Question 1

After teaching a client who was hospitalized for Salmonella food poisoning,a nurse assesses the client's understanding.Which statement made by the client indicates a need for additional teaching?

Accepted Answer

Ciprofloxacin should be taken for 10 to 14 days to treat Salmonella infection,and should not be stopped once the diarrhea has cleared.Clients should be advised to take the entire course of medication.People with Salmonella should not prepare foods for others because the infection may be spread in this way.Hands should be washed with antibacterial soap before and after eating to prevent spread of the bacteria.Dishes and eating utensils should not be shared and should be cleaned thoroughly.Clients can be carriers for up to 1 year.

Question 2

A nurse teaches a client who has viral gastroenteritis.Which dietary instruction should the nurse include in this client's teaching?

Accepted Answer

The client should drink plenty of fluids to prevent dehydration.Milk products may not be tolerated.Caffeinated beverages increase intestinal motility and should be avoided.

Question 3

A nurse reviews the chart of a client who has Crohn's disease and a draining fistula.Which documentation should alert the nurse to urgently contact the provider for additional prescriptions?

Accepted Answer

Fistulas place the client with Crohn's disease at risk for hypokalemia which can lead to serious dysrhythmias.This potassium level is low and should cause the nurse to intervene.The white blood cell count is normal.The other two findings are abnormal and also warrant intervention,but the potassium level takes priority.

Question 4

A nurse assesses a client who is hospitalized with an exacerbation of Crohn's disease.Which clinical manifestation should the nurse expect to find?

Accepted Answer

The nurse expects high-pitched,rushing bowel sounds due to narrowing of the bowel lumen in Crohn's disease.A positive Murphy's sign is indicative of gallbladder disease,and rebound tenderness often indicates peritonitis.Dullness in the lower abdominal quadrants and hypoactive bowel sounds are not commonly found with Crohn's disease.Nightly worsening of abdominal cramping is not consistent with Crohn's disease.

Question 5

After teaching a client who is prescribed adalimumab (Humira)for severe ulcerative colitis,the nurse assesses the client's understanding.Which statement made by the client indicates a need for additional teaching?

Accepted Answer

Adalimumab (Humira)is an immune modulator that must be given via subcutaneous injection.It does not need to be given with food or milk.Nausea and vomiting are two common side effects.Adalimumab can cause immune suppression,so clients receiving the medication should avoid large crowds and people who are sick,and should practice good handwashing.

Question 6

A nurse assesses a client who has appendicitis.Which clinical manifestation should the nurse expect to find?

Accepted Answer

Right lower quadrant pain,specifically at McBurney's point,is characteristic of appendicitis.Usually if nausea and vomiting begin first,the client has gastroenteritis.Marked peristalsis and hyperactive bowel sounds are not indicative of appendicitis.Abdominal pain due to appendicitis decreases with knee flexion.

Question 7

A nurse assesses a client who has ulcerative colitis and severe diarrhea.Which assessment should the nurse complete first?

Accepted Answer

Although the client with severe diarrhea may experience skin irritation and hypovolemia,the client is most at risk for cardiac dysrhythmias secondary to potassium and magnesium loss from severe diarrhea.The client should have her or his electrolyte levels monitored,and electrolyte replacement may be necessary.Oral mucosa inspection,recent dietary intake,and abdominal percussion are important parts of physical assessment but are lower priority for this client than heart rate and rhythm.

Question 8

A nurse cares for a client who is prescribed mesalamine (Asacol)for ulcerative colitis.The client states,"I am having trouble swallowing this pill." Which action should the nurse take?

Accepted Answer

Asacol is the oral formula for mesalamine and is produced as an enteric-coated pill that should not be crushed,chewed,or broken.Asacol is not available as a suspension or elixir.If the client is unable to swallow the Asacol pill,a mesalamine enema (Rowasa)may be administered instead,with a provider's order.

Question 9

A nurse cares for a client who has a Giardia infection.Which medication should the nurse anticipate being prescribed for this client?

Accepted Answer

Metronidazole is the drug of choice for a Giardia infection.Ciprofloxacin and ceftriaxone are antibiotics used for bacterial infections.Sulfasalazine is used for ulcerative colitis and Crohn's disease.

Question 10

A nurse assesses a client who is recovering from an ileostomy placement.Which clinical manifestation should alert the nurse to urgently contact the health care provider?

Accepted Answer

The nurse should assess the stoma for color and contact the health care provider if the stoma is pale,bluish,or dark.The nurse should expect the client to have an intact ostomy pouch with dark green liquid stool that may contain some blood.

Question 11

A nurse assesses a client with Crohn's disease and colonic strictures.Which clinical manifestation should alert the nurse to urgently contact the health care provider?

Accepted Answer

The presence of strictures predisposes the client to intestinal obstruction.Abdominal distention may indicate that the client has developed an obstruction of the large bowel,and the client's provider should be notified right away.Low-grade fever,bloody diarrhea,and abdominal cramps are common symptoms of Crohn's disease.

