IBD Summer Test 5

4 (4 Stopping the diarrhea is a priority for Ms. T. Chronic, frequent diarrhea is demoralizing, and fluid and electrolyte losses cause weakness. If the bowel is allowed to rest, the cramping will stop. The other options also provide accurate information, but the potential resolution of the most disturbing symptom will encourage her to continue. Focus: Prioritization)

Ms. T is discouraged and dispirited about her ulcerative colitis. She is resistant to TPN because "I'm being kept alive with tubes." Which explanation will encourage Ms. T to continue with the TPN therapy? 1. "It will help you regain your weight." 2. "It will create a positive nitrogen balance." 3. "Your physician has ordered this important therapy for you." 4. "Your bowel can rest and the diarrhea will decrease."

2 (clients may devlop folic acid deficiency. Green leafy veges are good for that)

A client has been placed on long term sulfasalazine therapy for treatment of ulcerative colitis. The nurse should encourage the client to eat which foods to help avoid the nutrient deficiencies that may develop as a result of this medication? 1. citrus fruits 2. green leafy vegetables 3. eggs 4. milk products

1 (The immediate problem is controlling the diarrhea. Addressing this problem is a step toward correcting the nutritional imbalance and decreasing the diarrheal cramping. Self-care and compliance with the treatment plan are important long-term goals that can be addressed when the client is feeling better physically. Focus: Prioritization)

A client hospitalized with ulcerative colitis reports 10 to 20 small diarrhea stools per day, with abdominal pain before defecation. The client appears depressed and underweight and is uninterested in self-care or suggested therapies. What is the priority nursing diagnosis? 1. Diarrhea related to irritated bowel 2. Imbalanced Nutrition: Less than Body Requirements related to nutrient loss 3. Acute Pain related to increased GI motility 4. Ineffective Self-Health Management related to treatment plan

4

A client is recieving TPN. The nurse should assess the clients ability to metabolize the solution adequately by monitoring the client for which sign? select all that apply 1. tachycardia 2. hypertension 3. elevated BUN 4. hyperglycemia

2

A client with a history of crohns has concentrated urine, decreased urinary output, dry skin with decreased turgor, hypotension and weak thready pulses. What should the nurse do first? 1. Encourage client to drink at least 1000 mL/day 2. Provide parental rehydration therapy as prescribed 3. Turn and reposition q2h 4. Monitor VS q8

a (Rationale The most correct goal or outcome for the client with inflammatory bowel disease is the client recognized the early signs of a flare up. The client should be free from infection with no loss of skin integrity or weight loss.)

A nurse is planning care for a client with inflammatory bowel disease. What goal or outcome is the best choice for this​ client? a Client recognized the early signs of a flare up. ​b Client's symptoms of infection have not worsened. c Client lost less than​ 5% of​ pre-illness body weight. ​d Client's skin excoriation has not worsened.

3 (Sulfasalazine is potentially nephrotoxic. The other adverse effects are also possible, but are less serious. Focus: Prioritization)

Ms. T is receiving sulfasalazine (Azulfidine) 500 mg by mouth every 6 hours for treatment of ulcerative colitis. Which assessment finding concerns you the most? 1. Urine discoloration 2. Nausea and vomiting 3. Decreased urine output 4. Headache

b,c,e (Rationale: Children with ulcerative colitis typically present with pancolitis which tends to be aggressive and may require clients to undergo bowel surgery to manage the disease and its complications. The primary pharmacologic treatment involves systemic and locally-acting anti-inflammatory drugs, corticosteroids, and anti-diarrheal agents. Because of compromised nutrient absorption from the inflamed bowel, dietary supplementation is needed. Children with ulcerative colitis, like adults, are at greater risk for developing cancer of the colon. It is also very important for affected individuals to adhere to a strict medication regimen even when asymptomatic)

Parents of a 9-year-old diagnosed with ulcerative colitis following a hospitalization for pancolitis ask the nurse to teach them more about the disease, its progression, and the typical treatment regimen. The nurse can accurately share what information with the parents? (Select all that apply.) a Nutritional supplements are usually not required since nutrient absorption is adequate for growth during the periods of remission. b These children often require surgery at some point to manage the disease or its complications. c Medications should be continued even when the child has no symptoms. d Children with ulcerative colitis are at not at greater risk for developing colon cancer in adulthood. e Typical treatment regimens include systemic and locally-acting anti-inflammatory drugs, corticosteroids, and anti-diarrheal agents.

