Module 10C - Inflammatory bowel disease- Pearson

The nurse is caring for a client in the early stages of Crohn disease. Which type of lesion should the nurse recall that occurs when at the beginning of this disease​ process? Fistula Canker sore Crypt abscess Aphthoid

Aphthoid Aphthoid lesions are​ small, inflammatory ulcers with a white base and elevated margin. They have a similar appearance to a canker​ sore, but they are not actually cankers. A crypt abscess is found in the beginning stages of ulcerative​ colitis, not Crohn disease. Fistulas appear as Crohn disease​ progresses, not in the early stages.

The nurse reviewed data collected during the assessment of a client with inflammatory bowel disease​ (IBD). Which nursing diagnosis should the nurse use to guide this​ client's care?​ (Select all that​ apply.) Fluid​ Volume: Deficient: Risk for ​Injury, Risk for Diarrhea Constipation ​Confusion, Acute

Fluid​ Volume: Deficient: Risk for Diarrhea Constipation The client with inflammatory bowel disease is at greatest risk for deficient fluid​ volume, diarrhea, and constipation. This client does not generally display acute confusion or risk for falls.​ (NANDA-I ©​ 2014)

A client with severe ulcerative colitis​ (UC) is prescribed bedrest. Which nursing diagnosis should the nurse identify as a priority for this​ client? ​Coping, Ineffective Skin​ Integrity, Risk for Impaired Body​ Image, Disturbed Constipation

Skin​ Integrity, Risk for Impaired Clients with severe UC may have diarrhea with up to 6 to 10 bowel movements every day. Someone who is also incontinent and prescribed bedrest will be at high risk for impaired skin​ integrity, pressure​ ulcers, and eventually infection.​ Therefore, the priority nursing diagnosis is Skin​ Integrity, Risk for Impaired. ​Coping, Ineffective and Body​ Image, Disturbed may be relevant and important but are not the priority diagnoses. Clients with UC have​ diarrhea, not constipation.

The nurse is preparing a community initiative to help reduce the rate of inflammatory bowel disease​ (IBD). On which behavior should the nurse​ focus? Increasing daily exercise habits Smoking cessation Eliminating alcohol use Making lifestyle changes to a​ low-fat diet

Smoking cessation Smoking cigarettes is a major risk factor for the development of IBD and should be the behavior on which the nurse focuses. Dietary​ changes, such as a​ low-fat diet or eliminating​ alcohol, are not associated with decreasing the risk of IBD. Increasing regular exercise does not reduce the risk of developing IBD.

The nurse is caring for a patient with persistent diarrhea. Which assessment finding should indicate to the nurse that the patient is experiencing ulcerative colitis (UC)? Palpable mass in the lower right quadrant Anorectal lesions Right-sided abdominal cramping Stools with blood and mucus

Stools with blood and mucus UC is characterized by frequent diarrhea with blood or mucus in the stool. Right-sided abdominal cramping and a palpable mass in the abdomen is characteristic of Crohn disease. Anorectal lesions are seen in patients with Crohn disease.

The nurse is caring for a young female adult with Crohn disease who was married a few weeks ago. Which question should the nurse include in the assessment interview? "Are you considering starting a family soon?" "Do you have a history of breast cancer in your family?" "Is your husband aware of your condition?" "Do you have any menstrual cycle problems?"

"Are you considering starting a family soon?" Women with IBD are at increased risk of severe preeclampsia, medically indicated preterm delivery, preterm premature rupture of membranes, and delivering infants with low Apgar scores and major congenital malformations. It is essential for women of childbearing age to be proactive in planning pregnancy to optimize their health and medications. The nurse should ask about plans to get pregnant so that this process can get started. There is no relationship between IBD and menstrual cycles or breast cancer. It is not necessary for the nurse to ask whether the patient's husband is aware of the condition.

A patient seeks medical attention for ongoing diarrhea. Which question should the nurse ask to confirm a diagnosis of ulcerative colitis (UC)? "What is your weight?" "Do you have right-sided abdominal pain?" "Is there blood or mucus in your stool?" "What medications are you taking?"

