Chapter 57: Care of Patients with Inflammatory Intestinal Disorders

SG#22 A patient is prescribed sulfasalazine for the treatment of ulcerative colitis (UC). Which patient statement indicates the patient is experiencing a side effect of this drug? a. "My skin is covered with a rash." b. "My knees hurt." c. "My appetite has increased." d. "I wake up at night sweating sometimes."

a. "My skin is covered with a rash."

21. A nurse cares for a client with a new ileostomy. The client states, I dont think my friends will accept me with this ostomy. How should the nurse respond? a. Your friends will be happy that you are alive. b. Tell me more about your concerns. c. A therapist can help you resolve your concerns. d. With time you will accept your new body.

b. Tell me more about your concerns. Social anxiety and apprehension are common in clients with a new ileostomy. The nurse should encourage the client to discuss concerns. The nurse should not minimize the clients concerns or provide false reassurance.

SG# 43 The patient who had an ileostomy asks the nurse about how to choose the best ostomy pouching system. Which guidelines best describe an effective system? Select all that apply. a. The adhesive barrier lasts 1-2 days. b. The system protects the patient's skin. c. The pouch system contains the drainage and reduces odor. d. The ostomy pouch system is relatively inexpensive. e. The pouch remains securely attached to the skin for a dependable period of time. f. A large pouch is best because it holds more stools.

b. The system protects the patient's skin. c. The pouch system contains the drainage and reduces odor. e. The pouch remains securely attached to the skin for a dependable period of time.

SG#19 The nurse is caring for a patient with gastroenteritis who has frequent stools. Which task is best to delegate to the UAP? a. Teach the patient to avoid use of toilet paper and harsh soaps. b. Instruct the patient on how to take a sitz bath. c. Use a warm washcloth to remove stool from the skin. d. Dry the skin with absorbent cotton.

c. Use a warm washcloth to remove stool from the skin.

SG#32 Which drug is often used in older patients for pain management of moderate to severe diverticulitis? a. An NSAID drug b. an acetaminophen-based drug c. An aspirin -based drug d. An opioid analgesic drug

d. An opioid analgesic drug

SG#18 As part of the routine treatment plan for a patient with bacterial gastroenteritis, which drugs does the nurse anticipate the patient will most likely be prescribed? a. Anticholinergics b. Antiemetics c. Antiperistaltic drugs d. Antibiotics

d. Antibiotics

SG# 26 A patient with Crohn's disease (CD) has a fistula. Which assessment finding indicates possible dehydration? a. Weight gain of 2 pounds in one day b. Abdominal pain c. Foul-smelling urine d. Decreased urinary output

d. Decreased urinary output

SG# 35 Which type of stoma will a patient with diverticulitis most likely have postoperatively? a. Ileostomy b. Jejunostomy c. Colostomy d. Cecostomy

c. Colostomy

SG#40 Which statements does the nurse include while providing discharge instructions for a patient with giardiasis? Select all that apply. a. "Avoid contact with stool from dogs and beavers." b. "All household and sexual partners should have stool examinations for parasites." c. "Treatment will most likely consist of metronidazole(Flagyl)." d. "The infection can be transmitted to others until the amebicides kill the parasites." e. "Stools are examined 6 days after treatment to assess for eradication." f. "Be sure to bathe or shower at least every other day."

a. "Avoid contact with stool from dogs and beavers." b. "All household and sexual partners should have stool examinations for parasites." c. "Treatment will most likely consist of metronidazole(Flagyl)." d. "The infection can be transmitted to others until the amebicides kill the parasites."

SG#8 The respiratory problems that may accompany peritonitis are a result of which factor? a. Associated pain interfering with ventilation b. Decreased pressure against the diaphragm c. Fluid shifts to the thoracic cavity d. Decreased oxygen demands related to the infectious process

a. Associated pain interfering with ventilation

SG#29 Which type of diet has been implicated in the formation of diverticula? a. High-fat diet b. Low-protein diet c. High-cholesterol diet d. Low-fiber diet

d. Low-fiber diet

SG#30 What is the nature of pain associated with diverticulitis? a. Intermittent becoming progressively steady b. Sharp and continuous c. Localized to the right upper quadrant d. Severe and incapacitating

a. Intermittent becoming progressively steady

SG#33 Which statement about diverticular disease is true? a. Most diverticula occur in the sigmoid colon. b. Diverticula are uncomfortable even when not inflamed. c. High-fiber diets contribute to diverticula occurrence d. Diverticula form where intestinal wall muscles are week.

a. Most diverticula occur in the sigmoid colon.

