Module 10 Class Quiz & Adaptive Quiz

A client is diagnosed with Crohn disease, and parenteral vitamins are prescribed. The client asks why the vitamins have to be given intravenously (IV) rather than by mouth. What rationales for this route should the nurse include in a response to the question? Select all that apply. A. More rapid action results B. They decrease colon irritability C. Oral vitamins are less effective D. Intestinal absorption may be inadequate E. Allergic responses are less likely to occur

A. More rapid action results C. Oral vitamins are less effective D. Intestinal absorption may be inadequate Absorption through the gastrointestinal tract is impaired, and parenteral administration goes directly into the intravascular compartment. Disease of the GI tract is damaged, its ability to absorb vitamins taken orally is greatly impaired. IV vitamins do not decrease colonic irritability. Route of administration does not affect allergic response.

You are caring for a 31 year old male patient who is being treated for ulcerative colitis and are educating him on his new medication sulfasalazine. Which of the following statements indicates the need for reinforcement of teachings? A. "I will take a vitamin C supplement while I am on this medication." B. "It cant take up to 4 weeks to see the effects on this medication." C. "I will notify my doctor if I develop a sore throat or headache." D. "It may be difficult for my wife and I to conceive a child while I am on this medication."

A. "I will take a vitamin C supplement while I am on this medication." The patient should take a folic acid supplement with this medication.

A nurse is providing discharge instructions to a client diagnosed with cirrhosis and varices. Which information should the nurse include in the teaching session? Select all that apply. A. Adhering to a low-carb diet B. Avoiding aspirin and aspirin-containing products C. Limiting alcohol consumption to two drinks weekly D. Avoiding acetaminophen and products containing acetaminophen E. Avoiding coughing, sneezing and straining to have a bowel movement

B. Avoiding aspirin and aspirin-containing products D. Avoiding acetaminophen and products containing acetaminophen E. Avoiding coughing, sneezing and straining to have a bowel movement Aspirin can damage the gastric mucosa and precipitate hemorrhage when esophageal or gastric varices are present. Acetaminophen is hepatotoxic and should not be used by the client with cirrhosis. The client with cirrhosis should avoid coughing, sneezing, and straining to have a bowel movement. These activities increase pressure in the portal venous system and increase the client risk of variceal hemorrhage. A high carb diet is encourages as the disease liver's ability to synthesize and store glucose is diminished. To decrease the risk of complications, the client must abstain from alcohol.

The nurse is providing care to a client with a cites secondary to liver failure. What is appropriate to include in the client's care. Select all that apply. A. High protein diet B. Low sodium diet C. Daily abdominal girth measurements D. Encourage increased by mouth fluid intake E. Daily weights

B. Low sodium diet C. Daily abdominal girth measurements E. Daily weights In the client with liver failure and ascites, the liver has lost its ability to synthesize proteins. This leads to hypoalbuminemia and decreased on optic pressure in the vessel.s This decrease in on optic pressure leads to fluids leaking out of the vessels and into the interstitial spaces and peritoneum, causing edema and ascites. A low sodium and low protein diet is recommended. A high protein diet will worsen symptoms, and often these clients are on a a fluid restriction. Taking daily weights is the most reliable indicator of fluid retention.

A client is admitted to the hospital with a diagnosis of Crohn disease. What is most important for the nurse to include in the teaching plan for this client? A. Controlling constipation B. Meeting nutritional needs C. Preventing increased weakness D. Anticipating a sexual alteration

B. Meeting nutritional needs To avoid gastrointestinal pain and diarrhea, these clients often refuse to eat and become malnourished. The consumption of a high-calorie, high-protein diet is advised. Diarrhea, not constipation, is a problem with Crohn disease. Preventing an increase in weakness is a secondary concern that results from malnutrition; correcting the malnutrition will increase strength. Anticipating a sexual alteration generally is not a problem with Crohn disease.

A nurse is teaching a client about prophylactic measures that minimize the risk of contracting hepatitis B. Which actions should be included in this teaching plan? Select all that apply. A. Preventing constipation B. Screening of blood donors C. Avoiding shellfish in the diet D. Limiting hepatotoxic drug therapy E. Maintaining a monogamous sexual relationship

B. Screening of blood donors E. Maintaining a monogamous sexual relationship Contracting hepatitis B through blood transfusion can be prevented by screening donors and testing the blood. Hepatitis B can be transmitted via contaminated body fluids such as semen, saliva, and urine. Having multiple sexual partners increases the risk. A monogamous sexual relationship with an infection-free individual eliminates the risk. Preventing constipation is not related to limiting the risk for contracting hepatitis B. Avoid shellfish in the diet limits the risk for contracting hepatitis A. Limiting hepatotoxic drug therapy does not prevent transmission of hepatitis B.

