MORGAN UNIT 6 PREP U

A client with Crohn's disease is losing weight. For which reason will the nurse anticipate the client being prescribed parenteral nutrition? Impaired ability to absorb food Prolonged preoperative nutritional needs Insufficient oral intake Unwilling to ingest nutrients orally

Impaired ability to absorb food Explanation: A client with Crohn's disease will have an impaired ability to ingest or absorb food orally or enterally. Clients with severe burns, malnutrition, short-bowel syndrome, AIDS, sepsis, and cancer would need parenteral nutrition because of insufficient oral intake. Unwillingness to ingest nutrients orally would cause a client with a major psychiatric illness to need parenteral nutrition. Prolonged surgical nutritional needs such as what occurs after extensive bowel surgery or acute pancreatitis would necessitate the need for parenteral nutrition. Reference: Chapter 41: Management of Patients with Intestinal and Rectal Disorders - Page 1313

While learning about corticosteroids in pharmacology class, a student asks the instructor what a clinical indication for the use of corticosteroids would be. What would be the instructor's best response? Any hormone excessive state A disease without an immunological component Any systemic disease state A disease with an inflammatory component

A disease with an inflammatory component Explanation: Indications: Replacement therapy in adrenal cortical insufficiency, short-term management of various inflammatory and allergic disorders, hypercalcemia associated with cancer, hematological disorders, ulcerative colitis, acute exacerbations of multiple sclerosis, palliation in some leukemias, trichinosis with systemic involvement. Reference: Karch, A.M. Focus on Nursing Pharmacology, 7th ed., Philadelphia: Wolters Kluwer Health, 2017, Chapter 36: Adrenocortical Agents, p. 596-597. Chapter 36: Adrenocortical Agents - Page 596-597

The nurse is replacing a client's ileostomy appliance and has identified that the diameter of the stoma is 3.5 cm. The nurse has trimmed the flange of the new appliance to a diameter of 7 cm. What will be the most likely outcome of the nurse's action? The appliance will fit securely to the client's skin. A risk that the peristomal skin will become excoriated A heightened risk that the stoma will prolapse The appliance will need to be changed daily.

A risk that the peristomal skin will become excoriated Explanation: An appliance that is too large will expose peristomal skin to digestive enzymes, leading to skin breakdown. It will not fit as securely as it should, but this does not necessarily mean that it will need to be changed daily. Prolapse is not related to the way that the appliance is sized or trimmed.

A nurse suspects that the client with Crohn's disease does not understand the medication regimen or diet modifications required to manage the illness. What is the nurse's most appropriate action? Ask the client to verbalize the medication regimen and diet modifications required. Refer the client to available community resources and support groups. Ask the gastroenterologist to explain the treatment plan to the client and family again. Ask the nutritionist to give the client strict meal plans to follow.

Ask the client to verbalize the medication regimen and diet modifications required. Explanation: If the nurse suspects a client does not understand instructions, the first step is to assess the client's understanding. The most effective way to do that is to have the client repeat the client's understanding of the instructions. The other steps might be interventions that the nurse would institute after determining the client's needs.

Many of the immunosuppressant drugs that are administered following organ transplantation may also be used for treatment of what condition? AIDS Autoimmune disorder Increased intracranial pressure Seizure disorder

Autoimmune disorder Explanation: Some immunosuppressant drugs are used in the treatment of autoimmune disorders like asthma, Crohn's disease, and rheumatoid arthritis.

The nurse is caring for a child with an ileostomy. What nursing intervention will be included in this child's plan of care? Apply a sterile dressing around the stoma. Check for leakage around the stoma. Leave the ileostomy open to the air. Clean the outside of the collection device.

Check for leakage around the stoma. Explanation: An ileostomy is made by bringing a part of the small intestine through the abdominal wall to create an outlet for fecal material. The drainage from the ileostomy contains digestive enzymes, so the stoma must be fitted with a collection device to prevent skin irritation and breakdown. A colostomy is a similar opening in the colon that allows fecal material to be eliminated. A new colostomy may be left open to the air; alternatively a bag, pouch, or other appliance may be used to collect the stool. A urostomy may be created to help in the elimination of urine. Ostomy bags should be checked for leakage, emptied frequently, and changed when needed.

The nurse is obtaining the medical history of a client with Crohn's disease. What medication would the nurse include when asking about what medications the client has taken for suppression of the inflammatory and immune response? Nonsteroidal anti-inflammatory Diuretics Angiotensin-converting enzyme inhibitors (ACE-I) Corticosteroids

Corticosteroids Explanation: The nurse obtains a history of immunizations, recent and past infectious diseases, and recent exposure to infectious diseases. The nurse reviews the client's drug history because certain drugs, such as corticosteroids, suppress the inflammatory and immune responses. Nonsteroidal anti-inflammatory medication does not suppress the inflammatory and immune responses of Crohn's disease. An ACE-I prevents the conversion of angiotensin I to angiotensin II and does not suppress the inflammatory or immune response. Diuretics also do not suppress the immune response but help reduce excess fluid from the kidneys.

