MCA 1 - Week 3 - Lower GI disorders

The nurse provides education for a group of nursing students about Clostridium difficile infection (CDI). Which statement made by a student indicates the need for further teaching? "Fecal transplantation has shown benefits." "It can progress to fulminant colitis and intestinal perforation." "With each occurrence, the probability of reoccurrence decreases." "It impairs intestinal absorption by destroying cells, causing inflammation in the colon, and producing toxins that cause damage."

"With each occurrence, the probability of reoccurrence decreases." Rationale: Recurrent CDI occurs in about 20% of patients, and the probability of a recurrence rises with each subsequent infection. Fecal transplantation and the use of probiotics have been shown to improve patient symptoms. C. difficile can cause severe intestinal compromise. Organisms such as C. difficile impair absorption by destroying cells, causing inflammation in the colon, and producing toxins that cause damage. p. 927

A patient reports periumbilical pain that increases after coughing and sneezing. The patient prefers to lie still with the right leg flexed. Which condition does the nurse suspect? Peritonitis Appendicitis Gastroenteritis Ulcerative colitis

Appendicitis Rationale: Periumbilical pain that increases with coughing and sneezing indicates appendicitis. In this condition, the patients prefer to lie still with the right leg flexed. Peritonitis is characterized by abdominal pain; patients tend to lie still and take shallow breaths. Gastroenteritis is the inflammation of mucosa of stomach and small intestine; it is characterized by diarrhea, vomiting, and abdominal cramping. Ulcerative colitis is a form of inflammatory bowel disease characterized by bloody diarrhea and abdominal pain. p. 937

Which is a cause of primary peritonitis? Pancreatitis Cirrhosis with ascites Appendicitis with rupture Ischemic bowel disorders

Cirrhosis with ascites Rationale: Cirrhosis causes a large amount of fluid to build up in the abdominal cavity; this is known as ascites. Ascites is susceptible to bacterial infection, which can cause primary peritonitis. Pancreatitis, appendicitis with rupture, and ischemic bowel disorders are causes of secondary peritonitis.

Which test is considered the best method for colorectal cancer (CRC) screening? Colonoscopy Barium enema Sigmoidoscopy Fecal occult blood test (FOBT)

Colonoscopy Rationale: Colonoscopy is the gold standard for CRC screening. It allows the entire colon to be examined, biopsies obtained, and polyps removed and sent to the laboratory for examination. Both barium enema and sigmoidoscopy are limited in that they only allow for visualization of the distal colon and sigmoid, so that diseased areas higher up may be missed. A less favorable, but acceptable, screening method includes testing the stool for fecal blood. The FOBT and fecal immunochemical test (FIT) look for blood in the stool. Stool tests must be done frequently because tumor bleeding occurs at intervals and easily may be missed if only a single test is done.

A patient has been admitted to a medical unit with clinical manifestations of a blockage of the large intestine. The nurse expects a prescription for which diagnostic procedure? Gastrectomy Colonoscopy Cholecystectomy Esophagogastroduodenoscopy

Colonoscopy Rationale: Sigmoidoscopy or colonoscopy provides direct visualization of a large bowl obstruction (LBO). Colonoscopy is an endoscopic diagnostic procedure that provides visualization of the colon. Gastrectomy (partial or complete removal of the stomach) and cholecystectomy (removal of the gallbladder) are surgical procedures. Esophagogastroduodenoscopy is an endoscopic diagnostic procedure used to directly visualize the mucosal lining of the esophagus, stomach, and duodenum. p. 944

Which condition involves inflammation of all layers of the bowel wall? Peritonitis Gastroenteritis Crohn's disease Ulcerative colitis

Crohn's disease Rationale: Crohn's disease is a type of inflammatory bowel disease (IBD). Crohn's disease can occur in any segment of the gastrointestinal tract and involves inflammation of all layers of the bowel wall. Peritonitis is inflammation of the peritoneum. Gastroenteritis involves inflammation of the mucosa of the small intestine and stomach. Ulcerative colitis involves inflammation starting from the rectum that moves toward the cecum. p. 940

The nurse presents information about gastroenteritis for a group of nursing students and includes which information? It is caused by a norovirus. It is often treated with sulfasalazine. It is classified as an ulcerative colitis. It is defined as the chronic inflammation of the gastrointestinal tract.

