prep chapter 48

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? "I don't understand this; I took the medication the doctor ordered and followed the diet." "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." "I don't understand why this happened again; I didn't travel out of the country." "I don't like oatmeal, so it doesn't matter that I can't have it."

he client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease.

What is the most common cause of small bowel obstruction? Hernias Neoplasms Adhesions Volvulus

Adhesions are scar tissue that forms as a result of inflammation and infection. Adhesions are the most common cause of small bowel obstruction, followed by hernias and neoplasms. Other causes include intussusceptions, volvulus, and paralytics ileus.

When a nurse recommends the following laxative, she emphasizes that it should not be taken with meals. Choose the laxative. Colace Dulcolax Mineral Oil Metamucil

Mineral oil should never be taken with meals because it can impair the absorption of fat-soluble vitamins and delay gastric emptying. Refer to Table 24-1 in the text.

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

The clusters of ulcers take on a cobblestone appearance.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? Right upper quadrant Right lower quadrant Left upper quadrant Left lower quadrant

The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

During assessment of a patient for a malabsorption disorder, the nurse notes a history of abdominal pain and weight loss, marked steatorrhea, azotorrhea, and frequent glucose intolerance. Based on these clinical features, the nurse suspects a diagnosis of: Lactose intolerance. Celiac disease. Pancreatic insufficiency. Ileal dysfunction.

These symptoms are consistent with a diagnosis of pancreatic insufficiency. Loss of ileal absorbing surface results in ileal dysfunction. A toxic response to gluten is characteristic of celiac disease, and a deficiency of intestinal lactase results in lactose intolerance. Refer to Table 24-2 in the text.

Vomiting results in which of the following acid-base imbalances? Metabolic alkalosis Metabolic acidosis Respiratory acidosis Respiratory alkalosis

Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse? Inform the patient that it will only last a minute and continue with the procedure. Clamp the tubing and give the patient a rest period. Stop the irrigation and remove the tube. Replace the fluid with cooler water since it is probably too warm.

When irrigating a colostomy, the nurse should allow tepid fluid to enter the colon slowly. If cramping occurs, the nurse should clamp off the tubing and allow the patient to rest before progressing. Water should flow in over a 5- to 10-minute period.

Which of the following is considered a stimulant laxative? Magnesium hydroxide (milk of Magnesia) Bisacodyl (Dulcolax) Mineral oil Psyllium hydrophilic mucilloid (Metamucil)

bisacodyl

What is the primary nursing diagnosis for a client with a bowel obstruction? Deficient fluid volume Deficient knowledge Acute pain Ineffective tissue perfusion

deficit fluid volume Feces, fluid, and gas accumulate above a bowel obstruction. Then the absorption of fluids decreases and gastric secretions increase. This process leads to a loss of fluids and electrolytes in circulation. Therefore, Deficient fluid volume is the primary diagnosis. Deficient knowledge, Acute pain, and Ineffective tissue perfusion are applicable but not the primary nursing diagnosis.

A patient with an ileostomy should avoid which of the following? Enteric-coated products Antacids and antibiotics Wax matrix coated products Nonlayered tablets

enteric coated

An elderly patient diagnosed with diarrhea is taking digoxin (Lanoxin). Which of the following electrolyte imbalances should the nurse be alert to? Hyperkalemia Hypokalemia Hyponatremia Hypernatremia

hypokalemia

Crohn's disease is a condition of malabsorption caused by which of the following pathophysiological processes? Inflammation of all layers of intestinal mucosa Infectious disease Disaccharidase deficiency Gastric resection

inflammation of all layeers of intestinal mucosa

A patient visited a nurse practitioner because he had diarrhea for 2 weeks. He described his stool as large and greasy. The nurse knows that this description is consistent with a diagnosis of: A small bowel disorder. Intestinal malabsorption. Inflammatory colitis. A disorder of the large bowel.

intestinal malabsorption

The nurse is conducting a gastrointestinal assessment. When the patient complains of the presence of mucus and pus in his stools, the nurse assesses for additional signs/symptoms of which of the following disease/conditions? Small-bowel disease Ulcerative colitis Disorders of the colon Intestinal malabsorption

ulcerative colitits

Celiac sprue is an example of which category of malabsorption? Infectious diseases causing generalized malabsorption Mucosal disorders causing generalized malabsorption Luminal problems causing malabsorption Postoperative malabsorption

mucosal disordere scausing generalized malabosrption

The nurse is monitoring a patient's postoperative course after an appendectomy. The nurse's assessment reveals that the patient has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse's report to the physician is that the patient has signs/symptoms of which of the following complications? Peritonitis Pelvic abscess Ileus Hemorrhage

peritonitis

A client is being treated for prolonged diarrhea. Which of the following foods should the nurse encourage the client to consume? Protein-rich foods Potassium-rich foods High-fiber foods High-fat foods

potassium rich

An elderly client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? stool consistency and client comfort one bowel movement daily one bowel movement every other day two bowel movements daily

stool consistency and client comfort

A client realizes that regular use of laxatives has greatly improved his bowel pattern. However, the nurse cautions this client against the prolonged use of laxatives for which reason? The client may develop inflammatory bowel disease. The client may develop arthritis or arthralgia. The client's natural bowel function may become sluggish. The client may lose his appetite.

the clients natural bowel function may become sluggish