The nurse is caring for a 77-year-old patient diagnosed with Crohn's disease. What would be especially important to monitor this patient for? Fluid overload Dehydration Fatigue Pain

Dehydration Explanation: Elderly patients can become dehydrated quickly and develop low potassium levels (i.e., hypokalemia) as a result of diarrhea. The nurse observes for clinical manifestations of muscle weakness, dysrhythmias, or decreased peristaltic motility that may lead to paralytic ileus. All options would be important to monitor, but especially important is monitoring for dehydration

The nurse is assessing a client who had an ileostomy created three days ago for the treatment of irritable bowel disease. The nurse observes that the client's stoma is bright red and there are scant amounts of blood on the stoma. What is the nurse's best action? Cleanse the stoma with alcohol or chlorhexidine. Contact the care provider to have the client's hemoglobin and hematocrit measured. Document these expected assessment findings. Apply barrier ointment to the stoma as prescribed.

Document these expected assessment findings. Explanation: Redness and slight bleeding are expected, so no further intervention or assessment is likely necessary.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, what would the nurse stress the importance of? Wearing an appliance pouch only at bedtime Consuming a low-protein, high-fiber diet Taking only enteric-coated medications Increasing fluid intake to prevent dehydration

Increasing fluid intake to prevent dehydration Explanation: Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? Disaccharidase deficiency Inflammation of all layers of intestinal mucosa Gastric resection Infectious disease

Inflammation of all layers of intestinal mucosa Explanation: Crohn's disease is also known as regional enteritis and can occur anywhere along the gastrointestinal tract, but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small-bowel bacterial overgrowth, leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.

A nurse caring for a client with a newly created ileostomy assesses the client and notes that the client has not had ostomy output for the past 12 hours. The client also reports worsening nausea. What is the nurse's priority action? Facilitate a referral to the wound-ostomy-continence (WOC) nurse. Report signs and symptoms of obstruction to the health care provider. Encourage the client to mobilize in order to enhance motility. Contact the health care provider and obtain a swab of the stoma for culture.

Report signs and symptoms of obstruction to the health care provider. Explanation: It is important to report nausea and abdominal distention, which may indicate intestinal obstruction. This requires prompt medical intervention. Referral to the WOC nurse is not an appropriate short-term response, since medical treatment is necessary. Physical mobility will not normally resolve an obstruction. There is no need to collect a culture from the stoma because infection is unrelated to this problem.

Inflammatory bowel disease (IBD) is used to designate two related inflammatory intestinal disorders: Crohn disease and ulcerative colitis. The nurse recognizes the difference between the distribution pattern between Crohn disease and ulcerative colitis. Which pattern describes Crohn's disease? Primarily rectum and colon involvement Continuous involvement of the colon starting at the rectum Development of cancer Skip lesions

Skip lesions Explanation: Distribution patterns of disease manifest with skip lesions in Crohn disease and continuous involvement of the colon starting at the rectum in ulcerative colitis. Crohn disease primarily affects the ileum and secondarily the colon, and the development of cancer is uncommon. Ulcerative colitis primarily affects the rectum and left colon, and development of cancer is relatively common.

The nurse is caring for a 13-year-old client with ulcerative colitis who has a new temporary colostomy. Which nursing intervention is priority? Teach the client how to perform colostomy care. Set up home health care for the client. Discuss the process for colostomy reversal with the client. Encourage the parents to care for the child.

Teach the client how to perform colostomy care. Explanation: The principles of atraumatic care state to promote sense of control; provide opportunities for control, such as participating in care; attempt to normalize the client's daily schedule; and provide direct suggestions. By teaching the client how to perform colostomy care, the nurse is promoting self-care. The parents need to know how to care for their child; however, it is a priority for the client to receive the education because the client is old enough to perform the care. The nurse will ensure home care is scheduled, but again, this is not a priority. Discussing the reversal process is something the client will be interested in and should be discussed; however, it is not a priority over understanding the current situation.

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which assessment best indicates that the disease is under control? The client verbalizes a manageable level of discomfort. The client expresses positive feelings about self-image. The client maintains skin integrity. The client exhibits signs of adequate GI perfusion with normal bowel sounds.

The client exhibits signs of adequate GI perfusion with normal bowel sounds. Explanation: Adequate GI perfusion can be maintained only if Crohn's disease is controlled. If the client experiences acute, uncontrolled episodes of Crohn's disease, impaired GI perfusion may lead to a bowel infarction. Positive self-image, a manageable level of discomfort, and intact skin integrity are expected client outcomes, but aren't related to control of the disease.

