372 Week 6 Inflammatory Bowel Diseases (PrepU)

Which is one of the primary symptoms of irritable bowel syndrome (IBS)? Diarrhea Pain Bloating Abdominal distention

Diarrhea o The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

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 Abdominal pain Bleeding The onset of a bacterial infection

The onset of a bacterial infection o 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).

A nurse is assigned to care for a group of clients. Which client is most likely to be diagnosed with malabsorption syndrome? A 5-year-old taking pancreatic enzymes for cystic fibrosis A 36-year-old with acute pancreatitis A 24-year-old with lactose intolerance A 40-year-old with severe inflammatory bowel disease

A 40-year-old with severe inflammatory bowel disease o Some types of malnutrition are caused by acute and chronic illnesses, such as occurs in people with Crohn disease who are unable to absorb nutrients from their food. Lactose intolerance does not cause malnutrition and can be controlled with deleting lactose from the diet. Acute pancreatitis will cause a short-term electrolyte imbalance. Pancreatic enzyme replacement does not cause malnutrition.

A nurse reading a sigmoidoscopy report notes that a client was found to have skip lesions. The nurse interprets this as an indication of: Crohn disease Zollinger-Ellison syndrome Peptic ulcer Ulcerative colitis

Crohn disease o Skip lesions, demarcated granulomatous lesions that are surrounded by normal-appearing mucosal tissue, are a characteristic feature of Crohn disease.

Crohn disease has a distinguishing pattern in the gastrointestinal (GI) tract. The surface has granulomatous lesions surrounded by normal-appearing mucosal tissue. A complication of the pattern includes: Dysphagia Fistula formation Constipation Rectal bleeding

Fistula formation o In Crohn disease all layers of the bowel are involved. Complications of Crohn disease include fistula formation, abdominal abscess formation, and intestinal obstruction. Fistulas are tubelike passages that form connections between different sites in the GI tract.

A nurse is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which action should the nurse take in order to minimize the potential for risks associated with prednisone treatment? Carefully assess the client for infections. Advocate for intravenous, rather than oral, administration. Avoid OTC antacids for the duration of treatment. Teach the client strategies for dealing with headaches.

Carefully assess the client for infections. o It is important to monitor clients who are taking prednisone carefully for signs of infection, because prednisone's immunologic activity may mask the symptoms of infection. Antacids may normally be used alongside prednisone. Headaches are not associated with the use of prednisone and IV administration is not typical.

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? Chronic constipation with sporadic bouts of diarrhea Blood and mucus in the stool Weight loss due to malabsorption Client is awakened from sleep due to abdominal pain.

Chronic constipation with sporadic bouts of diarrhea o Most clients with irritable bowel syndrome (IBS) describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.

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

Corticosteroids o 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.

A client with a 10-year history of Crohn's disease is seeing the physician due to increased diarrhea and fatigue. Additionally, the client has developed arthritis and conjunctivitis. What is the most likely cause of the latest symptoms? staph infections irritable bowel syndrome All options are correct. Crohn's disease

Crohn's disease o The systemic nature of Crohn's disease is evidenced by symptoms outside the GI tract, referred to as extraintestinal manifestations of IBD. They include arthritis, arthralgias, skin lesions, eye inflammation (uveitis, conjunctivitis, and iritis), and disorders of the liver and gallbladder.

A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be: Excessive weight gain Fistula formation Chronic constipation Difficulty swallowing

Fistula formation o Complications of Crohn disease include fistula formation, abdominal abscess formation, and intestinal obstruction. Clients with Crohn disease are at risk for weight loss and/or diarrhea. The disease does not cause difficulty swallowing as it typically is in the bowel.

The nurse is reviewing hospital discharge instructions with a client who has been diagnosed with secondary thrombocytosis and who also suffers from chronic ulcerative colitis, making anticoagulation inadvisable. The nurse stresses that the client should avoid: Select all that apply. Smoking Folate supplements Immobilization Oral contraceptives Low-fat diet

Immobilization Oral contraceptives Smoking o The goal with these clients would be to decrease thrombotic effects from other causes, such as immobilization, smoking, oral contraceptives, steroid therapy, vitamin B, and folate deficiencies, and to decrease the need for anticoagulation therapy.