SG#39 Which parasitic infection is manifested by diarrhea and occurs most commonly in immunosuppressed patients, especially those with human immunodeficiency virus (HIV)? a. Entamoeba histoytica b. Cryptosporidium c. Giardia lamblia d. Escherichia coli

b. Cryptosporidium

1. A nurse cares for a client who is prescribed 5 mg/kg of infliximab (Remicade) intravenously. The client weighs 110 lbs and the pharmacy supplies infliximab 100 mg/10 mL solution. How many milliliters should the nurse administer to this client? (Record your answer using a whole number.) ____ mL

25 mL 100 lb = 50 kg. 50 kg 5 mg/kg = 250 mg.

SG#17 Which are common manifestations in a 28-year-old patient with dehydration secondary to gastroenteritis? (Select all that apply.) a. Peripheral edema b. Elevated temperature c. Dry mucous membranes d. Hypertension e. Oliguria f. Poor skin turgor

b. Elevated temperature c. Dry mucous membranes e. Oliguria f. Poor skin turgor

12. A nurse assesses a client with Crohns disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider? a. Distended abdomen b. Temperature of 100.0 F (37.8 C) c. Loose and bloody stool d. Lower abdominal cramps

a. Distended abdomen The presence of strictures predisposes the client to intestinal obstruction. Abdominal distention may indicate that the client has developed an obstruction of the large bowel, and the clients provider should be notified right away. Low-grade fever, bloody diarrhea, and abdominal cramps are common symptoms of Crohns disease.

SG#24 A patient with ulcerative colitis (UC) who has had an ileostomy is being discharged home. Which statements by the patient indicate the discharge teaching has been effective? Select all that apply. a. "I will avoid foods that cause gas." b. "I will call the health care provider if I have a fever over 101° F. (38.3°C)." c. "I will change the adhesive for the appliance daily." d. "I know the pouch needs emptying when I feel pain in that area." e. "I will call the health care provider if I feel like my heart is beating fast." f. "I will include adequate amounts of salt and water in my diet because an ileostomy causes their loss."

a. "I will avoid foods that cause gas." b. "I will call the health care provider if I have a fever over 101° F. (38.3°C)." e. "I will call the health care provider if I feel like my heart is beating fast." f. "I will include adequate amounts of salt and water in my diet because an ileostomy causes their loss."

SG#14 Which interventions are useful in preventing spread of gastroenteritis? Select all that apply. a. Careful hand washing b. Sanitize all surfaces that may be contaminated c. Prophylactic use of antibiotics d. Easily accessible hand sanitizers e. Test all food preparation employees f. Proper food and beverage preparation

a. Careful hand washing b. Sanitize all surfaces that may be contaminated d. Easily accessible hand sanitizers f. Proper food and beverage preparation

SG#45 Which action should the nurse delegate to the unlicensed assistive personnel (UAP) when providing care for a patient with Crohn's disease? a. Check the patient's daily weight. b. Instruct the patient about the importance of adequate nutrition. c. Assess the patient's skin for areas of breakdown. d. Provide the patient with information about the disease process.

a. Check the patient's daily weight.

6. A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find? (Select all that apply.) a. Distended abdomen b. Inability to pass flatus c. Bradycardia d. Hyperactive bowel sounds e. Decreased urine output

a. Distended abdomen b. Inability to pass flatus e. Decreased urine output A client with peritonitis may present with a distended abdomen, diminished bowel sounds, inability to pass flatus or feces, tachycardia, and decreased urine output secondary to dehydration. Bradycardia and hyperactive bowel sounds are not associated with peritonitis.

3. A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this clients teaching? a. Drink plenty of fluids to prevent dehydration. b. You should only drink 1 liter of fluids daily. c. Increase your protein intake by drinking more milk. d. Sips of cola or tea may help to relieve your nausea.

a. Drink plenty of fluids to prevent dehydration. The client should drink plenty of fluids to prevent dehydration. Milk products may not be tolerated.Caffeinated beverages increase intestinal motility and should be avoided.

22. 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? a. Lets discuss potential factors that increase your symptoms. b. If you take the prescribed medications, you will no longer have diarrhea. c. To decrease distress, do not eat anything before you go out. d. You must retake control of your life. I will consult a therapist to help.

a. Lets discuss potential factors that increase your symptoms. Clients with ulcerative colitis often express that the disorder is disruptive to their lives. Stress factors can increase symptoms. These factors should be identified so that the client will have more control over his or her condition. Prescription medications and anorexia will not eliminate exacerbations. Although a therapist may assist the client, this is not an appropriate response.

