Nursing Evolve Questions Care for Pts w Inflammatory Intestinal Disorders

About which medication would the nurse teach the patient who is prescribed an antiperistaltic agent? 1 Loperamide 2 Ciprofloxacin 3 Acetaminophen 4 Docusate sodium

1

Which bacteria may cause gastroenteritis? 1 Shigella species 2 Gonococcal species 3 Pneumococcal species 4 Staphylococcal species

1

Which medication would be beneficial to the patient with gastroenteritis who has increased peristaltic movements? 1 Loperamide 2 Ciprofloxacin 3 Trimethoprim 4 Acetaminophen

1 Loperamide has antiperistaltic action and is occasionally prescribed for patients with gastroenteritis. Ciprofloxacin is an antibiotic. Acetaminophen is not indicated in the treatment of gastroenteritis. Docusate sodium is a drug used for softening stool.

Which classic symptom is seen in a patient with peritonitis? 1 Hematuria 2 Bradycardia 3 Severe diarrhea 4 Abdominal wall rigidity

4 In patients with peritonitis, abdominal wall rigidity is a cardinal sign of peritonitis and is referred to as a boardlike abdomen. Tachycardia may occur due to high fever and decreased circulating blood volume. Severe diarrhea may be observed in gastroenteritis. Hematuria is not typically associated with peritonitis.

Which incubation period is seen in a person with a normal immune system who has the Norwalk virus? 1 24 to 48 hours 2 1 to 10 days 3 7 days 4 2 to 7 weeks

1

Which medication would a patient with ulcerative colitis who complains of severe diarrhea with exacerbations be taught to take for flare-ups? 1 Glucocorticoids 2 Aminosalicylates 3 Immunomodulators 4 Antidiarrheal drugs

1

Which statement about appendicitis is accurate? 1 It occurs mostly in young adults. 2 It is mostly caused by parvovirus-type organisms. 3 It causes pain in the left lower quadrant. 4 It is a chronic inflammation of the appendix.

1 Appendicitis occurs mostly in young adults. It causes pain in the right lower quadrant and is an acute inflammation of the appendix. It is caused primarily by the obstruction of lumen of the appendix with hard pieces of feces composed of calcium phosphate-rich mucus and inorganic salts. Parvovirus-type organisms cause viral gastroenteritis.

Which patient is at risk for celiac disease? 1 The patient with multiple sclerosis 2 The patient who is receiving prednisone 3 The patient with diabetes mellitus type I 4 The patient who is receiving paromomycin

3

Which physiological change is seen in a patient with ulcerative colitis? 1 Increase in hemoglobin levels 2 Hyperalbuminemia 3 Leukocytosis 4 Hyperkalemia

3

Which complication is associated with Crohn disease? 1 Fistula 2 Hemorrhage 3 Hypovolemia 4 Colorectal cancer

1 Crohn disease is an inflammatory bowel disease that causes abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. Strictures and deep ulcerations occur in Crohn disease, which increases the risk for developing bowel fistulas. Hemorrhage is a complication associated with ulcerative colitis (UC). Hypovolemia is a complication associated with gastroenteritis. Colorectal cancer is a complication associated with UC.

A patient reports having seven to nine bloody stools per day. The nurse finds that the patient has fever, tachycardia, anemia, and abdominal pain. The patient's laboratory reports indicate elevated C-reactive protein. Which classification of ulcerative colitis (UC) do these findings support? 1 Mild 2 Severe 3 Moderate 4 Fulminant

2

Which potential complication is associated with Crohn disease? Select all that apply. One, some, or all responses may be correct. 1 Fistulas 2 Osteoporosis 3 Malabsorption 4 Stomach cancer 5 Abscess formation

1, 2, 3, 5

About which medication would the nurse teach a patient who is newly diagnosed with moderate ulcerative colitis (UC)? 1 Azathioprine 2 Sulfasalazine 3 Mercaptopurine 4 Sulfamethoxazole

2

Which finding in a patient with gastroenteritis indicates dehydration? Select all that apply. One, some, or all responses may be correct. 1 Fever 2 Oliguria 3 Hypertension 4 Poor skin turgor 5 Right lower quadrant pain