The nurse knows that sulfonamides are chosen to treat ulcerative colitis because of what action? Inflammation is decreased because of interaction with intestinal bacteria. It causes intestinal bacteria to replicate and repopulate. Bacteria causing ulcerative colitis are killed off. All intestinal bacteria are destroyed by the medication.

Inflammation is decreased because of interaction with intestinal bacteria. o Sulfonamides are bacteriostatic, which means they inhibit the growth of bacteria but do not destroy or kill off bacteria. They are used to treat ulcerative colitis because they interact with intestinal bacteria and help inhibit the inflammatory process.

A client is admitted to the medical surgical unit with a history of inflammatory bowel disease. The nurse knows that the clinical manifestations of both Crohn disease and ulcerative colitis are the result of activation of which cells? Alpha Beta Inflammatory Parietal

Inflammatory o The term "inflammatory bowel disease" is used to designate two related inflammatory intestinal disorders: Crohn disease and ulcerative colitis. Both diseases produce inflammation of the bowel. The clinical manifestations of both Crohn disease and ulcerative colitis are ultimately the result of inflammatory cells with elaboration of inflammatory mediators that cause nonspecific tissue damage.

Crohn disease is treated by several measures. Treatment with sulfasalazine will focus on which aspect of this disease? Decreased bleeding tendency Immune suppression Increased appetite Inflammatory suppression

Inflammatory suppression o Treatment methods focus on terminating the inflammatory response and promoting healing, maintaining adequate nutrition, and preventing and treating complications. Several medications have been successful in suppressing the inflammatory reaction, including corticosteroids, sulfasalazine, metronidazole, azathioprine, 6-mercaptopurine, methotrexate, and infliximab.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? Calorie restriction Low residue Low protein Iron restriction

Low residue o Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.

Which of the following agents would be least appropriate to use as treatment for ulcerative colitis? Balsalazide Salsalate Mesalamine Olsalazine

Salsalate o Salsalate is used to treat pain, fever, and inflammation in adults. Balsalazide can be used to treat mild to moderate acute ulcerative colitis in adults. Olsalazine can be used to treat ulcerative colitis and other inflammatory bowel diseases in adults. Mesalamine is used to treat ulcerative colitis and other inflammatory bowel diseases in adults.

A nurse is providing care for a client with a diagnosis of Crohn's disease. The nurse recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which type of tissue is most likely involved in the client's pathology? Glandular epithelium Simple cuboidal epithelium Simple columnar epithelium Stratified epithelium

Simple columnar epithelium o Simple columnar epithelium lines the intestine and its cilia and mucus-secreting goblet cells. The intestinal tract does not consist of glandular epithelium, simple cuboidal epithelium, or stratified epithelium.

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 o 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.

A client is recently diagnosed with Crohn's disease and is beginning treatment. What first-line treatment does the nurse expect that the client will be placed on to decrease the inflammatory response? Azathioprine Sulfasalazine Ciprofloxacin Methotrexate

Sulfasalazine o Considered first-line treatment for inflammatory bowel disease, 5-ASA drugs contain salicylate, which is bonded to a carrying agent that allows the drug to be absorbed in the intestine. These drugs work by decreasing the inflammatory response. Methotrexate or azathioprine are used when failure to maintain remission necessitates the use of an immune-modulating agent. Ciprofloxacin is used as an effective adjunct to treat the disease.

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 expresses positive feelings about self-image. The client verbalizes a manageable level of discomfort. The client exhibits signs of adequate GI perfusion with normal bowel sounds. The client maintains skin integrity.

The client exhibits signs of adequate GI perfusion with normal bowel sounds. o 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.

Which is a true statement regarding regional enteritis (Crohn's disease)? The clusters of ulcers take on a cobblestone appearance. It has a progressive disease pattern. It is characterized by pain in the lower left abdominal quadrant. The lesions are in continuous contact with one another.