7. A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes? (Select all that apply.) a. Lower gastrointestinal bleeding Erosion of the bowel wall b. Abscess formation Localized pockets of infection develop in the ulcerated bowel lining c. Toxic megacolon Transmural inflammation resulting in pyuria and fecaluria d. Nonmechanical bowel obstruction Paralysis of colon resulting from colorectal cancer e. Fistula Dilation and colonic ileus caused by paralysis of the colon

a. Lower gastrointestinal bleeding Erosion of the bowel wall b. Abscess formation Localized pockets of infection develop in the ulcerated bowel lining d. Nonmechanical bowel obstruction Paralysis of colon resulting from colorectal cancer Lower GI bleeding can lead to erosion of the bowel wall. Abscesses are localized pockets of infection that develop in the ulcerated bowel lining. Nonmechanical bowel obstruction is paralysis of the colon that results from colorectal cancer. When the inflammation is transmural, fistulas can occur between the bowel and bladder resulting in pyuria and fecaluria. Paralysis of the colon causing dilation and subsequent colonic ileus is known as a toxic megacolon.

SG#2 The nurse is caring for the patient with acute appendicitis. Which interventions will the nurse perform? Select all that apply. a. Maintain the patient on NPO status. b. Administer IV fluids as prescribed. c. Apply warm compresses to the right lower abdominal quadrant. d. Maintain the patient in the supine position. e. Administer laxatives. f. If tolerated, maintain the patient in a semi-fowler's position

a. Maintain the patient on NPO status. b. Administer IV fluids as prescribed. f. If tolerated, maintain the patient in a semi-fowler's position

SG#11 Which intervention does the nurse delegate to the unlicensed assistive personnel (UAP) when caring for a postoperative patient with peritonitis? a. Measure intake and output b. Assess wound drainage c. Administer IV antibiotics d. Teach patient about wound care

a. Measure intake and output

17. A nurse cares for a client who has a Giardia infection. Which medication should the nurse anticipate being prescribed for this client? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Sulfasalazine (Azulfidine) d. Ceftriaxone (Rocephin)

a. Metronidazole (Flagyl) Metronidazole is the drug of choice for a Giardia infection. Ciprofloxacin and ceftriaxone are antibiotics used for bacterial infections. Sulfasalazine is used for ulcerative colitis and Crohns disease.

20. 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? a. Pale and bluish stoma b. Liquid stool c. Ostomy pouch intact d. Blood-smeared output

a. Pale and bluish stoma The nurse should assess the stoma for color and contact the health care provider if the stoma is pale, bluish, or dark. The nurse should expect the client to have an intact ostomy pouch with dark green liquid stool that may contain some blood.

SG# 37 Which description best defines an anal fissure? a. Perianal tear that can be very painful b. Duct obstruction and infection c. Communicating tract d. Localized area of induration with pus

a. Perianal tear that can be very painful

SG#27 In caring for a patient with Crohn's disease (CD), the nurse observes for which complications? Select all that apply. a. Peritonitis b. Small bowel obstruction c. Nutritional and fluid imbalances d. Presence of fistulas e. Appendicitis f. Severe nausea and vomiting

a. Peritonitis b. Small bowel obstruction c. Nutritional and fluid imbalances d. Presence of fistulas

SG#6 Which statements about peritonitis are true? Select all that apply. a. Peritonitis is caused by contamination of the peritoneal cavity by bacteria or chemicals. b. Continuous ambulatory peritoneal dialysis (CAPD) can cause peritonitis. c. White blood cell counts are often decreased with peritonitis. d. Abdominal wall rigidity is a classic finding in patients with peritonitis. e. Chemical peritonitis is caused by leakage of pancreatic enzymes or gastric acids. f. Respiratory problems can be caused by increased abdominal pressure against diaphragm

a. Peritonitis is caused by contamination of the peritoneal cavity by bacteria or chemicals. b. Continuous ambulatory peritoneal dialysis (CAPD) can cause peritonitis. d. Abdominal wall rigidity is a classic finding in patients with peritonitis. e. Chemical peritonitis is caused by leakage of pancreatic enzymes or gastric acids. f. Respiratory problems can be caused by increased abdominal pressure against diaphragm

4. A nurse teaches a community group about food poisoning and gastroenteritis. Which statements should the nurse include in this groups teaching? (Select all that apply.) a. Rotavirus is more common among infants and younger children. b. Escherichia coli diarrhea is transmitted by contact with infected animals. c. To prevent E. coli infection, dont drink water when swimming. d. Clients who have botulism should be quarantined within their home. e. Parasitic diseases may not show up for 1 to 2 weeks after infection.

a. Rotavirus is more common among infants and younger children. c. To prevent E. coli infection, dont drink water when swimming. e. Parasitic diseases may not show up for 1 to 2 weeks after infection. Rotavirus is more common among the youngest of clients. Not drinking water while swimming can help prevent E. coli infection. Parasitic diseases may take up to 2 weeks to become symptomatic. People with botulism need to be hospitalized to monitor for respiratory failure and paralysis. Escherichia coli is not transmitted by contact with infected animals.

