to go to the operating room. The health care provider does not need to be contacted immediately. Checking the hemoglobin and hematocrit level is not indicated.

The nurse is caring for a patient admitted for gastroenteritis. What symptoms does the nurse expect to see in the patient? Select all that apply. 1 Fever 2 Hypertension 3 Acute confusion 4 Poor skin turgor 5 Excessive urination

1 Fever 3 Acute confusion 4 Poor skin turgor The patient with gastroenteritis loses a considerable amount of fluid through diarrhea and vomiting. This may lead to dehydration manifested by fever, acute confusion, and poor skin turgor. Therefore, the patient has oliguria or a decreased urine output. Hypotension, rather than hypertension, is present in patients with gastroenteritis.

Which findings does the nurse expect with a diagnosis of acute peritonitis? Select all that apply. 1 Fever 2 Diarrhea 3 Vomiting 4 Tachycardia 5 Rigid abdomen

1 Fever 3 Vomiting 4 Tachycardia 5 Rigid abdomen Fever, vomiting, tachycardia, and a rigid, boardlike abdomen accompany the diagnosis of peritonitis from the inflammation of the peritoneal cavity. Diarrhea would not be present, as bowel motility slows, bowel sounds become more distant, and the passage of flatus and feces cease.

While assessing a patient with gastroenteritis, the nurse suspects that the patient has severe dehydration. Which findings support the nurse's suspicion? Select all that apply. 1 Fever 2 Polyuria 3 Hypertension 4 Poor skin turgor 5 Dry mucous membranes

1 Fever 4 Poor skin turgor 5 Dry mucous membranes Gastroenteritis is a condition in which the stomach and the intestines become inflamed. A patient with gastroenteritis usually develops dehydration as fluids and electrolytes are lost as a result of diarrhea and vomiting. The clinical manifestations of severe dehydration include fever, poor skin turgor, and dry mucous membranes. Oliguria, not polyuria, and hypotension, not hypertension, are manifestations observed in patients with severe dehydration caused by gastroenteritis.

What is a common complication of Crohn's disease? 1 Fistulas 2 Tenesmus 3 Liquid stools 4 Bloody stools

1 Fistulas Crohn's disease is an inflammatory disease that usually affects the small intestine and the colon. The patient with Crohn's disease is at risk for fistulas due to the presence of strictures and deep ulcerations in the bowel wall. Patients with ulcerative colitis have bloody and liquid stools and report tenesmus, an unpleasant and urgent sensation to defecate. The lower abdominal colicky pain reduces with defecation.

What are potential complications of Crohn's disease? Select all that apply. 1 Fistulas 2 Osteoporosis 3 Malabsorption 4 Stomach cancer 5 Abscess formation

1 Fistulas 2 Osteoporosis 3 Malabsorption 5 Abscess formation The complications of Crohn's disease include abscess formation, colon cancer, malabsorption, fistulas, and osteoporosis. Stomach cancer is not a complication of Crohn's disease; colorectal cancer, however, is a possible complication of ulcerative colitis.

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

1 Glucocorticoids Glucocorticoids such as prednisone and prednisolone are prescribed during exacerbation of ulcerative colitis. Aminosalicylates are used to treat mild to moderate ulcerative colitis. Immunomodulators alone are not effective in treating ulcerative colitis. Antidiarrheal drugs provide symptomatic management of diarrhea.

The nurse is preparing to administer the prescribed dose of pancrelipase to a patient with chronic pancreatitis. What pancreatic enzymes make up this medication? Select all that apply. 1 Lipase 2 Trypsin 3 Elastase 4 Amylase 5 Protease

1 Lipase 4 Amylase 5 Protease Pancrelipase provides the enzymes that the body is unable to produce because of chronic pancreatitis. It is a combination of the enzymes lipase, amylase, and protease in different concentrations. It does not contain trypsin and elastase.

What would be the drug of choice for a patient with gastroenteritis who is prescribed antiperistaltic agents? 1 Loperamide 2 Ciprofloxacin 3 Acetaminophen 4 Docusate sodium

1 Loperamide Loperamide has antiperistaltic action and is used in patients with gastroenteritis. Ciprofloxacin is an antibiotic. Acetaminophen is not indicated in the treatment of gastroenteritis. Docusate sodium is a drug used for softening stool.

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.

1 Maintain clean bathroom facilities. Gastroenteritis can be transmitted via the fecal-oral route. Maintaining a clean bathroom facility helps to avoid exposure to infected stool. The sharing of glasses, dishes, and eating utensils with others should be avoided to prevent transmission of an infection. The preparation and handling of food that will be consumed by others may promote the spread of infection and should be avoided. Informing the primary health care provider if symptoms persist beyond 3 days prevents further progression of the disease.

