Deck 60: Care of Patients With Inflammatory Intestinal Disorders

Question 1

The nurse is caring for a client with perineal excoriation caused by diarrhea from acute gastroenteritis.Which client statement indicates that additional teaching about perineal care is needed?

A) "I will rinse my rectal area with warm water after each stool and then apply zinc oxide ointment."
B) "I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel."
C) "I will take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry."
D) "I will clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment."

Answer 1

"I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel."

Question 2

A female client is admitted with an exacerbation of ulcerative colitis.Which laboratory value does the nurse correlate with this condition?

A) Potassium, 5.5 mEq/L
B) Hemoglobin, 14.2 g/dL
C) Sodium, 144 mEq/L
D) Erythrocyte sedimentation rate (ESR), 55 mm/hr

Answer 2

Erythrocyte sedimentation rate (ESR), 55 mm/hr

Question 3

A client underwent the first stage of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA).What topic is a high priority for the nurse to teach?

A) Perineal care
B) Ostomy care
C) Nutrition therapy
D) Relaxation techniques

Answer 3

Ostomy care

Question 4

The nurse helps a client with diverticular disease choose appropriate dinner options.Which menu selections are most appropriate?

A) Roasted chicken, rice pilaf, cup of coffee with cream
B) Spaghetti with meat sauce, fresh fruit cup, hot tea with lemon
C) Chicken Caesar salad, cup of bean soup, glass of low-fat milk
D) Baked fish with steamed asparagus, dinner roll with butter, glass of apple juice

Question 5

The nurse conducts a physical assessment for a client with severe right lower quadrant (RLQ)abdominal pain.The nurse notes that the abdomen is rigid and the client's temperature is 101.1° F (38.4° C).Which laboratory value does the nurse bring to the attention of the health care provider as a priority?

A) A "left shift" in the white blood cell count
B) White blood cell count, 22,000/mm³
C) Serum sodium, 149 mEq/L
D) Serum creatinine, 0.7 mg/dL

Question 6

The nurse is caring for a client who is taking mesalamine (5-aminosalicylic acid)(Asacol,Rowasa)for ulcerative colitis.The client has trouble swallowing the pill.Which action by the nurse is most appropriate?

A) Crush the pill carefully and administer it to the client in applesauce or pudding.
B) Empty the contents of the capsule into applesauce or pudding for administration.
C) Contact the client's health care provider to request an order for Asacol suspension.
D) Contact the client's health care provider to request an order for Rowasa enemas instead.

Question 7

The nurse is caring for a client who is having approximately 20 foul-smelling stools each day.Laboratory Gram stain testing indicates the presence of white blood cells (WBCs)and red blood cells (RBCs)in the stool.Which organism does the nurse expect to see in the culture report?

A) Helicobacter pylori
B) Campylobacter jejuni
C) Clostridium botulinum
D) Norwalk virus

Question 8

The nurse is preparing to begin teaching the client about how to care for a new ileostomy.Which consideration is the highest priority for the nurse when planning teaching for this client?

A) Informing the client about what to expect with basic ostomy care
B) Starting the teaching after the client has received pain medication
C) Starting the teaching when the client is ready to look at the stoma
D) Making sure that all needed supplies are ready at the client's bedside

Question 9

The nurse is caring for a teenage girl with a new ileostomy.She tells the nurse tearfully that she cannot go to the prom with an ostomy.Which is the nurse's best response?

A) "You should get your prom dress one size larger to hide the ostomy appliance."
B) "You should avoid broccoli and carbonated drinks so that the pouch won't fill with air under your dress."
C) "Let's talk to the enterostomal therapist (ET) about options for ostomy supplies and dress styles so that you can look beautiful for the prom."
D) "You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable."

Question 10

The nurse is caring for a client with ulcerative colitis and severe diarrhea.Which nursing assessment is the highest priority?

A) Skin integrity
B) Blood pressure
C) Heart rate and rhythm
D) Abdominal percussion

Question 11

The nurse is caring for a client with Crohn's disease and colonic strictures.Which assessment finding requires the nurse to consult the health care provider immediately?

A) Distended abdomen
B) Temperature of 100.0° F (37.8° C)
C) Traces of blood in the stool
D) Crampy lower abdominal pain

Question 12

The nurse is caring for an older client with Salmonella food poisoning.Which is the priority action of the nurse?

