Chapter 57: Care of Patients with Inflammatory Intestinal Disorders

29. Which type of diet has been implicated in the formation of diverticula? a. High-fat diet b. Low-protein diet c. High-cholesterol diet d. Low-fiber diet

d. Low-fiber diet

17. Which are common manifestations in a 28-year-old patient with dehydration secondary to gastroenteritis? Select all that apply. a. Peripheral edema b. Elevated temperature c. Dry mucous membranes d. Hypertension e. Oliguria f. Poor skin turgor

b. Elevated temperature c. Dry mucous membranes e. Oliguria f. Poor skin turgor

40. Which statements does the nurse include while providing discharge instructions for a patient with giardiasis? Select all that apply. a. "Avoid contact with stool from dogs and beavers." b. "All household and sexual partners should have stool examinations for parasites." c. "Treatment will most likely consist of metronidazole(Flagyl)." d. "The infection can be transmitted to others until the amebicides kill the parasites." e. "Stools are examined 6 days after treatment to assess for eradication." f. "Be sure to bathe or shower at least every other day."

a. "Avoid contact with stool from dogs and beavers." b. "All household and sexual partners should have stool examinations for parasites." c. "Treatment will most likely consist of metronidazole(Flagyl)." d. "The infection can be transmitted to others until the amebicides kill the parasites."

24. A patient with ulcerative colitis (UC) who has had an ileostomy is being discharged home. Which statements by the patient indicate the discharge teaching has been effective? Select all that apply. a. "I will avoid foods that cause gas." b. "I will call the health care provider if I have a fever over 101° F. (38.3°C)." c. "I will change the adhesive for the appliance daily." d. "I know the pouch needs emptying when I feel pain in that area." e. "I will call the health care provider if I feel like my heart is beating fast." f. "I will include adequate amounts of salt and water in my diet because an ileostomy causes their loss."

a. "I will avoid foods that cause gas." b. "I will call the health care provider if I have a fever over 101° F. (38.3°C)." e. "I will call the health care provider if I feel like my heart is beating fast." f. "I will include adequate amounts of salt and water in my diet because an ileostomy causes their loss."

22. A patient is prescribed sulfasalazine for the treatment of ulcerative colitis (UC). Which patient statement indicates the patient is experiencing a side effect of this drug? a. "My skin is covered with a rash." b. "My knees hurt." c. "My appetite has increased." d. "I wake up at night sweating sometimes."

a. "My skin is covered with a rash."

8. The respiratory problems that may accompany peritonitis are a result of which factor? a. Associated pain interfering with ventilation b. Decreased pressure against the diaphragm c. Fluid shifts to the thoracic cavity d. Decreased oxygen demands related to the infectious process

a. Associated pain interfering with ventilation

14. Which interventions are useful in preventing spread of gastroenteritis? Select all that apply. a. Careful hand washing b. Sanitize all surfaces that may be contaminated c. Prophylactic use of antibiotics d. Easily accessible hand sanitizers e. Test all food preparation employees f. Proper food and beverage preparation

a. Careful hand washing b. Sanitize all surfaces that may be contaminated d. Easily accessible hand sanitizers f. Proper food and beverage preparation

45. Which action should the nurse delegate to the unlicensed assistive personnel (UAP) when providing care for a patient with Crohn's disease? a. Check the patient's daily weight. b. Instruct the patient about the importance of adequate nutrition. c. Assess the patient's skin for areas of breakdown. d. Provide the patient with information about the disease process.

a. Check the patient's daily weight.

33. Which statement about diverticular disease is true? a. Most diverticula occur in the sigmoid colon. b. Diverticula are uncomfortable even when not inflamed. c. High-fiber diets contribute to diverticula occurrence d. Diverticula form where intestinal wall muscles are week.

a. Most diverticula occur in the sigmoid colon.