"Is there blood or mucus in your stool?" Patients with UC often have blood or mucus in their stool. Asking about those symptoms can help the nurse identify UC or potential complications. The nurse should ask about weight but will also actually weigh the patient as part of the assessment. Current medications are important but do not distinguish UC. UC has cramping abdominal pain in the left lower quadrant; right-sided abdominal pain is a symptom of Crohn disease.

The nurse is assessing a patient with Crohn disease for systemic manifestations. For symptoms of which disorder should the nurse assess this patient? Arthritis Edema Headache Decreased urine output

Arthritis Systemic effects of inflammatory bowel disease (IBD) may include arthritis, uveitis, and thromboemboli. Headache, edema, and decreased urine output are associated with a variety of conditions but not IBD or Crohn disease.

The nurse prepares teaching for the parents of a child with inflammatory bowel disease​ (IBD). Which mineral should the nurse encourage the parents to provide to the child to prevent future​ complications? Magnesium Potassium Sodium Calcium

Calcium Children with IBD are at higher risk for poor bone density as they get older. It is important that they take in an adequate amount of calcium to promote bone health and strength.​ Magnesium, sodium, and potassium do not help to maintain strong bones.

The nurse is caring for a patient with a strong family history of Crohn disease. Which action should the nurse suggest to help prevent this patient from developing the disease? Eliminate smoking Reduce caffeine intake Decrease protein intake Avoid dietary fats

Eliminate smoking Crohn disease occurs more commonly among smokers. If the patient is a nonsmoker, the nurse should emphasize the importance of not starting the habit. Dietary habits or behaviors are not associated with a reduction in the risk of developing Crohn disease.

The nurse notes that a patient with severe ulcerative colitis (UC) has decreased hemoglobin and hematocrit levels. Which complication should cause the nurse to have the most concern? Toxic megacolon Hemorrhage Perforation Fulminant colitis

Hemorrhage Hemorrhage is the most common complication of UC, which results in large amounts of blood in the stool and decreasing hemoglobin and hematocrit levels on a CBC. Perforation leads to holes in the intestine and leakage of fecal material into the abdomen. Fulminant colitis occurs when there is intestinal dilation and paralysis. Toxic megacolon is a severe form of fulminant colitis and causes excessive gas to accumulate in the bowel, which can lead to perforation if not relieved.

The nurse is caring for a patient with inflammatory bowel disease (IBD). Which intervention should the nurse make a priority for this patient? Maintaining skin integrity Weighing every other day Discussing coping strategies Encouraging deep breathing and coughing

Maintaining skin integrity Interventions for a patient with inflammatory bowel disease primarily focus on preventing infection, monitoring weight daily, maintaining skin integrity, promoting nutritional balance, and maintaining fluid balance. Encouraging deep breathing and coughing may be an appropriate intervention, but this is not a primary focus for this patient. Teaching coping skills, especially how they relate to IBD and the treatment effects, is important but is not the primary focus for this patient.

The nurse is conducting a support group for parents of young children with ulcerative colitis (UC). Which suggestion made by a parent requires the nurse to intervene? "High-protein dietary supplements can help increase protein intake." "Try giving two to three larger meals per day to allow the bowel to rest in between feedings." "Try using a food diary to monitor for foods that can cause intestinal problems." "Offer cream soups or milkshakes if your child won't eat."

"Try giving two to three larger meals per day to allow the bowel to rest in between feedings." Children may tolerate multiple small feedings throughout the day better than they may two to three larger meals. The remaining statements are appropriate for parents with children with UC. It is important to offer high-calorie meals or protein shakes to prevent malnutrition and the use of a food diary can help to identify foods that aggravate the child's symptoms.

A patient prescribed bowel rest for an acute exacerbation of Crohn disease asks what food is permitted. Which response should the nurse make to this patient? "You can only eat soft, bland foods until the bowel has healed." "We will give you IV fluids so that you don't become dehydrated, but you won't be able to eat for a few days." "You won't be able to eat or drink anything for several days or weeks until the bowel has healed." "We will put a tube into your stomach and give you a special type of high-protein and high-calorie solution."