1, 2, 4

Which disorder would the nurse identify as acute inflammatory bowel disorders? Select all that apply. One, some, or all responses may be correct. 1 Peritonitis 2 Appendicitis 3 Gastroenteritis 4 Crohn disease 5 Ulcerative colitis

1, 2, 3

Which sign/symptom is consistent with the diagnosis of appendicitis? Select all that apply. One, some, or all responses may be correct. 1 Anorexia 2 Nausea and vomiting 3 Rebound tenderness 4 Decreased white blood cell count 5 Abdominal pain relieved by coughing

1, 2, 3 Symptoms consistent with appendicitis include abdominal pain that is aggravated by coughing, nausea and vomiting, anorexia, rebound tenderness, and an increased white blood cell count.

Which teaching point would the nurse include in a plan of care for a patient with gastroenteritis? Select all that apply. One, some, or all responses may be correct. 1 To use medicated cleansing wipes 2 To use toilet paper and harsh soaps 3 To apply a protective barrier cream to the skin 4 To take sitz baths for 10 minutes two or three times daily 5 To clean the genital area with cool water

1, 3, 4 The nurse should teach the patient to use medicated wipes to avoid skin irritation and infections. Applying protective barrier cream helps protect the skin. Taking sitz baths for 10 minutes two or three times daily helps relieve pain and itching in the genital area. Use of toilet paper and harsh soaps should be avoided. The genital area should be cleaned with warm water for relief from pain.

Which symptom would the nurse assess in a patient admitted for gastroenteritis? Select all that apply. One, some, or all responses may be correct. 1 Fever 2 Hypertension 3 Acute confusion 4 Poor skin turgor 5 Excessive urination

1, 3, 4 The patient with gastroenteritis loses a considerable amount of fluid through diarrhea and vomiting. This may lead to dehydration manifested by fever, acute confusion, and poor skin turgor. Therefore the patient has oliguria or a decreased urine output. Hypotension, rather than hypertension, is present in patients with gastroenteritis.

Which medication prevents the migration of white blood cells (WBCs) to inflamed bowel tissue? 1 Prednisone 2 Vedolizumab 3 Azathioprine 4 Metronidazole

2

Which patient requires infliximab treatment? 1 The patient with heart disease 2 The patient with Crohn disease 3 The patient with multiple sclerosis 4 The patient with diverticular disease

2

Which surgical intervention is beneficial when a patient with abdominal pain has an indefinitive diagnosis? 1 Appendectomy 2 Exploratory laparotomy 3 Natural orifice transluminal endoscopic surgery 4 Restorative proctocolectomy with ileo pouch-anal anastomosis

2

Which sign of gastroenteritis may appear first in an older adult? 1 Hypotension 2 Poor skin turgor 3 Acute confusion 4 Dry mucous membranes

3

Which surgical techniques are involved in the treatment of Crohn disease? 1 Minimal invasive surgery (MIS) and ileostomy 2 Minimal invasive surgery and stricturoplasty 3 Ileostomy and natural orifice transluminal endoscopic surgery (NOTES) 4 Stricturoplasty and natural orifice transluminal endoscopic surgery

2

Which term is used to describe a fistula that is present between the bowel and the bladder? 1 Enteroenteric fistula 2 Enterovesical fistula 3 Enterovaginal fistula 4 Enterocutaneous fistula

2

Which rationale is accurate as to why blood cultures are obtained in a patient with peritonitis? 1 To assess renal function 2 To determine septicemia 3 To assess respiratory status 4 To determine acid-base balance

2 Peritonitis is an inflammation of the peritoneum. Blood cultures are performed to determine whether septicemia has occurred. Electrolyte levels are assessed to determine renal function. Oxygen saturation is determined to assess the respiratory status and acid-base balance.

Which examination is used to identify an enlarged appendix in a patient? 1 X-ray study 2 Abdominal ultrasound 3 Magnetic resonance enterography (MRE) 4 Palpation of the abdomen

2 An abdominal ultrasound study may show the presence of an enlarged appendix. An x-ray is used to identify free air or abdominal fluid. An MRE is the main examination used to study the bowel in patients who have chronic irritable bowel disease (IBD). Palpation of the abdomen may reveal muscle rigidity and guarding.