The clusters of ulcers take on a cobblestone appearance. o The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue.

The nurse is caring for a client who has been prescribed a sulfonamide but does not have an infection. The nurse is aware that the medication has been prescribed to treat what condition? Crystalluria Gastritis Stomatitis Ulcerative Colitis

Ulcerative Colitis o Sulfonamides are primarily prescribed for treatment of infections but they are also used to manage ulcerative colitis. Stomatitis and crystalluria are possible adverse effects of sulfonamides. Gastritis is an inflammation of the stomach and sulfonamides would not be used to treat this condition.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition? Disorders of the colon Small-bowel disease Ulcerative colitis Intestinal malabsorption

Ulcerative colitis o The presence of mucus and pus in the stool suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

The nurse is caring for a client with chronic diarrhea. She knows that diarrhea could be caused by which condition? Select all that apply. Ulcerative colitis Fecal impaction Crohn disease Intestinal obstruction Lactase deficiency

Ulcerative colitis Fecal impaction Crohn disease Lactase deficiency o All of the disorders except intestinal obstruction will result in chronic diarrhea.

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 myelography genetic testing colonoscopy with biopsy

colonoscopy with biopsy o 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: permanent relief from the signs and symptoms. periodic occurrence in clients with long-standing diseases. reactivation of the disease and presence of symptoms. disappearance of signs and symptoms associated with the disease.

disappearance of signs and symptoms associated with the disease. o 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.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes: fluids with meals. caffeinated products. spicy foods. high-fiber diet.

high-fiber diet. o A high-fiber diet is prescribed to help control constipation. Individuals experiencing diarrhea may be advised to eat a low-fiber diet. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). What diagnosis will the nurse suspect for this client? inflammatory bowel disease (IBD) liver failure diverticulitis colorectal cancer

inflammatory bowel disease (IBD) o IBD is a collective term for several GI inflammatory diseases with unknown causes. The most prominent sign of IBD is mild diarrhea, which sometimes is accompanied by fever and abdominal discomfort. Colorectal cancer is usually diagnosed after the client complains of bloody stools; the client will rarely have abdominal discomfort. A client with diverticulitis commonly states he has chronic constipation with occasional diarrhea, nausea, vomiting, and abdominal distention. Jaundice, coagulopathies, edema, and hepatomegaly are common signs of liver failure.

An adolescent, age 14, is hospitalized for nutritional management and drug therapy after experiencing an acute episode of ulcerative colitis. Which nursing intervention is appropriate? providing high-fiber snacks administering antibiotics with meals as ordered providing small, frequent meals administering digestive enzymes before meals as ordered

providing small, frequent meals o Clients with ulcerative colitis, an inflammatory bowel disorder (IBD), tolerate small, frequent meals better than a few large meals daily. Eating large amounts of food may exacerbate the abdominal distention, cramps, and nausea IBD typically causes. Frequent meals also provide the additional calories needed to restore nutritional balance. This adolescent doesn't lack digestive enzymes and therefore doesn't need enzyme supplementation. Antibiotics are contraindicated because they may interfere with the actions of other ordered drugs and because ulcerative colitis isn't caused by bacteria. High-fiber foods may irritate the bowel further.

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred? "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "It's unusual for someone my age to get Crohn disease." "I have to be careful because I am prone to not absorbing nutrients." "I have a lot of diarrhea every day because of how my small intestine is damaged."

"I have to be careful because I am prone to not absorbing nutrients." o Crohn disease typically affects the small intestine more than the large intestine and its onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease affecting the intestine(s) in a continuous pattern.

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful? "She might lose some weight initially." "We should not stop this medication abruptly." "This drug helps to control the abdominal cramping." "We might notice some of the medication in her stool."

