Exam 2 IBD, Ulcerative Colitis, Crohn's Disease Practice Questions

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? A. "I should increase the fiber in my diet." B. "I will need to avoid caffeinated beverages." C. "I'm going to learn some stress reduction techniques." D. "I can have exacerbations and remissions with Crohn's disease."

A.) "I should increase the fiber in my diet." Crohn's disease is an inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. It is characterized by exacerbations and remissions. If stress increases the symptoms of the disease, the client is taught stress management techniques and may require additional counseling. The client is taught to avoid gastrointestinal stimulants containing caffeine and to follow a high-calorie and high-protein diet. A low-fiber diet may be prescribed, especially during periods of exacerbation.

Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching? A.) "The medication will cause constipation." B.) "I need to take the medication with meals." C.) "I may have increased sensitivity to sunlight." D.) "This medication should be taken as prescribed."

A.) "The medication will cause constipation."

A patient is newly diagnosed with mild ulcerative colitis. What type of anti-inflammatory medication is typically prescribed as first-line treatment for this condition? A.) 5-Aminosalicylates (Sulfasalazine) B.) Immunomodulators (Adalimumab) C.) Corticosteroids (Prednisone) D.) Immunosuppressors (Azathioprine)

A.) 5-Aminosalicylates (Sulfasalazine) usually prescribed for mild to moderate cases of ulcerative colitis as first-line treatment. If Aminosalicylates are not working (or the patient is allergic to sulfa) corticosteriods are prescribed. Corticosteriods may be used in combination with immunosupressors. Immunosupressors and immunomodulators are used in severe cases of ulcerative colitis when other medications have not worked.

A pt asks if surgery would cure her Crohn disease. She states that her friend's ulcerative colitis was cured with surgery. The nurse should explain that surgery is used to treat Crohn disease less often than to treat ulcerative colitis for what reason? A.) Crohn disease usually returns near the site of the anastomosis B.) Crohn disease typically involves the entire small & large intestines C.) Crohn disease usually can be cured with combination drug therapy D.) Crohn disease is associated with an increased risk of surgical complications

A.) Crohn disease usually returns near the site of the anastomosis Recurrence is so common that surgery is not usually done unless necessitated by serious complications. Postoperatively, the disease typically reappears at the site of anastomosis within 1 year. Newly affected areas also may appear in other sections of the intestine. Crohn disease can affect any area of the gastrointestinal tract. It is most often treated with a combination of drug therapy. There is no increased risk of surgical complications for Crohn disease. Patients with Crohn disease also are thought to have an increased risk of colon cancer.

What is characterized by a chronic inflammatory process that may involve any part of the GI tract from mouth to anus? A.) Crohn's disease B.) Meckel's diverticulum C.) Ulcerative colitis D.) Irritable bowel syndrome

A.) Crohn's disease The chronic inflammatory process of Crohn's disease involves any part of the GI tract from the mouth to the anus but most often affects the terminal ileum. Ulcerative colitis, Meckel's diverticulum, and irritable bowel syndrome do not affect the entire GI tract.

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this medication? A. Decreased diarrhea B. Decreased cramping C. Improved intestinal tone D. Elimination of peristalsis

A.) Decreased Diarrhea Diphenoxylate hydrochloride with atropine sulfate is an antidiarrheal product that decreases the frequency of defecation, usually by reducing the volume of liquid in the stools. The remaining options are not associated therapeutic effects of this medication.

The nurse is reviewing the record of a female client with Crohn disease. Which stool characteristics should the nurse expect to find in the pts history? A.) Diarrhea B.) Chronic constipation C.) Constipation alternating with diarrhea D.) Stools constantly oozing from the rectum

A.) Diarrhea With Crohn disease, an inflamed colon typically causes abdominal pain, cramping, rectal bleeding, and diarrhea.

You're providing diet teaching to a patient with ulcerative colitis about what types of foods to avoid during a "flare-up". Which foods below should the patient avoid? SATA A.) Ice Cream B.) White Rice C.) Fresh Apples and Pears D.) Popcorn E.) Cooked Carrots

A.) Ice Cream C.) Fresh Apples and Pears D.) Popcorn Patients experiencing a flare-up with ulcerative colitis should avoid dairy products (ice cream), food that are high in fiber (fresh apples or pears) (cooked fruits without the skin would be okay), and foods that are hard to digest (popcorn). Instead, patients should consume foods low in fiber (low residue) like cooked vegetables (carrots), bland foods (white rice) etc.