1

TPN is prescribed for a client with Crohns. The TPN solution is having an intended outcome when: 1. The clients nutritional needs are met 2. The client does not have metabolic acidosis 3. The client is hydrated 4 The client is in a negative nitrogen balance

2,4

The HCP has prescribed Cipro for a client who takes warfarin. What should the nurse instruct the client to do? Select all that apply 1. split the tablets and stir them in food 2. avoid exposure to sunlight 3. eleminate caffeine from the diet 4. report unusual bleeding 5. increase fluid intake to 3000 mL.day

a (Rationale While all choices are​ problems, which should be addressed in planning care for the client with inflammatory bowel​ disease, impaired fluid balance is priority as this problem may be​ life-threatening if not addressed.)

The nurse is planning care for a client with inflammatory bowel disease. What problem is priority for the nurse to address when caring for this​ client? a Impaired fluid balance b Impaired nutrition c Fatigue d Impaired skin integrity

b,c,d,e (Rationale Blood may or may not be present in the stool of a client with Crohn​ disease, and the nurse would assess for it. The client with Crohn disease will have​ right, not​ left, lower quadrant abdominal pain relieved by defecation. Persistent diarrhea is a symptom of Crohn disease. Malaise may be present in a client with Crohn disease.​ Fissures, ulcers,​ fistulas, and abscesses of the anorectal area may be present in a client with Crohn​ disease, and the nurse would assess the client for them.)

The nurse is questioning a client with Crohn disease about the presence of current symptoms. Which symptoms would the nurse find in the​ client? ​(Select all that​ apply.) a Left lower quadrant abdominal pain relieved by defecation b Blood in the stool c Persistent diarrhea d Malaise ​e Fissures, ulcers,​ fistulas, and abscesses of the anorectal area

B (Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration and severity. The other options are not associated with diarrhea.)

The nurse is reviewing the record of a client with Crohn's disease. Which of the following stool characteristics would the nurse expect to note documented on the client's record? A Chronic constipation B Diarrhea C Constipation alternating with diarrhea D Stool constantly oozing from the rectum

2 (priority of crohns care in acute exacerbation is to promote bowel rest, this is accomplished by decreasing activity, encouraging rest, and initial NPO status while maintaining nutrition parentally. Diarrhea is nonbloody in crohns and episodes of rectal bleeding are not expected)

What is a priority focus of care for a client experiencing exacerbation of crohns disease? 1. encouraging regular ambulation 2. promoting bowel rest 3. maintaining current weight 4. decreasing episodes of rectal bleeding

2

Which diet would be most appropriate for a client with ulcerative colitis? 1. a high calorie, low protein 2. high protein, low residue 3. low fat, high fiber 4. low sodium, high carbohydrate

2

Which goal for the clients 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

b (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)

Which goal of the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis? A Promoting self-care and independence B Managing diarrhea C Maintaining adequate nutrition D Promoting rest and comfort

3

The nurse changing the subclavian dressing of a client who is receiving TPN. When assessing the cath site the nurse notes the presence of yellow drainage around the sutures that are anchoring the cath. What should the nurse do first? 1. clean the insertion site and redress the area 2. document the assessment findings in the clients chart 3. request a prescription to obtain a culture of the drainage 4. check the clients temp.

d (Rationale Probiotics help reduce inflammation in the bowel and would be used in the treatment of inflammatory bowel disease. Glucose is needed for cellular energy. It is not considered an​ anti-inflammatory agent. Vitamin K is used for clotting. It is not considered an​ anti-inflammatory agent. Energy drinks contain sugars and electrolytes. They are not considered​ anti-inflammatory agents.)