A patient reports pain in the abdomen below the diaphragm. On assessment, the nurse finds the body temperature as 101 oF, hiccups, and pulse rate of 103 beats per minute. Which condition does the nurse suspect in the patient? 1 Peritonitis 2 Gastroenteritis 3 Crohn's disease 4 Ulcerative colitis (UC)

1 Peritonitis Peritonitis is an inflammation and infection of the visceral and parietal peritoneum and endothelial lining of the abdominal cavity; this is life-threatening. Peritonitis presents with pain in the abdominal area, elevated body temperature, hiccups, and increased pulse rate. Gastroenteritis may cause diarrhea, nausea, and vomiting due to inflammation and infection of the mucosa in the intestine and stomach. Crohn's disease and UC are types of inflammatory bowel disease. Crohn's disease is characterized by pain near the terminal ileum. UC begins in the rectum and proceeds in a continuous manner toward the cecum.

What disorders does the nurse identify as acute inflammatory bowel disorders? Select all that apply. 1 Peritonitis 2 Appendicitis 3 Gastroenteritis 4 Crohn's disease 5 Ulcerative colitis

1 Peritonitis 2 Appendicitis 3 Gastroenteritis Appendicitis, gastroenteritis, and peritonitis are classified as acute inflammatory bowel disorders. Appendicitis is an acute inflammation of the vermiform appendix. Gastroenteritis is an acute inflammation of the mucous membranes of the stomach and intestinal tract. Peritonitis is an acute inflammation of the visceral or parietal peritoneum and endothelial lining of the abdominal cavity. Ulcerative colitis and Crohn's disease are classified as chronic inflammatory bowel diseases.

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."

2 "Call the health care provider if your stoma has a bluish or pale look." If the stoma has a bluish, pale, or dark look, its blood supply may be compromised and the health care provider must be notified immediately. It is true that output from the stoma after surgery may be a loose, greenish-colored liquid that may contain some blood, but this information is not the highest priority for instruction. It is normal for output from the stoma to have very little odor or a sweetish smell. Although it is true that the patient will be required to wear a pouch system at all times, this is not the highest priority for instruction.

Which examination is used first to identify an enlarged appendix in a patient? 1 X-ray study 2 Abdominal ultrasound 3 Computed tomography 4 Palpation of the abdomen

2 Abdominal ultrasound An abdominal ultrasound study may show the presence of an enlarged appendix. An x-ray is used in identification of free air or abdominal fluid. A computed tomography scan may be used after an ultrasound to confirm the diagnosis. Palpation of the abdomen may reveal muscle rigidity and guarding.

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)

2 Minimal invasive surgery (MIS) and stricturoplasty MIS is performed for treating Crohn's disease which involves one or more small incisions, less pain, and quicker surgical recovery. Stricturoplasty is performed for bowel strictures related to Crohn's disease. Ileostomy and NOTES are the surgical techniques performed for treating ulcerative colitis.

A patient has a low-grade body temperature of 99 oF, tachycardia, and lesions in the mouth. The laboratory results reveal a hemoglobin level of 8.7 g/dL and the erythrocyte sedimentation rate (ESR) as 38 mm per hour. Which treatment strategy may benefit the patient? 1 Opioids 2 Aminosalicylates 3 Antiperistaltic agents 4 Bulk-producing agents

2 Aminosalicylates Low-grade body temperature of 99 oF, tachycardia, and lesions in the mouth may indicate inflammatory bowel disease (IBD). The patient may have a low hemoglobin level of 8.7 g/dL (normal range: 13 to 16 g/dL) and ESR of 38 per hour (normal range: 20 to 30 mm per hour). Aminosalicylates such as sulfasalazine are used in the treatment of IBD. They provide anti-inflammatory effects by inhibiting prostaglandins and are usually effective in 2 to 4 weeks. Opioids are used to provide comfort in a patient with appendicitis pain. Antiperistaltic agents are useful in controlling the bowel movements in a patient with diarrhea. Bulk-producing agents such as psyllium hydrophilic mucilloid help in minimizing the pain from defecation in a patient with anal fissure.

The nurse is caring for a patient with peritonitis. What assessment findings will the nurse observe? Select all that apply. 1 Diarrhea 2 Anorexia 3 Low-grade fever 4 Distended abdomen 5 Increased urine output

2 Anorexia 4 Distended abdomen Peritonitis is an acute inflammation of the visceral and the parietal peritoneum and the endothelial lining of the abdominal cavity. A patient with peritonitis presents with a distended abdomen and anorexia. The patient has a high fever rather than a low-grade fever. Urine output is decreased because fluid shifts from the vascular compartment to the peritoneal cavity. There is no diarrhea; rather, the patient is unable to pass flatus because peristalsis slows or stops due to severe peritoneal inflammation.