A) Monitor vital signs.
B) Maintain IV fluids.
C) Provide perineal care.
D) Initiate Isolation Precautions.

Question 13

The nurse is caring for a client with severe ulcerative colitis who has been prescribed adalimumab (Humira).Which client statement indicates that additional teaching about the medication is needed?

A) "I will avoid large crowds and people who are sick."
B) "I will take this medication with food or milk."
C) "Nausea and vomiting are common side effects."
D) "I will wash my hands after I play with my dog."

Question 14

The nurse is caring for a client who had ileostomy surgery 10 days ago.The client verbalizes concerns that the effluent has not become formed and is still liquid green.Which is the nurse's best response?

A) "I will call your health care provider right away because the stool should be semi-solid by now."
B) "Your stools will firm up in a few weeks as your body gets used to the ileostomy."
C) "You should eat a high-fiber diet to help make the stool bulkier and more solid."
D) "You can add buttermilk or yogurt to your diet and avoid carbonated soft drinks."

Question 15

The nurse is caring for an older client with gastroenteritis.Which order does the nurse consult with the health care provider about?

A) IV 0.45% NS at 50 mL/hr
B) Clear liquids as tolerated
C) Diphenoxylate hydrochloride/atropine sulfate (Lomotil) orally, after each loose stool
D) Acetaminophen (Tylenol), 325-650 mg orally every 4 hr PRN pain

Question 16

The nurse provides discharge teaching for a client who was hospitalized for Salmonella food poisoning.Which client statement indicates that additional teaching is needed?

A) "I will let my husband do the cooking for my family."
B) "I will take the ciprofloxacin (Cipro) until the diarrhea has resolved."
C) "I will wash my hands with antibacterial soap before and after each meal."
D) "I will make sure that my dishes go straight into the dishwasher after each meal."

Question 17

The nurse is caring for a client who has acute viral gastroenteritis.Which dietary instruction does the nurse provide to the client?

A) "Drink plenty of fluids to prevent dehydration."
B) "You can have only clear liquids to drink."
C) "Milk products will give you extra protein."
D) "You can have sips of cola or tea to relieve nausea."

Question 18

The nurse is teaching a client how to care for a new ileostomy.Which client statement indicates that additional teaching is needed?

A) "I will consult the pharmacist before filling any new prescriptions."
B) "I will empty the ostomy pouch when it is half-filled with stool or gas."
C) "I will wash my hands with antibacterial soap before and after ostomy care."
D) "I will call my health care provider if I have not had ostomy drainage for 3 hours."

Question 19

The nurse conducts a physical assessment for a client with abdominal pain.Which finding leads the nurse to suspect appendicitis?

A) Severe, steady right lower quadrant (RLQ) pain
B) Abdominal pain that started a day after vomiting began
C) Abdominal pain that increases with knee flexion
D) Marked peristalsis and hyperactive bowel sounds

Question 20

The nurse is caring for a client who is hospitalized with exacerbation of Crohn's disease.What does the nurse expect to find during the physical assessment?

A) Positive Murphy's sign with rebound tenderness
B) Dullness in the lower abdominal quadrants
C) High-pitched, rushing bowel sounds in the right lower quadrant
D) Abdominal cramping that the client says is worse at night

Question 21

The nurse has taught self-care measures to a client with an anal fissure.Which action by the client requires the nurse to do additional teaching?

A) Taking warm sitz baths several times daily
B) Administering daily enemas to prevent constipation
C) Using bulk-producing agents to aid elimination
D) Self-administering anti-inflammatory suppositories

Question 22

The nurse reviews a health teaching for a client with Crohn's disease.Which instruction does the nurse provide for the client?

A) "You should have a colonoscopy every few years."
B) "You should eat a diet that is high in protein and fiber."
C) "You should avoid heavy lifting and tight-fitting clothes."
D) "You should take the Asacol whenever you have loose stools."

Question 23

The nurse is preparing a client with diverticulitis for discharge from the hospital.Which statement by the client indicates that additional teaching is needed?

A) "I will ride my bike or take a long walk at least three times a week."
B) "I will try to include at least 25 g of fiber in my diet every day."
C) "I will take a senna laxative at bedtime to avoid becoming constipated."
D) "I will use my legs rather than my back muscles when I lift heavy objects."

Question 24

The nurse is caring for a client with Crohn's disease who has developed a fistula.Which nursing intervention is the highest priority?