30. What is the nature of pain associated with diverticulitis? a. Intermittent becoming progressively steady b. Sharp and continuous c. Localized to the right upper quadrant d. Severe and incapacitating

a. Intermittent becoming progressively steady

2. The nurse is caring for the patient with acute appendicitis. Which interventions will the nurse perform? Select all that apply. a. Maintain the patient on NPO status. b. Administer IV fluids as prescribed. c. Apply warm compresses to the right lower abdominal quadrant.d. Maintain the patient in the supine position. e. Administer laxatives. f. If tolerated, maintain the patient in a semi-fowler's position

a. Maintain the patient on NPO status. b. Administer IV fluids as prescribed. f. If tolerated, maintain the patient in a semi-fowler's position

11. Which intervention does the nurse delegate to the unlicensed assistive personnel (UAP) when caring for a postoperative patient with peritonitis? a. Measure intake and output b. Assess wound drainage c. Administer IV antibiotics d. Teach patient about wound care

a. Measure intake and output

37. Which description best defines an anal fissure? a. Perianal tear that can be very painful b. Duct obstruction and infection c. Communicating tract d. Localized area of induration with pus

a. Perianal tear that can be very painful

27. In caring for a patient with Crohn's disease (CD), the nurse observes for which complications? Select all that apply. a. Peritonitis b. Small bowel obstruction c. Nutritional and fluid imbalances d. Presence of fistulas e. Appendicitis f. Severe nausea and vomiting

a. Peritonitis b. Small bowel obstruction c. Nutritional and fluid imbalances d. Presence of fistulas

6. Which statements about peritonitis are true? Select all that apply. a. Peritonitis is caused by contamination of the peritoneal cavity by bacteria or chemicals. b. Continuous ambulatory peritoneal dialysis (CAPD) can cause peritonitis. c. White blood cell counts are often decreased with peritonitis. d. Abdominal wall rigidity is a classic finding in patients with peritonitis. e. Chemical peritonitis is caused by leakage of pancreatic enzymes or gastric acids. f. Respiratory problems can be caused by increased abdominal pressure against diaphragm

a. Peritonitis is caused by contamination of the peritoneal cavity by bacteria or chemicals. b. Continuous ambulatory peritoneal dialysis (CAPD) can cause peritonitis. d. Abdominal wall rigidity is a classic finding in patients with peritonitis. e. Chemical peritonitis is caused by leakage of pancreatic enzymes or gastric acids. f. Respiratory problems can be caused by increased abdominal pressure against diaphragm

41. The emergency department nurse is assessing a patient admitted with frequent, liquid, foul-smelling stools containing mucus and blood. Assessment findings include temperature 103.8° F (39,9°C), tenesmus, abdominal tenderness, and vomiting. Which additional laboratory test(s) does the nurse expect to collect? a. Serial stool samples b. Urine culture c. Throat culture d. Sputum culture

a. Serial stool samples

38. The nurse is providing teaching for a patient with an anal fissure as a complication of CD. Which statement by the patient indicates the need for further teaching? a. "I will use warm sitz baths." b. "A diet that is low in bulk-producing agents is best for me." c. "Hydrocortisone cream may be helpful to decrease discomfort." d. "Topical anti-inflammatory agents will help if I am uncomfortable."

b. "A diet that is low in bulk-producing agents is best for me."

13. The patient with gastroenteritis due to infection with the norovirus asks the nurse how this illness occurred. Which statement by the patient indicates correct understanding of the nurse's teaching? a. "I got this infection from being around my grandchildren when they had respiratory illnesses." b. "It is likely that I got this illness from either contaminated water or food." c. "I may have gotten sick when I was traveling last month." d. "It's really important that everything I eat is cooked until it is well done."

b. "It is likely that I got this illness from either contaminated water or food."

21. A patient is suspected to have ulcerative colitis (UC). Which diagnostic tests does the nurse expect the patient to undergo to confirm the diagnosis? Select all that apply. a. Sigmoidoscopy b. C-reactive protein c. Albumin levels d. Erythrocyte sedimentation rate e. Magnetic resonance enterography (MRE) f. Clotting studies

b. C-reactive protein c. Albumin levels d. Erythrocyte sedimentation rate e. Magnetic resonance enterography (MRE)

39. Which parasitic infection is manifested by diarrhea and occurs most commonly in immunosuppressed patients, especially those with human immunodeficiency virus (HIV)? a. Entamoeba histoytica b. Cryptosporidium c. Giardia lamblia d. Escherichia coli

b. Cryptosporidium

20. Which characteristics pertain to Crohn's disease (CD)? Select all that apply. a. It begins in the rectum and proceeds in a continuous manner toward the cecum b. Fistulas commonly develop c. The are five to six soft, loose, nonbloody stools per day. d. There is an increased risk of colon cancer e. Some patients experience extraintestinal manifestations such as migratory polyarthritis, ankylosing spondylitis,and erythema nodosum f. There is a cobblestone appearance of the internal intestine

b. Fistulas commonly develop c. The are five to six soft, loose, nonbloody stools per day. f. There is a cobblestone appearance of the internal intestine

