chapter 57
A male patient 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? CORRECT
"A change in position may be what is needed for you to have intercourse with your wife."
A nurse is teaching a patient with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the patient?
"Avoid large crowds and anyone who is sick."
A patient diagnosed with ulcerative colitis (UC) is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication?
"Be aware of the signs/symptoms of toxic megacolon that we discussed."
A Certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a patient about caring for a new ileostomy. What information is most important to include?
"Call your primary health care provider if your stoma has a bluish or pale look."
A nurse is teaching a patient about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advice the patient?
"Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet."
A patient 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 patient to do in the meantime?
"Consume extra fluids to replace fluid losses."
A patient with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving signs/symptoms. How does the nurse reply?
"It is absorbed quickly and allows the affected part of the GI tract to rest and heal."
A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices?
"Lactose-containing foods should be reduced or eliminated from your diet."
A patient is admitted with severe viral gastroenteritis caused by norovirus. The patient asks the nurse, "How did I get this disease?" Which answer by the nurse is correct?
"You may have consumed contaminated food or water."
A patient newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the patient about why this therapy has been prescribed?
"Your intestinal inflammation will be reduced."
The RN receives a change-of-shift report about four patients. Which patient does the nurse assess first?
A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F (37.9°C)
Which patient does the charge nurse assign to an experienced LPN/LVN?
A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy
An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which patient does the charge nurse assign to the float nurse?
A 36-year-old with peritonitis who just returned from surgery with multiple drains in place
The nurse is instructing a patient with recently diagnosed diverticular disease about diet. What food does the nurse suggest the patient include?
A slice of 5-grain bread
A patient is scheduled for discharge after surgery for inflammatory bowel disease. The patient's spouse will be assisting home health services with the patient's care. What is most important for the home health nurse to assess in the patient and the spouse with regard to the patient's home care? CORRECT
Ability of the patient and spouse to perform incision care and dressing changes
A home health patient has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the patient with self-care?
Checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions
A patient has vague symptoms that indicate an acute inflammatory bowel disorder. Which signs/symptoms are most indicative of Crohn's disease (CD)?
Chronic diarrhea, abdominal colicky pain, and fever
A patient with ulcerative colitis (UC) is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the patient's medication regimen?
Corticosteroid therapy will be tapered.
A patient 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 patient with a stoma who performs self-care talk with the patient
A patient with a history of osteoarthritis has a 10-inch (25.5 cm) incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the patient's care does the nurse make certain to discuss with the primary health care provider before the patient's discharge?
Having a home health consultation for wound care
A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms?
Ingestion of parasites in the water
A patient with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The patient asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond?
It is usually ready to be closed in about 1 to 2 months."
A patient admitted with severe gastroenteritis has been started on an IV, but the patient continues having excessive diarrhea. Which medication does the nurse expect the primary health care provider to prescribe?
Loperamide (Imodium)
Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)?
Patients with UC may experience hemorrhage.
A patient returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this patient after the patient is situated in bed?
Semi-Fowler's
An 80-year-old patient with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first?
Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.
An obese patient is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the patient's home health nurse requires immediate action?
States, "I feel like the incision is splitting open"
A patient has an anal fissure. Which intervention most effectively promotes perineal comfort for the patient?
Using hydrocortisone cream to relieve pain
A patient admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this patient?
Using sitz baths three times daily
A patient who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The patient tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members?
Written and oral instructions regarding signs/symptoms to report to the primary health care provider
The nurse is teaching a patient who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the patient to report to the primary health care provider?
anorexia headache vomit
the nurse is caring for an older adult who experiences an exacerbation of UC with diarrhea that lasts a week. What complications does the nurse assess for select all
dehydration hypokalemia skin breakdown
a client who recently had laparoscopic surgery to treat ruptured appendix has developed subsequent peritonitis. the client has 2 jackson pratt drainsin the abdomen. what findings would the nurse immediately report? select all
fever cloudy drainage painful abd distension
the nurse is caring for a client with celiac disease which food will the nurse remove from the dietary tray select all
graham crackers croissant
the nurse is teaching a client about nutrition and diverticuilitis what food should the client avoid
popcorn
the nurse is caring for a client who has been rx a glucocorticoid to tx exacerbation of UC. What teaching does the nurse provide
report fever to health care provider