ch. 52- Concepts of Care for Patients with Inflammatory Intestinal Disorders

Which client with symptoms of chronic abdominal pain and frequent bowel movements will the nurse consider at highest risk for a diagnosis of ulcerative colitis? a. 26 yo woman of Jewish ancestry who has an identical twin sister with the disorder b. 40 yo black man who has just returned home from a business trip to SE Asia c. 50 yo Latino man with liver cirrhosis whose uncle died of colon cancer d. 65 yo obese asian woman who has chronic inflammatory cystitis

a. 26 yo woman of Jewish ancestry who has an identical twin sister with the disorder

Which lunch food selection made by a client with diverticulosis indicates to the nurse the correct understanding of the necessary dietary modifications for management of the problem? a. A turkey sandwich on whole weight bread, steamed carrots, and a raw apple b. Roasted chicken, potato salad, and a glass of milk c. Chicken salad sandwich on white bread, creamed soup, and hot tea d. Fried shrimp, lettuce and tomato salad, and a dinner roll

a. A turkey sandwich on whole weight bread, steamed carrots, and a raw apple

Which interventions will the nurse include when care of a client with peritonitis is focused on restoring fluid volume balance? Select all that apply a. Administering IV isotonic fluids and broad-spectrum antibiotics b. Assigning the AP to weight the client daily and record intake and output c. Providing NGT care and keeping the stomach decompressed d. Administering opioid pain medications as prescribed by the primary health care provider e. Maintaining the client on NPO status while the NGT is in place to low suction f. Assessing whether the client retains fluid used for irrigation by comparing and recording the amount of fluid returned with the amount of fluid instilled

a. Administering IV isotonic fluids and broad-spectrum antibiotics b. Assigning the AP to weight the client daily and record intake and output c. Providing NGT care and keeping the stomach decompressed e. Maintaining the client on NPO status while the NGT is in place to low suction f. Assessing whether the client retains fluid used for irrigation by comparing and recording the amount of fluid returned with the amount of fluid instilled

Which actions will the nurse perform when caring for a client with acute appendicitis before surgical management? Select all that apply a. Maintaining the client on NPO status b. Administering IV fluids as prescribed c. Providing laxatives and enemas to clear the bowels d. Advising the client to maintain semi-Fowlers position e. Giving adequate medications to control the client's pain f. Applying hot compresses to the right lower quadrant

a. Maintaining the client on NPO status b. Administering IV fluids as prescribed d. Advising the client to maintain semi-Fowlers position e. Giving adequate medications to control the client's pain

What is the nurse's best first action when the stoma of a client who had a permanent ileostomy placed 2 days ago now has a dark bluish-purple appearance? a. Notifying the surgeon immediately b. Applying oxygen by nasal cannula c. Placing the client in a high-owlet position d. Documenting the findings as the only action

a. Notifying the surgeon immediately

Which important information will the nurse include when teaching a client about peritonitis? Select all that apply a. Peritonitis is caused by contamination of the peritoneal cavity by bacteria or chemicals b. Respiratory problems associated with peritonitis are related to increased abdominal pressure against the diaphragm c. White blood cell counts are often decreased when a client is diagnosed with peritonitis d. Chemical peritonitis is caused by leakage of pancreatic enzymes or gastric acids e. Fairly common causes of peritonitis include invasive tumors and continuous ambulatory peritoneal dialysis f. When the peritoneal cavity is contaminated by bacteria, the body begins an inflammatory reaction, walling off a localized area to fight the infection

a. Peritonitis is caused by contamination of the peritoneal cavity by bacteria or chemicals b. Respiratory problems associated with peritonitis are related to increased abdominal pressure against the diaphragm d. Chemical peritonitis is caused by leakage of pancreatic enzymes or gastric acids f. When the peritoneal cavity is contaminated by bacteria, the body begins an inflammatory reaction, walling off a localized area to fight the infection

