Chapter 52

After teaching a client who has a permanent ileostomy, a nurse assesses the client's understanding. Which dietary items chosen for dinner indicate the client needs further teaching. select all that apply A. corn B. String beans C. Carrots D. White rice E. Squash

A, B, D

A nurse cares for an older adult who is admitted to the hospital with complications of diverticulitis. Which actions would the nurse include in the client's plan of care? Select all that apply A. Administer pain medications as prescribed B. Palpate the abdomen for distention C. Assess for sudden changes in mental status D. Provide client with high fiber diet E. Evaluate stools for occult blood

A,B,C,E

A nurse prepares to discharge a client who is newly diagnosed with a chronic inflammatory bowel disease. Which questions would the nurse ask in preparation for discharge? Select all that apply A. does your gym provide yoga classes? B. When should you contact your HCP? C. What do you plan to eat for dinner? D. Do you have a scale for daily weights? E. How many bathrooms are in your home?

A,B,C,E

The nurse assesses a client with Ulcerative colitis. Which complications are paired correctly with their physiological processes? Select all that apply A. lower GI bleeding- erosion of the bowel wall B. Abscess formation- localized pockets of infection develop in the ulcerated bowel lining C. toxic megacolon- transmural inflammation resulting in pyuria and fecaluria D. non-mechanical bowel obstruction - paralysis of colon resulting from colorectal cancer E. Fistula- Dilation and colonic ileus caused by paralysis of the colon

A,B,D

The nurse is caring for a client who is diagnosed with celiac disease and preparing to start Natalizumab. Which health teaching would the nurse include in the teaching? Select all that apply A. need to have drug administered by a HCP B. Need to avoid crowds and individuals who have infection C. Need to report injection reactions such as redness and swelling D. Awareness of a rare but potentially fatal drug complication E. need to report any signs and symptoms of infection immediately

A,B,D,E

The nurse teaches a community group ways to prevent Escherichia coli infection. Which statements would the nurse include in the group's teaching? (Select all that apply) A. Wash your hands after contact with animals B. It is not necessary to buy a meat thermometer C. Stay away from people that are ill with diarrhea D. Use separate cutting boards for meat and vegatables E. Avoid swimming in backyard pools and using hot tubs

A,D

The nurse is caring for a client with peritonitis. What assessment findings would the nurse expect? Select all that apply A. N/V B. Distended rigid abdomen C. abdominal pain D. bradycardia E. decreased urine output F. fever

A. B,C, E, F

Th nurse teaches a patient with viral gastroenteritis. Which dietary instruction would the nurse include in health teaching? A. drink plenty of fluids to prevent dehydration B. you should only drink 1 L of fluid a day C. increase protein intake by drinking more milk D. sips of cola or tea may help to relieve your nausea

A. Drink plenty of fluids to prevent dehydration

The nurse assesses a patient who is recovering from an ileostomy placement. Which assessment finding would alert the nurse to immediately contact the HCP? A. pale and bluish stoma B. Liquid stool C. Ostomy pouch intact D. Blood-tinged output

A. Pale and bluish stoma

A nurse reviews the electronic health record of a client who has Crohn disease and a draining fistula, Which documentation would alert the nurse to contact the HCP for additional prescriptions? A. Serum potassium of 2.6 mEq/L (2.6 mmol/l) B. Client ate 20% of breakfast meal C. WBC of 8200//mm3 D. Clients weight decreased by 3 lb (1.4 kg)

A. Serum potassium of 2.6 mEq/L

The nurse assesses a client who has appendicitis. Which assessment finding would the nurse expect? A. severe, steady right lower quadrant pain B. abdominal pain associated with N/V C. marked peristalsis with hyperactive bowel sounds D. abdominal pain that increased with knee flexion

A. severe, steady right lower quadrant pain

A nurses assesses a patient with Celiac disease. Which S/S would the nurse expect? Select all that apply A. weight gain B. Anorexia C. Constipation D. Anal fistula E. Abdominal pain

B,C,E

A nurse is caring for a patient who has chronic inflammatory bowel disease. Which actions would the nurse take to prevent skin excoriation? Select all that apply. A. cleanse the perineum with an antibacterial soap B. Use medicated wipes instead of toilet paper C. Identify foods that decreased constipation D. Apply a think coat of aloe cream to perineum E. gently pat the perineum after cleansing

B,D,E

The nurse is caring for a client who is prescribed sulfasalazine. Which question would the nurse ask the client before starting this drug? A. "Are you taking vitamin C or D?" B. "Do you have any allergies to sulfa drugs?" C. "Can you swallow pills easily?" D. "DO you have insurance to cover this drug?"

