Quiz #3 Review

Umbilical hernias

Congenital or acquired. Congenital umbilical hernias appear in infancy. Acquired umbilical hernias directly result from increased intra-abdominal pressure. They are most commonly seen in people who are obese.

A client with a bowel obstruction is ordered a nasogastric (NG) tube. After the nurse inserts the tube, which nursing intervention is the highest priority for this client?

Connecting the tube to low intermittent suction

Risk factors for nomechanical obstructions

Result from decreased peristalsis secondary to: Neurogenic disorder, vascular disorders, electrolyte imbalances (hypokalemia), inflammatory responses (peritonitis or sepsis). Manifestations of nonmechanical obstructions include diffuse, constant pain, significant abdominal distention, and frequent vomiting.

Indirect inguinal hernia

Sac formed from the peritoneum that contains a portion of the intestine or omentum. In males, indirect inguinal hernias can become large and often descend into the scrotum.

Medications for UC and CD

Sulfonamides: Sulfasalazine. Nonsulfonamides: Mesalamine, Balsalazide, Olsalazine. Corticosteroids: Prednisone, prednisolone, hydrocortisone, budesonide. Immunosuppressants: Cyclosporine, methotrexate, azathioprine, mercaptopurine. Immunomodulators: Infliximab, adalimumab, natalizumab, certolizumab. Antidiarrheals: Diphenoxylate and atropine, loperamide.

A client admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this client?

Using sitz baths three times daily.

A male client with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond?

"A change in position may be what is needed for you to have intercourse with your wife."

The nurse is instructing a client with recently diagnosed diverticular disease about diet. What food does the nurse suggest the client include?

A slice of 5-grain bread.

Medications for Diverticulitis

Antimicrobials: Ciprofloxacin, Metronidazole, Sulfamethoxazole-trimethoprim.

A client is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possible causes of the client's problem?

Caffeinated drinks, stress, anxiety.

The nurse case manager is discussing community resources with a client who has colorectal cancer and is scheduled for a colostomy. Which referral is of greatest value to this client initially?

Certified Wound, Ostomy, and Continence Nurse (CWOCN).

Bowel herniation

Displacement of the bowel through a weakness of the abdominal muscle into other areas of the abdominal cavity.

Medications for Diarrhea-predominant IBS

Loperarmide, psylliun, alosetron.

Medications for Constipation-predominant iBS

Lubiprostone and linaclotide.

Risk factors for Hernias

Male sex, advanced age, increased intra-abdominal pressure due to pregnancy or obesity, and genetics.

Direct inguinal hernias

Pass through a weak point into the abdominal wall.

A client asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting colorectal cancer?" Which dietary selection does the nurse suggest?

Steamed broccoli with turkey.

A client is being evaluated in the emergency department for a possible small bowel obstruction. Which signs and/or symptoms does the nurse expect to assess?

Upper abdominal distention, metabolic alkalosis, and great amount of vomiting

A client has an anal fissure. Which intervention most effectively promotes perineal comfort for the client?

Using hydrocortisone cream to relieve pain.

Strangulated hernia

When the blood supply to the herniated segment of the bowel is cut off by pressure from the hernial ring.

A nurse is teaching a client with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client?

"Avoid large crowds and anyone who is sick."

A certified Wound, Ostomy, and Continence Nurse is teaching a client about caring for a new ileostomy. What information is most important to include?

"Call the health care provider if your stoma has a bluish or pale look."

A nurse is teaching a client about dietary methods to help manage exacerbations ("flare-ups") of diverticulitis. What does the nurse advise the client?

"Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet."

A client who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the client to do in the meantime?

"Consume extra fluids to replace fluid losses."

The home health nurse is teaching a client about the care of a new colostomy. Which client statement demonstrates a correct understanding of the instructions?

"I need to check for leakage underneath my colostomy."

A client with irritable bowel syndrome is constipated. The nurse instructs the client about a management plan. Which client statement shows an accurate understanding of the nurse's teaching?

"I need to go for a walk every evening."

The CWOCN is teaching a client with colorectal cancer how to care for a newly created colostomy. Which client statement reflects a correct understanding of the necessary self-management skills?

"I will make certain that I always have an extra bag available."