SG# 41 The emergency department nurse is assessing a patient admitted with frequent, liquid, foul-smelling stools containing mucus and blood. Assessment findings include temperature 103.8° F (39,9°C), tenesmus, abdominal tenderness, and vomiting. Which additional laboratory test(s) does the nurse expect to collect? a. Serial stool samples b. Urine culture c. Throat culture d. Sputum culture

a. Serial stool samples

13. A nurse reviews the chart of a client who has Crohns disease and a draining fistula. Which documentation should alert the nurse to urgently contact the provider for additional prescriptions? a. Serum potassium of 2.6 mEq/L b. Client ate 20% of breakfast meal c. White blood cell count of 8200/mm3 d. Clients weight decreased by 3 pounds

a. Serum potassium of 2.6 mEq/L Fistulas place the client with Crohns disease at risk for hypokalemia which can lead to serious dysrhythmias. This potassium level is low and should cause the nurse to intervene. The white blood cell count is normal. The other two findings are abnormal and also warrant intervention, but the potassium level takes priority.

1. A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find? a. Severe, steady right lower quadrant pain b. Abdominal pain associated with nausea and vomiting c. Marked peristalsis and hyperactive bowel sounds d. Abdominal pain that increases with knee flexion

a. Severe, steady right lower quadrant pain Right lower quadrant pain, specifically at McBurneys point, is characteristic of appendicitis. Usually if nausea and vomiting begin first, the client has gastroenteritis. Marked peristalsis and hyperactive bowel sounds are not indicative of appendicitis. Abdominal pain due to appendicitis decreases with knee flexion.

5. After teaching a client with an anal fissure, a nurse assesses the clients understanding. Which client actions indicate that the client correctly understands the teaching? (Select all that apply.) a. Taking a warm sitz bath several times each day b. Utilizing a daily enema to prevent constipation c. Using bulk-producing agents to aid elimination d. Self-administering anti-inflammatory suppositories e. Taking a laxative each morning

a. Taking a warm sitz bath several times each day c. Using bulk-producing agents to aid elimination d. Self-administering anti-inflammatory suppositories Taking warm sitz baths each day, using bulk-producing agents, and administering anti-inflammatory suppositories are all appropriate actions for the client with an anal fissure. The client should not use enemas or laxatives to promote elimination, but rather should rely on bulk-producing agents such as psyllium hydrophilic mucilloid (Metamucil).

2. A nurse teaches a client how to avoid becoming ill with Salmonella infection again. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. Wash leafy vegetables carefully before eating or cooking them. b. Do not ingest water from the garden hose or the pool. c. Wash your hands before and after using the bathroom. d. Be sure meat is cooked to the proper temperature. e. Avoid eating eggs that are sunny side up or undercooked.

a. Wash leafy vegetables carefully before eating or cooking them. c. Wash your hands before and after using the bathroom. d. Be sure meat is cooked to the proper temperature. e. Avoid eating eggs that are sunny side up or undercooked. Salmonella is usually contracted via contaminated eggs, beef, poultry, and green leafy vegetables. It is not transmitted through water in garden hoses or pools. Clients should wash leafy vegetables well, wash hands before and after using the restroom, make sure meat and eggs are cooked properly, and, because it can be transmitted by flies, keep flies off of food.

3. A nurse teaches a community group ways to prevent Escherichia coli infection. Which statements should the nurse include in this groups teaching? (Select all that apply.) a. Wash your hands after any contact with animals. b. It is not necessary to buy a meat thermometer. c. Stay away from people who are ill with diarrhea. d. Use separate cutting boards for meat and vegetables. e. Avoid swimming in backyard pools and using hot tubs.

a. Wash your hands after any contact with animals. d. Use separate cutting boards for meat and vegetables. Washing hands after contact with animals and using separate cutting boards for meat and other foods will help prevent E. coli infection. The other statements are not related to preventing E. coli infection.