A) Monitor the client's hematocrit and hemoglobin.
B) Position the client to allow gravity drainage of the fistula.
C) Check and record blood glucose levels every 6 hours.
D) Encourage the client to consume a diet high in protein and calories.

Question 25

The client asks the nurse how to avoid becoming ill with Salmonella infection again.Which are appropriate responses from the nurse?

A) "Wash leafy vegetables carefully before eating or cooking them."
B) "Do not ingest water from the garden hose or the pool."
C) "Wash your hands before and after using the bathroom."
D) "Be sure meat is cooked to the proper temperature."
E) "Avoid eating eggs that are sunny side up or undercooked."
F) "When eating outdoors, be sure to keep flies off your food."

Question 26

The nurse is to administer an infliximab (Remicade)infusion to a client who weighs 110 lb.The client is to receive 5 mg/kg of the drug,which is available as a 100-mg/10 mL solution.The nurse will draw up _____ milliliters of solution for the client's infusion.

Question 27

The nurse is caring for a client with a parasitic gastrointestinal infection.What statement by the client indicates a need for further teaching?

A) "I will have my housekeeper keep my toilet very clean."
B) "I need to shower or bathe every day."
C) "I need to have my well water tested."
D) "My sexual partner needs to have a stool test."

Question 28

A client is brought to the emergency department with an abrupt onset of vomiting,abdominal cramping,and diarrhea 2 hours after eating food at a picnic.Which infectious microorganism does the nurse suspect as the probable cause?

A) Salmonella
B) Giardia lamblia
C) Staphylococcus aureus
D) Clostridium botulinum

Question 29

The nurse is caring for a client with Giardia lamblia infection.Which medication does the nurse anticipate teaching the client about?

A) Metronidazole (Flagyl)
B) Ciprofloxacin (Cipro)
C) Sulfasalazine (Azulfidine)
D) Ceftriaxone (Rocephin)

Question 30

The nurse is caring for a client who has food poisoning that may be the result of Clostridium botulinum infection.Which is the priority nursing assessment for this client?

A) Heart rate and rhythm
B) Bowel sounds and heart tones
C) Fluid balance and urine output
D) Oxygen saturation and respiratory rate

Question 31

A client with Crohn's disease has a draining fistula.Which finding leads the nurse to intervene most rapidly?

A) Serum potassium of 2.6 mEq/L
B) The client not wanting to eat anything
C) White blood cell count of 8200/mm³
D) The client losing 3 pounds in a week

Question 32

The nurse has completed the teaching session for a client with a new colostomy.Which feedback statement by the nurse is the most appropriate?

A) "I realize that you had a tough time today, but it will get easier with practice."
B) "You cleaned the stoma well. Now you need to practice putting on the appliance."
C) "You seem to understand what I taught you today. What else can I help you with?"
D) "You seem uncomfortable. Do you want your daughter to care for your ostomy?"

Question 33

A nurse is caring for a client hospitalized with botulism.The nurse obtains the following vital signs: temperature-99.8° F (37.6° C),pulse-100,respiratory rate-10 and shallow,and blood pressure-100/62 mm Hg.What action by the nurse is most appropriate?

A) Allow the client rest periods without interruption.
B) Stay with the client while another nurse calls the physician.
C) Check the client's IV rate and document all findings.
D) Help the client order appropriate food items from the menu.

Question 34

A nurse is teaching a community group ways to prevent Escherichia coli infection.Which statements made by the nurse are accurate?

A) "Wash your hands after any contact with animals."
B) "It is not necessary to buy a meat thermometer."
C) "Stay away from people who are ill with diarrhea."
D) "Use separate cutting boards for meat and vegetables."
E) "Avoid swimming in backyard pools and using hot tubs."

Question 35

A nurse is teaching a community group about food poisoning and gastroenteritis.Which statements by the nurse are accurate?

A) Rotavirus is more common among infants and younger children.
B) Escherichia coli diarrhea is transmitted by contact with infected animals.
C) Don't drink water when swimming to prevent E. coli infection.
D) All clients with botulism require hospitalization.
E) Parasitic diseases may not show up for 1 to 2 weeks after infection.

Question 36

A client has an anorectal abscess.Which teaching topic does the nurse address as the priority?

A) Perineal hygiene
B) Comfort measures
C) Nutrition therapy
D) Antibiotic use