"We should not stop this medication abruptly." o Prednisone is a corticosteroid. Stopping the medication abruptly could lead to adrenal insufficiency. Weight gain would be associated with corticosteroid use. Weight loss is associated with the disease. Corticosteroids help to reduce inflammation and suppress the normal immune response. Typically, anti-inflammatory agents such as mesalamine may appear in the stool. This indicates poor absorption.

Which client most likely has ulcerative colitis rather than Crohn disease? 14-year-old female with full-thickness chronic inflammation of the intestinal mucosa 18-year-old male with abdominal pain 12-year-old with oral temperature of 101.6° F (38.7° C) 16-year-old female with continuous distribution of disease in the colon, distal to proximal

16-year-old female with continuous distribution of disease in the colon, distal to proximal o Ulcerative colitis is usually continuous through the colon while the distribution of Crohn disease is segmental. Crohn disease affects the full thickness of the intestine while ulcerative colitis is more superficial. Both conditions share age at onset of 10 to 20 years, with abdominal pain and fever in 40% to 50% of cases.

Which client is most clearly displaying the signs and symptoms of irritable bowel disease (IBD)? A 44-year-old man who works the evening shift at a factory and who states that his lower abdominal pain is much worse at night than during the day. A 24-year-old man who has a stressful job but whose diarrhea and cramping does not worsen during periods of high stress. A 51-year-old male who states that his stomach pain is in his lower abdomen, "comes and goes" and "feels more like a cramp than a dull ache." A 32-year-old mother who reports intermittent abdominal pain that is worse during her menstrual period.

A 51-year-old male who states that his stomach pain is in his lower abdomen, "comes and goes" and "feels more like a cramp than a dull ache." o IBD is commonly manifested as intermittent lower abdominal pain that feels like cramping. Defecation normally relieves the pain, and symptoms are normally not present at night or during sleep. Stress commonly exacerbates symptoms.

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? Refer the client to available community resources and support groups. Ask the nutritionist to give the client strict meal plans to follow. Ask the gastroenterologist to explain the treatment plan to the client and family again. Ask the client to verbalize the medication regimen and diet modifications required.

Ask the client to verbalize the medication regimen and diet modifications required. o 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.

A nurse is assessing the bowel sounds of a client who has Crohn's disease. What assessment technique would the nurse use? Palpation Percussion Auscultation Inspection

Auscultation o Auscultation refers to the assessment technique of listening with a stethoscope to sounds produced in the body, such as bowel sounds. Palpation uses the sense of touch, percussion is the act of striking one object against another to produce sound, and inspection refers to observing.

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet. A fruit salad with yogurt Salami on whole grain bread and V-8 juice Broiled chicken with low-fiber pasta A peanut butter sandwich and fruit cup

Broiled chicken with low-fiber pasta o A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child? clear lung sounds fever no joint swelling report of a headache

fever o Crohn disease may affect any area of the digestive tract. It causes acute and chronic inflammation. It may also cause abscesses and fistulas. Inflammation and abscesses can cause fever. An increasing temperature could be the manifestation of the inflammation worsening or the development of an abscess and subsequent infection. The progression of the disease will be reported to the health care provider. A headache may accompany the fever and is a sign of generally not feeling well. It does not indicate progression of the disease, thus does not need to be reported. Clear lung sounds and no swollen joints are good signs, but they are not associated with Crohn disease.

A client with Crohn's disease is to receive prednisone as part of the treatment plan. Which of the following instructions would be appropriate? "Avoid contact with other people who might have an infection." "Once your symptoms improve, you can stop taking the drug." "Take the drug on an empty stomach to avoid upsetting your stomach." "Make sure to increase your salt intake to compensate for the loss of fluid."

"Avoid contact with other people who might have an infection." o Clients taking corticosteroids may not experience a normal immune response to infection. The client needs to monitor himself or herself for signs and symptoms of infection and to avoid situations where they may be exposed to infection, such as others who might be ill. The drug should be taken with meals to decrease gastrointestinal irritation and should be withdrawn or tapered slowly to prevent Addisonian crisis. Clients also need to limit their sodium intake or follow a low-sodium diet to minimize water retention associated with this drug.