SG# 38 The nurse is providing teaching for a patient with an anal fissure as a complication of CD. Which statement by the patient indicates the need for further teaching? a. "I will use warm sitz baths." b. "A diet that is low in bulk-producing agents is best for me." c. "Hydrocortisone cream may be helpful to decrease discomfort." d. "Topical anti-inflammatory agents will help if I am uncomfortable."

b. "A diet that is low in bulk-producing agents is best for me."

SG#13 The patient with gastroenteritis due to infection with the norovirus asks the nurse how this illness occurred. Which statement by the patient indicates correct understanding of the nurse's teaching? a. "I got this infection from being around my grandchildren when they had respiratory illnesses." b. "It is likely that I got this illness from either contaminated water or food." c. "I may have gotten sick when I was traveling last month." d. "It's really important that everything I eat is cooked until it is well done."

b. "It is likely that I got this illness from either contaminated water or food."

2. A nurse cares for an older adult client who has Salmonella food poisoning. The clients 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? a. Apply oxygen via nasal cannula. b. Administer intravenous fluids. c. Provide perineal care with a premedicated wipe. d. Teach proper food preparation to prevent contamination.

b. Administer intravenous fluids. Dehydration caused by diarrhea can occur quickly in older clients with Salmonella food poisoning, so maintenance of fluid balance is a high priority. Monitoring vital signs and providing perineal care are important nursing actions but are of lower priority than fluid replacement. The nurse should teach the client about proper hand hygiene to prevent the spread of infection, and preparation of food and beverages to prevent contamination.

SG#21 A patient is suspected to have ulcerative colitis (UC). Which diagnostic tests does the nurse expect the patient to undergo to confirm the diagnosis? Select all that apply. a. Sigmoidoscopy b. C-reactive protein c. Albumin levels d. Erythrocyte sedimentation rate e. Magnetic resonance enterography (MRE) f. Clotting studies

b. C-reactive protein c. Albumin levels d. Erythrocyte sedimentation rate e. Magnetic resonance enterography (MRE)

SG #20 Which characteristics pertain to Crohn's disease (CD)? (Select all that apply.) a. It begins in the rectum and proceeds in a continuous manner toward the cecum b. Fistulas commonly develop c. The are five to six soft, loose, nonbloody stools per day. d. There is an increased risk of colon cancer e. Some patients experience extraintestinal manifestations such as migratory polyarthritis, ankylosing spondylitis,and erythema nodosum f. There is a cobblestone appearance of the internal intestine

b. Fistulas commonly develop c. The are five to six soft, loose, nonbloody stools per day. f. There is a cobblestone appearance of the internal intestine

SG#16 What is the priority nursing concern for a patient with gastroenteritis? a. Nutrition therapy b. Fluid replacement c. Skin care d. Drug therapy

b. Fluid replacement

1. After teaching a client with a parasitic gastrointestinal infection, a nurse assesses the clients understanding. Which statements made by the client indicate that the client correctly understands the teaching? (Select all that apply.) a. Ill have my housekeeper keep my toilet clean. b. I must take a shower or bathe every day. c. I should have my well water tested. d. I will ask my sexual partner to have a stool test. e. I must only eat raw vegetables from my own garden.

b. I must take a shower or bathe every day. c. I should have my well water tested. d. I will ask my sexual partner to have a stool test. Parasitic infections can be transmitted to other people. The client himself or herself should keep the toilet area clean instead of possibly exposing another person to the disease. Parasites are transmitted via unclean water sources and sexual practices with rectal contact. The client should test his or her well water and ask sexual partners to have their stool examined for parasites. Raw vegetables are not associated with parasitic gastrointestinal infections. The client can eat vegetables from the store or a home garden as long as the water source is clean.

8. After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? a. Ill rinse my rectal area with warm water after each stool and apply zinc oxide ointment. b. I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel. c. I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry. d. I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment.

b. I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel. Toilet paper can irritate the sensitive perineal skin, so warm water rinses or soft cotton washcloths should be used instead. Although aloe vera may facilitate healing of superficial abrasions, it is not an effective skin barrier for diarrhea. Skin barriers such as zinc oxide and vitamin A and D ointment help protect the rectal area from the excoriating effects of liquid stools. Patting the skin is recommended instead of rubbing the skin dry.

9. After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will avoid large crowds and people who are sick. b. I will take this medication with my breakfast each morning. c. Nausea and vomiting are common side effects of this drug. d. I must wash my hands after I play with my dog.

b. I will take this medication with my breakfast each morning. Adalimumab (Humira) is an immune modulator that must be given via subcutaneous injection. It does not need to be given with food or milk. Nausea and vomiting are two common side effects. Adalimumab can cause immune suppression, so clients receiving the medication should avoid large crowds and people who are sick, and should practice good handwashing.