The nurse is caring for a client who has chronic inflammatory bowel disease. The client tells the nurse the she is taking nutritional supplements that help reduce the inflammation. Which supplements are used in the treatment of chronic inflammatory bowel​ disease? a Vitamin K tablets b Energy drinks c Glucose tablets d Probiotics

a (The answer is A. 5-Aminosalicylates (Sulfasalazine) are usually prescribed for mild to moderate cases of ulcerative colitis as first-line treatment. If Aminosalicylates are not working (or the patient is allergic to sulfa) corticosteriods are prescribed. Corticosteriods may be used in combination with immunosupressors. Immunosupressors and immunomodulators are used in severe cases of ulcerative colitis when other medications have not worked.)

A patient is newly diagnosed with mild ulcerative colitis. What type of anti-inflammatory medication is typically prescribed as first-line treatment for this condition? A. 5-Aminosalicylates (Sulfasalazine) B. Immunomodulators (Adalimumab) C. Corticosteroids (Prednisone) D. Immunosupressors (Azathioprine)

a,b,c (Rationale The client with inflammatory bowel disease is at greatest risk for deficient fluid​ volume, diarrhea and constipation. This client does not generally display acute confusion or risk for falls.)

A nurse is caring for a client with inflammatory bowel disease and is planning for the most appropriate client interventions. Which nursing diagnosis best supports the interventions needed for the client with inflammatory bowel​ disease? ​(Select all that​ apply.) a Diarrhea b Constipation c Risk for deficient fluid volume d Acute confusion e Risk for injury

c (With Crohn​ disease, the bowel lumen begins to appear as​ "cobblestones," as fissures and ulcers surround islands of intact tissue over edematous submucosa. The inflammatory lesions are not continuous and often occur as​ "skip" lesions with intervals of​ normal-appearing bowel. Clients with ulcerative colitis have a bowel that appears​ red, edematous, and friable. The inflammation of ulcerative colitis begins at the crypts of​ Lieberkühn in the distal large intestine and rectum.)

Alicia​ Meritt, a​ 22-year-old woman with complaints of fatigue and persistent​ diarrhea, is suspected of having Crohn disease and is scheduled to have a colonoscopy. Which finding would​ Alicia's nurse expect to see from the colonoscopy if Alicia has Crohn​ disease? ​a Red, edematous, and friable tissue b Continuous inflammatory lesions of bowel c Cobblestone appearance of bowel d Inflammation that begins at the crypts of​ Lieberkühn in the distal large intestine and rectum

2,5

The nurse is assigning clients for the evening shift. Which clients are appropriate to assign to a LPN to provide client care? Select all that apply 1. a client with Crohns who is receiving TPN 2. a client who had inguinal hernia repair surgery 3 hours ago, VS are stable 3. a client with an intestinal obstruction who needs a cantor tube inserted 4. a client with diverticulitis who needs teaching about take home meds 5. a client who is experiencing an exacerbation of ulcerative colitis

b,d,e (Rationale Attacks of ulcerative colitis usually last 1 to 3 months. These attacks occur at intervals over months to years. Ulcerative​ colitis, a chronic inflammatory bowel​ disease, affects the mucosa and submucosa of the colon and​ rectum, not the small intestine. A secondary peak of ulcerative colitis occurs between the ages of 60 and 80​ years, not 40 and 50 years. The onset of ulcerative colitis is usually insidious. Most clients with ulcerative colitis have mild to moderate symptoms with six or fewer stools per day.)

The nurse is planning care for a client with ulcerative colitis. Which characteristics associated with ulcerative colitis will the nurse​ recognize? ​(Select all that​ apply.) a A secondary peak of ulcerative colitis occurs between the ages of 40 and 50 years. b Attacks last 1 to 3 months. c It affects the mucosa and submucosa of the small intestine. d Mild to moderate symptoms are present. e The onset is usually insidious.

d (The surgery Ms. Jacobs will undergo is a strictureplasty. Longitudinal incisions are made in the narrow bowel segments to relieve strictures. The total colectomy ileal​ pouch-anal anastomosis​ (IPAA) is usually performed on patients with ulcerative colitis. A bowel resection is aimed at reducing inflammation by removing the diseased part of the bowel. In​ Ms.Jacob's case, there is a less serious option. A sigmoidoscopy is a procedure to inspect the bowels for changes​ and, if​ needed, to take biopsies.)