"We will put a tube into your stomach and give you a special type of high-protein and high-calorie solution." When a patient is placed on bowel rest, enteral or parenteral feedings are initiated to ensure adequate nutrition. If tolerated, enteral feedings are preferred due to the decreased risk of complications. The patient should not be completely without any nutrition due to the higher risk of malabsorption or malnutrition. A large-bore IV for fluids does not address the patient's nutritional needs. Even a soft, bland diet is contraindicated in a patient on bowel rest.

The nurse is preparing to assess a group of patients. Which patient should the nurse anticipate to be at a higher risk for developing inflammatory bowel disease (IBD)? A Jewish male with a history of high NSAID use A female of Hispanic descent with a prior surgical history of appendectomy A South American male with a history of high animal-protein intake A female of Asian descent with a history of a high-fat diet

A Jewish male with a history of high NSAID use People of Ashkenazi Jewish ethnicity have a rate of ulcerative colitis that is three to five times higher than that of other ethnic groups, which suggests another genetic link. African Americans and Caucasian Americans are more likely to develop the disease than Hispanic Americans or Asian Americans. Use of NSAIDs, antibiotics, and smoking are also risk factors associated with IBD. Diet does not trigger IBD but can aggravate its symptoms. There is also evidence that having an appendectomy in the early adult years may prevent development of ulcerative colitis.

The nurse prepares materials about ulcerative colitis (UC) for a community health fair. Which age group should the nurse focus on when preparing this material? Between the ages of 5 and 15 years Between the ages of 15 and 30 years Between the ages of 25 and 55 years Between the ages of 30 and 60 years

Between the ages of 15 and 30 years The most common age of onset for ulcerative colitis is between 15 and 30 years, with a secondary peak between the ages of 50 to 70 years. The most common age of onset for ulcerative colitis is not between 5 and 15, 25 and 55, or 30 and 60 years.

The nurse is caring for a patient with severe ulcerative colitis (UC). Which clinical manifestation should the nurse anticipate to assess in this patient? Bloody diarrhea occurring at least six times per day Diarrhea with semiformed stools and abdominal cramping Leakage of intestinal contents into the abdomen Diarrhea fewer than six times per day

Bloody diarrhea occurring at least six times per day Severe ulcerative colitis is characterized by 6 to 10 bloody stools per day and can cause anemia, hypovolemia, and malnutrition. Mild UC is characterized by fewer than 6 stools per day. Patients who have Crohn disease have diarrhea and abdominal cramps. Intestinal perforation causes leakage of intestinal contents into the abdomen.

A client recovering from a colectomy has the following vital​ signs: ​Pulse: 92​ beats/min Blood​ pressure: 103/76 mmHg ​RR: 18​ breaths/min ​Temperature: 100.1degrees°F Which should be the​ nurse's priority​ action? Informing the healthcare provider Performing a focused assessment Administering acetaminophen as prescribed Documenting the findings as normal

Performing a focused assessment Before taking any​ action, it is important for the nurse to assess the client. The client is at high risk for​ infection, and the rising temperature is a good indication. The nurse should assess the surgical wound site and the skin for signs of breakdown. The nurse needs to act on the elevated​ temperature, not just document the results. Simply administering acetaminophen will not address a possible infection. The nurse should assess the client before informing the healthcare provider so that a complete picture of the​ client's status can be relayed.

A patient with inflammatory bowel disease (IBD) asks about dietary supplements to help with the symptoms. Which suggestion should the nurse make to this patient? Probiotics Energy drinks Vitamin K tablets Glucose tablets

Probiotics There is some preliminary evidence that suggests some probiotics may improve symptoms of IBS; however, benefits have not been conclusively demonstrated, and not all probiotics have the same effects. Glucose is needed for cellular energy. Vitamin K is used for clotting. Energy drinks contain sugars and electrolytes. Neither of these is considered an anti-inflammatory agent.