B. "Do you have any allergies to sulfa drugs?"

After teaching a client who is prescribed adalimumab for severe Ulcerative Colitis (UC), the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? A. "i will avoid large crowds and people who are sick." B. "I will take this medication with my breakfast every morning." C. "N/V are common side effects of this drug." D. "I should wash my hands after I play with my dog."

B. "I will take this medication with my breakfast every morning."

The nurse cares for a client with a new ileostomy. The client states, "I don't think my friends will accept me with the ostomy." How would the nurse respond?" A. "your friends will be happy that you are alive." B. "Tell me more about your concerns." C. "A therapist can help you resolve your problems." D. "With time you will accept your new body."

B. "Tell me more about your concerns."

The nurse plans care for a client with Crohn disease who has heavy draining fistula. Which intervention would be the nurses priority care? A. low-fiber diet B. Skin protection C. Antibiotic administration D. IV Glucocorticoids

B. Skin protection

A client prepared to have a laparoscopic restorative proctocolectomy with ileo-pouch-anal anastomosis . Which pre-op teaching would the nurse include? A. You will have to wear an appliance for your permanent ileostomy." B. "You should be able to have better bowel continence after healing occurs." C. "You will have a large abdominal incision that will require irrigation." D. " This procedure can be preformed under general or regional anesthesia."

B. You should be able to have better continence after healing occurs."

After teaching a client that who has diverticulitis, a nurse assesses the client's understanding. which statement made by the client indicates a need for further teaching? A. I'll ride my bike or take a long walk at least three times a week." B. I must try to include my 25 g of fiber in my diet everyday" C. I will take a laxative nightly at bedtime to avoid becoming constipated." D. I should use my legs rather than my back muscles when I lift heavy objects."

C. "I will take a laxative nightly at bedtime to avoid becoming constipated."

A nurse cares of a young client with a new ileostomy. The client states, "I cannot go to prom with an ostomy." How would the nurse respond? A. "Sure you can. purchase a prom dress one size larger to hide the ostomy appliance." B. " The pouch won't be noticeable if you avoid broccoli and carbonated drinks prior to prom." C. "Let's talk to the ostomy nurse about options for ostomy supplies and dress styles." D. "You can remove the pouch from your ostomy appliance when you are at prom so that it is less noticeable."

C. "let's talk to the ostomy nurse about options for ostomy supplies and dress styles."

The nurse reviews the lab results for a client who has possible appendicitis. Which laboratory results would the nurse expect? A. decreased potassium B. increased sodium C. Elevated leukocyte count D. decreased thrombocyte count

C. Elevated leukocyte count

A nurse assesses a client who has Ulcerative Colitis and severe diarrhea. Which assessment would the nurse complete first? A. Inspection of oral mucosa B. Recent dietary intake C. Heart rate and rhythm D. Percussion of abdomen

C. Heart rate and rhythm

The nurse assesses a client who is hospitalized with an exacerbation of Crohn disease. Which assessment finding would the nurse most likely find? A. Positive Murphy sign with rebound tenderness to palpation B. dull, hypoactive bowel sounds in the lower abdominal quadrants C. High-pitched rushing bowel sounds in the right lower quadrant D. reports abdominal cramping that is worse at night

C. high-pitched rushing bowel sounds in the right lower quadrant

The nurse teaches a client about how to prevent transmission of gastroenteritis. Which statement by the nurse indicates a need for further teaching? A. " I won't let anyone use my dishes or glasses" B. "Ill wash my hands with antibacterial soap." C. "I will keep my bathroom extra clean" D. I will cook all the meals for my family."

D. I will cook all the meals for my family

After teaching a patient with diverticular disease, a nurse assesses the client's understanding. Which menu selection indicates the client correctly understood the teaching? A. roasted chicken with rice pilaf and a cup of coffee with cream B. spaghetti with meat sauce, a cup of fresh fruit, and hot tea C. Garden salad with a cup of bean soup and a glass of low fat milk D. baked fish with steamed carrots and a glass of apple juice

D. baked fish with steamed carrots and a glass of apple juice

The nurse assess a client with gastroenteritis. Which factor would the nurse consider as the most likely cause of this disorder? A. consuming too much fruit B. consuming fried or pickled food C. consuming dairy products D. consuming raw seafood

D. consuming raw seafood