Question 12

A nurse cares for a client who has food poisoning resulting from a Clostridium botulinum infection.Which assessment should the nurse complete first?

Accepted Answer

Severe infection with C.botulinum can lead to respiratory failure,so assessments of oxygen saturation and respiratory rate are of high priority for clients with suspected C.botulinum infection.The other assessments may be completed after the respiratory system has been assessed.

Question 13

After teaching a client who has diverticulitis,a nurse assesses the client's understanding.Which statement made by the client indicates a need for additional teaching?

Accepted Answer

Laxatives are not recommended for clients with diverticulitis because they can increase pressure in the bowel,causing additional outpouching of the lumen.Exercise and a high-fiber diet are recommended for clients with diverticulitis because they promote regular bowel function.Using the leg muscles rather than the back for lifting prevents abdominal straining.

Question 14

A nurse plans care for a client with Crohn's disease who has a heavily draining fistula.Which intervention should the nurse indicate as the priority action in this client's plan of care?

Accepted Answer

Protecting the client's skin is the priority action for a client who has a heavily draining fistula.Intestinal fluid enzymes are caustic and can cause skin breakdown or fungal infections if the skin is not protected.The plan of care for a client who has Crohn's disease includes adequate nutrition focused on high-calorie,high-protein,high-vitamin,and low-fiber meals,antibiotic administration,and glucocorticoids.

Question 15

After teaching a client with diverticular disease,a nurse assesses the client's understanding.Which menu selection made by the client indicates the client correctly understood the teaching?

Accepted Answer

Clients who have diverticular disease are prescribed a low-residue diet.Whole grains (rice pilaf),uncooked fruits and vegetables (salad,fresh fruit cup),and high-fiber foods (cup of bean soup)should be avoided with a low-residue diet.Canned or cooked vegetables are appropriate.Apple juice does not contain fiber and is acceptable for a low-residue diet.

Question 16

A nurse assesses a client who is hospitalized for botulism.The client's vital signs are temperature: 99.8° F (37.6° C),heart rate: 100 beats/min,respiratory rate: 10 breaths/min,and blood pressure: 100/62 mm Hg.Which action should the nurse take?

Accepted Answer

A client with botulism is at risk for respiratory failure.This client's respiratory rate is slow,which could indicate impending respiratory distress or failure.The nurse should remain with the client while another nurse notifies the provider.The nurse should monitor and document the IV infusion per protocol,but this client does not require additional intravenous fluids.Allowing the client to rest or checking the client's blood glucose and administering orange juice are not appropriate actions.

Question 17

A nurse cares for a teenage girl with a new ileostomy.The client states,"I cannot go to prom with an ostomy." How should the nurse respond?

Accepted Answer

The ostomy nurse is a valuable resource for clients,providing suggestions for supplies and methods to manage the ostomy.A larger dress size will not necessarily help hide the ostomy appliance.Avoiding broccoli and carbonated drinks does not offer reassurance for the client.Ileostomies have an almost constant liquid effluent,so pouch removal during the prom is not feasible.

Question 18

After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis,a nurse assesses the client's understanding.Which statement by the client indicates a need for additional teaching?

Accepted Answer

Toilet paper can irritate the sensitive perineal skin,so warm water rinses or soft cotton washcloths should be used instead.Although aloe vera may facilitate healing of superficial abrasions,it is not an effective skin barrier for diarrhea.Skin barriers such as zinc oxide and vitamin A and D ointment help protect the rectal area from the excoriating effects of liquid stools.Patting the skin is recommended instead of rubbing the skin dry.

Question 19

A nurse cares for an older adult client who has Salmonella food poisoning.The client's vital signs are heart rate: 102 beats/min,blood pressure: 98/55 mm Hg,respiratory rate: 22 breaths/min,and oxygen saturation: 92%.Which action should the nurse complete first?

Accepted Answer

Dehydration caused by diarrhea can occur quickly in older clients with Salmonella food poisoning,so maintenance of fluid balance is a high priority.Monitoring vital signs and providing perineal care are important nursing actions but are of lower priority than fluid replacement.The nurse should teach the client about proper hand hygiene to prevent the spread of infection,and preparation of food and beverages to prevent contamination.

Question 20

After teaching a client who has a new colostomy,the nurse provides feedback based on the client's ability to complete self-care activities.Which statement should the nurse include in this feedback?

Accepted Answer

The nurse should provide both approval and room for improvement in feedback after a teaching session.Feedback should be objective and constructive,and not evaluative.Reassuring the client that things will improve does not offer anything concrete for the client to work on,nor does it let him or her know what was done well.The nurse should not make the client convey learning needs because the client may not know what else he or she needs to understand.The client needs to become the expert in self-management of the ostomy,and the nurse should not offer to teach the daughter instead of the client.

Quiz 57: Care of Patients with Inflammatory Intestinal Disorders