A client with Crohn disease is admitted to the hospital with abdominal pain, fever, poor skin turgor, and diarrhea, with 10 stools in the past 24 hours. Which signs are evident that the client most likely is dehydrated? Select all that apply. A. Moist skin B. Sunken eyes C. Decreased apical pulse D. Dry mucous membranes E. Increased blood pressure

B. Sunken eyes D. Dry mucous membranes Sunken eyes and loss of turgor occur because of decreased intracellular and interstitial fluid associated with dehydration. Dry mucous membranes occur because of decreased intracellular and interstitial fluid associated with dehydration. The skin will be dry, not moist, with dehydration. The first sign of dehydration usually is tachycardia. The blood pressure will decrease, not increase, because of hypovolemia.

The primary health care provider prescribed contact precautions for a client with hep A. What nursing intervention are required for contact precautions? A. Private room with door closed B. Gown, mask, and gloves for all persons entering the room C. Gown and gloves when handling articles contaminated by urine or feces D. Gowns and gloves only when handling the client's soiled license, dishes, or utensils.

C. Gown and gloves when handling articles contaminated by urine or feces Hepatitis A is transmitted via the fecal-oral route; contact precautions must be used when there are articles that potential fecal or urine contamination. Neither a private room nor closed door is required; these are necessary only for respiratory (airborne) precautions. Hepatitis A is not transmitted via the airborne route and therefore a mask is not necessary; a gown and gloves are required only one handling articles that may be contaminated. Wearing gowns and gloves only one handling the client soiled linen, dishes, or utensils is too limited; a gown and gloves also should be worn when handling other fecally contaminated articles, such as a bedpan or rectal thermometer.

The child is diagnosed with hepatitis A. The clients parent expresses concern of the other members of the family may get hepatitis because they all share the same bathroom. What is the nurses best reply? A. "I suggest that you buy come out exclusively for your child use." B. "Your child me use the bathroom but you need to use disposable toilet covers." C. "You will need to clean the bathroom from top to bottom every time a family member uses it." D. "All family members including your child need to wash their hands after using the bathroom."

D. "All family members including your child need to wash their hands after using the bathroom." Hepatitis A is spread via the fecal-oral route; transmission is prevented by proper hand washing. Buying a commode exclusively for the child's use is unnecessary; cleaning the toilet and washing the hands should control the transmission of microorganisms. It is not feasible to clean "from top to bottom" each time the bathroom is use. The use of disposable toilet cover is inadequate to prevent the spread of microorganisms if the bathroom used by the child also is used by other. Hand washing by all family members must be part of the plan to prevent the spread of hepatitis to other family members.

The client with hep B asks the nurse, "Are there any medication to help me get rid of this problem?" Which is the best response by the nurse? A. "Sedatives can be given to help you relax." B. "We can give you immune serum globulin." C. "Vitamin supplements are frequently helpful and hasten recovery." D. "There are medication to help reduce viral load and liver inflammation."

D. "There are medication to help reduce viral load and liver inflammation." Drugs are available to help reduce the viral load (antivirals), including lamivudine, rib a virgin, and adefovir dipivoxil. Although sedatives can be given to help relax, sedatives are given only as needed and do not react the hepatitis. The response "We can give you immune serum globulin" is used only during the incubation period. Vitamins are used as adjective therapy and will not eliminate the hepatitis.

A nurse is performing the physical assessment of a client admitted to the hospital with a diagnosis of cirrhosis. The nurse expect to observe what skin conditions? Select all that apply. A. Vitiligo B. Hirsutism C. Melanosis D. Ecchymoses E. Telangiectasis

D. Ecchymoses E. Telangiectasis Eccymoses are small areas of bleeding into the skin or mucous membrane, forming a blue or purple patch. With cirrhosis there is decreased synthesis of prothrombin in the liver. Telangiectasis is a vascular lesion formed by dilation of a group of small blood vessels. When cirrhosis causes an increase in pressure in the portal circulation that results in a dilation of cutaneous blood vessels around the umbilicus, it is specifically called Capet medusae. Vitiligo refers to patches of depigmentation resulting from destruction of melanocytes. Hirsutism is excessive growth of hair; with cirrhosis, endocrine disturbances results in loss of axillary and pubic hair. Dark pigment art deposits results from a disorder of pigment metabolism.