A patient with diarrhea containing both blood and mucus experiences seven to eight stools per day. The nurse notes decreased red blood cells on the patient's complete blood count (CBC). Which condition should the nurse suspect in this patient? Fulminant colitis Crohn disease Severe ulcerative colitis Mild ulcerative colitis

Severe ulcerative colitis Severe ulcerative colitis (UC) is characterized by 6 to 10 bloody stools per day and can cause anemia, hypovolemia, and malnutrition. Mild UC is characterized by fewer than 6 stools per day. Fulminant colitis is a severe complication of UC and can lead to intestinal dilation with paralysis and abdominal distention. Patients who have Crohn disease do not have stools that contain blood or mucus.

An adolescent with a new ileostomy is observed crying. Which action is best for the nurse take at this time? Call the parents to come into the room. Reassure the patient that everything will be okay. Sit next to the patient. Pull the curtains closed to provide privacy.

Sit next to the patient. Before responding, the nurse should find out why the patient is crying. Sitting quietly may help the patient feel comfortable enough to speak with the nurse. Simply closing the curtains and walking away is not supportive of the patient's feelings. It is also not the best action to just call the parents to come in and sit with the patient. The nurse does not know what the family dynamics are between this patient and the parents. The patient may not feel comfortable speaking with the parents at this time. Providing reassurance is not appropriate until the nurse knows what is causing the patient to cry.

The nurse is caring for a child with inflammatory bowel disease​ (IBD) and severe diarrhea. Which goal should the nurse identify as a priority for this​ client? The child reports improved sleep. The child demonstrates healthy coping skills. The child​ self-administers prescribed medication. The child maintains adequate hydration.

The child maintains adequate hydration. A child with severe UC is having frequent diarrhea and most likely has a fluid volume deficit. The priority goal for this child is to maintain adequate hydration in order to support​ fluid, electrolyte, and aciddash-base balance. Healthy coping skills are​ important, but physiological needs should be addressed first. The child may be too young to​ self-administer medication. There is no indication that the child is having difficulty sleeping.

The nurse is discussing the incidence of inflammatory bowel disease (IBD) with a community group. Which information should the nurse include? The disease is often linked to heredity. The disease occurs less frequently in the United States and northern European nations than it does elsewhere in the world. Environmental factors have no effect on the etiology of inflammatory bowel disease. Inflammatory bowel disease does not affect older adults.

The disease is often linked to heredity. A family history of IBD is the most important independent risk factor. Peak onset occurs between ages 15 and 30 years, with a second smaller peak between ages 50 and 70 years. Several environmental factors act as triggers or preventive factors. North America and Northern Europe have the highest incidence and prevalence of ulcerative colitis.

The nurse notes that a pediatric client with irritable bowel disease​ (IBD) has had poor growth since the last examination. Which suggestion should the nurse make to the​ client's parents? ​"Add daily probiotic​ supplements." ​"Administer liquid dietary​ supplements." ​"Increase fiber intake to add bulk to​ stools." ​"Decrease fluid intake to reduce​ diarrhea."

​"Administer liquid dietary​ supplements." A child with IBD is at higher risk for poor growth and malabsorption. The nurse should advise the parents to increase calorie and protein intake. Liquid dietary supplements can be very effective to promote growth. Adding fiber or probiotics and decreasing fluid intake will not promote growth and nutrition status in this child.

The parent of a child with inflammatory bowel disease​ (IBD) reports that the child is refusing to​ eat, causing the parent to become frustrated. Which advice should the nurse provide to this​ parent? ​"I'll arrange for a consult with a nutritionist to get more ideas for meal​ time." ​"It is important for the child to eat. Make foods that they​ like." ​"I'll let the healthcare provider know about your​ concerns." ​"Be firm. The child will eat when​ hungry."