Which condition is suspected in a patient who presents with right quadrant abdominal pain followed by anorexia, nausea, and vomiting? 1 Peritonitis 2 Appendicitis 3 Gastroenteritis 4 Crohn's disease

2 Appendicitis Appendicitis is an acute inflammation of the appendix associated with pain in the right lower quadrant followed by anorexia, nausea, and vomiting. Inflammation occurs due to the blockage of the appendix, which results in infection because the bacteria invade the wall of the appendix. Perforation of appendix leads to peritonitis, which results in inflammation and infection of peritoneum. Gastroenteritis is manifested by nausea and vomiting before abdominal pain. Crohn's disease is an inflammatory bowel disease that is manifested by pain at the terminal ileum.

A pathology report indicates a patient who has impaired digestion and bowel function is infected with Trypanosoma cruzi. The nurse notes the patient has cardiac dysrhythmia. Which condition does the nurse suspect? 1 Giardiasis 2 Chagas disease 3 Celiac disease (CD) 4 Intestinal amebiasis

2 Chagas disease Impaired digestion, impaired bowel function, and cardiac dysrhythmias with the infection of Trypanosoma cruzi indicate that the patient has Chagas disease. Giardiasis is caused by Giardia lamblia, which mainly affects intestinal system and leads to diarrhea and malabsorption syndrome. CD is characterized by anorexia, diarrhea and/or constipation, steatorrhea, and abdominal pain. Entamoeba histolytica causes intestinal amebiasis.

The nurse is caring for a patient with a low grade fever of 101°F, chills, and a heart rate of 98 beats per minute. The abdominal ultrasonography reveals bowel thickening. The blood test reports reveal a white blood cell (WBC) count of 19,000cells/ mm 3 and hemoglobin levels of 9.8 g/dL. Which condition does the nurse suspect in the patient? 1 Peritonitis 2 Diverticulitis 3 Gastroenteritis 4 Crohn's disease

2 Diverticulitis Diverticulitis is the inflammation of diverticula. A patient with diverticulitis may have an elevated WBC count of 19,000 cells/mm 3 and decreased hemoglobin and hematocrit values. Peritonitis is manifested by abdominal distention, hiccups, abdominal pain, a WBC above 20,000 cells/mm 3, and elevated neutrophils. Gastroenteritis causes diarrhea and vomiting due to inflammation of the mucous membranes of the stomach and intestinal tract. Crohn's disease is manifested by malaise, anorexia, anemia, dehydration, fever, and weight loss.

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

2 Enterovesical fistula A fistula that is present between the bowel and bladder is referred to as an enterovesical fistula. A fistula that is present between two segments of bowel is called an enteroenteric fistula. A fistula that is present between the skin and bowel is an enterocutaneous fistula. A fistula that is present between the bowel and vagina is called an enterovaginal fistula.

Which statements about shigellosis are accurate? Select all that apply. 1 Antibiotics are not typically ordered. 2 Humans are possible carriers for months. 3 Cipro may be used for treatment of gastroenteritis 4 Shigellosis is transmitted by direct fecal-oral routes. 5 Shigellosis carries an incubation period of 10 days or more.

2 Humans are possible carriers for months. 3 Cipro may be used for treatment of gastroenteritis 4 Shigellosis is transmitted by direct fecal-oral routes. Shigellosis is transmitted by direct and indirect fecal-oral routes and carries an incubation period of 1 to 7 days. It is communicable during the acute illness to 4 weeks after the illness. Humans are possible carriers for months. If gastroenteritis is due to shigellosis, anti-infective agents such as trimethoprim/sulfamethoxazole or ciprofloxacin are prescribed.

A patient is scheduled for magnetic resonance enterography (MRE). Which nursing action is effective in this situation? 1 Injecting the patient with general anesthesia before the test 2 Instructing the patient to fast for 4 to 6 hours before the test 3 Positioning the patient in supine, knee-chest position during the test 4 Instructing the patient to clean the anal region with absorbent material after the test

2 Instructing the patient to fast for 4 to 6 hours before the test MRE is performed to study the bowel in patients with inflammatory bowel disease. The nurse should instruct the patient to fast for 4 to 6 hours prior to the test because the patient is allowed to drink a contrast medium that leads to diarrhea. Consumption of food prior to the MRE may increase the time required to perform the test. General anesthesia is not used in the patient undergoing this test because it does not involve a procedure that induces pain. A patient with an ileostomy has to lie down in a supine, knee-chest position to obtain relief from pain. A patient with gastroenteritis has to clean the anal region with an absorbent material to prevent skin irritation.

Which organism causes gastroenteritis and is possibly transmitted through the respiratory route? 1 Shigella 2 Norovirus 3 Escherichia coli 4 Campylobacter enteritis

2 Norovirus Norovirus, also known as Norwalk-like viruses, causes gastroenteritis and is transmitted through the fecal-oral route and possibly the respiratory route. Shigella transmits through direct and indirect fecal-oral routes . Escherichia coli transmit through fecal contamination of food, water, or fomites. Campylobacter enteritis causes gastroenteritis through the fecal-oral route or by contact with infected animals or infants.