A nurse is evaluating a client who has been receiving medical intervention for the diagnosis of Crohn disease. Which expected outcome is most important for this client? A. Does skin care B. Takes oral fluids C. Experiences less abdominal cramping D. Gains half a pound (0.2 kg) per week

D. Gains half a pound (0.2 kg) per week Weight loss usually is severe with Crohn disease; therefore, weight gain is a priority. This goal is specific, realistic, measurable and has a time frame. Although skin care, taking oral fluids, and experiences less abdominal cramping are important, they are not as high a priority as weight gain.

A nurse is assessing two clients. One client has ulcerative colitis, and the other client has Crohn disease. Which is more likely to be identified in the client with ulcerative colitis than in the client with Crohn disease? A. Inclusion of trans mural involvement of the small bowel wall B. Higher occurrence of fistulas and abscesses from changes in the bowel wall C. Pathology beginning proximal with intermittent plaques found along the colon D. Involvement starting dismally with rectal bleeding that spreads continuously up the colon

D. Involvement starting dismally with rectal bleeding that spreads continuously up the colon Ulcerative colitis involvement starts dismally with rectal bleeding that spreads continuously up the colon to the cecum. In ulcerative colitis, pathology usually is in the descending colon; in Crohn disease, it is primarily in the terminal ileum, cecum, and ascending colon. Ulcerative colitis, as the name implies, affects the colon, not the small intestine. Intermittent areas of pathology occur in Crohn. In ulcerative colitis, the pathology is in the inner layer and does not extend throughout the entire bowel wall; therefore, abscesses and fistulas are rare. Abscesses and fistulas occur more frequently in Crohn disease.

What are two complications of ulcerative colitis?

- malnourishment - infection; abcess - hemorrhage - weight loss - osteoporosis - fistula - toxic megacolon

A nurse is reviewing discharge plans with a client who is hospitalized with hep A. The nurse concludes that the client understand preventive measures to reduce the risk of spreading the disease when the client makes what statement? A. "I should wash my hands frequently." B. "I should launder my clothes separately." C. "I should put used tissues in the garbage." D. "I should wear a mask when leaving the house."

A. "I should wash my hands frequently." Hep A microorganisms are transmitted via the anal-oral route; hand washing, particularly after toileting, is the most important precaution. The response "launder my clothes separately" will not deter the spread of the virus; hand washing is necessary. Putting used tissue in the garbage is important, but hand washing is the most important. Hep A microorganisms exit through the rectum, not the respiratory tract.

A client with the diagnosis of Crohn disease tells the nurse that her boyfriend dates other women. She believes that this behavior causes an increase in her symptoms. What should the nurse do first when counseling this client? A. Help the client explore attitudes about herself B. Educate the client's boyfriend about her illness C. Suggest the client should not see her boyfriend for a while D. Schedule the client and her boyfriend for a counseling session

A. Help the client explore attitudes about herself Because emotional stress can influence the progress of Crohn disease, initially the nurse should help the client to explore self-attitudes to aid in better understanding the feelings engendered by her boyfriend dating others. Initially the nurse should help the client explore the situation and the feelings it engenders rather than involve the boyfriend. Scheduling the client and her boyfriend for a counseling sessions is premature; the client is not ready for a joint counseling session.

You are educating a patient and her spouse on nutrition for helping manage her Crohn's disease. Which of the following statements from the spouse indicates an understanding? A. "We will make sure to eat 8-10 small meals a day." B. "She needs to eat fruits such as bananas or cooked fruits because they are lower in fiber." C. "We can continue to have our evening wine with our dinner meal." D. "Lactose does not worsen Crohn's disease and should not be avoided due to the need for calcium."

B. "She needs to eat fruits such as bananas or cooked fruits because they are lower in fiber." Eating refined grains, lower fiber fruits, lean protein, and a lactose free diet will aide in managing one's Crohn's disease. The patient should eat 4-6 meals daily, not 8-10. Alcohol should be avoided.

A patient who has been diagnosed with UC is complaining of various symptoms, which of the following are expected to be seen? (Select all that apply.) A. Afebrile B. Fatigue C. Inflamed joints D. Increase in appetite E. Lesions in mouth

B. Fatigue C. Inflamed joints E. Lesions in mouth

The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence? A. Dorsiflex the client's foot B. Measures the abdominal girth C. Ask the client to extend the arms D. Instruct the client to lean forward

C. Ask the client to extend the arms Asterixis is a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings.

Patients with ulcerative colitis with have increased: A. Lactic acid B. Hgb/Hct C. C-reactive protein D. Potassium

C. C-reactive protein C-reactive protein shows inflammation in the body.

What type of intravenous line should the patient have when receiving TPN?