​"I'll arrange for a consult with a nutritionist to get more ideas for meal​ time." It is important for the parents to avoid making mealtime a source of family struggle or difficulty. Referral to a nutritionist or dietitian can help the family learn new​ food/meal strategies. Telling the parent to be firm only reinforces the conflict. Simply making the food that the child likes may not be​ appropriate, because it may worsen symptoms. Informing the healthcare provider may be​ necessary, but it does not address the​ family's concerns.

A client newly diagnosed with Crohn disease asks the nurse whether surgery is necessary to treat the condition. How should the nurse​ respond? ​"Surgery is most often performed when there are complications such as bowel​ obstruction." ​"Surgery is always performed at some point to treat Crohn​ disease." ​"Surgery is almost never necessary and cannot treat Crohn disease or its​ complications." ​"Surgery can prevent the​ long-term spread or worsening of Crohn​ disease."

​"Surgery is most often performed when there are complications such as bowel​ obstruction." Bowel obstruction is the leading indication for surgery in Crohn​ disease, which is only performed when necessary to treat or prevent​ complications, or because of the failure of conservative treatments. Surgery is not always​ performed, but it is most often used to treat the complications of the disease. The disease process tends to recur in other areas following removal of affected bowel segments. The risk of fistula formation increases following surgery.

The nurse is caring for a patient newly diagnosed with Crohn disease. Which lifestyle change should the nurse suggest to this patient? "Increase intake of dairy products to increase calcium levels." "Avoid anti-inflammatory medications to minimize irritation of the stomach lining." "Increase dietary fiber to add bulk to stools." "Limit protein to prevent irritation of the bowel."

"Increase dietary fiber to add bulk to stools." A patient with inflammatory bowel disease (IBD) may require changes to their diet in order to manage the symptoms. Increasing dietary fiber can reduce diarrhea. Some patients may need to eliminate dairy products, not increase intake. Patients may need higher intake of protein to ensure that they are not malnourished. Anti-inflammatory medications can reduce inflammation in the bowel and do not need to be avoided.

The nurse is teaching the parents of a child newly diagnosed with inflammatory bowel disease (IBD). Which statement by the parents should indicate to the nurse that teaching has been effective? "We will restrict calories to prevent abdominal discomfort." "We will provide several small feedings a day." "We will avoid liquid dietary supplements to minimize protein overload." "We will increase fiber intake."

"We will provide several small feedings a day." When caring for a child with IBD, the nurse should advise the parents to feed the child with multiple small meals during the day, which may be better tolerated than larger meals. The parents should avoid high-fiber foods in order to decrease intestinal motility and inflammation. Children with IBD require increased protein and calories to minimize the risk of malnutrition.

The nurse notes that a patient with inflammatory bowel disease (IBD) has lost 3 pounds since the day before. Which should be the priority intervention by the nurse? Assessing the perianal area Filling in the stool chart Administering intravenous fluids as prescribed Administering an anti-inflammatory drug

Administering intravenous fluids as prescribed The loss of a few pounds from one day to the next indicates fluid volume deficit or dehydration. The priority is to administer fluids to promote good hydration. Anti-inflammatories will not address the patient's decreasing weight. Assessing the perianal area does not provide information about fluid status. Filling in the stool chart can give insight into why the patient is dehydrated, but this is not the priority intervention.

The nurse is caring for an older adult patient with a new diagnosis of ulcerative colitis (UC). Which medication prescription should the nurse anticipate for this patient? High-dose probiotics Anti-inflammatories An immunosuppressive agent Total parenteral nutrition (TPN)

An immunosuppressive agent Older adult patients are usually treated with immunosuppressive agents as a first-line medication for UC. Despite this, there is insufficient evidence as to the effectiveness of this type of medication. Anti-inflammatories and high-dose probiotics are not the first treatment prescribed for an older adult with UC. TPN is sometimes used to provide patients with bowel rest, but it is not routinely prescribed for patients with UC.