Which nursing action focuses on the promotion of nutrition intake for older adult? 1 Provide antiemetics after meals 2 Observe the patient during meals 3 Provide an environment of privacy 4 Bedpans should be placed within sight

2 Observe the patient during meals The patient should be observed during meal time to monitor food intake. The patient should be provided antiemetics prior to meals, if nausea and vomiting interfere with intake. A private environment can lead to loneliness so the patient should be in an environment that offers socialization and relaxation. Bedpans, urinals, and emesis basins should be removed from the patient's sight.

What medications are administered to a patient with acute pancreatitis to decrease gastric acid secretion? Select all that apply. 1 Imipenem 2 Ranitidine 3 Meperidine 5 Ciprofloxacin

2 Ranitidine 4 Omeprazole Ranitidine is a histamine receptor antagonist, and omeprazole is a proton pump inhibitor. Both medications help decrease gastric acid secretion. Imipenem and ciprofloxacin are antibiotics. Meperidine is an opiate analgesic.

A patient reports having seven to nine bloody stools per day. The nurse finds that the patient has fever, tachycardia, anemia, and abdominal pain. The patient's laboratory reports indicate elevated C-reactive protein. Which classification of ulcerative colitis should the nurse suspect? 1 Mild 2 Severe 3 Moderate 4 Fulminant

2 Severe A patient who presents with greater than 6 and less than 10 bloody stools per day, fever, tachycardia, anemia, abdominal pain, and elevated C-reactive protein levels is suspected to have severe ulcerative colitis (UC). Absence of abnormal laboratory findings and less than 4 stools per day without blood indicate mild UC. Mild abdominal pain, nausea, and more than 4 stools per day without blood indicate moderate UC. Colonic distention, anemia, and more than 10 stools per day indicate fulminant UC.

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

2 Steatorrhea 4 Abdominal pain 5 Diarrhea and/or constipation Classic symptoms of celiac disease include weight loss, anorexia, diarrhea and/or constipation, steatorrhea, abdominal pain and distention, and vomiting. Atypical symptoms include osteoporosis, joint pain, lactose intolerance, iron deficiency anemia, depression, and migraines.

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

2 Sulfasalazine Several drugs can be prescribed to treat UC, including two aminosalicylates, one of which is sulfasalazine. Sulfamethoxazole is an antibiotic that can be used to treat gastroenteritis caused by shigellosis. Both azathioprine and mercaptopurine are prescribed to manage the symptoms of Crohn disease.

The community health nurse educates people in a senior citizen center about consuming spinach and lettuce. What is the reason behind this instruction? 1 To prevent possible viral infection 2 To prevent possible gastroenteritis 3 To reduce the risk for acute kidney failure 4 To reduce the frequency of bowel movements

2 To prevent possible gastroenteritis The community health nurse should instruct people about spinach and lettuce because they may be highly contaminated with bacteria; this can help to prevent gastroenteritis. Viral infections do not occur from plants. However, patients must maintain proper hygiene to prevent transmission of the virus through the fecal-oral route. Acute kidney failure may occur in a patient with chronic peritonitis due to the shift in fluid and electrolytes. Frequency of bowel movements may be reduced only after elimination of the causative organism.

A patient has an anal fissure. Which intervention most effectively promotes perineal comfort for the patient? 1 Avoiding the use of bulk-forming agents 2 Using hydrocortisone cream to relieve pain 3 Administering a Fleet enema when needed 4 Applying heat to acute inflammation for pain relief

2 Using hydrocortisone cream to relieve pain Topical anti-inflammatory agents may be effective in relieving the pain associated with anal fissures. Enemas should be avoided when an anal fissure is present. Cold packs should be applied to acute inflammation to diminish discomfort. Bulk-forming agents should be used to decrease pain associated with defecation.

Which medication prevents the migration of white blood cells (WBCs) to inflamed bowel tissue? 1 Prednisone 2 Vedolizumab 3 Azathioprine 4 Metronidazole

2 Vedolizumab Vedolizumab is an intestinal-specific leukocyte traffic inhibitor. It prevents the migration of WBCs to inflamed bowel tissue. Prednisone is used to treat ulcerative colitis. Azathioprine is used to treat Crohn's disease. Metronidazole is the drug of choice to treat giardiasis.

The emergency room nurse is caring for a patient with an acute anal fissure. What time frame is expected for the fissure to heal? 1 6 days 2 6 years 3 6 weeks 4 6 months

3 6 weeks An acute anal fissure is expected to heal within 6 weeks. Chronic fissures may reoccur and require intervention, prolonging the healing process. Acute fissures won't heal in 6 days, but they will heal quicker than 6 years or 6 months.