The nurse is teaching a client who has undergone a hemorrhoidectomy about a follow-up plan of care. Which client statement demonstrates a correct understanding of the nurse's instructions?

"I will need to eat a diet high in fiber."

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair. Which client statement indicates a need for further teaching about this procedure?

"I will need to stay in the hospital overnight."

A client has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the client about diet and lifestyle choices?

"Lactose-containing foods should be reduced or eliminated from your diet."

A client with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this client?

"Tell me what worries you the most about this procedure."

A male's patient's sister was recently diagnosed with colorectal cancer, and his brother died of CRC 5 years ago. He asks the nurse whether he will inherit the disease too. How does the nurse respond?

"The only way to know whether you are predisposed to CRC is by genetic testing."

A client is admitted with severe viral gastroenteritis caused by norovirus. The client asks the nurse, "How did I get this disease?" Which answer by the nurse is correct?

"You may have consumed contaminated food or water."

The RN receives a change-of-shift report about four clients. Which client does the nurse assess first?

A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F

The RN on the medical-surgical unit receives a shift report about four clients. Which client does the nurse assess first?

A 36-year-old admitted after a motor vehicle crash with areas of ecchymoses on the abdomen in a "lap-belt" pattern

The nurse is teaching a client who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the client to report to the health care provider? (Select all that apply.)

Anorexia, headache, vomiting.

A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)?

Chronic diarrhea, abdominal pain, and fever.

The nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? (Select all that apply.)

Broccoli, Mushrooms, Onions, Peas

What does the nurse advise a client diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation?

Bulk-forming laxatives

A client with a family history of colorectal cancer regularly sees a HCP for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client?

Elevated carcinoembryonic antigen.

Risk factors for mechanical obstructions

Encirclement or compression of intestine by adhesions, tumors, fibrosis (endometriosis), or strictures (Crohn's disease, radiation). Post surgical adhesions are often the cause of small bowel obstructions, carcinomas are often the cause of large intestine obstructions. Diverticulitis, fecal impaction, and tumors are common causes of obstruction. (Bowel regimen can be effective in preventing impactions). Hernia (bowel becomes trapped in weakened area of abdominal wall). Volvulus (twisting) or intussusception (telescoping) of bowel segments.

A client with colorectal cancer had colostomy surgery performed yesterday. The client is very anxious about caring for the colostomy and states that the health care provider's instructions "seem overwhelming." What does the nurse do first for this client?

Encourages the client to look at and touch the colostomy stoma

A client with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next?

Has another client with a stoma who performs self-care talk with the client.

A hernia that cannot be moved back into place with gentle palpation is considered irreducible and requires immediate surgical intervention.

In a hernia that is strangulated, blood supply is cut off to a portion of the bowel, increasing the risk of obstruction, necrosis, and perforation. Findings include abdominal distention, tachycardia, vomiting, abdominal pain, and fever. Surgical intervention is necessary.

A client diagnosed with irritable bowel syndrome (IBS) is discharged home with a variety of medications for IBS symptoms. Upon returning to the clinic, the client states, "Most of my symptoms have improved, except for the diarrhea." What does the nurse anticipate will be prescribed for this client?

Muscarinic receptor antagonist

Mechanical obstruction occurs when the bowel is blocked by something outside or inside the intestines (adhesions, fecal impactions). Complete mechanical obstructions should be addressed surgically.

Nonmechanical obstructions are caused by diminished peristalsis within the bowel (paralytic ileus). This can occur postoperatively due to the handling of the intestines during surgery.

Incisional hernias

Occur as a postsurgical complication due to inadequate healing of the incisional site from malnutrition, infection, or obesity.

Incisional or ventral hernias

Occur at the site of previous surgical incision. These hernias result from inadequate healing of the incision, which is usually caused by post-operative wound infections, inadequate nutrition, and obesity.

A client with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first?

Prepares the client for emergency surgery

A client demonstrates the manifestations of diverticulitis with a suspected complication of peritonitis. What is the priority nursing intervention?

Preparing the client for emergency surgery.

Femoral hernias

Protrude through the femoral ring. A plug of fat in the femoral canal enlarges and eventually pulls the peritoneum and often the urinary bladder into the sac.

A 67-year-old male client reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have?

Reducible.