Iggy EAQ Ch 57 Care of Patients With Inflammatory Intestinal Disorders

Which complication is associated with Crohn's disease? 1 Fistula 2 Hemorrhage 3 Hypovolemia 4 Colorectal cancer

1 Crohn's disease is an inflammatory bowel disease that causes abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. Strictures and deep ulcerations occur in Crohn's disease, which increases the risk of developing bowel fistulas. Hemorrhage is a complication associated with ulcerative colitis (UC). Hypovolemia is a complication associated with gastroenteritis. Colorectal cancer is a complication associated with UC.

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 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 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 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.

Which medication is the drug of choice for the treatment of giardiasis? 1 Tinidazole 2 Metronidazole 3 Atropine sulfate 4 Diloxanide furoate

2 Metronidazole is the drug of choice for treating giardiasis and is taken orally, 250 mg three times daily, for 5 days. Tinidazole is used as an alternative for treating giardiasis. Diloxanide furoate is commonly used to treat amebiasis. Atropine sulfate is often used to control bowel motility.

What postoperative measures are typically implemented for patients who have undergone abdominal surgery for peritonitis? 1 Monitoring vital signs every 2 hours 2 Irrigating the drain via sterile technique 3 Maintaining the patient in supine position 4 Monitoring respiratory rate every 3 hours

2 Sometimes manual irrigation of the peritoneum must be performed through a drain as prescribed by the health care provider. The postoperative patient is maintained in a semi-Fowler's position to promote drainage of peritoneal contents into the lower region of the abdominal cavity. Respiratory rate and vital signs are monitored every hour immediately after abdominal surgery.

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, 4 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.

What laboratory findings are consistent with ulcerative colitis (UC)? Select all that apply. 1 Decreased erythrocyte sedimentation rate (ESR) 2 Increased C-reactive protein 3 Decreased white blood cell (WBC) count 4 Increased sodium levels 5 Decreased potassium levels

2, 5 An increase in C-reactive protein, WBC count, and ESR is observed in patients with inflammatory diseases such as UC. UC causes a decrease in potassium and sodium levels due to frequent diarrheal stools and malabsorption from the diseased bowel.

Which drug is often used to treat gastroenteritis caused by Shigella? 1 Tinidazole 2 Loperamide 3 Ciprofloxacin 4 Diloxanide furoate

3 Ciprofloxacin is used to treat gastroenteritis caused by Shigella. Loperamide is a drug that reduces peristaltic movement and is not commonly given for Shigella because it prevents elimination of the infecting organism. Diloxanide furoate is used to treat amebiasis caused by Entamoeba histolytica. Tinidazole is used to treat giardiasis caused by Giardia lamblia.

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 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.

A patient has been newly diagnosed with ulcerative colitis. Which statement by the patient indicates a need for further teaching about the complications of the disease? 1 "I may have up to 20 liquid, bloody stools a day." 2 "I should monitor closely for gastrointestinal hemorrhage." 3 "I may have an increased risk of bladder infections caused by fistulas." 4 "I will have an increased risk of colorectal cancer, especially after 10 years."

3 Patients with Crohn's disease have an increased risk for fistula. Gastrointestinal hemorrhage; increased risk of colorectal cancer; and frequent liquid, bloody stools are all complications that are typical of ulcerative colitis.

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 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.

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

3 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 clinical investigations may be performed to diagnose septicemia? 1 Abdominal x-ray 2 Serum creatinine 3 Blood urea nitrogen 4 White blood cell count

4 An elevated white blood cell count is consistent with infection or septicemia. An abdominal x-ray and abdominal ultrasound tests are useful in identifying edema and inflammation of small and large intestines. Serum creatinine is performed to determine kidney function. Blood urea nitrogen indicates renal function.

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 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.

A patient with an exacerbation of ulcerative colitis (UC) has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving symptoms. How does the nurse reply? 1 "It is bland and reduces the secretion of gastric acids." 2 "It does not contain caffeine or other gastrointestinal (GI) tract stimulants." 3 "It provides key nutrients and extra calories to promote healing." 4 "It is absorbed quickly and allows the affected part of the GI tract to rest and heal."

4 For less severe exacerbations of UC, an elemental or semi-elemental product such as Vivonex PLUS may be prescribed to induce remission. These products are absorbed in the jejunum and therefore permit the distal small intestine and colon to rest. GI stimulants such as caffeinated beverages and alcohol should be avoided, but this is not the reason for using Vivonex PLUS. The objective of Vivonex is not to reduce gastric acid secretions. Nutritional supplements such as Ensure or Sustacal are added to provide nutrients and more calories.

Which statement about the procedure for an appendectomy is correct? 1 The patient can likely be discharged the day after the surgery. 2 The patient can return to usual activities in 2 to 3 days after the surgery. 3 Natural orifice transluminal endoscopic surgery (NOTES) creates an incision near the umbilicus. 4 Laparoscopy is an invasive procedure used to remove the inflamed appendix.

4 Laparoscopy is an invasive procedure used to remove an inflamed appendix. One or more small incisions are created near the umbilicus through which a small endoscope is placed. NOTES does not require an external skin incision; the endoscope is placed through natural orifices such as the vagina. Patients having laparoscopy are typically discharged the same day of surgery. Patients can return to usual activities in 1 to 2 weeks.

The primary health care provider prescribes natalizumab to a patient with Crohn's disease. Which health teaching is most important before beginning the medication? 1 "This drug masks the symptoms of infection." 2 "A cold and a sore throat are common infections." 3 "A headache and abdominal pain are common side effects." 4 "Cognitive, motor, and sensory changes have very lethal effects."

4 Natalizumab causes progressive multifocal leukoencephalopathy (PML), a deadly infection that affects the brain. Cognitive, motor, and sensory changes indicate PML and should be immediately reported. Glucocorticoids mask the symptoms of infection; natalizumab is a monoclonal antibody drug. Cold, sore throat infections, headache, and abdominal pain are common side effects of infliximab and certolizumab.

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 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 medication is most likely to be prescribed by the primary health care provider for the condition depicted in the figure below? 1 Infliximab 2 Tinidazole 3 Adalimumab 4 Ciprofloxacin

4 The figure depicts diverticulitis, which is an inflammation of a diverticulum, especially in the colon. It causes pain and disturbance of bowel function. Ciprofloxacin should be administered in this condition to reduce inflammation. Infliximab is used to treat toxic megacolon. Tinidazole is used as an alternative drug to treat giardiasis. Adalimumab is a monoclonal antibody used to treat Crohn's disease.

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 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.