Which care actions does the nurse expect to perform when caring for a client who had an appendectomy with an abscess? Select all that apply a. Providing care for wound drains inserted during the surgery b. Administering IV antibiotics as prescribed by the surgeon c. Providing the client with clear liquid diet d. Assessing the NGT position and drainage e. Providing non steroidal anti-inflammatory drugs for pain control f. Helping the patient out of bed on the evening of surgery

a. Providing care for wound drains inserted during the surgery b. Administering IV antibiotics as prescribed by the surgeon d. Assessing the NGT position and drainage f. Helping the patient out of bed on the evening of surgery

In which position will the nurse place a client with peritonitis to promote comfort and prevent harm from potential complications? a. Semi-Fowler b. Left side-lying with knees to chest c. Right side-lying with knees to chest d. Supine flat with hips and knees flexed

a. Semi-Fowler

To prevent harm after a surgical procedure for peritonitis, which action will the nurse teach a client to avoid? a. Taking additional acetaminophen to prevent liver toxicity b. Lifting for at least 6 months after an open surgical procedure c. Resuming normal activities for at least 3 to 4 days after the procedure d. Using stool softeners and laxatives to prevent diarrhea

a. Taking additional acetaminophen to prevent liver toxicity

Which actions will the nurse teach a client to take to prevent the spread of gastroenteritis? Select all that apply a. Washing hands well for at least 30 seconds b. Using easily accessible hand sanitizers c. Taking broad spectrum antibiotics prophylactically d. Testing all food preparation employees e. Sanitizing all surfaces that may be contaminated f. Properly preparing food and beverages

a. Washing hands well for at least 30 seconds b. Using easily accessible hand sanitizers e. Sanitizing all surfaces that may be contaminated

Which common signs and symptoms will the nurse expect to find on assessment of a 60 yo client who had gastroenteritis for the past 2 days? Select all that apply a. Weight loss b. Elevated temperature c. Dry mucous membranes d. Hypotension e. Oliguria f. Poor skin turgor

a. Weight loss b. Elevated temperature c. Dry mucous membranes d. Hypotension e. Oliguria f. Poor skin turgor

Which new onset assessment finding in a client with Crohn disease indicates to the nurse the possibility of fistula development? a. Anorexia b. Pyuria with fever c. Smooth, beefy red tongue d. Decreased serum albumin

b. Pyuria with fever

What is the most important assessment for the nurse to perform before administering the first dose of sulfasalazine to a client diagnosed with ulcerative colitis? a. Obtaining an accurate weight b. Asking whether they have an allergy to sulfa drugs c. Measuring heart and respiratory rate and blood pressure d. Determining the number of times the client has had a stool today

b. Asking whether they have an allergy to sulfa drugs

In collaboration with the registered dietitian nutritionist, which nutrients and substances will the nurse instruct a client with ulcerative colitis to avoid to reduce symptoms? Select all that apply a. Eggs b. Corn c. Caffeine d. Vitamin C e. Dried fruits f. Carbohydrates g. Dairy products h. Pepper-based spices

b. Corn c. Caffeine e. Dried fruits g. Dairy products h. Pepper-based spices

Which laboratory assessment findings will the nurse expect in a client who is diagnosed with ulcerative colitis? Select all that apply a. Increased albumin b. Decreased hemoglobin c. Increased sodium d. Decreased potassium e. Elevated WBC count f. Elevate erythrocyte sedimentation rate

b. Decreased hemoglobin d. Decreased potassium e. Elevated WBC count f. Elevate erythrocyte sedimentation rate

Which disease features will the nurse commonly associate with a client who has Crohn disease that are rare or absent in a client with ulcerative colitis? Select all that apply a. The problem first appears in the rectum and proceeds in a continuous manner toward the cecum b. Fistulas commonly develop c. Clients have five to six soft, loose, nonbloody stools per day d. there is a greatly increased risk for colon cancer e. Many clients have one or more extra intestinal problems such as arthritis, ankylosing spondylitis, and erythema nondosum f. the appearance of the affected intestine areas resemble cobblestone

b. Fistulas commonly develop c. Clients have five to six soft, loose, nonbloody stools per day f. the appearance of the affected intestine areas resemble cobblestone

Which statement by a client with gastroenteritis due to infection with the norovirus indicates that the nurse's teaching about this illness has been successful? a. I got this infection from being around my grandchildren when they had respiratory illnesses b. It is most likely that I got this infectious illness from either contaminated food or water c. I may have gotten sick when I was traveling last month to Florida d. It's really important that I don't go to restaurants for at least a month after I am well

b. It is most likely that I got this infectious illness from either contaminated food or water