SG #36 Which interventions does the nurse expect to implement when caring for a patient with diverticulitis? Select all that apply. a. Laxative and enemas as ordered b. IV fluids to prevent dehydration c. Broad-spectrum antibiotics d. Teach the patient to refrain from lifting or straining e. Keep the patient NPO if symptoms are severe f. Administering diuretics to prevent fluid overload

b. IV fluids to prevent dehydration c. Broad-spectrum antibiotics d. Teach the patient to refrain from lifting or straining e. Keep the patient NPO if symptoms are severe

SG#1 The patient comes to the emergency department (ED) with right lower quadrant pain. What does the ED nurse suspect? a. Gastroenteritis b. Ulcerative colitis c. Appendicitis d. Crohn's disease

c. Appendicitis

4. After teaching a client who was hospitalized for Salmonella food poisoning, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will let my husband do all of the cooking for my family. b. Ill take the ciprofloxacin until the diarrhea has resolved. c. I should wash my hands with antibacterial soap before each meal. d. I must place my dishes into the dishwasher after each meal.

b. Ill take the ciprofloxacin until the diarrhea has resolved. Ciprofloxacin should be taken for 10 to 14 days to treat Salmonella infection, and should not be stopped once the diarrhea has cleared. Clients should be advised to take the entire course of medication. People with Salmonella should not prepare foods for others because the infection may be spread in this way. Hands should be washed with antibacterial soap before and after eating to prevent spread of the bacteria. Dishes and eating utensils should not be shared and should be cleaned thoroughly. Clients can be carriers for up to 1 year.

SG#23 Which statement is true about the medical treatment of ulcerative colitis (UC)? a. Infliximab (Remicade) is approved as a first-line therapy. b. Immunomodulators are not thought to be effective;however, in combination with steroids, they may offer a synergistic effect. c. When a therapeutic level of glucocorticoids is reached,the dosage of the drug stays the same to maintain the therapeutic effect. d. The method of action for the aminosalicylates is interruption of the pain pathway.

b. Immunomodulators are not thought to be effective;however, in combination with steroids, they may offer a synergistic effect.

SG#9 Which nursing intervention is part of nonsurgical management for a patient with peritonitis? a. Monitor weekly weight and intake and output. b. Insert a nasogastric tube to decompress the stomach. c. Order a breakfast tray when the patient is hungry. d. Administer NSAIDs for pain.

b. Insert a nasogastric tube to decompress the stomach.

SG#3 The patient has been diagnosed with acute appendicitis. Based on this diagnosis, which intervention does the nurse perform? a. Start a bowel cleansing program. b. Prepare the patient for surgery. c. Apply a heating pad to the lower abdomen. d. Assess the patient's knowledge about dietary modifications.

b. Prepare the patient for surgery.

19. A nurse plans care for a client with Crohns disease who has a heavily draining fistula. Which intervention should the nurse indicate as the priority action in this clients plan of care? a. Low-fiber diet b. Skin protection c. Antibiotic administration d. Intravenous glucocorticoids

b. Skin protection Protecting the clients skin is the priority action for a client who has a heavily draining fistula. Intestinal fluid enzymes are caustic and can cause skin breakdown or fungal infections if the skin is not protected. The plan of care for a client who has Crohns disease includes adequate nutrition focused on high-calorie, high-protein, high-vitamin, and low-fiber meals, antibiotic administration, and glucocorticoids.

15. A nurse assesses a client who is hospitalized for botulism. The clients 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? a. Decrease stimulation and allow the client to rest. b. Stay with the client while another nurse calls the provider. c. Increase the clients intravenous fluid replacement rate. d. Check the clients blood glucose and administer orange juice.

b. Stay with the client while another nurse calls the provider. A client with botulism is at risk for respiratory failure. This clients respiratory rate is slow, which could indicate impending respiratory distress or failure. The nurse should remain with the client while another nurse notifies the provider. The nurse should monitor and document the IV infusion per protocol, but this client does not require additional intravenous fluids. Allowing the client to rest or checking the clients blood glucose and administering orange juice are not appropriate actions.

SG#25 Which statement is true about drug therapy for Crohn's disease (CD) or ulcerative colitis (UC)? a. Infliximab is used to manage episodes of diarrhea with CD. b. Sulfasalazine is the first aminosalicylate approved for UC. c. Metronidazole has been helpful in patients with fistulas and UC. d. Adalimumab is a glucocorticoid approved for the treatment of CD.

b. Sulfasalazine is the first aminosalicylate approved for UC.