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? Diarrhea Bleeding The onset of a bacterial infection Abdominal pain

The onset of a bacterial infection Explanation: Lymphopenia (a lymphocyte count less than 1,500/mm3) can result from ionizing radiation, long-term use of corticosteroids, uremia, infections (particularly viral infections), some neoplasms (e.g., breast and lung cancers, advanced Hodgkin disease), and some protein-losing enteropathies (in which the lymphocytes within the intestines are lost) (Kipps, 2010). When lymphopenia is mild, it is often without sequelae; when severe, it can result in bacterial infections (due to low B lymphocytes) or in opportunistic infections (due to low T lymphocytes). Reference: Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 929

What observation should the nurse instruct the client with an ileostomy to report immediately? absence of drainage from the ileostomy for 6 or more hours passage of liquid stool from the stoma temperature of 99.8° F (37.7° C) occasional presence of undigested food in the effluent

absence of drainage from the ileostomy for 6 or more hours Explanation: Any sudden decrease in drainage or onset of severe abdominal pain should be reported to the health care provider (HCP) immediately because it could mean that an obstruction has developed. The ileostomy drains liquid stool at frequent intervals throughout the day. Undigested food may be present at times. A temperature of 99.8° F (37.7° C) is not necessarily abnormal or a cause for concern.

The risk for developing colorectal cancer during one's lifetime is 1 in 19. Nurses play an integral role in the promotion of colorectal cancer screening. What are risk factors for colorectal cancer? Select all that apply. age 50 and older a diet high in fruits, vegetables, and whole grains. a positive family history a history of inflammatory bowel disease

age 50 and older a positive family history a history of inflammatory bowel disease Explanation: The risks for colorectal cancer increase after the age of 50, with a positive family history of colorectal cancer, and also with Crohn's disease. An important nursing responsibility is to teach clients about annual screening beginning at 50, encourage endoscopic exam every 5 years, or colonoscopy every 10 years for normal-risk individuals.

A 13-year-old client is being evaluated for possible Crohn's disease. The nurse expects to prepare the client for which diagnostic study? cystoscopy genetic testing myelography colonoscopy with biopsy

colonoscopy with biopsy Explanation: Crohn's disease is an inflammatory bowel disorder characterized by inflammation, ulceration, and edema of the bowel wall (typically involving the terminal ileum). Colonoscopy with biopsy are the primary procedures used to establish the diagnosis; a barium enema also may be indicated. Although genetics may play a role in Crohn's disease, genetic testing isn't part of the diagnostic workup. Cystoscopy visualizes the bladder and urinary tract and isn't indicated for this client. Myelography is a radiographic procedure used to evaluate the spinal cord.

A client with Crohn's disease in remission is admitted to the nursing unit for follow-up care. The remission state is characterized by: periodic occurrence in clients with long-standing diseases. disappearance of signs and symptoms associated with the disease. reactivation of the disease and presence of symptoms. permanent relief from the signs and symptoms.

disappearance of signs and symptoms associated with the disease. Explanation: Remission is a temporary state of disappearance of the signs and symptoms related to a particular disease. It is of short duration, but the duration is unpredictable. It is a condition opposite to exacerbation, which is characterized by reactivation of symptoms. Remission is not permanent, but is rather a temporary relief from signs and symptoms. Exacerbation is the periodic occurrence of disease in clients with chronic diseases

The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation? "You must be meticulous in caring for the surrounding skin." "Call the doctor immediately if the stoma is not pink/red and moist." "You may need adhesive remover to ease pouch removal." "Gather all of your supplies before you begin."

"Call the doctor immediately if the stoma is not pink/red and moist." Explanation: A healthy stoma is pink and moist. If the stoma is dry or pale, the mother must notify the health care provider immediately because it could indicate compromised circulation. Gathering supplies is important but would not be involved in avoiding an emergency situation. All of the other instructions are valid, but emphasizing the color of the healthy stoma is most important to avoid an emergency situation. Adhesive remover may be needed to ease pouch removal, but this action would not necessarily avoid an emergency situation. Meticulous skin care is important, but this action would not necessarily avoid an emergency situation.

The nurse is caring for an infant with a temporary ileostomy. As part of the plan of care, the nurse monitors for skin breakdown around the stoma. If redness occurs, what would be most appropriate to promote healing and prevent further skin breakdown? Use a barrier wafer to attach the appliance. Sanitize the area with an alcohol wipe after each diaper change. Apply a barrier/healing cream or paste on the skin. Clean the area well with a scented diaper wipe.

Apply a barrier/healing cream or paste on the skin. Explanation: The nurse should use a barrier/healing cream or paste on the skin around the stoma to promote healing and prevent further skin breakdown. Diaper wipes that contain fragrance or alcohol can sting if used on nonintact skin and can worsen skin breakdown. The barrier wafer would be helpful, but does not address the skin breakdown. Reference: Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder - Page 1512

An older adult client is in the hospital following an intestinal diversion with an ileostomy on the right upper quadrant and a mucous fistula. What is the most important nursing action in the care of this client? Perform stoma irrigation. Have the client perform self stoma care Assess the color of the stoma. Apply device for stool collection.

