NCLEX-Style Practice Questions: Ulcerative Colitis

16. Fistulas are most common with which of the following bowel disorders? 1. Crohn's disease 2. Diverticulitis 3. Diverticulosis 4. Ulcerative colitis

16. Answer: 1. Crohn's disease The lesions of Crohn's disease are transmural; that is, they involve all thickness of the bowel. These lesions may perforate the bowel wall, forming fistulas with adjacent structures. Fistulas don't develop in diverticulitis or diverticulosis. The ulcers that occur in the submucosal and mucosal layers of the intestine in ulcerative colitis usually don't progress to fistula formation as in Crohn's disease.

15. Which of the following factors is believed to cause ulcerative colitis? 1. Acidic diet 2. Altered immunity 3. Chronic constipation 4. Emotional stress

15. Answer: 2. Altered immunity Several theories exist regarding the cause of ulcerative colitis. One suggests altered immunity as the cause based on the extraintestinal characteristics of the disease, such as peripheral arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis. Emotional stress can exacerbate the attacks but isn't believed to be the primary cause.

18. Which of the following associated disorders may a client with ulcerative colitis exhibit? 1. Gallstones 2. Hydronephrosis 3. Nephrolithiasis 4. Toxic megacolon

18. Answer: 4. Toxic megacolon Toxic megacolon is extreme dilation of a segment of the diseased colon caused by paralysis of the colon, resulting in complete obstruction. This disorder is associated with both Crohn's disease and ulcerative colitis. The other disorders are more commonly associated with Crohn's disease.

21. Which of the following symptoms is associated with ulcerative colitis? 1. Dumping syndrome 2. Rectal bleeding 3. Soft stools 4. Fistulas

21. Answer: 2. Rectal bleeding In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more commonly associated with Crohn's disease, in which malabsorption is more of a problem. Dumping syndrome occurs after gastric surgeries. Fistulas are associated with Crohn's disease.

22. If a client had irritable bowel syndrome, which of the following diagnostic tests would determine if the diagnosis is Crohn's disease or ulcerative colitis? 1. Abdominal computed tomography (CT) scan 2. Abdominal x-ray 3. Barium swallow 4. Colonoscopy with biopsy

22. Answer: 4. Colonoscopy with biopsy A colonoscopy with biopsy can be performed to determine the state of the colon's mucosal layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or CT scan wouldn't provide the cytologic information necessary to diagnose which disease it is. A barium swallow doesn't involve the intestine.

25. Surgical management of ulcerative colitis may be performed to treat which of the following complications? 1. Gastritis 2. Bowel herniation 3. Bowel outpouching 4. Bowel perforation

25. Answer: 4. Bowel perforation Perforation, obstruction, hemorrhage, and toxic megacolon are common complications of ulcerative colitis that may require surgery. Herniation and gastritis aren't associated with irritable bowel diseases, and outpouching of the bowel is diverticulosis.

27. During the first few days of recovery from ostomy surgery for ulcerative colitis, which of the following aspects should be the first priority of client care? 1. Body image 2. Ostomy care 3. Sexual concerns 4. Skin care

27. Answer: 2. Ostomy care Although all of these are concerns the nurse should address, being able to safely manage the ostomy is crucial for the client before discharge.

60. The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? 1. Bloody diarrhea 2. Hypotension 3. A hemoglobin of 12 mg/dL 4. Rebound tenderness

60. Answer: 4. Rebound tenderness Rebound tenderness may indicate peritonitis. Blood diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the physician.

77. A client with ulcerative colitis has an order to begin salicylate medication to reduce inflammation. The nurse instructs the client to take the medication: 1. 30 minutes before meals 2. On an empty stomach 3. After meals 4. On arising

77. Answer: 3. After meals Salicylate compounds act by inhibiting prostaglandin synthesis and reducing inflammation. The nurse teaches the client to take the medication with a full glass of water and to increase fluid intake throughout the day. This medication needs to be taken after meals to reduce GI irritation.

What is ulcerative colitis

It is a widespread inflammation of mainly the rectum and rectosigmoid colon; can extend to the entire colon.

28. Colon cancer is most closely associated with which of the following conditions? 1. Appendicitis 2. Hemorrhoids 3. Hiatal hernia 4. Ulcerative colitis

28. Answer: 4. Ulcerative colitis Chronic ulcerative colitis, granulomas, and familial polyposis seem to increase a person's chance of developing colon cancer. The other conditions listed have no known effect on colon cancer risk.

80. When planning care for a client with ulcerative colitis who is experiencing symptoms, which client care activities can the nurse appropriately delegate to a unlicensed assistant? Select all that apply. 1. Assessing the client's bowel sounds 2. Providing skin care following bowel movements 3. Evaluating the client's response to antidiarrheal medications 4. Maintaining intake and output records 5. Obtaining the client's weight.

80. Answer: 2, 4, and 5. The nurse can delegate the following basic care activities to the unlicensed assistant: providing skin care following bowel movements, maintaining intake and output records, and obtaining the client's weight. Assessing the client's bowel sounds and evaluating the client's response to medication are registered nurse activities that cannot be delegated.

81. Which goal of the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis? 1. Promoting self-care and independence 2. Managing diarrhea 3. Maintaining adequate nutrition 4. Promoting rest and comfort

81. Answer: 2. Managing diarrhea Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best achieved by halting the exacerbation. The client may receive antidiarrheal medications, antispasmodic agents, bulk hydrophilic agents, or anti-inflammatory drugs.

82. A client's ulcerative colitis symptoms have been present for longer than 1 week. The nurse recognizes that the client should be assessed carefully for signs of which of the following complications? 1. Heart failure 2. DVT 3. Hypokalemia 4. Hypocalcemia

82. Answer: 3. Hypokalemia Excessive diarrhea causes significant depletion of the body's stores of sodium and potassium as well as fluid. The client should be closely monitored for hypokalemia and hyponatremia. Ulcerative colitis does not place the client at risk for heart failure, DVT, or hypocalcemia.

83. A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help the client meet his nutritional needs? 1. Initiate continuous enteral feedings 2. Encourage a high protein, high-calorie diet 3. Implement total parenteral nutrition 4. Provide six small meals a day.

83. Answer: 3. Implement total parenteral nutrition Food will be withheld from the client with severe symptoms of ulcerative colitis to rest the bowel. To maintain the client's nutritional status, the client will be started on TPN. Enteral feedings or dividing the diet into 6 small meals does not allow the bowel to rest. A high-calorie, high-protein diet will worsen the client's symptoms.