Which organism causes gastroenteritis and is possibly transmitted through the respiratory route in addition to the fecal-oral route? 1 Shigella 2 Norovirus 3 Escherichia coli 4 Campylobacter enteritis

2 Norovirus, also known as Norwalk-like viruses, causes gastroenteritis and is transmitted through the fecal-oral route and possibly the respiratory route. Shigella transmits through direct and indirect fecal-oral routes . Escherichia coli transmit through fecal contamination of food, water, or fomites. Campylobacter enteritis causes gastroenteritis through the fecal-oral route or by contact with infected animals or infants.

Which postoperative action would be implemented for a patient who just had abdominal surgery for peritonitis? 1 Monitor level of consciousness every 4 hours. 2 Irrigate peritoneal drain using sterile technique. 3 Maintain the patient in a supine position. 4 Monitor respiratory rate every 2 hours.

2 Sometimes manual irrigation of the peritoneum must be performed through a drain as prescribed by the health care provider. The postoperative patient is maintained in a semi-Fowler position to promote drainage of peritoneal contents into the lower region of the abdominal cavity. Respiratory rate and level of consciousness are monitored every hour immediately after abdominal surgery.

Which nursing intervention is the highest priority when caring for a patient who has diverticulitis with a suspected complication of a perforated bowel that is causing peritonitis? 1 Medicating the patient for pain 2 Preparing the patient for emergency surgery 3 Assessing the patient for changes in vital signs 4 Monitoring for changes in the patient's mentation

2 The highest priority is to prepare this patient for emergency surgery so that the source of the infection (the perforated bowel) can be removed. It is expected that the patient will experience changes in vital signs as a result of the infectious process and accompanying pain. Although monitoring the patient's vital signs is important, the patient has an immediate need to go to surgery. Determining whether the patient is experiencing changes in mentation and medicating the patient for pain are important but are not the highest priority.

Which postoperative instruction would be given to the patient after undergoing abdominal surgery for peritonitis? 1 Avoid drugs such as docusate sodium. 2 Report a temperature higher than 101°F (38.3°C). 3 Avoid lifting anything for at least 4 weeks. 4 Stop taking antibiotics once the incision begins to heal.

2 The patient must report a temperature higher than 101°F (38.3°C) to the health care provider immediately. Drugs such as docusate sodium are used to soften the stool. Foul-smelling drainage is a sign of infection and must be reported. Antibiotics should be taken as prescribed until they are finished. Lifting is usually not allowed for at least 6 weeks.

Which intervention would be included in the plan of care for a patient with diarrhea who has developed skin irritation? Select all that apply. One, some, or all responses may be correct. 1 Using a tissue to wipe 2 Patting the area gently 3 Taking antidiarrheal medication 4 Refraining from taking sitz baths 5 Using mild soap to wash the skin

2, 3, 5 Patting the area gently will help absorb moisture and prevent skin irritation. Antidiarrheal medication will reduce bowel movements and the frequency of bowel movements. Using mild soap to wash the skin will help remove dirt. Sitz baths are beneficial for the patient with diarrhea, and skin irritation and should not be evaded. The nurse should use medicated wipes instead of tissues for wiping.

Which assessment finding would the nurse observe in a patient with peritonitis? Select all that apply. One, some, or all responses may be correct. 1 Diarrhea 2 Anorexia 3 Low-grade fever 4 Distended abdomen 5 Increased urine output

2, 4

Which assessment finding would the nurse observe in a patient with peritonitis? Select all that apply. One, some, or all responses may be correct. 1 Diarrhea 2 Anorexia 3 Low-grade fever 4 Distended abdomen 5 Increased urine output

2, 4 Peritonitis is an acute inflammation of the visceral, the parietal peritoneum, the endothelial lining of the abdominal cavity. A patient with peritonitis presents with a distended abdomen and anorexia. The patient has a high fever rather than a low-grade fever. Urine output is decreased because fluid shifts from the vascular compartment to the peritoneal cavity. There is no diarrhea; rather, the patient is unable to pass flatus because peristalsis slows or stops due to severe peritoneal inflammation.