Danae Jacobs is a​ 35-year-old woman with a history of Crohn​ disease, which manifested itself when she was 21 years old. For the last 2​ years, she has been on numerous antibiotics and steroids with less than desirable effects. After a recent​ colonoscopy, the surgeon has told Danae that strictures have formed in her bowel and he suggested surgery. What surgery does​ Danae's nurse anticipate Danae​ needing? a Sigmoidoscopy b Bowel resection c Total colectomy ileal​ pouch-anal anastomosis​ (IPAA) d Strictureplasty

a,b,d (Rationale Corticosteroids should be taken with food or at mealtimes to reduce the gastrointestinal side effects. A client taking corticosteroids tends to retain​ fluid, and sodium tends to exacerbate the retention.​ Therefore, the client should reduce the intake of foods that are high in sodium. Corticosteroids should be taken consistently and not be stopped abruptly to reduce the possibility of adrenal shutdown. A client taking corticosteroids tends to​ gain, not​ lose, weight. A client taking corticosteroids tends to have​ high, not​ low, blood pressure.)

The nurse is caring for a client with inflammatory bowel disease who is being treated with corticosteroids. Which information would the nurse provide for the client about the​ medications? ​(Select all that​ apply.) a Reduce intake of foods high in sodium b Take medication consistently and do not stop abruptly c It may cause low blood pressure. d Take with food or at mealtimes e Expect weight loss

3 4 1 2 6 5 (Immediate decontamination is appropriate, because time can affect viral load. The occupational health nurse will direct the UAP in filing the correct forms, getting the appropriate laboratory tests, obtaining appropriate prophylaxis, and following up on results. Focus: Prioritization, supervision)

While transferring a dirty laundry bag, a UAP sustains a puncture wound to the finger from a contaminated needle. The unit has several clients with hepatitis and acquired immunodeficiency syndrome (AIDS); the needle source is unknown. Place in order of priority the instructions that should be given to the UAP. 1. Have blood test(s) performed per protocol. 2. Complete and file an incident report. 3. Perform a thorough aseptic hand washing. 4. Report to the occupational health nurse. 5. Follow up for results and counseling. 6. Begin prophylactic drug therapy. _____, _____, _____, _____, _____, _____

d (The answer is D. Pancolitis affects all the colon and is a very severe form of ulcerative colon. The patient is at risk for toxic megacolon. In toxic megacolon, the large intestine dilates due to the overwhelming inflammation. The large intestine is unable to function properly and becomes paralyzed. Typical signs and symptoms of toxic megacolon include: abdominal distention, fever, diarrhea, abdominal pain, dehydration, and tachycardia.)

A patient diagnosed with pancolitis is experiencing extreme abdominal distension, pain 10 on 1-10 scale in the abdomen, temperature of 103.6 'F, HR 120, and profuse diarrhea. What complication due you suspect the pain is experiencing? A. Fistulae B. Stricture C. Bowel obstruction D. Toxic megacolon

d (The answer is D. Left-sided colitis (distal colitis) starts in the rectum and goes to the sigmoid and descending colon. Ulcerative proctitis affects the rectum only. Proctosigmoiditis affects the rectum and sigmoid colon. Right-sided colitis is NOT a type of ulcerative colitis.)

A patient is admitted with ulcerative colitis. In the physician's notes, it is stated that the patient's barium enema results showed the patient has colitis that starts in the rectum and extends into the sigmoid and descending colon. As the nurse, you know that this is what type of ulcerative colitis? A. Right-sided colitis B. Proctosigmoiditis C. Ulcerative procotitis D. Left-sided colitis

4 (Rationale: bowel perforation, obstruction or hemorrhage and toxic megacolon are common complications of ulcerative colitis that may require surgery. )

A HCP and nurse are discussing options with a client diagnosed with severe ulcerative colitis. When providing client teaching during early treatment the symptoms of which diagnosis would be discussed? 1. gastritis 2. bowel herniation 3. bowel outpouching 4. bowel perforation

4,5 (IBS (Crohns) is an inflammatory bowel disease caused by the inflammation of the lining of the digestive tract, which can lead to abdominal pain, severe diarrhea, and even malnutrition. Corticosteroids such as prednisone reduce the S/S of diarrhea, pain and bleeding by decreasing inflammation. Antidiarrheals, combat diarrhea by decreasing peristalsis. Lactulose is used to treat chronic constipation and would aggravate the symptoms of Crohns, A high fiber diet and milk and milk products are contraindicated in clients with Crohns because the may promote diarrhea.)