The primary health care provider inserts a nasogastric tube while performing open traditional abdominal surgery in a patient with right lower quadrant pain and a white blood cell (WBC) count of 20,500 cell/mm 3. The rationale behind this intervention is to prevent which condition? 1 Septicemia 2 Toxic megacolon 3 Abdominal distention 4 Respiratory atelectasis

3 Abdominal distention A patient with pain in the right lower quadrant and an elevated WBC count of 20,500 cell/mm 3 may have appendicitis. Open traditional surgery may be performed in the patient to remove the inflamed appendix. Nasogastic tube insertion is useful to decompress the stomach and prevent abdominal distension due to peritonitis or formation of abscesses while performing an open traditional surgery. The head of the patient's bed may be raised to reduce atelectasis after surgery. Intravenous antibiotic administration helps reduce septicemia. Infliximab may help reduce complications such as toxic megacolon in patients with ulcerative colitis.

What is a clinical manifestation of Crohn's disease? 1 Nausea 2 Vomiting 3 Abdominal pain 4 Dryness of mucous membranes

3 Abdominal pain Abdominal pain located in the right lower quadrant due to inflammation is a clinical manifestation of Crohn's disease. Nausea and vomiting are common symptoms in many bowel disorders. Dryness of the mucous membranes is due to dehydration.

While assessing a patient with peritonitis, which finding would make the nurse suspect that the inflammation has progressed? 1 Slow heart rate 2 Sunken abdomen 3 Absence of bowel sounds 4 Increased intestinal motility

3 Absence of bowel sounds Peritonitis is an inflammation of the peritoneum, which is the tissue that lines the inner wall of the abdomen that covers and supports most of the abdominal organs. Bowel sounds usually disappear when the inflammation progresses. Heart rate will increase due to the progression of inflammation in patients with peritonitis. Progressive abdominal distention is observed when the inflammation is progressed due to reduced intestinal motility.

The nurse is assessing a 70-year-old patient with abdominal distention, hyperactive bowel sounds, and poor skin turgor. The nurse suspects that the patient has gastroenteritis. What are the other findings that support the nurse's suspicion? Select all that apply. 1 Hemoglobin of 9.8 g/dL 2 Hematocrit of 25 percent 3 Body temperature of 101°F 4 Blood pressure of 100/70 mm Hg 5 Serum potassium level of 3.0 mEq/L

3 Body temperature of 101°F 4 Blood pressure of 100/70 mm Hg 5 Serum potassium level of 3.0 mEq/L An older patient with gastroenteritis may have an elevated body temperature of 101 oF due to a viral or bacterial infection. Heavy fluid imbalance may lead to hypotension (100/70 mm Hg) in the patient. The patient with gastroenteritis has severe emesis resulting in reduced serum potassium levels. Therefore, a low serum potassium level of 3.0 mEq/L (normal range: 3.5 to 5.5 mEq/L), sodium and chloride levels are observed in the patient. Low levels of hemoglobin (9.8 g/dL) and hematocrit (25 percent) may be observed in the patient with inflammatory bowel disease due to gastrointestinal bleeding.

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

3 Chronic diarrhea, abdominal pain, and fever Chronic diarrhea, abdominal pain, and fever are symptoms more indicative of CD than of other acute inflammatory bowel disorders. Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis. Epigastric cramping is a symptom more indicative of appendicitis. Hypotension with vomiting is not characteristic of CD.

Which sign of peritonitis appears first in an older adult? 1 Chills 2 Fever 3 Confusion 4 Abdominal pain

3 Confusion The first sign of peritonitis in older adults may be a sudden change in mental status (e.g., acute confusion). For those who have dementia, the confusion worsens. Fever and chills may not be present because of normal physiologic changes associated with aging. Abdominal pain will be present but will not be the first sign.

Which disorder is associated with inflammation of the small intestine? 1 Peritonitis 2 Gastroenteritis 3 Crohn's disease 4 Ulcerative colitis

3 Crohn's disease Crohn's disease is an inflammatory disorder of the small intestine, sometimes the colon, or both. Peritonitis is inflammation of the peritoneum. Gastroenteritis is inflammation of the gastrointestinal tract. Ulcerative colitis is inflammation of the rectum and rectosigmoid colon and can extend to the entire colon.

While assessing a patient with pain in the right lower quadrant, the nurse finds that the patient has a body temperature of 39 oC and a pulse rate of 100 beats per minute. Which surgical intervention does the nurse anticipate will control the patient's condition? 1 Ileostomy 2 Total proctocolectomy 3 Exploratory laparotomy 4 Uncomplicated appendectomy

3 Exploratory laparotomy A patient with pain in the right lower quadrant, a body temperature of 39 oC, and a pulse rate of 100 beats per minute may have a perforated appendix with peritonitis. An exploratory laparotomy is used to treat the patient's condition, which involves the surgical removal of the inflamed and perforated organ followed by irrigation of peritoneum with antibiotic solutions. An ileostomy involves the drainage of fecal material into a pouching system worn on the abdomen of a patient with ulcerative colitis. A total proctocolectomy is performed in a patient who does not want the ileo-anal pouch. The procedure involves the removal of the colon, rectum, and anus with surgical closure of the anus. Uncomplicated appendectomy involves the removal of the inflamed appendix.