A patient with ulcerative colitis is scheduled for ileoanal anastomosis (J-Pouch) surgery. You know that this procedure: A.) Removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus. B.) Removes the colon and rectum and creates a permanent ileostomy. C.) Removes the colon and creates a temporary colostomy. D.) Removes the rectum which allows a pouch to be created from the colon. This will allow stool to pass from the colon to the anus.

A.) Removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus.

The nurse is asked to speak at a support group for people with ulcerative colitis. Which content should be included in the presentation SATA A.) Stress management may help to control symptoms B.) Ulcerative colitis is caused by bacterial infection C.) Avoid caffeine and any food that causes symptoms D.) Have regular colon screening examinations E.) Medications are needed only when acute symptoms occur

A.) Stress management may help to control symptoms C.) Avoid caffeine and any food that causes symptoms D.) Have regular colon screening examinations E.) Medications are needed only when acute symptoms occur

A client with ulcerative colitis has a prescription to begin a salicylate compound medication to reduce inflammation. What instruction should the nurse give the client regarding when to take this medication? A.) On arising B.) After meals C.) On an empty stomach D.) 30 min before meals

B.) After meals Salicylate compounds, such as sulfasalazine, act by inhibiting prostaglandin synthesis and reducing inflammation. The nurse teaches the client to take the medication with a full glass of water and increase fluid intake throughout the day. The medication needs to be taken after meals to reduce gastrointestinal irritation. The other options are incorrect and could cause gastric irritation.

A client with Crohn's disease is experiencing acute pain, and the nurse provides information about measures to alleviate the pain. Which statement by the client indicates the need for further teaching? A. "I know I can massage my abdomen." B. "I will continue using antispasmodic medication." C. "One of the best things I can do is use relaxation techniques." D. "The best position for me is to lie supine with my legs straight."

D.) "The best position for me is to lie supine with my legs straight. Pain associated with Crohn's disease is alleviated by the use of analgesics and antispasmodics and also by practicing relaxation techniques, applying local cold or heat to the abdomen, massaging the abdomen, and lying with the legs flexed. Lying with the legs extended is not useful because it increases the muscle tension in the abdomen, which could aggravate inflamed intestinal tissues as the abdominal muscles are stretched.

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client? A. Carrots and ranch dip B. Whole-grain cereal and milk C. A cup of popcorn and a cola drink D. Applesauce and a graham cracker

D.) Applesauce and a graham cracker The diet for the client with ulcerative colitis should be low fiber (low residue). The nurse should avoid providing foods such as whole-wheat grains, nuts, and fresh fruits or vegetables. Typically, lactose-containing foods also are poorly tolerated. The client also should avoid caffeine, pepper, and alcohol.

What should the nurse stress in a teaching plan for the mother of an 11 year old boy with ulcerative colitis? A.) Preventing the spread of illness to others B.) Nutritional guidance and preventing constipation C.) Teaching daily use of enemas D.) Coping with stress and avoiding triggers

D.) Coping with stress and avoiding triggers Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child. Ulcerative colitis is not infectious. Although nutritional guidance is a priority teaching focus, diarrhea is a problem with ulcerative colitis, not constipation. Daily enemas are not part of the therapeutic plan of care.

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis? A. Hypercalcemia B. Hypernatremia C. Frothy, fatty stools D. Decreased hemoglobin

D.) Decreased Hemoglobin Ulcerative colitis is an inflammatory disease of the large colon. Findings associated with ulcerative colitis include diarrhea with up to 10 to 20 liquid bloody stools per day, weight loss, anorexia, fatigue, increased white blood cell count, increased erythrocyte sedimentation rate, dehydration, hyponatremia, and hypokalemia (not hypercalcemia). Because of the loss of blood, clients with ulcerative colitis commonly have decreased hemoglobin and hematocrit levels. Clients with ulcerative colitis have bloody diarrhea, not steatorrhea (fatty, frothy, foul-smelling stools).

A patient is admitted with ulcerative colitis. In the physician's notes, it is stated that the patient's barium enema results showed the patient has colitis that starts in the rectum and extends into the sigmoid and descending colon. As the nurse, you know that this is what type of ulcerative colitis? A. Right-sided colitis B. Proctosigmoiditis C. Ulcerative procotitis D. Left-sided colitis

D.) Left-sided colitis (distal colitis) starts in the rectum and goes to the sigmoid and descending colon. Ulcerative proctitis affects the rectum only. Proctosigmoiditis affects the rectum and sigmoid colon. Right-sided colitis is NOT a type of ulcerative colitis.