A client is admitted with inflammatory bowel syndrome (Crohns disease). When planning care for the health care team, which would be included? Select all that apply 1. Lactulose therapy 2. high-fiber diet 3. high protein milkshakes 4. corticosteroid therapy 5. antidiarrheal medications

2

A client newly diagnosed with ulcerative colitis who has been places on steroids asks the nurse why steroids are prescribed. The nurse should tell the client: 1. ulcerative colitis can be cured with steroids 2. steroids are used in severe flare ups because they can decrease the incidence of bleeding 3. long term use of steroids will prolong periods of remission 4. the side effects of steroids outweigh their benefits to clients with ulcerative colitis

c (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.)

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? A Initiate continuous enteral feedings B Encourage a high protein, high-calorie diet C Implement total parenteral nutrition D Provide six small meals a day

a,c,e (Rationale: A client with ulcerative colitis having a total colectomy with an ileal pouch-anal anastomosis and ileostomy can expect that the anal anastomosis will be healed in 2-3 months. The ileostomy is then closed. Meanwhile, the client will not have control of the bowels and must always wear a collection device. .Once the bowel is healed and the ileostomy closed, the client can expect to have 6-8 bowel movements a day)

A client who has ulcerative colitis is scheduled for a total colectomy with an ileal pouch-anal anastomosis (IPAA) and a temporary ileostomy. When the client asks the nurse what to expect related to bowel function and care after surgery, the nurse accurately responds with the following: (Select all that apply.) a "The stoma will require that you wear a collective device at all times." b "You will be able to have some control over your bowel movements with the ileostomy." c "The temporary ileostomy is usually maintained for 2-3 months while the bowel heals, then is closed." d "After the stoma heals, you can irrigate your bowel so you won't have to wear a collection pouch." e "Once the ileostomy is closed, you can expect to have 6-bowel movements through the anus daily."

c (Salicylate compounds act by inhibiting prostaglandin synthesis and reducing inflammation. The nurse teaches the client to take the medication with a full glass of water and to increase fluid intake throughout the day. This medication needs to be taken after meals to reduce GI irritation.)

A client with ulcerative colitis has an order to begin salicylate medication to reduce inflammation. The nurse instructs the client to take the medication: A 30 minutes before meals B On an empty stomach C After meals D On arising

1,2,4 (sulfasalazine may cause dizziness, acute intol s/s cramping, acute abd pain, bloody diarrhea, fever, headache, rash, D/C!, med may make urine change color to orange=ok. Take missed doses ASAP unless almost time for next dose)

A client with ulcerative colitis taking sufasalazine. which instructions should the nurse give the client about taking this med at home? select all 1. Drink enough fluids to maintain a urine output of 1200-1500 mL/day 2. D/C therapy if symptoms of acute intolerance develop and notify HCP 3. Stop taking the med if the urine turns orange-yellow 4. avoid activities that require alertness 5. If dose is missed, skip and continue with next dose

b,c,d,e (Rationale Interventions for a client with inflammatory bowel disease primarily focus on preventing​ infection, monitoring​ weight, maintaining skin​ integrity, promoting nutritional​ balance, and maintaining fluid balance. Encouraging deep breathing and coughing may be an appropriate​ intervention, but this is not a primary focus for this client.)