16. What is the priority nursing concern for a patient with gastroenteritis? a. Nutrition therapy b. Fluid replacement c. Skin care d. Drug therapy

b. Fluid replacement

36. Which interventions does the nurse expect to implement when caring for a patient with diverticulitis? Select all that apply. a. Laxative and enemas as ordered b. IV fluids to prevent dehydration c. Broad-spectrum antibiotics d. Teach the patient to refrain from lifting or straining e. Keep the patient NPO if symptoms are severe f. Administering diuretics to prevent fluid overload

b. IV fluids to prevent dehydration c. Broad-spectrum antibiotics d. Teach the patient to refrain from lifting or straining e. Keep the patient NPO if symptoms are severe

23. Which statement is true about the medical treatment of ulcerative colitis (UC)? a. Infliximab (Remicade) is approved as a first-line therapy. b. Immunomodulators are not thought to be effective;however, in combination with steroids, they may offer a synergistic effect. c. When a therapeutic level of glucocorticoids is reached,the dosage of the drug stays the same to maintain the therapeutic effect. d. The method of action for the aminosalicylates is interruption of the pain pathway.

b. Immunomodulators are not thought to be effective;however, in combination with steroids, they may offer a synergistic effect.

9. Which nursing intervention is part of nonsurgical management for a patient with peritonitis? a. Monitor weekly weight and intake and output. b. Insert a nasogastric tube to decompress the stomach. c. Order a breakfast tray when the patient is hungry. d. Administer NSAIDs for pain.

b. Insert a nasogastric tube to decompress the stomach.

3. The patient has been diagnosed with acute appendicitis. Based on this diagnosis, which intervention does the nurse perform? a. Start a bowel cleansing program. b. Prepare the patient for surgery. c. Apply a heating pad to the lower abdomen. d. Assess the patient's knowledge about dietary modifications.

b. Prepare the patient for surgery.

25. Which statement is true about drug therapy for Crohn's disease (CD) or ulcerative colitis (UC)? a. Infliximab is used to manage episodes of diarrhea with CD. b. Sulfasalazine is the first aminosalicylate approved for UC. c. Metronidazole has been helpful in patients with fistulas and UC. d. Adalimumab is a glucocorticoid approved for the treatment of CD.

b. Sulfasalazine is the first aminosalicylate approved for UC.

43. The patient who had an ileostomy asks the nurse about how to choose the best ostomy pouching system. Which guidelines best describe an effective system? Select all that apply. a. The adhesive barrier lasts 1-2 days. b. The system protects the patient's skin. c. The pouch system contains the drainage and reduces odor. d. The ostomy pouch system is relatively inexpensive. e. The pouch remains securely attached to the skin for a dependable period of time. f. A large pouch is best because it holds more stools.

b. The system protects the patient's skin. c. The pouch system contains the drainage and reduces odor. e. The pouch remains securely attached to the skin for a dependable period of time.

4. The nurse on the surgical unit is expecting to admit the patient who has had an appendectomy with abscess. What does the nurse anticipate care for this patient will include? Select all that apply. a. Clear liquids b. Wound drains c. IV antibiotics d. Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control e. Nasogastric (NG) tube care f. Prescribed opioid pain drugs

b. Wound drains c. IV antibiotics e. Nasogastric (NG) tube care f. Prescribed opioid pain drugs

12. The nurse is instructing a patient about home care after an exploratory laparotomy for peritonitis. Which statement by the patient indicates that teaching has been effective? a. "It is normal for the incision site to be warm." b. "I will stop taking the antibiotics if diarrhea develops." c. "I will call the health care provider for a temperature greater than 101° F." d. "I will resume activity with my bowling league this week for exercise."

c. "I will call the health care provider for a temperature greater than 101° F."