The nurse reviews the pathophysiology of Crohn disease with a patient who is newly diagnosed with the disorder. Which information about the patient's colonoscopy results should the nurse include in the discussion? Continuous inflammatory lesions of bowel Red, edematous, and friable tissue Inflammation that begins at the crypts of Lieberkühn in the distal large intestine and rectum Cobblestone appearance of bowel

Cobblestone appearance of bowel With Crohn disease, the bowel lumen begins to appear like "cobblestones," as fissures and ulcers surround islands of intact tissue over edematous submucosa. The inflammatory lesions are not continuous and often occur as "skip" lesions with intervals of normal-appearing bowel. Patients with ulcerative colitis have a bowel that appears red, edematous, and friable. The inflammation of ulcerative colitis begins at the crypts of Lieberkühn in the distal large intestine and rectum.

A patient seeks medical care for diarrhea and lower abdominal pain. Which diagnostic test should the nurse anticipate being prescribed for this patient? CT scan PET scan Colonoscopy Abdominal flat plate

Colonoscopy The patient is experiencing signs of Crohn disease, and the provider is likely to prescribe a colonoscopy to look for the characteristic findings associated with the disease, such as the cobblestone appearance of bowel mucosa. An abdominal flat plate will not evaluate tissue characteristics. PET or CT scans will not be able to see the lesions in the bowel for the diagnosis of Crohn disease.

A patient seeks medical attention for blood in the stool. Which laboratory test should the nurse anticipate to be prescribed first for this patient? Complete blood count (CBC) Liver enzymes BUN/creatinine Blood chemistry panel

Complete blood count (CBC) The nurse should be most concerned about hemorrhage in this patient and anticipate the provider prescribing a CBC to evaluate blood loss or anemia. Liver function, renal function, and blood chemistry labs are not initially indicated for this patient because the priority is determining whether there is a hemorrhage that needs to be addressed first.

The nurse notes that a client with inflammatory bowel disease​ (IBD) has a stoma with a nipple valve. Which type of ostomy should the nurse document that this client​ has? Continent ileostomy Temporary ostomy Loop ostomy Ileostomy

Continent ileostomy A continent ileostomy is a procedure where an​ intra-abdominal reservoir is created and a nipple valve is attached to prevent drainage of stool from the reservoir. A nipple valve is not used during an​ ileostomy, loop​ ostomy, or temporary ostomy.

A nurse is working at a​ gastroenterologist's office. Which distinction between inflammatory bowel diseases​ (IBD) in the pediatric population should the nurse understand as​ important? Most pediatric clients have little colonic involvement with Crohn disease. Surgery is not usually required in the pediatric population. IBD is more common in boys than in girls. Children often present with fistulizing or structuring Crohn disease.

IBD is more common in boys than in girls. In​ children, more boys than girls have Crohn​ disease, with the opposite true of adults. Pediatric clients with Crohn disease often have ileocolonic or colonic​ disease, where adults do not have any colonic involvement. While children present with inflammatory or nonstricturing or nonfistulizing​ disease, adults are more likely to have strictures or fistulas. IBD tends to be more aggressive in​ children, requiring surgery at a younger age.

The nurse is planning care for a client with inflammatory bowel disease​ (IBD). Which problem should the nurse make a priority for this​ client? Impaired fluid balance Fatigue Impaired skin integrity Impaired nutrition

Impaired fluid balance While all choices are​ problems, impaired fluid balance is a priority that should be addressed in planning care for the client with inflammatory bowel​ disease, because this problem may be life threatening if not addressed.

A client with severe Crohn disease has been on multiple medications without finding adequate relief from the symptoms. Which medication order should the nurse​ anticipate? Infliximab Olsalazine Metronidazole Methylprednisolone

Infliximab Infliximab, an immune response​ modifier, suppresses tumor necrosis factor​ (TNF) to reduce inflammation in the treatment of inflammatory bowel disease. Olsalazine and metronidazole are antibiotics that are used to treat inflammatory bowel disease and do not suppress tumor necrosis factor​ (TNF). Methylprednisolone is a​ corticosteroid, which is used to treat inflammatory bowel disease and does not suppress tumor necrosis factor​ (TNF).