The patient requires a large amount of calories daily to promote the healing of a fistula. Which kind of diet should the nurse provide to the patient? 1 High-fiber food 2 Low-vitamin food 3 High-protein food 4 Low-calorie meals

3 High-protein food A high-protein diet is beneficial for wound healing. High-fiber foods cause discomfort and indigestion problems. High-vitamin foods are suggested to speed up the wound cure. Low-calorie meals do not increase caloric intake.

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

3 Increase in white blood cell levels An increased white blood cell count is consistent with inflammatory conditions such as ulcerative colitis. Due to chronic blood loss, hemoglobin levels decrease in patients with ulcerative colitis. Serum albumin levels decrease due to loss of protein (albumin) in the stool. Blood levels of sodium, potassium, and chlorine decrease due to frequent diarrhea stools and malabsorption.

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

3 Inflammation of the joints Ulcerative colitis may have extraintestinal complications such as inflammation of the joints. Appetite would be decreased because mealtimes may be unpleasant since eating is associated with pain. Patients with ulcerative colitis have an increased frequency of stools rather than difficulty passing stools. Patients with ulcerative colitis may have lesions or ulcers inside the mouth involving the tongue, palate, and pharynx rather than outside the mouth.

Which type of intervention gives a patient who is diagnosed with liver cancer a chance for long-term survival? 1 Chemotherapy 2 Radiation therapy 3 Liver transplantation 4 Hepatic artery embolization

3 Liver transplantation Liver transplantation may ensure long-term survival in a patient with liver cancer. Chemotherapy, radiation therapy, and hepatic artery embolization individually do not assure long-term survival.

A patient reports pain midway between the anterior iliac crest and the umbilicus in the right lower quadrant. The nurse documents that the patient is experiencing pain in which location? 1 Rebound point 2 Appendix point 3 McBurney's point 4 Right lower quadrant point

3 McBurney's point McBurney's point is located midway between the anterior iliac crest and the umbilicus in the right lower quadrant. Pain in this area is common in the later stages of appendicitis.

What are the common signs and symptoms of gastroenteritis? 1 Fecaliths 2 Polyphagia 3 Nausea and vomiting 4 Abdominal pain that increases with cough

3 Nausea and vomiting Nausea and vomiting are the first symptoms in a patient who has gastroenteritis. Fecaliths usually occur when the lumen of the appendix is obstructed. Anorexia is associated with gastroenteritis but not polyphagia. Abdominal pain that increases with cough or movement and bending the right hip or the knees suggests peritonitis and perforation.

The nurse is caring for a patient who has had abdominal distention and loose stools for 3 days due to gastroenteritis. The serum potassium is 3.0 mEq/L and blood pressure is 94/60 mm Hg. Which treatment may be best suitable for the patient in this situation? 1 Loperamide 2 Sulfasalazine 3 Oral rehydration solution 4 Diphenoxylate hydrochloride

3 Oral rehydration solution Abdominal distention, loose stools, a low serum potassium level of 3.0 mEq/L, and blood pressure of 94/60 mm Hg indicate that the patient has gastroenteritis. Oral rehydration therapy in the patient helps replenish fluid and electrolyte levels. Loperamide can prevent the organism from being eliminated from the body; therefore, it should not be given to a patient with bacterial or viral gastroenteritis. Sulfasalazine is effective in the treatment of ulcerative colitis. Diphenoxylate hydrochloride reduces gastrointestinal motility, but it is used sparingly due to its habit-forming ability.

What are the less-common causes for peritonitis? Select all that apply. 1 Bacteria 2 Chemicals 3 Perforating tumors 4 Leakage during surgery 5 Contamination during surgery

3 Perforating tumors 4 Leakage during surgery 5 Contamination during surgery Peritonitis is an acute inflammation of the visceral or parietal peritoneum and endothelial lining of the abdominal cavity. Perforating tumors, leakage during surgery, and contamination during surgery are less-common causes for peritonitis. Bacteria and chemicals are the most-common causes for peritonitis.

In which position will the nurse place a patient who has had bariatric surgery in order to reduce the risk of sleep apnea? 1 Fowler's 2 Side-lying 3 Semi-Fowler's 4 Trendelenburg

3 Semi-Fowler's A postoperative patient should be placed in semi-Fowler's position to reduce the risk of sleep apnea; this will promote lung expansion in the patient. The patient should not be placed in Fowler's or side-lying positions as these may increase the risk of obstructive sleep apnea (OSA). Trendelenburg position does not improve airway patency.

Which question should the nurse ask while assessing a patient with ulcerative colitis (UC)? 1 "Did you eat street food in the last couple of days?" 2 "Have you undergone any surgeries in the past year?" 3 "Does anyone from your family have similar complaints?" 4 "Were you on antibiotic treatments in the past three months?"