Which classic symptom is seen in celiac disease? Select all that apply. One, some, or all responses may be correct. 1 Weight gain 2 Steatorrhea 3 Osteoporosis 4 Abdominal pain 5 Diarrhea and/or constipation

2, 4, 5

Which statement about gastroenteritis is accurate? 1 Fluid replacement is a priority in the patient with gastroenteritis. 2 Most causes of gastroenteritis are transmitted by the respiratory route. 3 Patients with gastroenteritis will present with hypoactive bowel sounds. 4 Wearing a mask is an effective intervention for preventing the transmission of gastroenteritis.

3

Which illness is associated with right lower quadrant pain? 1 Sepsis 2 Peritonitis 3 Appendicitis 4 Gastroenteritis

3

Which kind of diet would be provided to a patient to promote the healing of a fistula? 1 High-fiber food 2 Low-vitamin food 3 High-protein meals 4 Low-calorie meals

3

Which nursing intervention would be included in the plan of care for a patient with appendicitis? 1 Administering laxatives to loosen the stool 2 Applying warm compresses on the abdomen 3 Keeping the patient in a semi-Fowler position 4 Avoiding the administration of opioid analgesics

3

A patient has a low-grade fever and tenesmus. Which other clinical manifestation may indicate ulcerative colitis? 1 Increase in appetite 2 Difficulty passing stools 3 Inflammation of the joints 4 Formation of lesions outside the mouth

3

A patient has been diagnosed with ulcerative colitis (UC) and reports having between four and five bloody stools per day. How would the nurse classify the intensity of this patient's UC? 1 Mild 2 Severe 3 Moderate 4 Fulminant

3

A patient reports pain midway between the anterior iliac crest and the umbilicus in the right lower quadrant. The nurse would document that the patient is experiencing pain in which location? 1 Rebound point 2 Appendix point 3 McBurney point 4 Right lower quadrant point

3

Which clinical manifestation is seen in Crohn disease? 1 Weight gain 2 Vomiting 3 Abdominal pain 4 Six or more bloody stools per day

3

Which complication is seen exclusively in patients with ulcerative colitis? 1 Cholelithiasis 2 Malabsorption 3 Colorectal cancer 4 Abscess formation

3

Which disorder is associated with inflammation of the small intestine? 1 Peritonitis 2 Gastroenteritis 3 Crohn disease 4 Ulcerative colitis

3

Which symptom is most indicative of Crohn disease (CD)? 1 Epigastric cramping 2 Hypotension with vomiting 3 Chronic diarrhea, abdominal pain, and fever 4 Abdominal pain relieved by bending the knees

3

Which symptom is usually seen first in gastroenteritis? 1 Hypotension 2 Diarrhea 3 Vomiting 4 Abdominal cramping

3

Which drug is often used to treat gastroenteritis caused by Shigella? 1 Tinidazole 2 Loperamide 3 Ciprofloxacin 4 Sulfasalazine

3 Ciprofloxacin is used to treat gastroenteritis caused by Shigella. Tinidazole is used to treat giardiasis caused by Giardia lamblia. Loperamide is a drug that reduces peristaltic movement and is not commonly given for Shigella because it prevents elimination of the infecting organism. Sulfasalazine is an aminosalicylate that is used for ulcerative colitis.

Which medication would be prescribed to a patient who has severe diarrhea and an elevated temperature and who just returned from a trip South America? 1 Oxycodone 2 Loperamide 3 Ciprofloxacin 4 Sulfamethoxazole

3 In tropical regions and fast-food restaurants, lettuce and spinach are foods most commonly contaminated with bacteria. Ciprofloxacin is prescribed in cases of bacterial gastroenteritis with severe illness. Oxycodone is used to decrease inflammation in case of peritonitis. Loperamide is an antiperistaltic agent. Sulfamethoxazole is used to treat infections caused by Shigella.

Which classic symptom is associated with appendicitis? 1 Unintentional weight loss 2 Diarrhea 3 Cramping pain in the epigastric area 4 Temperature greater than 101°F (38.3°C)

3 A classic symptom of appendicitis is a cramping pain in the epigastric or periumbilical area. Gastroenteritis may manifest as diarrhea and unintentional weight loss due to loss of fluids from vomiting and diarrhea. Perforation of the appendix may result in peritonitis with a temperature greater than 101°F (38.3°C).