It is caused by a norovirus. Rationale: Viruses such as noroviruses are the leading cause of gastroenteritis. Inflammatory bowel disease (IBD) is treated with sulfasalazine; this disease is classified as an ulcerative colitis. Gastroenteritis is the inflammation of the mucosa of the small intestine and stomach. p. 939

The nurse recognizes that which treatment strategy is beneficial for patients with stage I colorectal tumors? Resection Reanastomosis Chemotherapy Laparoscopic surgery

Laparoscopic surgery Rationale: Laparoscopic surgery is used to treat stage I colorectal tumors. Stage II colorectal tumors are treated with resection and reanastomosis. Chemotherapy is used to treat high-risk stage II, stage III, and stage IV colorectal tumors.

Based on the data in a patient's chart, which information may increase the patient's risk for peritonitis? Background 22-year-old female Sickle cell disease Motor vehicle accident Depression Physical Assessment Moist mucous membranes BP 140/80 Heart rate 68 bpm Lungs clear Depression Lungs clear Motor vehicle accident Moist mucous membranes

Motor vehicle accident Rationale: A patient involved in a recent motor vehicle accident is at increased risk for developing peritonitis. The assessment of clear lung fields is a normal finding and does not increase the risk for developing peritonitis. A history of depression does not increase the risk for developing peritonitis. The presence of moist mucous membranes indicates adequate hydration, which does not cause peritonitis. p. 938

When assessing a patient with gastrointestinal disorder, the nurse finds an absence of bowel sounds. The assessment findings are indicative of which condition? Volvulus Borborygmi Paralytic ileus Pseudopolyps

Paralytic ileus Rationale: Lack of intestinal peristalsis and an absence of bowel sounds indicate paralytic ileus, which occurs due to paralysis of intestinal muscles. Volvulus is an intestinal obstruction that occurs by the bowel twisting around a focal point. Borborygmi are audible abdominal sounds due to hyperactive intestinal motility. Pseudopolyps are tongue-like projections into the bowel lumen. p. 946

The nurse is caring for a patient experiencing diarrhea caused by clostridium difficile. Which is a priority nursing action? Performing effective handwashing Providing antidiarrheal medication Administering mineral oil enemas Placing the patient on airborne isolation

Performing effective handwashing Rationale: Clostridium difficile is a highly contagious infection. Effective handwashing is crucially important to prevent the transmission to other patients. Antidiarrheal medications will prolong the exposure to this pathogen. Mineral oil enemas are not used to treat this pathogen. Patients with clostridium difficile will be placed on contact, not airborne, isolation. p. 927

The nurse provides education for a community group about ways to reduce the risk for colorectal cancer (CRC). The nurse includes a recommendation to decrease the intake of which food item? Red meat Grains Fruits Vegetables

Red meat Rationale: Development of CRC has been associated with consumption of a high-fat diet. Of the foods listed, red meat is the highest in fat content. Eating a diet with large amounts of fruits, vegetables, and grains may decrease the risk for CRC.

Which is a cause of nonmechanical intestinal obstruction? Hernia Intussusception Thoracic spinal fracture Strictures from Crohn's disease

Thoracic spinal fracture Rationale: Intestinal obstruction occurs when intestinal contents are unable to pass through the gastrointestinal tract. Paralytic ileus is the most common form of nonmechanical obstruction. A thoracic spinal fracture is a cause of paralytic ileus. Hernia, intussusceptions, and strictures from Crohn's disease cause mechanical obstruction. Test-Taking Tip: Avoid selecting answers that state hospital rules or regulations as a reason or rationale for action. p. 945