Med Surg Ch 43

A Acute diarrhea is usually caused by an infectious process and stool specimens are obtained for culture and examined for parasites or white blood cells. There is no indication that the patient needs a colonoscopy, blood cultures, or a barium enema.

30. A patient calls the clinic and tells the nurse about a new onset of severe and frequent, diarrhea. The nurse anticipates that the patient will need to a. collect a stool specimen. b. prepare for colonoscopy. c. schedule a barium enema. d. have blood cultures drawn.

B Since anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood. The other actions would not be appropriate for the patient with IBD. Because dietary fiber may increase gastrointestinal (GI) motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur.

10. Which nursing action will the nurse include in the plan of care when admitting a patient with an exacerbation of inflammatory bowel disease (IBD)? a. Restrict oral fluid intake. b. Monitor stools for blood. c. Increase dietary fiber intake. d. Ambulate four times daily.

C 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.

12. A patient who has 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 anal irritation. d. The patient cleans the perianal area with soap and water after each stool.

C During acute exacerbations of IBD, the patient should avoid high-fiber foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient.

13. After the nurse has provided patient teaching about recommended dietary choices for a patient with an acute exacerbation of inflammatory bowel disease (IBD), which diet choice by the patient indicates a need for more teaching? a. Scrambled eggs b. White toast and jam c. Oatmeal with cream d. Pancakes with syrup

A Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.

15. When caring for a patient who has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months, the nurse will plan to teach the patient about a. medication use. b. fluid restriction. c. enteral nutrition. d. activity restrictions.

B Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. There is no information indicating that the patient's risk for UTI is caused by poor cleaning or not voiding before and after intercourse. Steroid use may increase the risk for infection, but the characteristics of the patient's urine indicate that a fistula has occurred.

16. A patient with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. The nurse will teach the patient a. to clean the perianal area carefully after any stools. b. about fistula formation between the bowel and bladder. c. to empty the bladder before and after sexual intercourse. d. about the effects of corticosteroid use on immune function.

A The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery, and an ice pack is not needed.

22. During the initial postoperative assessment of a patient's stoma formed from a transverse colostomy, the nurse finds it to be deep pink with moderate edema and a small amount of bleeding. The nurse should a. document the stoma assessment. b. monitor the stoma every 30 minutes. c. notify the surgeon about the stoma appearance. d. place an ice pack on the stoma to reduce swelling.

B High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies lose the absorption of water in the colon and need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible.

23. A patient who has ulcerative colitis has a proctocolectomy and ileostomy. Which information will the nurse include in patient teaching? a. Restrict fluid intake to prevent constant liquid drainage from the stoma. b. Use care when eating high-fiber foods to avoid obstruction of the ileum. c. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. Change the pouch every day to prevent leakage of contents onto the skin.

D Crohn's disease frequently affects the ileum, where absorption of cobalamin occurs, and it must be administered regularly by nasal spray or IM to correct the anemia. Iron deficiency does not cause megaloblastic anemia. The patient may need occasional transfusions but not regularly scheduled transfusions.

31. A patient with Crohn's disease has megaloblastic anemia. The nurse will anticipate teaching the patient about the ongoing need for a. oral ferrous sulfate tablets. b. regular blood transfusions. c. iron dextran (Imferon) infusion. d. cobalamin (B12) nasal spray or injections.

C Rovsing sign occurs when palpation of the left lower quadrant causes pain in the right lower quadrant. McBurney point, rebound pain, and Cullen sign are used to describe other aspects of the abdominal assessment.

32. When performing an admission assessment for a patient with abdominal pain, the nurse palpates the left lower quadrant and the patient complains of right lower quadrant pain. The nurse will document this as a. rebound pain. b. Cullen sign. c. Rovsing sign. d. McBurney point.

C Fecal management systems are designed to contain loose stools and can be in place for as long as 4 weeks without causing damage to the rectum or anal sphincters. Rectal tubes are avoided because of possible damage to the anal sphincter and ulceration of the rectal mucosa. Incontinence briefs may be helpful but, unless they are changed frequently, are likely to increase the risk for skin breakdown. A critically ill patient will not be able to use the commode or bathroom.

33. A critically ill patient develops incontinence of watery stools. What action will be best for the nurse to take to prevent complications associated with ongoing incontinence? a. Insert a rectal tube. b. Use incontinence briefs. c. Implement fecal management system. d. Assist the patient to a bedside commode or to the bathroom at frequent intervals.

B Since peritonitis can be fatal if treatment is delayed, the initial action should be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated.

35. Which of these prescribed interventions will the nurse implement first when caring for a patient who has just been diagnosed with peritonitis caused by a ruptured diverticulum? a. Administer morphine sulfate 4 mg IV. b. Infuse metronidazole (Flagyl) 500 mg IV. c. Send the patient for a computerized tomography scan. d. Insert a nasogastric (NG) tube and connect it to intermittent low suction.

A The initial response by the nurse should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment.

36. Which action should the nurse take first when a patient calls the clinic complaining of diarrhea of 24 hours' duration? a. Ask the patient to describe the character of the stools and any associated symptoms. b. Inform the patient that laboratory testing of blood and stool specimens will be necessary. c. Suggest that the patient drink clear liquid fluids with electrolytes, such as Gatorade or Pedialyte. d. Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal (GI) motility.

D The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.

37. A patient is admitted to the emergency department with severe abdominal pain with rebound tenderness. The vital signs include temperature 101° F (38.3° C), pulse 130, respirations 34, and blood pressure (BP) 84/50. Which of the following interventions should the nurse implement first? a. Administer IV ketorolac (Toradol) 15 mg. b. Draw blood for a complete blood count (CBC). c. Obtain a computed tomography (CT) scan of the abdomen. d. Infuse 1000 mL of lactated Ringer's solution over 30 minutes.

D Blood in the stools is a possible clinical manifestation of colorectal cancer and requires further testing by the health care provider. The other patient information also will be communicated to the health care provider, but does not indicate an urgent need for further testing or intervention.

41. The nurse who is interviewing a 40-year-old obtains information about the following patient problems. Which information is most important to communicate to the health care provider? a. The patient had an appendectomy at age 17. b. The patient smokes a pack/day of cigarettes. c. The patient has a history of frequent constipation. d. The patient has recently noticed blood in the stools.

D The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients also should be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses.

44. After receiving change-of-shift report, which of the following patients should the nurse assess first? a. A patient whose new ileostomy has drained 800 mL over the previous 8 hours b. A patient with familial adenomatous polyposis who has occult blood in the stool c. A patient with ulcerative colitis who has had six liquid stools in the previous 4 hours d. A patient who has abdominal distention and an apical heart rate of 136 beats/minute

D Since infliximab suppresses immune function, rapid treatment of infection is essential. The other patient complaints are common side effects of the medication, but do not indicate any potentially life-threatening complications.

45. A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about all of these symptoms. Which symptom is most important to communicate to the health care provider? a. Nausea b. Joint pain c. Frequent headaches d. Elevated temperature

A An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate. Metoclopramide increases peristalsis and will worsen symptoms.

9. A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to a. place the patient on NPO status. b. administer IV metoclopramide (Reglan). c. teach the patient about total colectomy surgery. d. administer cobalamin (vitamin B12) injections.