Central line The tubing should be changed every 12-24 hours to reduce the risk of crystallization and bacteria production. (Bacteria loves the dextrose!)

What intervention should be included in the nursing plan of care to help a 10-year-old girl live with Crohn disease? A. Recommending several rest periods throughout the day B. Emphasizing the high-residue foods be included in the diet C. Assuring her that when she reaches puberty she may discontinue her medication D. Encouraging her to express feelings while focusing on the way she is like her friends

D. Encouraging her to express feelings while focusing on the way she is like her friends Focusing on feelings and abilities promotes effective coping and increases self-esteem. Children do not like to be different from their friends. The child will self-limit activity during an exacerbation; at other times the child should not need any more rest than her healthy peers. High roughage foods are limited because they can trigger intestinal inflammation. Telling the child that she may discontinue the special diet once she reaches puberty is false reassurance; there is no time limit as to when or if medications can be discontinued.

A nurse is eliciting a health history from a client with ulcerative colitis. What factor does the nurse consider to be most likely associated with the client's colitis? A. Food allergy B. Infectious agent C. Dietary components D. Genetic predisposition

D. Genetic predisposition Studies indicate that inflammatory bowel diseases, which include ulcerative colitis and Crohn disease, are familiar, which suggest that they are hereditary. Although food allergy and infectious agent may be causative factors, they are not the most common factors. No specific dietary component has been identified.

The patient you are caring for has just been diagnosed with UC and asks you why she has been having bloody stools, what would be your response?

UC causes frequent bowel movements and puts the patient at risk for irritation and ulceration in the perinatal area.

Ulcerative colitis effects ____________ area of the GI tract compared to Crohn's Disease that effects _____________ area of the GI tract.

colon; small intestine, the colon, or both

A client is about to have a blood transfusion and asks the nurse which type of hepatitis is most frequently transmitted through food. Which type of hepatitis should the nurse teach the client about being most associated with food? A. A B. B C. C D. D

A. A Hepatitis A, also known as infectious hepatitis, is cause by an RNA virus that is transmitted via the fecal-oral route and is most frequently transmitted through food. Hepatitis B is transmitted parenterally, sexually, and by direct contact with infected body secretion. Hepatitis C is cause by an RNA virus that is transmitted parenterally. Hepatitis D is a complication of hepatitis B.

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding? A. Malaise B. Dark stools C. Weight gain D. Left upper quadrant discomfort

A. Malaise Hepatitis causes GI symptoms such as anorexia, nausea, right upper quadrant discomfort and weight loss. Fatigue and malaise are common. Stools will be light or clay colored if conjugated bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts.

A client is admitted to the hospital with a diagnosis of cirrhosis of the liver. For which assessment signs of hepatic encephalopathy should the nurse assess the client? Select all that apply. A. Mental confusion B. Increased cholesterol C. Brown-colored stools D. Flapping hand tremors E. Musty, sweet breath odor

A. Mental confusion D. Flapping hand tremors E. Musty, sweet breath odor An accumulation of nitrogenous wastes in hepatic encephalopathy affects the central nervous system, causing mental confusing. Flapping tremors and generalized twitching occur in the second and third stages, respectively. Fetor hepaticus is the musty, sweet odor of the client's breath. Increased cholesterol levels are not necessarily present. Stool is often clay-colored because of lack of bile cause by biliary obstruction.

The registered nurse determines that the new graduate understands the type(s) of hepatitis that generally develop into a chronic hepatitis infection if the graduate identifies which disease(s)? Select all that apply. A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

B. Hepatitis B C. Hepatitis C D. Hepatitis D Hepatitis B and C generally develop into chronic hepatitis. Hepatitis D is an incomplete virus that can become chronic and is dependent on the presence of hepatitis B to survive. Hepatitis A and E are acute, self-limiting infections that resolve over time and do not develop into chronic hepatitis.

A client with jaundice associated with hepatitis expresses concern over the change in skin color. What does the nurse explain is the cause of this color change? A. Stimulation of the liver to produce an excess quantity of bile pigments B. Inability of the liver to remove normal amounts of bilirubin from the blood C. Increased destruction of red blood cells during the acute phase of the disease. D. Decreased prothrombin levels, leading to multiple sites of intradermal bleeding

B. Inability of the liver to remove normal amounts of bilirubin from the blood Damage to liver cells affects the ability to facilitate removal of bilirubin from the blood, with resulting deposition in the skin and sclera. With hepatitis, the liver does not secrete excess bile. Destruction of red blood cells does not increase hepatitis. Decreased prothrombin levels cause spontaneous bleeding, not jaundice.