4 "Were you on antibiotic treatments in the past three months?" It is essential to collect the patient's medical and medication history before proceeding with the care plan and treatment. Therefore, the nurse should inquire about any antibiotic treatment the patient may have had in the past 2 to 3 months to prevent resistance and overuse. UC may occur due to genetic, immunological, and environmental factors. It is not triggered by street food nor influenced by the history of surgery. UC is a non-communicable disease and may not be transmitted to family members.

What is the incubation period of norovirus? 1 1 to 7 days 2 1 to 10 days 3 10 to 51 hours 4 24 to 48 hours

4 24 to 48 hours Norovirus causes gastroenteritis through the fecal-oral route from person to person and from contaminated food and water. The incubation period is 24 to 48 hours. Shigella causes gastroenteritis within 1 to 7 days after invading the patient. The incubation period of Campylobacter is 1 to 10 days. An epidemic virus may show its pathological effects within 10 to 51 hours after invading the patient.

The nurse is preparing the patient for magnetic resonance enterography (MRE). What intervention slows down the bowel activity and motility in the patient in preparation for the MRE? 1 Positioning the patient in prone position 2 Having the patient drink a contrast medium 3 Teaching the patient to fast 4 to 6 hours prior to the test 4 Administering two subcutaneous injections of glucagon

4 Administering two subcutaneous injections of glucagon MRE is a major examination used to study the bowel in a patient who has inflammatory bowel disease. Two doses of glucagon are administered subcutaneously to slow bowel activity and motility in the patient. Positioning the patient, having the patient drink a contrast medium, and teaching the patient to fast are not interventions used to slow down the bowel motility.

Which is the most common manifestation of anal fissures? 1 Dysuria 2 Pruritus 3 Urinary retention 4 Bright red blood in the stool

4 Bright red blood in the stool Bright red blood in the stool and pain during and after defecation are the most common manifestations of anal fissures. Dysuria, pruritus, and urinary retention are the other less common manifestations of anal fissure.

A 68-year-old patient with severe abdominal pain, vomiting, and loose watery-mucous stools for 3 days is receiving medication to treat the symptoms. The patient reports frequent dizziness and falls. Which medication may contribute to frequent falls in the patient? 1 Oxycodone 2 Loperamide 3 Azithromycin 4 Diphenoxylate with atropine sulfate

4 Diphenoxylate with atropine sulfate A 68-year-old patient with severe abdominal pain, vomiting, and loose watery-mucous stools for 3 days may have gastroenteritis. Diphenoxylate hydrochloride with atropine sulfate reduces gastrointestinal motility in the patient, thereby reducing the symptoms. This medication, however, may contribute to drowsiness and falls. Therefore it should not be used for older adult patients. Oxycodone may be used cautiously in older adult patients to reduce pain. Loperamide is used to treat diarrhea and may not cause falls in the patient. Azithromycin is an antibiotic used to treat gastroenteritis caused by bacterial infections.

A patient with an anal fissure reports having painful intercourse. Which term should the nurse use in recording and reporting this condition? 1 Pyuria 2 Tenesmus 3 Atelectasis 4 Dyspareunia

4 Dyspareunia Dyspareunia is painful sexual intercourse, which is experienced in patients with anal fissures. Pyuria is the presence of white blood cells or pus in the urine. Tenesmus is feeling the urge to defecate and is observed in patients with parasitic infections. Atelectasis reduces gas exchange due to closure of the lungs.

The student nurse is caring for a patient who underwent open abdominal surgery for peritonitis. Which intervention made by the student nurse indicates a need for further teaching? 1 Positioning the patient at a 45° angle in bed 2 Monitoring the level of patient's consciousness 3 Supplying oxygen to the patient through facial mask 4 Encouraging the patient to lift 20 pound weights daily

4 Encouraging the patient to lift 20 pound weights daily The student nurse should advise the patient who underwent open abdominal surgery for peritonitis to refrain from lifting objects for at least 6 weeks after surgery. This helps in preventing abdominal pressure and complications. Positioning the patient at a 45 oangle in bed, which is in semi-Fowler's position, promotes drainage of the peritoneal contents into the lower region of the abdominal cavity; this also provides lung expansion. Monitoring the level of consciousness, vital signs, intake and output of fluids, and respiratory status is essential in the patient who underwent abdominal surgery. The nurse should continuously monitor the oxygen saturation in the patient and provide oxygen when the pulse oximetry reads less than 93 percent.

A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms? 1 Overcooked food 2 Insufficient vaccinations 3 Bacteria on the patient's hands 4 Ingestion of parasites in the water

4 Ingestion of parasites in the water A main cause of gastroenteritis when traveling outside the country is ingestion of water that is infested with parasites. Bacteria on the patient's hands will not produce gastroenteritis unless food or water is contaminated with the bacteria. Insufficient vaccinations may cause other disease processes, but not gastroenteritis. Undercooked, not overcooked, food may produce gastroenteritis.

