AH-Ex 8: Chap 60 Evolve
A client has a total colectomy, and a continent ileostomy is created. Which postoperative instruction does the nurse emphasize to this client?
a. A small dressing must be worn over the stoma @ all times
Which client does the charge nurse assign to an experienced LPN/LVN?
b. 30yo who needs to receive neomycin sulfate (Mycifradin) before colectomy
A male client with a long history of ulcerative colitis (UC) 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?
a. "A change in position may be what is needed for you to have intercourse w/your wife."
A nurse is teaching a client with Crohn's disease (CD) about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client?
a. "Avoid large crowds and anyone who is sick."
A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileoanal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond?
a. "It is usually ready to be closed in about 1 to 2 mths."
Situation: A 38-year-old male is admitted with severe gastroenteritis. He states, "I've had watery diarrhea and frequent vomiting for the past couple of days; I am becoming very weak." A health care provider prescribes an IV for him. What fluid does the nurse expect to be administered?
a. .45% normal saline
A nurse is instructing a client with recently diagnosed diverticular disease about diet. What food does the nurse suggest the client include?
a. A slice of 5-grain bread
A client is scheduled for discharge after surgery for inflammatory bowel disease (IBD). The client's spouse will be assisting home health services with the client's care. What is most important for the home health nurse to assess in the client and the spouse with regard to the client's home care?
a. Ability of the couple to perform incision care & dressing changes
A nurse is teaching a client who recently began taking sulfasalazine (Azulfidine) about the drug. What does the nurse tell the client to report to the health care provider? Select all that apply.
a. Anorexia e. Headache f. Vomiting
Situation: A 21-year-old woman has abdominal pain, cramping, and diarrhea. She reports having 10 to 12 liquid bloody stools per day. A stool sample for ova and parasites is negative. A diagnosis of ulcerative colitis (UC) is made. She is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does a nurse include in the teaching about this medication?
a. Be aware of the symptoms (as we discussed) of toxic megacolon
Situation: A 38-year-old male is admitted with severe gastroenteritis. He states, "I've had watery diarrhea and frequent vomiting for the past couple of days; I am becoming very weak." A health care provider prescribes an IV for him. The IV has been started, but the client continues with excessive diarrhea. He is given the maximum amount of an antispasmodic agent and yet continues to have diarrhea. What is additionally prescribed to decrease the watery volume of his stools?
a. Bismuth subsalicylate (Pepto-Bismol)
A client with a history of osteoarthritis has a 10-inch incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the client's care does the nurse make certain to discuss with the health care provider before the client's discharge?
a. Having a home health consultation for wound care
A certified wound, ostomy, continence nurse (CWOCN) nurse is teaching a client about caring for a new ileostomy. What information is most important to include?
b. "Call the healthcare provider if your stoma has a bluish or pale look."
A nurse is teaching a client about dietary methods to help manage exacerbations ("flare-ups") of diverticulitis. What does the nurse advise the client?
b. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, resume a high-fiber diet."
An RN receives a change-of-shift report about four clients. Which client does the nurse assess first?
b. 25yo who has just been admitted w/possible appendicitis w/a temp of 102F
A client has vague symptoms that indicate an acute inflammatory bowel disorder (IBD). Which symptom is most indicative of Crohn's disease (CD)?
b. Chronic diarrhea, abdominal pain, & fever
Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)?
b. Clients w/UC may experience hemorrhage
A client 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?
b. Has another client w/a stoma who performs self-care come & talk w/the client
A client has developed gastroenteritis while traveling outside the country. What is the likely cause of the client's symptoms?
b. Ingestion of parasites in water
Situation: A 38-year-old male is admitted with severe gastroenteritis. He states, "I've had watery diarrhea and frequent vomiting for the past couple of days; I am becoming very weak." A health care provider prescribes an IV for him. The IV has been started, but the client continues with excessive diarrhea. Which medication does the nurse ask the health care provider about prescribing?
b. Loporamide (Imodium)
A client attending a summer camp develops an Escherichia coli infection. What does the camp nurse tell campers about how to prevent this infection?
c. "If you are swimming, avoid swallowing the water."
A client has newly diagnosed ulcerative colitis (UC). What does the nurse tell the client about diet and lifestyle choices?
c. "Lactose containing foods should be reduced or eliminated for your diet."
A home health client has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to a home health aide (unlicensed assistive personnel [UAP]) who assists the client with self-care?
c. Checking & reporting the client's hr & ortho BP
A client with an exacerbation of ulcerative colitis (UC) has been prescribed a low-residue diet. Which meal does the nurse help the client select?
c. Scrambled eggs, white toast w/margarine
A nurse is caring for a client who returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this client after the client is situated in bed?
c. Semi-Fowler's
Situation: A 21-year-old woman has abdominal pain, cramping, and diarrhea. She reports having 10 to 12 liquid bloody stools per day. A stool sample for ova and parasites is negative. A diagnosis of ulcerative colitis (UC) is made, and she is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in her medication regimen?
c. Taper the corticosteroid therapy
Situation: A 21-year-old woman has abdominal pain, cramping, and diarrhea. She reports having 10 to 12 liquid, bloody stools per day. A stool sample for ova and parasites is negative. A diagnosis of ulcerative colitis (UC) is made, and she is started on sulfasalazine (Azulfidine). What does the nurse tell her about why she is receiving this therapy?
d. "Your intestinal inflammation will be reduced."
An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which client does the charge nurse assign to the float nurse?
d. 36 w/peritonitis who just returned from surgery w/multiple drains in place
A client demonstrates the manifestations of appendicitis with a suspected complication of peritonitis. What is the priority nursing intervention?
d. Preparing the client for emergency surgery
An 80-year-old client with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to a medical-surgical unit with a diagnosis of gastroenteritis. Which health care provider request does the nurse implement first?
d. Start an IV infusion of 5% dextrose in .45 normal saline @ 125mL/hr
An obese client is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the client's home health nurse requires immediate action?
d. States, "I feel the incision is splitting open."
A client has an anal fissure. Which nursing intervention most effectively promotes perineal comfort for the client?
d. Using witch hazel wipes to relieve pain
A client who had surgery for inflammatory bowel disease (IBD) is being discharged. The case manager will arrange for home health care follow-up. The client 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?
d. Written & oral instructions regarding symptoms to report to the healthcare provider
