Week 4 - Nutrition & Meds

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a. Navy bean soup and vegetable salad b. Whole grain pasta with tomato sauce c. Baked potato with low-fat sour cream d. Roast beef sandwich on whole wheat bread

ANS: A A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis. Although all the choices have some fiber, the bean soup and salad will be the highest in fiber and the lowest in fat.

Which action would the nurse plan when admitting a patient with acute diverticulitis plan for initial care? a. Administer IV fluids. b. Prepare for colonoscopy. c. Encourage a high-fiber diet. d. Give stool softeners and enemas.

ANS: A A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given. These will be implemented later in the hospitalization. The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis.

After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What would the nurse plan to teach the patient? a. Medication use b. Fluid restriction c. Enteral nutrition d. Activity restrictions

ANS: A Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings if the patient is able to eat.

A nurse is caring for a client who has acute diverticulitis. While the client has active inflammation, the nurse should instruct which of the following foods in her diet? a. white bread and plain yogurt b. shredded wheat cereal and blueberries c. broccoli and kidney beans d. oatmeal and fresh pears

Ans: A Maintain low-fiber, low-fat

A patient with a new ileostomy asks how much it will drain after the bowel has adapted in a few months. How many cups of drainage per day would the nurse tell the patient to expect? a. 2 b. 3 c. 4 d. 5

ANS: A After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL.

Which action will the nurse include in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)? a. Encourage the patient to express concerns and ask questions about IBS. b. Suggest that the patient increase the intake of milk and other dairy products. c. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs). d. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.

ANS: A Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Alosetron has serious side effects and is used only for female patients who have not responded to other therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.

A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. Which information will the nurse add to a teaching plan about UTIs for this patient that goes beyond a general teaching plan for UTIs? a. Fistulas can form between the bowel and bladder. b. Bacteria in the perianal area can enter the urethra. c. Drink adequate fluids to maintain normal hydration. d. Empty the bladder before and after sexual intercourse.

ANS: A Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse.

Which patient would the nurse assess first after receiving change-of-shift report? a. A 40-yr-old patient who has a distended abdomen and tachycardia b. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours c. A 30-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours d. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool

ANS: A The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients would be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. Which intervention would the nurse include in the patient's plan of care? a. Administer oral metoclopramide. b. Instruct the patient not to eat or drink. c. Administer cobalamin (vitamin B12) injections. d. Teach the patient about total colectomy surgery

ANS: B An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate during this acute phase.

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin.

ANS: B High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies do not have a colon for the absorption of water; they need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible.

A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction. The patient reports anxiety and incisional pain. The patient's respiratory rate is 32 breaths/min, and the arterial blood gases (ABGs) indicate respiratory alkalosis with a normal arterial oxygen level. Which action would the nurse take first? a. Check to make sure the nasogastric tube is patent. b. Give the patient the PRN IV morphine sulfate 4 mg. c. Notify the health care provider about the ABG results. d. Teach the patient to take slow, deep breaths when anxious.

ANS: B The patient's respiratory alkalosis is likely caused by the increased respiratory rate associated with pain and anxiety. The nurse's first action would be to medicate the patient for pain. The health care provider may be notified about the ABGs but is likely to instruct the nurse to medicate for pain. The patient will not be able to take slow, deep breaths when experiencing pain. Checking the nasogastric tube can wait until the patient has been medicated for pain.

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that the nurse's teaching about skin integrity has been effective? a. The patient uses incontinence briefs to contain loose stools. b. The patient uses witch hazel compresses to soothe irritation. c. The patient asks for antidiarrheal medication after each stool. d. The patient cleans the perianal area with soap after each stool.

ANS: B Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications cannot be given 15 to 20 times a day. The perianal area should be washed with plain water or pH balanced cleanser after each stool.

A 72-yr-old patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? a. Skin is dry with tenting and poor turgor. b. Patient has not voided for the last 2 hours. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the previous 6 hours.

ANS: C The presence of crackles in an older patient receiving IV fluids at a high rate suggests volume overload and a need to reduce the rate of the IV infusion. The other data will be reported but are consistent with the patient's age and diagnosis and do not require a change in the prescribed treatment.

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? a. Scrambled eggs b. White toast and jam c. Oatmeal with cream d. Pancakes with syrup

ANS: C During acute exacerbations of IBD, the patient would avoid high-fiber foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient.

Which finding is likely in the nurse's assessment of a patient who has a large bowel obstruction? a. Referred back pain b. Metabolic alkalosis c. Projectile vomiting d. Abdominal distention

ANS: D Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction.

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)? a. Have you been passing a lot of gas? b. What foods affect your bowel patterns? c. Do you have any abdominal distention? d. How long have you had abdominal pain?

ANS: D One criterion for the diagnosis of irritable bowel syndrome is the presence of abdominal discomfort or pain for at least 3 months. Abdominal distention, flatulence, and food intolerance are associated with IBS but are not diagnostic criteria.