SG#4 The nurse on the surgical unit is expecting to admit the patient who has had an appendectomy with abscess. What does the nurse anticipate care for this patient will include? Select all that apply. a. Clear liquids b. Wound drains c. IV antibiotics d. Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control e. Nasogastric (NG) tube care f. Prescribed opioid pain drugs

b. Wound drains c. IV antibiotics e. Nasogastric (NG) tube care f. Prescribed opioid pain drugs

14. After teaching a client who has a new colostomy, the nurse provides feedback based on the clients ability to complete self-care activities. Which statement should the nurse include in this feedback? a. I realize that you had a tough time today, but it will get easier with practice. b. You cleaned the stoma well. Now you need to practice putting on the appliance. c. You seem to understand what I taught you today. What else can I help you with? d. You seem uncomfortable. Do you want your daughter to care for your ostomy?

b. You cleaned the stoma well. Now you need to practice putting on the appliance. The nurse should provide both approval and room for improvement in feedback after a teaching session. Feedback should be objective and constructive, and not evaluative. Reassuring the client that things will improve does not offer anything concrete for the client to work on, nor does it let him or her know what was done well. The nurse should not make the client convey learning needs because the client may not know what else he or she needs to understand. The client needs to become the expert in self-management of the ostomy, and the nurse should not offer to teach the daughter instead of the client.

SG#12 The nurse is instructing a patient about home care after an exploratory laparotomy for peritonitis. Which statement by the patient indicates that teaching has been effective? a. "It is normal for the incision site to be warm." b. "I will stop taking the antibiotics if diarrhea develops." c. "I will call the health care provider for a temperature greater than 101° F." d. "I will resume activity with my bowling league this week for exercise."

c. "I will call the health care provider for a temperature greater than 101° F."

SG#10 What key assessment data would the nurse expect to find in a patient with peritonitis? a. Fever and headache b. Dizziness with nausea and vomiting c. Abdominal pain, distention, and tenderness d. Nausea and loss of appetite

c. Abdominal pain, distention, and tenderness

10. 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? a. Contact the clinical pharmacist and request the medication in suspension form. b. Empty the contents of the capsule into applesauce or pudding for administration. c. Ask the health care provider to prescribe the medication as an enema instead. d. Crush the pill carefully and administer it in applesauce or pudding.

c. Ask the health care provider to prescribe the medication as an enema instead. Asacol is the oral formula for mesalamine and is produced as an enteric-coated pill that should not be crushed, chewed, or broken. Asacol is not available as a suspension or elixir. If the client is unable to swallow the Asacol pill, a mesalamine enema (Rowasa) may be administered instead, with a providers order.

SG#7 The fluid shift that occurs in peritonitis may result in which of the following? a. Intracellular fluid moving into the peritoneal cavity b. Significant increase in circulatory volume c. Decreased circulatory volume and hypovolemic shock d. Increased bowel motility caused by increased fluid volume

c. Decreased circulatory volume and hypovolemic shock

11. A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first? a. Inspection of oral mucosa b. Recent dietary intake c. Heart rate and rhythm d. Percussion of abdomen

c. Heart rate and rhythm Although the client with severe diarrhea may experience skin irritation and hypovolemia, the client is most at risk for cardiac dysrhythmias secondary to potassium and magnesium loss from severe diarrhea. The client should have her or his electrolyte levels monitored, and electrolyte replacement may be necessary. Oral mucosa inspection, recent dietary intake, and abdominal percussion are important parts of physical assessment but are lower priority for this client than heart rate and rhythm.

5. A nurse assesses a client who is hospitalized with an exacerbation of Crohns disease. Which clinical manifestation should the nurse expect to find? a. Positive Murphys sign with rebound tenderness to palpitation b. Dull, hypoactive bowel sounds in the lower abdominal quadrants c. High-pitched, rushing bowel sounds in the right lower quadrant d. Reports of abdominal cramping that is worse at night

c. High-pitched, rushing bowel sounds in the right lower quadrant The nurse expects high-pitched, rushing bowel sounds due to narrowing of the bowel lumen in Crohns disease. A positive Murphys sign is indicative of gallbladder disease, and rebound tenderness often indicates peritonitis. Dullness in the lower abdominal quadrants and hypoactive bowel sounds are not commonly found with Crohns disease. Nightly worsening of abdominal cramping is not consistent with Crohns disease.

16. After teaching a client who has diverticulitis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. Ill ride my bike or take a long walk at least three times a week. b. I must try to include at least 25 grams of fiber in my diet every day. c. I will take a laxative nightly at bedtime to avoid becoming constipated. d. I should use my legs rather than my back muscles when I lift heavy objects.

c. 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. Exercise and a high-fiber diet are recommended for clients with diverticulitis because they promote regular bowel function. Using the leg muscles rather than the back for lifting prevents abdominal straining.