A nurse is caring for a client with inflammatory bowel disease. When planning care for this​ client, which interventions take primary​ focus? ​(Select all that​ apply.) a Encourage deep breathing and coughing b Monitor weight c Promote nutritional balance d Maintain skin integrity e Maintain fluid balance

b (Rationale: The client with Crohn's disease is likely to have diarrhea with no obvious blood or mucus in the stools. Frothy stools are not characteristic of Crohn's disease. Abdominal pain in Crohn's disease is typically cramping or steady and located in the lower right quadrant or around the umbilicus. A clinical manifestation of ulcerative colitis is cramping in the lower left quadrant relieved by defecation. )

A nurse is caring for the client with Crohn's disease who was admitted last night. Which of the following manifestations would the nurse expect to note for this client? a Cramping in the lower left quadrant with relief with defecation b Diarrhea c Frothy stools d Bloody stools

d (Rationale: Young adult clients typically have concerns about managing sexual activity with an ileostomy. Validating these concerns and helping these individuals obtain the knowledge they are seeking will them cope more effectively with this significant threat to self-image. The nurse should indicate that she understands this client's concern and then ensure that the two of them can have privacy to discuss sensitive questions. The United Ostomy Association and its local chapters have printed materials available on this topic, but simply handing the patient a brochure is not the best strategy to address the client's needs. )

A young adult client with inflammatory bowel disease has just undergone a temporary ileostomy. He tells the nurse that he is not sure how he can handle any future sexual encounters. What is the best response the nurse might provide? a "Granted, this will be a challenge, but you'll figure it out over time." b "It's a bit early to be thinking about this...let's plan to talk about it on a follow-up visit." c "Here's a pamphlet from the United Ostomy Association that you can read about sex and ostomies." d "I can understand how this can be a real concern. Let's go find a place to talk where we can have privacy."

b,e (Rationale: Essential content with TPN instruction includes teaching about central venous line dressing changes using sterile technique and the need to carefully monitor the client's intake and output. While monitoring for fever is important to identify the onset of a possible infection, an alert adult will able to inform the caregiver if s/he begins to feel warm or has fever. Routine listening for bowel sounds and palpating the abdomen are not aspects of routine home care for the alert adult client on TNP therapy. )

An alert adult client with severe inflammatory bowel disease (IBD) requires short-term total parenteral nutrition (TPN) following discharge home. Which nursing actions are particularly important when teaching this client and family members about TPN? (Select all that apply.) a Periodically palpate the abdomen for tenderness. b Carefully document the client's intake and output. c Listen for bowel sounds regularly using the stethoscope provided to the family. d Take the client's temperature every 4 hours whether or not the client feels warm to the touch. e Make sure the client and family members use sterile technique when changing the central venous catheter dressing.

d (​Eli's ulcerative colitis is causing severe​ diarrhea, and he is most likely dehydrated.​ Therefore, the nurse should provide intravenous fluids as prescribed.​ Anti-inflammatory medications should be administered as prescribed to help ameliorate the diarrhea episodes. The nurse should assess the perianal region for irritation or excoriation and apply a protective cream to the irritated areas as indicated. Daily weights should be performed to help assess​ Eli's hydration status.)

Eli Schwartz is a​ 15-year-old boy who was recently diagnosed with ulcerative colitis and is admitted to the hospital with severe diarrhea. Which nursing intervention would​ Eli's nurse provide for​ Eli? a Weigh every other day b Avoid placing any kind of cream on the perianal region c Avoid​ anti-inflammatory medications d Infuse intravenous fluids as prescribed

2 (Explaining the physiologic reason helps the UAP to understand that rest is part of the therapy. Following physician's orders is important, but it is an inadequate explanation. Depression does not justify bed rest. Using large words to explain common concepts should be avoided, regardless of the audience. Focus: Supervision; QSEN: TC; Concept: Professionalism)

The UAP asks, "Why can't Ms. T get out of bed and do things for herself? She's only 29." What is your best response? 1. "The physician ordered bed rest for a few days." 2. "Decreasing activity helps to decrease the diarrhea." 3. "Acute exacerbations require decreased GI motility." 4. "She is too depressed and malnourished."