A nurse is caring for a client who has an acute exacerbation of Crohn's disease. Which of the the following actions should the nurse take? a. ensure bowel rest b. offer sparkling water c. administer a stool softener d. offer plain warm tea frequently

Ans: A Clients who have an exacerbation of Crohn's disease usually require NPO status to ensure bowel rest and promote healing and recovery.

A nurse is caring for a client who is NPO and has an NG tube to suction. When the client reports nausea, which of the following actions should the nurse take? a. irrigate with normal saline b. provide oral hygiene c. clamp tube for 30 min d. increase amount of suction

Ans: A Determine patency.

A nurse is teaching a client who has a colostomy about ways to reduce flatus and odor. Which of the following strategies should the nurse include? a. eat crackers and yogurt regularly b. chew mind hum throughout the day c. drink orange juice every day d. put an aspirin in the pouch

Ans: A helps reduce flatus, which contributes to odor

A nurse is teaching a newly licensed nurse about caring for a client who is scheduled for an esophagogastric balloon tamponade tube to treat bleeding esophageal varices. Which of the following pieces of information should the nurse include in the teaching? a. the client will be placed on mechanical ventilation prior to this procedure b. the tube will be inserted into the clients trachea c. the client will receive bowel preparation with cathartics prior to this procedure d. the tube allows the application of a a ligation band to the bleeding varices

Ans: A to protect airway

A nurse is providing dietary teaching to a client who has ulcerative colitis. Which of the following food selections by the client indicates an understanding of the teaching? a. raw vegetable salad w/ low fat dressing b. roast chicken and white rice c. fresh fruit salad and milk d. peanut butter on whole wheat bread

Ans: B Clients who has UC are restricted to a low-fiber diet, which omits whole grains and raw fruits and vegetables. Roast chicken with white rice is the best choice.

A nurse is caring for a client who has ulcerative colitis. The provider prescribes bed rest with bathroom privileges. When the client asks the nurse why he has to stay in bed, which of the following responses should the nurse provide? a. you need to conserve energy at this time b. lying quietly in bed helps slow down the activity in your intestines c. staying in bed promotes the rest and comfort you need d. staying in bed will help prevent injury and minimize your fall risk.

Ans: B The greatest risk to the client is complication from severe diarrhea such as dehydration, electrolyte imbalances, and gastrointestinal bleeding and trauma. Activity restriction can help reduce intestinal peristalsis and diarrhea.

A nurse is caring for a client who has recovered from acute diverticulitis. The nurse should instruct the client to increase his intake of which of the following foods when the inflammation subsides? a. cucumbers and tomatoes b. cabbage and peaches c. strawberries and corn d. figs and nuts

Ans: B When the acute inflammation has subsided, the client should increase his intake of foods that are high in fiber, such as wheat bran, whole-grain bread, and fresh fruits and vegetables and do not contain seeds.

A nurse is demonstrating colostomy care to a client who has a new colostomy. Which of the following actions should the nurse teach the client to perform? (SATA) a. use antimicrobial ointment on the peristomal skin b. empty the bag when it is one-third to one-half full c. cute the skin barrier opening a little larger than the ostomy d. wash the peristomal skin with mild soap and water e. apply the skin barrier while the skin is slightly moist

Ans: B C D Avoid full bag, cut opening about 1/16 to 1/8 larger than the stoma to avoid applying any constricting pressure to stoma.

A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings indicates that a possible bowel perforation has occurred? a. elevated blood pressure b. bowel sounds increase in frequency and pitch c. rigid abdomen d. emesis of undigested food

Ans: C As fluid escaped into the peritoneal cavity, a reduction in circulating blood volume occurs, lowering blood pressure.

A nurse in the emergency department is caring for a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? a. famotidine b. esomeprazole c. vasopressin d. omeprazole

Ans: C Vasopressin constricts the splanchnic bed and decreases portal pressure. Vasopressin also constricts the distal esophageal and proximal gastric veins, which reduces inflow into the portal system and is used to treat bleeding varices.

A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend? a. foods high in vitamin b. foods low in fat c. foods high in fiber d. foods love in calories

Ans: C Long-term low-fiber eating habits and increased intracolonic pressure lead to straining during bowel movements, causing the development of diverticula. High-fiber foods help strengthen and maintain the active motility of the gastrointestinal tract.

A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray? a. canned fruit b. white bread c. broiled hamburger d. coleslaw

Ans: D Coleslaw contains raw cabbage, which is high in fiber. Clients who are on a low-fiber diet should avoid most raw vegetables.

A nurse is caring for a client who has gastrointestinal bleeding. The provider suspects a bleeding lesion in the colon. The initial approach to treatment likely will involve which of the following procedures? a. exploratory laparotomy b. double-contract barium enema c. magnetic resonance imaging d. colonoscopy

Ans: D Identifies cause and location of bleeding.

A nurse is assessing a client who has a complete intestinal obstruction. Which of the following findings should the nurse expect? a. absence of bowel sounds in all 4 quadrants b. passage of blood-tinged liquid stool c. presence of flatus d. hyperactive bowel sounds above the obstruction

Ans: D Intestinal peristalsis above the obstruction attempts to push the obstruction through the intestines. With a complete intestinal obstruction, there are no bowel sounds bellow the obstruction.