While assessing a patient with pain in the right lower quadrant, the nurse finds that the patient has a body temperature of 39°C (102.2°F) and a pulse rate of 100 beats/min. About which surgical intervention would the nurse anticipate teaching the patient that will control the patient's condition? 1 Ileostomy 2 Total proctocolectomy 3 Exploratory laparotomy 4 Uncomplicated appendectomy

3 A patient with pain in the right lower quadrant, a body temperature of 39°C (102.2°F), and a pulse rate of 100 beats/min may have a perforated appendix with peritonitis. An exploratory laparotomy is used to treat the patient's condition, which involves the surgical removal of the inflamed and perforated organ, followed by irrigation of peritoneum with antibiotic solutions. An ileostomy involves the drainage of fecal material into a pouching system worn on the abdomen of a patient with ulcerative colitis. A total proctocolectomy is performed in a patient who does not want the ileo-anal pouch. The procedure involves the removal of the colon, rectum, and anus with surgical closure of the anus. Uncomplicated appendectomy involves the removal of the inflamed appendix.

The nurse is caring for an older patient who has had abdominal distention and loose stools for 3 days. The serum potassium is 3.0 mEq/L, and blood pressure is 94/60 mm Hg. Which treatment would be suitable for the patient at this time? 1 Loperamide 2 Sulfasalazine 3 Oral rehydration solution 4 Diphenoxylate hydrochloride

3 Abdominal distention, loose stools, a low serum potassium level of 3.0 mEq/L, and blood pressure of 94/60 mm Hg indicate that the patient has gastroenteritis. Oral rehydration therapy in the patient helps replenish fluid and electrolyte levels. Loperamide can prevent the organism from being eliminated from the body; therefore it should not be given to a patient with bacterial or viral gastroenteritis. Sulfasalazine is effective in the treatment of ulcerative colitis. Diphenoxylate hydrochloride reduces GI motility, but it is not used with the older adult because it also causes drowsiness and could contribute to falls.

While assessing a patient with peritonitis, which finding would the nurse be concerned about that indicates that the inflammation has progressed? 1 Heart rate becoming bradycardic 2 Abdomen becoming more sunken 3 Diminishing bowel sounds 4 Increasing urinary output

3 Peritonitis is an inflammation of the peritoneum, which is the tissue that lines the inner wall of the abdomen that covers and supports most of the abdominal organs. Bowel sounds usually disappear when the inflammation progresses. Heart rate will increase due to the progression of inflammation in patients with peritonitis. Progressive abdominal distention is observed when the inflammation is progressed due to reduced intestinal motility. Urinary output would decrease due to increased dehydration.

In which position would the nurse place a patient after having an exploratory abdominal laparotomy? 1 Supine 2 High-Fowler 3 Semi-Fowler 4 Lateral Sims (side-lying)

3 The patient is maintained in a semi-Fowler position to facilitate the drainage of peritoneal contents into the lower region of the abdominal cavity after an abdominal laparotomy. This position also helps increase lung expansion. A high-Fowler position would be too high for the patient postoperatively; it would place strain on the abdominal incision(s), and, if the patient was still drowsy from anesthesia, this position would not enhance the patient's ability to rest. Sims position does not promote drainage to the lower abdomen. The supine position does not facilitate drainage to the abdomen or increased lung expansion; the patient would be more likely to develop complications (wound drainage stasis and atelectasis) in this position.

Which would be most likely in a patient when there is bacterial contamination of the peritoneal cavity? 1 Leakage of bile 2 Perforating tumor 3 Gangrenous gallbladder 4 Infection by skin pathogens

3 Gangrenous gallbladder may contaminate the peritoneal cavity, which is prone to bacterial infections. Leakage of bile can cause chemical peritonitis. Perforating tumor is a less common reason for contamination of the peritoneal cavity. Skin pathogens can infect a patient undergoing continuous ambulatory peritoneal dialysis but are a not a common cause of bacterial contamination of the peritoneal cavity.