A client with inflammatory bowel disease is prescribed sulfasalazine. Which information should the nurse instruct the client about this​ medication? (Select all that​ apply.) It blocks the production of prostaglandin to reduce inflammation. Reduce intake of sodium when taking this. Use sunscreen when taking this. It reduces the number of stools per day to maintain fluid balance. The main side effect is appetite stimulation.

It blocks the production of prostaglandin to reduce inflammation. Use sunscreen when taking this. Sulfasalazine blocks the production of prostaglandin to reduce inflammation. The client should use sunscreen when taking this medication because it causes photosensitivity. This medication does not stimulate appetite or reduce the number of stools per day. Clients taking​ corticosteroids, not​ antibiotics, should decrease sodium intake. This medication is an​ antibiotic, which does not require reducing sodium intake.

The nurse is planning care for a female client with ulcerative colitis​ (UC). Which characteristic should the nurse​ recognize? (Select all that​ apply.) It may include arthritis involving one or several joints. It affects more women than men. Vomiting is the predominant manifestation. Left lower quadrant cramping is relieved by defecation. Mild to moderate symptoms includes six or fewer stools per day.

It may include arthritis involving one or several joints. Left lower quadrant cramping is relieved by defecation. Mild to moderate symptoms includes six or fewer stools per day. Clients with severe disease may have systemic manifestations such as arthritis involving one or several​ joints, skin and mucous membrane​ lesions, or uveitis​ (inflammation of the​ uvea, the vascular layer of the​ eye, which may involve the sclera and cornea as​ well). Left lower quadrant cramping relieved by defecation is common. Mild to moderate UC is characterized by six or fewer stools per​ day, intermittent rectal bleeding and​ mucus, and few systemic manifestations. It is more common in men than in​ women, with an average age of diagnosis of 40 years.​ Diarrhea, not​ vomiting, is the predominant manifestation of UC.

The nurse is questioning a client with Crohn disease about the presence of current symptoms. Which symptom should the nurse expect to find in the​ client? (Select all that​ apply.) Malaise Left lower quadrant abdominal pain relieved by defecation ​Fissures, ulcers,​ fistulas, and abscesses of the anorectal area Blood in the stool Persistent diarrhea

Malaise ​Fissures, ulcers,​ fistulas, and abscesses of the anorectal area Blood in the stool Persistent diarrhea Blood may or may not be present in the stool of a client with Crohn​ disease, and the nurse would need to assess for it. A client with Crohn disease will have​ right, not​ left, lower quadrant abdominal pain relieved by defecation. Persistent diarrhea is a symptom of Crohn disease. Malaise may be present in a client with Crohn disease.​ Fissures, ulcers,​ fistulas, and abscesses of the anorectal area may be present in a client with Crohn​ disease, and the nurse would assess the client for them.

A patient with a history of being treated with antibiotics and steroids for Crohn disease is being considered for surgery because of strictures in the colon. Which surgery should the nurse anticipate for the patient? Total colectomy ileal pouch-anal anastomosis Strictureplasty Sigmoidoscopy Bowel resection

Strictureplasty The patient is likely to undergo a strictureplasty. Longitudinal incisions are made in the narrow bowel segments to relieve strictures. A sigmoidoscopy is a procedure to inspect the bowels for changes and, if needed, to take biopsies. A bowel resection is aimed at reducing inflammation by removing the diseased part of the bowel. The total colectomy ileal pouch-anal anastomosis (IPAA) is usually performed on patients with ulcerative colitis.

A patient with inflammatory bowel disease (IBD) has an allergy to sulfonamides. Which medication prescription should the nurse question? Metronidazole Clarithromycin Sulfasalazine Ciprofloxacin

Sulfasalazine Sulfasalazine combines a sulfonamide antibiotic that is poorly absorbed from the GI tract with mesalamine, which acts topically on the colonic mucosa to inhibit the inflammatory process. The other medication choices are antibiotics that do not contain sulfa and would not cause an allergic reaction in the patient.