Which assessment findings on a client with peritonitis indicate to the nurse the probability that the fluid shift into the peritoneal cavity is continuing? Select all that apply a. Weight loss b. Tachycardia c. Hypertension d. Decreasing urine output e. Hyperactive bowel sounds f. Skin tenting over the forehead and sternum

b. Tachycardia d. Decreasing urine output f. Skin tenting over the forehead and sternum

When the nurse is providing discharge instructions for a client recovering from peritonitis, which essential findings will the client and family be instructed to report immediately to the primary health care provider? Select all that apply a. Completion of broad-spectrum antibiotics as prescribed b. Unusual or foul smelling drainage c. Signs of wound dehiscence or ileus d. Swelling, redness, warmth, or bleeding from the incision site e. A temperature higher than 101 F f. Abdominal pain or board-like stiffness in the abdomen

b. Unusual or foul smelling drainage c. Signs of wound dehiscence or ileus d. Swelling, redness, warmth, or bleeding from the incision site e. A temperature higher than 101 F f. Abdominal pain or board-like stiffness in the abdomen

Which action is appropriate for the nurse to take to prevent harm when caring for a client with ulcerative colitis who has undergone a total proctocolectomy with placement of a permanent ileostomy? a. Irrigating the ileostomy to maintain patency b. Using a skin barrier to prevent exorciation c. Monitoring the client for nausea due to decreased intestinal motility d. Giving small, frequent feedings to compensate for malnutrition from short-gut syndrome

b. Using a skin barrier to prevent exorciation

What does the nurse suspect when a client comes to the ED with right lower cramping pain, nausea, vomiting, and guarding with rigidity of the abdomen? a. Gastroenteritis b. Ulcerative colitis c. Appendicitis d. Crohn disease

c. Appendicitis

Which laboratory finding will the nurse expect to see in a client who is suspected of having an acute, uncomplicated appendicitis? a. Decreased serum potassium level b. Increased international normalized ratio c. Increased WBC count d. Decreased erythrocyte sedimentation rate

c. Increased WBC count

Which complication will the nurse suspect when a client with peritonitis reports increased pain in the upper left abdominal quadrant and in the left shoulder, especially during inhalation? a. Sepsis b. Pneumonia c. Localized abscess d. Bacterial hepatitis

c. Localized abscess

Which serum laboratory value is most important for the nurse to monitor when caring for an older client with gastroenteritis who has an irregular heart rate and reports "feeling weak"? a. Albumin b. Sodium c. Potassium d. Leukocyte count

c. Potassium

Which action will the nurse instruct a client with celiac disease to perform to reduce symptoms? a. Limiting caffeine b. Drinking more liquids c. Reading labels on prepared foods d. Avoiding raw fruits and vegetables

c. Reading labels on prepared foods

Which surgical client will the nurse recognize as having the highest risk for development of peritonitis? a. 35 yo having a laparoscopic appendectomy b. 45 yo having a vaginal hysterectomy c. 60 yo having a traditional cholecystectomy for cholelithiasis d. 72 yo having a bowel resection for colon cancer

d. 72 yo having a bowel resection for colon cancer

Which cardinal signs will the nurse expect to assess in a client diagnosed with peritonitis? a. Fever with headache and confusion b. Dizziness with nausea and vomiting c. Loss of appetite with nausea and weight loss d. Abdominal pain with distention and tenderness

d. Abdominal pain with distention and tenderness

For which client finding will the nurse withheld the scheduled monthly dose of a prescribed parenteral biologic for management of ulcerative colitis? a. 5lb weight gain b. Increased number of diarrhea stools per day c. Presence of occult blood in today's stool sample d. Cough and fever of 102 F

d. Cough and fever of 102 F

Which drug will the nurse be sure to question to prevent harm when prescribed for an older adult with gastroenteritis? a. Azythromycin b. Protective skin barrier cream c. Ciprofloxacin d. Diphenoxylate hydrochloride with atropine sulfate

d. Diphenoxylate hydrochloride with atropine sulfate