2

The basic component of TPN solution is likely to be: 1 isotonic dextrose solution 2 hypertonic dextrose solution 3 hypotonic dextrose solution 4 colloidal dextrose solution

c (Rationale: The signs and symptoms of Crohn disease vary widely since any portion of the GI tract, from the mouth to the anus, can be affected. Early manifestations of the disease can be insidious, and it is not uncommon for individuals to learn they have the disease when they develop an intestinal obstruction or abscess. Careful adherence to drug therapy plays a key role in terminating acute illness episodes and in preventing relapse. In spite of frequent diarrhea, clients with Crohn disease on long-term corticosteroid therapy may experience Cushingoid effects (e.g., abnormal fat deposition in the face and trunk, osteoporosis). )

The nurse and pharmacist are planning an educational session for families of newly-diagnosed clients with Crohn's disease. Content they should cover include which facts about this chronic condition? a Corticosteroids used to reduce inflammation and induce remission in Crohn's disease have few systemic side effects because of their rapid transit through the gut. b Adherence to a prescribed treatment regimen does not significantly improve rates of reoccurrences or disease flares. c The manifestations of Crohn's disease vary widely among individuals with this condition. d It is rare for clients to first learn they have Crohn's disease by experiencing a bowel obstruction or intestinal abscess.

a (Rationale A total colectomy IPAA is a treatment for a client with ulcerative colitis. It entails the removal of the entire colon and rectum and the formation of a temporary or loop ileostomy at the same time. The ileostomy is used for 2 to 3 months. A strictureplasty is used to treat bowel strictures and does not involve the removal of the bowel or creation of an ostomy. A gastric resection is the removal of part of the​ stomach, not the bowel. It does not involve the creation of an ostomy. A pyloroplasty is a surgical procedure to widen the opening of the pyloric valve at the lower portion of the stomach. It does not involve the removal of the bowel or the creation of an ostomy.)

The nurse is admitting a client with ulcerative colitis who is scheduled for surgery. The client tells the nurse that he is having his bowel removed and will have a temporary ostomy for 2 to 3 months. Which upcoming surgical procedure is the client​ describing? a Total colectomy ileal​ pouch-anal anastomosis​ (IPAA) b Gastric resection c Pyloroplasty d Strictureplasty

a,b,d (Rationale Mesalamine is a​ sulfa-based medication that has the same active ingredients as sulfasalazine and therefore should not be administered to a client with a sulfa allergy. Cipro is a​ fluoroquinolone, not a sulfa​ drug, and could be given to a client with a sulfa allergy. Sulfasalazine is a sulfonamide and therefore should not be administered to a client with a sulfa allergy. Olsalazine is a​ sulfa-based medication that has the same active ingredients as sulfasalazine and therefore should not be administered to a client with a sulfa allergy. Clarithromycin is a​ macrolide, not a sulfa​ drug, and could be given to a client with a sulfa allergy.)

The nurse is caring for a client with chronic inflammatory bowel disease who is prescribed antibiotics to treat the condition. The client reports an allergy to sulfa. Which medication orders will the nurse​ question? ​(Select all that​ apply.) a Olsalazine​ (Dipentum) b Mesalamine​ (Asacol, Rowasa) c Ciprofloxacin​ (Cipro) d Sulfasalazine​ (Azulfidine) e Clarithromycin​ (Biaxin)

a,b,c,d (Rationale Chronic inflammatory bowel disease tends to run in​ families, with​ 15% to​ 25% of clients having a family member with one of the diseases. Although the peak incidence of chronic inflammatory bowel disease is in adolescence and young​ adulthood, it can also affect older adults. Chronic inflammatory bowel disease is not caused by environmental factors​ alone, but these factors do play a role in the etiology of the disease. The peak incidence of chronic inflammatory bowel disease is in adolescence and young​ adulthood, between the ages of 15 and 30 years. Chronic inflammatory bowel disease occurs more frequently in the United States and northern European nations. As many as 1 million Americans have chronic inflammatory bowel disease.)