7. 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? a. Sure you can. Purchase a prom dress one size larger to hide the ostomy appliance. b. The pouch wont be as noticeable if you avoid broccoli and carbonated drinks prior to the prom. c. Lets talk to the enterostomal therapist about options for ostomy supplies and dress styles. d. You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable.

c. Lets talk to the enterostomal therapist about options for ostomy supplies and dress styles. The ostomy nurse is a valuable resource for clients, providing suggestions for supplies and methods to manage the ostomy. A larger dress size will not necessarily help hide the ostomy appliance. Avoiding broccoli and carbonated drinks does not offer reassurance for the client. Ileostomies have an almost constant liquid effluent, so pouch removal during the prom is not feasible.

SG#5 Which laboratory finding does the nurse expect may occur with a diagnosis of appendicitis? a. Decreased hematocrit and hemoglobin b. Increased coagulation time c. Decreased potassium d. Increased WBC count

d. Increased WBC count

SG#42 The patient recovering from surgery for peritonitis tells the nurse that he is experiencing abdominal pain and has developed foul-smelling drainage from his wound, and his incision is red and swollen. What is the nurse's best first action? a. Clean and dress the incision. b. Measure the patient's abdominal girth. c. Notify the health care provider. d. Place the patient on bedrest in semi-Fowler's position.

c. Notify the health care provider.

SG# 34 The nurse would teach the patient about what preventive measures for diverticular disease? a. Excluding whole-grain breads from the diet b. Avoiding fresh apples, broccoli, and lettuce c. Taking bulk agents such as psyllium hydrophilic mucilloid d. Taking routine anticholinergics to reduce bowel spasms

c. Taking bulk agents such as psyllium hydrophilic mucilloid

6. After teaching a client with diverticular disease, a nurse assesses the clients understanding. Which menu selection made by the client indicates the client correctly understood the teaching? a. Roasted chicken with rice pilaf and a cup of coffee with cream b. Spaghetti with meat sauce, a fresh fruit cup, and hot tea c. Garden salad with a cup of bean soup and a glass of low-fat milk d. Baked fish with steamed carrots and a glass of apple juice

d. Baked fish with steamed carrots and a glass of apple juice Clients who have diverticular disease are prescribed a low-residue diet. Whole grains (rice pilaf), uncooked fruits and vegetables (salad, fresh fruit cup), and high-fiber foods (cup of bean soup) should be avoided with a low-residue diet. Canned or cooked vegetables are appropriate. Apple juice does not contain fiber and is acceptable for a low-residue diet.

SG#28 A patient returns to the unit following a total proctocolectomy with a permanent ileostomy. The nurse understands that with organ we removed during this procedure? a. All of the small intestine b. Distal colon and rectum c. Colon, rectum, and anus d. Colon, rectum, and anus, with surgical closure of the anus.

d. Colon, rectum, and anus, with surgical closure of the anus.

SG#44 The patient comes to the Urgent Care Unit and describes symptoms of diarrhea, abdominal pain, and low-grade fever. She states she has constant abdominal pain in the right lower quadrant and has lost 25 pounds in the past month. What diagnosis does the nurse suspect? a. Ulcerative colitis b. Diverticulitis c. Peritonitis d. Crohn's disease

d. Crohn's disease

SG#31 The nurse is assessing an older adult patient with abdominal pain. Assessment findings include generalized abdominal pain with rigidity, nausea, and vomiting, temperature 101.2°F (38.4°C), heart rate 122/minute, and chills. The patient is also somewhat confused and does not know where he is. What does the nurse suspect with the patient? a. Crohn's disease b. Ulcerative colitis c. Diverticulitis d. Peritonitis

d. Peritonitis

SG#15 The nurse is assessing a patient with viral gastroenteritis. Which data is the nurse most concerned about? a. Orthostatic blood pressure changes b. Poor skin turgor c. Dry mucous membranes d. Rebound tenderness

d. Rebound tenderness

18. A nurse cares for a client who has food poisoning resulting from a Clostridium botulinum infection. Which assessment should the nurse complete first? a. Heart rate and rhythm b. Bowel sounds c. Urinary output d. Respiratory rate

d. Respiratory rate Severe infection with C. botulinum can lead to respiratory failure, so assessments of oxygen saturation and respiratory rate are of high priority for clients with suspected C. botulinum infection. The other assessments may be completed after the respiratory system has been assessed.