The nurse is planning care for a patient with inflammatory bowel disease (IBD). Which outcome should the nurse consider as most appropriate for this patient? The patient recognizes the early signs of a flare-up. The patient has no symptoms of infection. The patient's skin excoriation is improving. The patient loses less than 5% of pre-illness body weight.

The patient has no symptoms of infection. The most correct outcome for the patient with inflammatory bowel disease is for the patient to demonstrate no signs of an infection. The patient should have no loss of skin integrity or weight loss.

The nurse is planning care for a client in the early stages of ulcerative colitis. Which part of the colon should the nurse understand to be initially affected by ulcerative​ colitis? The duodenum The transverse colon The ileocecal junction The rectosigmoid area

The rectosigmoid area Ulcerative colitis begins with inflammation at the base of the crypts of​ Lieberkühn in the distal large intestine and rectal mucosa.​ Microscopic, pinpoint mucosal hemorrhages​ occur, and crypt abscesses develop. These abscesses penetrate the superficial submucosa and spread​ laterally, leading to necrosis and sloughing of bowel mucosa. Ulcerative colitis can progress to the entire​ colon, stopping at the ileocecal junction. The duodenum is part of the small intestine and is not affected by ulcerative colitis. The transverse colon is not initially affected by ulcerative colitis.

A patient with ulcerative colitis is scheduled for surgery to remove the bowel and place a temporary ostomy. For which surgical procedure should the nurse prepare teaching material for this patient? Pyloroplasty Stricturoplasty Total colectomy ileal pouch-anal anastomosis (IPAA) Gastric resection

Total colectomy ileal pouch-anal anastomosis (IPAA) A total colectomy IPAA is a treatment for a patient with ulcerative colitis. It entails the removal of the entire colon and rectum and the formation of a temporary or loop ileostomy at the same time. The ileostomy is used for 2 to 3 months. A stricturoplasty is used to treat bowel strictures and does not involve the removal of the bowel or creation of an ostomy. A gastric resection is the removal of part of the stomach, not the bowel. It does not involve the creation of an ostomy. A pyloroplasty is a surgical procedure to widen the opening of the pyloric valve at the lower portion of the stomach. It does not involve the removal of the bowel or the creation of an ostomy.

A client with inflammatory bowel disease​ (IBD) is prescribed corticosteroids. Which information should the nurse provide about the​ medications? (Select all that​ apply.) ​"Expect weight​ loss." ​"Reduce intake of foods high in​ sodium." ​"It may cause low blood​ pressure." ​"Take with food or at​ mealtimes." ​"Take medication consistently and do not stop​ abruptly."

​"Reduce intake of foods high in​ sodium." ​"Take with food or at​ mealtimes." ​"Take medication consistently and do not stop​ abruptly." Corticosteroids should be taken with food or at mealtimes to reduce the gastrointestinal side effects. A client taking corticosteroids tends to retain​ fluid, and sodium tends to exacerbate the retention.​ Therefore, the client should reduce the intake of foods that are high in sodium. Corticosteroids should be taken consistently and not be stopped abruptly to reduce the possibility of adrenal shutdown. A client taking corticosteroids tends to​ gain, not​ lose, weight. A client taking corticosteroids tends to have​ high, not​ low, blood pressure.

A newly pregnant client who has a history of inflammatory bowel disease​ (IBD) asks how the disease will impact their pregnancy. Which response by the nurse is accurate​? ​"Your disease may increase the risk for some pregnancy​ complications." ​"The medications used to treat your disease are safe to use during your​ pregnancy." ​"IBD should have no effect on pregnancy or the baby.​ We'll watch you​ closely." ​"You will need to be on bedrest throughout the entire​ pregnancy."

​"Your disease may increase the risk for some pregnancy​ complications." Pregnant women with IBD are at higher risk for​ preeclampsia, medically indicated preterm​ delivery, preterm premature rupture of​ membranes, and delivering infants with low APGAR scores. There is also a risk of some major congenital​ malformations, which are not completely explained by the medications used. It is not necessary for a woman to be on complete bedrest throughout her entire pregnancy. Not all drugs are safe for the pregnant woman.