A patient is being discharged after a laparotomy for treatment of peritonitis. Which sign or symptom would the nurse teach the patient to report to the primary health care provider immediately? Select all that apply. One, some, or all responses may be correct. 1 Incisional tenderness 2 Active bowel sounds 3 Signs of wound dehiscence 4 Unusual or foul-smelling drainage 5 A temperature higher than 101°F (38.3°C)

3, 4, 5

Which cause of peritonitis is less common? Select all that apply. One, some, or all responses may be correct. 1 Bacteria 2 Chemicals 3 Perforating tumors 4 Leakage during surgery 5 Contamination during surgery

3, 4, 5

An 80-year-old patient with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which health care provider prescription would the nurse implement first? 1 Administer acetaminophen 650 mg rectally. 2 Obtain a stool specimen for culture and sensitivity. 3 Draw blood for a complete blood count and serum electrolytes. 4 Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.

4

Which clinical findings in a patient indicate ulcerative colitis? 1 Bowel fistulas 2 Thickened bowel wall 3 Inflammation of the ileum and colon 4 Presence of blood and mucus in the stool

4

Which diagnostic test is preferred to differentiate between ulcerative colitis and Crohn disease? 1 CT scan 2 Colonoscopy 3 Magnetic resonance enterography 4 X-ray examination with barium enema

4

Which medication would be helpful in a patient who has a fistula associated with Crohn disease? 1 Mesalamine 2 Sulfasalazine 3 Azithromycin 4 Metronidazole

4

Which medication would be used as the first-line treatment for mild ulcerative colitis? 1 Infliximab 2 Prednisone 3 Loperamide 4 Sulfasalazine

4

Which physiological changes take place in a patient after about a week after having a total proctocolectomy with a permanent ileostomy? 1 The effluent has a foul odor. 2 The stool becomes reddish in color. 3 Stool volume increases and becomes thin. 4 Stool volume decreases and becomes thick.

4

Which source of gastroenteritis is the likely cause for a patient who has travelled outside the country? 1 Overcooked food 2 Insufficient vaccinations 3 Bacteria on the patient's hands 4 Ingestion of food from a farmer's market

4

Which statement about a laparoscopic procedure for an appendectomy is correct? 1 The patient can likely be discharged the day after the surgery. 2 The patient can return to usual activities 2 to 3 days after the surgery. 3 Natural orifice transluminal endoscopic surgery (NOTES) creates an incision near the umbilicus. 4 The patient usually has less pain with this minimally invasive procedure.

4

The nurse is teaching a patient with gastroenteritis regarding self-management and hygiene. Which statement made by the patient indicates effective learning? 1 "It is safe to cook meals for my family." 2 "It is necessary to clean my bathroom once a month." 3 "I should wash hands for 2 minutes with an antibacterial soap." 4 "I must keep my toothbrush and toothpaste separate from others."

4 A patient with gastroenteritis may have either a bacterial or viral infection. The patient must maintain personal hygiene to prevent the transmission of disease to other members of the family. Therefore the patient must keep a toothbrush and toothpaste and eating utensils away from those of family members. The patient should not prepare or handle food that will be consumed by others. The patient should maintain clean bathroom facilities to prevent exposure to stool. The patient should wash hands for 30 seconds with an antibacterial soap after a bowel movement and should maintain good personal hygiene.

The nurse is teaching a patient with ulcerative colitis about different medication regimens. Which drug would the nurse explain has a complication of hemolytic anemia if taken in higher doses? 1 Olsalazine 2 Balsalazide 3 Mesalamine 4 Sulfasalazine

4 Sulfasalazine is an aminosalicylate drug that causes hemolytic anemia if taken in high doses. Olsalazine, balsalazide, and mesalamine are drugs used for ulcerative colitis that do not necessarily cause hemolytic anemia.

Which surgical procedure for removing an inflamed appendix involves minimal intervention without an external incision? 1 Laparotomy 2 Laparoscopy 3 Exploratory laparotomy 4 Transluminal endoscopic surgery

4 Transluminal endoscopic surgery is a new procedure that does not require an external skin incision. Instead, an endoscope is inserted through a natural orifice, such as the vagina, and then an internal incision is made into the colon, thus avoiding any external incision. Laparotomy is an open surgical method used for complicated or atypical appendicitis. Uncomplicated appendectomy procedures are performed through laparoscopy, which is considered a minimally invasive surgery (MIS) but requires small incisions near the umbilicus. An exploratory laparotomy is a surgical opening into the abdomen to remove or repair the inflamed or perforated organ.