Which medication is helpful in patients who have fistulas associated with Crohn's disease? 1 Mesalamine 2 Sulfasalazine 3 Azithromycin 4 Metronidazole

4 Metronidazole Fistulas occur due to acute exacerbations of Crohn's disease. Metronidazole is used to treat patients with fistulas due to Crohn's disease. Mesalamine and sulfasalazine are effective in the treatment of inflammatory bowel disease. Azithromycin is used in the treatment of gastroenteritis.

A patient with suspected appendicitis reports having abdominal pain around the umbilicus for the past 2 days, associated with decreased hunger and episodes of vomiting. Which nursing statement and patient response helps in confirming the diagnosis? 1 Nurse: "Have you eaten in restaurants within the past two days?" Patient response: "Yes, once at a fast-food restaurant." 2 Nurse: "Do you have an allergy toward milk and milk products?" Patient response: "Yes." 3 Nurse: "Were you traveling recently?" Patient response: "Yes, two week ago." 4 Nurse: "When did the pain and vomiting begin?" Patient response: "The pain started 2 days ago, and yesterday I started vomiting."

4 Nurse: "When did the pain and vomiting begin?" Patient response: "The pain started 2 days ago, and yesterday I started vomiting." A patient with pain in the periumbilical region, anorexia, and vomiting may have appendicitis. Pain followed by nausea and vomiting indicate appendicitis and could help differentiate the diagnosis from gastroenteritis. A patient with gastroenteritis may have nausea and vomiting prior to abdominal pain. The nurse should ask the patient with gastroenteritis about travel history and about consumption of food from restaurants to detect the source of outbreak of infection. The nurse has to inquire about travel history and food allergies such as allergy to milk and milk products to evaluate the presence of inflammatory bowel disease from other gastrointestinal disorders.

The nurse is evaluating a patient who is scheduled to start a protein-sparing modified fast. Which interventions should be initiated before the diet is started? Select all that apply. 1 Renal function tests 2 A respiratory evaluation 3 A low-impact exercise program 4 Nutrition counseling by a dietitian 5 Vitamin and mineral supplementation

4 Nutrition counseling by a dietitian 5 Vitamin and mineral supplementation Nutritional counseling and vitamin and mineral supplementation are important before starting a protein-sparing modified fast. Respiratory evaluation, renal function tests, and a low-impact exercise program are not indicated for this diet prior to starting.

The laboratory report of a patient with appendicitis indicates a white blood count (WBC) of 23,000/mm 3. Which condition does the nurse suspect from this finding? 1 Fecalith 2 Anal fissure 3 Gastroenteritis 4 Perforated appendix

4 Perforated appendix A WBC count that is greater than 20,000/mm 3 indicates a perforated appendix in the patient with appendicitis. Fecaliths, gastroenteritis, and anal fissures do not typically manifest with a WBC greater than 20,000/mm 3.

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.

4 Stool volume decreases and becomes thick. After undergoing a total proctocolectomy with a permanent ileostomy, the stool volume decreases and becomes thick or pastelike due to increased absorption of sodium and water. Effluent has little sweet odor; a foul odor only occurs when there is a blockage or infection. After the procedure, the stool becomes yellow-green or yellow-brown in color. If the stool is red in color, the surgery was not successful.

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

4 Sulfasalazine Sulfasalazine is an aminosalicylate drug that causes hemolytic anemia if taken in high doses. Oslalazine, balsalazide, mesalamine are drugs used for ulcerative colitis that do not necessarily cause hemolytic anemia.

A patient has had abdominal surgery for peritonitis and is being discharged home with antibiotics and opioid analgesics. The primary health care provider prescribes docusate sodium. What is the rationale for the use of docusate sodium? 1 To relieve pain 2 To relieve fever 3 To fight infections 4 To soften the stools

4 To soften the stools Docusate sodium is a stool softener that may be prescribed to a patient taking opioid analgesics to help soften the stools. Opioid analgesics are prescribed to relieve pain. Acetaminophen is prescribed to relieve fever. Antibiotics are prescribed to fight infections.

Which surgical procedure for removal of an inflamed appendix involves minimal intervention? 1 Laparotomy 2 Laparoscopy 3 Exploratory laparotomy 4 Transluminal endoscopic surgery

4 Transluminal endoscopic surgery Transluminal endoscopic surgery is a new procedure that does not require an external skin incision. Instead, an endoscope is inserted through a natural orifice such as the mouth or anus and then an internal incision is made into the colon, thus avoiding any external incision. Laparotomy is an open surgical method used for complicated or atypical appendicitis. Uncomplicated appendectomy procedures are performed through laparoscopy. An exploratory laparotomy is a surgical opening into the abdomen to remove or repair the inflamed or perforated organ.

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

4 X-ray examination with barium enema An x-ray examination with a barium enema is preferred over other tests to differentiate between ulcerative colitis and Crohn's disease due to its accuracy. A CT scan is done to confirm the disease or its complications. A colonoscopy may be done to aid in diagnosis. A magnetic resonance enterography helps to assess the status of a patient's inflammatory bowel disease.