ulcerative colitis, crohns disease, IBSyndrome, bowel obstruction

Which of the following factors is believed to cause ulcerative colitis? 1. Acidic diet 2. Altered immunity 3. Chronic constipation 4. Emotional stress

2. Altered immunity Several theories exist regarding the cause of ulcerative colitis. One suggests altered immunity as the cause based on the extraintestinal characteristics of the disease, such as peripheral arthritis and cholangitis. Diet and constipation have no effect on the development of ulcerative colitis. Emotional stress can exacerbate the attacks but isn't believed to be the primary cause.

Which goal of the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis? 1. Promoting self-care and independence 2. Managing diarrhea 3. Maintaining adequate nutrition 4. Promoting rest and comfort

2. Managing diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best achieved by halting the exacerbation. The client may receive antidiarrheal medications, antispasmodic agents, bulk hydrophilic agents, or anti-inflammatory drugs.

A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help the client meet his nutritional needs? 1. Initiate continuous enteral feedings 2. Encourage a high protein, high-calorie diet 3. Implement total parenteral nutrition 4. Provide six small meals a day.

3. Implement total parenteral nutrition Food will be withheld from the client with severe symptoms of ulcerative colitis to rest the bowel. To maintain the client's nutritional status, the client will be started on TPN. Enteral feedings or dividing the diet into 6 small meals does not allow the bowel to rest. A high-calorie, high-protein diet will worsen the client's symptoms.

Surgical management of ulcerative colitis may be performed to treat which of the following complications? 1. Gastritis 2. Bowel herniation 3. Bowel outpouching 4. Bowel perforation

4. Bowel perforation Perforation, obstruction, hemorrhage, and toxic megacolon are common complications of ulcerative colitis that may require surgery. Herniation and gastritis aren't associated with irritable bowel diseases, and outpouching of the bowel is diverticulosis.

If a client had irritable bowel syndrome, which of the following diagnostic tests would determine if the diagnosis is Crohn's disease or ulcerative colitis? 1. Abdominal computed tomography (CT) scan 2. Abdominal x-ray 3. Barium swallow 4. Colonoscopy with biopsy

4. Colonoscopy with biopsy A colonoscopy with biopsy can be performed to determine the state of the colon's mucosal layers, presence of ulcerations, and level of cytologic development. An abdominal x-ray or CT scan wouldn't provide the cytologic information necessary to diagnose which disease it is. A barium swallow doesn't involve the intestine.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on the assessment of the client, would the nurse report to the physician? 1. Bloody diarrhea 2. Hypotension 3. A hemoglobin of 12 mg/dL 4. Rebound tenderness

4. Rebound tenderness Rebound tenderness may indicate peritonitis. Blood 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 physician.

Which of the following associated disorders may a client with ulcerative colitis exhibit? 1. Gallstones 2. Hydronephrosis 3. Nephrolithiasis 4. Toxic megacolon

4. Toxic megacolon Toxic megacolon is extreme dilation of a segment of the diseased colon caused by paralysis of the colon, resulting in complete obstruction. This disorder is associated with both Crohn's disease and ulcerative colitis. The other disorders are more commonly associated with Crohn's disease.

You're educating a group of outpatients about signs and symptoms of ulcerative colitis. Which of the following are NOT typical signs and symptoms of ulcerative colitis? SELECT-ALL-THAT-APPLY:* A. Rectal Bleeding B. Abdominal mass C. Bloody diarrhea D. Fistulae E. Extreme Hungry F. Anemia

A. Rectal Bleeding D. Fistulae E. Extreme Hungry

Which of the following symptoms is associated with ulcerative colitis? 1. Dumping syndrome 2. Rectal bleeding 3. Soft stools 4. Fistulas

Answer: 2. Rectal bleeding In ulcerative colitis, rectal bleeding is the predominant symptom. Soft stools are more commonly associated with Crohn's disease, in which malabsorption is more of a problem. Dumping syndrome occurs after gastric surgeries. Fistulas are associated with Crohn's disease.

Assessment findings suggestive of peritonitis include a. rebound abdominal pain b. a soft, distended abdomen. c. dull, continuous abdominal pain. d. observing that the patient is restless.

a. rebound abdominal pain the abdomen is hard, like a board, and the patient has severe abdominal pain that is worse with any sudden movement. The patient lies very still. Palpating the abdomen and releasing the hands suddenly causes sudden movement within the abdomen and severe pain. This is called rebound tenderness.

Which patient statement indicates that the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective? a. "The medication will be tapered if I need surgery." b. "I will need to use a sunscreen when I am outdoors." c. "I will need to avoid contact with people who are sick." d. "The medication will prevent infections that cause the diarrhea."

b. "I will need to use a sunscreen when I am outdoors." Sulfasalazine may cause photosensitivity in some patients. It is not used to treat infections. Sulfasalazine does not reduce immune function. Unlike corticosteroids, tapering of sulfasalazine is not needed.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to a. administer IV metoclopramide (Reglan). b. discontinue the patient's oral food intake. c. administer cobalamin (vitamin B12) injections. d. teach the patient about total colectomy surgery.

b. discontinue the patient's oral food intake. An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO.

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply)? a. Restricted to rectum b. Strictures are common. c. Bloody, diarrhea stools d. Cramping abdominal pain e. Lesions penetrate intestine.

c. Bloody, diarrhea stools d. Cramping abdominal pain Rationale: Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? a. Patient has not voided for the last 4 hours. b. Skin is dry with poor turgor on all extremities. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the last 6 hours.

c. Crackles are heard halfway up the posterior chest. The presence of crackles in an older patient receiving IV fluids at a high rate suggests volume overload and a need to reduce the rate of the IV infusion. The other data will also be reported, but are consistent with the patient's age and diagnosis and do not require a change in the prescribed treatment.

A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? a. The patient uses incontinence briefs to contain loose stools. b. The patient asks for antidiarrheal medication after each stool. c. The patient uses witch hazel compresses to decrease irritation. d. The patient cleans the perianal area with soap after

c. The patient uses witch hazel compresses to decrease Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications are not given 15 to 20 times a day. The perianal area should be washed with plain water after each stool.

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. Rationale: 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.