10. What key assessment data would the nurse expect to find in a patient with peritonitis? a. Fever and headache b. Dizziness with nausea and vomiting c. Abdominal pain, distention, and tenderness d. Nausea and loss of appetite

c. Abdominal pain, distention, and tenderness

1. The patient comes to the emergency department (ED) with right lower quadrant pain. What does the ED nurse suspect? a. Gastroenteritis b. Ulcerative colitis c. Appendicitis d. Crohn's disease

c. Appendicitis

35. Which type of stoma will a patient with diverticulitis most likely have postoperatively? a. Ileostomy b. Jejunostomy c. Colostomy d. Cecostomy

c. Colostomy

7. The fluid shift that occurs in peritonitis may result in which of the following? a. Intracellular fluid moving into the peritoneal cavity b. Significant increase in circulatory volume c. Decreased circulatory volume and hypovolemic shock d. Increased bowel motility caused by increased fluid volume

c. Decreased circulatory volume and hypovolemic shock

42. The patient recovering from surgery for peritonitis tells the nurse that he is experiencing abdominal pain and has developed foul-smelling drainage from his wound, and his incision is red and swollen. What is the nurse's best first action? a. Clean and dress the incision. b. Measure the patient's abdominal girth. c. Notify the health care provider. d. Place the patient on bedrest in semi-Fowler's position.

c. Notify the health care provider.

34. The nurse would teach the patient about what preventive measures for diverticular disease? a. Excluding whole-grain breads from the diet b. Avoiding fresh apples, broccoli, and lettuce c. Taking bulk agents such as psyllium hydrophilic mucilloid d. Taking routine anticholinergics to reduce bowel spasms

c. Taking bulk agents such as psyllium hydrophilic mucilloid

19. The nurse is caring for a patient with gastroenteritis who has frequent stools. Which task is best to delegate to the UAP? a. Teach the patient to avoid use of toilet paper and harsh soaps. b. Instruct the patient on how to take a sitz bath. c. Use a warm washcloth to remove stool from the skin. d. Dry the skin with absorbent cotton.

c. Use a warm washcloth to remove stool from the skin.

32. Which drug is often used in older patients for pain management of moderate to severe diverticulitis? a. An NSAID drug b. an acetaminophen-based drug c. An aspirin -based drug d. An opioid analgesic drug

d. An opioid analgesic drug

18. As part of the routine treatment plan for a patient with bacterial gastroenteritis, which drugs does the nurse anticipate the patient will most likely be prescribed? a. Anticholinergics b. Antiemetics c. Antiperistaltic drugs d. Antibiotics

d. Antibiotics

28. A patient returns to the unit following a total proctocolectomy with a permanent ileostomy. The nurse understands that with organ wee removed during this procedure? a. All of the small intestine b. Distal colon and rectum c. Colon, rectum, and anus d. Colon, rectum, and anus, with surgical closure of the anus.

d. Colon, rectum, and anus, with surgical closure of the anus.

44. The patient comes to the Urgent Care Unit and describes symptoms of diarrhea, abdominal pain, and low-grade fever. She states she has constant abdominal pain in the right lower quadrant and has lost 25 pounds in the past month. What diagnosis does the nurse suspect? a. Ulcerative colitis b. Diverticulitis c. Peritonitis d. Crohn's disease

d. Crohn's disease

26. A patient with Crohn's disease (CD) has a fistula. Which assessment finding indicates possible dehydration? a. Weight gain of 2 pounds in one day b. Abdominal pain c. Foul-smelling urine d. Decreased urinary output

d. Decreased urinary output

5. Which laboratory finding does the nurse expect may occur with a diagnosis of appendicitis? a. Decreased hematocrit and hemoglobin b. Increased coagulation time c. Decreased potassium d. Increased WBC count

d. Increased WBC count

31. The nurse is assessing an older adult patient with abdominal pain. Assessment findings include generalized abdominal pain with rigidity, nausea, and vomiting, temperature 101.2°F (38.4°C), heart rate 122/minute, and chills. The patient is also somewhat confused and does not know where he is. What does the nurse suspect with the patient? a. Crohn's disease b. Ulcerative colitis c. Diverticulitis d. Peritonitis

d. Peritonitis

15. The nurse is assessing a patient with viral gastroenteritis. Which data is the nurse most concerned about? a. Orthostatic blood pressure changes b. Poor skin turgor c. Dry mucous membranes d. Rebound tenderness

d. Rebound tenderness