The nurse is discussing the incidence of inflammatory bowel disease with a group of nursing students. Which information would the nurse include in the​ discussion? ​(Select all that​ apply.) a The disease occurs more frequently in the United States and northern European nations. b Environmental factors can contribute to the etiology of chronic inflammatory bowel disease. c The disease is often linked to heredity. d The peak incidence of the disease is in adolescence and young adulthood. e Chronic inflammatory bowel disease does not affect older adults.

b (Rationale: Frequent diarrhea results in irritated or denuded perianal skin. Gentle cleansing agents such as Peri-Wash, tucks, diaper wipes, and cotton balls saturated with witch hazel can be both soothing and facilitate healing. Protective creams like zinc oxide-based products also help to protect the skin around the anus from breakdown. Antibiotics are not routinely placed around the anus. Maintaining good fluid intake will lessen the risk of having dehydrated skin that is more susceptible to excoriation. )

The nurse is evaluating the client's understanding regarding care of the skin during an acute exacerbation of inflammatory bowel disease with frequent stooling. The nurse determines that teaching goals have been met when the client indicates he will follow which actions for self-care? a Apply antibiotic ointment around the anus. b Carefully clean the perianal skin with a mild cleanser. c Limit intake of fluids. d Use a perfumed or scented lotion around the anus.

b (Rationale Ulcerative colitis begins with inflammation at the rectosigmoid area of the anal canal and progresses proximally. Ulcerative colitis can progress to the entire​ colon, stopping at the ileocecal junction. The duodenum is part of the small intestine and is not affected by ulcerative colitis. The transverse colon is not initially affected by ulcerative colitis.)

The nurse is planning care for a client in the early stages of ulcerative colitis. The nurse understands that which part of the colon is initially affected by ulcerative​ colitis? a Transverse colon b Rectosigmoid area c Ileocecal junction d Duodenum

b,c (Sulfasalazine​ (Azulfidine) blocks the production of prostaglandin to reduce inflammation. The client should use sunscreen when taking​ this, since this medication causes photosensitivity. This medication does not stimulate appetite or reduce the number of stools per day. Clients taking corticosteroids should decrease sodium​ intake, and this medication is an​ antibiotic, which does not require this dietary restriction.)

What is true regarding sulfasalazine​ (Azulfidine) prescribed for clients with inflammatory bowel​ disease? ​(Select all that​ apply.) a The client should reduce intake of sodium when taking this. b It blocks the production of prostaglandin to reduce inflammation. c The client should use sunscreen when taking this. d It reduces the amount of stools per day to maintain fluid balance. e The main side effect is appetite stimulation.

c (The most common age of onset for ulcerative colitis is between 15 and 30​ years, with a secondary peak between the ages of 60 to 80 years. The most common age of onset for ulcerative colitis is not between 5 and​ 15, 25 and​ 55, or 30 and 60 years.)

When does the onset of ulcerative colitis most commonly​ occur? a Between the ages of 5 and 15 years b Between the ages of 30 and 60 years c Between the ages of 15 and 30 years d Between the ages of 25 and 55 years

a (Rationale: Sulfasalazine makes the client more susceptible to sunburn, so the client is instructed to use sunscreen when outside. The medication should be taken following meals rather than before meals to increase intestinal transit time. It should also be taken with a full glass of water, and daily fluid intake should be increased to a minimum of about 2000 mL (2 quarts) rather than 1.5 mL. There is no known reason to take vitamin C while on this medication, although individuals with IBD are at risk for decreased absorption of vitamins and minerals due to the disease process. )

When teaching a client with inflammatory bowel disease about prescribed oral sulfasalazine, the nurse should instruct the client to: a use sunscreen while taking the medication. b take vitamin C while on this medication. c limit fluids to 1500 mL or less per day. d take the medication on an empty stomach.

c (Infliximab​ (Remicade), an immune response​ modifier, suppresses tumor necrosis factor​ (TNF) to reduce inflammation in the treatment of inflammatory bowel disease. Olsalazine​ (Dipentum) and metronidazole​ (Flagyl) are antibiotics which are used to treat inflammatory bowel disease and do not suppress tumor necrosis factor​ (TNF). Methylprednisolone​ (Solu-Medrol) is a​ corticosteroid, which is used to treat inflammatory bowel disease and does not suppress tumor necrosis factor​ (TNF).)

Which pharmacologic therapy used in the treatment of inflammatory bowel diseases suppresses tumor necrosis factor​ (TNF) to reduce​ inflammation? a Methylprednisolone​ (Solu-Medrol) b Olsalazine​ (Dipentum) c Infliximab​ (Remicade) d Metronidazole​ (Flagyl)