Assess the color of the stoma. Explanation: A bluish or dark stoma indicates impaired circulation to the stoma. This requires intervention to improve circulation to avoid permanent damage to the stoma. Applying the device would be secondary after the assessment. A stoma irrigation is not a priority in the care of the client. Having the client perform self stoma care would be one of the last interventions provided prior to discharge from the hospital after assessing for readiness.

A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding? An intestinal obstruction has occurred. The ostomy bag should be adjusted. This is a normal finding 1 day after surgery. Blood supply to the stoma has been interrupted.

Blood supply to the stoma has been interrupted. Explanation: An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion. The nurse should interpret this finding as an indication that the stoma's blood supply is interrupted, which may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding 1 day after surgery. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color.

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir? Three or four times daily At least once every 2 days At least once a day Every 4 to 6 hours

Every 4 to 6 hours Explanation: The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infection.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? Scrubbing fecal material from the skin surrounding the stoma Maintaining wrinkles in the faceplate so it doesn't irritate the skin Gently washing the area surrounding the stoma using a facecloth and mild soap Cutting the faceplate opening no more than 2 inches larger than the stoma

Gently washing the area surrounding the stoma using a facecloth and mild soap Explanation: For a client with an ostomy, maintaining skin integrity is a priority. The nurse should gently wash the area surrounding the stoma using a facecloth and mild soap. Scrubbing the area around the stoma can damage the skin and cause bleeding. The faceplate opening should be no more than 1/8-inch to 1/6-inch larger than the stoma. This size protects the skin from exposure to irritating fecal material. The nurse can create an adequate seal and prevent leakage of fecal material from under the faceplate by applying a thin layer of skin barrier and smoothing out wrinkles in the faceplate. Eliminating wrinkles in the faceplate also protects the skin surrounding the stoma from pressure.

A nurse is documenting the appearance of feces from a client with a permanent ileostomy. Which scenario would she document? "Ileostomy bag half filled with liquid feces." "Colostomy bag filled with flatus and feces." "Colostomy bag intact without feces." "Ileostomy bag half filled with hard, formed feces."

Ileostomy bag half filled with liquid feces." Explanation: The client with an ileostomy (temporary or permanent) has an opening into the small intestine. Because feces do not reach the large intestine, water is not absorbed, and the feces will be liquid. A colostomy is when a portion of the large intestine is diverted through the abdominal wall.

A client presents to the emergency department with complaints of acute GI distress, bloody diarrhea, weight loss, and fever. Which condition in the family history is most pertinent to the client's current health problem? Gastroesophageal reflux disease Hypertension Ulcerative colitis Appendicitis

Ulcerative colitis Explanation: A family history of ulcerative colitis, particularly if the relative affected is a first-degree relative, increases the likelihood of the client having ulcerative colitis. Although hypertension has familial tendencies, the client's symptoms aren't related to hypertension. A family history of gastroesophageal reflux disease or appendicitis isn't a significant factor in the client history because these conditions aren't considered familial traits.

The nurse is caring for a 6-year-old girl who will be undergoing a surgical procedure that will result in a temporary ileostomy. Which approach would be most effective in helping prepare the child for surgery? Draw a picture that explains the procedure. Use a doll to role-play the events surrounding the surgical experience and the procedure. Show the child a teaching DVD about ileostomy care. Show the child photographs of another girl with her ileostomy.

Use a doll to role-play the events surrounding the surgical experience and the procedure. Explanation: Using a doll to help the child understand surgery and the procedure will promote understanding in a developmentally appropriate way. Children this age enjoy role-play and regularly use it in everyday life to rehearse events. Drawing a picture may be helpful and age appropriate but less effective than the role-play. Showing the teaching DVD will include information the child is not yet ready for and, unless prepared for young school-agers (unlikely), would not be at her level of understanding. Showing the child photographs of another girl with an ileostomy would be more helpful to an older school-ager. At that time peer modeling can be helpful in teaching as well as in capturing interest.

The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be: soft semi-formed. bloody. liquid consistency. mucus-filled.

liquid consistency. Explanation: Stool produced from an ileostomy is liquid and contains large quantities of electrolytes.

A nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. What else would the nurse expect to find? tenderness and pain in the right upper abdominal quadrant rectal bleeding and a change in bowel habits jaundice and vomiting severe abdominal pain with direct palpation or rebound tenderness

severe abdominal pain with direct palpation or rebound tenderness Explanation: Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (i.e., appendicitis, diverticulitis, ulcerative colitis, a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.