A pt. in the clinic is prescribed an immunosuppressant drug for treatment of IBD. Which pt teaching point related to this drug is appropriate? A.) Always take your medication w/ food or milk B.) Avoid people w/ active infections C.) Stop the medication if you have diarrhea D.) Take this medication only when you have symptoms

B.) Avoid people w/ active infections Patients taking immunosuppressants need to avoid contact with people with active infection. Corticosteroids are used in inflammatory bowel disease (IBD) for their ability to reduce inflammation. Unfortunately, this action also decreases the ability of the body to resist infection. Patients on steroids must be monitored for any signs and symptoms of infections. A low-roughage diet without milk products is prescribed for mild to moderate IBD. A low-maintenance dose of the immunosuppressant may be given for as long as 1 year, so discontinuing the drug early may result in another acute attack. Frequently, patients have diarrhea with frequent bloody stools and abdominal cramping. Medications should not be stopped if diarrhea occurs. The patient needs to report this to the physician.

The nurse is planning for nutritional support for a patient suffering from inflammatory bowel disease (IBD). What will be the most suitable combination of food for the patient? A.) Lentils B.) Milkshakes C.) Oat bran D.) Blackberries

B.) Milkshakes Milkshakes, eggnogs, and puddings are high protein and high calorific and are appropriate food choices for managing patients with IBD.

An LPN is teaching a pt with Crohn disease about nutrition. Which selection by the pt indicates a need for further teaching? A.) Applesauce B.) Whole-grain muffin C.) Decaffeinated coffee D.) Cream of chicken soup

B.) Whole-Grain muffin Pt. with Crohn disease is placed on a low-residue diet without caffeine, pepper or alc. Foods that are not allowed include whole grains, nuts and raw fruits and vegetables

The nurse is reviewing the plan of care with the parent of a child with Crohn's disease. Which statement made by the parent indicates a need for further education? A.) "This illness is why my child has delayed puberty." B.) "This illness is exacerbated by the intake of fiber-rich food." C.) "This illness is God's way of testing our religious faith." D.) "This illness has impaired my child's growth and development."

C.) "This illness is God's way of testing out religious faith." Crohn's disease is an autoimmune disorder that affects the gastrointestinal tract, causing inflammation that can result in excessive diarrhea, abdominal pain, and other symptoms. Crohn's disease can stunt growth and weaken bones in children who are going through puberty. Parents are advised to refrain from serving fiber-rich food to such children because these foods are difficult to digest and may block the intestine.

The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease? A. Blood in the stool B. Chalky gray stool C. Loose, watery stool D. Dry, hard, constipated stool

C.) Loose, watery stool Crohn's disease is characterized by nonbloody diarrhea of usually not more than 4 or 5 stools daily. Over time, the episodes of diarrhea increase in frequency, duration, and severity. Options 1, 2, and 4 are not characteristics of the stool in Crohn's disease.

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease A.) Frequently results in toxic megacolon. B.) Causes fewer nutritional deficiencies than ulcerative colitis. C.) Often recurs after surgery, whereas ulcerative colitis is curable with a colectomy. D.) Is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis.

C.) Often recurs after surgery, whereas ulcerative colitis is curable with a colectomy. Ulcerative colitis affects only the colon and rectum; it can cause megacolon and rectal bleeding, but not nutrient malabsorption. Surgical removal of the colon and rectum cures it. Crohn's disease usually involves the ileum, where bile salts and vitamin cobalamin are absorbed. After surgical treatment, disease recurrence at the site is common.

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention should the nurse anticipate the health care provider prescribing? A. Enteral feedings B. Fluid restrictions C. Oral corticosteroids D. Activity restrictions

C.) Oral corticosteroids Crohn's disease is a form of inflammatory bowel disease that is a chronic inflammation of the gastrointestinal (GI) tract. It is characterized by periods of remission interspersed with periods of exacerbation. Oral corticosteroids are used to treat the inflammation of Crohn's disease, so option 3 is the correct one. In addition to treating the GI inflammation of Crohn's disease with medications, it is also treated by resting the bowel. Therefore, option 1 is incorrect. Option 2 is incorrect, as clients with Crohn's disease typically have diarrhea and would not be on fluid restrictions. Option 4, activity restrictions, is not indicated. The client can do activities as tolerated but should avoid stress and strain.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, should the nurse report to the health care provider (HCP)? A.) Hypotenstion B.) Blood diarrhea C.) Rebound tenderness D.) A hemoglobin level of 12 mg/dL (120 mmol/L)

C.) Rebound Tenderness Rebound tenderness may indicate peritonitis. Bloody 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 HCP.